|
Repair lateral collateral ligament, elbow, with local tissue
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 24343
|
| Hospital Charge Code |
36024343
|
|
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
|
|
|
Repair lip, full thickness; over one-half vertical height, or complex
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 40654
|
| Hospital Charge Code |
36040654
|
|
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 |
$420.64
|
| 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 |
$2,253.40
|
| Rate for Payer: BCBS of TX Blue Essentials |
$2,698.68
|
| Rate for Payer: BCBS of TX Medicare |
$1,394.72
|
| Rate for Payer: BCBS of TX PPO |
$3,400.34
|
| Rate for Payer: Cigna Commercial |
$3,159.45
|
| Rate for Payer: Cigna Medicaid |
$420.64
|
| 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 |
$420.64
|
| 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 |
$420.64
|
| 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 |
$420.64
|
| 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
|
|
|
Repair non-union, metacarpal or phalanx (includes obtaining bone graft with or without external or i
|
Facility
|
OP
|
$15,074.51
|
|
|
Service Code
|
CPT 26546
|
| Hospital Charge Code |
36026546
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$144.31 |
| Max. Negotiated Rate |
$15,074.51 |
| Rate for Payer: Aetna Commercial |
$4,635.00
|
| Rate for Payer: Aetna Medicare |
$9,814.08
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2,398.52
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$6,542.72
|
| Rate for Payer: Amerigroup Medicare |
$6,542.72
|
| Rate for Payer: BCBS of TX Blue Advantage |
$9,989.86
|
| Rate for Payer: BCBS of TX Blue Essentials |
$11,963.90
|
| Rate for Payer: BCBS of TX Medicare |
$6,542.72
|
| Rate for Payer: BCBS of TX PPO |
$15,074.51
|
| Rate for Payer: Cigna Commercial |
$14,821.16
|
| Rate for Payer: Cigna Medicaid |
$2,398.52
|
| Rate for Payer: Cigna Medicare |
$6,542.72
|
| Rate for Payer: Employer Direct Commercial |
$6,542.72
|
| Rate for Payer: Humana Medicare/TRICARE |
$6,542.72
|
| Rate for Payer: Molina CHIP/Medicaid |
$2,398.52
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$6,542.72
|
| Rate for Payer: Molina Medicare |
$6,542.72
|
| Rate for Payer: Multiplan Auto |
$10,000.00
|
| Rate for Payer: Multiplan Commercial |
$10,000.00
|
| Rate for Payer: Multiplan Workers Comp |
$10,000.00
|
| Rate for Payer: Parkland Medicaid |
$2,398.52
|
| Rate for Payer: Scott and White EPO/PPO |
$144.31
|
| Rate for Payer: Scott and White Medicare |
$6,542.72
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$2,398.52
|
| Rate for Payer: Superior Health Plan EPO |
$6,542.72
|
| Rate for Payer: Superior Health Plan Medicare |
$6,542.72
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$6,542.72
|
| Rate for Payer: Universal American Medicare |
$6,542.72
|
| Rate for Payer: Wellcare Medicare |
$6,542.72
|
| Rate for Payer: Wellmed Medicare |
$6,542.72
|
|
|
Repair of anterior abdominal hernia(s) (ie, epigastric, incisional, ventral, umbilical, spigelian),
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 49593
|
| Hospital Charge Code |
36049593
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$69.79 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$4,635.00
|
| Rate for Payer: Aetna Medicare |
$4,746.03
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,151.54
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3,164.02
|
| Rate for Payer: Amerigroup Medicare |
$3,164.02
|
| Rate for Payer: BCBS of TX Blue Advantage |
$5,915.02
|
| Rate for Payer: BCBS of TX Blue Essentials |
$7,083.86
|
| Rate for Payer: BCBS of TX Medicare |
$3,164.02
|
| Rate for Payer: BCBS of TX PPO |
$8,925.66
|
| Rate for Payer: Cigna Commercial |
$7,167.43
|
| Rate for Payer: Cigna Medicaid |
$1,151.54
|
| Rate for Payer: Cigna Medicare |
$3,164.02
|
| Rate for Payer: Employer Direct Commercial |
$3,164.02
|
| Rate for Payer: Humana Medicare/TRICARE |
$3,164.02
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,151.54
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3,164.02
|
| Rate for Payer: Molina Medicare |
$3,164.02
|
| 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 |
$1,151.54
|
| Rate for Payer: Scott and White EPO/PPO |
$69.79
|
| Rate for Payer: Scott and White Medicare |
$3,164.02
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,151.54
|
| Rate for Payer: Superior Health Plan EPO |
$3,164.02
|
| Rate for Payer: Superior Health Plan Medicare |
$3,164.02
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3,164.02
|
| Rate for Payer: Universal American Medicare |
$3,164.02
|
| Rate for Payer: Wellcare Medicare |
$3,164.02
|
| Rate for Payer: Wellmed Medicare |
$3,164.02
|
|
|
Repair of anterior abdominal hernia(s) (ie, epigastric, incisional, ventral, umbilical, spigelian),
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 49591
|
| Hospital Charge Code |
36049591
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$69.79 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$4,635.00
|
| Rate for Payer: Aetna Medicare |
$4,746.03
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,151.54
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3,164.02
|
| Rate for Payer: Amerigroup Medicare |
$3,164.02
|
| Rate for Payer: BCBS of TX Blue Advantage |
$5,915.02
|
| Rate for Payer: BCBS of TX Blue Essentials |
$7,083.86
|
| Rate for Payer: BCBS of TX Medicare |
$3,164.02
|
| Rate for Payer: BCBS of TX PPO |
$8,925.66
|
| Rate for Payer: Cigna Commercial |
$7,167.43
|
| Rate for Payer: Cigna Medicaid |
$1,151.54
|
| Rate for Payer: Cigna Medicare |
$3,164.02
|
| Rate for Payer: Employer Direct Commercial |
$3,164.02
|
| Rate for Payer: Humana Medicare/TRICARE |
$3,164.02
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,151.54
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3,164.02
|
| Rate for Payer: Molina Medicare |
$3,164.02
|
| 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 |
$1,151.54
|
| Rate for Payer: Scott and White EPO/PPO |
$69.79
|
| Rate for Payer: Scott and White Medicare |
$3,164.02
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,151.54
|
| Rate for Payer: Superior Health Plan EPO |
$3,164.02
|
| Rate for Payer: Superior Health Plan Medicare |
$3,164.02
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3,164.02
|
| Rate for Payer: Universal American Medicare |
$3,164.02
|
| Rate for Payer: Wellcare Medicare |
$3,164.02
|
| Rate for Payer: Wellmed Medicare |
$3,164.02
|
|
|
Repair of anterior abdominal hernia(s) (ie, epigastric, incisional, ventral, umbilical, spigelian),
|
Facility
|
OP
|
$13,134.62
|
|
|
Service Code
|
CPT 49592
|
| Hospital Charge Code |
36049592
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$116.39 |
| Max. Negotiated Rate |
$13,134.62 |
| Rate for Payer: Aetna Commercial |
$7,210.00
|
| Rate for Payer: Aetna Medicare |
$7,915.38
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,151.54
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$5,276.92
|
| Rate for Payer: Amerigroup Medicare |
$5,276.92
|
| Rate for Payer: BCBS of TX Blue Advantage |
$8,704.29
|
| Rate for Payer: BCBS of TX Blue Essentials |
$10,424.30
|
| Rate for Payer: BCBS of TX Medicare |
$5,276.92
|
| Rate for Payer: BCBS of TX PPO |
$13,134.62
|
| Rate for Payer: Cigna Commercial |
$11,953.74
|
| Rate for Payer: Cigna Medicaid |
$1,151.54
|
| Rate for Payer: Cigna Medicare |
$5,276.92
|
| Rate for Payer: Employer Direct Commercial |
$5,276.92
|
| Rate for Payer: Humana Medicare/TRICARE |
$5,276.92
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,151.54
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$5,276.92
|
| Rate for Payer: Molina Medicare |
$5,276.92
|
| 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 |
$1,151.54
|
| Rate for Payer: Scott and White EPO/PPO |
$116.39
|
| Rate for Payer: Scott and White Medicare |
$5,276.92
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,151.54
|
| Rate for Payer: Superior Health Plan EPO |
$5,276.92
|
| Rate for Payer: Superior Health Plan Medicare |
$5,276.92
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$5,276.92
|
| Rate for Payer: Universal American Medicare |
$5,276.92
|
| Rate for Payer: Wellcare Medicare |
$5,276.92
|
| Rate for Payer: Wellmed Medicare |
$5,276.92
|
|
|
Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 67908
|
| Hospital Charge Code |
36067908
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$47.14 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$3,090.00
|
| Rate for Payer: Aetna Medicare |
$3,205.66
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$698.30
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$2,137.11
|
| Rate for Payer: Amerigroup Medicare |
$2,137.11
|
| Rate for Payer: BCBS of TX Blue Advantage |
$3,231.78
|
| Rate for Payer: BCBS of TX Blue Essentials |
$3,870.40
|
| Rate for Payer: BCBS of TX Medicare |
$2,137.11
|
| Rate for Payer: BCBS of TX PPO |
$4,876.70
|
| Rate for Payer: Cigna Commercial |
$4,841.18
|
| Rate for Payer: Cigna Medicaid |
$698.30
|
| Rate for Payer: Cigna Medicare |
$2,137.11
|
| Rate for Payer: Employer Direct Commercial |
$2,137.11
|
| Rate for Payer: Humana Medicare/TRICARE |
$2,137.11
|
| Rate for Payer: Molina CHIP/Medicaid |
$698.30
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$2,137.11
|
| Rate for Payer: Molina Medicare |
$2,137.11
|
| 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 |
$698.30
|
| Rate for Payer: Scott and White EPO/PPO |
$47.14
|
| Rate for Payer: Scott and White Medicare |
$2,137.11
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$698.30
|
| Rate for Payer: Superior Health Plan EPO |
$2,137.11
|
| Rate for Payer: Superior Health Plan Medicare |
$2,137.11
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$2,137.11
|
| Rate for Payer: Universal American Medicare |
$2,137.11
|
| Rate for Payer: Wellcare Medicare |
$2,137.11
|
| Rate for Payer: Wellmed Medicare |
$2,137.11
|
|
|
Repair of blepharoptosis (tarso) levator resection or advancement, external approach
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 67904
|
| Hospital Charge Code |
36067904
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$47.14 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$3,090.00
|
| Rate for Payer: Aetna Medicare |
$3,205.66
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$698.30
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$2,137.11
|
| Rate for Payer: Amerigroup Medicare |
$2,137.11
|
| Rate for Payer: BCBS of TX Blue Advantage |
$3,231.78
|
| Rate for Payer: BCBS of TX Blue Essentials |
$3,870.40
|
| Rate for Payer: BCBS of TX Medicare |
$2,137.11
|
| Rate for Payer: BCBS of TX PPO |
$4,876.70
|
| Rate for Payer: Cigna Commercial |
$4,841.18
|
| Rate for Payer: Cigna Medicaid |
$698.30
|
| Rate for Payer: Cigna Medicare |
$2,137.11
|
| Rate for Payer: Employer Direct Commercial |
$2,137.11
|
| Rate for Payer: Humana Medicare/TRICARE |
$2,137.11
|
| Rate for Payer: Molina CHIP/Medicaid |
$698.30
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$2,137.11
|
| Rate for Payer: Molina Medicare |
$2,137.11
|
| 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 |
$698.30
|
| Rate for Payer: Scott and White EPO/PPO |
$47.14
|
| Rate for Payer: Scott and White Medicare |
$2,137.11
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$698.30
|
| Rate for Payer: Superior Health Plan EPO |
$2,137.11
|
| Rate for Payer: Superior Health Plan Medicare |
$2,137.11
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$2,137.11
|
| Rate for Payer: Universal American Medicare |
$2,137.11
|
| Rate for Payer: Wellcare Medicare |
$2,137.11
|
| Rate for Payer: Wellmed Medicare |
$2,137.11
|
|
|
Repair of ectropion; extensive (eg, tarsal strip operations)
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 67917
|
| Hospital Charge Code |
36067917
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$47.14 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$3,090.00
|
| Rate for Payer: Aetna Medicare |
$3,205.66
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$698.30
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$2,137.11
|
| Rate for Payer: Amerigroup Medicare |
$2,137.11
|
| Rate for Payer: BCBS of TX Blue Advantage |
$3,231.78
|
| Rate for Payer: BCBS of TX Blue Essentials |
$3,870.40
|
| Rate for Payer: BCBS of TX Medicare |
$2,137.11
|
| Rate for Payer: BCBS of TX PPO |
$4,876.70
|
| Rate for Payer: Cigna Commercial |
$4,841.18
|
| Rate for Payer: Cigna Medicaid |
$698.30
|
| Rate for Payer: Cigna Medicare |
$2,137.11
|
| Rate for Payer: Employer Direct Commercial |
$2,137.11
|
| Rate for Payer: Humana Medicare/TRICARE |
$2,137.11
|
| Rate for Payer: Molina CHIP/Medicaid |
$698.30
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$2,137.11
|
| Rate for Payer: Molina Medicare |
$2,137.11
|
| 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 |
$698.30
|
| Rate for Payer: Scott and White EPO/PPO |
$47.14
|
| Rate for Payer: Scott and White Medicare |
$2,137.11
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$698.30
|
| Rate for Payer: Superior Health Plan EPO |
$2,137.11
|
| Rate for Payer: Superior Health Plan Medicare |
$2,137.11
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$2,137.11
|
| Rate for Payer: Universal American Medicare |
$2,137.11
|
| Rate for Payer: Wellcare Medicare |
$2,137.11
|
| Rate for Payer: Wellmed Medicare |
$2,137.11
|
|
|
Repair of extensor tendon, central slip, secondary (eg, boutonniere deformity) using local tissue(s
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 26426
|
| Hospital Charge Code |
36026426
|
|
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
|
|
|
Repair of extensor tendon, distal insertion, primary or secondary; with free graft (includes obtaini
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 26434
|
| Hospital Charge Code |
36026434
|
|
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
|
|
|
Repair of nail bed
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 11760
|
| Hospital Charge Code |
36011760
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$12.67 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Medicare |
$861.57
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$105.20
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$574.38
|
| Rate for Payer: Amerigroup Medicare |
$574.38
|
| Rate for Payer: BCBS of TX Blue Advantage |
$830.02
|
| Rate for Payer: BCBS of TX Blue Essentials |
$994.04
|
| Rate for Payer: BCBS of TX Medicare |
$574.38
|
| Rate for Payer: BCBS of TX PPO |
$1,252.49
|
| Rate for Payer: Cigna Commercial |
$1,301.14
|
| Rate for Payer: Cigna Medicaid |
$105.20
|
| Rate for Payer: Cigna Medicare |
$574.38
|
| Rate for Payer: Employer Direct Commercial |
$574.38
|
| Rate for Payer: Humana Medicare/TRICARE |
$574.38
|
| Rate for Payer: Molina CHIP/Medicaid |
$105.20
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$574.38
|
| Rate for Payer: Molina Medicare |
$574.38
|
| 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 |
$105.20
|
| Rate for Payer: Scott and White EPO/PPO |
$12.67
|
| Rate for Payer: Scott and White Medicare |
$574.38
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$105.20
|
| Rate for Payer: Superior Health Plan EPO |
$574.38
|
| Rate for Payer: Superior Health Plan Medicare |
$574.38
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$574.38
|
| Rate for Payer: Universal American Medicare |
$574.38
|
| Rate for Payer: Wellcare Medicare |
$574.38
|
| Rate for Payer: Wellmed Medicare |
$574.38
|
|
|
Repair of nasal valve collapse with subcutaneous/submucosal lateral wall implant(s)
|
Facility
|
OP
|
$12,816.85
|
|
|
Service Code
|
CPT 30468
|
| Hospital Charge Code |
36030468
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$118.13 |
| Max. Negotiated Rate |
$12,816.85 |
| Rate for Payer: Aetna Commercial |
$6,077.00
|
| Rate for Payer: Aetna Medicare |
$8,033.61
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2,843.09
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$5,355.74
|
| Rate for Payer: Amerigroup Medicare |
$5,355.74
|
| Rate for Payer: BCBS of TX Blue Advantage |
$8,493.70
|
| Rate for Payer: BCBS of TX Blue Essentials |
$10,172.10
|
| Rate for Payer: BCBS of TX Medicare |
$5,355.74
|
| Rate for Payer: BCBS of TX PPO |
$12,816.85
|
| Rate for Payer: Cigna Commercial |
$12,132.30
|
| Rate for Payer: Cigna Medicaid |
$2,843.09
|
| Rate for Payer: Cigna Medicare |
$5,355.74
|
| Rate for Payer: Employer Direct Commercial |
$5,355.74
|
| Rate for Payer: Humana Medicare/TRICARE |
$5,355.74
|
| Rate for Payer: Molina CHIP/Medicaid |
$2,843.09
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$5,355.74
|
| Rate for Payer: Molina Medicare |
$5,355.74
|
| 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 |
$2,843.09
|
| Rate for Payer: Scott and White EPO/PPO |
$118.13
|
| Rate for Payer: Scott and White Medicare |
$5,355.74
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$2,843.09
|
| Rate for Payer: Superior Health Plan EPO |
$5,355.74
|
| Rate for Payer: Superior Health Plan Medicare |
$5,355.74
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$5,355.74
|
| Rate for Payer: Universal American Medicare |
$5,355.74
|
| Rate for Payer: Wellcare Medicare |
$5,355.74
|
| Rate for Payer: Wellmed Medicare |
$5,355.74
|
|
|
Repair of nasal vestibular stenosis (eg, spreader grafting, lateral nasal wall reconstruction)
|
Facility
|
OP
|
$12,223.34
|
|
|
Service Code
|
CPT 30465
|
| Hospital Charge Code |
36030465
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$118.13 |
| Max. Negotiated Rate |
$12,223.34 |
| Rate for Payer: Aetna Commercial |
$6,077.00
|
| Rate for Payer: Aetna Medicare |
$8,033.61
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,954.22
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$5,355.74
|
| Rate for Payer: Amerigroup Medicare |
$5,355.74
|
| Rate for Payer: BCBS of TX Blue Advantage |
$8,100.39
|
| Rate for Payer: BCBS of TX Blue Essentials |
$9,701.06
|
| Rate for Payer: BCBS of TX Medicare |
$5,355.74
|
| Rate for Payer: BCBS of TX PPO |
$12,223.34
|
| Rate for Payer: Cigna Commercial |
$12,132.30
|
| Rate for Payer: Cigna Medicaid |
$1,954.22
|
| Rate for Payer: Cigna Medicare |
$5,355.74
|
| Rate for Payer: Employer Direct Commercial |
$5,355.74
|
| Rate for Payer: Humana Medicare/TRICARE |
$5,355.74
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,954.22
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$5,355.74
|
| Rate for Payer: Molina Medicare |
$5,355.74
|
| 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 |
$1,954.22
|
| Rate for Payer: Scott and White EPO/PPO |
$118.13
|
| Rate for Payer: Scott and White Medicare |
$5,355.74
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,954.22
|
| Rate for Payer: Superior Health Plan EPO |
$5,355.74
|
| Rate for Payer: Superior Health Plan Medicare |
$5,355.74
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$5,355.74
|
| Rate for Payer: Universal American Medicare |
$5,355.74
|
| Rate for Payer: Wellcare Medicare |
$5,355.74
|
| Rate for Payer: Wellmed Medicare |
$5,355.74
|
|
|
Repair of nonunion of carpal bone (excluding carpal scaphoid (navicular)) (includes obtaining graft
|
Facility
|
OP
|
$15,074.51
|
|
|
Service Code
|
CPT 25431
|
| Hospital Charge Code |
36025431
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$144.31 |
| Max. Negotiated Rate |
$15,074.51 |
| Rate for Payer: Aetna Commercial |
$6,077.00
|
| Rate for Payer: Aetna Medicare |
$9,814.08
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2,398.52
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$6,542.72
|
| Rate for Payer: Amerigroup Medicare |
$6,542.72
|
| Rate for Payer: BCBS of TX Blue Advantage |
$9,989.86
|
| Rate for Payer: BCBS of TX Blue Essentials |
$11,963.90
|
| Rate for Payer: BCBS of TX Medicare |
$6,542.72
|
| Rate for Payer: BCBS of TX PPO |
$15,074.51
|
| Rate for Payer: Cigna Commercial |
$14,821.16
|
| Rate for Payer: Cigna Medicaid |
$2,398.52
|
| Rate for Payer: Cigna Medicare |
$6,542.72
|
| Rate for Payer: Employer Direct Commercial |
$6,542.72
|
| Rate for Payer: Humana Medicare/TRICARE |
$6,542.72
|
| Rate for Payer: Molina CHIP/Medicaid |
$2,398.52
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$6,542.72
|
| Rate for Payer: Molina Medicare |
$6,542.72
|
| Rate for Payer: Multiplan Auto |
$10,000.00
|
| Rate for Payer: Multiplan Commercial |
$10,000.00
|
| Rate for Payer: Multiplan Workers Comp |
$10,000.00
|
| Rate for Payer: Parkland Medicaid |
$2,398.52
|
| Rate for Payer: Scott and White EPO/PPO |
$144.31
|
| Rate for Payer: Scott and White Medicare |
$6,542.72
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$2,398.52
|
| Rate for Payer: Superior Health Plan EPO |
$6,542.72
|
| Rate for Payer: Superior Health Plan Medicare |
$6,542.72
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$6,542.72
|
| Rate for Payer: Universal American Medicare |
$6,542.72
|
| Rate for Payer: Wellcare Medicare |
$6,542.72
|
| Rate for Payer: Wellmed Medicare |
$6,542.72
|
|
|
Repair of nonunion, scaphoid carpal (navicular) bone, with or without radial styloidectomy (includes
|
Facility
|
OP
|
$15,074.51
|
|
|
Service Code
|
CPT 25440
|
| Hospital Charge Code |
36025440
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$144.31 |
| Max. Negotiated Rate |
$15,074.51 |
| Rate for Payer: Aetna Commercial |
$6,077.00
|
| Rate for Payer: Aetna Medicare |
$9,814.08
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2,398.52
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$6,542.72
|
| Rate for Payer: Amerigroup Medicare |
$6,542.72
|
| Rate for Payer: BCBS of TX Blue Advantage |
$9,989.86
|
| Rate for Payer: BCBS of TX Blue Essentials |
$11,963.90
|
| Rate for Payer: BCBS of TX Medicare |
$6,542.72
|
| Rate for Payer: BCBS of TX PPO |
$15,074.51
|
| Rate for Payer: Cigna Commercial |
$14,821.16
|
| Rate for Payer: Cigna Medicaid |
$2,398.52
|
| Rate for Payer: Cigna Medicare |
$6,542.72
|
| Rate for Payer: Employer Direct Commercial |
$6,542.72
|
| Rate for Payer: Humana Medicare/TRICARE |
$6,542.72
|
| Rate for Payer: Molina CHIP/Medicaid |
$2,398.52
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$6,542.72
|
| Rate for Payer: Molina Medicare |
$6,542.72
|
| Rate for Payer: Multiplan Auto |
$10,000.00
|
| Rate for Payer: Multiplan Commercial |
$10,000.00
|
| Rate for Payer: Multiplan Workers Comp |
$10,000.00
|
| Rate for Payer: Parkland Medicaid |
$2,398.52
|
| Rate for Payer: Scott and White EPO/PPO |
$144.31
|
| Rate for Payer: Scott and White Medicare |
$6,542.72
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$2,398.52
|
| Rate for Payer: Superior Health Plan EPO |
$6,542.72
|
| Rate for Payer: Superior Health Plan Medicare |
$6,542.72
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$6,542.72
|
| Rate for Payer: Universal American Medicare |
$6,542.72
|
| Rate for Payer: Wellcare Medicare |
$6,542.72
|
| Rate for Payer: Wellmed Medicare |
$6,542.72
|
|
|
Repair of ruptured musculotendinous cuff (eg, rotator cuff) open acute
|
Facility
|
OP
|
$15,074.51
|
|
|
Service Code
|
CPT 23410
|
| Hospital Charge Code |
36023410
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$144.31 |
| Max. Negotiated Rate |
$15,074.51 |
| Rate for Payer: Aetna Commercial |
$6,077.00
|
| Rate for Payer: Aetna Medicare |
$9,814.08
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2,398.52
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$6,542.72
|
| Rate for Payer: Amerigroup Medicare |
$6,542.72
|
| Rate for Payer: BCBS of TX Blue Advantage |
$9,989.86
|
| Rate for Payer: BCBS of TX Blue Essentials |
$11,963.90
|
| Rate for Payer: BCBS of TX Medicare |
$6,542.72
|
| Rate for Payer: BCBS of TX PPO |
$15,074.51
|
| Rate for Payer: Cigna Commercial |
$14,821.16
|
| Rate for Payer: Cigna Medicaid |
$2,398.52
|
| Rate for Payer: Cigna Medicare |
$6,542.72
|
| Rate for Payer: Employer Direct Commercial |
$6,542.72
|
| Rate for Payer: Humana Medicare/TRICARE |
$6,542.72
|
| Rate for Payer: Molina CHIP/Medicaid |
$2,398.52
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$6,542.72
|
| Rate for Payer: Molina Medicare |
$6,542.72
|
| Rate for Payer: Multiplan Auto |
$10,000.00
|
| Rate for Payer: Multiplan Commercial |
$10,000.00
|
| Rate for Payer: Multiplan Workers Comp |
$10,000.00
|
| Rate for Payer: Parkland Medicaid |
$2,398.52
|
| Rate for Payer: Scott and White EPO/PPO |
$144.31
|
| Rate for Payer: Scott and White Medicare |
$6,542.72
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$2,398.52
|
| Rate for Payer: Superior Health Plan EPO |
$6,542.72
|
| Rate for Payer: Superior Health Plan Medicare |
$6,542.72
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$6,542.72
|
| Rate for Payer: Universal American Medicare |
$6,542.72
|
| Rate for Payer: Wellcare Medicare |
$6,542.72
|
| Rate for Payer: Wellmed Medicare |
$6,542.72
|
|
|
Repair of ruptured musculotendinous cuff (eg, rotator cuff) open chronic
|
Facility
|
OP
|
$15,074.51
|
|
|
Service Code
|
CPT 23412
|
| Hospital Charge Code |
36023412
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$144.31 |
| Max. Negotiated Rate |
$15,074.51 |
| Rate for Payer: Aetna Commercial |
$6,077.00
|
| Rate for Payer: Aetna Medicare |
$9,814.08
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2,398.52
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$6,542.72
|
| Rate for Payer: Amerigroup Medicare |
$6,542.72
|
| Rate for Payer: BCBS of TX Blue Advantage |
$9,989.86
|
| Rate for Payer: BCBS of TX Blue Essentials |
$11,963.90
|
| Rate for Payer: BCBS of TX Medicare |
$6,542.72
|
| Rate for Payer: BCBS of TX PPO |
$15,074.51
|
| Rate for Payer: Cigna Commercial |
$14,821.16
|
| Rate for Payer: Cigna Medicaid |
$2,398.52
|
| Rate for Payer: Cigna Medicare |
$6,542.72
|
| Rate for Payer: Employer Direct Commercial |
$6,542.72
|
| Rate for Payer: Humana Medicare/TRICARE |
$6,542.72
|
| Rate for Payer: Molina CHIP/Medicaid |
$2,398.52
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$6,542.72
|
| Rate for Payer: Molina Medicare |
$6,542.72
|
| Rate for Payer: Multiplan Auto |
$10,000.00
|
| Rate for Payer: Multiplan Commercial |
$10,000.00
|
| Rate for Payer: Multiplan Workers Comp |
$10,000.00
|
| Rate for Payer: Parkland Medicaid |
$2,398.52
|
| Rate for Payer: Scott and White EPO/PPO |
$144.31
|
| Rate for Payer: Scott and White Medicare |
$6,542.72
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$2,398.52
|
| Rate for Payer: Superior Health Plan EPO |
$6,542.72
|
| Rate for Payer: Superior Health Plan Medicare |
$6,542.72
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$6,542.72
|
| Rate for Payer: Universal American Medicare |
$6,542.72
|
| Rate for Payer: Wellcare Medicare |
$6,542.72
|
| Rate for Payer: Wellmed Medicare |
$6,542.72
|
|
|
Repair or advancement-flexor tendon
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 26356
|
| Hospital Charge Code |
36026356
|
|
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
|
|
|
Repair or advancement, flexor tendon, in zone 2 digital flexor tendon sheath (eg, no man's land); se
|
Facility
|
OP
|
$15,074.51
|
|
|
Service Code
|
CPT 26358
|
| Hospital Charge Code |
36026358
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$144.31 |
| Max. Negotiated Rate |
$15,074.51 |
| Rate for Payer: Aetna Commercial |
$4,635.00
|
| Rate for Payer: Aetna Medicare |
$9,814.08
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2,398.52
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$6,542.72
|
| Rate for Payer: Amerigroup Medicare |
$6,542.72
|
| Rate for Payer: BCBS of TX Blue Advantage |
$9,989.86
|
| Rate for Payer: BCBS of TX Blue Essentials |
$11,963.90
|
| Rate for Payer: BCBS of TX Medicare |
$6,542.72
|
| Rate for Payer: BCBS of TX PPO |
$15,074.51
|
| Rate for Payer: Cigna Commercial |
$14,821.16
|
| Rate for Payer: Cigna Medicaid |
$2,398.52
|
| Rate for Payer: Cigna Medicare |
$6,542.72
|
| Rate for Payer: Employer Direct Commercial |
$6,542.72
|
| Rate for Payer: Humana Medicare/TRICARE |
$6,542.72
|
| Rate for Payer: Molina CHIP/Medicaid |
$2,398.52
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$6,542.72
|
| Rate for Payer: Molina Medicare |
$6,542.72
|
| Rate for Payer: Multiplan Auto |
$10,000.00
|
| Rate for Payer: Multiplan Commercial |
$10,000.00
|
| Rate for Payer: Multiplan Workers Comp |
$10,000.00
|
| Rate for Payer: Parkland Medicaid |
$2,398.52
|
| Rate for Payer: Scott and White EPO/PPO |
$144.31
|
| Rate for Payer: Scott and White Medicare |
$6,542.72
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$2,398.52
|
| Rate for Payer: Superior Health Plan EPO |
$6,542.72
|
| Rate for Payer: Superior Health Plan Medicare |
$6,542.72
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$6,542.72
|
| Rate for Payer: Universal American Medicare |
$6,542.72
|
| Rate for Payer: Wellcare Medicare |
$6,542.72
|
| Rate for Payer: Wellmed Medicare |
$6,542.72
|
|
|
Repair or advancement, flexor tendon, not in zone 2 digital flexor tendon sheath (eg, no man's land)
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 26350
|
| Hospital Charge Code |
36026350
|
|
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
|
|
|
Repair or advancement of profundus tendon, with intact superficialis tendon; primary, each tendon
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 26370
|
| Hospital Charge Code |
36026370
|
|
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
|
|
|
Repair, paraesophageal hiatal hernia, (including fundoplication), via thoracoabdominal incision, exc
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 43337
|
| Hospital Charge Code |
36043337
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,683.66 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$4,017.00
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,683.66
|
| Rate for Payer: BCBS of TX Blue Essentials |
$3,213.96
|
| Rate for Payer: BCBS of TX PPO |
$4,049.59
|
| 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
|
|
|
Repair, primary, disrupted ligament, ankle; collateral
|
Facility
|
OP
|
$15,074.51
|
|
|
Service Code
|
CPT 27695
|
| Hospital Charge Code |
36027695
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$144.31 |
| Max. Negotiated Rate |
$15,074.51 |
| Rate for Payer: Aetna Commercial |
$4,635.00
|
| Rate for Payer: Aetna Medicare |
$9,814.08
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$3,138.19
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$6,542.72
|
| Rate for Payer: Amerigroup Medicare |
$6,542.72
|
| Rate for Payer: BCBS of TX Blue Advantage |
$9,989.86
|
| Rate for Payer: BCBS of TX Blue Essentials |
$11,963.90
|
| Rate for Payer: BCBS of TX Medicare |
$6,542.72
|
| Rate for Payer: BCBS of TX PPO |
$15,074.51
|
| Rate for Payer: Cigna Commercial |
$14,821.16
|
| Rate for Payer: Cigna Medicaid |
$3,138.19
|
| Rate for Payer: Cigna Medicare |
$6,542.72
|
| Rate for Payer: Employer Direct Commercial |
$6,542.72
|
| Rate for Payer: Humana Medicare/TRICARE |
$6,542.72
|
| Rate for Payer: Molina CHIP/Medicaid |
$3,138.19
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$6,542.72
|
| Rate for Payer: Molina Medicare |
$6,542.72
|
| Rate for Payer: Multiplan Auto |
$10,000.00
|
| Rate for Payer: Multiplan Commercial |
$10,000.00
|
| Rate for Payer: Multiplan Workers Comp |
$10,000.00
|
| Rate for Payer: Parkland Medicaid |
$3,138.19
|
| Rate for Payer: Scott and White EPO/PPO |
$144.31
|
| Rate for Payer: Scott and White Medicare |
$6,542.72
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$3,138.19
|
| Rate for Payer: Superior Health Plan EPO |
$6,542.72
|
| Rate for Payer: Superior Health Plan Medicare |
$6,542.72
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$6,542.72
|
| Rate for Payer: Universal American Medicare |
$6,542.72
|
| Rate for Payer: Wellcare Medicare |
$6,542.72
|
| Rate for Payer: Wellmed Medicare |
$6,542.72
|
|
|
Repair, primary, open or percutaneous, ruptured Achilles tendon
|
Facility
|
OP
|
$15,074.51
|
|
|
Service Code
|
CPT 27650
|
| Hospital Charge Code |
36027650
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$144.31 |
| Max. Negotiated Rate |
$15,074.51 |
| Rate for Payer: Aetna Commercial |
$6,077.00
|
| Rate for Payer: Aetna Medicare |
$9,814.08
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2,398.52
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$6,542.72
|
| Rate for Payer: Amerigroup Medicare |
$6,542.72
|
| Rate for Payer: BCBS of TX Blue Advantage |
$9,989.86
|
| Rate for Payer: BCBS of TX Blue Essentials |
$11,963.90
|
| Rate for Payer: BCBS of TX Medicare |
$6,542.72
|
| Rate for Payer: BCBS of TX PPO |
$15,074.51
|
| Rate for Payer: Cigna Commercial |
$14,821.16
|
| Rate for Payer: Cigna Medicaid |
$2,398.52
|
| Rate for Payer: Cigna Medicare |
$6,542.72
|
| Rate for Payer: Employer Direct Commercial |
$6,542.72
|
| Rate for Payer: Humana Medicare/TRICARE |
$6,542.72
|
| Rate for Payer: Molina CHIP/Medicaid |
$2,398.52
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$6,542.72
|
| Rate for Payer: Molina Medicare |
$6,542.72
|
| Rate for Payer: Multiplan Auto |
$10,000.00
|
| Rate for Payer: Multiplan Commercial |
$10,000.00
|
| Rate for Payer: Multiplan Workers Comp |
$10,000.00
|
| Rate for Payer: Parkland Medicaid |
$2,398.52
|
| Rate for Payer: Scott and White EPO/PPO |
$144.31
|
| Rate for Payer: Scott and White Medicare |
$6,542.72
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$2,398.52
|
| Rate for Payer: Superior Health Plan EPO |
$6,542.72
|
| Rate for Payer: Superior Health Plan Medicare |
$6,542.72
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$6,542.72
|
| Rate for Payer: Universal American Medicare |
$6,542.72
|
| Rate for Payer: Wellcare Medicare |
$6,542.72
|
| Rate for Payer: Wellmed Medicare |
$6,542.72
|
|
