|
Injection(s), anesthetic agent(s) and/or steroid other peripheral nerve or branch
|
Facility
|
OP
|
$2,538.36
|
|
|
Service Code
|
HCPCS 64450
|
| Hospital Charge Code |
9900788
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$39.31 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$39.31
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$709.10
|
| Rate for Payer: Amerigroup Medicare |
$709.10
|
| Rate for Payer: BCBS of TX Blue Advantage |
$80.76
|
| Rate for Payer: BCBS of TX Blue Essentials |
$96.72
|
| Rate for Payer: BCBS of TX Medicare |
$709.10
|
| Rate for Payer: BCBS of TX PPO |
$121.87
|
| Rate for Payer: Cash Price |
$1,726.08
|
| Rate for Payer: Cash Price |
$1,726.08
|
| Rate for Payer: Cash Price |
$1,726.08
|
| Rate for Payer: Cigna Commercial |
$1,498.91
|
| Rate for Payer: Cigna Medicaid |
$1,827.62
|
| 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 |
$1,827.62
|
| 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 |
$1,827.62
|
| Rate for Payer: Scott and White EPO/PPO |
$1,170.03
|
| Rate for Payer: Scott and White Medicare |
$709.10
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,827.62
|
| 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(s), anesthetic agent(s) and/or steroid paracervical (uterine) nerve
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 64435
|
| Hospital Charge Code |
36064435
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$43.19 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$43.19
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$709.10
|
| Rate for Payer: Amerigroup Medicare |
$709.10
|
| Rate for Payer: BCBS of TX Blue Advantage |
$74.13
|
| Rate for Payer: BCBS of TX Blue Essentials |
$88.78
|
| Rate for Payer: BCBS of TX Medicare |
$709.10
|
| Rate for Payer: BCBS of TX PPO |
$111.86
|
| 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 |
$1,170.03
|
| 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(s), anesthetic agent(s) and/or steroid paracervical (uterine) nerve
|
Facility
|
IP
|
$10,882.70
|
|
|
Service Code
|
HCPCS 64435
|
| Hospital Charge Code |
9900785
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$7,400.24
|
|
|
Injection(s), anesthetic agent(s) and/or steroid paracervical (uterine) nerve
|
Facility
|
OP
|
$10,882.70
|
|
|
Service Code
|
HCPCS 64435
|
| Hospital Charge Code |
9900785
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$43.19 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$43.19
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$709.10
|
| Rate for Payer: Amerigroup Medicare |
$709.10
|
| Rate for Payer: BCBS of TX Blue Advantage |
$74.13
|
| Rate for Payer: BCBS of TX Blue Essentials |
$88.78
|
| Rate for Payer: BCBS of TX Medicare |
$709.10
|
| Rate for Payer: BCBS of TX PPO |
$111.86
|
| Rate for Payer: Cash Price |
$7,400.24
|
| Rate for Payer: Cash Price |
$7,400.24
|
| Rate for Payer: Cash Price |
$7,400.24
|
| Rate for Payer: Cigna Commercial |
$1,498.91
|
| Rate for Payer: Cigna Medicaid |
$7,835.54
|
| 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 |
$7,835.54
|
| 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 |
$7,835.54
|
| Rate for Payer: Scott and White EPO/PPO |
$1,170.03
|
| Rate for Payer: Scott and White Medicare |
$709.10
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$7,835.54
|
| 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(s), anesthetic agent(s) and/or steroid sciatic nerve
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 64445
|
| Hospital Charge Code |
36064445
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$73.64 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$73.64
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$709.10
|
| Rate for Payer: Amerigroup Medicare |
$709.10
|
| Rate for Payer: BCBS of TX Blue Advantage |
$149.47
|
| Rate for Payer: BCBS of TX Blue Essentials |
$179.00
|
| Rate for Payer: BCBS of TX Medicare |
$709.10
|
| Rate for Payer: BCBS of TX PPO |
$225.54
|
| 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 |
$1,170.03
|
| 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(s), anesthetic agent(s) and/or steroid sciatic nerve
|
Facility
|
OP
|
$2,855.66
|
|
|
Service Code
|
HCPCS 64445
|
| Hospital Charge Code |
9900786
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$73.64 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$73.64
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$709.10
|
| Rate for Payer: Amerigroup Medicare |
$709.10
|
| Rate for Payer: BCBS of TX Blue Advantage |
$149.47
|
| Rate for Payer: BCBS of TX Blue Essentials |
$179.00
|
| Rate for Payer: BCBS of TX Medicare |
$709.10
|
| Rate for Payer: BCBS of TX PPO |
$225.54
|
| Rate for Payer: Cash Price |
$1,941.85
|
| Rate for Payer: Cash Price |
$1,941.85
|
| Rate for Payer: Cash Price |
$1,941.85
|
| Rate for Payer: Cigna Commercial |
$1,498.91
|
| Rate for Payer: Cigna Medicaid |
$2,056.08
|
| 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 |
$2,056.08
|
| 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 |
$2,056.08
|
| Rate for Payer: Scott and White EPO/PPO |
$1,170.03
|
| Rate for Payer: Scott and White Medicare |
$709.10
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$2,056.08
|
| 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(s), anesthetic agent(s) and/or steroid sciatic nerve
|
Facility
|
IP
|
$2,855.66
|
|
|
Service Code
|
HCPCS 64445
|
| Hospital Charge Code |
9900786
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$1,941.85
|
|
|
Injection(s), anesthetic agent(s) and/or steroid suprascapular nerve
|
Facility
|
OP
|
$3,172.95
|
|
|
Service Code
|
HCPCS 64418
|
| Hospital Charge Code |
9900781
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$38.76 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$38.76
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$709.10
|
| Rate for Payer: Amerigroup Medicare |
$709.10
|
| Rate for Payer: BCBS of TX Blue Advantage |
$72.33
|
| Rate for Payer: BCBS of TX Blue Essentials |
$86.62
|
| Rate for Payer: BCBS of TX Medicare |
$709.10
|
| Rate for Payer: BCBS of TX PPO |
$109.14
|
| Rate for Payer: Cash Price |
$2,157.61
|
| Rate for Payer: Cash Price |
$2,157.61
|
| Rate for Payer: Cash Price |
$2,157.61
|
| Rate for Payer: Cigna Commercial |
$1,498.91
|
| Rate for Payer: Cigna Medicaid |
$2,284.52
|
| 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 |
$2,284.52
|
| 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 |
$2,284.52
|
| Rate for Payer: Scott and White EPO/PPO |
$1,170.03
|
| Rate for Payer: Scott and White Medicare |
$709.10
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$2,284.52
|
| 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(s), anesthetic agent(s) and/or steroid suprascapular nerve
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 64418
|
| Hospital Charge Code |
36064418
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$38.76 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$38.76
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$709.10
|
| Rate for Payer: Amerigroup Medicare |
$709.10
|
| Rate for Payer: BCBS of TX Blue Advantage |
$72.33
|
| Rate for Payer: BCBS of TX Blue Essentials |
$86.62
|
| Rate for Payer: BCBS of TX Medicare |
$709.10
|
| Rate for Payer: BCBS of TX PPO |
$109.14
|
| 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 |
$1,170.03
|
| 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(s), anesthetic agent(s) and/or steroid suprascapular nerve
|
Facility
|
IP
|
$3,172.95
|
|
|
Service Code
|
HCPCS 64418
|
| Hospital Charge Code |
9900781
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$2,157.61
|
|
|
Injection(s), anesthetic agent(s) and/or steroid trigeminal nerve, each branch (ie, ophthalmic, max
|
Facility
|
OP
|
$1,567.02
|
|
|
Service Code
|
HCPCS 64400
|
| Hospital Charge Code |
9900778
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$67.55 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$67.55
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$308.35
|
| Rate for Payer: Amerigroup Medicare |
$308.35
|
| Rate for Payer: BCBS of TX Blue Advantage |
$127.77
|
| Rate for Payer: BCBS of TX Blue Essentials |
$153.02
|
| Rate for Payer: BCBS of TX Medicare |
$308.35
|
| Rate for Payer: BCBS of TX PPO |
$192.81
|
| Rate for Payer: Cash Price |
$1,065.57
|
| Rate for Payer: Cash Price |
$1,065.57
|
| Rate for Payer: Cash Price |
$1,065.57
|
| Rate for Payer: Cigna Commercial |
$651.79
|
| Rate for Payer: Cigna Medicaid |
$1,128.25
|
| Rate for Payer: Cigna Medicare |
$308.35
|
| Rate for Payer: Employer Direct Commercial |
$308.35
|
| Rate for Payer: Humana Medicare/TRICARE |
$308.35
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,128.25
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$308.35
|
| Rate for Payer: Molina Medicare |
$308.35
|
| 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 |
$1,128.25
|
| Rate for Payer: Scott and White EPO/PPO |
$501.11
|
| Rate for Payer: Scott and White Medicare |
$308.35
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,128.25
|
| Rate for Payer: Superior Health Plan EPO |
$308.35
|
| Rate for Payer: Superior Health Plan Medicare |
$308.35
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$308.35
|
| Rate for Payer: Universal American Medicare |
$308.35
|
| Rate for Payer: Wellcare Medicare |
$308.35
|
| Rate for Payer: Wellmed Medicare |
$308.35
|
|
|
Injection(s), anesthetic agent(s) and/or steroid trigeminal nerve, each branch (ie, ophthalmic, max
|
Facility
|
IP
|
$1,567.02
|
|
|
Service Code
|
HCPCS 64400
|
| Hospital Charge Code |
9900778
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$1,065.57
|
|
|
Injection(s), anesthetic agent(s) and/or steroid trigeminal nerve, each branch (ie, ophthalmic, max
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 64400
|
| Hospital Charge Code |
36064400
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$67.55 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$67.55
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$308.35
|
| Rate for Payer: Amerigroup Medicare |
$308.35
|
| Rate for Payer: BCBS of TX Blue Advantage |
$127.77
|
| Rate for Payer: BCBS of TX Blue Essentials |
$153.02
|
| Rate for Payer: BCBS of TX Medicare |
$308.35
|
| Rate for Payer: BCBS of TX PPO |
$192.81
|
| Rate for Payer: Cigna Commercial |
$651.79
|
| Rate for Payer: Cigna Medicare |
$308.35
|
| Rate for Payer: Employer Direct Commercial |
$308.35
|
| Rate for Payer: Humana Medicare/TRICARE |
$308.35
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$308.35
|
| Rate for Payer: Molina Medicare |
$308.35
|
| 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 |
$501.11
|
| Rate for Payer: Scott and White Medicare |
$308.35
|
| Rate for Payer: Superior Health Plan EPO |
$308.35
|
| Rate for Payer: Superior Health Plan Medicare |
$308.35
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$308.35
|
| Rate for Payer: Universal American Medicare |
$308.35
|
| Rate for Payer: Wellcare Medicare |
$308.35
|
| Rate for Payer: Wellmed Medicare |
$308.35
|
|
|
Injection(s), bone-substitute material (eg, calcium phosphate) into subchondral bone defect (ie, bon
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 0707T
|
| Hospital Charge Code |
3600707T
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,286.91 |
| 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 |
$4,830.11
|
| Rate for Payer: BCBS of TX Blue Essentials |
$5,784.56
|
| Rate for Payer: BCBS of TX Medicare |
$3,286.91
|
| Rate for Payer: BCBS of TX PPO |
$7,288.55
|
| 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 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
|
|
|
Injection(s), bone-substitute material (eg, calcium phosphate) into subchondral bone defect (ie, bon
|
Facility
|
IP
|
$8,676.84
|
|
|
Service Code
|
HCPCS 0707T
|
| Hospital Charge Code |
9900915
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$5,900.25
|
|
|
Injection(s), bone-substitute material (eg, calcium phosphate) into subchondral bone defect (ie, bon
|
Facility
|
OP
|
$8,676.84
|
|
|
Service Code
|
HCPCS 0707T
|
| Hospital Charge Code |
9900915
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$780.92 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$780.92
|
| 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 |
$4,830.11
|
| Rate for Payer: BCBS of TX Blue Essentials |
$5,784.56
|
| Rate for Payer: BCBS of TX Medicare |
$3,286.91
|
| Rate for Payer: BCBS of TX PPO |
$7,288.55
|
| Rate for Payer: Cash Price |
$5,900.25
|
| Rate for Payer: Cash Price |
$5,900.25
|
| Rate for Payer: Cash Price |
$5,900.25
|
| Rate for Payer: Cigna Commercial |
$6,947.94
|
| Rate for Payer: Cigna Medicaid |
$6,247.32
|
| 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 |
$6,247.32
|
| 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 |
$6,247.32
|
| Rate for Payer: Scott and White EPO/PPO |
$4,338.42
|
| Rate for Payer: Scott and White Medicare |
$3,286.91
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$6,247.32
|
| 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
|
|
|
Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophys
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 64495
|
| Hospital Charge Code |
36064495
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$63.10 |
| 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
|
| Rate for Payer: Scott and White EPO/PPO |
$63.10
|
|
|
Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophys
|
Facility
|
OP
|
$1,681.46
|
|
|
Service Code
|
HCPCS 64495
|
| Hospital Charge Code |
9900805
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$151.33 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$151.33
|
| Rate for Payer: BCBS of TX Blue Advantage |
$504.44
|
| Rate for Payer: BCBS of TX Blue Essentials |
$605.33
|
| Rate for Payer: BCBS of TX PPO |
$672.58
|
| Rate for Payer: Cash Price |
$1,143.39
|
| Rate for Payer: Cash Price |
$1,143.39
|
| Rate for Payer: Cigna Medicaid |
$1,210.65
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,210.65
|
| 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 |
$1,210.65
|
| Rate for Payer: Scott and White EPO/PPO |
$840.73
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,210.65
|
| Rate for Payer: Superior Health Plan EPO |
$228.68
|
|
|
Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophys
|
Facility
|
IP
|
$1,681.46
|
|
|
Service Code
|
HCPCS 64495
|
| Hospital Charge Code |
9900805
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$1,143.39
|
|
|
Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal)
|
Facility
|
IP
|
$2,467.38
|
|
|
Service Code
|
HCPCS 64490
|
| Hospital Charge Code |
9900800
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$1,677.82
|
|
|
Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal)
|
Facility
|
OP
|
$2,467.38
|
|
|
Service Code
|
HCPCS 64493
|
| Hospital Charge Code |
9900803
|
|
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 |
$1,542.14
|
| 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(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal)
|
Facility
|
IP
|
$2,467.38
|
|
|
Service Code
|
HCPCS 64493
|
| Hospital Charge Code |
9900803
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$1,677.82
|
|
|
Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal)
|
Facility
|
IP
|
$1,681.46
|
|
|
Service Code
|
HCPCS 64494
|
| Hospital Charge Code |
9900804
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$1,143.39
|
|
|
Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal)
|
Facility
|
OP
|
$1,681.46
|
|
|
Service Code
|
HCPCS 64494
|
| Hospital Charge Code |
9900804
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$151.33 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$151.33
|
| Rate for Payer: BCBS of TX Blue Advantage |
$504.44
|
| Rate for Payer: BCBS of TX Blue Essentials |
$605.33
|
| Rate for Payer: BCBS of TX PPO |
$672.58
|
| Rate for Payer: Cash Price |
$1,143.39
|
| Rate for Payer: Cash Price |
$1,143.39
|
| Rate for Payer: Cigna Medicaid |
$1,210.65
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,210.65
|
| 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 |
$1,210.65
|
| Rate for Payer: Scott and White EPO/PPO |
$840.73
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,210.65
|
| Rate for Payer: Superior Health Plan EPO |
$228.68
|
|
|
Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal)
|
Facility
|
OP
|
$1,681.46
|
|
|
Service Code
|
HCPCS 64491
|
| Hospital Charge Code |
9900801
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$151.33 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$151.33
|
| Rate for Payer: BCBS of TX Blue Advantage |
$504.44
|
| Rate for Payer: BCBS of TX Blue Essentials |
$605.33
|
| Rate for Payer: BCBS of TX PPO |
$672.58
|
| Rate for Payer: Cash Price |
$1,143.39
|
| Rate for Payer: Cash Price |
$1,143.39
|
| Rate for Payer: Cigna Medicaid |
$1,210.65
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,210.65
|
| 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 |
$1,210.65
|
| Rate for Payer: Scott and White EPO/PPO |
$840.73
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,210.65
|
| Rate for Payer: Superior Health Plan EPO |
$228.68
|
|
