|
Injection(s), of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, ster
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 62323
|
| Hospital Charge Code |
36062323
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$262.86 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$262.86
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$709.10
|
| Rate for Payer: Amerigroup Medicare |
$709.10
|
| Rate for Payer: BCBS of TX Blue Advantage |
$1,043.83
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,250.10
|
| Rate for Payer: BCBS of TX Medicare |
$709.10
|
| Rate for Payer: BCBS of TX PPO |
$1,575.13
|
| Rate for Payer: Cigna Commercial |
$1,498.91
|
| Rate for Payer: Cigna Medicare |
$709.10
|
| Rate for Payer: Employer Direct Commercial |
$709.10
|
| Rate for Payer: Humana Medicare/TRICARE |
$709.10
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$709.10
|
| Rate for Payer: Molina Medicare |
$709.10
|
| Rate for Payer: Multiplan Auto |
$10,000.00
|
| Rate for Payer: Multiplan Commercial |
$10,000.00
|
| Rate for Payer: Multiplan Workers Comp |
$10,000.00
|
| Rate for Payer: Scott and White EPO/PPO |
$1,170.03
|
| 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) single or multiple trigger point(s), 1 or 2 muscle(s)
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 20552
|
| Hospital Charge Code |
36020552
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$23.26 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$23.26
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$308.35
|
| Rate for Payer: Amerigroup Medicare |
$308.35
|
| Rate for Payer: BCBS of TX Blue Advantage |
$50.63
|
| Rate for Payer: BCBS of TX Blue Essentials |
$60.64
|
| Rate for Payer: BCBS of TX Medicare |
$308.35
|
| Rate for Payer: BCBS of TX PPO |
$76.41
|
| 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) single or multiple trigger point(s), 1 or 2 muscle(s)
|
Facility
|
IP
|
$914.10
|
|
|
Service Code
|
HCPCS 20552
|
| Hospital Charge Code |
9900172
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$621.59
|
|
|
Injection(s) single or multiple trigger point(s), 1 or 2 muscle(s)
|
Facility
|
OP
|
$914.10
|
|
|
Service Code
|
HCPCS 20552
|
| Hospital Charge Code |
9900172
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$23.26 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$23.26
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$308.35
|
| Rate for Payer: Amerigroup Medicare |
$308.35
|
| Rate for Payer: BCBS of TX Blue Advantage |
$50.63
|
| Rate for Payer: BCBS of TX Blue Essentials |
$60.64
|
| Rate for Payer: BCBS of TX Medicare |
$308.35
|
| Rate for Payer: BCBS of TX PPO |
$76.41
|
| Rate for Payer: Cash Price |
$621.59
|
| Rate for Payer: Cash Price |
$621.59
|
| Rate for Payer: Cash Price |
$621.59
|
| Rate for Payer: Cigna Commercial |
$651.79
|
| Rate for Payer: Cigna Medicaid |
$658.15
|
| 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 |
$658.15
|
| 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 |
$658.15
|
| 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 |
$658.15
|
| 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) single or multiple trigger point(s), 3 or more muscles
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 20553
|
| Hospital Charge Code |
36020553
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$27.13 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$27.13
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$308.35
|
| Rate for Payer: Amerigroup Medicare |
$308.35
|
| Rate for Payer: BCBS of TX Blue Advantage |
$59.07
|
| Rate for Payer: BCBS of TX Blue Essentials |
$70.74
|
| Rate for Payer: BCBS of TX Medicare |
$308.35
|
| Rate for Payer: BCBS of TX PPO |
$89.13
|
| 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) single or multiple trigger point(s), 3 or more muscles
|
Facility
|
OP
|
$1,305.85
|
|
|
Service Code
|
HCPCS 20553
|
| Hospital Charge Code |
9900173
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$27.13 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$27.13
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$308.35
|
| Rate for Payer: Amerigroup Medicare |
$308.35
|
| Rate for Payer: BCBS of TX Blue Advantage |
$59.07
|
| Rate for Payer: BCBS of TX Blue Essentials |
$70.74
|
| Rate for Payer: BCBS of TX Medicare |
$308.35
|
| Rate for Payer: BCBS of TX PPO |
$89.13
|
| Rate for Payer: Cash Price |
$887.98
|
| Rate for Payer: Cash Price |
$887.98
|
| Rate for Payer: Cash Price |
$887.98
|
| Rate for Payer: Cigna Commercial |
$651.79
|
| Rate for Payer: Cigna Medicaid |
$940.21
|
| 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 |
$940.21
|
| 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 |
$940.21
|
| 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 |
$940.21
|
| 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) single or multiple trigger point(s), 3 or more muscles
|
Facility
|
IP
|
$1,305.85
|
|
|
Service Code
|
HCPCS 20553
|
| Hospital Charge Code |
9900173
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$887.98
|
|
|
Injection(s) single tendon origin/insertion
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 20551
|
| Hospital Charge Code |
36020551
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$24.36 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$24.36
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$308.35
|
| Rate for Payer: Amerigroup Medicare |
$308.35
|
| Rate for Payer: BCBS of TX Blue Advantage |
$45.81
|
| Rate for Payer: BCBS of TX Blue Essentials |
$54.86
|
| Rate for Payer: BCBS of TX Medicare |
$308.35
|
| Rate for Payer: BCBS of TX PPO |
$69.12
|
| 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) single tendon origin/insertion
|
Facility
|
IP
|
$914.10
|
|
|
Service Code
|
HCPCS 20551
|
| Hospital Charge Code |
9900171
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$621.59
|
|
|
Injection(s) single tendon origin/insertion
|
Facility
|
OP
|
$914.10
|
|
|
Service Code
|
HCPCS 20551
|
| Hospital Charge Code |
9900171
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$24.36 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$24.36
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$308.35
|
| Rate for Payer: Amerigroup Medicare |
$308.35
|
| Rate for Payer: BCBS of TX Blue Advantage |
$45.81
|
| Rate for Payer: BCBS of TX Blue Essentials |
$54.86
|
| Rate for Payer: BCBS of TX Medicare |
$308.35
|
| Rate for Payer: BCBS of TX PPO |
$69.12
|
| Rate for Payer: Cash Price |
$621.59
|
| Rate for Payer: Cash Price |
$621.59
|
| Rate for Payer: Cash Price |
$621.59
|
| Rate for Payer: Cigna Commercial |
$651.79
|
| Rate for Payer: Cigna Medicaid |
$658.15
|
| 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 |
$658.15
|
| 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 |
$658.15
|
| 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 |
$658.15
|
| 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) single tendon sheath, or ligament, aponeurosis (eg, plantar "fascia")
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 20550
|
| Hospital Charge Code |
36020550
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$23.54 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$23.54
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$308.35
|
| Rate for Payer: Amerigroup Medicare |
$308.35
|
| Rate for Payer: BCBS of TX Blue Advantage |
$43.39
|
| Rate for Payer: BCBS of TX Blue Essentials |
$51.96
|
| Rate for Payer: BCBS of TX Medicare |
$308.35
|
| Rate for Payer: BCBS of TX PPO |
$65.47
|
| 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) single tendon sheath, or ligament, aponeurosis (eg, plantar 'fascia)
|
Facility
|
IP
|
$1,175.27
|
|
|
Service Code
|
HCPCS 20550
|
| Hospital Charge Code |
9900170
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$799.18
|
|
|
Injection(s) single tendon sheath, or ligament, aponeurosis (eg, plantar 'fascia)
|
Facility
|
OP
|
$1,175.27
|
|
|
Service Code
|
HCPCS 20550
|
| Hospital Charge Code |
9900170
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$23.54 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$23.54
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$308.35
|
| Rate for Payer: Amerigroup Medicare |
$308.35
|
| Rate for Payer: BCBS of TX Blue Advantage |
$43.39
|
| Rate for Payer: BCBS of TX Blue Essentials |
$51.96
|
| Rate for Payer: BCBS of TX Medicare |
$308.35
|
| Rate for Payer: BCBS of TX PPO |
$65.47
|
| Rate for Payer: Cash Price |
$799.18
|
| Rate for Payer: Cash Price |
$799.18
|
| Rate for Payer: Cash Price |
$799.18
|
| Rate for Payer: Cigna Commercial |
$651.79
|
| Rate for Payer: Cigna Medicaid |
$846.19
|
| 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 |
$846.19
|
| 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 |
$846.19
|
| 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 |
$846.19
|
| 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, therapeutic (eg, local anesthetic, corticosteroid), carpal tunnel
|
Facility
|
OP
|
$1,567.02
|
|
|
Service Code
|
HCPCS 20526
|
| Hospital Charge Code |
9900169
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$36.54 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$36.54
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$308.35
|
| Rate for Payer: Amerigroup Medicare |
$308.35
|
| Rate for Payer: BCBS of TX Blue Advantage |
$69.31
|
| Rate for Payer: BCBS of TX Blue Essentials |
$83.00
|
| Rate for Payer: BCBS of TX Medicare |
$308.35
|
| Rate for Payer: BCBS of TX PPO |
$104.58
|
| 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, therapeutic (eg, local anesthetic, corticosteroid), carpal tunnel
|
Facility
|
IP
|
$1,567.02
|
|
|
Service Code
|
HCPCS 20526
|
| Hospital Charge Code |
9900169
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$1,065.57
|
|
|
Injection, therapeutic (eg, local anesthetic, corticosteroid), carpal tunnel
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 20526
|
| Hospital Charge Code |
36020526
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$36.54 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$36.54
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$308.35
|
| Rate for Payer: Amerigroup Medicare |
$308.35
|
| Rate for Payer: BCBS of TX Blue Advantage |
$69.31
|
| Rate for Payer: BCBS of TX Blue Essentials |
$83.00
|
| Rate for Payer: BCBS of TX Medicare |
$308.35
|
| Rate for Payer: BCBS of TX PPO |
$104.58
|
| 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
|
|
|
INJECTOR, UTERINE MANIPULATOR BLLN TIPPD 13'L DISP -- DHF
|
Facility
|
OP
|
$165.36
|
|
| Hospital Charge Code |
81778250
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$14.88 |
| Max. Negotiated Rate |
$119.06 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$14.88
|
| Rate for Payer: BCBS of TX Blue Advantage |
$49.61
|
| Rate for Payer: BCBS of TX Blue Essentials |
$59.53
|
| Rate for Payer: BCBS of TX PPO |
$66.14
|
| Rate for Payer: Cash Price |
$112.44
|
| Rate for Payer: Cigna Medicaid |
$119.06
|
| Rate for Payer: Molina CHIP/Medicaid |
$119.06
|
| Rate for Payer: Multiplan Auto |
$107.48
|
| Rate for Payer: Multiplan Commercial |
$107.48
|
| Rate for Payer: Multiplan Workers Comp |
$107.48
|
| Rate for Payer: Parkland Medicaid |
$119.06
|
| Rate for Payer: Scott and White EPO/PPO |
$82.68
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$119.06
|
| Rate for Payer: Superior Health Plan EPO |
$22.49
|
|
|
INJECTOR, UTERINE MANIPULATOR BLLN TIPPD 13'L DISP -- DHF
|
Facility
|
IP
|
$165.36
|
|
| Hospital Charge Code |
81778250
|
|
Hospital Revenue Code
|
270
|
| Rate for Payer: Cash Price |
$112.44
|
|
|
INJECT PULM ART HRT CATH
|
Facility
|
OP
|
$2,230.00
|
|
|
Service Code
|
HCPCS 93568
|
| Hospital Charge Code |
4613571
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$55.24 |
| Max. Negotiated Rate |
$1,605.60 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$200.70
|
| Rate for Payer: BCBS of TX Blue Advantage |
$669.00
|
| Rate for Payer: BCBS of TX Blue Essentials |
$802.80
|
| Rate for Payer: BCBS of TX PPO |
$892.00
|
| Rate for Payer: Cash Price |
$1,516.40
|
| Rate for Payer: Cash Price |
$1,516.40
|
| Rate for Payer: Cigna Medicaid |
$1,605.60
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,605.60
|
| Rate for Payer: Multiplan Auto |
$1,449.50
|
| Rate for Payer: Multiplan Commercial |
$1,449.50
|
| Rate for Payer: Multiplan Workers Comp |
$1,449.50
|
| Rate for Payer: Parkland Medicaid |
$1,605.60
|
| Rate for Payer: Scott and White EPO/PPO |
$55.24
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,605.60
|
| Rate for Payer: Superior Health Plan EPO |
$303.28
|
|
|
INJECT PULM ART HRT CATH
|
Facility
|
IP
|
$2,230.00
|
|
|
Service Code
|
HCPCS 93568
|
| Hospital Charge Code |
4613571
|
|
Hospital Revenue Code
|
481
|
| Rate for Payer: Cash Price |
$1,516.40
|
|
|
INJ EPID BLD PATCH
|
Facility
|
OP
|
$1,339.00
|
|
|
Service Code
|
HCPCS 62273
|
| Hospital Charge Code |
4610101
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$262.86 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$262.86
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$709.10
|
| Rate for Payer: Amerigroup Medicare |
$709.10
|
| Rate for Payer: BCBS of TX Blue Advantage |
$1,043.83
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,250.10
|
| Rate for Payer: BCBS of TX Medicare |
$709.10
|
| Rate for Payer: BCBS of TX PPO |
$1,575.13
|
| Rate for Payer: Cash Price |
$910.52
|
| Rate for Payer: Cash Price |
$910.52
|
| Rate for Payer: Cash Price |
$910.52
|
| Rate for Payer: Cigna Commercial |
$1,498.91
|
| Rate for Payer: Cigna Medicaid |
$964.08
|
| 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 |
$964.08
|
| 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 |
$964.08
|
| 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 |
$964.08
|
| 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
|
|
|
INJ EPID BLD PATCH
|
Facility
|
IP
|
$1,339.00
|
|
|
Service Code
|
HCPCS 62273
|
| Hospital Charge Code |
4610101
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$910.52
|
|
|
INJ NEPHROGRM EXIS ACC
|
Facility
|
OP
|
$1,616.00
|
|
|
Service Code
|
HCPCS 50431
|
| Hospital Charge Code |
4617665
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$145.44 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$145.44
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$700.47
|
| Rate for Payer: Amerigroup Medicare |
$700.47
|
| Rate for Payer: BCBS of TX Blue Advantage |
$929.41
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,113.06
|
| Rate for Payer: BCBS of TX Medicare |
$700.47
|
| Rate for Payer: BCBS of TX PPO |
$1,402.46
|
| Rate for Payer: Cash Price |
$1,098.88
|
| Rate for Payer: Cash Price |
$1,098.88
|
| Rate for Payer: Cash Price |
$1,098.88
|
| Rate for Payer: Cigna Commercial |
$1,480.67
|
| Rate for Payer: Cigna Medicaid |
$1,163.52
|
| Rate for Payer: Cigna Medicare |
$700.47
|
| Rate for Payer: Employer Direct Commercial |
$700.47
|
| Rate for Payer: Humana Medicare/TRICARE |
$700.47
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,163.52
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$700.47
|
| Rate for Payer: Molina Medicare |
$700.47
|
| 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 |
$1,163.52
|
| Rate for Payer: Scott and White EPO/PPO |
$1,155.75
|
| Rate for Payer: Scott and White Medicare |
$700.47
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,163.52
|
| Rate for Payer: Superior Health Plan EPO |
$700.47
|
| Rate for Payer: Superior Health Plan Medicare |
$700.47
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$700.47
|
| Rate for Payer: Universal American Medicare |
$700.47
|
| Rate for Payer: Wellcare Medicare |
$700.47
|
| Rate for Payer: Wellmed Medicare |
$700.47
|
|
|
INJ NEPHROGRM EXIS ACC
|
Facility
|
IP
|
$1,616.00
|
|
|
Service Code
|
HCPCS 50431
|
| Hospital Charge Code |
4617665
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$1,098.88
|
|
|
INJ PERC TX OF EXT PSEUDOANERYSM BCE
|
Facility
|
OP
|
$1,987.00
|
|
|
Service Code
|
HCPCS 36002
|
| Hospital Charge Code |
2117968
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$223.75 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$223.75
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$630.16
|
| Rate for Payer: Amerigroup Medicare |
$630.16
|
| Rate for Payer: BCBS of TX Blue Advantage |
$1,052.95
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,261.02
|
| Rate for Payer: BCBS of TX Medicare |
$630.16
|
| Rate for Payer: BCBS of TX PPO |
$1,588.89
|
| Rate for Payer: Cash Price |
$1,351.16
|
| Rate for Payer: Cash Price |
$1,351.16
|
| Rate for Payer: Cash Price |
$1,351.16
|
| Rate for Payer: Cigna Commercial |
$1,332.05
|
| Rate for Payer: Cigna Medicaid |
$1,430.64
|
| Rate for Payer: Cigna Medicare |
$630.16
|
| Rate for Payer: Employer Direct Commercial |
$630.16
|
| Rate for Payer: Humana Medicare/TRICARE |
$630.16
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,430.64
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$630.16
|
| Rate for Payer: Molina Medicare |
$630.16
|
| 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 |
$1,430.64
|
| Rate for Payer: Scott and White EPO/PPO |
$1,062.86
|
| Rate for Payer: Scott and White Medicare |
$630.16
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,430.64
|
| Rate for Payer: Superior Health Plan EPO |
$630.16
|
| Rate for Payer: Superior Health Plan Medicare |
$630.16
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$630.16
|
| Rate for Payer: Universal American Medicare |
$630.16
|
| Rate for Payer: Wellcare Medicare |
$630.16
|
| Rate for Payer: Wellmed Medicare |
$630.16
|
|
