|
PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITH MCC
|
Facility
|
IP
|
$74,043.00
|
|
|
Service Code
|
MSDRG 273
|
| Min. Negotiated Rate |
$30,664.02 |
| Max. Negotiated Rate |
$74,043.00 |
| Rate for Payer: Aetna Commercial |
$43,841.25
|
| Rate for Payer: Aetna Medicare |
$45,996.03
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$30,664.02
|
| Rate for Payer: Amerigroup Medicare |
$30,664.02
|
| Rate for Payer: BCBS of TX Blue Advantage |
$30,998.70
|
| Rate for Payer: BCBS of TX Blue Essentials |
$37,690.15
|
| Rate for Payer: BCBS of TX Medicare |
$30,664.02
|
| Rate for Payer: BCBS of TX PPO |
$41,879.56
|
| Rate for Payer: Cigna Commercial |
$50,193.36
|
| Rate for Payer: Cigna Medicare |
$30,664.02
|
| Rate for Payer: Employer Direct Commercial |
$30,664.02
|
| Rate for Payer: Humana Medicare/TRICARE |
$30,664.02
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$30,664.02
|
| Rate for Payer: Molina Medicare |
$30,664.02
|
| Rate for Payer: Multiplan Auto |
$74,043.00
|
| Rate for Payer: Multiplan Commercial |
$74,043.00
|
| Rate for Payer: Multiplan Workers Comp |
$74,043.00
|
| Rate for Payer: Scott and White EPO/PPO |
$34,098.75
|
| Rate for Payer: Scott and White Medicare |
$30,664.02
|
| Rate for Payer: Superior Health Plan EPO |
$30,664.02
|
| Rate for Payer: Superior Health Plan Medicare |
$30,664.02
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$30,664.02
|
| Rate for Payer: Universal American Medicare |
$30,664.02
|
| Rate for Payer: Wellcare Medicare |
$30,664.02
|
| Rate for Payer: Wellmed Medicare |
$30,664.02
|
|
|
PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITHOUT MCC
|
Facility
|
IP
|
$61,575.20
|
|
|
Service Code
|
MSDRG 274
|
| Min. Negotiated Rate |
$21,760.58 |
| Max. Negotiated Rate |
$61,575.20 |
| Rate for Payer: Aetna Commercial |
$36,459.00
|
| Rate for Payer: Aetna Medicare |
$38,972.00
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$25,981.33
|
| Rate for Payer: Amerigroup Medicare |
$25,981.33
|
| Rate for Payer: BCBS of TX Blue Advantage |
$21,760.58
|
| Rate for Payer: BCBS of TX Blue Essentials |
$30,733.08
|
| Rate for Payer: BCBS of TX Medicare |
$25,981.33
|
| Rate for Payer: BCBS of TX PPO |
$34,149.19
|
| Rate for Payer: Cigna Commercial |
$41,741.50
|
| Rate for Payer: Cigna Medicare |
$25,981.33
|
| Rate for Payer: Employer Direct Commercial |
$25,981.33
|
| Rate for Payer: Humana Medicare/TRICARE |
$25,981.33
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$25,981.33
|
| Rate for Payer: Molina Medicare |
$25,981.33
|
| Rate for Payer: Multiplan Auto |
$61,575.20
|
| Rate for Payer: Multiplan Commercial |
$61,575.20
|
| Rate for Payer: Multiplan Workers Comp |
$61,575.20
|
| Rate for Payer: Scott and White EPO/PPO |
$28,357.00
|
| Rate for Payer: Scott and White Medicare |
$25,981.33
|
| Rate for Payer: Superior Health Plan EPO |
$25,981.33
|
| Rate for Payer: Superior Health Plan Medicare |
$25,981.33
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$25,981.33
|
| Rate for Payer: Universal American Medicare |
$25,981.33
|
| Rate for Payer: Wellcare Medicare |
$25,981.33
|
| Rate for Payer: Wellmed Medicare |
$25,981.33
|
|
|
PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH INTRALUMINAL DEVICE WITH MCC OR 4+ ARTERIES/INTRALUMINAL DEVICES
|
Facility
|
IP
|
$54,619.30
|
|
|
Service Code
|
MSDRG 321
|
| Min. Negotiated Rate |
$23,368.82 |
| Max. Negotiated Rate |
$54,619.30 |
| Rate for Payer: Aetna Commercial |
$32,340.38
|
| Rate for Payer: Aetna Medicare |
$35,053.23
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$23,368.82
|
| Rate for Payer: Amerigroup Medicare |
$23,368.82
|
| Rate for Payer: BCBS of TX Medicare |
$23,368.82
|
| Rate for Payer: Cigna Commercial |
$37,026.14
|
| Rate for Payer: Cigna Medicare |
$23,368.82
|
| Rate for Payer: Employer Direct Commercial |
$23,368.82
|
| Rate for Payer: Humana Medicare/TRICARE |
$23,368.82
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$23,368.82
|
| Rate for Payer: Molina Medicare |
$23,368.82
|
| Rate for Payer: Multiplan Auto |
$54,619.30
|
| Rate for Payer: Multiplan Commercial |
$54,619.30
|
| Rate for Payer: Multiplan Workers Comp |
$54,619.30
|
| Rate for Payer: Scott and White EPO/PPO |
$25,153.62
|
| Rate for Payer: Scott and White Medicare |
$23,368.82
|
| Rate for Payer: Superior Health Plan EPO |
$23,368.82
|
| Rate for Payer: Superior Health Plan Medicare |
$23,368.82
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$23,368.82
|
| Rate for Payer: Universal American Medicare |
$23,368.82
|
| Rate for Payer: Wellcare Medicare |
$23,368.82
|
| Rate for Payer: Wellmed Medicare |
$23,368.82
|
|
|
PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH INTRALUMINAL DEVICE WITHOUT MCC
|
Facility
|
IP
|
$34,644.60
|
|
|
Service Code
|
MSDRG 322
|
| Min. Negotiated Rate |
$15,866.67 |
| Max. Negotiated Rate |
$34,644.60 |
| Rate for Payer: Aetna Commercial |
$20,513.25
|
| Rate for Payer: Aetna Medicare |
$23,800.00
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$15,866.67
|
| Rate for Payer: Amerigroup Medicare |
$15,866.67
|
| Rate for Payer: BCBS of TX Medicare |
$15,866.67
|
| Rate for Payer: Cigna Commercial |
$23,485.39
|
| Rate for Payer: Cigna Medicare |
$15,866.67
|
| Rate for Payer: Employer Direct Commercial |
$15,866.67
|
| Rate for Payer: Humana Medicare/TRICARE |
$15,866.67
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$15,866.67
|
| Rate for Payer: Molina Medicare |
$15,866.67
|
| Rate for Payer: Multiplan Auto |
$34,644.60
|
| Rate for Payer: Multiplan Commercial |
$34,644.60
|
| Rate for Payer: Multiplan Workers Comp |
$34,644.60
|
| Rate for Payer: Scott and White EPO/PPO |
$15,954.75
|
| Rate for Payer: Scott and White Medicare |
$15,866.67
|
| Rate for Payer: Superior Health Plan EPO |
$15,866.67
|
| Rate for Payer: Superior Health Plan Medicare |
$15,866.67
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$15,866.67
|
| Rate for Payer: Universal American Medicare |
$15,866.67
|
| Rate for Payer: Wellcare Medicare |
$15,866.67
|
| Rate for Payer: Wellmed Medicare |
$15,866.67
|
|
|
PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT INTRALUMINAL DEVICE WITH MCC
|
Facility
|
IP
|
$44,665.20
|
|
|
Service Code
|
MSDRG 250
|
| Min. Negotiated Rate |
$19,630.23 |
| Max. Negotiated Rate |
$44,665.20 |
| Rate for Payer: Aetna Commercial |
$26,446.50
|
| Rate for Payer: Aetna Medicare |
$29,445.34
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$19,630.23
|
| Rate for Payer: Amerigroup Medicare |
$19,630.23
|
| Rate for Payer: BCBS of TX Blue Advantage |
$22,617.14
|
| Rate for Payer: BCBS of TX Blue Essentials |
$26,693.19
|
| Rate for Payer: BCBS of TX Medicare |
$19,630.23
|
| Rate for Payer: BCBS of TX PPO |
$29,660.25
|
| Rate for Payer: Cigna Commercial |
$30,278.30
|
| Rate for Payer: Cigna Medicare |
$19,630.23
|
| Rate for Payer: Employer Direct Commercial |
$19,630.23
|
| Rate for Payer: Humana Medicare/TRICARE |
$19,630.23
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$19,630.23
|
| Rate for Payer: Molina Medicare |
$19,630.23
|
| Rate for Payer: Multiplan Auto |
$44,665.20
|
| Rate for Payer: Multiplan Commercial |
$44,665.20
|
| Rate for Payer: Multiplan Workers Comp |
$44,665.20
|
| Rate for Payer: Scott and White EPO/PPO |
$20,569.50
|
| Rate for Payer: Scott and White Medicare |
$19,630.23
|
| Rate for Payer: Superior Health Plan EPO |
$19,630.23
|
| Rate for Payer: Superior Health Plan Medicare |
$19,630.23
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$19,630.23
|
| Rate for Payer: Universal American Medicare |
$19,630.23
|
| Rate for Payer: Wellcare Medicare |
$19,630.23
|
| Rate for Payer: Wellmed Medicare |
$19,630.23
|
|
|
PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT INTRALUMINAL DEVICE WITHOUT MCC
|
Facility
|
IP
|
$30,151.10
|
|
|
Service Code
|
MSDRG 251
|
| Min. Negotiated Rate |
$13,885.38 |
| Max. Negotiated Rate |
$30,151.10 |
| Rate for Payer: Aetna Commercial |
$17,852.62
|
| Rate for Payer: Aetna Medicare |
$21,268.48
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$14,178.99
|
| Rate for Payer: Amerigroup Medicare |
$14,178.99
|
| Rate for Payer: BCBS of TX Blue Advantage |
$14,506.48
|
| Rate for Payer: BCBS of TX Blue Essentials |
$17,313.22
|
| Rate for Payer: BCBS of TX Medicare |
$14,178.99
|
| Rate for Payer: BCBS of TX PPO |
$19,237.65
|
| Rate for Payer: Cigna Commercial |
$20,439.27
|
| Rate for Payer: Cigna Medicare |
$14,178.99
|
| Rate for Payer: Employer Direct Commercial |
$14,178.99
|
| Rate for Payer: Humana Medicare/TRICARE |
$14,178.99
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$14,178.99
|
| Rate for Payer: Molina Medicare |
$14,178.99
|
| Rate for Payer: Multiplan Auto |
$30,151.10
|
| Rate for Payer: Multiplan Commercial |
$30,151.10
|
| Rate for Payer: Multiplan Workers Comp |
$30,151.10
|
| Rate for Payer: Scott and White EPO/PPO |
$13,885.38
|
| Rate for Payer: Scott and White Medicare |
$14,178.99
|
| Rate for Payer: Superior Health Plan EPO |
$14,178.99
|
| Rate for Payer: Superior Health Plan Medicare |
$14,178.99
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$14,178.99
|
| Rate for Payer: Universal American Medicare |
$14,178.99
|
| Rate for Payer: Wellcare Medicare |
$14,178.99
|
| Rate for Payer: Wellmed Medicare |
$14,178.99
|
|
|
Percutaneous implantation of neurostimulator electrode array, epidural
|
Facility
|
OP
|
$15,591.57
|
|
|
Service Code
|
CPT 63650
|
| Hospital Charge Code |
36063650
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$137.96 |
| Max. Negotiated Rate |
$15,591.57 |
| Rate for Payer: Aetna Commercial |
$7,210.00
|
| Rate for Payer: Aetna Medicare |
$9,382.08
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$3,656.02
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$6,254.72
|
| Rate for Payer: Amerigroup Medicare |
$6,254.72
|
| Rate for Payer: BCBS of TX Blue Advantage |
$10,332.51
|
| Rate for Payer: BCBS of TX Blue Essentials |
$12,374.26
|
| Rate for Payer: BCBS of TX Medicare |
$6,254.72
|
| Rate for Payer: BCBS of TX PPO |
$15,591.57
|
| Rate for Payer: Cigna Commercial |
$14,168.74
|
| Rate for Payer: Cigna Medicaid |
$3,656.02
|
| Rate for Payer: Cigna Medicare |
$6,254.72
|
| Rate for Payer: Employer Direct Commercial |
$6,254.72
|
| Rate for Payer: Humana Medicare/TRICARE |
$6,254.72
|
| Rate for Payer: Molina CHIP/Medicaid |
$3,656.02
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$6,254.72
|
| Rate for Payer: Molina Medicare |
$6,254.72
|
| 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 |
$3,656.02
|
| Rate for Payer: Scott and White EPO/PPO |
$137.96
|
| Rate for Payer: Scott and White Medicare |
$6,254.72
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$3,656.02
|
| Rate for Payer: Superior Health Plan EPO |
$6,254.72
|
| Rate for Payer: Superior Health Plan Medicare |
$6,254.72
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$6,254.72
|
| Rate for Payer: Universal American Medicare |
$6,254.72
|
| Rate for Payer: Wellcare Medicare |
$6,254.72
|
| Rate for Payer: Wellmed Medicare |
$6,254.72
|
|
|
Percutaneous implantation of neurostimulator electrode array peripheral nerve (excludes sacral nerv
|
Facility
|
OP
|
$15,591.57
|
|
|
Service Code
|
CPT 64555
|
| Hospital Charge Code |
36064555
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$137.96 |
| Max. Negotiated Rate |
$15,591.57 |
| Rate for Payer: Aetna Commercial |
$7,210.00
|
| Rate for Payer: Aetna Medicare |
$9,382.08
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$3,908.38
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$6,254.72
|
| Rate for Payer: Amerigroup Medicare |
$6,254.72
|
| Rate for Payer: BCBS of TX Blue Advantage |
$10,332.51
|
| Rate for Payer: BCBS of TX Blue Essentials |
$12,374.26
|
| Rate for Payer: BCBS of TX Medicare |
$6,254.72
|
| Rate for Payer: BCBS of TX PPO |
$15,591.57
|
| Rate for Payer: Cigna Commercial |
$14,168.74
|
| Rate for Payer: Cigna Medicaid |
$3,908.38
|
| Rate for Payer: Cigna Medicare |
$6,254.72
|
| Rate for Payer: Employer Direct Commercial |
$6,254.72
|
| Rate for Payer: Humana Medicare/TRICARE |
$6,254.72
|
| Rate for Payer: Molina CHIP/Medicaid |
$3,908.38
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$6,254.72
|
| Rate for Payer: Molina Medicare |
$6,254.72
|
| 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 |
$3,908.38
|
| Rate for Payer: Scott and White EPO/PPO |
$137.96
|
| Rate for Payer: Scott and White Medicare |
$6,254.72
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$3,908.38
|
| Rate for Payer: Superior Health Plan EPO |
$6,254.72
|
| Rate for Payer: Superior Health Plan Medicare |
$6,254.72
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$6,254.72
|
| Rate for Payer: Universal American Medicare |
$6,254.72
|
| Rate for Payer: Wellcare Medicare |
$6,254.72
|
| Rate for Payer: Wellmed Medicare |
$6,254.72
|
|
|
Percutaneous lysis of epidural adhesions using solution injection (eg, hypertonic saline, enzyme)
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 62263
|
| Hospital Charge Code |
36062263
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$18.39 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$1,400.00
|
| Rate for Payer: Aetna Medicare |
$1,250.38
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$340.77
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$833.59
|
| Rate for Payer: Amerigroup Medicare |
$833.59
|
| 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 |
$833.59
|
| Rate for Payer: BCBS of TX PPO |
$2,046.37
|
| Rate for Payer: Cigna Commercial |
$1,888.32
|
| Rate for Payer: Cigna Medicaid |
$340.77
|
| Rate for Payer: Cigna Medicare |
$833.59
|
| Rate for Payer: Employer Direct Commercial |
$833.59
|
| Rate for Payer: Humana Medicare/TRICARE |
$833.59
|
| Rate for Payer: Molina CHIP/Medicaid |
$340.77
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$833.59
|
| Rate for Payer: Molina Medicare |
$833.59
|
| 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 |
$340.77
|
| Rate for Payer: Scott and White EPO/PPO |
$18.39
|
| Rate for Payer: Scott and White Medicare |
$833.59
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$340.77
|
| Rate for Payer: Superior Health Plan EPO |
$833.59
|
| Rate for Payer: Superior Health Plan Medicare |
$833.59
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$833.59
|
| Rate for Payer: Universal American Medicare |
$833.59
|
| Rate for Payer: Wellcare Medicare |
$833.59
|
| Rate for Payer: Wellmed Medicare |
$833.59
|
|
|
Percutaneous lysis of epidural adhesions using solution injection (eg, hypertonic saline, enzyme) or
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 62264
|
| Hospital Charge Code |
36062264
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$18.39 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$1,400.00
|
| Rate for Payer: Aetna Medicare |
$1,250.38
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$340.77
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$833.59
|
| Rate for Payer: Amerigroup Medicare |
$833.59
|
| 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 |
$833.59
|
| Rate for Payer: BCBS of TX PPO |
$2,046.37
|
| Rate for Payer: Cigna Commercial |
$1,888.32
|
| Rate for Payer: Cigna Medicaid |
$340.77
|
| Rate for Payer: Cigna Medicare |
$833.59
|
| Rate for Payer: Employer Direct Commercial |
$833.59
|
| Rate for Payer: Humana Medicare/TRICARE |
$833.59
|
| Rate for Payer: Molina CHIP/Medicaid |
$340.77
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$833.59
|
| Rate for Payer: Molina Medicare |
$833.59
|
| 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 |
$340.77
|
| Rate for Payer: Scott and White EPO/PPO |
$18.39
|
| Rate for Payer: Scott and White Medicare |
$833.59
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$340.77
|
| Rate for Payer: Superior Health Plan EPO |
$833.59
|
| Rate for Payer: Superior Health Plan Medicare |
$833.59
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$833.59
|
| Rate for Payer: Universal American Medicare |
$833.59
|
| Rate for Payer: Wellcare Medicare |
$833.59
|
| Rate for Payer: Wellmed Medicare |
$833.59
|
|
|
Percutaneous skeletal fixation of carpometacarpal dislocation, other than thumb, with manipulation,
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 26676
|
| Hospital Charge Code |
36026676
|
|
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
|
|
|
Percutaneous skeletal fixation of distal phalangeal fracture, finger or thumb, each
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 26756
|
| Hospital Charge Code |
36026756
|
|
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
|
|
|
Percutaneous skeletal fixation of interphalangeal joint dislocation, single, with manipulation
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 26776
|
| Hospital Charge Code |
36026776
|
|
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
|
|
|
Percutaneous skeletal fixation of metacarpal fracture, each bone
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 26608
|
| Hospital Charge Code |
36026608
|
|
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
|
|
|
Percutaneous skeletal fixation of ulnar styloid fracture
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 25651
|
| Hospital Charge Code |
36025651
|
|
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
|
|
|
Percutaneous skeletal fixation of unstable phalangeal shaft fracture, proximal or middle phalanx, fi
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 26727
|
| Hospital Charge Code |
36026727
|
|
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
|
|
|
Percutaneous vertebral augmentation, including cavity creation (fracture reduction and bone biopsy
|
Facility
|
OP
|
$15,074.51
|
|
|
Service Code
|
CPT 22514
|
| Hospital Charge Code |
36022514
|
|
Hospital Revenue Code
|
360
|
| 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: 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
|
|
|
Percutaneous vertebral augmentation, including cavity creation (fracture reduction and bone biopsy
|
Facility
|
OP
|
$15,074.51
|
|
|
Service Code
|
CPT 22513
|
| Hospital Charge Code |
36022513
|
|
Hospital Revenue Code
|
360
|
| 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: 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
|
|
|
Percutaneous vertebral augmentation, including cavity creation (fracture reduction and bone biopsy i
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 22515
|
| Hospital Charge Code |
36022515
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$10,000.00 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Multiplan Auto |
$10,000.00
|
| Rate for Payer: Multiplan Commercial |
$10,000.00
|
| Rate for Payer: Multiplan Workers Comp |
$10,000.00
|
|
|
PER CUT CORO ANGIOPLASTY EA ADD ART
|
Facility
|
OP
|
$3,621.00
|
|
|
Service Code
|
CPT 92921
|
| Hospital Charge Code |
2350031
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$325.89 |
| Max. Negotiated Rate |
$7,210.00 |
| Rate for Payer: Aetna Commercial |
$7,210.00
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$325.89
|
| Rate for Payer: Cash Price |
$3,186.48
|
| Rate for Payer: Cash Price |
$3,186.48
|
| Rate for Payer: Multiplan Auto |
$2,353.65
|
| Rate for Payer: Multiplan Commercial |
$2,353.65
|
| Rate for Payer: Multiplan Workers Comp |
$2,353.65
|
| Rate for Payer: Scott and White EPO/PPO |
$1,810.50
|
| Rate for Payer: Superior Health Plan EPO |
$492.46
|
|
|
PER CUT CORO ANGIOPLASTY EA ADD ART
|
Facility
|
IP
|
$3,621.00
|
|
|
Service Code
|
CPT 92921
|
| Hospital Charge Code |
2350031
|
|
Hospital Revenue Code
|
481
|
| Rate for Payer: Cash Price |
$3,186.48
|
|
|
PER CUT CORONRY ANGIOPLASTY 1ST ART
|
Facility
|
OP
|
$8,180.00
|
|
|
Service Code
|
CPT 92920
|
| Hospital Charge Code |
2350030
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$93.48 |
| Max. Negotiated Rate |
$12,483.85 |
| Rate for Payer: Aetna Commercial |
$7,210.00
|
| Rate for Payer: Aetna Medicare |
$7,840.86
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$736.20
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$5,227.24
|
| Rate for Payer: Amerigroup Medicare |
$5,227.24
|
| Rate for Payer: BCBS of TX Blue Advantage |
$8,273.03
|
| Rate for Payer: BCBS of TX Blue Essentials |
$9,907.82
|
| Rate for Payer: BCBS of TX Medicare |
$5,227.24
|
| Rate for Payer: BCBS of TX PPO |
$12,483.85
|
| Rate for Payer: Cash Price |
$7,198.40
|
| Rate for Payer: Cash Price |
$7,198.40
|
| Rate for Payer: Cash Price |
$7,198.40
|
| Rate for Payer: Cigna Commercial |
$11,841.22
|
| Rate for Payer: Cigna Medicare |
$5,227.24
|
| Rate for Payer: Employer Direct Commercial |
$5,227.24
|
| Rate for Payer: Humana Medicare/TRICARE |
$5,227.24
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$5,227.24
|
| Rate for Payer: Molina Medicare |
$5,227.24
|
| Rate for Payer: Multiplan Auto |
$5,317.00
|
| Rate for Payer: Multiplan Commercial |
$5,317.00
|
| Rate for Payer: Multiplan Workers Comp |
$5,317.00
|
| Rate for Payer: Scott and White EPO/PPO |
$93.48
|
| Rate for Payer: Scott and White Medicare |
$5,227.24
|
| Rate for Payer: Superior Health Plan EPO |
$5,227.24
|
| Rate for Payer: Superior Health Plan Medicare |
$5,227.24
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$5,227.24
|
| Rate for Payer: Universal American Medicare |
$5,227.24
|
| Rate for Payer: Wellcare Medicare |
$5,227.24
|
| Rate for Payer: Wellmed Medicare |
$5,227.24
|
|
|
PER CUT CORONRY ANGIOPLASTY 1ST ART
|
Facility
|
IP
|
$8,180.00
|
|
|
Service Code
|
CPT 92920
|
| Hospital Charge Code |
2350030
|
|
Hospital Revenue Code
|
481
|
| Rate for Payer: Cash Price |
$7,198.40
|
|
|
PERC VERT 1 BD ADD/IMG
|
Facility
|
OP
|
$885.00
|
|
|
Service Code
|
CPT 22512
|
| Hospital Charge Code |
4614480
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$79.65 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$486.75
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$79.65
|
| Rate for Payer: Cash Price |
$778.80
|
| Rate for Payer: Cash Price |
$778.80
|
| 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 |
$442.50
|
| Rate for Payer: Superior Health Plan EPO |
$120.36
|
|
|
PERC VERT 1 BD ADD/IMG
|
Facility
|
IP
|
$885.00
|
|
|
Service Code
|
CPT 22512
|
| Hospital Charge Code |
4614480
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$778.80
|
|
