|
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 |
$292.61 |
| 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
|
| Rate for Payer: Scott and White EPO/PPO |
$292.61
|
|
|
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 |
$5,392.94
|
| 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 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 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 |
$15,949.03
|
| 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 |
$15,949.03
|
| 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 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 peripheral or gastric neurostimulator pulse generator or receiver, direc
|
Facility
|
OP
|
$154,966.56
|
|
|
Service Code
|
HCPCS 64590
|
| Hospital Charge Code |
9900817
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$10,000.00 |
| Max. Negotiated Rate |
$111,575.92 |
| 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: Cash Price |
$105,377.26
|
| Rate for Payer: Cash Price |
$105,377.26
|
| Rate for Payer: Cash Price |
$105,377.26
|
| Rate for Payer: Cigna Commercial |
$41,195.19
|
| Rate for Payer: Cigna Medicaid |
$111,575.92
|
| 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 CHIP/Medicaid |
$111,575.92
|
| 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: Parkland Medicaid |
$111,575.92
|
| Rate for Payer: Scott and White EPO/PPO |
$37,011.49
|
| Rate for Payer: Scott and White Medicare |
$19,488.52
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$111,575.92
|
| 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
|
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 |
$37,011.49
|
| 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
|
|
|
INSERTION, REVISION AND REPLACEMENTS OF PACEMAKER AND OTHER CARDIAC DEVICES
|
Facility
|
IP
|
$15,397.23
|
|
|
Service Code
|
APR-DRG 1763
|
| Min. Negotiated Rate |
$14,517.05 |
| Max. Negotiated Rate |
$15,397.23 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$14,517.05
|
| Rate for Payer: Cigna Medicaid |
$14,517.05
|
| Rate for Payer: Molina CHIP/Medicaid |
$14,517.05
|
| Rate for Payer: Parkland Medicaid |
$14,517.05
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$15,397.23
|
|
|
INSERTION, REVISION AND REPLACEMENTS OF PACEMAKER AND OTHER CARDIAC DEVICES
|
Facility
|
IP
|
$27,592.13
|
|
|
Service Code
|
APR-DRG 1764
|
| Min. Negotiated Rate |
$26,014.83 |
| Max. Negotiated Rate |
$27,592.13 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$26,014.83
|
| Rate for Payer: Cigna Medicaid |
$26,014.83
|
| Rate for Payer: Molina CHIP/Medicaid |
$26,014.83
|
| Rate for Payer: Parkland Medicaid |
$26,014.83
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$27,592.13
|
|
|
INSERTION, REVISION AND REPLACEMENTS OF PACEMAKER AND OTHER CARDIAC DEVICES
|
Facility
|
IP
|
$6,783.37
|
|
|
Service Code
|
APR-DRG 1762
|
| Min. Negotiated Rate |
$6,395.60 |
| Max. Negotiated Rate |
$6,783.37 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$6,395.60
|
| Rate for Payer: Cigna Medicaid |
$6,395.60
|
| Rate for Payer: Molina CHIP/Medicaid |
$6,395.60
|
| Rate for Payer: Parkland Medicaid |
$6,395.60
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$6,783.37
|
|
|
INSERTION, REVISION AND REPLACEMENTS OF PACEMAKER AND OTHER CARDIAC DEVICES
|
Facility
|
IP
|
$5,565.05
|
|
|
Service Code
|
APR-DRG 1761
|
| Min. Negotiated Rate |
$5,246.92 |
| Max. Negotiated Rate |
$5,565.05 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$5,246.92
|
| Rate for Payer: Cigna Medicaid |
$5,246.92
|
| Rate for Payer: Molina CHIP/Medicaid |
$5,246.92
|
| Rate for Payer: Parkland Medicaid |
$5,246.92
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$5,565.05
|
|
|
INSERT NON-TUNNEL CV CATH
|
Facility
|
IP
|
$4,645.00
|
|
|
Service Code
|
HCPCS 36556
|
| Hospital Charge Code |
2300531
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$3,158.60
|
|
|
INSERT NON-TUNNEL CV CATH
|
Facility
|
OP
|
$4,645.00
|
|
|
Service Code
|
HCPCS 36556
|
| Hospital Charge Code |
2300531
|
|
Hospital Revenue Code
|
361
|
| 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 |
$2,723.99
|
| Rate for Payer: BCBS of TX Blue Essentials |
$3,262.26
|
| Rate for Payer: BCBS of TX Medicare |
$3,171.87
|
| Rate for Payer: BCBS of TX PPO |
$4,110.45
|
| Rate for Payer: Cash Price |
$3,158.60
|
| Rate for Payer: Cash Price |
$3,158.60
|
| Rate for Payer: Cash Price |
$3,158.60
|
| Rate for Payer: Cigna Commercial |
$6,704.76
|
| Rate for Payer: Cigna Medicaid |
$3,344.40
|
| 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 |
$3,344.40
|
| 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 |
$3,344.40
|
| Rate for Payer: Scott and White EPO/PPO |
$5,392.94
|
| Rate for Payer: Scott and White Medicare |
$3,171.87
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$3,344.40
|
| 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
|
|
|
INSERT PACING LEAD & CONNECT
|
Facility
|
IP
|
$16,178.00
|
|
|
Service Code
|
HCPCS 33224
|
| Hospital Charge Code |
2303303
|
|
Hospital Revenue Code
|
481
|
| Rate for Payer: Cash Price |
$11,001.04
|
|
|
INSERT PACING LEAD & CONNECT
|
Facility
|
OP
|
$16,178.00
|
|
|
Service Code
|
HCPCS 33224
|
| Hospital Charge Code |
2303303
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$608.41 |
| Max. Negotiated Rate |
$25,834.89 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,456.02
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$10,499.62
|
| Rate for Payer: Amerigroup Medicare |
$10,499.62
|
| Rate for Payer: BCBS of TX Blue Advantage |
$17,120.74
|
| Rate for Payer: BCBS of TX Blue Essentials |
$20,503.88
|
| Rate for Payer: BCBS of TX Medicare |
$10,499.62
|
| Rate for Payer: BCBS of TX PPO |
$25,834.89
|
| Rate for Payer: Cash Price |
$11,001.04
|
| Rate for Payer: Cash Price |
$11,001.04
|
| Rate for Payer: Cash Price |
$11,001.04
|
| Rate for Payer: Cigna Commercial |
$22,194.30
|
| Rate for Payer: Cigna Medicaid |
$11,648.16
|
| Rate for Payer: Cigna Medicare |
$10,499.62
|
| Rate for Payer: Employer Direct Commercial |
$10,499.62
|
| Rate for Payer: Humana Medicare/TRICARE |
$10,499.62
|
| Rate for Payer: Molina CHIP/Medicaid |
$11,648.16
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$10,499.62
|
| Rate for Payer: Molina Medicare |
$10,499.62
|
| Rate for Payer: Multiplan Auto |
$10,515.70
|
| Rate for Payer: Multiplan Commercial |
$10,515.70
|
| Rate for Payer: Multiplan Workers Comp |
$10,515.70
|
| Rate for Payer: Parkland Medicaid |
$11,648.16
|
| Rate for Payer: Scott and White EPO/PPO |
$608.41
|
| Rate for Payer: Scott and White Medicare |
$10,499.62
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$11,648.16
|
| Rate for Payer: Superior Health Plan EPO |
$10,499.62
|
| Rate for Payer: Superior Health Plan Medicare |
$10,499.62
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$10,499.62
|
| Rate for Payer: Universal American Medicare |
$10,499.62
|
| Rate for Payer: Wellcare Medicare |
$10,499.62
|
| Rate for Payer: Wellmed Medicare |
$10,499.62
|
|
|
Insert/Redo Spine Generator
|
Facility
|
IP
|
$174,156.00
|
|
|
Service Code
|
HCPCS 63685
|
| Hospital Charge Code |
9900776
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$118,426.08
|
|
|
Insert/Redo Spine Generator
|
Facility
|
OP
|
$174,156.00
|
|
|
Service Code
|
HCPCS 63685
|
| Hospital Charge Code |
9900776
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$10,000.00 |
| Max. Negotiated Rate |
$125,392.32 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$19,537.92
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$30,998.31
|
| Rate for Payer: Amerigroup Medicare |
$30,998.31
|
| Rate for Payer: BCBS of TX Blue Advantage |
$48,628.30
|
| Rate for Payer: BCBS of TX Blue Essentials |
$58,237.48
|
| Rate for Payer: BCBS of TX Medicare |
$30,998.31
|
| Rate for Payer: BCBS of TX PPO |
$73,379.22
|
| Rate for Payer: Cash Price |
$118,426.08
|
| Rate for Payer: Cash Price |
$118,426.08
|
| Rate for Payer: Cash Price |
$118,426.08
|
| Rate for Payer: Cigna Commercial |
$65,524.82
|
| Rate for Payer: Cigna Medicaid |
$125,392.32
|
| Rate for Payer: Cigna Medicare |
$30,998.31
|
| Rate for Payer: Employer Direct Commercial |
$30,998.31
|
| Rate for Payer: Humana Medicare/TRICARE |
$30,998.31
|
| Rate for Payer: Molina CHIP/Medicaid |
$125,392.32
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$30,998.31
|
| Rate for Payer: Molina Medicare |
$30,998.31
|
| 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 |
$125,392.32
|
| Rate for Payer: Scott and White EPO/PPO |
$52,537.60
|
| Rate for Payer: Scott and White Medicare |
$30,998.31
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$125,392.32
|
| Rate for Payer: Superior Health Plan EPO |
$30,998.31
|
| Rate for Payer: Superior Health Plan Medicare |
$30,998.31
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$30,998.31
|
| Rate for Payer: Universal American Medicare |
$30,998.31
|
| Rate for Payer: Wellcare Medicare |
$30,998.31
|
| Rate for Payer: Wellmed Medicare |
$30,998.31
|
|
|
Insert/Redo Spine Generator
|
Facility
|
OP
|
$73,379.22
|
|
|
Service Code
|
CPT 63685
|
| Hospital Charge Code |
36063685
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$10,000.00 |
| Max. Negotiated Rate |
$73,379.22 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$19,537.92
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$30,998.31
|
| Rate for Payer: Amerigroup Medicare |
$30,998.31
|
| Rate for Payer: BCBS of TX Blue Advantage |
$48,628.30
|
| Rate for Payer: BCBS of TX Blue Essentials |
$58,237.48
|
| Rate for Payer: BCBS of TX Medicare |
$30,998.31
|
| Rate for Payer: BCBS of TX PPO |
$73,379.22
|
| Rate for Payer: Cigna Commercial |
$65,524.82
|
| Rate for Payer: Cigna Medicare |
$30,998.31
|
| Rate for Payer: Employer Direct Commercial |
$30,998.31
|
| Rate for Payer: Humana Medicare/TRICARE |
$30,998.31
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$30,998.31
|
| Rate for Payer: Molina Medicare |
$30,998.31
|
| 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 |
$52,537.60
|
| Rate for Payer: Scott and White Medicare |
$30,998.31
|
| Rate for Payer: Superior Health Plan EPO |
$30,998.31
|
| Rate for Payer: Superior Health Plan Medicare |
$30,998.31
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$30,998.31
|
| Rate for Payer: Universal American Medicare |
$30,998.31
|
| Rate for Payer: Wellcare Medicare |
$30,998.31
|
| Rate for Payer: Wellmed Medicare |
$30,998.31
|
|
|
INSERT/REPOSIT DUAL CHMBR ELECT
|
Facility
|
OP
|
$15,170.00
|
|
|
Service Code
|
HCPCS 33217
|
| Hospital Charge Code |
2302263
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$443.43 |
| Max. Negotiated Rate |
$19,257.46 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,365.30
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$8,313.10
|
| Rate for Payer: Amerigroup Medicare |
$8,313.10
|
| Rate for Payer: BCBS of TX Blue Advantage |
$12,761.89
|
| Rate for Payer: BCBS of TX Blue Essentials |
$15,283.70
|
| Rate for Payer: BCBS of TX Medicare |
$8,313.10
|
| Rate for Payer: BCBS of TX PPO |
$19,257.46
|
| Rate for Payer: Cash Price |
$10,315.60
|
| Rate for Payer: Cash Price |
$10,315.60
|
| Rate for Payer: Cash Price |
$10,315.60
|
| Rate for Payer: Cigna Commercial |
$17,572.38
|
| Rate for Payer: Cigna Medicaid |
$10,922.40
|
| Rate for Payer: Cigna Medicare |
$8,313.10
|
| Rate for Payer: Employer Direct Commercial |
$8,313.10
|
| Rate for Payer: Humana Medicare/TRICARE |
$8,313.10
|
| Rate for Payer: Molina CHIP/Medicaid |
$10,922.40
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$8,313.10
|
| Rate for Payer: Molina Medicare |
$8,313.10
|
| Rate for Payer: Multiplan Auto |
$9,860.50
|
| Rate for Payer: Multiplan Commercial |
$9,860.50
|
| Rate for Payer: Multiplan Workers Comp |
$9,860.50
|
| Rate for Payer: Parkland Medicaid |
$10,922.40
|
| Rate for Payer: Scott and White EPO/PPO |
$443.43
|
| Rate for Payer: Scott and White Medicare |
$8,313.10
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$10,922.40
|
| Rate for Payer: Superior Health Plan EPO |
$8,313.10
|
| Rate for Payer: Superior Health Plan Medicare |
$8,313.10
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$8,313.10
|
| Rate for Payer: Universal American Medicare |
$8,313.10
|
| Rate for Payer: Wellcare Medicare |
$8,313.10
|
| Rate for Payer: Wellmed Medicare |
$8,313.10
|
|
|
INSERT/REPOSIT DUAL CHMBR ELECT
|
Facility
|
IP
|
$15,170.00
|
|
|
Service Code
|
HCPCS 33217
|
| Hospital Charge Code |
2302263
|
|
Hospital Revenue Code
|
481
|
| Rate for Payer: Cash Price |
$10,315.60
|
|
|
INSERT SWANGANZ CATHETER
|
Facility
|
IP
|
$4,967.00
|
|
|
Service Code
|
HCPCS 93503
|
| Hospital Charge Code |
4613535
|
|
Hospital Revenue Code
|
481
|
| Rate for Payer: Cash Price |
$3,377.56
|
|
|
INSERT SWANGANZ CATHETER
|
Facility
|
OP
|
$4,967.00
|
|
|
Service Code
|
HCPCS 93503
|
| Hospital Charge Code |
4613535
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$105.30 |
| Max. Negotiated Rate |
$4,110.45 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$447.03
|
| 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 |
$3,377.56
|
| Rate for Payer: Cash Price |
$3,377.56
|
| Rate for Payer: Cash Price |
$3,377.56
|
| Rate for Payer: Cigna Commercial |
$3,342.63
|
| Rate for Payer: Cigna Medicaid |
$3,576.24
|
| 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 |
$3,576.24
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,581.33
|
| Rate for Payer: Molina Medicare |
$1,581.33
|
| Rate for Payer: Multiplan Auto |
$3,228.55
|
| Rate for Payer: Multiplan Commercial |
$3,228.55
|
| Rate for Payer: Multiplan Workers Comp |
$3,228.55
|
| Rate for Payer: Parkland Medicaid |
$3,576.24
|
| Rate for Payer: Scott and White EPO/PPO |
$105.30
|
| Rate for Payer: Scott and White Medicare |
$1,581.33
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$3,576.24
|
| 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
|
|
|
Insert tunneled cv cath
|
Facility
|
OP
|
$12,148.04
|
|
|
Service Code
|
HCPCS 36561
|
| Hospital Charge Code |
9900628
|
|
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 |
$8,260.67
|
| Rate for Payer: Cash Price |
$8,260.67
|
| Rate for Payer: Cash Price |
$8,260.67
|
| Rate for Payer: Cigna Commercial |
$6,704.76
|
| Rate for Payer: Cigna Medicaid |
$8,746.59
|
| 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 |
$8,746.59
|
| 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 |
$8,746.59
|
| Rate for Payer: Scott and White EPO/PPO |
$5,392.94
|
| Rate for Payer: Scott and White Medicare |
$3,171.87
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$8,746.59
|
| 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
|
|
