|
RED BLOOD CELL DISORDERS WITHOUT MCC
|
Facility
|
IP
|
$17,113.30
|
|
|
Service Code
|
MSDRG 812
|
| Min. Negotiated Rate |
$7,423.52 |
| Max. Negotiated Rate |
$17,113.30 |
| Rate for Payer: Aetna Commercial |
$10,132.88
|
| Rate for Payer: Aetna Medicare |
$13,923.36
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$9,282.24
|
| Rate for Payer: Amerigroup Medicare |
$9,282.24
|
| Rate for Payer: BCBS of TX Blue Advantage |
$7,423.52
|
| Rate for Payer: BCBS of TX Blue Essentials |
$9,113.74
|
| Rate for Payer: BCBS of TX Medicare |
$9,282.24
|
| Rate for Payer: BCBS of TX PPO |
$10,126.77
|
| Rate for Payer: Cigna Commercial |
$11,601.02
|
| Rate for Payer: Cigna Medicare |
$9,282.24
|
| Rate for Payer: Employer Direct Commercial |
$9,282.24
|
| Rate for Payer: Humana Medicare/TRICARE |
$9,282.24
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$9,282.24
|
| Rate for Payer: Molina Medicare |
$9,282.24
|
| Rate for Payer: Multiplan Auto |
$17,113.30
|
| Rate for Payer: Multiplan Commercial |
$17,113.30
|
| Rate for Payer: Multiplan Workers Comp |
$17,113.30
|
| Rate for Payer: Scott and White EPO/PPO |
$7,881.12
|
| Rate for Payer: Scott and White Medicare |
$9,282.24
|
| Rate for Payer: Superior Health Plan EPO |
$9,282.24
|
| Rate for Payer: Superior Health Plan Medicare |
$9,282.24
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$9,282.24
|
| Rate for Payer: Universal American Medicare |
$9,282.24
|
| Rate for Payer: Wellcare Medicare |
$9,282.24
|
| Rate for Payer: Wellmed Medicare |
$9,282.24
|
|
|
Reduction mammaplasty
|
Facility
|
OP
|
$13,509.82
|
|
|
Service Code
|
CPT 19318
|
| Hospital Charge Code |
36019318
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$131.54 |
| Max. Negotiated Rate |
$13,509.82 |
| Rate for Payer: Aetna Commercial |
$6,077.00
|
| Rate for Payer: Aetna Medicare |
$8,945.76
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,845.21
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$5,963.84
|
| Rate for Payer: Amerigroup Medicare |
$5,963.84
|
| Rate for Payer: BCBS of TX Blue Advantage |
$8,746.27
|
| Rate for Payer: BCBS of TX Blue Essentials |
$10,474.58
|
| Rate for Payer: BCBS of TX Medicare |
$5,963.84
|
| Rate for Payer: BCBS of TX PPO |
$13,197.97
|
| Rate for Payer: Cigna Commercial |
$13,509.82
|
| Rate for Payer: Cigna Medicaid |
$1,845.21
|
| Rate for Payer: Cigna Medicare |
$5,963.84
|
| Rate for Payer: Employer Direct Commercial |
$5,963.84
|
| Rate for Payer: Humana Medicare/TRICARE |
$5,963.84
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,845.21
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$5,963.84
|
| Rate for Payer: Molina Medicare |
$5,963.84
|
| 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 |
$1,845.21
|
| Rate for Payer: Scott and White EPO/PPO |
$131.54
|
| Rate for Payer: Scott and White Medicare |
$5,963.84
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,845.21
|
| Rate for Payer: Superior Health Plan EPO |
$5,963.84
|
| Rate for Payer: Superior Health Plan Medicare |
$5,963.84
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$5,963.84
|
| Rate for Payer: Universal American Medicare |
$5,963.84
|
| Rate for Payer: Wellcare Medicare |
$5,963.84
|
| Rate for Payer: Wellmed Medicare |
$5,963.84
|
|
|
REFILL/MAINT PMP ADM MD BCE
|
Facility
|
IP
|
$1,218.00
|
|
|
Service Code
|
CPT 95991
|
| Hospital Charge Code |
3219903
|
|
Hospital Revenue Code
|
940
|
| Rate for Payer: Cash Price |
$1,071.84
|
|
|
REFILL/MAINT PMP ADM MD BCE
|
Facility
|
OP
|
$1,218.00
|
|
|
Service Code
|
CPT 95991
|
| Hospital Charge Code |
3219903
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$4.84 |
| Max. Negotiated Rate |
$791.70 |
| Rate for Payer: Aetna Commercial |
$669.90
|
| Rate for Payer: Aetna Medicare |
$406.30
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$109.62
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$270.87
|
| Rate for Payer: Amerigroup Medicare |
$270.87
|
| Rate for Payer: BCBS of TX Blue Advantage |
$71.48
|
| Rate for Payer: BCBS of TX Blue Essentials |
$85.45
|
| Rate for Payer: BCBS of TX Medicare |
$270.87
|
| Rate for Payer: BCBS of TX PPO |
$95.31
|
| Rate for Payer: Cash Price |
$1,071.84
|
| Rate for Payer: Cash Price |
$1,071.84
|
| Rate for Payer: Cash Price |
$1,071.84
|
| Rate for Payer: Cigna Commercial |
$613.60
|
| Rate for Payer: Cigna Medicare |
$270.87
|
| Rate for Payer: Employer Direct Commercial |
$270.87
|
| Rate for Payer: Humana Medicare/TRICARE |
$270.87
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$270.87
|
| Rate for Payer: Molina Medicare |
$270.87
|
| Rate for Payer: Multiplan Auto |
$791.70
|
| Rate for Payer: Multiplan Commercial |
$791.70
|
| Rate for Payer: Multiplan Workers Comp |
$791.70
|
| Rate for Payer: Scott and White EPO/PPO |
$4.84
|
| Rate for Payer: Scott and White Medicare |
$270.87
|
| Rate for Payer: Superior Health Plan EPO |
$270.87
|
| Rate for Payer: Superior Health Plan Medicare |
$270.87
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$270.87
|
| Rate for Payer: Universal American Medicare |
$270.87
|
| Rate for Payer: Wellcare Medicare |
$270.87
|
| Rate for Payer: Wellmed Medicare |
$270.87
|
|
|
Ref Lab Antibody Identification
|
Facility
|
IP
|
$466.00
|
|
|
Service Code
|
CPT 86870
|
| Hospital Charge Code |
2403061
|
|
Hospital Revenue Code
|
302
|
| Rate for Payer: Cash Price |
$410.08
|
|
|
Ref Lab Antibody Identification
|
Facility
|
OP
|
$466.00
|
|
|
Service Code
|
CPT 86870
|
| Hospital Charge Code |
2403061
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.88 |
| Max. Negotiated Rate |
$744.67 |
| Rate for Payer: Aetna Commercial |
$46.97
|
| Rate for Payer: Aetna Medicare |
$493.10
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$17.83
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$328.73
|
| Rate for Payer: Amerigroup Medicare |
$328.73
|
| Rate for Payer: BCBS of TX Blue Advantage |
$467.63
|
| Rate for Payer: BCBS of TX Blue Essentials |
$561.15
|
| Rate for Payer: BCBS of TX Medicare |
$328.73
|
| Rate for Payer: BCBS of TX PPO |
$626.34
|
| Rate for Payer: Cash Price |
$410.08
|
| Rate for Payer: Cash Price |
$410.08
|
| Rate for Payer: Cash Price |
$410.08
|
| Rate for Payer: Cigna Commercial |
$744.67
|
| Rate for Payer: Cigna Medicare |
$328.73
|
| Rate for Payer: Employer Direct Commercial |
$328.73
|
| Rate for Payer: Humana Medicare/TRICARE |
$328.73
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$328.73
|
| Rate for Payer: Molina Medicare |
$328.73
|
| Rate for Payer: Multiplan Auto |
$302.90
|
| Rate for Payer: Multiplan Commercial |
$302.90
|
| Rate for Payer: Multiplan Workers Comp |
$302.90
|
| Rate for Payer: Scott and White EPO/PPO |
$5.88
|
| Rate for Payer: Scott and White Medicare |
$328.73
|
| Rate for Payer: Superior Health Plan EPO |
$328.73
|
| Rate for Payer: Superior Health Plan Medicare |
$328.73
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$328.73
|
| Rate for Payer: Universal American Medicare |
$328.73
|
| Rate for Payer: Wellcare Medicare |
$328.73
|
| Rate for Payer: Wellmed Medicare |
$328.73
|
|
|
Ref Lab Antibody Titer
|
Facility
|
IP
|
$297.00
|
|
|
Service Code
|
CPT 86886
|
| Hospital Charge Code |
2403145
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$261.36
|
|
|
Ref Lab Antibody Titer
|
Facility
|
OP
|
$297.00
|
|
|
Service Code
|
CPT 86886
|
| Hospital Charge Code |
2403145
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.02 |
| Max. Negotiated Rate |
$353.86 |
| Rate for Payer: Aetna Commercial |
$5.44
|
| Rate for Payer: Aetna Medicare |
$234.32
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2.02
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$156.21
|
| Rate for Payer: Amerigroup Medicare |
$156.21
|
| Rate for Payer: BCBS of TX Blue Advantage |
$236.78
|
| Rate for Payer: BCBS of TX Blue Essentials |
$284.13
|
| Rate for Payer: BCBS of TX Medicare |
$156.21
|
| Rate for Payer: BCBS of TX PPO |
$317.14
|
| Rate for Payer: Cash Price |
$261.36
|
| Rate for Payer: Cash Price |
$261.36
|
| Rate for Payer: Cash Price |
$261.36
|
| Rate for Payer: Cigna Commercial |
$353.86
|
| Rate for Payer: Cigna Medicaid |
$5.18
|
| Rate for Payer: Cigna Medicare |
$156.21
|
| Rate for Payer: Employer Direct Commercial |
$156.21
|
| Rate for Payer: Humana Medicare/TRICARE |
$156.21
|
| Rate for Payer: Molina CHIP/Medicaid |
$5.18
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$156.21
|
| Rate for Payer: Molina Medicare |
$156.21
|
| Rate for Payer: Multiplan Auto |
$193.05
|
| Rate for Payer: Multiplan Commercial |
$193.05
|
| Rate for Payer: Multiplan Workers Comp |
$193.05
|
| Rate for Payer: Parkland Medicaid |
$5.18
|
| Rate for Payer: Scott and White EPO/PPO |
$6.48
|
| Rate for Payer: Scott and White Medicare |
$156.21
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$5.18
|
| Rate for Payer: Superior Health Plan EPO |
$156.21
|
| Rate for Payer: Superior Health Plan Medicare |
$156.21
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$156.21
|
| Rate for Payer: Universal American Medicare |
$156.21
|
| Rate for Payer: Wellcare Medicare |
$156.21
|
| Rate for Payer: Wellmed Medicare |
$156.21
|
|
|
Ref Lab Antigen Type
|
Facility
|
OP
|
$217.00
|
|
|
Service Code
|
CPT 86902
|
| Hospital Charge Code |
2408749
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.48 |
| Max. Negotiated Rate |
$744.67 |
| Rate for Payer: Aetna Commercial |
$6.67
|
| Rate for Payer: Aetna Medicare |
$493.10
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2.48
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$328.73
|
| Rate for Payer: Amerigroup Medicare |
$328.73
|
| Rate for Payer: BCBS of TX Blue Advantage |
$467.63
|
| Rate for Payer: BCBS of TX Blue Essentials |
$561.15
|
| Rate for Payer: BCBS of TX Medicare |
$328.73
|
| Rate for Payer: BCBS of TX PPO |
$626.34
|
| Rate for Payer: Cash Price |
$190.96
|
| Rate for Payer: Cash Price |
$190.96
|
| Rate for Payer: Cash Price |
$190.96
|
| Rate for Payer: Cigna Commercial |
$744.67
|
| Rate for Payer: Cigna Medicaid |
$6.35
|
| Rate for Payer: Cigna Medicare |
$328.73
|
| Rate for Payer: Employer Direct Commercial |
$328.73
|
| Rate for Payer: Humana Medicare/TRICARE |
$328.73
|
| Rate for Payer: Molina CHIP/Medicaid |
$6.35
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$328.73
|
| Rate for Payer: Molina Medicare |
$328.73
|
| Rate for Payer: Multiplan Auto |
$141.05
|
| Rate for Payer: Multiplan Commercial |
$141.05
|
| Rate for Payer: Multiplan Workers Comp |
$141.05
|
| Rate for Payer: Parkland Medicaid |
$6.35
|
| Rate for Payer: Scott and White EPO/PPO |
$7.94
|
| Rate for Payer: Scott and White Medicare |
$328.73
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$6.35
|
| Rate for Payer: Superior Health Plan EPO |
$328.73
|
| Rate for Payer: Superior Health Plan Medicare |
$328.73
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$328.73
|
| Rate for Payer: Universal American Medicare |
$328.73
|
| Rate for Payer: Wellcare Medicare |
$328.73
|
| Rate for Payer: Wellmed Medicare |
$328.73
|
|
|
Ref Lab Antigen Type
|
Facility
|
IP
|
$217.00
|
|
|
Service Code
|
CPT 86902
|
| Hospital Charge Code |
2408749
|
|
Hospital Revenue Code
|
302
|
| Rate for Payer: Cash Price |
$190.96
|
|
|
regadenoson 0.4 mg/5 mL IV Soln 5 mL
|
Facility
|
OP
|
$790.15
|
|
|
Service Code
|
HCPCS J2785
|
| Hospital Charge Code |
77792588
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$71.11 |
| Max. Negotiated Rate |
$513.60 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$71.11
|
| Rate for Payer: BCBS of TX Blue Advantage |
$88.07
|
| Rate for Payer: BCBS of TX Blue Essentials |
$105.69
|
| Rate for Payer: BCBS of TX PPO |
$117.23
|
| Rate for Payer: Cash Price |
$537.30
|
| Rate for Payer: Cash Price |
$537.30
|
| Rate for Payer: Multiplan Auto |
$513.60
|
| Rate for Payer: Multiplan Commercial |
$513.60
|
| Rate for Payer: Multiplan Workers Comp |
$513.60
|
| Rate for Payer: Scott and White EPO/PPO |
$395.08
|
| Rate for Payer: Superior Health Plan EPO |
$107.46
|
|
|
regadenoson 0.4 mg/5 mL IV Soln 5 mL
|
Facility
|
IP
|
$790.15
|
|
|
Service Code
|
HCPCS J2785
|
| Hospital Charge Code |
77792588
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$197.54 |
| Max. Negotiated Rate |
$395.08 |
| Rate for Payer: Cash Price |
$537.30
|
| Rate for Payer: Cigna Commercial |
$197.54
|
| Rate for Payer: Scott and White EPO/PPO |
$395.08
|
|
|
regenecare wound care gel ha spray
|
Facility
|
OP
|
$64.51
|
|
| Hospital Charge Code |
8656565
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.81 |
| Max. Negotiated Rate |
$41.93 |
| Rate for Payer: Aetna Commercial |
$35.48
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$5.81
|
| Rate for Payer: BCBS of TX Blue Advantage |
$19.35
|
| Rate for Payer: BCBS of TX Blue Essentials |
$23.22
|
| Rate for Payer: BCBS of TX PPO |
$25.80
|
| Rate for Payer: Cash Price |
$56.77
|
| Rate for Payer: Multiplan Auto |
$41.93
|
| Rate for Payer: Multiplan Commercial |
$41.93
|
| Rate for Payer: Multiplan Workers Comp |
$41.93
|
| Rate for Payer: Scott and White EPO/PPO |
$32.26
|
| Rate for Payer: Superior Health Plan EPO |
$8.77
|
|
|
regenecare wound care gel ha spray
|
Facility
|
IP
|
$64.51
|
|
| Hospital Charge Code |
8656565
|
|
Hospital Revenue Code
|
270
|
| Rate for Payer: Cash Price |
$56.77
|
|
|
REHABILITATION WITH CC/MCC
|
Facility
|
IP
|
$28,680.50
|
|
|
Service Code
|
MSDRG 945
|
| Min. Negotiated Rate |
$10,521.24 |
| Max. Negotiated Rate |
$28,680.50 |
| Rate for Payer: Aetna Commercial |
$16,981.88
|
| Rate for Payer: Aetna Medicare |
$20,439.99
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$13,626.66
|
| Rate for Payer: Amerigroup Medicare |
$13,626.66
|
| Rate for Payer: BCBS of TX Blue Advantage |
$10,521.24
|
| Rate for Payer: BCBS of TX Blue Essentials |
$14,084.40
|
| Rate for Payer: BCBS of TX Medicare |
$13,626.66
|
| Rate for Payer: BCBS of TX PPO |
$15,649.94
|
| Rate for Payer: Cigna Commercial |
$19,442.36
|
| Rate for Payer: Cigna Medicare |
$13,626.66
|
| Rate for Payer: Employer Direct Commercial |
$13,626.66
|
| Rate for Payer: Humana Medicare/TRICARE |
$13,626.66
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$13,626.66
|
| Rate for Payer: Molina Medicare |
$13,626.66
|
| Rate for Payer: Multiplan Auto |
$28,680.50
|
| Rate for Payer: Multiplan Commercial |
$28,680.50
|
| Rate for Payer: Multiplan Workers Comp |
$28,680.50
|
| Rate for Payer: Scott and White EPO/PPO |
$13,208.12
|
| Rate for Payer: Scott and White Medicare |
$13,626.66
|
| Rate for Payer: Superior Health Plan EPO |
$13,626.66
|
| Rate for Payer: Superior Health Plan Medicare |
$13,626.66
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$13,626.66
|
| Rate for Payer: Universal American Medicare |
$13,626.66
|
| Rate for Payer: Wellcare Medicare |
$13,626.66
|
| Rate for Payer: Wellmed Medicare |
$13,626.66
|
|
|
REHABILITATION WITHOUT CC/MCC
|
Facility
|
IP
|
$19,241.30
|
|
|
Service Code
|
MSDRG 946
|
| Min. Negotiated Rate |
$8,861.12 |
| Max. Negotiated Rate |
$19,241.30 |
| Rate for Payer: Aetna Commercial |
$11,392.88
|
| Rate for Payer: Aetna Medicare |
$15,122.19
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$10,081.46
|
| Rate for Payer: Amerigroup Medicare |
$10,081.46
|
| Rate for Payer: BCBS of TX Blue Advantage |
$9,059.24
|
| Rate for Payer: BCBS of TX Blue Essentials |
$10,759.62
|
| Rate for Payer: BCBS of TX Medicare |
$10,081.46
|
| Rate for Payer: BCBS of TX PPO |
$11,955.60
|
| Rate for Payer: Cigna Commercial |
$13,043.58
|
| Rate for Payer: Cigna Medicare |
$10,081.46
|
| Rate for Payer: Employer Direct Commercial |
$10,081.46
|
| Rate for Payer: Humana Medicare/TRICARE |
$10,081.46
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$10,081.46
|
| Rate for Payer: Molina Medicare |
$10,081.46
|
| Rate for Payer: Multiplan Auto |
$19,241.30
|
| Rate for Payer: Multiplan Commercial |
$19,241.30
|
| Rate for Payer: Multiplan Workers Comp |
$19,241.30
|
| Rate for Payer: Scott and White EPO/PPO |
$8,861.12
|
| Rate for Payer: Scott and White Medicare |
$10,081.46
|
| Rate for Payer: Superior Health Plan EPO |
$10,081.46
|
| Rate for Payer: Superior Health Plan Medicare |
$10,081.46
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$10,081.46
|
| Rate for Payer: Universal American Medicare |
$10,081.46
|
| Rate for Payer: Wellcare Medicare |
$10,081.46
|
| Rate for Payer: Wellmed Medicare |
$10,081.46
|
|
|
Reinsertion of ruptured biceps or triceps tendon, distal, with or without tendon graft
|
Facility
|
OP
|
$15,074.51
|
|
|
Service Code
|
CPT 24342
|
| Hospital Charge Code |
36024342
|
|
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
|
|
|
Release foot/toe nerve
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 64726
|
| Hospital Charge Code |
36064726
|
|
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
|
|
|
Release Hand/Finger Tendon
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 26445
|
| Hospital Charge Code |
36026445
|
|
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
|
|
|
RELOAD, ENDOSCOPIC ECHELON 45 REGULAR 6 ROW BLUE -- DHF
|
Facility
|
OP
|
$615.69
|
|
| Hospital Charge Code |
81911703
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$55.41 |
| Max. Negotiated Rate |
$400.20 |
| Rate for Payer: Aetna Commercial |
$338.63
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$55.41
|
| Rate for Payer: BCBS of TX Blue Advantage |
$184.71
|
| Rate for Payer: BCBS of TX Blue Essentials |
$221.65
|
| Rate for Payer: BCBS of TX PPO |
$246.28
|
| Rate for Payer: Cash Price |
$541.81
|
| Rate for Payer: Multiplan Auto |
$400.20
|
| Rate for Payer: Multiplan Commercial |
$400.20
|
| Rate for Payer: Multiplan Workers Comp |
$400.20
|
| Rate for Payer: Scott and White EPO/PPO |
$307.84
|
| Rate for Payer: Superior Health Plan EPO |
$83.73
|
|
|
RELOAD, ENDOSCOPIC ECHELON 45 REGULAR 6 ROW WHITE -- DHF
|
Facility
|
OP
|
$615.69
|
|
| Hospital Charge Code |
81911703
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$55.41 |
| Max. Negotiated Rate |
$400.20 |
| Rate for Payer: Aetna Commercial |
$338.63
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$55.41
|
| Rate for Payer: BCBS of TX Blue Advantage |
$184.71
|
| Rate for Payer: BCBS of TX Blue Essentials |
$221.65
|
| Rate for Payer: BCBS of TX PPO |
$246.28
|
| Rate for Payer: Cash Price |
$541.81
|
| Rate for Payer: Multiplan Auto |
$400.20
|
| Rate for Payer: Multiplan Commercial |
$400.20
|
| Rate for Payer: Multiplan Workers Comp |
$400.20
|
| Rate for Payer: Scott and White EPO/PPO |
$307.84
|
| Rate for Payer: Superior Health Plan EPO |
$83.73
|
|
|
RELOAD, ENDOSCOPIC LINEAR CUTTER ETS45 WHITE 45MM -- DHF
|
Facility
|
OP
|
$615.69
|
|
| Hospital Charge Code |
81911703
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$55.41 |
| Max. Negotiated Rate |
$400.20 |
| Rate for Payer: Aetna Commercial |
$338.63
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$55.41
|
| Rate for Payer: BCBS of TX Blue Advantage |
$184.71
|
| Rate for Payer: BCBS of TX Blue Essentials |
$221.65
|
| Rate for Payer: BCBS of TX PPO |
$246.28
|
| Rate for Payer: Cash Price |
$541.81
|
| Rate for Payer: Multiplan Auto |
$400.20
|
| Rate for Payer: Multiplan Commercial |
$400.20
|
| Rate for Payer: Multiplan Workers Comp |
$400.20
|
| Rate for Payer: Scott and White EPO/PPO |
$307.84
|
| Rate for Payer: Superior Health Plan EPO |
$83.73
|
|
|
RELOAD, ENDOSCOPIC LINEAR RELOADABLE BLACK 60MM -- DHF
|
Facility
|
OP
|
$615.69
|
|
| Hospital Charge Code |
81911703
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$55.41 |
| Max. Negotiated Rate |
$400.20 |
| Rate for Payer: Aetna Commercial |
$338.63
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$55.41
|
| Rate for Payer: BCBS of TX Blue Advantage |
$184.71
|
| Rate for Payer: BCBS of TX Blue Essentials |
$221.65
|
| Rate for Payer: BCBS of TX PPO |
$246.28
|
| Rate for Payer: Cash Price |
$541.81
|
| Rate for Payer: Multiplan Auto |
$400.20
|
| Rate for Payer: Multiplan Commercial |
$400.20
|
| Rate for Payer: Multiplan Workers Comp |
$400.20
|
| Rate for Payer: Scott and White EPO/PPO |
$307.84
|
| Rate for Payer: Superior Health Plan EPO |
$83.73
|
|
|
RELOAD, ENDOSCOPIC LINEAR RELOADABLE BLUE 60MM -- DHF
|
Facility
|
OP
|
$1,558.66
|
|
| Hospital Charge Code |
81945859
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$140.28 |
| Max. Negotiated Rate |
$1,013.13 |
| Rate for Payer: Aetna Commercial |
$857.26
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$140.28
|
| Rate for Payer: BCBS of TX Blue Advantage |
$467.60
|
| Rate for Payer: BCBS of TX Blue Essentials |
$561.12
|
| Rate for Payer: BCBS of TX PPO |
$623.46
|
| Rate for Payer: Cash Price |
$1,371.62
|
| Rate for Payer: Multiplan Auto |
$1,013.13
|
| Rate for Payer: Multiplan Commercial |
$1,013.13
|
| Rate for Payer: Multiplan Workers Comp |
$1,013.13
|
| Rate for Payer: Scott and White EPO/PPO |
$779.33
|
| Rate for Payer: Superior Health Plan EPO |
$211.98
|
|
|
RELOAD, ENDOSCOPIC LINEAR RELOADABLE GOLD 60MM -- DHF
|
Facility
|
OP
|
$1,558.66
|
|
| Hospital Charge Code |
81945859
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$140.28 |
| Max. Negotiated Rate |
$1,013.13 |
| Rate for Payer: Aetna Commercial |
$857.26
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$140.28
|
| Rate for Payer: BCBS of TX Blue Advantage |
$467.60
|
| Rate for Payer: BCBS of TX Blue Essentials |
$561.12
|
| Rate for Payer: BCBS of TX PPO |
$623.46
|
| Rate for Payer: Cash Price |
$1,371.62
|
| Rate for Payer: Multiplan Auto |
$1,013.13
|
| Rate for Payer: Multiplan Commercial |
$1,013.13
|
| Rate for Payer: Multiplan Workers Comp |
$1,013.13
|
| Rate for Payer: Scott and White EPO/PPO |
$779.33
|
| Rate for Payer: Superior Health Plan EPO |
$211.98
|
|
