|
Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, fo
|
Facility
|
OP
|
$15,408.22
|
|
|
Service Code
|
CPT 63020
|
| Hospital Charge Code |
36063020
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,398.52 |
| Max. Negotiated Rate |
$15,408.22 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2,398.52
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$7,289.28
|
| Rate for Payer: Amerigroup Medicare |
$7,289.28
|
| 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 |
$7,289.28
|
| Rate for Payer: BCBS of TX PPO |
$15,074.51
|
| Rate for Payer: Cigna Commercial |
$15,408.22
|
| Rate for Payer: Cigna Medicare |
$7,289.28
|
| Rate for Payer: Employer Direct Commercial |
$7,289.28
|
| Rate for Payer: Humana Medicare/TRICARE |
$7,289.28
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$7,289.28
|
| Rate for Payer: Molina Medicare |
$7,289.28
|
| 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 |
$13,485.17
|
| Rate for Payer: Scott and White Medicare |
$7,289.28
|
| Rate for Payer: Superior Health Plan EPO |
$7,289.28
|
| Rate for Payer: Superior Health Plan Medicare |
$7,289.28
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$7,289.28
|
| Rate for Payer: Universal American Medicare |
$7,289.28
|
| Rate for Payer: Wellcare Medicare |
$7,289.28
|
| Rate for Payer: Wellmed Medicare |
$7,289.28
|
|
|
Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, fo
|
Facility
|
IP
|
$39,687.78
|
|
|
Service Code
|
HCPCS 63042
|
| Hospital Charge Code |
9900763
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$26,987.69
|
|
|
Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, fo
|
Facility
|
OP
|
$31,324.75
|
|
|
Service Code
|
HCPCS 63030
|
| Hospital Charge Code |
9900761
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,398.52 |
| Max. Negotiated Rate |
$22,553.82 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2,398.52
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$7,289.28
|
| Rate for Payer: Amerigroup Medicare |
$7,289.28
|
| 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 |
$7,289.28
|
| Rate for Payer: BCBS of TX PPO |
$15,074.51
|
| Rate for Payer: Cash Price |
$21,300.83
|
| Rate for Payer: Cash Price |
$21,300.83
|
| Rate for Payer: Cash Price |
$21,300.83
|
| Rate for Payer: Cigna Commercial |
$15,408.22
|
| Rate for Payer: Cigna Medicaid |
$22,553.82
|
| Rate for Payer: Cigna Medicare |
$7,289.28
|
| Rate for Payer: Employer Direct Commercial |
$7,289.28
|
| Rate for Payer: Humana Medicare/TRICARE |
$7,289.28
|
| Rate for Payer: Molina CHIP/Medicaid |
$22,553.82
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$7,289.28
|
| Rate for Payer: Molina Medicare |
$7,289.28
|
| 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 |
$22,553.82
|
| Rate for Payer: Scott and White EPO/PPO |
$13,485.17
|
| Rate for Payer: Scott and White Medicare |
$7,289.28
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$22,553.82
|
| Rate for Payer: Superior Health Plan EPO |
$7,289.28
|
| Rate for Payer: Superior Health Plan Medicare |
$7,289.28
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$7,289.28
|
| Rate for Payer: Universal American Medicare |
$7,289.28
|
| Rate for Payer: Wellcare Medicare |
$7,289.28
|
| Rate for Payer: Wellmed Medicare |
$7,289.28
|
|
|
Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, fo
|
Facility
|
IP
|
$39,687.78
|
|
|
Service Code
|
HCPCS 63035
|
| Hospital Charge Code |
9900762
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$26,987.69
|
|
|
Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, fo
|
Facility
|
OP
|
$15,408.22
|
|
|
Service Code
|
CPT 63030
|
| Hospital Charge Code |
36063030
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,398.52 |
| Max. Negotiated Rate |
$15,408.22 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2,398.52
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$7,289.28
|
| Rate for Payer: Amerigroup Medicare |
$7,289.28
|
| 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 |
$7,289.28
|
| Rate for Payer: BCBS of TX PPO |
$15,074.51
|
| Rate for Payer: Cigna Commercial |
$15,408.22
|
| Rate for Payer: Cigna Medicare |
$7,289.28
|
| Rate for Payer: Employer Direct Commercial |
$7,289.28
|
| Rate for Payer: Humana Medicare/TRICARE |
$7,289.28
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$7,289.28
|
| Rate for Payer: Molina Medicare |
$7,289.28
|
| 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 |
$13,485.17
|
| Rate for Payer: Scott and White Medicare |
$7,289.28
|
| Rate for Payer: Superior Health Plan EPO |
$7,289.28
|
| Rate for Payer: Superior Health Plan Medicare |
$7,289.28
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$7,289.28
|
| Rate for Payer: Universal American Medicare |
$7,289.28
|
| Rate for Payer: Wellcare Medicare |
$7,289.28
|
| Rate for Payer: Wellmed Medicare |
$7,289.28
|
|
|
Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, fo
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 63035
|
| Hospital Charge Code |
36063035
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$10,000.00 |
| Max. Negotiated Rate |
$10,000.00 |
| 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
|
|
|
Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, fo
|
Facility
|
OP
|
$39,687.78
|
|
|
Service Code
|
HCPCS 63042
|
| Hospital Charge Code |
9900763
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,398.52 |
| Max. Negotiated Rate |
$28,575.20 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2,398.52
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$7,289.28
|
| Rate for Payer: Amerigroup Medicare |
$7,289.28
|
| 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 |
$7,289.28
|
| Rate for Payer: BCBS of TX PPO |
$15,074.51
|
| Rate for Payer: Cash Price |
$26,987.69
|
| Rate for Payer: Cash Price |
$26,987.69
|
| Rate for Payer: Cash Price |
$26,987.69
|
| Rate for Payer: Cigna Commercial |
$15,408.22
|
| Rate for Payer: Cigna Medicaid |
$28,575.20
|
| Rate for Payer: Cigna Medicare |
$7,289.28
|
| Rate for Payer: Employer Direct Commercial |
$7,289.28
|
| Rate for Payer: Humana Medicare/TRICARE |
$7,289.28
|
| Rate for Payer: Molina CHIP/Medicaid |
$28,575.20
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$7,289.28
|
| Rate for Payer: Molina Medicare |
$7,289.28
|
| 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 |
$28,575.20
|
| Rate for Payer: Scott and White EPO/PPO |
$13,485.17
|
| Rate for Payer: Scott and White Medicare |
$7,289.28
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$28,575.20
|
| Rate for Payer: Superior Health Plan EPO |
$7,289.28
|
| Rate for Payer: Superior Health Plan Medicare |
$7,289.28
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$7,289.28
|
| Rate for Payer: Universal American Medicare |
$7,289.28
|
| Rate for Payer: Wellcare Medicare |
$7,289.28
|
| Rate for Payer: Wellmed Medicare |
$7,289.28
|
|
|
Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, fo
|
Facility
|
IP
|
$39,687.78
|
|
|
Service Code
|
HCPCS 63020
|
| Hospital Charge Code |
9900760
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$26,987.69
|
|
|
Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, fo
|
Facility
|
OP
|
$39,687.78
|
|
|
Service Code
|
HCPCS 63020
|
| Hospital Charge Code |
9900760
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,398.52 |
| Max. Negotiated Rate |
$28,575.20 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2,398.52
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$7,289.28
|
| Rate for Payer: Amerigroup Medicare |
$7,289.28
|
| 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 |
$7,289.28
|
| Rate for Payer: BCBS of TX PPO |
$15,074.51
|
| Rate for Payer: Cash Price |
$26,987.69
|
| Rate for Payer: Cash Price |
$26,987.69
|
| Rate for Payer: Cash Price |
$26,987.69
|
| Rate for Payer: Cigna Commercial |
$15,408.22
|
| Rate for Payer: Cigna Medicaid |
$28,575.20
|
| Rate for Payer: Cigna Medicare |
$7,289.28
|
| Rate for Payer: Employer Direct Commercial |
$7,289.28
|
| Rate for Payer: Humana Medicare/TRICARE |
$7,289.28
|
| Rate for Payer: Molina CHIP/Medicaid |
$28,575.20
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$7,289.28
|
| Rate for Payer: Molina Medicare |
$7,289.28
|
| 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 |
$28,575.20
|
| Rate for Payer: Scott and White EPO/PPO |
$13,485.17
|
| Rate for Payer: Scott and White Medicare |
$7,289.28
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$28,575.20
|
| Rate for Payer: Superior Health Plan EPO |
$7,289.28
|
| Rate for Payer: Superior Health Plan Medicare |
$7,289.28
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$7,289.28
|
| Rate for Payer: Universal American Medicare |
$7,289.28
|
| Rate for Payer: Wellcare Medicare |
$7,289.28
|
| Rate for Payer: Wellmed Medicare |
$7,289.28
|
|
|
Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, fo
|
Facility
|
OP
|
$39,687.78
|
|
|
Service Code
|
HCPCS 63035
|
| Hospital Charge Code |
9900762
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,571.90 |
| Max. Negotiated Rate |
$28,575.20 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$3,571.90
|
| Rate for Payer: BCBS of TX Blue Advantage |
$11,906.33
|
| Rate for Payer: BCBS of TX Blue Essentials |
$14,287.60
|
| Rate for Payer: BCBS of TX PPO |
$15,875.11
|
| Rate for Payer: Cash Price |
$26,987.69
|
| Rate for Payer: Cash Price |
$26,987.69
|
| Rate for Payer: Cigna Medicaid |
$28,575.20
|
| Rate for Payer: Molina CHIP/Medicaid |
$28,575.20
|
| 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 |
$28,575.20
|
| Rate for Payer: Scott and White EPO/PPO |
$19,843.89
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$28,575.20
|
| Rate for Payer: Superior Health Plan EPO |
$5,397.54
|
|
|
lamoTRIgine 100 mg Tab
|
Facility
|
OP
|
$8.00
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
77653245
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.72 |
| Max. Negotiated Rate |
$5.76 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$0.72
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2.40
|
| Rate for Payer: BCBS of TX Blue Essentials |
$2.88
|
| Rate for Payer: BCBS of TX PPO |
$3.20
|
| Rate for Payer: Cash Price |
$5.44
|
| Rate for Payer: Cigna Medicaid |
$5.76
|
| Rate for Payer: Molina CHIP/Medicaid |
$5.76
|
| Rate for Payer: Multiplan Auto |
$5.20
|
| Rate for Payer: Multiplan Commercial |
$5.20
|
| Rate for Payer: Multiplan Workers Comp |
$5.20
|
| Rate for Payer: Parkland Medicaid |
$5.76
|
| Rate for Payer: Scott and White EPO/PPO |
$4.00
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$5.76
|
| Rate for Payer: Superior Health Plan EPO |
$1.09
|
|
|
lamoTRIgine 100 mg Tab
|
Facility
|
IP
|
$8.00
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
77653245
|
|
Hospital Revenue Code
|
250
|
| Rate for Payer: Cash Price |
$5.44
|
|
|
lamoTRIgine 25 mg Tab
|
Facility
|
OP
|
$8.00
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
77653708
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.72 |
| Max. Negotiated Rate |
$5.76 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$0.72
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2.40
|
| Rate for Payer: BCBS of TX Blue Essentials |
$2.88
|
| Rate for Payer: BCBS of TX PPO |
$3.20
|
| Rate for Payer: Cash Price |
$5.44
|
| Rate for Payer: Cigna Medicaid |
$5.76
|
| Rate for Payer: Molina CHIP/Medicaid |
$5.76
|
| Rate for Payer: Multiplan Auto |
$5.20
|
| Rate for Payer: Multiplan Commercial |
$5.20
|
| Rate for Payer: Multiplan Workers Comp |
$5.20
|
| Rate for Payer: Parkland Medicaid |
$5.76
|
| Rate for Payer: Scott and White EPO/PPO |
$4.00
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$5.76
|
| Rate for Payer: Superior Health Plan EPO |
$1.09
|
|
|
lamoTRIgine 25 mg Tab
|
Facility
|
IP
|
$8.00
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
77653708
|
|
Hospital Revenue Code
|
250
|
| Rate for Payer: Cash Price |
$5.44
|
|
|
Lamotrigine (Lamictal), Serum SO
|
Facility
|
IP
|
$161.00
|
|
|
Service Code
|
HCPCS 80175
|
| Hospital Charge Code |
1740990
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$109.48
|
|
|
Lamotrigine (Lamictal), Serum SO
|
Facility
|
OP
|
$161.00
|
|
|
Service Code
|
HCPCS 80175
|
| Hospital Charge Code |
1740990
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.17 |
| Max. Negotiated Rate |
$115.92 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$5.17
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$13.25
|
| Rate for Payer: Amerigroup Medicare |
$13.25
|
| Rate for Payer: BCBS of TX Blue Advantage |
$48.30
|
| Rate for Payer: BCBS of TX Blue Essentials |
$57.96
|
| Rate for Payer: BCBS of TX Medicare |
$13.25
|
| Rate for Payer: BCBS of TX PPO |
$64.40
|
| Rate for Payer: Cash Price |
$109.48
|
| Rate for Payer: Cash Price |
$109.48
|
| Rate for Payer: Cigna Medicaid |
$115.92
|
| Rate for Payer: Cigna Medicare |
$13.25
|
| Rate for Payer: Employer Direct Commercial |
$13.25
|
| Rate for Payer: Humana Medicare/TRICARE |
$13.25
|
| Rate for Payer: Molina CHIP/Medicaid |
$115.92
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$13.25
|
| Rate for Payer: Molina Medicare |
$13.25
|
| Rate for Payer: Multiplan Auto |
$104.65
|
| Rate for Payer: Multiplan Commercial |
$104.65
|
| Rate for Payer: Multiplan Workers Comp |
$104.65
|
| Rate for Payer: Parkland Medicaid |
$115.92
|
| Rate for Payer: Scott and White EPO/PPO |
$16.56
|
| Rate for Payer: Scott and White Medicare |
$13.25
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$115.92
|
| Rate for Payer: Superior Health Plan EPO |
$13.25
|
| Rate for Payer: Superior Health Plan Medicare |
$13.25
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$13.25
|
| Rate for Payer: Universal American Medicare |
$13.25
|
| Rate for Payer: Wellcare Medicare |
$13.25
|
| Rate for Payer: Wellmed Medicare |
$13.25
|
|
|
Laparo proc abdm/per/oment
|
Facility
|
IP
|
$15,181.32
|
|
|
Service Code
|
HCPCS 49329
|
| Hospital Charge Code |
9900711
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$10,323.30
|
|
|
Laparo proc abdm/per/oment
|
Facility
|
OP
|
$15,181.32
|
|
|
Service Code
|
HCPCS 49329
|
| Hospital Charge Code |
9900711
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,073.08 |
| Max. Negotiated Rate |
$12,837.39 |
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$6,073.08
|
| Rate for Payer: Amerigroup Medicare |
$6,073.08
|
| Rate for Payer: BCBS of TX Blue Advantage |
$8,072.30
|
| Rate for Payer: BCBS of TX Blue Essentials |
$9,667.42
|
| Rate for Payer: BCBS of TX Medicare |
$6,073.08
|
| Rate for Payer: BCBS of TX PPO |
$12,180.95
|
| Rate for Payer: Cash Price |
$10,323.30
|
| Rate for Payer: Cash Price |
$10,323.30
|
| Rate for Payer: Cash Price |
$10,323.30
|
| Rate for Payer: Cigna Commercial |
$12,837.39
|
| Rate for Payer: Cigna Medicaid |
$10,930.55
|
| Rate for Payer: Cigna Medicare |
$6,073.08
|
| Rate for Payer: Employer Direct Commercial |
$6,073.08
|
| Rate for Payer: Humana Medicare/TRICARE |
$6,073.08
|
| Rate for Payer: Molina CHIP/Medicaid |
$10,930.55
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$6,073.08
|
| Rate for Payer: Molina Medicare |
$6,073.08
|
| 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 |
$10,930.55
|
| Rate for Payer: Scott and White EPO/PPO |
$11,235.20
|
| Rate for Payer: Scott and White Medicare |
$6,073.08
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$10,930.55
|
| Rate for Payer: Superior Health Plan EPO |
$6,073.08
|
| Rate for Payer: Superior Health Plan Medicare |
$6,073.08
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$6,073.08
|
| Rate for Payer: Universal American Medicare |
$6,073.08
|
| Rate for Payer: Wellcare Medicare |
$6,073.08
|
| Rate for Payer: Wellmed Medicare |
$6,073.08
|
|
|
Laparo proc abdm/per/oment
|
Facility
|
OP
|
$12,837.39
|
|
|
Service Code
|
CPT 49329
|
| Hospital Charge Code |
36049329
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,073.08 |
| Max. Negotiated Rate |
$12,837.39 |
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$6,073.08
|
| Rate for Payer: Amerigroup Medicare |
$6,073.08
|
| Rate for Payer: BCBS of TX Blue Advantage |
$8,072.30
|
| Rate for Payer: BCBS of TX Blue Essentials |
$9,667.42
|
| Rate for Payer: BCBS of TX Medicare |
$6,073.08
|
| Rate for Payer: BCBS of TX PPO |
$12,180.95
|
| Rate for Payer: Cigna Commercial |
$12,837.39
|
| Rate for Payer: Cigna Medicare |
$6,073.08
|
| Rate for Payer: Employer Direct Commercial |
$6,073.08
|
| Rate for Payer: Humana Medicare/TRICARE |
$6,073.08
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$6,073.08
|
| Rate for Payer: Molina Medicare |
$6,073.08
|
| 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 |
$11,235.20
|
| Rate for Payer: Scott and White Medicare |
$6,073.08
|
| Rate for Payer: Superior Health Plan EPO |
$6,073.08
|
| Rate for Payer: Superior Health Plan Medicare |
$6,073.08
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$6,073.08
|
| Rate for Payer: Universal American Medicare |
$6,073.08
|
| Rate for Payer: Wellcare Medicare |
$6,073.08
|
| Rate for Payer: Wellmed Medicare |
$6,073.08
|
|
|
LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH CC
|
Facility
|
IP
|
$32,140.40
|
|
|
Service Code
|
MSDRG 418
|
| Min. Negotiated Rate |
$14,312.12 |
| Max. Negotiated Rate |
$32,140.40 |
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$17,157.86
|
| Rate for Payer: Amerigroup Medicare |
$17,157.86
|
| Rate for Payer: BCBS of TX Medicare |
$17,157.86
|
| Rate for Payer: Cigna Commercial |
$21,787.81
|
| Rate for Payer: Cigna Medicare |
$17,157.86
|
| Rate for Payer: Employer Direct Commercial |
$17,157.86
|
| Rate for Payer: Humana Medicare/TRICARE |
$17,157.86
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$17,157.86
|
| Rate for Payer: Molina Medicare |
$17,157.86
|
| Rate for Payer: Multiplan Auto |
$32,140.40
|
| Rate for Payer: Multiplan Commercial |
$32,140.40
|
| Rate for Payer: Multiplan Workers Comp |
$32,140.40
|
| Rate for Payer: Scott and White EPO/PPO |
$14,801.50
|
| Rate for Payer: Scott and White Medicare |
$17,157.86
|
| Rate for Payer: Superior Health Plan EPO |
$17,157.86
|
| Rate for Payer: Superior Health Plan Medicare |
$17,157.86
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$17,157.86
|
| Rate for Payer: Universal American Medicare |
$17,157.86
|
| Rate for Payer: Wellcare Medicare |
$17,157.86
|
| Rate for Payer: Wellmed Medicare |
$17,157.86
|
|
|
LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH MCC
|
Facility
|
IP
|
$45,341.60
|
|
|
Service Code
|
MSDRG 417
|
| Min. Negotiated Rate |
$20,841.24 |
| Max. Negotiated Rate |
$45,341.60 |
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$22,250.07
|
| Rate for Payer: Amerigroup Medicare |
$22,250.07
|
| Rate for Payer: BCBS of TX Medicare |
$22,250.07
|
| Rate for Payer: Cigna Commercial |
$30,736.83
|
| Rate for Payer: Cigna Medicare |
$22,250.07
|
| Rate for Payer: Employer Direct Commercial |
$22,250.07
|
| Rate for Payer: Humana Medicare/TRICARE |
$22,250.07
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$22,250.07
|
| Rate for Payer: Molina Medicare |
$22,250.07
|
| Rate for Payer: Multiplan Auto |
$45,341.60
|
| Rate for Payer: Multiplan Commercial |
$45,341.60
|
| Rate for Payer: Multiplan Workers Comp |
$45,341.60
|
| Rate for Payer: Scott and White EPO/PPO |
$20,881.00
|
| Rate for Payer: Scott and White Medicare |
$22,250.07
|
| Rate for Payer: Superior Health Plan EPO |
$22,250.07
|
| Rate for Payer: Superior Health Plan Medicare |
$22,250.07
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$22,250.07
|
| Rate for Payer: Universal American Medicare |
$22,250.07
|
| Rate for Payer: Wellcare Medicare |
$22,250.07
|
| Rate for Payer: Wellmed Medicare |
$22,250.07
|
|
|
LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITHOUT CC/MCC
|
Facility
|
IP
|
$25,950.20
|
|
|
Service Code
|
MSDRG 419
|
| Min. Negotiated Rate |
$11,216.12 |
| Max. Negotiated Rate |
$25,950.20 |
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$14,770.07
|
| Rate for Payer: Amerigroup Medicare |
$14,770.07
|
| Rate for Payer: BCBS of TX Medicare |
$14,770.07
|
| Rate for Payer: Cigna Commercial |
$17,591.50
|
| Rate for Payer: Cigna Medicare |
$14,770.07
|
| Rate for Payer: Employer Direct Commercial |
$14,770.07
|
| Rate for Payer: Humana Medicare/TRICARE |
$14,770.07
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$14,770.07
|
| Rate for Payer: Molina Medicare |
$14,770.07
|
| Rate for Payer: Multiplan Auto |
$25,950.20
|
| Rate for Payer: Multiplan Commercial |
$25,950.20
|
| Rate for Payer: Multiplan Workers Comp |
$25,950.20
|
| Rate for Payer: Scott and White EPO/PPO |
$11,950.75
|
| Rate for Payer: Scott and White Medicare |
$14,770.07
|
| Rate for Payer: Superior Health Plan EPO |
$14,770.07
|
| Rate for Payer: Superior Health Plan Medicare |
$14,770.07
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$14,770.07
|
| Rate for Payer: Universal American Medicare |
$14,770.07
|
| Rate for Payer: Wellcare Medicare |
$14,770.07
|
| Rate for Payer: Wellmed Medicare |
$14,770.07
|
|
|
LAPAROSCOPIC CHOLECYSTECTOMY W/O C.D.E. W CC
|
Facility
|
IP
|
$32,140.40
|
|
|
Service Code
|
MSDRG 418
|
| Min. Negotiated Rate |
$14,312.12 |
| Max. Negotiated Rate |
$32,140.40 |
| Rate for Payer: BCBS of TX Blue Advantage |
$14,312.12
|
| Rate for Payer: BCBS of TX Blue Essentials |
$17,172.88
|
| Rate for Payer: BCBS of TX PPO |
$19,081.72
|
|
|
LAPAROSCOPIC CHOLECYSTECTOMY W/O C.D.E. W MCC
|
Facility
|
IP
|
$45,341.60
|
|
|
Service Code
|
MSDRG 417
|
| Min. Negotiated Rate |
$20,841.24 |
| Max. Negotiated Rate |
$45,341.60 |
| Rate for Payer: BCBS of TX Blue Advantage |
$20,841.24
|
| Rate for Payer: BCBS of TX Blue Essentials |
$25,007.06
|
| Rate for Payer: BCBS of TX PPO |
$27,786.70
|
|
|
LAPAROSCOPIC CHOLECYSTECTOMY W/O C.D.E. W/O CC/MCC
|
Facility
|
IP
|
$25,950.20
|
|
|
Service Code
|
MSDRG 419
|
| Min. Negotiated Rate |
$11,216.12 |
| Max. Negotiated Rate |
$25,950.20 |
| Rate for Payer: BCBS of TX Blue Advantage |
$11,216.12
|
| Rate for Payer: BCBS of TX Blue Essentials |
$13,458.04
|
| Rate for Payer: BCBS of TX PPO |
$14,953.96
|
|
