|
RELOAD TRI STPL 60 TAN EGIA60AVM
|
Facility
|
OP
|
$2,655.99
|
|
| Hospital Charge Code |
8612531
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$239.04 |
| Max. Negotiated Rate |
$1,726.39 |
| Rate for Payer: Aetna Commercial |
$1,460.79
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$239.04
|
| Rate for Payer: BCBS of TX Blue Advantage |
$796.80
|
| Rate for Payer: BCBS of TX Blue Essentials |
$956.16
|
| Rate for Payer: BCBS of TX PPO |
$1,062.40
|
| Rate for Payer: Cash Price |
$2,337.27
|
| Rate for Payer: Multiplan Auto |
$1,726.39
|
| Rate for Payer: Multiplan Commercial |
$1,726.39
|
| Rate for Payer: Multiplan Workers Comp |
$1,726.39
|
| Rate for Payer: Scott and White EPO/PPO |
$1,328.00
|
| Rate for Payer: Superior Health Plan EPO |
$361.21
|
|
|
RELOAD TRI STPL 60 TAN EGIA60AVM
|
Facility
|
IP
|
$2,655.99
|
|
| Hospital Charge Code |
8612531
|
|
Hospital Revenue Code
|
272
|
| Rate for Payer: Cash Price |
$2,337.27
|
|
|
REM AICD LDS TRANSVEN
|
Facility
|
IP
|
$6,343.00
|
|
|
Service Code
|
CPT 33244
|
| Hospital Charge Code |
2302503
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$5,581.84
|
|
|
REM AICD LDS TRANSVEN
|
Facility
|
OP
|
$6,343.00
|
|
|
Service Code
|
CPT 33244
|
| Hospital Charge Code |
2302503
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$79.22 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$4,635.00
|
| Rate for Payer: Aetna Medicare |
$5,387.14
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$570.87
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3,591.43
|
| Rate for Payer: Amerigroup Medicare |
$3,591.43
|
| Rate for Payer: BCBS of TX Blue Advantage |
$4,983.30
|
| Rate for Payer: BCBS of TX Blue Essentials |
$5,968.02
|
| Rate for Payer: BCBS of TX Medicare |
$3,591.43
|
| Rate for Payer: BCBS of TX PPO |
$7,519.71
|
| Rate for Payer: Cash Price |
$5,581.84
|
| Rate for Payer: Cash Price |
$5,581.84
|
| Rate for Payer: Cash Price |
$5,581.84
|
| Rate for Payer: Cigna Commercial |
$8,135.63
|
| Rate for Payer: Cigna Medicare |
$3,591.43
|
| Rate for Payer: Employer Direct Commercial |
$3,591.43
|
| Rate for Payer: Humana Medicare/TRICARE |
$3,591.43
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3,591.43
|
| Rate for Payer: Molina Medicare |
$3,591.43
|
| Rate for Payer: Multiplan Auto |
$10,000.00
|
| Rate for Payer: Multiplan Commercial |
$10,000.00
|
| Rate for Payer: Multiplan Workers Comp |
$10,000.00
|
| Rate for Payer: Scott and White EPO/PPO |
$79.22
|
| Rate for Payer: Scott and White Medicare |
$3,591.43
|
| Rate for Payer: Superior Health Plan EPO |
$3,591.43
|
| Rate for Payer: Superior Health Plan Medicare |
$3,591.43
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3,591.43
|
| Rate for Payer: Universal American Medicare |
$3,591.43
|
| Rate for Payer: Wellcare Medicare |
$3,591.43
|
| Rate for Payer: Wellmed Medicare |
$3,591.43
|
|
|
Remote Physiologic Monitoring 20+ Minutes Of Monitoring 99457 BCE
|
Facility
|
OP
|
$183.00
|
|
|
Service Code
|
CPT 99457
|
| Hospital Charge Code |
6019908
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$16.47 |
| Max. Negotiated Rate |
$118.95 |
| Rate for Payer: Aetna Commercial |
$100.65
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$16.47
|
| Rate for Payer: BCBS of TX Blue Advantage |
$56.45
|
| Rate for Payer: BCBS of TX Blue Essentials |
$67.48
|
| Rate for Payer: BCBS of TX PPO |
$75.26
|
| Rate for Payer: Cash Price |
$161.04
|
| Rate for Payer: Cash Price |
$161.04
|
| Rate for Payer: Multiplan Auto |
$118.95
|
| Rate for Payer: Multiplan Commercial |
$118.95
|
| Rate for Payer: Multiplan Workers Comp |
$118.95
|
| Rate for Payer: Scott and White EPO/PPO |
$91.50
|
|
|
Remote Physiologic Monitoring 20+ Minutes Of Monitoring 99457 BCE
|
Facility
|
IP
|
$183.00
|
|
|
Service Code
|
CPT 99457
|
| Hospital Charge Code |
6019908
|
|
Hospital Revenue Code
|
510
|
| Rate for Payer: Cash Price |
$161.04
|
|
|
Remote Physiologic Monitoring Device (Each 30 Days) 99454 BCE
|
Facility
|
IP
|
$183.00
|
|
|
Service Code
|
CPT 99454
|
| Hospital Charge Code |
6019907
|
|
Hospital Revenue Code
|
510
|
| Rate for Payer: Cash Price |
$161.04
|
|
|
Remote Physiologic Monitoring Device (Each 30 Days) 99454 BCE
|
Facility
|
OP
|
$183.00
|
|
|
Service Code
|
CPT 99454
|
| Hospital Charge Code |
6019907
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$118.95 |
| Rate for Payer: Aetna Commercial |
$100.65
|
| Rate for Payer: Aetna Medicare |
$51.74
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$16.47
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$34.49
|
| Rate for Payer: Amerigroup Medicare |
$34.49
|
| Rate for Payer: BCBS of TX Blue Advantage |
$63.08
|
| Rate for Payer: BCBS of TX Blue Essentials |
$75.40
|
| Rate for Payer: BCBS of TX Medicare |
$34.49
|
| Rate for Payer: BCBS of TX PPO |
$84.10
|
| Rate for Payer: Cash Price |
$161.04
|
| Rate for Payer: Cash Price |
$161.04
|
| Rate for Payer: Cash Price |
$161.04
|
| Rate for Payer: Cigna Commercial |
$78.13
|
| Rate for Payer: Cigna Medicare |
$34.49
|
| Rate for Payer: Employer Direct Commercial |
$34.49
|
| Rate for Payer: Humana Medicare/TRICARE |
$34.49
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$34.49
|
| Rate for Payer: Molina Medicare |
$34.49
|
| Rate for Payer: Multiplan Auto |
$118.95
|
| Rate for Payer: Multiplan Commercial |
$118.95
|
| Rate for Payer: Multiplan Workers Comp |
$118.95
|
| Rate for Payer: Scott and White EPO/PPO |
$0.62
|
| Rate for Payer: Scott and White Medicare |
$34.49
|
| Rate for Payer: Superior Health Plan EPO |
$34.49
|
| Rate for Payer: Superior Health Plan Medicare |
$34.49
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$34.49
|
| Rate for Payer: Universal American Medicare |
$34.49
|
| Rate for Payer: Wellcare Medicare |
$34.49
|
| Rate for Payer: Wellmed Medicare |
$34.49
|
|
|
Remote Physiologic Monitoring Initial Setup 99453 BCE
|
Facility
|
IP
|
$570.00
|
|
|
Service Code
|
CPT 99453
|
| Hospital Charge Code |
6019906
|
|
Hospital Revenue Code
|
510
|
| Rate for Payer: Cash Price |
$501.60
|
|
|
Remote Physiologic Monitoring Initial Setup 99453 BCE
|
Facility
|
OP
|
$570.00
|
|
|
Service Code
|
CPT 99453
|
| Hospital Charge Code |
6019906
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$2.16 |
| Max. Negotiated Rate |
$370.50 |
| Rate for Payer: Aetna Commercial |
$313.50
|
| Rate for Payer: Aetna Medicare |
$181.34
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$51.30
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$120.89
|
| Rate for Payer: Amerigroup Medicare |
$120.89
|
| Rate for Payer: BCBS of TX Blue Advantage |
$201.72
|
| Rate for Payer: BCBS of TX Blue Essentials |
$241.13
|
| Rate for Payer: BCBS of TX Medicare |
$120.89
|
| Rate for Payer: BCBS of TX PPO |
$268.96
|
| Rate for Payer: Cash Price |
$501.60
|
| Rate for Payer: Cash Price |
$501.60
|
| Rate for Payer: Cash Price |
$501.60
|
| Rate for Payer: Cigna Commercial |
$273.87
|
| Rate for Payer: Cigna Medicare |
$120.89
|
| Rate for Payer: Employer Direct Commercial |
$120.89
|
| Rate for Payer: Humana Medicare/TRICARE |
$120.89
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$120.89
|
| Rate for Payer: Molina Medicare |
$120.89
|
| Rate for Payer: Multiplan Auto |
$370.50
|
| Rate for Payer: Multiplan Commercial |
$370.50
|
| Rate for Payer: Multiplan Workers Comp |
$370.50
|
| Rate for Payer: Scott and White EPO/PPO |
$2.16
|
| Rate for Payer: Scott and White Medicare |
$120.89
|
| Rate for Payer: Superior Health Plan EPO |
$120.89
|
| Rate for Payer: Superior Health Plan Medicare |
$120.89
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$120.89
|
| Rate for Payer: Universal American Medicare |
$120.89
|
| Rate for Payer: Wellcare Medicare |
$120.89
|
| Rate for Payer: Wellmed Medicare |
$120.89
|
|
|
REMOVAL AICD GENERATOR
|
Facility
|
IP
|
$5,613.00
|
|
|
Service Code
|
CPT 33241
|
| Hospital Charge Code |
2302313
|
|
Hospital Revenue Code
|
481
|
| Rate for Payer: Cash Price |
$4,939.44
|
|
|
REMOVAL AICD GENERATOR
|
Facility
|
OP
|
$5,613.00
|
|
|
Service Code
|
CPT 33241
|
| Hospital Charge Code |
2302313
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$64.23 |
| Max. Negotiated Rate |
$8,135.63 |
| Rate for Payer: Aetna Commercial |
$4,635.00
|
| Rate for Payer: Aetna Medicare |
$5,387.14
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$505.17
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3,591.43
|
| Rate for Payer: Amerigroup Medicare |
$3,591.43
|
| Rate for Payer: BCBS of TX Blue Advantage |
$4,983.30
|
| Rate for Payer: BCBS of TX Blue Essentials |
$5,968.02
|
| Rate for Payer: BCBS of TX Medicare |
$3,591.43
|
| Rate for Payer: BCBS of TX PPO |
$7,519.71
|
| Rate for Payer: Cash Price |
$4,939.44
|
| Rate for Payer: Cash Price |
$4,939.44
|
| Rate for Payer: Cash Price |
$4,939.44
|
| Rate for Payer: Cigna Commercial |
$8,135.63
|
| Rate for Payer: Cigna Medicaid |
$1,425.44
|
| Rate for Payer: Cigna Medicare |
$3,591.43
|
| Rate for Payer: Employer Direct Commercial |
$3,591.43
|
| Rate for Payer: Humana Medicare/TRICARE |
$3,591.43
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,425.44
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3,591.43
|
| Rate for Payer: Molina Medicare |
$3,591.43
|
| Rate for Payer: Multiplan Auto |
$3,648.45
|
| Rate for Payer: Multiplan Commercial |
$3,648.45
|
| Rate for Payer: Multiplan Workers Comp |
$3,648.45
|
| Rate for Payer: Parkland Medicaid |
$1,425.44
|
| Rate for Payer: Scott and White EPO/PPO |
$64.23
|
| Rate for Payer: Scott and White Medicare |
$3,591.43
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,425.44
|
| Rate for Payer: Superior Health Plan EPO |
$3,591.43
|
| Rate for Payer: Superior Health Plan Medicare |
$3,591.43
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3,591.43
|
| Rate for Payer: Universal American Medicare |
$3,591.43
|
| Rate for Payer: Wellcare Medicare |
$3,591.43
|
| Rate for Payer: Wellmed Medicare |
$3,591.43
|
|
|
Removal foreign body from external auditory canal; with general anesthesia
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 69205
|
| Hospital Charge Code |
36069205
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$32.70 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$2,200.00
|
| Rate for Payer: Aetna Medicare |
$2,224.11
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$486.45
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,482.74
|
| Rate for Payer: Amerigroup Medicare |
$1,482.74
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,292.24
|
| Rate for Payer: BCBS of TX Blue Essentials |
$2,745.20
|
| Rate for Payer: BCBS of TX Medicare |
$1,482.74
|
| Rate for Payer: BCBS of TX PPO |
$3,458.95
|
| Rate for Payer: Cigna Commercial |
$3,358.84
|
| Rate for Payer: Cigna Medicaid |
$486.45
|
| Rate for Payer: Cigna Medicare |
$1,482.74
|
| Rate for Payer: Employer Direct Commercial |
$1,482.74
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,482.74
|
| Rate for Payer: Molina CHIP/Medicaid |
$486.45
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,482.74
|
| Rate for Payer: Molina Medicare |
$1,482.74
|
| 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 |
$486.45
|
| Rate for Payer: Scott and White EPO/PPO |
$32.70
|
| Rate for Payer: Scott and White Medicare |
$1,482.74
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$486.45
|
| Rate for Payer: Superior Health Plan EPO |
$1,482.74
|
| Rate for Payer: Superior Health Plan Medicare |
$1,482.74
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,482.74
|
| Rate for Payer: Universal American Medicare |
$1,482.74
|
| Rate for Payer: Wellcare Medicare |
$1,482.74
|
| Rate for Payer: Wellmed Medicare |
$1,482.74
|
|
|
REMOVAL IAB CATHETER
|
Facility
|
IP
|
$3,723.00
|
|
|
Service Code
|
CPT 33968
|
| Hospital Charge Code |
2330001
|
|
Hospital Revenue Code
|
480
|
| Rate for Payer: Cash Price |
$3,276.24
|
|
|
REMOVAL IAB CATHETER
|
Facility
|
OP
|
$3,723.00
|
|
|
Service Code
|
CPT 33968
|
| Hospital Charge Code |
2330001
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$58.98 |
| Max. Negotiated Rate |
$13,390.00 |
| Rate for Payer: Aetna Commercial |
$13,390.00
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$335.07
|
| Rate for Payer: BCBS of TX Blue Advantage |
$58.98
|
| Rate for Payer: BCBS of TX Blue Essentials |
$70.64
|
| Rate for Payer: BCBS of TX PPO |
$89.01
|
| Rate for Payer: Cash Price |
$3,276.24
|
| Rate for Payer: Cash Price |
$3,276.24
|
| Rate for Payer: Cash Price |
$3,276.24
|
| Rate for Payer: Multiplan Auto |
$2,419.95
|
| Rate for Payer: Multiplan Commercial |
$2,419.95
|
| Rate for Payer: Multiplan Workers Comp |
$2,419.95
|
| Rate for Payer: Scott and White EPO/PPO |
$1,861.50
|
| Rate for Payer: Superior Health Plan EPO |
$506.33
|
|
|
Removal of ankle implant
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 27704
|
| Hospital Charge Code |
36027704
|
|
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
|
|
|
REMOVAL OF EAR WAX BY INSTRU UNILAT
|
Facility
|
OP
|
$1,639.00
|
|
|
Service Code
|
CPT 69210
|
| Hospital Charge Code |
7150378
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$1,065.35 |
| Rate for Payer: Aetna Commercial |
$901.45
|
| Rate for Payer: Aetna Medicare |
$83.91
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$147.51
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$55.94
|
| Rate for Payer: Amerigroup Medicare |
$55.94
|
| Rate for Payer: BCBS of TX Blue Advantage |
$91.87
|
| Rate for Payer: BCBS of TX Blue Essentials |
$110.02
|
| Rate for Payer: BCBS of TX Medicare |
$55.94
|
| Rate for Payer: BCBS of TX PPO |
$138.63
|
| Rate for Payer: Cash Price |
$1,442.32
|
| Rate for Payer: Cash Price |
$1,442.32
|
| Rate for Payer: Cash Price |
$1,442.32
|
| Rate for Payer: Cigna Commercial |
$126.71
|
| Rate for Payer: Cigna Medicare |
$55.94
|
| Rate for Payer: Employer Direct Commercial |
$55.94
|
| Rate for Payer: Humana Medicare/TRICARE |
$55.94
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$55.94
|
| Rate for Payer: Molina Medicare |
$55.94
|
| Rate for Payer: Multiplan Auto |
$1,065.35
|
| Rate for Payer: Multiplan Commercial |
$1,065.35
|
| Rate for Payer: Multiplan Workers Comp |
$1,065.35
|
| Rate for Payer: Scott and White EPO/PPO |
$1.00
|
| Rate for Payer: Scott and White Medicare |
$55.94
|
| Rate for Payer: Superior Health Plan EPO |
$55.94
|
| Rate for Payer: Superior Health Plan Medicare |
$55.94
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$55.94
|
| Rate for Payer: Universal American Medicare |
$55.94
|
| Rate for Payer: Wellcare Medicare |
$55.94
|
| Rate for Payer: Wellmed Medicare |
$55.94
|
|
|
Removal of embedded foreign body from dentoalveolar structures; soft tissues
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 41805
|
| Hospital Charge Code |
36041805
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$30.76 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$2,200.00
|
| Rate for Payer: Aetna Medicare |
$2,092.08
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$220.93
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,394.72
|
| Rate for Payer: Amerigroup Medicare |
$1,394.72
|
| Rate for Payer: BCBS of TX Blue Advantage |
$421.29
|
| Rate for Payer: BCBS of TX Blue Essentials |
$504.54
|
| Rate for Payer: BCBS of TX Medicare |
$1,394.72
|
| Rate for Payer: BCBS of TX PPO |
$635.72
|
| Rate for Payer: Cigna Commercial |
$3,159.45
|
| Rate for Payer: Cigna Medicaid |
$220.93
|
| Rate for Payer: Cigna Medicare |
$1,394.72
|
| Rate for Payer: Employer Direct Commercial |
$1,394.72
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,394.72
|
| Rate for Payer: Molina CHIP/Medicaid |
$220.93
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,394.72
|
| Rate for Payer: Molina Medicare |
$1,394.72
|
| 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 |
$220.93
|
| Rate for Payer: Scott and White EPO/PPO |
$30.76
|
| Rate for Payer: Scott and White Medicare |
$1,394.72
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$220.93
|
| Rate for Payer: Superior Health Plan EPO |
$1,394.72
|
| Rate for Payer: Superior Health Plan Medicare |
$1,394.72
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,394.72
|
| Rate for Payer: Universal American Medicare |
$1,394.72
|
| Rate for Payer: Wellcare Medicare |
$1,394.72
|
| Rate for Payer: Wellmed Medicare |
$1,394.72
|
|
|
Removal of embedded foreign body, vestibule of mouth; complicated
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 40808
|
| Hospital Charge Code |
36040808
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$11.10 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Medicare |
$754.78
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$107.70
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$503.19
|
| Rate for Payer: Amerigroup Medicare |
$503.19
|
| Rate for Payer: BCBS of TX Blue Advantage |
$203.71
|
| Rate for Payer: BCBS of TX Blue Essentials |
$243.96
|
| Rate for Payer: BCBS of TX Medicare |
$503.19
|
| Rate for Payer: BCBS of TX PPO |
$307.39
|
| Rate for Payer: Cigna Commercial |
$1,139.87
|
| Rate for Payer: Cigna Medicaid |
$107.70
|
| Rate for Payer: Cigna Medicare |
$503.19
|
| Rate for Payer: Employer Direct Commercial |
$503.19
|
| Rate for Payer: Humana Medicare/TRICARE |
$503.19
|
| Rate for Payer: Molina CHIP/Medicaid |
$107.70
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$503.19
|
| Rate for Payer: Molina Medicare |
$503.19
|
| 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 |
$107.70
|
| Rate for Payer: Scott and White EPO/PPO |
$11.10
|
| Rate for Payer: Scott and White Medicare |
$503.19
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$107.70
|
| Rate for Payer: Superior Health Plan EPO |
$503.19
|
| Rate for Payer: Superior Health Plan Medicare |
$503.19
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$503.19
|
| Rate for Payer: Universal American Medicare |
$503.19
|
| Rate for Payer: Wellcare Medicare |
$503.19
|
| Rate for Payer: Wellmed Medicare |
$503.19
|
|
|
Removal of embedded foreign body, vestibule of mouth; complicated
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 40805
|
| Hospital Charge Code |
36040805
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$11.10 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Medicare |
$754.78
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$150.61
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$503.19
|
| Rate for Payer: Amerigroup Medicare |
$503.19
|
| Rate for Payer: BCBS of TX Blue Advantage |
$328.47
|
| Rate for Payer: BCBS of TX Blue Essentials |
$393.38
|
| Rate for Payer: BCBS of TX Medicare |
$503.19
|
| Rate for Payer: BCBS of TX PPO |
$495.66
|
| Rate for Payer: Cigna Commercial |
$1,139.87
|
| Rate for Payer: Cigna Medicaid |
$150.61
|
| Rate for Payer: Cigna Medicare |
$503.19
|
| Rate for Payer: Employer Direct Commercial |
$503.19
|
| Rate for Payer: Humana Medicare/TRICARE |
$503.19
|
| Rate for Payer: Molina CHIP/Medicaid |
$150.61
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$503.19
|
| Rate for Payer: Molina Medicare |
$503.19
|
| 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 |
$150.61
|
| Rate for Payer: Scott and White EPO/PPO |
$11.10
|
| Rate for Payer: Scott and White Medicare |
$503.19
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$150.61
|
| Rate for Payer: Superior Health Plan EPO |
$503.19
|
| Rate for Payer: Superior Health Plan Medicare |
$503.19
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$503.19
|
| Rate for Payer: Universal American Medicare |
$503.19
|
| Rate for Payer: Wellcare Medicare |
$503.19
|
| Rate for Payer: Wellmed Medicare |
$503.19
|
|
|
Removal of foreign body, deep, thigh region or knee area
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 27372
|
| Hospital Charge Code |
36027372
|
|
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
|
|
|
Removal of foreign body, foot; complicated
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 28193
|
| Hospital Charge Code |
36028193
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$32.70 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$1,400.00
|
| Rate for Payer: Aetna Medicare |
$2,224.11
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$486.45
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,482.74
|
| Rate for Payer: Amerigroup Medicare |
$1,482.74
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,292.24
|
| Rate for Payer: BCBS of TX Blue Essentials |
$2,745.20
|
| Rate for Payer: BCBS of TX Medicare |
$1,482.74
|
| Rate for Payer: BCBS of TX PPO |
$3,458.95
|
| Rate for Payer: Cigna Commercial |
$3,358.84
|
| Rate for Payer: Cigna Medicaid |
$486.45
|
| Rate for Payer: Cigna Medicare |
$1,482.74
|
| Rate for Payer: Employer Direct Commercial |
$1,482.74
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,482.74
|
| Rate for Payer: Molina CHIP/Medicaid |
$486.45
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,482.74
|
| Rate for Payer: Molina Medicare |
$1,482.74
|
| 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 |
$486.45
|
| Rate for Payer: Scott and White EPO/PPO |
$32.70
|
| Rate for Payer: Scott and White Medicare |
$1,482.74
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$486.45
|
| Rate for Payer: Superior Health Plan EPO |
$1,482.74
|
| Rate for Payer: Superior Health Plan Medicare |
$1,482.74
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,482.74
|
| Rate for Payer: Universal American Medicare |
$1,482.74
|
| Rate for Payer: Wellcare Medicare |
$1,482.74
|
| Rate for Payer: Wellmed Medicare |
$1,482.74
|
|
|
Removal of foreign body, foot deep
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 28192
|
| Hospital Charge Code |
36028192
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$32.70 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$2,200.00
|
| Rate for Payer: Aetna Medicare |
$2,224.11
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$486.45
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,482.74
|
| Rate for Payer: Amerigroup Medicare |
$1,482.74
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,292.24
|
| Rate for Payer: BCBS of TX Blue Essentials |
$2,745.20
|
| Rate for Payer: BCBS of TX Medicare |
$1,482.74
|
| Rate for Payer: BCBS of TX PPO |
$3,458.95
|
| Rate for Payer: Cigna Commercial |
$3,358.84
|
| Rate for Payer: Cigna Medicaid |
$486.45
|
| Rate for Payer: Cigna Medicare |
$1,482.74
|
| Rate for Payer: Employer Direct Commercial |
$1,482.74
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,482.74
|
| Rate for Payer: Molina CHIP/Medicaid |
$486.45
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,482.74
|
| Rate for Payer: Molina Medicare |
$1,482.74
|
| 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 |
$486.45
|
| Rate for Payer: Scott and White EPO/PPO |
$32.70
|
| Rate for Payer: Scott and White Medicare |
$1,482.74
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$486.45
|
| Rate for Payer: Superior Health Plan EPO |
$1,482.74
|
| Rate for Payer: Superior Health Plan Medicare |
$1,482.74
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,482.74
|
| Rate for Payer: Universal American Medicare |
$1,482.74
|
| Rate for Payer: Wellcare Medicare |
$1,482.74
|
| Rate for Payer: Wellmed Medicare |
$1,482.74
|
|
|
Removal of foreign body in muscle or tendon sheath deep or complicated
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 20525
|
| Hospital Charge Code |
36020525
|
|
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
|
|
|
Removal of implant deep (eg, buried wire, pin, screw, metal band, nail, rod or plate)
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 20680
|
| Hospital Charge Code |
36020680
|
|
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
|
|
