|
innovance d-dimer
|
Facility
|
IP
|
$2,860.15
|
|
| Hospital Charge Code |
993842
|
|
Hospital Revenue Code
|
270
|
| Rate for Payer: Cash Price |
$1,944.90
|
|
|
innovance d-dimer controls
|
Facility
|
OP
|
$29.42
|
|
| Hospital Charge Code |
993563
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.65 |
| Max. Negotiated Rate |
$21.18 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2.65
|
| Rate for Payer: BCBS of TX Blue Advantage |
$8.83
|
| Rate for Payer: BCBS of TX Blue Essentials |
$10.59
|
| Rate for Payer: BCBS of TX PPO |
$11.77
|
| Rate for Payer: Cash Price |
$20.01
|
| Rate for Payer: Cigna Medicaid |
$21.18
|
| Rate for Payer: Molina CHIP/Medicaid |
$21.18
|
| Rate for Payer: Multiplan Auto |
$19.12
|
| Rate for Payer: Multiplan Commercial |
$19.12
|
| Rate for Payer: Multiplan Workers Comp |
$19.12
|
| Rate for Payer: Parkland Medicaid |
$21.18
|
| Rate for Payer: Scott and White EPO/PPO |
$14.71
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$21.18
|
| Rate for Payer: Superior Health Plan EPO |
$4.00
|
|
|
innovance d-dimer controls
|
Facility
|
IP
|
$29.42
|
|
| Hospital Charge Code |
993563
|
|
Hospital Revenue Code
|
270
|
| Rate for Payer: Cash Price |
$20.01
|
|
|
INPATIENT DIALYSIS
|
Facility
|
IP
|
$1,688.00
|
|
|
Service Code
|
HCPCS 90945
|
| Hospital Charge Code |
991025
|
|
Hospital Revenue Code
|
801
|
| Rate for Payer: Cash Price |
$1,147.84
|
|
|
INPATIENT DIALYSIS
|
Facility
|
OP
|
$1,688.00
|
|
|
Service Code
|
HCPCS 90945
|
| Hospital Charge Code |
991025
|
|
Hospital Revenue Code
|
801
|
| Min. Negotiated Rate |
$151.92 |
| Max. Negotiated Rate |
$1,215.36 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$151.92
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$419.16
|
| Rate for Payer: Amerigroup Medicare |
$419.16
|
| Rate for Payer: BCBS of TX Blue Advantage |
$506.40
|
| Rate for Payer: BCBS of TX Blue Essentials |
$607.68
|
| Rate for Payer: BCBS of TX Medicare |
$419.16
|
| Rate for Payer: BCBS of TX PPO |
$675.20
|
| Rate for Payer: Cash Price |
$1,147.84
|
| Rate for Payer: Cash Price |
$1,147.84
|
| Rate for Payer: Cash Price |
$1,147.84
|
| Rate for Payer: Cigna Commercial |
$886.05
|
| Rate for Payer: Cigna Medicaid |
$1,215.36
|
| Rate for Payer: Cigna Medicare |
$419.16
|
| Rate for Payer: Employer Direct Commercial |
$419.16
|
| Rate for Payer: Humana Medicare/TRICARE |
$419.16
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,215.36
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$419.16
|
| Rate for Payer: Molina Medicare |
$419.16
|
| Rate for Payer: Multiplan Auto |
$1,097.20
|
| Rate for Payer: Multiplan Commercial |
$1,097.20
|
| Rate for Payer: Multiplan Workers Comp |
$1,097.20
|
| Rate for Payer: Parkland Medicaid |
$1,215.36
|
| Rate for Payer: Scott and White EPO/PPO |
$844.00
|
| Rate for Payer: Scott and White Medicare |
$419.16
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,215.36
|
| Rate for Payer: Superior Health Plan EPO |
$419.16
|
| Rate for Payer: Superior Health Plan Medicare |
$419.16
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$419.16
|
| Rate for Payer: Universal American Medicare |
$419.16
|
| Rate for Payer: Wellcare Medicare |
$419.16
|
| Rate for Payer: Wellmed Medicare |
$419.16
|
|
|
INPATIENT DIALYSIS
|
Facility
|
IP
|
$2,663.24
|
|
|
Service Code
|
HCPCS 90935
|
| Hospital Charge Code |
991059
|
|
Hospital Revenue Code
|
801
|
| Rate for Payer: Cash Price |
$1,811.00
|
|
|
INPATIENT DIALYSIS
|
Facility
|
OP
|
$2,495.91
|
|
|
Service Code
|
HCPCS 90945
|
| Hospital Charge Code |
8856543
|
|
Hospital Revenue Code
|
801
|
| Min. Negotiated Rate |
$224.63 |
| Max. Negotiated Rate |
$1,797.06 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$224.63
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$419.16
|
| Rate for Payer: Amerigroup Medicare |
$419.16
|
| Rate for Payer: BCBS of TX Blue Advantage |
$748.77
|
| Rate for Payer: BCBS of TX Blue Essentials |
$898.53
|
| Rate for Payer: BCBS of TX Medicare |
$419.16
|
| Rate for Payer: BCBS of TX PPO |
$998.36
|
| Rate for Payer: Cash Price |
$1,697.22
|
| Rate for Payer: Cash Price |
$1,697.22
|
| Rate for Payer: Cash Price |
$1,697.22
|
| Rate for Payer: Cigna Commercial |
$886.05
|
| Rate for Payer: Cigna Medicaid |
$1,797.06
|
| Rate for Payer: Cigna Medicare |
$419.16
|
| Rate for Payer: Employer Direct Commercial |
$419.16
|
| Rate for Payer: Humana Medicare/TRICARE |
$419.16
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,797.06
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$419.16
|
| Rate for Payer: Molina Medicare |
$419.16
|
| Rate for Payer: Multiplan Auto |
$1,622.34
|
| Rate for Payer: Multiplan Commercial |
$1,622.34
|
| Rate for Payer: Multiplan Workers Comp |
$1,622.34
|
| Rate for Payer: Parkland Medicaid |
$1,797.06
|
| Rate for Payer: Scott and White EPO/PPO |
$1,247.95
|
| Rate for Payer: Scott and White Medicare |
$419.16
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,797.06
|
| Rate for Payer: Superior Health Plan EPO |
$419.16
|
| Rate for Payer: Superior Health Plan Medicare |
$419.16
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$419.16
|
| Rate for Payer: Universal American Medicare |
$419.16
|
| Rate for Payer: Wellcare Medicare |
$419.16
|
| Rate for Payer: Wellmed Medicare |
$419.16
|
|
|
INPATIENT DIALYSIS
|
Facility
|
IP
|
$2,495.91
|
|
|
Service Code
|
HCPCS 90945
|
| Hospital Charge Code |
8856543
|
|
Hospital Revenue Code
|
801
|
| Rate for Payer: Cash Price |
$1,697.22
|
|
|
INPATIENT DIALYSIS
|
Facility
|
OP
|
$2,663.24
|
|
|
Service Code
|
HCPCS 90935
|
| Hospital Charge Code |
991059
|
|
Hospital Revenue Code
|
801
|
| Min. Negotiated Rate |
$239.69 |
| Max. Negotiated Rate |
$1,917.53 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$239.69
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$689.44
|
| Rate for Payer: Amerigroup Medicare |
$689.44
|
| Rate for Payer: BCBS of TX Blue Advantage |
$798.97
|
| Rate for Payer: BCBS of TX Blue Essentials |
$958.77
|
| Rate for Payer: BCBS of TX Medicare |
$689.44
|
| Rate for Payer: BCBS of TX PPO |
$1,065.30
|
| Rate for Payer: Cash Price |
$1,811.00
|
| Rate for Payer: Cash Price |
$1,811.00
|
| Rate for Payer: Cash Price |
$1,811.00
|
| Rate for Payer: Cigna Commercial |
$1,457.36
|
| Rate for Payer: Cigna Medicaid |
$1,917.53
|
| Rate for Payer: Cigna Medicare |
$689.44
|
| Rate for Payer: Employer Direct Commercial |
$689.44
|
| Rate for Payer: Humana Medicare/TRICARE |
$689.44
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,917.53
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$689.44
|
| Rate for Payer: Molina Medicare |
$689.44
|
| Rate for Payer: Multiplan Auto |
$1,731.11
|
| Rate for Payer: Multiplan Commercial |
$1,731.11
|
| Rate for Payer: Multiplan Workers Comp |
$1,731.11
|
| Rate for Payer: Parkland Medicaid |
$1,917.53
|
| Rate for Payer: Scott and White EPO/PPO |
$1,331.62
|
| Rate for Payer: Scott and White Medicare |
$689.44
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,917.53
|
| Rate for Payer: Superior Health Plan EPO |
$689.44
|
| Rate for Payer: Superior Health Plan Medicare |
$689.44
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$689.44
|
| Rate for Payer: Universal American Medicare |
$689.44
|
| Rate for Payer: Wellcare Medicare |
$689.44
|
| Rate for Payer: Wellmed Medicare |
$689.44
|
|
|
INPATIENT-ONLY SERVICE, VERIFY!! Open Fusion, Sacroiliac Joint
|
Facility
|
IP
|
$95,208.78
|
|
|
Service Code
|
HCPCS 27280
|
| Hospital Charge Code |
9900387
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$64,741.97
|
|
|
INPATIENT-ONLY SERVICE, VERIFY!! Open Fusion, Sacroiliac Joint
|
Facility
|
OP
|
$95,208.78
|
|
|
Service Code
|
HCPCS 27280
|
| Hospital Charge Code |
9900387
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,360.46 |
| Max. Negotiated Rate |
$68,550.32 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$8,568.79
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$17,613.72
|
| Rate for Payer: Amerigroup Medicare |
$17,613.72
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,360.46
|
| Rate for Payer: BCBS of TX Blue Essentials |
$2,826.90
|
| Rate for Payer: BCBS of TX Medicare |
$17,613.72
|
| Rate for Payer: BCBS of TX PPO |
$3,561.89
|
| Rate for Payer: Cash Price |
$64,741.97
|
| Rate for Payer: Cash Price |
$64,741.97
|
| Rate for Payer: Cash Price |
$64,741.97
|
| Rate for Payer: Cigna Commercial |
$37,232.21
|
| Rate for Payer: Cigna Medicaid |
$68,550.32
|
| Rate for Payer: Cigna Medicare |
$17,613.72
|
| Rate for Payer: Employer Direct Commercial |
$17,613.72
|
| Rate for Payer: Humana Medicare/TRICARE |
$17,613.72
|
| Rate for Payer: Molina CHIP/Medicaid |
$68,550.32
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$17,613.72
|
| Rate for Payer: Molina Medicare |
$17,613.72
|
| 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 |
$68,550.32
|
| Rate for Payer: Scott and White EPO/PPO |
$32,585.38
|
| Rate for Payer: Scott and White Medicare |
$17,613.72
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$68,550.32
|
| Rate for Payer: Superior Health Plan EPO |
$17,613.72
|
| Rate for Payer: Superior Health Plan Medicare |
$17,613.72
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$17,613.72
|
| Rate for Payer: Universal American Medicare |
$17,613.72
|
| Rate for Payer: Wellcare Medicare |
$17,613.72
|
| Rate for Payer: Wellmed Medicare |
$17,613.72
|
|
|
INPATIENT-ONLY SERVICE, VERIFY!! Open Fusion, Sacroiliac Joint
|
Facility
|
OP
|
$37,232.21
|
|
|
Service Code
|
CPT 27280
|
| Hospital Charge Code |
36027280
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,360.46 |
| Max. Negotiated Rate |
$37,232.21 |
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$17,613.72
|
| Rate for Payer: Amerigroup Medicare |
$17,613.72
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,360.46
|
| Rate for Payer: BCBS of TX Blue Essentials |
$2,826.90
|
| Rate for Payer: BCBS of TX Medicare |
$17,613.72
|
| Rate for Payer: BCBS of TX PPO |
$3,561.89
|
| Rate for Payer: Cigna Commercial |
$37,232.21
|
| Rate for Payer: Cigna Medicare |
$17,613.72
|
| Rate for Payer: Employer Direct Commercial |
$17,613.72
|
| Rate for Payer: Humana Medicare/TRICARE |
$17,613.72
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$17,613.72
|
| Rate for Payer: Molina Medicare |
$17,613.72
|
| 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 |
$32,585.38
|
| Rate for Payer: Scott and White Medicare |
$17,613.72
|
| Rate for Payer: Superior Health Plan EPO |
$17,613.72
|
| Rate for Payer: Superior Health Plan Medicare |
$17,613.72
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$17,613.72
|
| Rate for Payer: Universal American Medicare |
$17,613.72
|
| Rate for Payer: Wellcare Medicare |
$17,613.72
|
| Rate for Payer: Wellmed Medicare |
$17,613.72
|
|
|
INS CATH REN ART 1ST UNI
|
Facility
|
IP
|
$8,679.00
|
|
|
Service Code
|
HCPCS 36251
|
| Hospital Charge Code |
4616251
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$5,901.72
|
|
|
INS CATH REN ART 1ST UNI
|
Facility
|
OP
|
$8,679.00
|
|
|
Service Code
|
HCPCS 36251
|
| Hospital Charge Code |
4616251
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$781.11 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$781.11
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3,171.87
|
| Rate for Payer: Amerigroup Medicare |
$3,171.87
|
| Rate for Payer: BCBS of TX Blue Advantage |
$4,628.04
|
| Rate for Payer: BCBS of TX Blue Essentials |
$5,542.56
|
| Rate for Payer: BCBS of TX Medicare |
$3,171.87
|
| Rate for Payer: BCBS of TX PPO |
$6,983.63
|
| Rate for Payer: Cash Price |
$5,901.72
|
| Rate for Payer: Cash Price |
$5,901.72
|
| Rate for Payer: Cash Price |
$5,901.72
|
| Rate for Payer: Cigna Commercial |
$6,704.76
|
| Rate for Payer: Cigna Medicaid |
$6,248.88
|
| Rate for Payer: Cigna Medicare |
$3,171.87
|
| Rate for Payer: Employer Direct Commercial |
$3,171.87
|
| Rate for Payer: Humana Medicare/TRICARE |
$3,171.87
|
| Rate for Payer: Molina CHIP/Medicaid |
$6,248.88
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3,171.87
|
| Rate for Payer: Molina Medicare |
$3,171.87
|
| 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 |
$6,248.88
|
| Rate for Payer: Scott and White EPO/PPO |
$5,867.96
|
| Rate for Payer: Scott and White Medicare |
$3,171.87
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$6,248.88
|
| Rate for Payer: Superior Health Plan EPO |
$3,171.87
|
| Rate for Payer: Superior Health Plan Medicare |
$3,171.87
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3,171.87
|
| Rate for Payer: Universal American Medicare |
$3,171.87
|
| Rate for Payer: Wellcare Medicare |
$3,171.87
|
| Rate for Payer: Wellmed Medicare |
$3,171.87
|
|
|
INSER/REPLAC DIFIBRILATOR SUB CUT
|
Facility
|
IP
|
$38,514.00
|
|
|
Service Code
|
HCPCS 33270
|
| Hospital Charge Code |
2351000
|
|
Hospital Revenue Code
|
481
|
| Rate for Payer: Cash Price |
$26,189.52
|
|
|
INSER/REPLAC DIFIBRILATOR SUB CUT
|
Facility
|
OP
|
$38,514.00
|
|
|
Service Code
|
HCPCS 33270
|
| Hospital Charge Code |
2351000
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,466.26 |
| Max. Negotiated Rate |
$81,352.25 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$3,466.26
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$31,531.90
|
| Rate for Payer: Amerigroup Medicare |
$31,531.90
|
| Rate for Payer: BCBS of TX Blue Advantage |
$53,912.01
|
| Rate for Payer: BCBS of TX Blue Essentials |
$64,565.28
|
| Rate for Payer: BCBS of TX Medicare |
$31,531.90
|
| Rate for Payer: BCBS of TX PPO |
$81,352.25
|
| Rate for Payer: Cash Price |
$26,189.52
|
| Rate for Payer: Cash Price |
$26,189.52
|
| Rate for Payer: Cash Price |
$26,189.52
|
| Rate for Payer: Cigna Commercial |
$66,652.72
|
| Rate for Payer: Cigna Medicaid |
$27,730.08
|
| Rate for Payer: Cigna Medicare |
$31,531.90
|
| Rate for Payer: Employer Direct Commercial |
$31,531.90
|
| Rate for Payer: Humana Medicare/TRICARE |
$31,531.90
|
| Rate for Payer: Molina CHIP/Medicaid |
$27,730.08
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$31,531.90
|
| Rate for Payer: Molina Medicare |
$31,531.90
|
| Rate for Payer: Multiplan Auto |
$25,034.10
|
| Rate for Payer: Multiplan Commercial |
$25,034.10
|
| Rate for Payer: Multiplan Workers Comp |
$25,034.10
|
| Rate for Payer: Parkland Medicaid |
$27,730.08
|
| Rate for Payer: Scott and White EPO/PPO |
$19,257.00
|
| Rate for Payer: Scott and White Medicare |
$31,531.90
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$27,730.08
|
| Rate for Payer: Superior Health Plan EPO |
$31,531.90
|
| Rate for Payer: Superior Health Plan Medicare |
$31,531.90
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$31,531.90
|
| Rate for Payer: Universal American Medicare |
$31,531.90
|
| Rate for Payer: Wellcare Medicare |
$31,531.90
|
| Rate for Payer: Wellmed Medicare |
$31,531.90
|
|
|
INSERT CLICKLINE SCISSOR STRL OUTER SHEATH 36CM
|
Facility
|
OP
|
$177.24
|
|
| Hospital Charge Code |
144481
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.95 |
| Max. Negotiated Rate |
$127.61 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$15.95
|
| Rate for Payer: BCBS of TX Blue Advantage |
$53.17
|
| Rate for Payer: BCBS of TX Blue Essentials |
$63.81
|
| Rate for Payer: BCBS of TX PPO |
$70.90
|
| Rate for Payer: Cash Price |
$120.52
|
| Rate for Payer: Cigna Medicaid |
$127.61
|
| Rate for Payer: Molina CHIP/Medicaid |
$127.61
|
| Rate for Payer: Multiplan Auto |
$115.21
|
| Rate for Payer: Multiplan Commercial |
$115.21
|
| Rate for Payer: Multiplan Workers Comp |
$115.21
|
| Rate for Payer: Parkland Medicaid |
$127.61
|
| Rate for Payer: Scott and White EPO/PPO |
$88.62
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$127.61
|
| Rate for Payer: Superior Health Plan EPO |
$24.10
|
|
|
INSERT CLICKLINE SCISSOR STRL OUTER SHEATH 36CM
|
Facility
|
IP
|
$177.24
|
|
| Hospital Charge Code |
144481
|
|
Hospital Revenue Code
|
272
|
| Rate for Payer: Cash Price |
$120.52
|
|
|
inserter tip psn pk
|
Facility
|
IP
|
$381.36
|
|
| Hospital Charge Code |
144814
|
|
Hospital Revenue Code
|
272
|
| Rate for Payer: Cash Price |
$259.32
|
|
|
inserter tip psn pk
|
Facility
|
OP
|
$381.36
|
|
| Hospital Charge Code |
144814
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$34.32 |
| Max. Negotiated Rate |
$274.58 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$34.32
|
| Rate for Payer: BCBS of TX Blue Advantage |
$114.41
|
| Rate for Payer: BCBS of TX Blue Essentials |
$137.29
|
| Rate for Payer: BCBS of TX PPO |
$152.54
|
| Rate for Payer: Cash Price |
$259.32
|
| Rate for Payer: Cigna Medicaid |
$274.58
|
| Rate for Payer: Molina CHIP/Medicaid |
$274.58
|
| Rate for Payer: Multiplan Auto |
$247.88
|
| Rate for Payer: Multiplan Commercial |
$247.88
|
| Rate for Payer: Multiplan Workers Comp |
$247.88
|
| Rate for Payer: Parkland Medicaid |
$274.58
|
| Rate for Payer: Scott and White EPO/PPO |
$190.68
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$274.58
|
| Rate for Payer: Superior Health Plan EPO |
$51.86
|
|
|
INSERTION CATH SVC/IVC
|
Facility
|
OP
|
$4,428.00
|
|
|
Service Code
|
HCPCS 36010
|
| Hospital Charge Code |
2330004
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$398.52 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$398.52
|
| Rate for Payer: BCBS of TX Blue Advantage |
$1,328.40
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,594.08
|
| Rate for Payer: BCBS of TX PPO |
$1,771.20
|
| Rate for Payer: Cash Price |
$3,011.04
|
| Rate for Payer: Cash Price |
$3,011.04
|
| Rate for Payer: Cigna Medicaid |
$3,188.16
|
| Rate for Payer: Molina CHIP/Medicaid |
$3,188.16
|
| 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 |
$3,188.16
|
| Rate for Payer: Scott and White EPO/PPO |
$2,214.00
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$3,188.16
|
| Rate for Payer: Superior Health Plan EPO |
$602.21
|
|
|
INSERTION CATH SVC/IVC
|
Facility
|
IP
|
$4,428.00
|
|
|
Service Code
|
HCPCS 36010
|
| Hospital Charge Code |
2330004
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$3,011.04
|
|
|
Insertion, drug-delivery implant (ie, bioresorbable, biodegradable, non-biodegradable)
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 11981
|
| Hospital Charge Code |
36011981
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$46.38 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$46.38
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$133.65
|
| Rate for Payer: Amerigroup Medicare |
$133.65
|
| Rate for Payer: BCBS of TX Blue Advantage |
$182.08
|
| Rate for Payer: BCBS of TX Blue Essentials |
$218.06
|
| Rate for Payer: BCBS of TX Medicare |
$133.65
|
| Rate for Payer: BCBS of TX PPO |
$274.76
|
| Rate for Payer: Cigna Commercial |
$282.53
|
| Rate for Payer: Cigna Medicare |
$133.65
|
| Rate for Payer: Employer Direct Commercial |
$133.65
|
| Rate for Payer: Humana Medicare/TRICARE |
$133.65
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$133.65
|
| Rate for Payer: Molina Medicare |
$133.65
|
| 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: Scott and White EPO/PPO |
$247.25
|
| Rate for Payer: Scott and White Medicare |
$133.65
|
| Rate for Payer: Superior Health Plan EPO |
$133.65
|
| Rate for Payer: Superior Health Plan Medicare |
$133.65
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$133.65
|
| Rate for Payer: Universal American Medicare |
$133.65
|
| Rate for Payer: Wellcare Medicare |
$133.65
|
| Rate for Payer: Wellmed Medicare |
$133.65
|
|
|
Insertion, drug-delivery implant (ie, bioresorbable, biodegradable, non-biodegradable)
|
Facility
|
OP
|
$486.84
|
|
|
Service Code
|
HCPCS 11981
|
| Hospital Charge Code |
990975
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$46.38 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$46.38
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$133.65
|
| Rate for Payer: Amerigroup Medicare |
$133.65
|
| Rate for Payer: BCBS of TX Blue Advantage |
$182.08
|
| Rate for Payer: BCBS of TX Blue Essentials |
$218.06
|
| Rate for Payer: BCBS of TX Medicare |
$133.65
|
| Rate for Payer: BCBS of TX PPO |
$274.76
|
| Rate for Payer: Cash Price |
$331.05
|
| Rate for Payer: Cash Price |
$331.05
|
| Rate for Payer: Cash Price |
$331.05
|
| Rate for Payer: Cigna Commercial |
$282.53
|
| Rate for Payer: Cigna Medicaid |
$350.52
|
| Rate for Payer: Cigna Medicare |
$133.65
|
| Rate for Payer: Employer Direct Commercial |
$133.65
|
| Rate for Payer: Humana Medicare/TRICARE |
$133.65
|
| Rate for Payer: Molina CHIP/Medicaid |
$350.52
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$133.65
|
| Rate for Payer: Molina Medicare |
$133.65
|
| 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 |
$350.52
|
| Rate for Payer: Scott and White EPO/PPO |
$247.25
|
| Rate for Payer: Scott and White Medicare |
$133.65
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$350.52
|
| Rate for Payer: Superior Health Plan EPO |
$133.65
|
| Rate for Payer: Superior Health Plan Medicare |
$133.65
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$133.65
|
| Rate for Payer: Universal American Medicare |
$133.65
|
| Rate for Payer: Wellcare Medicare |
$133.65
|
| Rate for Payer: Wellmed Medicare |
$133.65
|
|
|
Insertion, drug-delivery implant (ie, bioresorbable, biodegradable, non-biodegradable)
|
Facility
|
OP
|
$345.48
|
|
|
Service Code
|
HCPCS 11981
|
| Hospital Charge Code |
9900106
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$46.38 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$46.38
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$133.65
|
| Rate for Payer: Amerigroup Medicare |
$133.65
|
| Rate for Payer: BCBS of TX Blue Advantage |
$182.08
|
| Rate for Payer: BCBS of TX Blue Essentials |
$218.06
|
| Rate for Payer: BCBS of TX Medicare |
$133.65
|
| Rate for Payer: BCBS of TX PPO |
$274.76
|
| Rate for Payer: Cash Price |
$234.93
|
| Rate for Payer: Cash Price |
$234.93
|
| Rate for Payer: Cash Price |
$234.93
|
| Rate for Payer: Cigna Commercial |
$282.53
|
| Rate for Payer: Cigna Medicaid |
$248.75
|
| Rate for Payer: Cigna Medicare |
$133.65
|
| Rate for Payer: Employer Direct Commercial |
$133.65
|
| Rate for Payer: Humana Medicare/TRICARE |
$133.65
|
| Rate for Payer: Molina CHIP/Medicaid |
$248.75
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$133.65
|
| Rate for Payer: Molina Medicare |
$133.65
|
| 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 |
$248.75
|
| Rate for Payer: Scott and White EPO/PPO |
$247.25
|
| Rate for Payer: Scott and White Medicare |
$133.65
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$248.75
|
| Rate for Payer: Superior Health Plan EPO |
$133.65
|
| Rate for Payer: Superior Health Plan Medicare |
$133.65
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$133.65
|
| Rate for Payer: Universal American Medicare |
$133.65
|
| Rate for Payer: Wellcare Medicare |
$133.65
|
| Rate for Payer: Wellmed Medicare |
$133.65
|
|
