|
Insertion, drug-delivery implant (ie, bioresorbable, biodegradable, non-biodegradable)
|
Facility
|
IP
|
$345.48
|
|
|
Service Code
|
HCPCS 11981
|
| Hospital Charge Code |
9900106
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$234.93
|
|
|
Insertion, drug-delivery implant (ie, bioresorbable, biodegradable, non-biodegradable)
|
Facility
|
IP
|
$486.84
|
|
|
Service Code
|
HCPCS 11981
|
| Hospital Charge Code |
990975
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$331.05
|
|
|
INSERTION IVC FILTER W/GUIDANCE
|
Facility
|
IP
|
$12,866.00
|
|
|
Service Code
|
HCPCS 37191
|
| Hospital Charge Code |
2320569
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$8,748.88
|
|
|
INSERTION IVC FILTER W/GUIDANCE
|
Facility
|
OP
|
$12,866.00
|
|
|
Service Code
|
HCPCS 37191
|
| Hospital Charge Code |
2320569
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,157.94 |
| Max. Negotiated Rate |
$11,815.91 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,157.94
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$5,589.84
|
| Rate for Payer: Amerigroup Medicare |
$5,589.84
|
| Rate for Payer: BCBS of TX Blue Advantage |
$7,675.64
|
| Rate for Payer: BCBS of TX Blue Essentials |
$9,192.38
|
| Rate for Payer: BCBS of TX Medicare |
$5,589.84
|
| Rate for Payer: BCBS of TX PPO |
$11,582.40
|
| Rate for Payer: Cash Price |
$8,748.88
|
| Rate for Payer: Cash Price |
$8,748.88
|
| Rate for Payer: Cash Price |
$8,748.88
|
| Rate for Payer: Cigna Commercial |
$11,815.91
|
| Rate for Payer: Cigna Medicaid |
$9,263.52
|
| Rate for Payer: Cigna Medicare |
$5,589.84
|
| Rate for Payer: Employer Direct Commercial |
$5,589.84
|
| Rate for Payer: Humana Medicare/TRICARE |
$5,589.84
|
| Rate for Payer: Molina CHIP/Medicaid |
$9,263.52
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$5,589.84
|
| Rate for Payer: Molina Medicare |
$5,589.84
|
| 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 |
$9,263.52
|
| Rate for Payer: Scott and White EPO/PPO |
$10,341.20
|
| Rate for Payer: Scott and White Medicare |
$5,589.84
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$9,263.52
|
| Rate for Payer: Superior Health Plan EPO |
$5,589.84
|
| Rate for Payer: Superior Health Plan Medicare |
$5,589.84
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$5,589.84
|
| Rate for Payer: Universal American Medicare |
$5,589.84
|
| Rate for Payer: Wellcare Medicare |
$5,589.84
|
| Rate for Payer: Wellmed Medicare |
$5,589.84
|
|
|
Insertion of catheter (PICC), without subcutaneous port or pump
|
Facility
|
IP
|
$2,825.00
|
|
|
Service Code
|
HCPCS 36573
|
| Hospital Charge Code |
994141
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$1,921.00
|
|
|
Insertion of catheter (PICC), without subcutaneous port or pump
|
Facility
|
IP
|
$2,825.00
|
|
|
Service Code
|
HCPCS 36573
|
| Hospital Charge Code |
4616573
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$1,921.00
|
|
|
Insertion of catheter (PICC), without subcutaneous port or pump
|
Facility
|
OP
|
$2,825.00
|
|
|
Service Code
|
HCPCS 36573
|
| Hospital Charge Code |
994141
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$254.25 |
| Max. Negotiated Rate |
$4,110.45 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$254.25
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,581.33
|
| Rate for Payer: Amerigroup Medicare |
$1,581.33
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,723.99
|
| Rate for Payer: BCBS of TX Blue Essentials |
$3,262.26
|
| Rate for Payer: BCBS of TX Medicare |
$1,581.33
|
| Rate for Payer: BCBS of TX PPO |
$4,110.45
|
| Rate for Payer: Cash Price |
$1,921.00
|
| Rate for Payer: Cash Price |
$1,921.00
|
| Rate for Payer: Cash Price |
$1,921.00
|
| Rate for Payer: Cigna Commercial |
$3,342.63
|
| Rate for Payer: Cigna Medicaid |
$2,034.00
|
| Rate for Payer: Cigna Medicare |
$1,581.33
|
| Rate for Payer: Employer Direct Commercial |
$1,581.33
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,581.33
|
| Rate for Payer: Molina CHIP/Medicaid |
$2,034.00
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,581.33
|
| Rate for Payer: Molina Medicare |
$1,581.33
|
| Rate for Payer: Multiplan Auto |
$1,836.25
|
| Rate for Payer: Multiplan Commercial |
$1,836.25
|
| Rate for Payer: Multiplan Workers Comp |
$1,836.25
|
| Rate for Payer: Parkland Medicaid |
$2,034.00
|
| Rate for Payer: Scott and White EPO/PPO |
$1,412.50
|
| Rate for Payer: Scott and White Medicare |
$1,581.33
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$2,034.00
|
| Rate for Payer: Superior Health Plan EPO |
$1,581.33
|
| Rate for Payer: Superior Health Plan Medicare |
$1,581.33
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,581.33
|
| Rate for Payer: Universal American Medicare |
$1,581.33
|
| Rate for Payer: Wellcare Medicare |
$1,581.33
|
| Rate for Payer: Wellmed Medicare |
$1,581.33
|
|
|
Insertion of catheter (PICC), without subcutaneous port or pump
|
Facility
|
OP
|
$2,825.00
|
|
|
Service Code
|
HCPCS 36573
|
| Hospital Charge Code |
4616573
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$254.25 |
| Max. Negotiated Rate |
$4,110.45 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$254.25
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,581.33
|
| Rate for Payer: Amerigroup Medicare |
$1,581.33
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,723.99
|
| Rate for Payer: BCBS of TX Blue Essentials |
$3,262.26
|
| Rate for Payer: BCBS of TX Medicare |
$1,581.33
|
| Rate for Payer: BCBS of TX PPO |
$4,110.45
|
| Rate for Payer: Cash Price |
$1,921.00
|
| Rate for Payer: Cash Price |
$1,921.00
|
| Rate for Payer: Cash Price |
$1,921.00
|
| Rate for Payer: Cigna Commercial |
$3,342.63
|
| Rate for Payer: Cigna Medicaid |
$2,034.00
|
| Rate for Payer: Cigna Medicare |
$1,581.33
|
| Rate for Payer: Employer Direct Commercial |
$1,581.33
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,581.33
|
| Rate for Payer: Molina CHIP/Medicaid |
$2,034.00
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,581.33
|
| Rate for Payer: Molina Medicare |
$1,581.33
|
| Rate for Payer: Multiplan Auto |
$1,836.25
|
| Rate for Payer: Multiplan Commercial |
$1,836.25
|
| Rate for Payer: Multiplan Workers Comp |
$1,836.25
|
| Rate for Payer: Parkland Medicaid |
$2,034.00
|
| Rate for Payer: Scott and White EPO/PPO |
$1,412.50
|
| Rate for Payer: Scott and White Medicare |
$1,581.33
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$2,034.00
|
| Rate for Payer: Superior Health Plan EPO |
$1,581.33
|
| Rate for Payer: Superior Health Plan Medicare |
$1,581.33
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,581.33
|
| Rate for Payer: Universal American Medicare |
$1,581.33
|
| Rate for Payer: Wellcare Medicare |
$1,581.33
|
| Rate for Payer: Wellmed Medicare |
$1,581.33
|
|
|
INSERTION OF FOLEY CATH LAB
|
Facility
|
OP
|
$564.00
|
|
|
Service Code
|
HCPCS 51702
|
| Hospital Charge Code |
4613670
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$50.76 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$50.76
|
| 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 |
$383.52
|
| Rate for Payer: Cash Price |
$383.52
|
| Rate for Payer: Cash Price |
$383.52
|
| Rate for Payer: Cigna Commercial |
$282.53
|
| Rate for Payer: Cigna Medicaid |
$406.08
|
| 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 |
$406.08
|
| 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 |
$406.08
|
| 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 |
$406.08
|
| 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 OF FOLEY CATH LAB
|
Facility
|
IP
|
$564.00
|
|
|
Service Code
|
HCPCS 51702
|
| Hospital Charge Code |
4613670
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$383.52
|
|
|
Insertion of interlaminar/interspinous process stabilization/distraction device, without fusion, inc
|
Facility
|
OP
|
$24,770.04
|
|
|
Service Code
|
HCPCS 22868
|
| Hospital Charge Code |
9900211
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,229.30 |
| Max. Negotiated Rate |
$17,834.43 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2,229.30
|
| Rate for Payer: BCBS of TX Blue Advantage |
$7,431.01
|
| Rate for Payer: BCBS of TX Blue Essentials |
$8,917.21
|
| Rate for Payer: BCBS of TX PPO |
$9,908.02
|
| Rate for Payer: Cash Price |
$16,843.63
|
| Rate for Payer: Cash Price |
$16,843.63
|
| Rate for Payer: Cigna Medicaid |
$17,834.43
|
| Rate for Payer: Molina CHIP/Medicaid |
$17,834.43
|
| 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 |
$17,834.43
|
| Rate for Payer: Scott and White EPO/PPO |
$12,385.02
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$17,834.43
|
| Rate for Payer: Superior Health Plan EPO |
$3,368.73
|
|
|
Insertion of interlaminar/interspinous process stabilization/distraction device, without fusion, inc
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 22868
|
| Hospital Charge Code |
36022868
|
|
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
|
|
|
Insertion of interlaminar/interspinous process stabilization/distraction device, without fusion, inc
|
Facility
|
IP
|
$99,080.16
|
|
|
Service Code
|
HCPCS 22867
|
| Hospital Charge Code |
9900210
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$67,374.51
|
|
|
Insertion of interlaminar/interspinous process stabilization/distraction device, without fusion, inc
|
Facility
|
OP
|
$99,080.16
|
|
|
Service Code
|
HCPCS 22867
|
| Hospital Charge Code |
9900210
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$8,917.21 |
| Max. Negotiated Rate |
$71,337.72 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$8,917.21
|
| 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 |
$26,629.95
|
| Rate for Payer: BCBS of TX Blue Essentials |
$31,892.16
|
| Rate for Payer: BCBS of TX Medicare |
$17,613.72
|
| Rate for Payer: BCBS of TX PPO |
$40,184.12
|
| Rate for Payer: Cash Price |
$67,374.51
|
| Rate for Payer: Cash Price |
$67,374.51
|
| Rate for Payer: Cash Price |
$67,374.51
|
| Rate for Payer: Cigna Commercial |
$37,232.21
|
| Rate for Payer: Cigna Medicaid |
$71,337.72
|
| 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 |
$71,337.72
|
| 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: Parkland Medicaid |
$71,337.72
|
| 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 |
$71,337.72
|
| 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
|
|
|
Insertion of interlaminar/interspinous process stabilization/distraction device, without fusion, inc
|
Facility
|
IP
|
$24,770.04
|
|
|
Service Code
|
HCPCS 22868
|
| Hospital Charge Code |
9900211
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$16,843.63
|
|
|
Insertion of interlaminar/interspinous process stabilization/distraction device, without fusion, inc
|
Facility
|
OP
|
$40,184.12
|
|
|
Service Code
|
CPT 22867
|
| Hospital Charge Code |
36022867
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$10,000.00 |
| Max. Negotiated Rate |
$40,184.12 |
| 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 |
$26,629.95
|
| Rate for Payer: BCBS of TX Blue Essentials |
$31,892.16
|
| Rate for Payer: BCBS of TX Medicare |
$17,613.72
|
| Rate for Payer: BCBS of TX PPO |
$40,184.12
|
| 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
|
|
|
Insertion of non-indwelling bladder catheter
|
Facility
|
IP
|
$564.00
|
|
|
Service Code
|
HCPCS 51701
|
| Hospital Charge Code |
994226
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$383.52
|
|
|
Insertion of non-indwelling bladder catheter
|
Facility
|
OP
|
$564.00
|
|
|
Service Code
|
HCPCS 51701
|
| Hospital Charge Code |
994226
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$50.76 |
| Max. Negotiated Rate |
$406.08 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$50.76
|
| 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 |
$383.52
|
| Rate for Payer: Cash Price |
$383.52
|
| Rate for Payer: Cash Price |
$383.52
|
| Rate for Payer: Cigna Commercial |
$282.53
|
| Rate for Payer: Cigna Medicaid |
$406.08
|
| 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 |
$406.08
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$133.65
|
| Rate for Payer: Molina Medicare |
$133.65
|
| Rate for Payer: Multiplan Auto |
$366.60
|
| Rate for Payer: Multiplan Commercial |
$366.60
|
| Rate for Payer: Multiplan Workers Comp |
$366.60
|
| Rate for Payer: Parkland Medicaid |
$406.08
|
| Rate for Payer: Scott and White EPO/PPO |
$282.00
|
| Rate for Payer: Scott and White Medicare |
$133.65
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$406.08
|
| 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 of peripherally inserted central venous access device, with subcutaneous port; age 5 years or older
|
Facility
|
IP
|
$3,770.21
|
|
|
Service Code
|
HCPCS 36571
|
| Hospital Charge Code |
4616571
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$2,563.74
|
|
|
Insertion of peripherally inserted central venous access device, with subcutaneous port; age 5 years or older
|
Facility
|
OP
|
$3,770.21
|
|
|
Service Code
|
HCPCS 36571
|
| Hospital Charge Code |
4616571
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,118.22 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,118.22
|
| 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 |
$2,563.74
|
| Rate for Payer: Cash Price |
$2,563.74
|
| Rate for Payer: Cash Price |
$2,563.74
|
| Rate for Payer: Cigna Commercial |
$6,704.76
|
| Rate for Payer: Cigna Medicaid |
$2,714.55
|
| 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 |
$2,714.55
|
| 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 |
$2,714.55
|
| 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 |
$2,714.55
|
| 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
|
|
|
Insertion or replacement of breast implant on a separate day from mastectomy
|
Facility
|
IP
|
$26,760.12
|
|
|
Service Code
|
HCPCS 19342
|
| Hospital Charge Code |
9900161
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$18,196.88
|
|
|
Insertion or replacement of breast implant on a separate day from mastectomy
|
Facility
|
OP
|
$26,760.12
|
|
|
Service Code
|
HCPCS 19342
|
| Hospital Charge Code |
9900161
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,281.73 |
| Max. Negotiated Rate |
$20,501.61 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2,281.73
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$8,210.63
|
| Rate for Payer: Amerigroup Medicare |
$8,210.63
|
| Rate for Payer: BCBS of TX Blue Advantage |
$13,586.39
|
| Rate for Payer: BCBS of TX Blue Essentials |
$16,271.12
|
| Rate for Payer: BCBS of TX Medicare |
$8,210.63
|
| Rate for Payer: BCBS of TX PPO |
$20,501.61
|
| Rate for Payer: Cash Price |
$18,196.88
|
| Rate for Payer: Cash Price |
$18,196.88
|
| Rate for Payer: Cash Price |
$18,196.88
|
| Rate for Payer: Cigna Commercial |
$17,355.80
|
| Rate for Payer: Cigna Medicaid |
$19,267.29
|
| Rate for Payer: Cigna Medicare |
$8,210.63
|
| Rate for Payer: Employer Direct Commercial |
$8,210.63
|
| Rate for Payer: Humana Medicare/TRICARE |
$8,210.63
|
| Rate for Payer: Molina CHIP/Medicaid |
$19,267.29
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$8,210.63
|
| Rate for Payer: Molina Medicare |
$8,210.63
|
| 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 |
$19,267.29
|
| Rate for Payer: Scott and White EPO/PPO |
$15,189.67
|
| Rate for Payer: Scott and White Medicare |
$8,210.63
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$19,267.29
|
| Rate for Payer: Superior Health Plan EPO |
$8,210.63
|
| Rate for Payer: Superior Health Plan Medicare |
$8,210.63
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$8,210.63
|
| Rate for Payer: Universal American Medicare |
$8,210.63
|
| Rate for Payer: Wellcare Medicare |
$8,210.63
|
| Rate for Payer: Wellmed Medicare |
$8,210.63
|
|
|
Insertion or replacement of breast implant on a separate day from mastectomy
|
Facility
|
OP
|
$20,501.61
|
|
|
Service Code
|
CPT 19342
|
| Hospital Charge Code |
36019342
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,281.73 |
| Max. Negotiated Rate |
$20,501.61 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2,281.73
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$8,210.63
|
| Rate for Payer: Amerigroup Medicare |
$8,210.63
|
| Rate for Payer: BCBS of TX Blue Advantage |
$13,586.39
|
| Rate for Payer: BCBS of TX Blue Essentials |
$16,271.12
|
| Rate for Payer: BCBS of TX Medicare |
$8,210.63
|
| Rate for Payer: BCBS of TX PPO |
$20,501.61
|
| Rate for Payer: Cigna Commercial |
$17,355.80
|
| Rate for Payer: Cigna Medicare |
$8,210.63
|
| Rate for Payer: Employer Direct Commercial |
$8,210.63
|
| Rate for Payer: Humana Medicare/TRICARE |
$8,210.63
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$8,210.63
|
| Rate for Payer: Molina Medicare |
$8,210.63
|
| 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 |
$15,189.67
|
| Rate for Payer: Scott and White Medicare |
$8,210.63
|
| Rate for Payer: Superior Health Plan EPO |
$8,210.63
|
| Rate for Payer: Superior Health Plan Medicare |
$8,210.63
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$8,210.63
|
| Rate for Payer: Universal American Medicare |
$8,210.63
|
| Rate for Payer: Wellcare Medicare |
$8,210.63
|
| Rate for Payer: Wellmed Medicare |
$8,210.63
|
|
|
Insertion or replacement of peripheral or gastric neurostimulator pulse generator or receiver, direc
|
Facility
|
OP
|
$48,584.14
|
|
|
Service Code
|
CPT 64590
|
| Hospital Charge Code |
36064590
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$10,000.00 |
| Max. Negotiated Rate |
$48,584.14 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$14,745.31
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$19,488.52
|
| Rate for Payer: Amerigroup Medicare |
$19,488.52
|
| Rate for Payer: BCBS of TX Blue Advantage |
$32,196.63
|
| Rate for Payer: BCBS of TX Blue Essentials |
$38,558.84
|
| Rate for Payer: BCBS of TX Medicare |
$19,488.52
|
| Rate for Payer: BCBS of TX PPO |
$48,584.14
|
| Rate for Payer: Cigna Commercial |
$41,195.19
|
| Rate for Payer: Cigna Medicare |
$19,488.52
|
| Rate for Payer: Employer Direct Commercial |
$19,488.52
|
| Rate for Payer: Humana Medicare/TRICARE |
$19,488.52
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$19,488.52
|
| Rate for Payer: Molina Medicare |
$19,488.52
|
| 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 |
$36,053.76
|
| Rate for Payer: Scott and White Medicare |
$19,488.52
|
| Rate for Payer: Superior Health Plan EPO |
$19,488.52
|
| Rate for Payer: Superior Health Plan Medicare |
$19,488.52
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$19,488.52
|
| Rate for Payer: Universal American Medicare |
$19,488.52
|
| Rate for Payer: Wellcare Medicare |
$19,488.52
|
| Rate for Payer: Wellmed Medicare |
$19,488.52
|
|
|
Insertion or replacement of peripheral or gastric neurostimulator pulse generator or receiver, direc
|
Facility
|
IP
|
$154,966.56
|
|
|
Service Code
|
HCPCS 64590
|
| Hospital Charge Code |
9900817
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$105,377.26
|
|
