|
Punch Biopsy Skin, Ea Add
|
Facility
|
OP
|
$346.00
|
|
|
Service Code
|
CPT 11105
|
| Hospital Charge Code |
7150054
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$31.14 |
| Max. Negotiated Rate |
$224.90 |
| Rate for Payer: Aetna Commercial |
$190.30
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$31.14
|
| Rate for Payer: BCBS of TX Blue Advantage |
$38.00
|
| Rate for Payer: BCBS of TX Blue Essentials |
$45.00
|
| Rate for Payer: BCBS of TX PPO |
$50.00
|
| Rate for Payer: Cash Price |
$304.48
|
| Rate for Payer: Cash Price |
$304.48
|
| Rate for Payer: Multiplan Auto |
$224.90
|
| Rate for Payer: Multiplan Commercial |
$224.90
|
| Rate for Payer: Multiplan Workers Comp |
$224.90
|
| Rate for Payer: Scott and White EPO/PPO |
$173.00
|
| Rate for Payer: Superior Health Plan EPO |
$47.06
|
|
|
Punch Biopsy Skn, One Lsn
|
Facility
|
OP
|
$688.00
|
|
|
Service Code
|
CPT 11104
|
| Hospital Charge Code |
7150051
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$6.52 |
| Max. Negotiated Rate |
$826.08 |
| Rate for Payer: Aetna Commercial |
$378.40
|
| Rate for Payer: Aetna Medicare |
$547.00
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$61.92
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$364.67
|
| Rate for Payer: Amerigroup Medicare |
$364.67
|
| Rate for Payer: BCBS of TX Blue Advantage |
$147.44
|
| Rate for Payer: BCBS of TX Blue Essentials |
$176.58
|
| Rate for Payer: BCBS of TX Medicare |
$364.67
|
| Rate for Payer: BCBS of TX PPO |
$222.49
|
| Rate for Payer: Cash Price |
$605.44
|
| Rate for Payer: Cash Price |
$605.44
|
| Rate for Payer: Cash Price |
$605.44
|
| Rate for Payer: Cigna Commercial |
$826.08
|
| Rate for Payer: Cigna Medicaid |
$79.46
|
| Rate for Payer: Cigna Medicare |
$364.67
|
| Rate for Payer: Employer Direct Commercial |
$364.67
|
| Rate for Payer: Humana Medicare/TRICARE |
$364.67
|
| Rate for Payer: Molina CHIP/Medicaid |
$79.46
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$364.67
|
| Rate for Payer: Molina Medicare |
$364.67
|
| Rate for Payer: Multiplan Auto |
$447.20
|
| Rate for Payer: Multiplan Commercial |
$447.20
|
| Rate for Payer: Multiplan Workers Comp |
$447.20
|
| Rate for Payer: Parkland Medicaid |
$79.46
|
| Rate for Payer: Scott and White EPO/PPO |
$6.52
|
| Rate for Payer: Scott and White Medicare |
$364.67
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$79.46
|
| Rate for Payer: Superior Health Plan EPO |
$364.67
|
| Rate for Payer: Superior Health Plan Medicare |
$364.67
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$364.67
|
| Rate for Payer: Universal American Medicare |
$364.67
|
| Rate for Payer: Wellcare Medicare |
$364.67
|
| Rate for Payer: Wellmed Medicare |
$364.67
|
|
|
punch poplok 4.5
|
Facility
|
OP
|
$1,385.56
|
|
| Hospital Charge Code |
8646516
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$124.70 |
| Max. Negotiated Rate |
$900.61 |
| Rate for Payer: Aetna Commercial |
$762.06
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$124.70
|
| Rate for Payer: BCBS of TX Blue Advantage |
$415.67
|
| Rate for Payer: BCBS of TX Blue Essentials |
$498.80
|
| Rate for Payer: BCBS of TX PPO |
$554.22
|
| Rate for Payer: Cash Price |
$1,219.29
|
| Rate for Payer: Multiplan Auto |
$900.61
|
| Rate for Payer: Multiplan Commercial |
$900.61
|
| Rate for Payer: Multiplan Workers Comp |
$900.61
|
| Rate for Payer: Scott and White EPO/PPO |
$692.78
|
| Rate for Payer: Superior Health Plan EPO |
$188.44
|
|
|
punch poplok 4.5
|
Facility
|
IP
|
$1,385.56
|
|
| Hospital Charge Code |
8646516
|
|
Hospital Revenue Code
|
272
|
| Rate for Payer: Cash Price |
$1,219.29
|
|
|
PUNCTURE DRAINAGE OF LESION
|
Facility
|
OP
|
$895.00
|
|
|
Service Code
|
CPT 10160
|
| Hospital Charge Code |
7150113
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$6.52 |
| Max. Negotiated Rate |
$826.08 |
| Rate for Payer: Aetna Commercial |
$492.25
|
| Rate for Payer: Aetna Medicare |
$547.00
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$80.55
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$364.67
|
| Rate for Payer: Amerigroup Medicare |
$364.67
|
| Rate for Payer: BCBS of TX Blue Advantage |
$139.23
|
| Rate for Payer: BCBS of TX Blue Essentials |
$166.74
|
| Rate for Payer: BCBS of TX Medicare |
$364.67
|
| Rate for Payer: BCBS of TX PPO |
$210.09
|
| Rate for Payer: Cash Price |
$787.60
|
| Rate for Payer: Cash Price |
$787.60
|
| Rate for Payer: Cash Price |
$787.60
|
| Rate for Payer: Cigna Commercial |
$826.08
|
| Rate for Payer: Cigna Medicaid |
$67.83
|
| Rate for Payer: Cigna Medicare |
$364.67
|
| Rate for Payer: Employer Direct Commercial |
$364.67
|
| Rate for Payer: Humana Medicare/TRICARE |
$364.67
|
| Rate for Payer: Molina CHIP/Medicaid |
$67.83
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$364.67
|
| Rate for Payer: Molina Medicare |
$364.67
|
| Rate for Payer: Multiplan Auto |
$581.75
|
| Rate for Payer: Multiplan Commercial |
$581.75
|
| Rate for Payer: Multiplan Workers Comp |
$581.75
|
| Rate for Payer: Parkland Medicaid |
$67.83
|
| Rate for Payer: Scott and White EPO/PPO |
$6.52
|
| Rate for Payer: Scott and White Medicare |
$364.67
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$67.83
|
| Rate for Payer: Superior Health Plan EPO |
$364.67
|
| Rate for Payer: Superior Health Plan Medicare |
$364.67
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$364.67
|
| Rate for Payer: Universal American Medicare |
$364.67
|
| Rate for Payer: Wellcare Medicare |
$364.67
|
| Rate for Payer: Wellmed Medicare |
$364.67
|
|
|
Puncture of shunt tubing or reservoir for aspiration or injection procedure
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 61070
|
| Hospital Charge Code |
36061070
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$13.95 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$1,400.00
|
| Rate for Payer: Aetna Medicare |
$948.68
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$262.86
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$632.45
|
| Rate for Payer: Amerigroup Medicare |
$632.45
|
| 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 |
$632.45
|
| Rate for Payer: BCBS of TX PPO |
$1,575.13
|
| Rate for Payer: Cigna Commercial |
$1,432.68
|
| Rate for Payer: Cigna Medicaid |
$262.86
|
| Rate for Payer: Cigna Medicare |
$632.45
|
| Rate for Payer: Employer Direct Commercial |
$632.45
|
| Rate for Payer: Humana Medicare/TRICARE |
$632.45
|
| Rate for Payer: Molina CHIP/Medicaid |
$262.86
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$632.45
|
| Rate for Payer: Molina Medicare |
$632.45
|
| 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 |
$262.86
|
| Rate for Payer: Scott and White EPO/PPO |
$13.95
|
| Rate for Payer: Scott and White Medicare |
$632.45
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$262.86
|
| Rate for Payer: Superior Health Plan EPO |
$632.45
|
| Rate for Payer: Superior Health Plan Medicare |
$632.45
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$632.45
|
| Rate for Payer: Universal American Medicare |
$632.45
|
| Rate for Payer: Wellcare Medicare |
$632.45
|
| Rate for Payer: Wellmed Medicare |
$632.45
|
|
|
PURAPLY AM PER SQ CM
|
Facility
|
OP
|
$508.48
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
40242646
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$45.76 |
| Max. Negotiated Rate |
$259.39 |
| Rate for Payer: Aetna Commercial |
$152.54
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$45.76
|
| Rate for Payer: BCBS of TX Blue Advantage |
$194.88
|
| Rate for Payer: BCBS of TX Blue Essentials |
$233.86
|
| Rate for Payer: BCBS of TX PPO |
$259.39
|
| Rate for Payer: Cash Price |
$447.46
|
| Rate for Payer: Cash Price |
$447.46
|
| Rate for Payer: Multiplan Auto |
$254.24
|
| Rate for Payer: Multiplan Commercial |
$254.24
|
| Rate for Payer: Multiplan Workers Comp |
$254.24
|
| Rate for Payer: Scott and White EPO/PPO |
$254.24
|
| Rate for Payer: Superior Health Plan EPO |
$69.15
|
|
|
PURAPLY AM PER SQ CM
|
Facility
|
IP
|
$508.48
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
40242646
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$127.12 |
| Max. Negotiated Rate |
$254.24 |
| Rate for Payer: Aetna Commercial |
$152.54
|
| Rate for Payer: Cash Price |
$447.46
|
| Rate for Payer: Cigna Commercial |
$127.12
|
| Rate for Payer: Multiplan Auto |
$254.24
|
| Rate for Payer: Multiplan Commercial |
$254.24
|
| Rate for Payer: Multiplan Workers Comp |
$254.24
|
| Rate for Payer: Scott and White EPO/PPO |
$254.24
|
|
|
Quadricepsplasty (eg, Bennett or Thompson type)
|
Facility
|
OP
|
$15,074.51
|
|
|
Service Code
|
CPT 27430
|
| Hospital Charge Code |
36027430
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$144.31 |
| Max. Negotiated Rate |
$15,074.51 |
| Rate for Payer: Aetna Commercial |
$6,077.00
|
| Rate for Payer: Aetna Medicare |
$9,814.08
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2,398.52
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$6,542.72
|
| Rate for Payer: Amerigroup Medicare |
$6,542.72
|
| Rate for Payer: BCBS of TX Blue Advantage |
$9,989.86
|
| Rate for Payer: BCBS of TX Blue Essentials |
$11,963.90
|
| Rate for Payer: BCBS of TX Medicare |
$6,542.72
|
| Rate for Payer: BCBS of TX PPO |
$15,074.51
|
| Rate for Payer: Cigna Commercial |
$14,821.16
|
| Rate for Payer: Cigna Medicaid |
$2,398.52
|
| Rate for Payer: Cigna Medicare |
$6,542.72
|
| Rate for Payer: Employer Direct Commercial |
$6,542.72
|
| Rate for Payer: Humana Medicare/TRICARE |
$6,542.72
|
| Rate for Payer: Molina CHIP/Medicaid |
$2,398.52
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$6,542.72
|
| Rate for Payer: Molina Medicare |
$6,542.72
|
| Rate for Payer: Multiplan Auto |
$10,000.00
|
| Rate for Payer: Multiplan Commercial |
$10,000.00
|
| Rate for Payer: Multiplan Workers Comp |
$10,000.00
|
| Rate for Payer: Parkland Medicaid |
$2,398.52
|
| Rate for Payer: Scott and White EPO/PPO |
$144.31
|
| Rate for Payer: Scott and White Medicare |
$6,542.72
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$2,398.52
|
| Rate for Payer: Superior Health Plan EPO |
$6,542.72
|
| Rate for Payer: Superior Health Plan Medicare |
$6,542.72
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$6,542.72
|
| Rate for Payer: Universal American Medicare |
$6,542.72
|
| Rate for Payer: Wellcare Medicare |
$6,542.72
|
| Rate for Payer: Wellmed Medicare |
$6,542.72
|
|
|
QuantiFERON-TB Gold Plus SO
|
Facility
|
OP
|
$234.00
|
|
|
Service Code
|
CPT 86480
|
| Hospital Charge Code |
1620046
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$24.17 |
| Max. Negotiated Rate |
$152.10 |
| Rate for Payer: Aetna Commercial |
$65.08
|
| Rate for Payer: Aetna Medicare |
$92.97
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$24.17
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$61.98
|
| Rate for Payer: Amerigroup Medicare |
$61.98
|
| Rate for Payer: BCBS of TX Blue Advantage |
$102.27
|
| Rate for Payer: BCBS of TX Blue Essentials |
$122.72
|
| Rate for Payer: BCBS of TX Medicare |
$61.98
|
| Rate for Payer: BCBS of TX PPO |
$136.98
|
| Rate for Payer: Cash Price |
$205.92
|
| Rate for Payer: Cash Price |
$205.92
|
| Rate for Payer: Cigna Medicaid |
$61.98
|
| Rate for Payer: Cigna Medicare |
$61.98
|
| Rate for Payer: Employer Direct Commercial |
$61.98
|
| Rate for Payer: Humana Medicare/TRICARE |
$61.98
|
| Rate for Payer: Molina CHIP/Medicaid |
$61.98
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$61.98
|
| Rate for Payer: Molina Medicare |
$61.98
|
| Rate for Payer: Multiplan Auto |
$152.10
|
| Rate for Payer: Multiplan Commercial |
$152.10
|
| Rate for Payer: Multiplan Workers Comp |
$152.10
|
| Rate for Payer: Parkland Medicaid |
$61.98
|
| Rate for Payer: Scott and White EPO/PPO |
$77.48
|
| Rate for Payer: Scott and White Medicare |
$61.98
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$61.98
|
| Rate for Payer: Superior Health Plan EPO |
$61.98
|
| Rate for Payer: Superior Health Plan Medicare |
$61.98
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$61.98
|
| Rate for Payer: Universal American Medicare |
$61.98
|
| Rate for Payer: Wellcare Medicare |
$61.98
|
| Rate for Payer: Wellmed Medicare |
$61.98
|
|
|
QuantiFERON-TB Gold Plus SO
|
Facility
|
IP
|
$234.00
|
|
|
Service Code
|
CPT 86480
|
| Hospital Charge Code |
1620046
|
|
Hospital Revenue Code
|
302
|
| Rate for Payer: Cash Price |
$205.92
|
|
|
QUANT OF DRUG NOT ELSEWHRE SPEC
|
Facility
|
OP
|
$245.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
1707082
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.27 |
| Max. Negotiated Rate |
$159.25 |
| Rate for Payer: Aetna Commercial |
$19.56
|
| Rate for Payer: Aetna Medicare |
$27.96
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$7.27
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$18.64
|
| Rate for Payer: Amerigroup Medicare |
$18.64
|
| Rate for Payer: BCBS of TX Blue Advantage |
$30.76
|
| Rate for Payer: BCBS of TX Blue Essentials |
$36.91
|
| Rate for Payer: BCBS of TX Medicare |
$18.64
|
| Rate for Payer: BCBS of TX PPO |
$41.19
|
| Rate for Payer: Cash Price |
$215.60
|
| Rate for Payer: Cash Price |
$215.60
|
| Rate for Payer: Cigna Medicaid |
$18.64
|
| Rate for Payer: Cigna Medicare |
$18.64
|
| Rate for Payer: Employer Direct Commercial |
$18.64
|
| Rate for Payer: Humana Medicare/TRICARE |
$18.64
|
| Rate for Payer: Molina CHIP/Medicaid |
$18.64
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$18.64
|
| Rate for Payer: Molina Medicare |
$18.64
|
| Rate for Payer: Multiplan Auto |
$159.25
|
| Rate for Payer: Multiplan Commercial |
$159.25
|
| Rate for Payer: Multiplan Workers Comp |
$159.25
|
| Rate for Payer: Parkland Medicaid |
$18.64
|
| Rate for Payer: Scott and White EPO/PPO |
$23.30
|
| Rate for Payer: Scott and White Medicare |
$18.64
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$18.64
|
| Rate for Payer: Superior Health Plan EPO |
$18.64
|
| Rate for Payer: Superior Health Plan Medicare |
$18.64
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$18.64
|
| Rate for Payer: Universal American Medicare |
$18.64
|
| Rate for Payer: Wellcare Medicare |
$18.64
|
| Rate for Payer: Wellmed Medicare |
$18.64
|
|
|
QUEtiapine 100 mg Tab
|
Facility
|
OP
|
$49.90
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
77789050
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.49 |
| Max. Negotiated Rate |
$32.44 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$4.49
|
| Rate for Payer: BCBS of TX Blue Advantage |
$14.97
|
| Rate for Payer: BCBS of TX Blue Essentials |
$17.96
|
| Rate for Payer: BCBS of TX PPO |
$19.96
|
| Rate for Payer: Cash Price |
$33.93
|
| Rate for Payer: Multiplan Auto |
$32.44
|
| Rate for Payer: Multiplan Commercial |
$32.44
|
| Rate for Payer: Multiplan Workers Comp |
$32.44
|
| Rate for Payer: Scott and White EPO/PPO |
$24.95
|
| Rate for Payer: Superior Health Plan EPO |
$6.79
|
|
|
QUEtiapine 100 mg Tab
|
Facility
|
IP
|
$49.90
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
77789050
|
|
Hospital Revenue Code
|
250
|
| Rate for Payer: Cash Price |
$33.93
|
|
|
QUEtiapine 25 mg Tab
|
Facility
|
IP
|
$17.35
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
77789254
|
|
Hospital Revenue Code
|
250
|
| Rate for Payer: Cash Price |
$11.80
|
|
|
QUEtiapine 25 mg Tab
|
Facility
|
OP
|
$17.35
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
77789254
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.56 |
| Max. Negotiated Rate |
$11.28 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1.56
|
| Rate for Payer: BCBS of TX Blue Advantage |
$5.20
|
| Rate for Payer: BCBS of TX Blue Essentials |
$6.25
|
| Rate for Payer: BCBS of TX PPO |
$6.94
|
| Rate for Payer: Cash Price |
$11.80
|
| Rate for Payer: Multiplan Auto |
$11.28
|
| Rate for Payer: Multiplan Commercial |
$11.28
|
| Rate for Payer: Multiplan Workers Comp |
$11.28
|
| Rate for Payer: Scott and White EPO/PPO |
$8.68
|
| Rate for Payer: Superior Health Plan EPO |
$2.36
|
|
|
racepinephrine 2.25% Sol UD
|
Facility
|
IP
|
$8.15
|
|
|
Service Code
|
HCPCS J7699
|
| Hospital Charge Code |
78744463
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.04 |
| Max. Negotiated Rate |
$4.08 |
| Rate for Payer: Cash Price |
$5.54
|
| Rate for Payer: Cigna Commercial |
$2.04
|
| Rate for Payer: Scott and White EPO/PPO |
$4.08
|
|
|
racepinephrine 2.25% Sol UD
|
Facility
|
OP
|
$8.15
|
|
|
Service Code
|
HCPCS J7699
|
| Hospital Charge Code |
78744463
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.73 |
| Max. Negotiated Rate |
$5.30 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$0.73
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2.44
|
| Rate for Payer: BCBS of TX Blue Essentials |
$2.93
|
| Rate for Payer: BCBS of TX PPO |
$3.26
|
| Rate for Payer: Cash Price |
$5.54
|
| Rate for Payer: Multiplan Auto |
$5.30
|
| Rate for Payer: Multiplan Commercial |
$5.30
|
| Rate for Payer: Multiplan Workers Comp |
$5.30
|
| Rate for Payer: Scott and White EPO/PPO |
$4.08
|
| Rate for Payer: Superior Health Plan EPO |
$1.11
|
|
|
Radial Shaft fx / Distal radioulnar joint dislocation
|
Facility
|
IP
|
$3,323.00
|
|
|
Service Code
|
CPT 25520
|
| Hospital Charge Code |
8546479
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$2,924.24
|
|
|
Radial Shaft fx / Distal radioulnar joint dislocation
|
Facility
|
OP
|
$3,323.00
|
|
|
Service Code
|
CPT 25520
|
| Hospital Charge Code |
8546479
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$26.29 |
| Max. Negotiated Rate |
$3,415.58 |
| Rate for Payer: Aetna Commercial |
$1,827.65
|
| Rate for Payer: Aetna Medicare |
$2,204.79
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$299.07
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,469.86
|
| Rate for Payer: Amerigroup Medicare |
$1,469.86
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,263.50
|
| Rate for Payer: BCBS of TX Blue Essentials |
$2,710.78
|
| Rate for Payer: BCBS of TX Medicare |
$1,469.86
|
| Rate for Payer: BCBS of TX PPO |
$3,415.58
|
| Rate for Payer: Cash Price |
$2,924.24
|
| Rate for Payer: Cash Price |
$2,924.24
|
| Rate for Payer: Cash Price |
$2,924.24
|
| Rate for Payer: Cigna Commercial |
$3,329.66
|
| Rate for Payer: Cigna Medicaid |
$593.04
|
| Rate for Payer: Cigna Medicare |
$1,469.86
|
| Rate for Payer: Employer Direct Commercial |
$1,469.86
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,469.86
|
| Rate for Payer: Molina CHIP/Medicaid |
$593.04
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,469.86
|
| Rate for Payer: Molina Medicare |
$1,469.86
|
| Rate for Payer: Multiplan Auto |
$2,159.95
|
| Rate for Payer: Multiplan Commercial |
$2,159.95
|
| Rate for Payer: Multiplan Workers Comp |
$2,159.95
|
| Rate for Payer: Parkland Medicaid |
$593.04
|
| Rate for Payer: Scott and White EPO/PPO |
$26.29
|
| Rate for Payer: Scott and White Medicare |
$1,469.86
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$593.04
|
| Rate for Payer: Superior Health Plan EPO |
$1,469.86
|
| Rate for Payer: Superior Health Plan Medicare |
$1,469.86
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,469.86
|
| Rate for Payer: Universal American Medicare |
$1,469.86
|
| Rate for Payer: Wellcare Medicare |
$1,469.86
|
| Rate for Payer: Wellmed Medicare |
$1,469.86
|
|
|
Radial styloidectomy (separate procedure)
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 25230
|
| Hospital Charge Code |
36025230
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$65.29 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$4,635.00
|
| Rate for Payer: Aetna Medicare |
$4,440.36
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,088.27
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$2,960.24
|
| Rate for Payer: Amerigroup Medicare |
$2,960.24
|
| Rate for Payer: BCBS of TX Blue Advantage |
$4,571.54
|
| Rate for Payer: BCBS of TX Blue Essentials |
$5,474.90
|
| Rate for Payer: BCBS of TX Medicare |
$2,960.24
|
| Rate for Payer: BCBS of TX PPO |
$6,898.37
|
| Rate for Payer: Cigna Commercial |
$6,705.80
|
| Rate for Payer: Cigna Medicaid |
$1,088.27
|
| Rate for Payer: Cigna Medicare |
$2,960.24
|
| Rate for Payer: Employer Direct Commercial |
$2,960.24
|
| Rate for Payer: Humana Medicare/TRICARE |
$2,960.24
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,088.27
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$2,960.24
|
| Rate for Payer: Molina Medicare |
$2,960.24
|
| Rate for Payer: Multiplan Auto |
$10,000.00
|
| Rate for Payer: Multiplan Commercial |
$10,000.00
|
| Rate for Payer: Multiplan Workers Comp |
$10,000.00
|
| Rate for Payer: Parkland Medicaid |
$1,088.27
|
| Rate for Payer: Scott and White EPO/PPO |
$65.29
|
| Rate for Payer: Scott and White Medicare |
$2,960.24
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,088.27
|
| Rate for Payer: Superior Health Plan EPO |
$2,960.24
|
| Rate for Payer: Superior Health Plan Medicare |
$2,960.24
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$2,960.24
|
| Rate for Payer: Universal American Medicare |
$2,960.24
|
| Rate for Payer: Wellcare Medicare |
$2,960.24
|
| Rate for Payer: Wellmed Medicare |
$2,960.24
|
|
|
Radical excision of bursa, synovia of wrist, or forearm tendon sheaths (eg, tenosynovitis, fungus,
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 25115
|
| Hospital Charge Code |
36025115
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$32.42 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$3,090.00
|
| Rate for Payer: Aetna Medicare |
$2,204.79
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$593.04
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,469.86
|
| Rate for Payer: Amerigroup Medicare |
$1,469.86
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,263.50
|
| Rate for Payer: BCBS of TX Blue Essentials |
$2,710.78
|
| Rate for Payer: BCBS of TX Medicare |
$1,469.86
|
| Rate for Payer: BCBS of TX PPO |
$3,415.58
|
| Rate for Payer: Cigna Commercial |
$3,329.66
|
| Rate for Payer: Cigna Medicaid |
$593.04
|
| Rate for Payer: Cigna Medicare |
$1,469.86
|
| Rate for Payer: Employer Direct Commercial |
$1,469.86
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,469.86
|
| Rate for Payer: Molina CHIP/Medicaid |
$593.04
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,469.86
|
| Rate for Payer: Molina Medicare |
$1,469.86
|
| 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 |
$593.04
|
| Rate for Payer: Scott and White EPO/PPO |
$32.42
|
| Rate for Payer: Scott and White Medicare |
$1,469.86
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$593.04
|
| Rate for Payer: Superior Health Plan EPO |
$1,469.86
|
| Rate for Payer: Superior Health Plan Medicare |
$1,469.86
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,469.86
|
| Rate for Payer: Universal American Medicare |
$1,469.86
|
| Rate for Payer: Wellcare Medicare |
$1,469.86
|
| Rate for Payer: Wellmed Medicare |
$1,469.86
|
|
|
Radical excision of bursa, synovia of wrist, or forearm tendon sheaths (eg, tenosynovitis, fungus, T
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 25116
|
| Hospital Charge Code |
36025116
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$65.29 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$3,090.00
|
| Rate for Payer: Aetna Medicare |
$4,440.36
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,088.27
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$2,960.24
|
| Rate for Payer: Amerigroup Medicare |
$2,960.24
|
| Rate for Payer: BCBS of TX Blue Advantage |
$4,571.54
|
| Rate for Payer: BCBS of TX Blue Essentials |
$5,474.90
|
| Rate for Payer: BCBS of TX Medicare |
$2,960.24
|
| Rate for Payer: BCBS of TX PPO |
$6,898.37
|
| Rate for Payer: Cigna Commercial |
$6,705.80
|
| Rate for Payer: Cigna Medicaid |
$1,088.27
|
| Rate for Payer: Cigna Medicare |
$2,960.24
|
| Rate for Payer: Employer Direct Commercial |
$2,960.24
|
| Rate for Payer: Humana Medicare/TRICARE |
$2,960.24
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,088.27
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$2,960.24
|
| Rate for Payer: Molina Medicare |
$2,960.24
|
| Rate for Payer: Multiplan Auto |
$10,000.00
|
| Rate for Payer: Multiplan Commercial |
$10,000.00
|
| Rate for Payer: Multiplan Workers Comp |
$10,000.00
|
| Rate for Payer: Parkland Medicaid |
$1,088.27
|
| Rate for Payer: Scott and White EPO/PPO |
$65.29
|
| Rate for Payer: Scott and White Medicare |
$2,960.24
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,088.27
|
| Rate for Payer: Superior Health Plan EPO |
$2,960.24
|
| Rate for Payer: Superior Health Plan Medicare |
$2,960.24
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$2,960.24
|
| Rate for Payer: Universal American Medicare |
$2,960.24
|
| Rate for Payer: Wellcare Medicare |
$2,960.24
|
| Rate for Payer: Wellmed Medicare |
$2,960.24
|
|
|
Radical resection of capsule, soft tissue, and heterotopic bone, elbow, with contracture release (se
|
Facility
|
OP
|
$15,074.51
|
|
|
Service Code
|
CPT 24149
|
| Hospital Charge Code |
36024149
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$144.31 |
| Max. Negotiated Rate |
$15,074.51 |
| Rate for Payer: Aetna Commercial |
$4,635.00
|
| Rate for Payer: Aetna Medicare |
$9,814.08
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2,398.52
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$6,542.72
|
| Rate for Payer: Amerigroup Medicare |
$6,542.72
|
| Rate for Payer: BCBS of TX Blue Advantage |
$9,989.86
|
| Rate for Payer: BCBS of TX Blue Essentials |
$11,963.90
|
| Rate for Payer: BCBS of TX Medicare |
$6,542.72
|
| Rate for Payer: BCBS of TX PPO |
$15,074.51
|
| Rate for Payer: Cigna Commercial |
$14,821.16
|
| Rate for Payer: Cigna Medicaid |
$2,398.52
|
| Rate for Payer: Cigna Medicare |
$6,542.72
|
| Rate for Payer: Employer Direct Commercial |
$6,542.72
|
| Rate for Payer: Humana Medicare/TRICARE |
$6,542.72
|
| Rate for Payer: Molina CHIP/Medicaid |
$2,398.52
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$6,542.72
|
| Rate for Payer: Molina Medicare |
$6,542.72
|
| Rate for Payer: Multiplan Auto |
$10,000.00
|
| Rate for Payer: Multiplan Commercial |
$10,000.00
|
| Rate for Payer: Multiplan Workers Comp |
$10,000.00
|
| Rate for Payer: Parkland Medicaid |
$2,398.52
|
| Rate for Payer: Scott and White EPO/PPO |
$144.31
|
| Rate for Payer: Scott and White Medicare |
$6,542.72
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$2,398.52
|
| Rate for Payer: Superior Health Plan EPO |
$6,542.72
|
| Rate for Payer: Superior Health Plan Medicare |
$6,542.72
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$6,542.72
|
| Rate for Payer: Universal American Medicare |
$6,542.72
|
| Rate for Payer: Wellcare Medicare |
$6,542.72
|
| Rate for Payer: Wellmed Medicare |
$6,542.72
|
|
|
Radical resection of tumor (eg, sarcoma), soft tissue of forearm and/or wrist area 3 cm or greater
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 25078
|
| Hospital Charge Code |
36025078
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$57.32 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$3,090.00
|
| Rate for Payer: Aetna Medicare |
$3,898.02
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$815.20
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$2,598.68
|
| Rate for Payer: Amerigroup Medicare |
$2,598.68
|
| Rate for Payer: BCBS of TX Blue Advantage |
$3,872.55
|
| Rate for Payer: BCBS of TX Blue Essentials |
$4,637.78
|
| Rate for Payer: BCBS of TX Medicare |
$2,598.68
|
| Rate for Payer: BCBS of TX PPO |
$5,843.60
|
| Rate for Payer: Cigna Commercial |
$5,886.75
|
| Rate for Payer: Cigna Medicaid |
$815.20
|
| Rate for Payer: Cigna Medicare |
$2,598.68
|
| Rate for Payer: Employer Direct Commercial |
$2,598.68
|
| Rate for Payer: Humana Medicare/TRICARE |
$2,598.68
|
| Rate for Payer: Molina CHIP/Medicaid |
$815.20
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$2,598.68
|
| Rate for Payer: Molina Medicare |
$2,598.68
|
| 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 |
$815.20
|
| Rate for Payer: Scott and White EPO/PPO |
$57.32
|
| Rate for Payer: Scott and White Medicare |
$2,598.68
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$815.20
|
| Rate for Payer: Superior Health Plan EPO |
$2,598.68
|
| Rate for Payer: Superior Health Plan Medicare |
$2,598.68
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$2,598.68
|
| Rate for Payer: Universal American Medicare |
$2,598.68
|
| Rate for Payer: Wellcare Medicare |
$2,598.68
|
| Rate for Payer: Wellmed Medicare |
$2,598.68
|
|
