|
Radical resection of tumor (eg, sarcoma), soft tissue of hand or finger 3 cm or greater
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 26118
|
| Hospital Charge Code |
36026118
|
|
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
|
|
|
Radical resection of tumor (eg, sarcoma), soft tissue of neck or anterior thorax 5 cm or greater
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 21558
|
| Hospital Charge Code |
36021558
|
|
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
|
|
|
Radical resection of tumor (eg, sarcoma), soft tissue of upper arm or elbow area 5 cm or greater
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 24079
|
| Hospital Charge Code |
36024079
|
|
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
|
|
|
Radiofrequency ablation, nerves innervating the sacroiliac joint, with image guidance
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 64625
|
| Hospital Charge Code |
36064625
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$38.95 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$3,090.00
|
| Rate for Payer: Aetna Medicare |
$2,648.68
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$659.94
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,765.79
|
| Rate for Payer: Amerigroup Medicare |
$1,765.79
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,871.31
|
| Rate for Payer: BCBS of TX Blue Essentials |
$3,438.70
|
| Rate for Payer: BCBS of TX Medicare |
$1,765.79
|
| Rate for Payer: BCBS of TX PPO |
$4,332.76
|
| Rate for Payer: Cigna Commercial |
$4,000.01
|
| Rate for Payer: Cigna Medicaid |
$659.94
|
| Rate for Payer: Cigna Medicare |
$1,765.79
|
| Rate for Payer: Employer Direct Commercial |
$1,765.79
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,765.79
|
| Rate for Payer: Molina CHIP/Medicaid |
$659.94
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,765.79
|
| Rate for Payer: Molina Medicare |
$1,765.79
|
| 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 |
$659.94
|
| Rate for Payer: Scott and White EPO/PPO |
$38.95
|
| Rate for Payer: Scott and White Medicare |
$1,765.79
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$659.94
|
| Rate for Payer: Superior Health Plan EPO |
$1,765.79
|
| Rate for Payer: Superior Health Plan Medicare |
$1,765.79
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,765.79
|
| Rate for Payer: Universal American Medicare |
$1,765.79
|
| Rate for Payer: Wellcare Medicare |
$1,765.79
|
| Rate for Payer: Wellmed Medicare |
$1,765.79
|
|
|
RADIOTHERAPY
|
Facility
|
IP
|
$51,136.60
|
|
|
Service Code
|
MSDRG 849
|
| Min. Negotiated Rate |
$15,066.34 |
| Max. Negotiated Rate |
$51,136.60 |
| Rate for Payer: Aetna Commercial |
$30,278.25
|
| Rate for Payer: Aetna Medicare |
$33,091.17
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$22,060.78
|
| Rate for Payer: Amerigroup Medicare |
$22,060.78
|
| Rate for Payer: BCBS of TX Blue Advantage |
$15,066.34
|
| Rate for Payer: BCBS of TX Blue Essentials |
$20,330.49
|
| Rate for Payer: BCBS of TX Medicare |
$22,060.78
|
| Rate for Payer: BCBS of TX PPO |
$22,590.31
|
| Rate for Payer: Cigna Commercial |
$34,665.23
|
| Rate for Payer: Cigna Medicare |
$22,060.78
|
| Rate for Payer: Employer Direct Commercial |
$22,060.78
|
| Rate for Payer: Humana Medicare/TRICARE |
$22,060.78
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$22,060.78
|
| Rate for Payer: Molina Medicare |
$22,060.78
|
| Rate for Payer: Multiplan Auto |
$51,136.60
|
| Rate for Payer: Multiplan Commercial |
$51,136.60
|
| Rate for Payer: Multiplan Workers Comp |
$51,136.60
|
| Rate for Payer: Scott and White EPO/PPO |
$23,549.75
|
| Rate for Payer: Scott and White Medicare |
$22,060.78
|
| Rate for Payer: Superior Health Plan EPO |
$22,060.78
|
| Rate for Payer: Superior Health Plan Medicare |
$22,060.78
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$22,060.78
|
| Rate for Payer: Universal American Medicare |
$22,060.78
|
| Rate for Payer: Wellcare Medicare |
$22,060.78
|
| Rate for Payer: Wellmed Medicare |
$22,060.78
|
|
|
ranolazine 500 mg ER Tab
|
Facility
|
IP
|
$8.00
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
77792227
|
|
Hospital Revenue Code
|
250
|
| Rate for Payer: Cash Price |
$5.44
|
|
|
ranolazine 500 mg ER Tab
|
Facility
|
OP
|
$8.00
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
77792227
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.72 |
| Max. Negotiated Rate |
$5.20 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$0.72
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2.40
|
| Rate for Payer: BCBS of TX Blue Essentials |
$2.88
|
| Rate for Payer: BCBS of TX PPO |
$3.20
|
| Rate for Payer: Cash Price |
$5.44
|
| Rate for Payer: Multiplan Auto |
$5.20
|
| Rate for Payer: Multiplan Commercial |
$5.20
|
| Rate for Payer: Multiplan Workers Comp |
$5.20
|
| Rate for Payer: Scott and White EPO/PPO |
$4.00
|
| Rate for Payer: Superior Health Plan EPO |
$1.09
|
|
|
.Rapid Grower Broth Suscep 182917 SO
|
Facility
|
OP
|
$251.00
|
|
|
Service Code
|
CPT 87186
|
| Hospital Charge Code |
1604610
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.37 |
| Max. Negotiated Rate |
$163.15 |
| Rate for Payer: Aetna Commercial |
$9.08
|
| Rate for Payer: Aetna Medicare |
$12.98
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$3.37
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$8.65
|
| Rate for Payer: Amerigroup Medicare |
$8.65
|
| Rate for Payer: BCBS of TX Blue Advantage |
$14.27
|
| Rate for Payer: BCBS of TX Blue Essentials |
$17.13
|
| Rate for Payer: BCBS of TX Medicare |
$8.65
|
| Rate for Payer: BCBS of TX PPO |
$19.12
|
| Rate for Payer: Cash Price |
$220.88
|
| Rate for Payer: Cash Price |
$220.88
|
| Rate for Payer: Cigna Medicaid |
$8.65
|
| Rate for Payer: Cigna Medicare |
$8.65
|
| Rate for Payer: Employer Direct Commercial |
$8.65
|
| Rate for Payer: Humana Medicare/TRICARE |
$8.65
|
| Rate for Payer: Molina CHIP/Medicaid |
$8.65
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$8.65
|
| Rate for Payer: Molina Medicare |
$8.65
|
| Rate for Payer: Multiplan Auto |
$163.15
|
| Rate for Payer: Multiplan Commercial |
$163.15
|
| Rate for Payer: Multiplan Workers Comp |
$163.15
|
| Rate for Payer: Parkland Medicaid |
$8.65
|
| Rate for Payer: Scott and White EPO/PPO |
$10.81
|
| Rate for Payer: Scott and White Medicare |
$8.65
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$8.65
|
| Rate for Payer: Superior Health Plan EPO |
$8.65
|
| Rate for Payer: Superior Health Plan Medicare |
$8.65
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$8.65
|
| Rate for Payer: Universal American Medicare |
$8.65
|
| Rate for Payer: Wellcare Medicare |
$8.65
|
| Rate for Payer: Wellmed Medicare |
$8.65
|
|
|
Rapid Plasma Reagin
|
Facility
|
OP
|
$164.00
|
|
|
Service Code
|
CPT 86592
|
| Hospital Charge Code |
1605450
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.67 |
| Max. Negotiated Rate |
$106.60 |
| Rate for Payer: Aetna Commercial |
$4.48
|
| Rate for Payer: Aetna Medicare |
$6.40
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1.67
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$4.27
|
| Rate for Payer: Amerigroup Medicare |
$4.27
|
| Rate for Payer: BCBS of TX Blue Advantage |
$7.05
|
| Rate for Payer: BCBS of TX Blue Essentials |
$8.45
|
| Rate for Payer: BCBS of TX Medicare |
$4.27
|
| Rate for Payer: BCBS of TX PPO |
$9.44
|
| Rate for Payer: Cash Price |
$144.32
|
| Rate for Payer: Cash Price |
$144.32
|
| Rate for Payer: Cigna Medicaid |
$4.27
|
| Rate for Payer: Cigna Medicare |
$4.27
|
| Rate for Payer: Employer Direct Commercial |
$4.27
|
| Rate for Payer: Humana Medicare/TRICARE |
$4.27
|
| Rate for Payer: Molina CHIP/Medicaid |
$4.27
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$4.27
|
| Rate for Payer: Molina Medicare |
$4.27
|
| Rate for Payer: Multiplan Auto |
$106.60
|
| Rate for Payer: Multiplan Commercial |
$106.60
|
| Rate for Payer: Multiplan Workers Comp |
$106.60
|
| Rate for Payer: Parkland Medicaid |
$4.27
|
| Rate for Payer: Scott and White EPO/PPO |
$5.34
|
| Rate for Payer: Scott and White Medicare |
$4.27
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$4.27
|
| Rate for Payer: Superior Health Plan EPO |
$4.27
|
| Rate for Payer: Superior Health Plan Medicare |
$4.27
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$4.27
|
| Rate for Payer: Universal American Medicare |
$4.27
|
| Rate for Payer: Wellcare Medicare |
$4.27
|
| Rate for Payer: Wellmed Medicare |
$4.27
|
|
|
.Rapid Plasma Reagin Titer
|
Facility
|
IP
|
$185.00
|
|
|
Service Code
|
CPT 86593
|
| Hospital Charge Code |
1605468
|
|
Hospital Revenue Code
|
302
|
| Rate for Payer: Cash Price |
$162.80
|
|
|
.Rapid Plasma Reagin Titer
|
Facility
|
OP
|
$185.00
|
|
|
Service Code
|
CPT 86593
|
| Hospital Charge Code |
1605468
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.72 |
| Max. Negotiated Rate |
$120.25 |
| Rate for Payer: Aetna Commercial |
$4.62
|
| Rate for Payer: Aetna Medicare |
$6.60
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1.72
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$4.40
|
| Rate for Payer: Amerigroup Medicare |
$4.40
|
| Rate for Payer: BCBS of TX Blue Advantage |
$7.26
|
| Rate for Payer: BCBS of TX Blue Essentials |
$8.71
|
| Rate for Payer: BCBS of TX Medicare |
$4.40
|
| Rate for Payer: BCBS of TX PPO |
$9.72
|
| Rate for Payer: Cash Price |
$162.80
|
| Rate for Payer: Cash Price |
$162.80
|
| Rate for Payer: Cigna Medicaid |
$4.40
|
| Rate for Payer: Cigna Medicare |
$4.40
|
| Rate for Payer: Employer Direct Commercial |
$4.40
|
| Rate for Payer: Humana Medicare/TRICARE |
$4.40
|
| Rate for Payer: Molina CHIP/Medicaid |
$4.40
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$4.40
|
| Rate for Payer: Molina Medicare |
$4.40
|
| Rate for Payer: Multiplan Auto |
$120.25
|
| Rate for Payer: Multiplan Commercial |
$120.25
|
| Rate for Payer: Multiplan Workers Comp |
$120.25
|
| Rate for Payer: Parkland Medicaid |
$4.40
|
| Rate for Payer: Scott and White EPO/PPO |
$5.50
|
| Rate for Payer: Scott and White Medicare |
$4.40
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$4.40
|
| Rate for Payer: Superior Health Plan EPO |
$4.40
|
| Rate for Payer: Superior Health Plan Medicare |
$4.40
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$4.40
|
| Rate for Payer: Universal American Medicare |
$4.40
|
| Rate for Payer: Wellcare Medicare |
$4.40
|
| Rate for Payer: Wellmed Medicare |
$4.40
|
|
|
Rapid Strep A Antigen
|
Facility
|
OP
|
$384.00
|
|
|
Service Code
|
CPT 87880
|
| Hospital Charge Code |
1603778
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$6.45 |
| Max. Negotiated Rate |
$249.60 |
| Rate for Payer: Aetna Commercial |
$17.36
|
| Rate for Payer: Aetna Medicare |
$24.80
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$6.45
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$16.53
|
| Rate for Payer: Amerigroup Medicare |
$16.53
|
| Rate for Payer: BCBS of TX Blue Advantage |
$27.27
|
| Rate for Payer: BCBS of TX Blue Essentials |
$32.73
|
| Rate for Payer: BCBS of TX Medicare |
$16.53
|
| Rate for Payer: BCBS of TX PPO |
$36.53
|
| Rate for Payer: Cash Price |
$337.92
|
| Rate for Payer: Cash Price |
$337.92
|
| Rate for Payer: Cigna Medicaid |
$16.53
|
| Rate for Payer: Cigna Medicare |
$16.53
|
| Rate for Payer: Employer Direct Commercial |
$16.53
|
| Rate for Payer: Humana Medicare/TRICARE |
$16.53
|
| Rate for Payer: Molina CHIP/Medicaid |
$16.53
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$16.53
|
| Rate for Payer: Molina Medicare |
$16.53
|
| Rate for Payer: Multiplan Auto |
$249.60
|
| Rate for Payer: Multiplan Commercial |
$249.60
|
| Rate for Payer: Multiplan Workers Comp |
$249.60
|
| Rate for Payer: Parkland Medicaid |
$16.53
|
| Rate for Payer: Scott and White EPO/PPO |
$20.66
|
| Rate for Payer: Scott and White Medicare |
$16.53
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$16.53
|
| Rate for Payer: Superior Health Plan EPO |
$16.53
|
| Rate for Payer: Superior Health Plan Medicare |
$16.53
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$16.53
|
| Rate for Payer: Universal American Medicare |
$16.53
|
| Rate for Payer: Wellcare Medicare |
$16.53
|
| Rate for Payer: Wellmed Medicare |
$16.53
|
|
|
Rapid Strep A Antigen
|
Facility
|
IP
|
$384.00
|
|
|
Service Code
|
CPT 87880
|
| Hospital Charge Code |
1603778
|
|
Hospital Revenue Code
|
306
|
| Rate for Payer: Cash Price |
$337.92
|
|
|
RASP HELIOCOIDAL 5820080021
|
Facility
|
OP
|
$480.19
|
|
| Hospital Charge Code |
8532469
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$43.22 |
| Max. Negotiated Rate |
$312.12 |
| Rate for Payer: Aetna Commercial |
$264.10
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$43.22
|
| Rate for Payer: BCBS of TX Blue Advantage |
$144.06
|
| Rate for Payer: BCBS of TX Blue Essentials |
$172.87
|
| Rate for Payer: BCBS of TX PPO |
$192.08
|
| Rate for Payer: Cash Price |
$422.57
|
| Rate for Payer: Multiplan Auto |
$312.12
|
| Rate for Payer: Multiplan Commercial |
$312.12
|
| Rate for Payer: Multiplan Workers Comp |
$312.12
|
| Rate for Payer: Scott and White EPO/PPO |
$240.10
|
| Rate for Payer: Superior Health Plan EPO |
$65.31
|
|
|
RASP HELIOCOIDAL 5820080021
|
Facility
|
IP
|
$480.19
|
|
| Hospital Charge Code |
8532469
|
|
Hospital Revenue Code
|
272
|
| Rate for Payer: Cash Price |
$422.57
|
|
|
RD CARBON -- DHF
|
Facility
|
IP
|
$1,775.14
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
81350035
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$443.78 |
| Max. Negotiated Rate |
$887.57 |
| Rate for Payer: Aetna Commercial |
$532.54
|
| Rate for Payer: Cash Price |
$1,562.12
|
| Rate for Payer: Cigna Commercial |
$443.78
|
| Rate for Payer: Multiplan Auto |
$887.57
|
| Rate for Payer: Multiplan Commercial |
$887.57
|
| Rate for Payer: Multiplan Workers Comp |
$887.57
|
| Rate for Payer: Scott and White EPO/PPO |
$887.57
|
|
|
RD CARBON -- DHF
|
Facility
|
OP
|
$1,775.14
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
81350035
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$159.76 |
| Max. Negotiated Rate |
$887.57 |
| Rate for Payer: Aetna Commercial |
$532.54
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$159.76
|
| Rate for Payer: BCBS of TX Blue Advantage |
$532.54
|
| Rate for Payer: BCBS of TX Blue Essentials |
$639.05
|
| Rate for Payer: BCBS of TX PPO |
$710.06
|
| Rate for Payer: Cash Price |
$1,562.12
|
| Rate for Payer: Multiplan Auto |
$887.57
|
| Rate for Payer: Multiplan Commercial |
$887.57
|
| Rate for Payer: Multiplan Workers Comp |
$887.57
|
| Rate for Payer: Scott and White EPO/PPO |
$887.57
|
| Rate for Payer: Superior Health Plan EPO |
$241.42
|
|
|
Realignment of extensor tendon, hand, each tendon
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 26437
|
| Hospital Charge Code |
36026437
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$65.29 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$2,200.00
|
| 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
|
|
|
reamer acorn
|
Facility
|
OP
|
$2,256.38
|
|
| Hospital Charge Code |
8612543
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$203.07 |
| Max. Negotiated Rate |
$1,466.65 |
| Rate for Payer: Aetna Commercial |
$1,241.01
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$203.07
|
| Rate for Payer: BCBS of TX Blue Advantage |
$676.91
|
| Rate for Payer: BCBS of TX Blue Essentials |
$812.30
|
| Rate for Payer: BCBS of TX PPO |
$902.55
|
| Rate for Payer: Cash Price |
$1,985.61
|
| Rate for Payer: Multiplan Auto |
$1,466.65
|
| Rate for Payer: Multiplan Commercial |
$1,466.65
|
| Rate for Payer: Multiplan Workers Comp |
$1,466.65
|
| Rate for Payer: Scott and White EPO/PPO |
$1,128.19
|
| Rate for Payer: Superior Health Plan EPO |
$306.87
|
|
|
reamer acorn
|
Facility
|
IP
|
$2,256.38
|
|
| Hospital Charge Code |
8612543
|
|
Hospital Revenue Code
|
272
|
| Rate for Payer: Cash Price |
$1,985.61
|
|
|
REAMER CANULATE -- DHF
|
Facility
|
OP
|
$1,362.00
|
|
| Hospital Charge Code |
80826506
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$122.58 |
| Max. Negotiated Rate |
$885.30 |
| Rate for Payer: Aetna Commercial |
$749.10
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$122.58
|
| Rate for Payer: BCBS of TX Blue Advantage |
$408.60
|
| Rate for Payer: BCBS of TX Blue Essentials |
$490.32
|
| Rate for Payer: BCBS of TX PPO |
$544.80
|
| Rate for Payer: Cash Price |
$1,198.56
|
| Rate for Payer: Multiplan Auto |
$885.30
|
| Rate for Payer: Multiplan Commercial |
$885.30
|
| Rate for Payer: Multiplan Workers Comp |
$885.30
|
| Rate for Payer: Scott and White EPO/PPO |
$681.00
|
| Rate for Payer: Superior Health Plan EPO |
$185.23
|
|
|
REAMER CANULATE -- DHF
|
Facility
|
IP
|
$1,362.00
|
|
| Hospital Charge Code |
80826506
|
|
Hospital Revenue Code
|
272
|
| Rate for Payer: Cash Price |
$1,198.56
|
|
|
reamer constant 5.5
|
Facility
|
IP
|
$1,623.05
|
|
| Hospital Charge Code |
8646514
|
|
Hospital Revenue Code
|
272
|
| Rate for Payer: Cash Price |
$1,428.28
|
|
|
reamer constant 5.5
|
Facility
|
OP
|
$1,623.05
|
|
| Hospital Charge Code |
8646514
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$146.07 |
| Max. Negotiated Rate |
$1,054.98 |
| Rate for Payer: Aetna Commercial |
$892.68
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$146.07
|
| Rate for Payer: BCBS of TX Blue Advantage |
$486.92
|
| Rate for Payer: BCBS of TX Blue Essentials |
$584.30
|
| Rate for Payer: BCBS of TX PPO |
$649.22
|
| Rate for Payer: Cash Price |
$1,428.28
|
| Rate for Payer: Multiplan Auto |
$1,054.98
|
| Rate for Payer: Multiplan Commercial |
$1,054.98
|
| Rate for Payer: Multiplan Workers Comp |
$1,054.98
|
| Rate for Payer: Scott and White EPO/PPO |
$811.52
|
| Rate for Payer: Superior Health Plan EPO |
$220.73
|
|
|
REAMER GRAFTMAX FLEX SENTINEL
|
Facility
|
IP
|
$1,514.14
|
|
| Hospital Charge Code |
141510
|
|
Hospital Revenue Code
|
272
|
| Rate for Payer: Cash Price |
$1,332.44
|
|
