|
Laparoscopy, abdomen, peritoneum, and omentum, diagnostic, with or without collection of specimen(s)
|
Facility
|
OP
|
$12,837.39
|
|
|
Service Code
|
CPT 49320
|
| Hospital Charge Code |
36049320
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,888.85 |
| Max. Negotiated Rate |
$12,837.39 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,888.85
|
| 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 |
$9,762.30
|
| 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
|
|
|
Laparoscopy, abdomen, peritoneum, and omentum, diagnostic, with or without collection of specimen(s)
|
Facility
|
IP
|
$22,771.98
|
|
|
Service Code
|
HCPCS 49320
|
| Hospital Charge Code |
9900709
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$15,484.95
|
|
|
Laparoscopy, abdomen, peritoneum, and omentum, diagnostic, with or without collection of specimen(s)
|
Facility
|
OP
|
$22,771.98
|
|
|
Service Code
|
HCPCS 49320
|
| Hospital Charge Code |
9900709
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,888.85 |
| Max. Negotiated Rate |
$16,395.83 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,888.85
|
| 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 |
$15,484.95
|
| Rate for Payer: Cash Price |
$15,484.95
|
| Rate for Payer: Cash Price |
$15,484.95
|
| Rate for Payer: Cigna Commercial |
$12,837.39
|
| Rate for Payer: Cigna Medicaid |
$16,395.83
|
| 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 |
$16,395.83
|
| 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 |
$16,395.83
|
| Rate for Payer: Scott and White EPO/PPO |
$9,762.30
|
| Rate for Payer: Scott and White Medicare |
$6,073.08
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$16,395.83
|
| 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
|
|
|
Laparoscopy, surgical, appendectomy
|
Facility
|
IP
|
$21,990.36
|
|
|
Service Code
|
HCPCS 44970
|
| Hospital Charge Code |
990980
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$14,953.44
|
|
|
Laparoscopy, surgical, appendectomy
|
Facility
|
OP
|
$21,990.36
|
|
|
Service Code
|
HCPCS 44970
|
| Hospital Charge Code |
990980
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,979.13 |
| Max. Negotiated Rate |
$15,833.06 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,979.13
|
| 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 |
$14,953.44
|
| Rate for Payer: Cash Price |
$14,953.44
|
| Rate for Payer: Cash Price |
$14,953.44
|
| Rate for Payer: Cigna Commercial |
$12,837.39
|
| Rate for Payer: Cigna Medicaid |
$15,833.06
|
| 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 |
$15,833.06
|
| 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 |
$15,833.06
|
| Rate for Payer: Scott and White EPO/PPO |
$9,762.30
|
| Rate for Payer: Scott and White Medicare |
$6,073.08
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$15,833.06
|
| 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
|
|
|
Laparoscopy, surgical cholecystectomy
|
Facility
|
OP
|
$12,837.39
|
|
|
Service Code
|
CPT 47562
|
| Hospital Charge Code |
36047562
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,888.85 |
| Max. Negotiated Rate |
$12,837.39 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,888.85
|
| 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 |
$9,762.30
|
| 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
|
|
|
Laparoscopy, surgical cholecystectomy
|
Facility
|
OP
|
$15,181.32
|
|
|
Service Code
|
HCPCS 47562
|
| Hospital Charge Code |
9900706
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,888.85 |
| Max. Negotiated Rate |
$12,837.39 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,888.85
|
| 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 |
$9,762.30
|
| 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
|
|
|
Laparoscopy, surgical cholecystectomy
|
Facility
|
IP
|
$15,181.32
|
|
|
Service Code
|
HCPCS 47562
|
| Hospital Charge Code |
9900706
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$10,323.30
|
|
|
Laparoscopy, surgical; cholecystectomy with cholangiography
|
Facility
|
OP
|
$31,006.14
|
|
|
Service Code
|
HCPCS 47563
|
| Hospital Charge Code |
9900707
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,888.85 |
| Max. Negotiated Rate |
$22,324.42 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,888.85
|
| 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 |
$21,084.18
|
| Rate for Payer: Cash Price |
$21,084.18
|
| Rate for Payer: Cash Price |
$21,084.18
|
| Rate for Payer: Cigna Commercial |
$12,837.39
|
| Rate for Payer: Cigna Medicaid |
$22,324.42
|
| 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 |
$22,324.42
|
| 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 |
$22,324.42
|
| Rate for Payer: Scott and White EPO/PPO |
$9,762.30
|
| Rate for Payer: Scott and White Medicare |
$6,073.08
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$22,324.42
|
| 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
|
|
|
Laparoscopy, surgical; cholecystectomy with cholangiography
|
Facility
|
OP
|
$12,837.39
|
|
|
Service Code
|
CPT 47563
|
| Hospital Charge Code |
36047563
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,888.85 |
| Max. Negotiated Rate |
$12,837.39 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,888.85
|
| 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 |
$9,762.30
|
| 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
|
|
|
Laparoscopy, surgical; cholecystectomy with cholangiography
|
Facility
|
IP
|
$31,006.14
|
|
|
Service Code
|
HCPCS 47563
|
| Hospital Charge Code |
9900707
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$21,084.18
|
|
|
Laparoscopy, surgical; enterectomy, resection of small intestine, single resection and anastomosis
|
Facility
|
IP
|
$23,325.00
|
|
|
Service Code
|
HCPCS 44202
|
| Hospital Charge Code |
9900925
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$15,861.00
|
|
|
Laparoscopy, surgical; enterectomy, resection of small intestine, single resection and anastomosis
|
Facility
|
OP
|
$23,325.00
|
|
|
Service Code
|
HCPCS 44202
|
| Hospital Charge Code |
9900925
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,099.25 |
| Max. Negotiated Rate |
$16,794.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2,099.25
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,415.24
|
| Rate for Payer: BCBS of TX Blue Essentials |
$2,892.50
|
| Rate for Payer: BCBS of TX PPO |
$3,644.55
|
| Rate for Payer: Cash Price |
$15,861.00
|
| Rate for Payer: Cash Price |
$15,861.00
|
| Rate for Payer: Cash Price |
$15,861.00
|
| Rate for Payer: Cigna Medicaid |
$16,794.00
|
| Rate for Payer: Molina CHIP/Medicaid |
$16,794.00
|
| 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
|
| Rate for Payer: Parkland Medicaid |
$16,794.00
|
| Rate for Payer: Scott and White EPO/PPO |
$11,662.50
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$16,794.00
|
| Rate for Payer: Superior Health Plan EPO |
$3,172.20
|
|
|
Laparoscopy, surgical, enterolysis (freeing of intestinal adhesion) (separate procedure)
|
Facility
|
OP
|
$79,281.84
|
|
|
Service Code
|
HCPCS 44180
|
| Hospital Charge Code |
9900695
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,073.08 |
| Max. Negotiated Rate |
$57,082.92 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$7,135.37
|
| 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 |
$53,911.65
|
| Rate for Payer: Cash Price |
$53,911.65
|
| Rate for Payer: Cash Price |
$53,911.65
|
| Rate for Payer: Cigna Commercial |
$12,837.39
|
| Rate for Payer: Cigna Medicaid |
$57,082.92
|
| 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 |
$57,082.92
|
| 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 |
$57,082.92
|
| Rate for Payer: Scott and White EPO/PPO |
$9,762.30
|
| Rate for Payer: Scott and White Medicare |
$6,073.08
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$57,082.92
|
| 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
|
|
|
Laparoscopy, surgical, enterolysis (freeing of intestinal adhesion) (separate procedure)
|
Facility
|
OP
|
$12,837.39
|
|
|
Service Code
|
CPT 44180
|
| Hospital Charge Code |
36044180
|
|
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 |
$9,762.30
|
| 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
|
|
|
Laparoscopy, surgical, enterolysis (freeing of intestinal adhesion) (separate procedure)
|
Facility
|
IP
|
$79,281.84
|
|
|
Service Code
|
HCPCS 44180
|
| Hospital Charge Code |
9900695
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$53,911.65
|
|
|
Laparoscopy, surgical, esophagogastric fundoplasty (eg, Nissen, Toupet procedures)
|
Facility
|
OP
|
$1,817.46
|
|
|
Service Code
|
HCPCS 43280
|
| Hospital Charge Code |
9900679
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$163.57 |
| Max. Negotiated Rate |
$22,571.94 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$163.57
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$10,678.27
|
| Rate for Payer: Amerigroup Medicare |
$10,678.27
|
| Rate for Payer: BCBS of TX Blue Advantage |
$14,049.89
|
| Rate for Payer: BCBS of TX Blue Essentials |
$16,826.22
|
| Rate for Payer: BCBS of TX Medicare |
$10,678.27
|
| Rate for Payer: BCBS of TX PPO |
$21,201.04
|
| Rate for Payer: Cash Price |
$1,235.87
|
| Rate for Payer: Cash Price |
$1,235.87
|
| Rate for Payer: Cash Price |
$1,235.87
|
| Rate for Payer: Cigna Commercial |
$22,571.94
|
| Rate for Payer: Cigna Medicaid |
$1,308.57
|
| Rate for Payer: Cigna Medicare |
$10,678.27
|
| Rate for Payer: Employer Direct Commercial |
$10,678.27
|
| Rate for Payer: Humana Medicare/TRICARE |
$10,678.27
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,308.57
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$10,678.27
|
| Rate for Payer: Molina Medicare |
$10,678.27
|
| 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 |
$1,308.57
|
| Rate for Payer: Scott and White EPO/PPO |
$17,416.05
|
| Rate for Payer: Scott and White Medicare |
$10,678.27
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,308.57
|
| Rate for Payer: Superior Health Plan EPO |
$10,678.27
|
| Rate for Payer: Superior Health Plan Medicare |
$10,678.27
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$10,678.27
|
| Rate for Payer: Universal American Medicare |
$10,678.27
|
| Rate for Payer: Wellcare Medicare |
$10,678.27
|
| Rate for Payer: Wellmed Medicare |
$10,678.27
|
|
|
Laparoscopy, surgical, esophagogastric fundoplasty (eg, Nissen, Toupet procedures)
|
Facility
|
IP
|
$1,817.46
|
|
|
Service Code
|
HCPCS 43280
|
| Hospital Charge Code |
9900679
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$1,235.87
|
|
|
Laparoscopy, surgical, esophagogastric fundoplasty (eg, Nissen, Toupet procedures)
|
Facility
|
OP
|
$22,571.94
|
|
|
Service Code
|
CPT 43280
|
| Hospital Charge Code |
36043280
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$10,000.00 |
| Max. Negotiated Rate |
$22,571.94 |
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$10,678.27
|
| Rate for Payer: Amerigroup Medicare |
$10,678.27
|
| Rate for Payer: BCBS of TX Blue Advantage |
$14,049.89
|
| Rate for Payer: BCBS of TX Blue Essentials |
$16,826.22
|
| Rate for Payer: BCBS of TX Medicare |
$10,678.27
|
| Rate for Payer: BCBS of TX PPO |
$21,201.04
|
| Rate for Payer: Cigna Commercial |
$22,571.94
|
| Rate for Payer: Cigna Medicare |
$10,678.27
|
| Rate for Payer: Employer Direct Commercial |
$10,678.27
|
| Rate for Payer: Humana Medicare/TRICARE |
$10,678.27
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$10,678.27
|
| Rate for Payer: Molina Medicare |
$10,678.27
|
| 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 |
$17,416.05
|
| Rate for Payer: Scott and White Medicare |
$10,678.27
|
| Rate for Payer: Superior Health Plan EPO |
$10,678.27
|
| Rate for Payer: Superior Health Plan Medicare |
$10,678.27
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$10,678.27
|
| Rate for Payer: Universal American Medicare |
$10,678.27
|
| Rate for Payer: Wellcare Medicare |
$10,678.27
|
| Rate for Payer: Wellmed Medicare |
$10,678.27
|
|
|
Laparoscopy, surgical, gastric restrictive procedure
|
Facility
|
IP
|
$13,649.51
|
|
|
Service Code
|
HCPCS 43775
|
| Hospital Charge Code |
9900690
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$9,281.67
|
|
|
Laparoscopy, surgical, gastric restrictive procedure
|
Facility
|
OP
|
$13,649.51
|
|
|
Service Code
|
HCPCS 43775
|
| Hospital Charge Code |
9900690
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,228.46 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,228.46
|
| Rate for Payer: BARInet Commercial |
$10,000.00
|
| Rate for Payer: BCBS of TX Blue Advantage |
$1,947.60
|
| Rate for Payer: BCBS of TX Blue Essentials |
$2,332.46
|
| Rate for Payer: BCBS of TX PPO |
$2,938.90
|
| Rate for Payer: Cash Price |
$9,281.67
|
| Rate for Payer: Cash Price |
$9,281.67
|
| Rate for Payer: Cash Price |
$9,281.67
|
| Rate for Payer: Cigna Medicaid |
$9,827.65
|
| Rate for Payer: Molina CHIP/Medicaid |
$9,827.65
|
| 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 |
$9,827.65
|
| Rate for Payer: Scott and White EPO/PPO |
$6,824.76
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$9,827.65
|
| Rate for Payer: Superior Health Plan EPO |
$1,856.33
|
|
|
Laparoscopy, surgical, gastric restrictive procedure longitudinal gastrectomy (ie, sleeve gastrecto
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 43775
|
| Hospital Charge Code |
36043775
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,337.06 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: BARInet Commercial |
$10,000.00
|
| Rate for Payer: BCBS of TX Blue Advantage |
$1,947.60
|
| Rate for Payer: BCBS of TX Blue Essentials |
$2,332.46
|
| Rate for Payer: BCBS of TX PPO |
$2,938.90
|
| 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 |
$1,337.06
|
|
|
Laparoscopy, surgical, gastric restrictive procedure placement of adjustable gastric restrictive de
|
Facility
|
IP
|
$9,216.90
|
|
|
Service Code
|
HCPCS 43770
|
| Hospital Charge Code |
9900688
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$6,267.49
|
|
|
Laparoscopy, surgical, gastric restrictive procedure placement of adjustable gastric restrictive de
|
Facility
|
OP
|
$9,216.90
|
|
|
Service Code
|
HCPCS 43770
|
| Hospital Charge Code |
9900688
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$829.52 |
| Max. Negotiated Rate |
$22,571.94 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$829.52
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$10,678.27
|
| Rate for Payer: Amerigroup Medicare |
$10,678.27
|
| Rate for Payer: BCBS of TX Blue Advantage |
$14,049.89
|
| Rate for Payer: BCBS of TX Blue Essentials |
$16,826.22
|
| Rate for Payer: BCBS of TX Medicare |
$10,678.27
|
| Rate for Payer: BCBS of TX PPO |
$21,201.04
|
| Rate for Payer: Cash Price |
$6,267.49
|
| Rate for Payer: Cash Price |
$6,267.49
|
| Rate for Payer: Cash Price |
$6,267.49
|
| Rate for Payer: Cigna Commercial |
$22,571.94
|
| Rate for Payer: Cigna Medicaid |
$6,636.17
|
| Rate for Payer: Cigna Medicare |
$10,678.27
|
| Rate for Payer: Employer Direct Commercial |
$10,678.27
|
| Rate for Payer: Humana Medicare/TRICARE |
$10,678.27
|
| Rate for Payer: Molina CHIP/Medicaid |
$6,636.17
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$10,678.27
|
| Rate for Payer: Molina Medicare |
$10,678.27
|
| 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 |
$6,636.17
|
| Rate for Payer: Scott and White EPO/PPO |
$17,416.05
|
| Rate for Payer: Scott and White Medicare |
$10,678.27
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$6,636.17
|
| Rate for Payer: Superior Health Plan EPO |
$10,678.27
|
| Rate for Payer: Superior Health Plan Medicare |
$10,678.27
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$10,678.27
|
| Rate for Payer: Universal American Medicare |
$10,678.27
|
| Rate for Payer: Wellcare Medicare |
$10,678.27
|
| Rate for Payer: Wellmed Medicare |
$10,678.27
|
|
|
Laparoscopy, surgical, gastric restrictive procedure placement of adjustable gastric restrictive de
|
Facility
|
OP
|
$22,571.94
|
|
|
Service Code
|
CPT 43770
|
| Hospital Charge Code |
36043770
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$10,000.00 |
| Max. Negotiated Rate |
$22,571.94 |
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$10,678.27
|
| Rate for Payer: Amerigroup Medicare |
$10,678.27
|
| Rate for Payer: BCBS of TX Blue Advantage |
$14,049.89
|
| Rate for Payer: BCBS of TX Blue Essentials |
$16,826.22
|
| Rate for Payer: BCBS of TX Medicare |
$10,678.27
|
| Rate for Payer: BCBS of TX PPO |
$21,201.04
|
| Rate for Payer: Cigna Commercial |
$22,571.94
|
| Rate for Payer: Cigna Medicare |
$10,678.27
|
| Rate for Payer: Employer Direct Commercial |
$10,678.27
|
| Rate for Payer: Humana Medicare/TRICARE |
$10,678.27
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$10,678.27
|
| Rate for Payer: Molina Medicare |
$10,678.27
|
| 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 |
$17,416.05
|
| Rate for Payer: Scott and White Medicare |
$10,678.27
|
| Rate for Payer: Superior Health Plan EPO |
$10,678.27
|
| Rate for Payer: Superior Health Plan Medicare |
$10,678.27
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$10,678.27
|
| Rate for Payer: Universal American Medicare |
$10,678.27
|
| Rate for Payer: Wellcare Medicare |
$10,678.27
|
| Rate for Payer: Wellmed Medicare |
$10,678.27
|
|
