|
Removal of implant; superficial (eg, buried wire, pin or rod) (separate procedure)
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 20670
|
| Hospital Charge Code |
36020670
|
|
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 lens material aspiration technique, 1 or more stages
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 66840
|
| Hospital Charge Code |
36066840
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$47.01 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$3,090.00
|
| Rate for Payer: Aetna Medicare |
$3,196.84
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$849.94
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$2,131.23
|
| Rate for Payer: Amerigroup Medicare |
$2,131.23
|
| Rate for Payer: BCBS of TX Blue Advantage |
$3,376.51
|
| Rate for Payer: BCBS of TX Blue Essentials |
$4,043.72
|
| Rate for Payer: BCBS of TX Medicare |
$2,131.23
|
| Rate for Payer: BCBS of TX PPO |
$5,095.09
|
| Rate for Payer: Cigna Commercial |
$4,827.84
|
| Rate for Payer: Cigna Medicaid |
$849.94
|
| Rate for Payer: Cigna Medicare |
$2,131.23
|
| Rate for Payer: Employer Direct Commercial |
$2,131.23
|
| Rate for Payer: Humana Medicare/TRICARE |
$2,131.23
|
| Rate for Payer: Molina CHIP/Medicaid |
$849.94
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$2,131.23
|
| Rate for Payer: Molina Medicare |
$2,131.23
|
| 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 |
$849.94
|
| Rate for Payer: Scott and White EPO/PPO |
$47.01
|
| Rate for Payer: Scott and White Medicare |
$2,131.23
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$849.94
|
| Rate for Payer: Superior Health Plan EPO |
$2,131.23
|
| Rate for Payer: Superior Health Plan Medicare |
$2,131.23
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$2,131.23
|
| Rate for Payer: Universal American Medicare |
$2,131.23
|
| Rate for Payer: Wellcare Medicare |
$2,131.23
|
| Rate for Payer: Wellmed Medicare |
$2,131.23
|
|
|
Removal Of Nail Bed
|
Facility
|
OP
|
$4,009.00
|
|
|
Service Code
|
CPT 11750
|
| Hospital Charge Code |
7150818
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$6.52 |
| Max. Negotiated Rate |
$2,605.85 |
| Rate for Payer: Aetna Commercial |
$2,204.95
|
| Rate for Payer: Aetna Medicare |
$547.00
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$360.81
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$364.67
|
| Rate for Payer: Amerigroup Medicare |
$364.67
|
| Rate for Payer: BCBS of TX Blue Advantage |
$165.75
|
| Rate for Payer: BCBS of TX Blue Essentials |
$198.50
|
| Rate for Payer: BCBS of TX Medicare |
$364.67
|
| Rate for Payer: BCBS of TX PPO |
$250.11
|
| Rate for Payer: Cash Price |
$3,527.92
|
| Rate for Payer: Cash Price |
$3,527.92
|
| Rate for Payer: Cash Price |
$3,527.92
|
| Rate for Payer: Cigna Commercial |
$826.08
|
| Rate for Payer: Cigna Medicaid |
$84.71
|
| 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 |
$84.71
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$364.67
|
| Rate for Payer: Molina Medicare |
$364.67
|
| Rate for Payer: Multiplan Auto |
$2,605.85
|
| Rate for Payer: Multiplan Commercial |
$2,605.85
|
| Rate for Payer: Multiplan Workers Comp |
$2,605.85
|
| Rate for Payer: Parkland Medicaid |
$84.71
|
| 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 |
$84.71
|
| 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
|
|
|
Removal of posterior nonsegmental instrumentation (eg, Harrington rod)
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 22850
|
| Hospital Charge Code |
36022850
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,266.29 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$7,210.00
|
| Rate for Payer: BCBS of TX Blue Advantage |
$1,266.29
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,516.52
|
| Rate for Payer: BCBS of TX PPO |
$1,910.82
|
| 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
|
|
|
Removal of previously implanted intrathecal or epidural catheter
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 62355
|
| Hospital Charge Code |
36062355
|
|
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
|
|
|
Removal of prosthesis, includes debridement and synovectomy when performed humeral and glenoid comp
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 23335
|
| Hospital Charge Code |
36023335
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,218.43 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$3,090.00
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,218.43
|
| Rate for Payer: BCBS of TX Blue Essentials |
$2,656.80
|
| Rate for Payer: BCBS of TX PPO |
$3,347.57
|
| 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
|
|
|
Removal of prosthetic material or mesh, abdominal wall for infection (eg, for chronic or recurrent m
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 11008
|
| Hospital Charge Code |
36011008
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$479.07 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$4,635.00
|
| Rate for Payer: BCBS of TX Blue Advantage |
$479.07
|
| Rate for Payer: BCBS of TX Blue Essentials |
$573.74
|
| Rate for Payer: BCBS of TX PPO |
$722.91
|
| 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
|
|
|
Removal of ruptured breast implant, including implant contents (eg, saline, silicone gel)
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 19330
|
| Hospital Charge Code |
36019330
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$76.89 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$4,635.00
|
| Rate for Payer: Aetna Medicare |
$5,229.02
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$963.66
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3,486.01
|
| Rate for Payer: Amerigroup Medicare |
$3,486.01
|
| Rate for Payer: BCBS of TX Blue Advantage |
$5,059.35
|
| Rate for Payer: BCBS of TX Blue Essentials |
$6,059.10
|
| Rate for Payer: BCBS of TX Medicare |
$3,486.01
|
| Rate for Payer: BCBS of TX PPO |
$7,634.47
|
| Rate for Payer: Cigna Commercial |
$7,896.82
|
| Rate for Payer: Cigna Medicaid |
$963.66
|
| Rate for Payer: Cigna Medicare |
$3,486.01
|
| Rate for Payer: Employer Direct Commercial |
$3,486.01
|
| Rate for Payer: Humana Medicare/TRICARE |
$3,486.01
|
| Rate for Payer: Molina CHIP/Medicaid |
$963.66
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3,486.01
|
| Rate for Payer: Molina Medicare |
$3,486.01
|
| 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 |
$963.66
|
| Rate for Payer: Scott and White EPO/PPO |
$76.89
|
| Rate for Payer: Scott and White Medicare |
$3,486.01
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$963.66
|
| Rate for Payer: Superior Health Plan EPO |
$3,486.01
|
| Rate for Payer: Superior Health Plan Medicare |
$3,486.01
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3,486.01
|
| Rate for Payer: Universal American Medicare |
$3,486.01
|
| Rate for Payer: Wellcare Medicare |
$3,486.01
|
| Rate for Payer: Wellmed Medicare |
$3,486.01
|
|
|
REMOVAL OF SKIN LESION
|
Facility
|
OP
|
$2,477.00
|
|
|
Service Code
|
CPT 11200
|
| Hospital Charge Code |
7150212
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3.27 |
| Max. Negotiated Rate |
$1,610.05 |
| Rate for Payer: Aetna Commercial |
$1,362.35
|
| Rate for Payer: Aetna Medicare |
$274.64
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$222.93
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$183.09
|
| Rate for Payer: Amerigroup Medicare |
$183.09
|
| Rate for Payer: BCBS of TX Blue Advantage |
$291.80
|
| Rate for Payer: BCBS of TX Blue Essentials |
$349.46
|
| Rate for Payer: BCBS of TX Medicare |
$183.09
|
| Rate for Payer: BCBS of TX PPO |
$440.32
|
| Rate for Payer: Cash Price |
$2,179.76
|
| Rate for Payer: Cash Price |
$2,179.76
|
| Rate for Payer: Cash Price |
$2,179.76
|
| Rate for Payer: Cigna Commercial |
$414.75
|
| Rate for Payer: Cigna Medicare |
$183.09
|
| Rate for Payer: Employer Direct Commercial |
$183.09
|
| Rate for Payer: Humana Medicare/TRICARE |
$183.09
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$183.09
|
| Rate for Payer: Molina Medicare |
$183.09
|
| Rate for Payer: Multiplan Auto |
$1,610.05
|
| Rate for Payer: Multiplan Commercial |
$1,610.05
|
| Rate for Payer: Multiplan Workers Comp |
$1,610.05
|
| Rate for Payer: Scott and White EPO/PPO |
$3.27
|
| Rate for Payer: Scott and White Medicare |
$183.09
|
| Rate for Payer: Superior Health Plan EPO |
$183.09
|
| Rate for Payer: Superior Health Plan Medicare |
$183.09
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$183.09
|
| Rate for Payer: Universal American Medicare |
$183.09
|
| Rate for Payer: Wellcare Medicare |
$183.09
|
| Rate for Payer: Wellmed Medicare |
$183.09
|
|
|
Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 11200
|
| Hospital Charge Code |
36011200
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4.04 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Medicare |
$274.64
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$183.09
|
| Rate for Payer: Amerigroup Medicare |
$183.09
|
| Rate for Payer: BCBS of TX Blue Advantage |
$291.80
|
| Rate for Payer: BCBS of TX Blue Essentials |
$349.46
|
| Rate for Payer: BCBS of TX Medicare |
$183.09
|
| Rate for Payer: BCBS of TX PPO |
$440.32
|
| Rate for Payer: Cigna Commercial |
$414.75
|
| Rate for Payer: Cigna Medicare |
$183.09
|
| Rate for Payer: Employer Direct Commercial |
$183.09
|
| Rate for Payer: Humana Medicare/TRICARE |
$183.09
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$183.09
|
| Rate for Payer: Molina Medicare |
$183.09
|
| 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 |
$4.04
|
| Rate for Payer: Scott and White Medicare |
$183.09
|
| Rate for Payer: Superior Health Plan EPO |
$183.09
|
| Rate for Payer: Superior Health Plan Medicare |
$183.09
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$183.09
|
| Rate for Payer: Universal American Medicare |
$183.09
|
| Rate for Payer: Wellcare Medicare |
$183.09
|
| Rate for Payer: Wellmed Medicare |
$183.09
|
|
|
Removal of spinal neurostimulator electrode percutaneous array(s)
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 63661
|
| Hospital Charge Code |
36063661
|
|
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
|
|
|
Removal of subcutaneous reservoir or pump, previously implanted for intrathecal or epidural infusion
|
Facility
|
OP
|
$13,882.71
|
|
|
Service Code
|
CPT 62365
|
| Hospital Charge Code |
36062365
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$134.37 |
| Max. Negotiated Rate |
$13,882.71 |
| Rate for Payer: Aetna Commercial |
$7,210.00
|
| Rate for Payer: Aetna Medicare |
$9,138.30
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,996.58
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$6,092.20
|
| Rate for Payer: Amerigroup Medicare |
$6,092.20
|
| Rate for Payer: BCBS of TX Blue Advantage |
$9,200.05
|
| Rate for Payer: BCBS of TX Blue Essentials |
$11,018.02
|
| Rate for Payer: BCBS of TX Medicare |
$6,092.20
|
| Rate for Payer: BCBS of TX PPO |
$13,882.71
|
| Rate for Payer: Cigna Commercial |
$13,800.59
|
| Rate for Payer: Cigna Medicaid |
$1,996.58
|
| Rate for Payer: Cigna Medicare |
$6,092.20
|
| Rate for Payer: Employer Direct Commercial |
$6,092.20
|
| Rate for Payer: Humana Medicare/TRICARE |
$6,092.20
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,996.58
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$6,092.20
|
| Rate for Payer: Molina Medicare |
$6,092.20
|
| 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 |
$1,996.58
|
| Rate for Payer: Scott and White EPO/PPO |
$134.37
|
| Rate for Payer: Scott and White Medicare |
$6,092.20
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,996.58
|
| Rate for Payer: Superior Health Plan EPO |
$6,092.20
|
| Rate for Payer: Superior Health Plan Medicare |
$6,092.20
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$6,092.20
|
| Rate for Payer: Universal American Medicare |
$6,092.20
|
| Rate for Payer: Wellcare Medicare |
$6,092.20
|
| Rate for Payer: Wellmed Medicare |
$6,092.20
|
|
|
Removal of vitreous, anterior approach (open sky technique or limbal incision); partial removal
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 67005
|
| Hospital Charge Code |
36067005
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$47.01 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$3,090.00
|
| Rate for Payer: Aetna Medicare |
$3,196.84
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$849.94
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$2,131.23
|
| Rate for Payer: Amerigroup Medicare |
$2,131.23
|
| Rate for Payer: BCBS of TX Blue Advantage |
$3,376.51
|
| Rate for Payer: BCBS of TX Blue Essentials |
$4,043.72
|
| Rate for Payer: BCBS of TX Medicare |
$2,131.23
|
| Rate for Payer: BCBS of TX PPO |
$5,095.09
|
| Rate for Payer: Cigna Commercial |
$4,827.84
|
| Rate for Payer: Cigna Medicaid |
$849.94
|
| Rate for Payer: Cigna Medicare |
$2,131.23
|
| Rate for Payer: Employer Direct Commercial |
$2,131.23
|
| Rate for Payer: Humana Medicare/TRICARE |
$2,131.23
|
| Rate for Payer: Molina CHIP/Medicaid |
$849.94
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$2,131.23
|
| Rate for Payer: Molina Medicare |
$2,131.23
|
| 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 |
$849.94
|
| Rate for Payer: Scott and White EPO/PPO |
$47.01
|
| Rate for Payer: Scott and White Medicare |
$2,131.23
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$849.94
|
| Rate for Payer: Superior Health Plan EPO |
$2,131.23
|
| Rate for Payer: Superior Health Plan Medicare |
$2,131.23
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$2,131.23
|
| Rate for Payer: Universal American Medicare |
$2,131.23
|
| Rate for Payer: Wellcare Medicare |
$2,131.23
|
| Rate for Payer: Wellmed Medicare |
$2,131.23
|
|
|
Removal of vitreous, anterior approach (open sky technique or limbal incision); subtotal removal wit
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 67010
|
| Hospital Charge Code |
36067010
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$47.01 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$3,090.00
|
| Rate for Payer: Aetna Medicare |
$3,196.84
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$849.94
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$2,131.23
|
| Rate for Payer: Amerigroup Medicare |
$2,131.23
|
| Rate for Payer: BCBS of TX Blue Advantage |
$3,376.51
|
| Rate for Payer: BCBS of TX Blue Essentials |
$4,043.72
|
| Rate for Payer: BCBS of TX Medicare |
$2,131.23
|
| Rate for Payer: BCBS of TX PPO |
$5,095.09
|
| Rate for Payer: Cigna Commercial |
$4,827.84
|
| Rate for Payer: Cigna Medicaid |
$849.94
|
| Rate for Payer: Cigna Medicare |
$2,131.23
|
| Rate for Payer: Employer Direct Commercial |
$2,131.23
|
| Rate for Payer: Humana Medicare/TRICARE |
$2,131.23
|
| Rate for Payer: Molina CHIP/Medicaid |
$849.94
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$2,131.23
|
| Rate for Payer: Molina Medicare |
$2,131.23
|
| 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 |
$849.94
|
| Rate for Payer: Scott and White EPO/PPO |
$47.01
|
| Rate for Payer: Scott and White Medicare |
$2,131.23
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$849.94
|
| Rate for Payer: Superior Health Plan EPO |
$2,131.23
|
| Rate for Payer: Superior Health Plan Medicare |
$2,131.23
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$2,131.23
|
| Rate for Payer: Universal American Medicare |
$2,131.23
|
| Rate for Payer: Wellcare Medicare |
$2,131.23
|
| Rate for Payer: Wellmed Medicare |
$2,131.23
|
|
|
Removal or repair of electromagnetic bone conduction hearing device in temporal bone
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 69711
|
| Hospital Charge Code |
36069711
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$64.95 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$6,077.00
|
| Rate for Payer: Aetna Medicare |
$4,416.74
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$886.62
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$2,944.49
|
| Rate for Payer: Amerigroup Medicare |
$2,944.49
|
| Rate for Payer: BCBS of TX Blue Advantage |
$4,374.21
|
| Rate for Payer: BCBS of TX Blue Essentials |
$5,238.58
|
| Rate for Payer: BCBS of TX Medicare |
$2,944.49
|
| Rate for Payer: BCBS of TX PPO |
$6,600.61
|
| Rate for Payer: Cigna Commercial |
$6,670.12
|
| Rate for Payer: Cigna Medicaid |
$886.62
|
| Rate for Payer: Cigna Medicare |
$2,944.49
|
| Rate for Payer: Employer Direct Commercial |
$2,944.49
|
| Rate for Payer: Humana Medicare/TRICARE |
$2,944.49
|
| Rate for Payer: Molina CHIP/Medicaid |
$886.62
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$2,944.49
|
| Rate for Payer: Molina Medicare |
$2,944.49
|
| 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 |
$886.62
|
| Rate for Payer: Scott and White EPO/PPO |
$64.95
|
| Rate for Payer: Scott and White Medicare |
$2,944.49
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$886.62
|
| Rate for Payer: Superior Health Plan EPO |
$2,944.49
|
| Rate for Payer: Superior Health Plan Medicare |
$2,944.49
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$2,944.49
|
| Rate for Payer: Universal American Medicare |
$2,944.49
|
| Rate for Payer: Wellcare Medicare |
$2,944.49
|
| Rate for Payer: Wellmed Medicare |
$2,944.49
|
|
|
Removal, under anesthesia, of external fixation system
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 20694
|
| Hospital Charge Code |
36020694
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$32.42 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$2,200.00
|
| 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
|
|
|
REMOVE BILI DRAIN CATH
|
Facility
|
IP
|
$1,937.00
|
|
|
Service Code
|
CPT 47537
|
| Hospital Charge Code |
4617537
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$1,704.56
|
|
|
REMOVE BILI DRAIN CATH
|
Facility
|
OP
|
$1,937.00
|
|
|
Service Code
|
CPT 47537
|
| Hospital Charge Code |
4617537
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$18.29 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$2,200.00
|
| Rate for Payer: Aetna Medicare |
$1,243.53
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$334.95
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$829.02
|
| Rate for Payer: Amerigroup Medicare |
$829.02
|
| Rate for Payer: BCBS of TX Blue Advantage |
$1,312.49
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,571.84
|
| Rate for Payer: BCBS of TX Medicare |
$829.02
|
| Rate for Payer: BCBS of TX PPO |
$1,980.52
|
| Rate for Payer: Cash Price |
$1,704.56
|
| Rate for Payer: Cash Price |
$1,704.56
|
| Rate for Payer: Cigna Commercial |
$1,877.98
|
| Rate for Payer: Cigna Medicaid |
$334.95
|
| Rate for Payer: Cigna Medicare |
$829.02
|
| Rate for Payer: Employer Direct Commercial |
$829.02
|
| Rate for Payer: Humana Medicare/TRICARE |
$829.02
|
| Rate for Payer: Molina CHIP/Medicaid |
$334.95
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$829.02
|
| Rate for Payer: Molina Medicare |
$829.02
|
| 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 |
$334.95
|
| Rate for Payer: Scott and White EPO/PPO |
$18.29
|
| Rate for Payer: Scott and White Medicare |
$829.02
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$334.95
|
| Rate for Payer: Superior Health Plan EPO |
$829.02
|
| Rate for Payer: Superior Health Plan Medicare |
$829.02
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$829.02
|
| Rate for Payer: Universal American Medicare |
$829.02
|
| Rate for Payer: Wellcare Medicare |
$829.02
|
| Rate for Payer: Wellmed Medicare |
$829.02
|
|
|
REMOVE DUAL LEAD PACER ELECTRODE
|
Facility
|
IP
|
$12,912.00
|
|
|
Service Code
|
CPT 33235
|
| Hospital Charge Code |
2302495
|
|
Hospital Revenue Code
|
481
|
| Rate for Payer: Cash Price |
$11,362.56
|
|
|
REMOVE DUAL LEAD PACER ELECTRODE
|
Facility
|
OP
|
$12,912.00
|
|
|
Service Code
|
CPT 33235
|
| Hospital Charge Code |
2302495
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$64.23 |
| Max. Negotiated Rate |
$8,392.80 |
| Rate for Payer: Aetna Commercial |
$4,635.00
|
| Rate for Payer: Aetna Medicare |
$5,387.14
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,162.08
|
| 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 |
$11,362.56
|
| Rate for Payer: Cash Price |
$11,362.56
|
| Rate for Payer: Cash Price |
$11,362.56
|
| Rate for Payer: Cigna Commercial |
$8,135.63
|
| Rate for Payer: Cigna Medicaid |
$1,870.58
|
| 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 |
$1,870.58
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3,591.43
|
| Rate for Payer: Molina Medicare |
$3,591.43
|
| Rate for Payer: Multiplan Auto |
$8,392.80
|
| Rate for Payer: Multiplan Commercial |
$8,392.80
|
| Rate for Payer: Multiplan Workers Comp |
$8,392.80
|
| Rate for Payer: Parkland Medicaid |
$1,870.58
|
| 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 |
$1,870.58
|
| 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
|
|
|
Remove Foreign Body, Simple
|
Facility
|
OP
|
$1,029.00
|
|
|
Service Code
|
CPT 10120
|
| Hospital Charge Code |
7150139
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$6.52 |
| Max. Negotiated Rate |
$826.08 |
| Rate for Payer: Aetna Commercial |
$565.95
|
| Rate for Payer: Aetna Medicare |
$547.00
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$92.61
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$364.67
|
| Rate for Payer: Amerigroup Medicare |
$364.67
|
| Rate for Payer: BCBS of TX Blue Advantage |
$178.41
|
| Rate for Payer: BCBS of TX Blue Essentials |
$213.66
|
| Rate for Payer: BCBS of TX Medicare |
$364.67
|
| Rate for Payer: BCBS of TX PPO |
$269.21
|
| Rate for Payer: Cash Price |
$905.52
|
| Rate for Payer: Cash Price |
$905.52
|
| Rate for Payer: Cash Price |
$905.52
|
| Rate for Payer: Cigna Commercial |
$826.08
|
| Rate for Payer: Cigna Medicaid |
$86.38
|
| 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 |
$86.38
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$364.67
|
| Rate for Payer: Molina Medicare |
$364.67
|
| Rate for Payer: Multiplan Auto |
$668.85
|
| Rate for Payer: Multiplan Commercial |
$668.85
|
| Rate for Payer: Multiplan Workers Comp |
$668.85
|
| Rate for Payer: Parkland Medicaid |
$86.38
|
| 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 |
$86.38
|
| 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
|
|
|
REMOVE LEADLESS PACMAKR VENTRICULAR
|
Facility
|
OP
|
$10,428.00
|
|
|
Service Code
|
CPT 33275
|
| Hospital Charge Code |
2300305
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$52.13 |
| Max. Negotiated Rate |
$6,983.63 |
| Rate for Payer: Aetna Commercial |
$4,635.00
|
| Rate for Payer: Aetna Medicare |
$4,372.65
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$938.52
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$2,915.10
|
| Rate for Payer: Amerigroup Medicare |
$2,915.10
|
| Rate for Payer: BCBS of TX Blue Advantage |
$4,628.04
|
| Rate for Payer: BCBS of TX Blue Essentials |
$5,542.56
|
| Rate for Payer: BCBS of TX Medicare |
$2,915.10
|
| Rate for Payer: BCBS of TX PPO |
$6,983.63
|
| Rate for Payer: Cash Price |
$9,176.64
|
| Rate for Payer: Cash Price |
$9,176.64
|
| Rate for Payer: Cash Price |
$9,176.64
|
| Rate for Payer: Cigna Commercial |
$6,603.56
|
| Rate for Payer: Cigna Medicare |
$2,915.10
|
| Rate for Payer: Employer Direct Commercial |
$2,915.10
|
| Rate for Payer: Humana Medicare/TRICARE |
$2,915.10
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$2,915.10
|
| Rate for Payer: Molina Medicare |
$2,915.10
|
| Rate for Payer: Multiplan Auto |
$6,778.20
|
| Rate for Payer: Multiplan Commercial |
$6,778.20
|
| Rate for Payer: Multiplan Workers Comp |
$6,778.20
|
| Rate for Payer: Scott and White EPO/PPO |
$52.13
|
| Rate for Payer: Scott and White Medicare |
$2,915.10
|
| Rate for Payer: Superior Health Plan EPO |
$2,915.10
|
| Rate for Payer: Superior Health Plan Medicare |
$2,915.10
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$2,915.10
|
| Rate for Payer: Universal American Medicare |
$2,915.10
|
| Rate for Payer: Wellcare Medicare |
$2,915.10
|
| Rate for Payer: Wellmed Medicare |
$2,915.10
|
|
|
REMOVE LEADLESS PACMAKR VENTRICULAR
|
Facility
|
IP
|
$10,428.00
|
|
|
Service Code
|
CPT 33275
|
| Hospital Charge Code |
2300305
|
|
Hospital Revenue Code
|
481
|
| Rate for Payer: Cash Price |
$9,176.64
|
|
|
REMOVE PERM PACER PULSE GEN
|
Facility
|
OP
|
$14,810.00
|
|
|
Service Code
|
CPT 33233
|
| Hospital Charge Code |
2302479
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$138.95 |
| Max. Negotiated Rate |
$19,257.46 |
| Rate for Payer: Aetna Commercial |
$4,635.00
|
| Rate for Payer: Aetna Medicare |
$11,654.54
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,332.90
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$7,769.69
|
| Rate for Payer: Amerigroup Medicare |
$7,769.69
|
| Rate for Payer: BCBS of TX Blue Advantage |
$12,761.89
|
| Rate for Payer: BCBS of TX Blue Essentials |
$15,283.70
|
| Rate for Payer: BCBS of TX Medicare |
$7,769.69
|
| Rate for Payer: BCBS of TX PPO |
$19,257.46
|
| Rate for Payer: Cash Price |
$13,032.80
|
| Rate for Payer: Cash Price |
$13,032.80
|
| Rate for Payer: Cash Price |
$13,032.80
|
| Rate for Payer: Cigna Commercial |
$17,600.59
|
| Rate for Payer: Cigna Medicaid |
$4,703.20
|
| Rate for Payer: Cigna Medicare |
$7,769.69
|
| Rate for Payer: Employer Direct Commercial |
$7,769.69
|
| Rate for Payer: Humana Medicare/TRICARE |
$7,769.69
|
| Rate for Payer: Molina CHIP/Medicaid |
$4,703.20
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$7,769.69
|
| Rate for Payer: Molina Medicare |
$7,769.69
|
| Rate for Payer: Multiplan Auto |
$9,626.50
|
| Rate for Payer: Multiplan Commercial |
$9,626.50
|
| Rate for Payer: Multiplan Workers Comp |
$9,626.50
|
| Rate for Payer: Parkland Medicaid |
$4,703.20
|
| Rate for Payer: Scott and White EPO/PPO |
$138.95
|
| Rate for Payer: Scott and White Medicare |
$7,769.69
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$4,703.20
|
| Rate for Payer: Superior Health Plan EPO |
$7,769.69
|
| Rate for Payer: Superior Health Plan Medicare |
$7,769.69
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$7,769.69
|
| Rate for Payer: Universal American Medicare |
$7,769.69
|
| Rate for Payer: Wellcare Medicare |
$7,769.69
|
| Rate for Payer: Wellmed Medicare |
$7,769.69
|
|
|
REMOVE PERM PACER PULSE GEN
|
Facility
|
IP
|
$14,810.00
|
|
|
Service Code
|
CPT 33233
|
| Hospital Charge Code |
2302479
|
|
Hospital Revenue Code
|
481
|
| Rate for Payer: Cash Price |
$13,032.80
|
|
