|
Paring of Single Callus
|
Facility
|
OP
|
$358.00
|
|
|
Service Code
|
CPT 11055
|
| Hospital Charge Code |
7150778
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3.27 |
| Max. Negotiated Rate |
$440.32 |
| Rate for Payer: Aetna Commercial |
$196.90
|
| Rate for Payer: Aetna Medicare |
$274.64
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$32.22
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$183.09
|
| Rate for Payer: Amerigroup Medicare |
$183.09
|
| 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 |
$183.09
|
| Rate for Payer: BCBS of TX PPO |
$440.32
|
| Rate for Payer: Cash Price |
$315.04
|
| Rate for Payer: Cash Price |
$315.04
|
| Rate for Payer: Cash Price |
$315.04
|
| Rate for Payer: Cigna Commercial |
$414.75
|
| Rate for Payer: Cigna Medicare |
$183.09
|
| Rate for Payer: Employer Direct Commercial |
$183.09
|
| Rate for Payer: Humana Medicare/TRICARE |
$183.09
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$183.09
|
| Rate for Payer: Molina Medicare |
$183.09
|
| Rate for Payer: Multiplan Auto |
$232.70
|
| Rate for Payer: Multiplan Commercial |
$232.70
|
| Rate for Payer: Multiplan Workers Comp |
$232.70
|
| Rate for Payer: Scott and White EPO/PPO |
$3.27
|
| Rate for Payer: Scott and White Medicare |
$183.09
|
| Rate for Payer: Superior Health Plan EPO |
$183.09
|
| Rate for Payer: Superior Health Plan Medicare |
$183.09
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$183.09
|
| Rate for Payer: Universal American Medicare |
$183.09
|
| Rate for Payer: Wellcare Medicare |
$183.09
|
| Rate for Payer: Wellmed Medicare |
$183.09
|
|
|
Partial excision (craterization, saucerization, or diaphysectomy) bone (eg, osteomyelitis); distal p
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 26236
|
| Hospital Charge Code |
36026236
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$32.42 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$2,200.00
|
| Rate for Payer: Aetna Medicare |
$2,204.79
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$593.04
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,469.86
|
| Rate for Payer: Amerigroup Medicare |
$1,469.86
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,263.50
|
| Rate for Payer: BCBS of TX Blue Essentials |
$2,710.78
|
| Rate for Payer: BCBS of TX Medicare |
$1,469.86
|
| Rate for Payer: BCBS of TX PPO |
$3,415.58
|
| Rate for Payer: Cigna Commercial |
$3,329.66
|
| Rate for Payer: Cigna Medicaid |
$593.04
|
| Rate for Payer: Cigna Medicare |
$1,469.86
|
| Rate for Payer: Employer Direct Commercial |
$1,469.86
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,469.86
|
| Rate for Payer: Molina CHIP/Medicaid |
$593.04
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,469.86
|
| Rate for Payer: Molina Medicare |
$1,469.86
|
| 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 |
$593.04
|
| Rate for Payer: Scott and White EPO/PPO |
$32.42
|
| Rate for Payer: Scott and White Medicare |
$1,469.86
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$593.04
|
| Rate for Payer: Superior Health Plan EPO |
$1,469.86
|
| Rate for Payer: Superior Health Plan Medicare |
$1,469.86
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,469.86
|
| Rate for Payer: Universal American Medicare |
$1,469.86
|
| Rate for Payer: Wellcare Medicare |
$1,469.86
|
| Rate for Payer: Wellmed Medicare |
$1,469.86
|
|
|
Partial excision (craterization, saucerization, or diaphysectomy), bone (eg, osteomyelitis) tibia
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 27640
|
| Hospital Charge Code |
36027640
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$65.29 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$4,635.00
|
| Rate for Payer: Aetna Medicare |
$4,440.36
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,088.27
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$2,960.24
|
| Rate for Payer: Amerigroup Medicare |
$2,960.24
|
| 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 |
$2,960.24
|
| Rate for Payer: BCBS of TX PPO |
$6,898.37
|
| Rate for Payer: Cigna Commercial |
$6,705.80
|
| Rate for Payer: Cigna Medicaid |
$1,088.27
|
| Rate for Payer: Cigna Medicare |
$2,960.24
|
| Rate for Payer: Employer Direct Commercial |
$2,960.24
|
| Rate for Payer: Humana Medicare/TRICARE |
$2,960.24
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,088.27
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$2,960.24
|
| Rate for Payer: Molina Medicare |
$2,960.24
|
| 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 |
$1,088.27
|
| Rate for Payer: Scott and White EPO/PPO |
$65.29
|
| Rate for Payer: Scott and White Medicare |
$2,960.24
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,088.27
|
| Rate for Payer: Superior Health Plan EPO |
$2,960.24
|
| Rate for Payer: Superior Health Plan Medicare |
$2,960.24
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$2,960.24
|
| Rate for Payer: Universal American Medicare |
$2,960.24
|
| Rate for Payer: Wellcare Medicare |
$2,960.24
|
| Rate for Payer: Wellmed Medicare |
$2,960.24
|
|
|
Partial excision (craterization, saucerization, sequestrectomy, or diaphysectomy) bone (eg, osteomye
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 28120
|
| Hospital Charge Code |
36028120
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$65.29 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$3,090.00
|
| Rate for Payer: Aetna Medicare |
$4,440.36
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,088.27
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$2,960.24
|
| Rate for Payer: Amerigroup Medicare |
$2,960.24
|
| 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 |
$2,960.24
|
| Rate for Payer: BCBS of TX PPO |
$6,898.37
|
| Rate for Payer: Cigna Commercial |
$6,705.80
|
| Rate for Payer: Cigna Medicaid |
$1,088.27
|
| Rate for Payer: Cigna Medicare |
$2,960.24
|
| Rate for Payer: Employer Direct Commercial |
$2,960.24
|
| Rate for Payer: Humana Medicare/TRICARE |
$2,960.24
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,088.27
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$2,960.24
|
| Rate for Payer: Molina Medicare |
$2,960.24
|
| 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 |
$1,088.27
|
| Rate for Payer: Scott and White EPO/PPO |
$65.29
|
| Rate for Payer: Scott and White Medicare |
$2,960.24
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,088.27
|
| Rate for Payer: Superior Health Plan EPO |
$2,960.24
|
| Rate for Payer: Superior Health Plan Medicare |
$2,960.24
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$2,960.24
|
| Rate for Payer: Universal American Medicare |
$2,960.24
|
| Rate for Payer: Wellcare Medicare |
$2,960.24
|
| Rate for Payer: Wellmed Medicare |
$2,960.24
|
|
|
Partial excision (craterization, saucerization, sequestrectomy, or diaphysectomy) bone (eg, osteomye
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 28124
|
| Hospital Charge Code |
36028124
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$65.29 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$3,090.00
|
| Rate for Payer: Aetna Medicare |
$4,440.36
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$238.37
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$2,960.24
|
| Rate for Payer: Amerigroup Medicare |
$2,960.24
|
| Rate for Payer: BCBS of TX Blue Advantage |
$503.86
|
| Rate for Payer: BCBS of TX Blue Essentials |
$603.42
|
| Rate for Payer: BCBS of TX Medicare |
$2,960.24
|
| Rate for Payer: BCBS of TX PPO |
$760.31
|
| Rate for Payer: Cigna Commercial |
$6,705.80
|
| Rate for Payer: Cigna Medicaid |
$238.37
|
| Rate for Payer: Cigna Medicare |
$2,960.24
|
| Rate for Payer: Employer Direct Commercial |
$2,960.24
|
| Rate for Payer: Humana Medicare/TRICARE |
$2,960.24
|
| Rate for Payer: Molina CHIP/Medicaid |
$238.37
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$2,960.24
|
| Rate for Payer: Molina Medicare |
$2,960.24
|
| 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 |
$238.37
|
| Rate for Payer: Scott and White EPO/PPO |
$65.29
|
| Rate for Payer: Scott and White Medicare |
$2,960.24
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$238.37
|
| Rate for Payer: Superior Health Plan EPO |
$2,960.24
|
| Rate for Payer: Superior Health Plan Medicare |
$2,960.24
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$2,960.24
|
| Rate for Payer: Universal American Medicare |
$2,960.24
|
| Rate for Payer: Wellcare Medicare |
$2,960.24
|
| Rate for Payer: Wellmed Medicare |
$2,960.24
|
|
|
Partial excision (craterization, saucerization, sequestrectomy, or diaphysectomy) bone (eg, osteomye
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 28122
|
| Hospital Charge Code |
36028122
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$65.29 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$3,090.00
|
| Rate for Payer: Aetna Medicare |
$4,440.36
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,088.27
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$2,960.24
|
| Rate for Payer: Amerigroup Medicare |
$2,960.24
|
| 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 |
$2,960.24
|
| Rate for Payer: BCBS of TX PPO |
$6,898.37
|
| Rate for Payer: Cigna Commercial |
$6,705.80
|
| Rate for Payer: Cigna Medicaid |
$1,088.27
|
| Rate for Payer: Cigna Medicare |
$2,960.24
|
| Rate for Payer: Employer Direct Commercial |
$2,960.24
|
| Rate for Payer: Humana Medicare/TRICARE |
$2,960.24
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,088.27
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$2,960.24
|
| Rate for Payer: Molina Medicare |
$2,960.24
|
| 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 |
$1,088.27
|
| Rate for Payer: Scott and White EPO/PPO |
$65.29
|
| Rate for Payer: Scott and White Medicare |
$2,960.24
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,088.27
|
| Rate for Payer: Superior Health Plan EPO |
$2,960.24
|
| Rate for Payer: Superior Health Plan Medicare |
$2,960.24
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$2,960.24
|
| Rate for Payer: Universal American Medicare |
$2,960.24
|
| Rate for Payer: Wellcare Medicare |
$2,960.24
|
| Rate for Payer: Wellmed Medicare |
$2,960.24
|
|
|
Partial Thromboplastin Time
|
Facility
|
IP
|
$220.00
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
1600535
|
|
Hospital Revenue Code
|
305
|
| Rate for Payer: Cash Price |
$193.60
|
|
|
Partial Thromboplastin Time
|
Facility
|
OP
|
$220.00
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
1600535
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$2.34 |
| Max. Negotiated Rate |
$143.00 |
| Rate for Payer: Aetna Commercial |
$6.32
|
| Rate for Payer: Aetna Medicare |
$9.02
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2.34
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$6.01
|
| Rate for Payer: Amerigroup Medicare |
$6.01
|
| Rate for Payer: BCBS of TX Blue Advantage |
$9.92
|
| Rate for Payer: BCBS of TX Blue Essentials |
$11.90
|
| Rate for Payer: BCBS of TX Medicare |
$6.01
|
| Rate for Payer: BCBS of TX PPO |
$13.28
|
| Rate for Payer: Cash Price |
$193.60
|
| Rate for Payer: Cash Price |
$193.60
|
| Rate for Payer: Cigna Medicaid |
$6.01
|
| Rate for Payer: Cigna Medicare |
$6.01
|
| Rate for Payer: Employer Direct Commercial |
$6.01
|
| Rate for Payer: Humana Medicare/TRICARE |
$6.01
|
| Rate for Payer: Molina CHIP/Medicaid |
$6.01
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$6.01
|
| Rate for Payer: Molina Medicare |
$6.01
|
| Rate for Payer: Multiplan Auto |
$143.00
|
| Rate for Payer: Multiplan Commercial |
$143.00
|
| Rate for Payer: Multiplan Workers Comp |
$143.00
|
| Rate for Payer: Parkland Medicaid |
$6.01
|
| Rate for Payer: Scott and White EPO/PPO |
$7.51
|
| Rate for Payer: Scott and White Medicare |
$6.01
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$6.01
|
| Rate for Payer: Superior Health Plan EPO |
$6.01
|
| Rate for Payer: Superior Health Plan Medicare |
$6.01
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$6.01
|
| Rate for Payer: Universal American Medicare |
$6.01
|
| Rate for Payer: Wellcare Medicare |
$6.01
|
| Rate for Payer: Wellmed Medicare |
$6.01
|
|
|
Parvovirus B19, Human, IgG/IgM SO
|
Facility
|
OP
|
$28.00
|
|
|
Service Code
|
CPT 86747
|
| Hospital Charge Code |
1703842
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.86 |
| Max. Negotiated Rate |
$33.22 |
| Rate for Payer: Aetna Commercial |
$15.78
|
| Rate for Payer: Aetna Medicare |
$22.54
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$5.86
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$15.03
|
| Rate for Payer: Amerigroup Medicare |
$15.03
|
| Rate for Payer: BCBS of TX Blue Advantage |
$24.80
|
| Rate for Payer: BCBS of TX Blue Essentials |
$29.76
|
| Rate for Payer: BCBS of TX Medicare |
$15.03
|
| Rate for Payer: BCBS of TX PPO |
$33.22
|
| Rate for Payer: Cash Price |
$24.64
|
| Rate for Payer: Cash Price |
$24.64
|
| Rate for Payer: Cigna Medicaid |
$15.03
|
| Rate for Payer: Cigna Medicare |
$15.03
|
| Rate for Payer: Employer Direct Commercial |
$15.03
|
| Rate for Payer: Humana Medicare/TRICARE |
$15.03
|
| Rate for Payer: Molina CHIP/Medicaid |
$15.03
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$15.03
|
| Rate for Payer: Molina Medicare |
$15.03
|
| Rate for Payer: Multiplan Auto |
$18.20
|
| Rate for Payer: Multiplan Commercial |
$18.20
|
| Rate for Payer: Multiplan Workers Comp |
$18.20
|
| Rate for Payer: Parkland Medicaid |
$15.03
|
| Rate for Payer: Scott and White EPO/PPO |
$18.79
|
| Rate for Payer: Scott and White Medicare |
$15.03
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$15.03
|
| Rate for Payer: Superior Health Plan EPO |
$15.03
|
| Rate for Payer: Superior Health Plan Medicare |
$15.03
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$15.03
|
| Rate for Payer: Universal American Medicare |
$15.03
|
| Rate for Payer: Wellcare Medicare |
$15.03
|
| Rate for Payer: Wellmed Medicare |
$15.03
|
|
|
Parvovirus B19, Human, IgG/IgM SO
|
Facility
|
IP
|
$28.00
|
|
|
Service Code
|
CPT 86747
|
| Hospital Charge Code |
1703842
|
|
Hospital Revenue Code
|
302
|
| Rate for Payer: Cash Price |
$24.64
|
|
|
Parvovirus B19, IgM SO
|
Facility
|
OP
|
$28.00
|
|
|
Service Code
|
CPT 86747
|
| Hospital Charge Code |
1703842
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.86 |
| Max. Negotiated Rate |
$33.22 |
| Rate for Payer: Aetna Commercial |
$15.78
|
| Rate for Payer: Aetna Medicare |
$22.54
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$5.86
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$15.03
|
| Rate for Payer: Amerigroup Medicare |
$15.03
|
| Rate for Payer: BCBS of TX Blue Advantage |
$24.80
|
| Rate for Payer: BCBS of TX Blue Essentials |
$29.76
|
| Rate for Payer: BCBS of TX Medicare |
$15.03
|
| Rate for Payer: BCBS of TX PPO |
$33.22
|
| Rate for Payer: Cash Price |
$24.64
|
| Rate for Payer: Cash Price |
$24.64
|
| Rate for Payer: Cigna Medicaid |
$15.03
|
| Rate for Payer: Cigna Medicare |
$15.03
|
| Rate for Payer: Employer Direct Commercial |
$15.03
|
| Rate for Payer: Humana Medicare/TRICARE |
$15.03
|
| Rate for Payer: Molina CHIP/Medicaid |
$15.03
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$15.03
|
| Rate for Payer: Molina Medicare |
$15.03
|
| Rate for Payer: Multiplan Auto |
$18.20
|
| Rate for Payer: Multiplan Commercial |
$18.20
|
| Rate for Payer: Multiplan Workers Comp |
$18.20
|
| Rate for Payer: Parkland Medicaid |
$15.03
|
| Rate for Payer: Scott and White EPO/PPO |
$18.79
|
| Rate for Payer: Scott and White Medicare |
$15.03
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$15.03
|
| Rate for Payer: Superior Health Plan EPO |
$15.03
|
| Rate for Payer: Superior Health Plan Medicare |
$15.03
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$15.03
|
| Rate for Payer: Universal American Medicare |
$15.03
|
| Rate for Payer: Wellcare Medicare |
$15.03
|
| Rate for Payer: Wellmed Medicare |
$15.03
|
|
|
PASSER, SUTURE LAPAROSCOPIC 14G SINGLE USE -- DHF
|
Facility
|
OP
|
$49.49
|
|
| Hospital Charge Code |
80320914
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.45 |
| Max. Negotiated Rate |
$32.17 |
| Rate for Payer: Aetna Commercial |
$27.22
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$4.45
|
| Rate for Payer: BCBS of TX Blue Advantage |
$14.85
|
| Rate for Payer: BCBS of TX Blue Essentials |
$17.82
|
| Rate for Payer: BCBS of TX PPO |
$19.80
|
| Rate for Payer: Cash Price |
$43.55
|
| Rate for Payer: Multiplan Auto |
$32.17
|
| Rate for Payer: Multiplan Commercial |
$32.17
|
| Rate for Payer: Multiplan Workers Comp |
$32.17
|
| Rate for Payer: Scott and White EPO/PPO |
$24.74
|
| Rate for Payer: Superior Health Plan EPO |
$6.73
|
|
|
PASSER, SUTURE LAPAROSCOPIC 14G SINGLE USE -- DHF
|
Facility
|
IP
|
$49.49
|
|
| Hospital Charge Code |
80320914
|
|
Hospital Revenue Code
|
272
|
| Rate for Payer: Cash Price |
$43.55
|
|
|
passer suture super shuttle
|
Facility
|
OP
|
$342.54
|
|
| Hospital Charge Code |
140687
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$30.83 |
| Max. Negotiated Rate |
$222.65 |
| Rate for Payer: Aetna Commercial |
$188.40
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$30.83
|
| Rate for Payer: BCBS of TX Blue Advantage |
$102.76
|
| Rate for Payer: BCBS of TX Blue Essentials |
$123.31
|
| Rate for Payer: BCBS of TX PPO |
$137.02
|
| Rate for Payer: Cash Price |
$301.44
|
| Rate for Payer: Multiplan Auto |
$222.65
|
| Rate for Payer: Multiplan Commercial |
$222.65
|
| Rate for Payer: Multiplan Workers Comp |
$222.65
|
| Rate for Payer: Scott and White EPO/PPO |
$171.27
|
| Rate for Payer: Superior Health Plan EPO |
$46.59
|
|
|
passer suture super shuttle
|
Facility
|
IP
|
$342.54
|
|
| Hospital Charge Code |
140687
|
|
Hospital Revenue Code
|
272
|
| Rate for Payer: Cash Price |
$301.44
|
|
|
PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH CC
|
Facility
|
IP
|
$20,723.30
|
|
|
Service Code
|
MSDRG 543
|
| Min. Negotiated Rate |
$9,506.44 |
| Max. Negotiated Rate |
$20,723.30 |
| Rate for Payer: Aetna Commercial |
$12,270.38
|
| Rate for Payer: Aetna Medicare |
$15,957.14
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$10,638.09
|
| Rate for Payer: Amerigroup Medicare |
$10,638.09
|
| Rate for Payer: BCBS of TX Blue Advantage |
$9,506.44
|
| Rate for Payer: BCBS of TX Blue Essentials |
$11,067.13
|
| Rate for Payer: BCBS of TX Medicare |
$10,638.09
|
| Rate for Payer: BCBS of TX PPO |
$12,297.28
|
| Rate for Payer: Cigna Commercial |
$14,048.22
|
| Rate for Payer: Cigna Medicare |
$10,638.09
|
| Rate for Payer: Employer Direct Commercial |
$10,638.09
|
| Rate for Payer: Humana Medicare/TRICARE |
$10,638.09
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$10,638.09
|
| Rate for Payer: Molina Medicare |
$10,638.09
|
| Rate for Payer: Multiplan Auto |
$20,723.30
|
| Rate for Payer: Multiplan Commercial |
$20,723.30
|
| Rate for Payer: Multiplan Workers Comp |
$20,723.30
|
| Rate for Payer: Scott and White EPO/PPO |
$9,543.62
|
| Rate for Payer: Scott and White Medicare |
$10,638.09
|
| Rate for Payer: Superior Health Plan EPO |
$10,638.09
|
| Rate for Payer: Superior Health Plan Medicare |
$10,638.09
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$10,638.09
|
| Rate for Payer: Universal American Medicare |
$10,638.09
|
| Rate for Payer: Wellcare Medicare |
$10,638.09
|
| Rate for Payer: Wellmed Medicare |
$10,638.09
|
|
|
PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH MCC
|
Facility
|
IP
|
$34,650.30
|
|
|
Service Code
|
MSDRG 542
|
| Min. Negotiated Rate |
$15,863.56 |
| Max. Negotiated Rate |
$34,650.30 |
| Rate for Payer: Aetna Commercial |
$20,516.62
|
| Rate for Payer: Aetna Medicare |
$23,803.23
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$15,868.82
|
| Rate for Payer: Amerigroup Medicare |
$15,868.82
|
| Rate for Payer: BCBS of TX Blue Advantage |
$15,863.56
|
| Rate for Payer: BCBS of TX Blue Essentials |
$18,835.27
|
| Rate for Payer: BCBS of TX Medicare |
$15,868.82
|
| Rate for Payer: BCBS of TX PPO |
$20,928.89
|
| Rate for Payer: Cigna Commercial |
$23,489.26
|
| Rate for Payer: Cigna Medicare |
$15,868.82
|
| Rate for Payer: Employer Direct Commercial |
$15,868.82
|
| Rate for Payer: Humana Medicare/TRICARE |
$15,868.82
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$15,868.82
|
| Rate for Payer: Molina Medicare |
$15,868.82
|
| Rate for Payer: Multiplan Auto |
$34,650.30
|
| Rate for Payer: Multiplan Commercial |
$34,650.30
|
| Rate for Payer: Multiplan Workers Comp |
$34,650.30
|
| Rate for Payer: Scott and White EPO/PPO |
$15,957.38
|
| Rate for Payer: Scott and White Medicare |
$15,868.82
|
| Rate for Payer: Superior Health Plan EPO |
$15,868.82
|
| Rate for Payer: Superior Health Plan Medicare |
$15,868.82
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$15,868.82
|
| Rate for Payer: Universal American Medicare |
$15,868.82
|
| Rate for Payer: Wellcare Medicare |
$15,868.82
|
| Rate for Payer: Wellmed Medicare |
$15,868.82
|
|
|
PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITHOUT CC/MCC
|
Facility
|
IP
|
$14,582.50
|
|
|
Service Code
|
MSDRG 544
|
| Min. Negotiated Rate |
$6,664.14 |
| Max. Negotiated Rate |
$14,582.50 |
| Rate for Payer: Aetna Commercial |
$8,634.38
|
| Rate for Payer: Aetna Medicare |
$12,497.56
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$8,331.71
|
| Rate for Payer: Amerigroup Medicare |
$8,331.71
|
| Rate for Payer: BCBS of TX Blue Advantage |
$6,664.14
|
| Rate for Payer: BCBS of TX Blue Essentials |
$8,238.69
|
| Rate for Payer: BCBS of TX Medicare |
$8,331.71
|
| Rate for Payer: BCBS of TX PPO |
$9,154.45
|
| Rate for Payer: Cigna Commercial |
$9,885.40
|
| Rate for Payer: Cigna Medicare |
$8,331.71
|
| Rate for Payer: Employer Direct Commercial |
$8,331.71
|
| Rate for Payer: Humana Medicare/TRICARE |
$8,331.71
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$8,331.71
|
| Rate for Payer: Molina Medicare |
$8,331.71
|
| Rate for Payer: Multiplan Auto |
$14,582.50
|
| Rate for Payer: Multiplan Commercial |
$14,582.50
|
| Rate for Payer: Multiplan Workers Comp |
$14,582.50
|
| Rate for Payer: Scott and White EPO/PPO |
$6,715.62
|
| Rate for Payer: Scott and White Medicare |
$8,331.71
|
| Rate for Payer: Superior Health Plan EPO |
$8,331.71
|
| Rate for Payer: Superior Health Plan Medicare |
$8,331.71
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$8,331.71
|
| Rate for Payer: Universal American Medicare |
$8,331.71
|
| Rate for Payer: Wellcare Medicare |
$8,331.71
|
| Rate for Payer: Wellmed Medicare |
$8,331.71
|
|
|
Patient Antigen Type Bill Quantity:1
|
Facility
|
IP
|
$124.00
|
|
|
Service Code
|
CPT 86905
|
| Hospital Charge Code |
2402949
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$109.12
|
|
|
Patient Antigen Type Bill Quantity:1
|
Facility
|
OP
|
$124.00
|
|
|
Service Code
|
CPT 86905
|
| Hospital Charge Code |
2402949
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$744.67 |
| Rate for Payer: Aetna Commercial |
$4.02
|
| Rate for Payer: Aetna Medicare |
$493.10
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1.49
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$328.73
|
| Rate for Payer: Amerigroup Medicare |
$328.73
|
| Rate for Payer: BCBS of TX Blue Advantage |
$467.63
|
| Rate for Payer: BCBS of TX Blue Essentials |
$561.15
|
| Rate for Payer: BCBS of TX Medicare |
$328.73
|
| Rate for Payer: BCBS of TX PPO |
$626.34
|
| Rate for Payer: Cash Price |
$109.12
|
| Rate for Payer: Cash Price |
$109.12
|
| Rate for Payer: Cash Price |
$109.12
|
| Rate for Payer: Cigna Commercial |
$744.67
|
| Rate for Payer: Cigna Medicaid |
$3.83
|
| Rate for Payer: Cigna Medicare |
$328.73
|
| Rate for Payer: Employer Direct Commercial |
$328.73
|
| Rate for Payer: Humana Medicare/TRICARE |
$328.73
|
| Rate for Payer: Molina CHIP/Medicaid |
$3.83
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$328.73
|
| Rate for Payer: Molina Medicare |
$328.73
|
| Rate for Payer: Multiplan Auto |
$80.60
|
| Rate for Payer: Multiplan Commercial |
$80.60
|
| Rate for Payer: Multiplan Workers Comp |
$80.60
|
| Rate for Payer: Parkland Medicaid |
$3.83
|
| Rate for Payer: Scott and White EPO/PPO |
$4.79
|
| Rate for Payer: Scott and White Medicare |
$328.73
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$3.83
|
| Rate for Payer: Superior Health Plan EPO |
$328.73
|
| Rate for Payer: Superior Health Plan Medicare |
$328.73
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$328.73
|
| Rate for Payer: Universal American Medicare |
$328.73
|
| Rate for Payer: Wellcare Medicare |
$328.73
|
| Rate for Payer: Wellmed Medicare |
$328.73
|
|
|
Patient Antigen Type Bill Quantity:2
|
Facility
|
OP
|
$124.00
|
|
|
Service Code
|
CPT 86905
|
| Hospital Charge Code |
2402949
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$744.67 |
| Rate for Payer: Aetna Commercial |
$4.02
|
| Rate for Payer: Aetna Medicare |
$493.10
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1.49
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$328.73
|
| Rate for Payer: Amerigroup Medicare |
$328.73
|
| Rate for Payer: BCBS of TX Blue Advantage |
$467.63
|
| Rate for Payer: BCBS of TX Blue Essentials |
$561.15
|
| Rate for Payer: BCBS of TX Medicare |
$328.73
|
| Rate for Payer: BCBS of TX PPO |
$626.34
|
| Rate for Payer: Cash Price |
$109.12
|
| Rate for Payer: Cash Price |
$109.12
|
| Rate for Payer: Cash Price |
$109.12
|
| Rate for Payer: Cigna Commercial |
$744.67
|
| Rate for Payer: Cigna Medicaid |
$3.83
|
| Rate for Payer: Cigna Medicare |
$328.73
|
| Rate for Payer: Employer Direct Commercial |
$328.73
|
| Rate for Payer: Humana Medicare/TRICARE |
$328.73
|
| Rate for Payer: Molina CHIP/Medicaid |
$3.83
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$328.73
|
| Rate for Payer: Molina Medicare |
$328.73
|
| Rate for Payer: Multiplan Auto |
$80.60
|
| Rate for Payer: Multiplan Commercial |
$80.60
|
| Rate for Payer: Multiplan Workers Comp |
$80.60
|
| Rate for Payer: Parkland Medicaid |
$3.83
|
| Rate for Payer: Scott and White EPO/PPO |
$4.79
|
| Rate for Payer: Scott and White Medicare |
$328.73
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$3.83
|
| Rate for Payer: Superior Health Plan EPO |
$328.73
|
| Rate for Payer: Superior Health Plan Medicare |
$328.73
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$328.73
|
| Rate for Payer: Universal American Medicare |
$328.73
|
| Rate for Payer: Wellcare Medicare |
$328.73
|
| Rate for Payer: Wellmed Medicare |
$328.73
|
|
|
Patient Antigen Type Bill Quantity:3
|
Facility
|
OP
|
$124.00
|
|
|
Service Code
|
CPT 86905
|
| Hospital Charge Code |
2402949
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$744.67 |
| Rate for Payer: Aetna Commercial |
$4.02
|
| Rate for Payer: Aetna Medicare |
$493.10
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1.49
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$328.73
|
| Rate for Payer: Amerigroup Medicare |
$328.73
|
| Rate for Payer: BCBS of TX Blue Advantage |
$467.63
|
| Rate for Payer: BCBS of TX Blue Essentials |
$561.15
|
| Rate for Payer: BCBS of TX Medicare |
$328.73
|
| Rate for Payer: BCBS of TX PPO |
$626.34
|
| Rate for Payer: Cash Price |
$109.12
|
| Rate for Payer: Cash Price |
$109.12
|
| Rate for Payer: Cash Price |
$109.12
|
| Rate for Payer: Cigna Commercial |
$744.67
|
| Rate for Payer: Cigna Medicaid |
$3.83
|
| Rate for Payer: Cigna Medicare |
$328.73
|
| Rate for Payer: Employer Direct Commercial |
$328.73
|
| Rate for Payer: Humana Medicare/TRICARE |
$328.73
|
| Rate for Payer: Molina CHIP/Medicaid |
$3.83
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$328.73
|
| Rate for Payer: Molina Medicare |
$328.73
|
| Rate for Payer: Multiplan Auto |
$80.60
|
| Rate for Payer: Multiplan Commercial |
$80.60
|
| Rate for Payer: Multiplan Workers Comp |
$80.60
|
| Rate for Payer: Parkland Medicaid |
$3.83
|
| Rate for Payer: Scott and White EPO/PPO |
$4.79
|
| Rate for Payer: Scott and White Medicare |
$328.73
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$3.83
|
| Rate for Payer: Superior Health Plan EPO |
$328.73
|
| Rate for Payer: Superior Health Plan Medicare |
$328.73
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$328.73
|
| Rate for Payer: Universal American Medicare |
$328.73
|
| Rate for Payer: Wellcare Medicare |
$328.73
|
| Rate for Payer: Wellmed Medicare |
$328.73
|
|
|
Patient Antigen Type Bill Quantity:4
|
Facility
|
OP
|
$124.00
|
|
|
Service Code
|
CPT 86905
|
| Hospital Charge Code |
2402949
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$744.67 |
| Rate for Payer: Aetna Commercial |
$4.02
|
| Rate for Payer: Aetna Medicare |
$493.10
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1.49
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$328.73
|
| Rate for Payer: Amerigroup Medicare |
$328.73
|
| Rate for Payer: BCBS of TX Blue Advantage |
$467.63
|
| Rate for Payer: BCBS of TX Blue Essentials |
$561.15
|
| Rate for Payer: BCBS of TX Medicare |
$328.73
|
| Rate for Payer: BCBS of TX PPO |
$626.34
|
| Rate for Payer: Cash Price |
$109.12
|
| Rate for Payer: Cash Price |
$109.12
|
| Rate for Payer: Cash Price |
$109.12
|
| Rate for Payer: Cigna Commercial |
$744.67
|
| Rate for Payer: Cigna Medicaid |
$3.83
|
| Rate for Payer: Cigna Medicare |
$328.73
|
| Rate for Payer: Employer Direct Commercial |
$328.73
|
| Rate for Payer: Humana Medicare/TRICARE |
$328.73
|
| Rate for Payer: Molina CHIP/Medicaid |
$3.83
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$328.73
|
| Rate for Payer: Molina Medicare |
$328.73
|
| Rate for Payer: Multiplan Auto |
$80.60
|
| Rate for Payer: Multiplan Commercial |
$80.60
|
| Rate for Payer: Multiplan Workers Comp |
$80.60
|
| Rate for Payer: Parkland Medicaid |
$3.83
|
| Rate for Payer: Scott and White EPO/PPO |
$4.79
|
| Rate for Payer: Scott and White Medicare |
$328.73
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$3.83
|
| Rate for Payer: Superior Health Plan EPO |
$328.73
|
| Rate for Payer: Superior Health Plan Medicare |
$328.73
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$328.73
|
| Rate for Payer: Universal American Medicare |
$328.73
|
| Rate for Payer: Wellcare Medicare |
$328.73
|
| Rate for Payer: Wellmed Medicare |
$328.73
|
|
|
Patient Antigen Type Bill Quantity:5
|
Facility
|
OP
|
$124.00
|
|
|
Service Code
|
CPT 86905
|
| Hospital Charge Code |
2402949
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$744.67 |
| Rate for Payer: Aetna Commercial |
$4.02
|
| Rate for Payer: Aetna Medicare |
$493.10
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1.49
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$328.73
|
| Rate for Payer: Amerigroup Medicare |
$328.73
|
| Rate for Payer: BCBS of TX Blue Advantage |
$467.63
|
| Rate for Payer: BCBS of TX Blue Essentials |
$561.15
|
| Rate for Payer: BCBS of TX Medicare |
$328.73
|
| Rate for Payer: BCBS of TX PPO |
$626.34
|
| Rate for Payer: Cash Price |
$109.12
|
| Rate for Payer: Cash Price |
$109.12
|
| Rate for Payer: Cash Price |
$109.12
|
| Rate for Payer: Cigna Commercial |
$744.67
|
| Rate for Payer: Cigna Medicaid |
$3.83
|
| Rate for Payer: Cigna Medicare |
$328.73
|
| Rate for Payer: Employer Direct Commercial |
$328.73
|
| Rate for Payer: Humana Medicare/TRICARE |
$328.73
|
| Rate for Payer: Molina CHIP/Medicaid |
$3.83
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$328.73
|
| Rate for Payer: Molina Medicare |
$328.73
|
| Rate for Payer: Multiplan Auto |
$80.60
|
| Rate for Payer: Multiplan Commercial |
$80.60
|
| Rate for Payer: Multiplan Workers Comp |
$80.60
|
| Rate for Payer: Parkland Medicaid |
$3.83
|
| Rate for Payer: Scott and White EPO/PPO |
$4.79
|
| Rate for Payer: Scott and White Medicare |
$328.73
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$3.83
|
| Rate for Payer: Superior Health Plan EPO |
$328.73
|
| Rate for Payer: Superior Health Plan Medicare |
$328.73
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$328.73
|
| Rate for Payer: Universal American Medicare |
$328.73
|
| Rate for Payer: Wellcare Medicare |
$328.73
|
| Rate for Payer: Wellmed Medicare |
$328.73
|
|
|
patiromer 8.4 g Pow
|
Facility
|
IP
|
$128.17
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
78872129
|
|
Hospital Revenue Code
|
250
|
| Rate for Payer: Cash Price |
$87.16
|
|
