|
PENIS PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$23,451.70
|
|
|
Service Code
|
MSDRG 710
|
| Min. Negotiated Rate |
$10,800.12 |
| Max. Negotiated Rate |
$23,451.70 |
| Rate for Payer: Aetna Commercial |
$13,885.88
|
| Rate for Payer: Aetna Medicare |
$18,168.58
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$12,112.39
|
| Rate for Payer: Amerigroup Medicare |
$12,112.39
|
| Rate for Payer: BCBS of TX Blue Advantage |
$12,599.00
|
| Rate for Payer: BCBS of TX Blue Essentials |
$17,227.57
|
| Rate for Payer: BCBS of TX Medicare |
$12,112.39
|
| Rate for Payer: BCBS of TX PPO |
$19,142.49
|
| Rate for Payer: Cigna Commercial |
$15,897.78
|
| Rate for Payer: Cigna Medicare |
$12,112.39
|
| Rate for Payer: Employer Direct Commercial |
$12,112.39
|
| Rate for Payer: Humana Medicare/TRICARE |
$12,112.39
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$12,112.39
|
| Rate for Payer: Molina Medicare |
$12,112.39
|
| Rate for Payer: Multiplan Auto |
$23,451.70
|
| Rate for Payer: Multiplan Commercial |
$23,451.70
|
| Rate for Payer: Multiplan Workers Comp |
$23,451.70
|
| Rate for Payer: Scott and White EPO/PPO |
$10,800.12
|
| Rate for Payer: Scott and White Medicare |
$12,112.39
|
| Rate for Payer: Superior Health Plan EPO |
$12,112.39
|
| Rate for Payer: Superior Health Plan Medicare |
$12,112.39
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$12,112.39
|
| Rate for Payer: Universal American Medicare |
$12,112.39
|
| Rate for Payer: Wellcare Medicare |
$12,112.39
|
| Rate for Payer: Wellmed Medicare |
$12,112.39
|
|
|
PERC AUG 1 BD LUMB/IMG
|
Facility
|
IP
|
$15,995.00
|
|
|
Service Code
|
CPT 22514
|
| Hospital Charge Code |
4619720
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$14,075.60
|
|
|
PERC AUG 1 BD LUMB/IMG
|
Facility
|
OP
|
$15,995.00
|
|
|
Service Code
|
CPT 22514
|
| Hospital Charge Code |
4619720
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$144.31 |
| Max. Negotiated Rate |
$15,074.51 |
| Rate for Payer: Aetna Commercial |
$7,210.00
|
| Rate for Payer: Aetna Medicare |
$9,814.08
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2,398.52
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$6,542.72
|
| Rate for Payer: Amerigroup Medicare |
$6,542.72
|
| 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 |
$6,542.72
|
| Rate for Payer: BCBS of TX PPO |
$15,074.51
|
| Rate for Payer: Cash Price |
$14,075.60
|
| Rate for Payer: Cash Price |
$14,075.60
|
| Rate for Payer: Cigna Commercial |
$14,821.16
|
| Rate for Payer: Cigna Medicaid |
$2,398.52
|
| Rate for Payer: Cigna Medicare |
$6,542.72
|
| Rate for Payer: Employer Direct Commercial |
$6,542.72
|
| Rate for Payer: Humana Medicare/TRICARE |
$6,542.72
|
| Rate for Payer: Molina CHIP/Medicaid |
$2,398.52
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$6,542.72
|
| Rate for Payer: Molina Medicare |
$6,542.72
|
| 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 |
$2,398.52
|
| Rate for Payer: Scott and White EPO/PPO |
$144.31
|
| Rate for Payer: Scott and White Medicare |
$6,542.72
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$2,398.52
|
| Rate for Payer: Superior Health Plan EPO |
$6,542.72
|
| Rate for Payer: Superior Health Plan Medicare |
$6,542.72
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$6,542.72
|
| Rate for Payer: Universal American Medicare |
$6,542.72
|
| Rate for Payer: Wellcare Medicare |
$6,542.72
|
| Rate for Payer: Wellmed Medicare |
$6,542.72
|
|
|
PERC AUG 1 BD THOR/IMG
|
Facility
|
IP
|
$15,995.00
|
|
|
Service Code
|
CPT 22513
|
| Hospital Charge Code |
4619718
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$14,075.60
|
|
|
PERC AUG 1 BD THOR/IMG
|
Facility
|
OP
|
$15,995.00
|
|
|
Service Code
|
CPT 22513
|
| Hospital Charge Code |
4619718
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$144.31 |
| Max. Negotiated Rate |
$15,074.51 |
| Rate for Payer: Aetna Commercial |
$7,210.00
|
| Rate for Payer: Aetna Medicare |
$9,814.08
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2,398.52
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$6,542.72
|
| Rate for Payer: Amerigroup Medicare |
$6,542.72
|
| 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 |
$6,542.72
|
| Rate for Payer: BCBS of TX PPO |
$15,074.51
|
| Rate for Payer: Cash Price |
$14,075.60
|
| Rate for Payer: Cash Price |
$14,075.60
|
| Rate for Payer: Cigna Commercial |
$14,821.16
|
| Rate for Payer: Cigna Medicaid |
$2,398.52
|
| Rate for Payer: Cigna Medicare |
$6,542.72
|
| Rate for Payer: Employer Direct Commercial |
$6,542.72
|
| Rate for Payer: Humana Medicare/TRICARE |
$6,542.72
|
| Rate for Payer: Molina CHIP/Medicaid |
$2,398.52
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$6,542.72
|
| Rate for Payer: Molina Medicare |
$6,542.72
|
| 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 |
$2,398.52
|
| Rate for Payer: Scott and White EPO/PPO |
$144.31
|
| Rate for Payer: Scott and White Medicare |
$6,542.72
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$2,398.52
|
| Rate for Payer: Superior Health Plan EPO |
$6,542.72
|
| Rate for Payer: Superior Health Plan Medicare |
$6,542.72
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$6,542.72
|
| Rate for Payer: Universal American Medicare |
$6,542.72
|
| Rate for Payer: Wellcare Medicare |
$6,542.72
|
| Rate for Payer: Wellmed Medicare |
$6,542.72
|
|
|
PERC AUG ADD T/L IMG
|
Facility
|
OP
|
$5,864.00
|
|
|
Service Code
|
CPT 22515
|
| Hospital Charge Code |
4619719
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$527.76 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$3,225.20
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$527.76
|
| Rate for Payer: Cash Price |
$5,160.32
|
| Rate for Payer: Cash Price |
$5,160.32
|
| 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 |
$2,932.00
|
| Rate for Payer: Superior Health Plan EPO |
$797.50
|
|
|
PERC AUG ADD T/L IMG
|
Facility
|
IP
|
$5,864.00
|
|
|
Service Code
|
CPT 22515
|
| Hospital Charge Code |
4619719
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$5,160.32
|
|
|
PERC CHOLECYSTOSTOMY
|
Facility
|
OP
|
$7,171.00
|
|
|
Service Code
|
CPT 47490
|
| Hospital Charge Code |
4617600
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$69.79 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$4,635.00
|
| Rate for Payer: Aetna Medicare |
$4,746.03
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$645.39
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3,164.02
|
| Rate for Payer: Amerigroup Medicare |
$3,164.02
|
| Rate for Payer: BCBS of TX Blue Advantage |
$5,192.60
|
| Rate for Payer: BCBS of TX Blue Essentials |
$6,218.68
|
| Rate for Payer: BCBS of TX Medicare |
$3,164.02
|
| Rate for Payer: BCBS of TX PPO |
$7,835.54
|
| Rate for Payer: Cash Price |
$6,310.48
|
| Rate for Payer: Cash Price |
$6,310.48
|
| Rate for Payer: Cash Price |
$6,310.48
|
| Rate for Payer: Cigna Commercial |
$7,167.43
|
| Rate for Payer: Cigna Medicare |
$3,164.02
|
| Rate for Payer: Employer Direct Commercial |
$3,164.02
|
| Rate for Payer: Humana Medicare/TRICARE |
$3,164.02
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3,164.02
|
| Rate for Payer: Molina Medicare |
$3,164.02
|
| 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 |
$69.79
|
| Rate for Payer: Scott and White Medicare |
$3,164.02
|
| Rate for Payer: Superior Health Plan EPO |
$3,164.02
|
| Rate for Payer: Superior Health Plan Medicare |
$3,164.02
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3,164.02
|
| Rate for Payer: Universal American Medicare |
$3,164.02
|
| Rate for Payer: Wellcare Medicare |
$3,164.02
|
| Rate for Payer: Wellmed Medicare |
$3,164.02
|
|
|
PERC CHOLECYSTOSTOMY
|
Facility
|
IP
|
$7,171.00
|
|
|
Service Code
|
CPT 47490
|
| Hospital Charge Code |
4617600
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$6,310.48
|
|
|
PERC COR DRUG-ELUT STNT
|
Facility
|
OP
|
$27,809.00
|
|
|
Service Code
|
HCPCS C9600
|
| Hospital Charge Code |
2350060
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$179.93 |
| Max. Negotiated Rate |
$24,969.37 |
| Rate for Payer: Aetna Commercial |
$8,755.00
|
| Rate for Payer: Aetna Medicare |
$15,091.60
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2,502.81
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$10,061.07
|
| Rate for Payer: Amerigroup Medicare |
$10,061.07
|
| Rate for Payer: BCBS of TX Blue Advantage |
$16,547.16
|
| Rate for Payer: BCBS of TX Blue Essentials |
$19,816.96
|
| Rate for Payer: BCBS of TX Medicare |
$10,061.07
|
| Rate for Payer: BCBS of TX PPO |
$24,969.37
|
| Rate for Payer: Cash Price |
$24,471.92
|
| Rate for Payer: Cash Price |
$24,471.92
|
| Rate for Payer: Cash Price |
$24,471.92
|
| Rate for Payer: Cigna Commercial |
$22,791.24
|
| Rate for Payer: Cigna Medicare |
$10,061.07
|
| Rate for Payer: Employer Direct Commercial |
$10,061.07
|
| Rate for Payer: Humana Medicare/TRICARE |
$10,061.07
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$10,061.07
|
| Rate for Payer: Molina Medicare |
$10,061.07
|
| Rate for Payer: Multiplan Auto |
$18,075.85
|
| Rate for Payer: Multiplan Commercial |
$18,075.85
|
| Rate for Payer: Multiplan Workers Comp |
$18,075.85
|
| Rate for Payer: Scott and White EPO/PPO |
$179.93
|
| Rate for Payer: Scott and White Medicare |
$10,061.07
|
| Rate for Payer: Superior Health Plan EPO |
$10,061.07
|
| Rate for Payer: Superior Health Plan Medicare |
$10,061.07
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$10,061.07
|
| Rate for Payer: Universal American Medicare |
$10,061.07
|
| Rate for Payer: Wellcare Medicare |
$10,061.07
|
| Rate for Payer: Wellmed Medicare |
$10,061.07
|
|
|
PERC COR DRUG-ELUT STNT
|
Facility
|
IP
|
$27,809.00
|
|
|
Service Code
|
HCPCS C9600
|
| Hospital Charge Code |
2350060
|
|
Hospital Revenue Code
|
481
|
| Rate for Payer: Cash Price |
$24,471.92
|
|
|
PERC CORON THROMBECT
|
Facility
|
IP
|
$4,146.00
|
|
|
Service Code
|
CPT 92973
|
| Hospital Charge Code |
4612973
|
|
Hospital Revenue Code
|
481
|
| Rate for Payer: Cash Price |
$3,648.48
|
|
|
PERC CORON THROMBECT
|
Facility
|
OP
|
$4,146.00
|
|
|
Service Code
|
CPT 92973
|
| Hospital Charge Code |
4612973
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$373.14 |
| Max. Negotiated Rate |
$2,694.90 |
| Rate for Payer: Aetna Commercial |
$2,280.30
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$373.14
|
| Rate for Payer: Cash Price |
$3,648.48
|
| Rate for Payer: Multiplan Auto |
$2,694.90
|
| Rate for Payer: Multiplan Commercial |
$2,694.90
|
| Rate for Payer: Multiplan Workers Comp |
$2,694.90
|
| Rate for Payer: Scott and White EPO/PPO |
$2,073.00
|
| Rate for Payer: Superior Health Plan EPO |
$563.86
|
|
|
Perc Coro Revasc DES/Chronic 1st
|
Facility
|
OP
|
$34,358.00
|
|
|
Service Code
|
HCPCS C9607
|
| Hospital Charge Code |
8400469
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$286.80 |
| Max. Negotiated Rate |
$40,168.72 |
| Rate for Payer: Aetna Commercial |
$8,755.00
|
| Rate for Payer: Aetna Medicare |
$24,055.02
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$3,092.22
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$16,036.68
|
| Rate for Payer: Amerigroup Medicare |
$16,036.68
|
| Rate for Payer: BCBS of TX Blue Advantage |
$26,619.75
|
| Rate for Payer: BCBS of TX Blue Essentials |
$31,879.94
|
| Rate for Payer: BCBS of TX Medicare |
$16,036.68
|
| Rate for Payer: BCBS of TX PPO |
$40,168.72
|
| Rate for Payer: Cash Price |
$30,235.04
|
| Rate for Payer: Cash Price |
$30,235.04
|
| Rate for Payer: Cash Price |
$30,235.04
|
| Rate for Payer: Cigna Commercial |
$36,327.72
|
| Rate for Payer: Cigna Medicare |
$16,036.68
|
| Rate for Payer: Employer Direct Commercial |
$16,036.68
|
| Rate for Payer: Humana Medicare/TRICARE |
$16,036.68
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$16,036.68
|
| Rate for Payer: Molina Medicare |
$16,036.68
|
| Rate for Payer: Multiplan Auto |
$22,332.70
|
| Rate for Payer: Multiplan Commercial |
$22,332.70
|
| Rate for Payer: Multiplan Workers Comp |
$22,332.70
|
| Rate for Payer: Scott and White EPO/PPO |
$286.80
|
| Rate for Payer: Scott and White Medicare |
$16,036.68
|
| Rate for Payer: Superior Health Plan EPO |
$16,036.68
|
| Rate for Payer: Superior Health Plan Medicare |
$16,036.68
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$16,036.68
|
| Rate for Payer: Universal American Medicare |
$16,036.68
|
| Rate for Payer: Wellcare Medicare |
$16,036.68
|
| Rate for Payer: Wellmed Medicare |
$16,036.68
|
|
|
Perc Coro Revasc DES/Chronic 1st
|
Facility
|
IP
|
$34,358.00
|
|
|
Service Code
|
HCPCS C9607
|
| Hospital Charge Code |
8400469
|
|
Hospital Revenue Code
|
481
|
| Rate for Payer: Cash Price |
$30,235.04
|
|
|
PERC DRUG-ELUT STNT ADDL
|
Facility
|
OP
|
$11,036.00
|
|
|
Service Code
|
HCPCS C9601
|
| Hospital Charge Code |
2350061
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$993.24 |
| Max. Negotiated Rate |
$7,173.40 |
| Rate for Payer: Aetna Commercial |
$6,069.80
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$993.24
|
| Rate for Payer: Cash Price |
$9,711.68
|
| Rate for Payer: Multiplan Auto |
$7,173.40
|
| Rate for Payer: Multiplan Commercial |
$7,173.40
|
| Rate for Payer: Multiplan Workers Comp |
$7,173.40
|
| Rate for Payer: Scott and White EPO/PPO |
$5,518.00
|
| Rate for Payer: Superior Health Plan EPO |
$1,500.90
|
|
|
PERC DRUG-ELUT STNT ADDL
|
Facility
|
IP
|
$11,036.00
|
|
|
Service Code
|
HCPCS C9601
|
| Hospital Charge Code |
2350061
|
|
Hospital Revenue Code
|
481
|
| Rate for Payer: Cash Price |
$9,711.68
|
|
|
PERC RF ABLATE RENL TUMR
|
Facility
|
OP
|
$12,650.00
|
|
|
Service Code
|
CPT 50592
|
| Hospital Charge Code |
4610592
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$116.39 |
| Max. Negotiated Rate |
$12,180.95 |
| Rate for Payer: Aetna Commercial |
$7,210.00
|
| Rate for Payer: Aetna Medicare |
$7,915.38
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,888.85
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$5,276.92
|
| Rate for Payer: Amerigroup Medicare |
$5,276.92
|
| Rate for Payer: BCBS of TX Blue Advantage |
$8,072.30
|
| Rate for Payer: BCBS of TX Blue Essentials |
$9,667.42
|
| Rate for Payer: BCBS of TX Medicare |
$5,276.92
|
| Rate for Payer: BCBS of TX PPO |
$12,180.95
|
| Rate for Payer: Cash Price |
$11,132.00
|
| Rate for Payer: Cash Price |
$11,132.00
|
| Rate for Payer: Cigna Commercial |
$11,953.74
|
| Rate for Payer: Cigna Medicaid |
$1,888.85
|
| Rate for Payer: Cigna Medicare |
$5,276.92
|
| Rate for Payer: Employer Direct Commercial |
$5,276.92
|
| Rate for Payer: Humana Medicare/TRICARE |
$5,276.92
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,888.85
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$5,276.92
|
| Rate for Payer: Molina Medicare |
$5,276.92
|
| 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 |
$1,888.85
|
| Rate for Payer: Scott and White EPO/PPO |
$116.39
|
| Rate for Payer: Scott and White Medicare |
$5,276.92
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,888.85
|
| Rate for Payer: Superior Health Plan EPO |
$5,276.92
|
| Rate for Payer: Superior Health Plan Medicare |
$5,276.92
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$5,276.92
|
| Rate for Payer: Universal American Medicare |
$5,276.92
|
| Rate for Payer: Wellcare Medicare |
$5,276.92
|
| Rate for Payer: Wellmed Medicare |
$5,276.92
|
|
|
PERC RF ABLATE RENL TUMR
|
Facility
|
IP
|
$12,650.00
|
|
|
Service Code
|
CPT 50592
|
| Hospital Charge Code |
4610592
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$11,132.00
|
|
|
PERC SACRL AUGMENT BILAT
|
Facility
|
IP
|
$21,024.00
|
|
|
Service Code
|
CPT 0201T
|
| Hospital Charge Code |
4612011
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$18,501.12
|
|
|
PERC SACRL AUGMENT BILAT
|
Facility
|
OP
|
$21,024.00
|
|
|
Service Code
|
CPT 0201T
|
| Hospital Charge Code |
4612011
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$117.01 |
| Max. Negotiated Rate |
$15,074.51 |
| Rate for Payer: Aetna Commercial |
$4,635.00
|
| Rate for Payer: Aetna Medicare |
$9,814.08
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,892.16
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$6,542.72
|
| Rate for Payer: Amerigroup Medicare |
$6,542.72
|
| 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 |
$6,542.72
|
| Rate for Payer: BCBS of TX PPO |
$15,074.51
|
| Rate for Payer: Cash Price |
$18,501.12
|
| Rate for Payer: Cash Price |
$18,501.12
|
| Rate for Payer: Cash Price |
$18,501.12
|
| Rate for Payer: Cigna Commercial |
$14,821.16
|
| Rate for Payer: Cigna Medicare |
$6,542.72
|
| Rate for Payer: Employer Direct Commercial |
$6,542.72
|
| Rate for Payer: Humana Medicare/TRICARE |
$6,542.72
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$6,542.72
|
| Rate for Payer: Molina Medicare |
$6,542.72
|
| 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 |
$117.01
|
| Rate for Payer: Scott and White Medicare |
$6,542.72
|
| Rate for Payer: Superior Health Plan EPO |
$6,542.72
|
| Rate for Payer: Superior Health Plan Medicare |
$6,542.72
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$6,542.72
|
| Rate for Payer: Universal American Medicare |
$6,542.72
|
| Rate for Payer: Wellcare Medicare |
$6,542.72
|
| Rate for Payer: Wellmed Medicare |
$6,542.72
|
|
|
PERC SACRL AUGMENT UNIL
|
Facility
|
OP
|
$14,016.00
|
|
|
Service Code
|
CPT 0200T
|
| Hospital Charge Code |
4610200
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$117.01 |
| Max. Negotiated Rate |
$15,074.51 |
| Rate for Payer: Aetna Commercial |
$4,635.00
|
| Rate for Payer: Aetna Medicare |
$9,814.08
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,261.44
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$6,542.72
|
| Rate for Payer: Amerigroup Medicare |
$6,542.72
|
| 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 |
$6,542.72
|
| Rate for Payer: BCBS of TX PPO |
$15,074.51
|
| Rate for Payer: Cash Price |
$12,334.08
|
| Rate for Payer: Cash Price |
$12,334.08
|
| Rate for Payer: Cash Price |
$12,334.08
|
| Rate for Payer: Cigna Commercial |
$14,821.16
|
| Rate for Payer: Cigna Medicare |
$6,542.72
|
| Rate for Payer: Employer Direct Commercial |
$6,542.72
|
| Rate for Payer: Humana Medicare/TRICARE |
$6,542.72
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$6,542.72
|
| Rate for Payer: Molina Medicare |
$6,542.72
|
| 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 |
$117.01
|
| Rate for Payer: Scott and White Medicare |
$6,542.72
|
| Rate for Payer: Superior Health Plan EPO |
$6,542.72
|
| Rate for Payer: Superior Health Plan Medicare |
$6,542.72
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$6,542.72
|
| Rate for Payer: Universal American Medicare |
$6,542.72
|
| Rate for Payer: Wellcare Medicare |
$6,542.72
|
| Rate for Payer: Wellmed Medicare |
$6,542.72
|
|
|
PERC SACRL AUGMENT UNIL
|
Facility
|
IP
|
$14,016.00
|
|
|
Service Code
|
CPT 0200T
|
| Hospital Charge Code |
4610200
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$12,334.08
|
|
|
PERC TRNSHEP PORT W/EVL
|
Facility
|
IP
|
$4,336.00
|
|
|
Service Code
|
CPT 75885
|
| Hospital Charge Code |
4615885
|
|
Hospital Revenue Code
|
323
|
| Rate for Payer: Cash Price |
$3,815.68
|
|
|
PERC TRNSHEP PORT W/EVL
|
Facility
|
OP
|
$4,336.00
|
|
|
Service Code
|
CPT 75885
|
| Hospital Charge Code |
4615885
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$52.13 |
| Max. Negotiated Rate |
$6,603.56 |
| Rate for Payer: Aetna Commercial |
$82.27
|
| Rate for Payer: Aetna Medicare |
$4,372.65
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$136.66
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$2,915.10
|
| Rate for Payer: Amerigroup Medicare |
$2,915.10
|
| Rate for Payer: BCBS of TX Blue Advantage |
$4,572.61
|
| Rate for Payer: BCBS of TX Blue Essentials |
$5,487.13
|
| Rate for Payer: BCBS of TX Medicare |
$2,915.10
|
| Rate for Payer: BCBS of TX PPO |
$6,124.53
|
| Rate for Payer: Cash Price |
$3,815.68
|
| Rate for Payer: Cash Price |
$3,815.68
|
| Rate for Payer: Cash Price |
$3,815.68
|
| Rate for Payer: Cigna Commercial |
$6,603.56
|
| Rate for Payer: Cigna Medicaid |
$136.66
|
| Rate for Payer: Cigna Medicare |
$2,915.10
|
| Rate for Payer: Employer Direct Commercial |
$2,915.10
|
| Rate for Payer: Humana Medicare/TRICARE |
$2,915.10
|
| Rate for Payer: Molina CHIP/Medicaid |
$136.66
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$2,915.10
|
| Rate for Payer: Molina Medicare |
$2,915.10
|
| Rate for Payer: Multiplan Auto |
$2,818.40
|
| Rate for Payer: Multiplan Commercial |
$2,818.40
|
| Rate for Payer: Multiplan Workers Comp |
$2,818.40
|
| Rate for Payer: Parkland Medicaid |
$136.66
|
| Rate for Payer: Scott and White EPO/PPO |
$52.13
|
| Rate for Payer: Scott and White Medicare |
$2,915.10
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$136.66
|
| Rate for Payer: Superior Health Plan EPO |
$2,915.10
|
| Rate for Payer: Superior Health Plan Medicare |
$2,915.10
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$2,915.10
|
| Rate for Payer: Universal American Medicare |
$2,915.10
|
| Rate for Payer: Wellcare Medicare |
$2,915.10
|
| Rate for Payer: Wellmed Medicare |
$2,915.10
|
|
