|
LARYNGEAL MASK, SZ 5, FLEXIBLE, DISP
|
Facility
|
OP
|
$38.99
|
|
| Hospital Charge Code |
992999
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.51 |
| Max. Negotiated Rate |
$28.07 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$3.51
|
| Rate for Payer: BCBS of TX Blue Advantage |
$11.70
|
| Rate for Payer: BCBS of TX Blue Essentials |
$14.04
|
| Rate for Payer: BCBS of TX PPO |
$15.60
|
| Rate for Payer: Cash Price |
$26.51
|
| Rate for Payer: Cigna Medicaid |
$28.07
|
| Rate for Payer: Molina CHIP/Medicaid |
$28.07
|
| Rate for Payer: Multiplan Auto |
$25.34
|
| Rate for Payer: Multiplan Commercial |
$25.34
|
| Rate for Payer: Multiplan Workers Comp |
$25.34
|
| Rate for Payer: Parkland Medicaid |
$28.07
|
| Rate for Payer: Scott and White EPO/PPO |
$19.50
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$28.07
|
| Rate for Payer: Superior Health Plan EPO |
$5.30
|
|
|
LARYNGEAL MASK, SZ 5, FLEXIBLE, DISP
|
Facility
|
IP
|
$38.99
|
|
| Hospital Charge Code |
992999
|
|
Hospital Revenue Code
|
270
|
| Rate for Payer: Cash Price |
$26.51
|
|
|
laryngoscope blade size 4
|
Facility
|
IP
|
$67.56
|
|
| Hospital Charge Code |
992831
|
|
Hospital Revenue Code
|
270
|
| Rate for Payer: Cash Price |
$45.94
|
|
|
laryngoscope blade size 4
|
Facility
|
OP
|
$67.56
|
|
| Hospital Charge Code |
992831
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.08 |
| Max. Negotiated Rate |
$48.64 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$6.08
|
| Rate for Payer: BCBS of TX Blue Advantage |
$20.27
|
| Rate for Payer: BCBS of TX Blue Essentials |
$24.32
|
| Rate for Payer: BCBS of TX PPO |
$27.02
|
| Rate for Payer: Cash Price |
$45.94
|
| Rate for Payer: Cigna Medicaid |
$48.64
|
| Rate for Payer: Molina CHIP/Medicaid |
$48.64
|
| Rate for Payer: Multiplan Auto |
$43.91
|
| Rate for Payer: Multiplan Commercial |
$43.91
|
| Rate for Payer: Multiplan Workers Comp |
$43.91
|
| Rate for Payer: Parkland Medicaid |
$48.64
|
| Rate for Payer: Scott and White EPO/PPO |
$33.78
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$48.64
|
| Rate for Payer: Superior Health Plan EPO |
$9.19
|
|
|
LARYNGOSCOPE DISP HNDL MCTSH FBR OPTC
|
Facility
|
IP
|
$42.64
|
|
| Hospital Charge Code |
993589
|
|
Hospital Revenue Code
|
270
|
| Rate for Payer: Cash Price |
$29.00
|
|
|
LARYNGOSCOPE DISP HNDL MCTSH FBR OPTC
|
Facility
|
OP
|
$42.64
|
|
| Hospital Charge Code |
993589
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.84 |
| Max. Negotiated Rate |
$30.70 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$3.84
|
| Rate for Payer: BCBS of TX Blue Advantage |
$12.79
|
| Rate for Payer: BCBS of TX Blue Essentials |
$15.35
|
| Rate for Payer: BCBS of TX PPO |
$17.06
|
| Rate for Payer: Cash Price |
$29.00
|
| Rate for Payer: Cigna Medicaid |
$30.70
|
| Rate for Payer: Molina CHIP/Medicaid |
$30.70
|
| Rate for Payer: Multiplan Auto |
$27.72
|
| Rate for Payer: Multiplan Commercial |
$27.72
|
| Rate for Payer: Multiplan Workers Comp |
$27.72
|
| Rate for Payer: Parkland Medicaid |
$30.70
|
| Rate for Payer: Scott and White EPO/PPO |
$21.32
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$30.70
|
| Rate for Payer: Superior Health Plan EPO |
$5.80
|
|
|
Laryngoscope Handle BritePro%E2%84%A2 Solo Conventional Disp
|
Facility
|
IP
|
$170.57
|
|
| Hospital Charge Code |
993039
|
|
Hospital Revenue Code
|
270
|
| Rate for Payer: Cash Price |
$115.99
|
|
|
Laryngoscope Handle BritePro%E2%84%A2 Solo Conventional Disp
|
Facility
|
OP
|
$170.57
|
|
| Hospital Charge Code |
993039
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$15.35 |
| Max. Negotiated Rate |
$122.81 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$15.35
|
| Rate for Payer: BCBS of TX Blue Advantage |
$51.17
|
| Rate for Payer: BCBS of TX Blue Essentials |
$61.41
|
| Rate for Payer: BCBS of TX PPO |
$68.23
|
| Rate for Payer: Cash Price |
$115.99
|
| Rate for Payer: Cigna Medicaid |
$122.81
|
| Rate for Payer: Molina CHIP/Medicaid |
$122.81
|
| Rate for Payer: Multiplan Auto |
$110.87
|
| Rate for Payer: Multiplan Commercial |
$110.87
|
| Rate for Payer: Multiplan Workers Comp |
$110.87
|
| Rate for Payer: Parkland Medicaid |
$122.81
|
| Rate for Payer: Scott and White EPO/PPO |
$85.28
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$122.81
|
| Rate for Payer: Superior Health Plan EPO |
$23.20
|
|
|
Laryngoscopy, direct, operative, with biopsy
|
Facility
|
OP
|
$13,941.09
|
|
|
Service Code
|
HCPCS 31535
|
| Hospital Charge Code |
9900615
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,062.24 |
| Max. Negotiated Rate |
$10,037.58 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,062.24
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3,745.34
|
| Rate for Payer: Amerigroup Medicare |
$3,745.34
|
| Rate for Payer: BCBS of TX Blue Advantage |
$4,904.64
|
| Rate for Payer: BCBS of TX Blue Essentials |
$5,873.82
|
| Rate for Payer: BCBS of TX Medicare |
$3,745.34
|
| Rate for Payer: BCBS of TX PPO |
$7,401.01
|
| Rate for Payer: Cash Price |
$9,479.94
|
| Rate for Payer: Cash Price |
$9,479.94
|
| Rate for Payer: Cash Price |
$9,479.94
|
| Rate for Payer: Cigna Commercial |
$7,916.96
|
| Rate for Payer: Cigna Medicaid |
$10,037.58
|
| Rate for Payer: Cigna Medicare |
$3,745.34
|
| Rate for Payer: Employer Direct Commercial |
$3,745.34
|
| Rate for Payer: Humana Medicare/TRICARE |
$3,745.34
|
| Rate for Payer: Molina CHIP/Medicaid |
$10,037.58
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3,745.34
|
| Rate for Payer: Molina Medicare |
$3,745.34
|
| 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 |
$10,037.58
|
| Rate for Payer: Scott and White EPO/PPO |
$6,335.94
|
| Rate for Payer: Scott and White Medicare |
$3,745.34
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$10,037.58
|
| Rate for Payer: Superior Health Plan EPO |
$3,745.34
|
| Rate for Payer: Superior Health Plan Medicare |
$3,745.34
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3,745.34
|
| Rate for Payer: Universal American Medicare |
$3,745.34
|
| Rate for Payer: Wellcare Medicare |
$3,745.34
|
| Rate for Payer: Wellmed Medicare |
$3,745.34
|
|
|
Laryngoscopy, direct, operative, with biopsy
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 31535
|
| Hospital Charge Code |
36031535
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,062.24 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,062.24
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3,745.34
|
| Rate for Payer: Amerigroup Medicare |
$3,745.34
|
| Rate for Payer: BCBS of TX Blue Advantage |
$4,904.64
|
| Rate for Payer: BCBS of TX Blue Essentials |
$5,873.82
|
| Rate for Payer: BCBS of TX Medicare |
$3,745.34
|
| Rate for Payer: BCBS of TX PPO |
$7,401.01
|
| Rate for Payer: Cigna Commercial |
$7,916.96
|
| Rate for Payer: Cigna Medicare |
$3,745.34
|
| Rate for Payer: Employer Direct Commercial |
$3,745.34
|
| Rate for Payer: Humana Medicare/TRICARE |
$3,745.34
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3,745.34
|
| Rate for Payer: Molina Medicare |
$3,745.34
|
| 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 |
$6,335.94
|
| Rate for Payer: Scott and White Medicare |
$3,745.34
|
| Rate for Payer: Superior Health Plan EPO |
$3,745.34
|
| Rate for Payer: Superior Health Plan Medicare |
$3,745.34
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3,745.34
|
| Rate for Payer: Universal American Medicare |
$3,745.34
|
| Rate for Payer: Wellcare Medicare |
$3,745.34
|
| Rate for Payer: Wellmed Medicare |
$3,745.34
|
|
|
Laryngoscopy, direct, operative, with biopsy
|
Facility
|
IP
|
$13,941.09
|
|
|
Service Code
|
HCPCS 31535
|
| Hospital Charge Code |
9900615
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$9,479.94
|
|
|
Laryngoscopy, direct, operative, with biopsy; with operating microscope or telescope
|
Facility
|
OP
|
$7,745.05
|
|
|
Service Code
|
HCPCS 31536
|
| Hospital Charge Code |
9900616
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,062.24 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,062.24
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3,745.34
|
| Rate for Payer: Amerigroup Medicare |
$3,745.34
|
| Rate for Payer: BCBS of TX Blue Advantage |
$4,904.64
|
| Rate for Payer: BCBS of TX Blue Essentials |
$5,873.82
|
| Rate for Payer: BCBS of TX Medicare |
$3,745.34
|
| Rate for Payer: BCBS of TX PPO |
$7,401.01
|
| Rate for Payer: Cash Price |
$5,266.63
|
| Rate for Payer: Cash Price |
$5,266.63
|
| Rate for Payer: Cash Price |
$5,266.63
|
| Rate for Payer: Cigna Commercial |
$7,916.96
|
| Rate for Payer: Cigna Medicaid |
$5,576.44
|
| Rate for Payer: Cigna Medicare |
$3,745.34
|
| Rate for Payer: Employer Direct Commercial |
$3,745.34
|
| Rate for Payer: Humana Medicare/TRICARE |
$3,745.34
|
| Rate for Payer: Molina CHIP/Medicaid |
$5,576.44
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3,745.34
|
| Rate for Payer: Molina Medicare |
$3,745.34
|
| 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 |
$5,576.44
|
| Rate for Payer: Scott and White EPO/PPO |
$6,335.94
|
| Rate for Payer: Scott and White Medicare |
$3,745.34
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$5,576.44
|
| Rate for Payer: Superior Health Plan EPO |
$3,745.34
|
| Rate for Payer: Superior Health Plan Medicare |
$3,745.34
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3,745.34
|
| Rate for Payer: Universal American Medicare |
$3,745.34
|
| Rate for Payer: Wellcare Medicare |
$3,745.34
|
| Rate for Payer: Wellmed Medicare |
$3,745.34
|
|
|
Laryngoscopy, direct, operative, with biopsy; with operating microscope or telescope
|
Facility
|
IP
|
$7,745.05
|
|
|
Service Code
|
HCPCS 31536
|
| Hospital Charge Code |
9900616
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$5,266.63
|
|
|
Laryngoscopy, direct, operative, with biopsy; with operating microscope or telescope
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 31536
|
| Hospital Charge Code |
36031536
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,062.24 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,062.24
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3,745.34
|
| Rate for Payer: Amerigroup Medicare |
$3,745.34
|
| Rate for Payer: BCBS of TX Blue Advantage |
$4,904.64
|
| Rate for Payer: BCBS of TX Blue Essentials |
$5,873.82
|
| Rate for Payer: BCBS of TX Medicare |
$3,745.34
|
| Rate for Payer: BCBS of TX PPO |
$7,401.01
|
| Rate for Payer: Cigna Commercial |
$7,916.96
|
| Rate for Payer: Cigna Medicare |
$3,745.34
|
| Rate for Payer: Employer Direct Commercial |
$3,745.34
|
| Rate for Payer: Humana Medicare/TRICARE |
$3,745.34
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3,745.34
|
| Rate for Payer: Molina Medicare |
$3,745.34
|
| 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 |
$6,335.94
|
| Rate for Payer: Scott and White Medicare |
$3,745.34
|
| Rate for Payer: Superior Health Plan EPO |
$3,745.34
|
| Rate for Payer: Superior Health Plan Medicare |
$3,745.34
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3,745.34
|
| Rate for Payer: Universal American Medicare |
$3,745.34
|
| Rate for Payer: Wellcare Medicare |
$3,745.34
|
| Rate for Payer: Wellmed Medicare |
$3,745.34
|
|
|
Laryngoscopy, direct, operative, with excision of tumor and/or stripping of vocal cords or epiglotti
|
Facility
|
OP
|
$9,294.06
|
|
|
Service Code
|
HCPCS 31541
|
| Hospital Charge Code |
9900617
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,062.24 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,062.24
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3,745.34
|
| Rate for Payer: Amerigroup Medicare |
$3,745.34
|
| Rate for Payer: BCBS of TX Blue Advantage |
$4,904.64
|
| Rate for Payer: BCBS of TX Blue Essentials |
$5,873.82
|
| Rate for Payer: BCBS of TX Medicare |
$3,745.34
|
| Rate for Payer: BCBS of TX PPO |
$7,401.01
|
| Rate for Payer: Cash Price |
$6,319.96
|
| Rate for Payer: Cash Price |
$6,319.96
|
| Rate for Payer: Cash Price |
$6,319.96
|
| Rate for Payer: Cigna Commercial |
$7,916.96
|
| Rate for Payer: Cigna Medicaid |
$6,691.72
|
| Rate for Payer: Cigna Medicare |
$3,745.34
|
| Rate for Payer: Employer Direct Commercial |
$3,745.34
|
| Rate for Payer: Humana Medicare/TRICARE |
$3,745.34
|
| Rate for Payer: Molina CHIP/Medicaid |
$6,691.72
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3,745.34
|
| Rate for Payer: Molina Medicare |
$3,745.34
|
| 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 |
$6,691.72
|
| Rate for Payer: Scott and White EPO/PPO |
$6,335.94
|
| Rate for Payer: Scott and White Medicare |
$3,745.34
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$6,691.72
|
| Rate for Payer: Superior Health Plan EPO |
$3,745.34
|
| Rate for Payer: Superior Health Plan Medicare |
$3,745.34
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3,745.34
|
| Rate for Payer: Universal American Medicare |
$3,745.34
|
| Rate for Payer: Wellcare Medicare |
$3,745.34
|
| Rate for Payer: Wellmed Medicare |
$3,745.34
|
|
|
Laryngoscopy, direct, operative, with excision of tumor and/or stripping of vocal cords or epiglotti
|
Facility
|
IP
|
$9,294.06
|
|
|
Service Code
|
HCPCS 31541
|
| Hospital Charge Code |
9900617
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$6,319.96
|
|
|
Laryngoscopy, direct, operative, with excision of tumor and/or stripping of vocal cords or epiglotti
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 31541
|
| Hospital Charge Code |
36031541
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,062.24 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,062.24
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3,745.34
|
| Rate for Payer: Amerigroup Medicare |
$3,745.34
|
| Rate for Payer: BCBS of TX Blue Advantage |
$4,904.64
|
| Rate for Payer: BCBS of TX Blue Essentials |
$5,873.82
|
| Rate for Payer: BCBS of TX Medicare |
$3,745.34
|
| Rate for Payer: BCBS of TX PPO |
$7,401.01
|
| Rate for Payer: Cigna Commercial |
$7,916.96
|
| Rate for Payer: Cigna Medicare |
$3,745.34
|
| Rate for Payer: Employer Direct Commercial |
$3,745.34
|
| Rate for Payer: Humana Medicare/TRICARE |
$3,745.34
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3,745.34
|
| Rate for Payer: Molina Medicare |
$3,745.34
|
| 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 |
$6,335.94
|
| Rate for Payer: Scott and White Medicare |
$3,745.34
|
| Rate for Payer: Superior Health Plan EPO |
$3,745.34
|
| Rate for Payer: Superior Health Plan Medicare |
$3,745.34
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3,745.34
|
| Rate for Payer: Universal American Medicare |
$3,745.34
|
| Rate for Payer: Wellcare Medicare |
$3,745.34
|
| Rate for Payer: Wellmed Medicare |
$3,745.34
|
|
|
Laryngoscopy, direct, operative, with operating microscope or telescope, with submucosal removal of
|
Facility
|
IP
|
$6,661.00
|
|
|
Service Code
|
HCPCS 31545
|
| Hospital Charge Code |
9900618
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$4,529.48
|
|
|
Laryngoscopy, direct, operative, with operating microscope or telescope, with submucosal removal of
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 31545
|
| Hospital Charge Code |
36031545
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,062.24 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,062.24
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3,745.34
|
| Rate for Payer: Amerigroup Medicare |
$3,745.34
|
| Rate for Payer: BCBS of TX Blue Advantage |
$4,904.64
|
| Rate for Payer: BCBS of TX Blue Essentials |
$5,873.82
|
| Rate for Payer: BCBS of TX Medicare |
$3,745.34
|
| Rate for Payer: BCBS of TX PPO |
$7,401.01
|
| Rate for Payer: Cigna Commercial |
$7,916.96
|
| Rate for Payer: Cigna Medicare |
$3,745.34
|
| Rate for Payer: Employer Direct Commercial |
$3,745.34
|
| Rate for Payer: Humana Medicare/TRICARE |
$3,745.34
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3,745.34
|
| Rate for Payer: Molina Medicare |
$3,745.34
|
| 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 |
$6,335.94
|
| Rate for Payer: Scott and White Medicare |
$3,745.34
|
| Rate for Payer: Superior Health Plan EPO |
$3,745.34
|
| Rate for Payer: Superior Health Plan Medicare |
$3,745.34
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3,745.34
|
| Rate for Payer: Universal American Medicare |
$3,745.34
|
| Rate for Payer: Wellcare Medicare |
$3,745.34
|
| Rate for Payer: Wellmed Medicare |
$3,745.34
|
|
|
Laryngoscopy, direct, operative, with operating microscope or telescope, with submucosal removal of
|
Facility
|
OP
|
$6,661.00
|
|
|
Service Code
|
HCPCS 31545
|
| Hospital Charge Code |
9900618
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,062.24 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,062.24
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3,745.34
|
| Rate for Payer: Amerigroup Medicare |
$3,745.34
|
| Rate for Payer: BCBS of TX Blue Advantage |
$4,904.64
|
| Rate for Payer: BCBS of TX Blue Essentials |
$5,873.82
|
| Rate for Payer: BCBS of TX Medicare |
$3,745.34
|
| Rate for Payer: BCBS of TX PPO |
$7,401.01
|
| Rate for Payer: Cash Price |
$4,529.48
|
| Rate for Payer: Cash Price |
$4,529.48
|
| Rate for Payer: Cash Price |
$4,529.48
|
| Rate for Payer: Cigna Commercial |
$7,916.96
|
| Rate for Payer: Cigna Medicaid |
$4,795.92
|
| Rate for Payer: Cigna Medicare |
$3,745.34
|
| Rate for Payer: Employer Direct Commercial |
$3,745.34
|
| Rate for Payer: Humana Medicare/TRICARE |
$3,745.34
|
| Rate for Payer: Molina CHIP/Medicaid |
$4,795.92
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3,745.34
|
| Rate for Payer: Molina Medicare |
$3,745.34
|
| 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 |
$4,795.92
|
| Rate for Payer: Scott and White EPO/PPO |
$6,335.94
|
| Rate for Payer: Scott and White Medicare |
$3,745.34
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$4,795.92
|
| Rate for Payer: Superior Health Plan EPO |
$3,745.34
|
| Rate for Payer: Superior Health Plan Medicare |
$3,745.34
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3,745.34
|
| Rate for Payer: Universal American Medicare |
$3,745.34
|
| Rate for Payer: Wellcare Medicare |
$3,745.34
|
| Rate for Payer: Wellmed Medicare |
$3,745.34
|
|
|
Laryngoscopy, direct, with injection into vocal cord(s), therapeutic; with operating microscope or t
|
Facility
|
IP
|
$9,294.06
|
|
|
Service Code
|
HCPCS 31571
|
| Hospital Charge Code |
9900619
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$6,319.96
|
|
|
Laryngoscopy, direct, with injection into vocal cord(s), therapeutic; with operating microscope or t
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 31571
|
| Hospital Charge Code |
36031571
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,062.24 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,062.24
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3,745.34
|
| Rate for Payer: Amerigroup Medicare |
$3,745.34
|
| Rate for Payer: BCBS of TX Blue Advantage |
$4,904.64
|
| Rate for Payer: BCBS of TX Blue Essentials |
$5,873.82
|
| Rate for Payer: BCBS of TX Medicare |
$3,745.34
|
| Rate for Payer: BCBS of TX PPO |
$7,401.01
|
| Rate for Payer: Cigna Commercial |
$7,916.96
|
| Rate for Payer: Cigna Medicare |
$3,745.34
|
| Rate for Payer: Employer Direct Commercial |
$3,745.34
|
| Rate for Payer: Humana Medicare/TRICARE |
$3,745.34
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3,745.34
|
| Rate for Payer: Molina Medicare |
$3,745.34
|
| 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 |
$6,335.94
|
| Rate for Payer: Scott and White Medicare |
$3,745.34
|
| Rate for Payer: Superior Health Plan EPO |
$3,745.34
|
| Rate for Payer: Superior Health Plan Medicare |
$3,745.34
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3,745.34
|
| Rate for Payer: Universal American Medicare |
$3,745.34
|
| Rate for Payer: Wellcare Medicare |
$3,745.34
|
| Rate for Payer: Wellmed Medicare |
$3,745.34
|
|
|
Laryngoscopy, direct, with injection into vocal cord(s), therapeutic; with operating microscope or t
|
Facility
|
OP
|
$9,294.06
|
|
|
Service Code
|
HCPCS 31571
|
| Hospital Charge Code |
9900619
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,062.24 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,062.24
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3,745.34
|
| Rate for Payer: Amerigroup Medicare |
$3,745.34
|
| Rate for Payer: BCBS of TX Blue Advantage |
$4,904.64
|
| Rate for Payer: BCBS of TX Blue Essentials |
$5,873.82
|
| Rate for Payer: BCBS of TX Medicare |
$3,745.34
|
| Rate for Payer: BCBS of TX PPO |
$7,401.01
|
| Rate for Payer: Cash Price |
$6,319.96
|
| Rate for Payer: Cash Price |
$6,319.96
|
| Rate for Payer: Cash Price |
$6,319.96
|
| Rate for Payer: Cigna Commercial |
$7,916.96
|
| Rate for Payer: Cigna Medicaid |
$6,691.72
|
| Rate for Payer: Cigna Medicare |
$3,745.34
|
| Rate for Payer: Employer Direct Commercial |
$3,745.34
|
| Rate for Payer: Humana Medicare/TRICARE |
$3,745.34
|
| Rate for Payer: Molina CHIP/Medicaid |
$6,691.72
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3,745.34
|
| Rate for Payer: Molina Medicare |
$3,745.34
|
| 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 |
$6,691.72
|
| Rate for Payer: Scott and White EPO/PPO |
$6,335.94
|
| Rate for Payer: Scott and White Medicare |
$3,745.34
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$6,691.72
|
| Rate for Payer: Superior Health Plan EPO |
$3,745.34
|
| Rate for Payer: Superior Health Plan Medicare |
$3,745.34
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3,745.34
|
| Rate for Payer: Universal American Medicare |
$3,745.34
|
| Rate for Payer: Wellcare Medicare |
$3,745.34
|
| Rate for Payer: Wellmed Medicare |
$3,745.34
|
|
|
Laryngoscopy direct, with or without tracheoscopy diagnostic, except newborn
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 31525
|
| Hospital Charge Code |
36031525
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$525.71 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$525.71
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,788.01
|
| Rate for Payer: Amerigroup Medicare |
$1,788.01
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,389.12
|
| Rate for Payer: BCBS of TX Blue Essentials |
$2,861.22
|
| Rate for Payer: BCBS of TX Medicare |
$1,788.01
|
| Rate for Payer: BCBS of TX PPO |
$3,605.14
|
| Rate for Payer: Cigna Commercial |
$3,779.52
|
| Rate for Payer: Cigna Medicare |
$1,788.01
|
| Rate for Payer: Employer Direct Commercial |
$1,788.01
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,788.01
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,788.01
|
| Rate for Payer: Molina Medicare |
$1,788.01
|
| Rate for Payer: Multiplan Auto |
$10,000.00
|
| Rate for Payer: Multiplan Commercial |
$10,000.00
|
| Rate for Payer: Multiplan Workers Comp |
$10,000.00
|
| Rate for Payer: Scott and White EPO/PPO |
$2,871.63
|
| Rate for Payer: Scott and White Medicare |
$1,788.01
|
| Rate for Payer: Superior Health Plan EPO |
$1,788.01
|
| Rate for Payer: Superior Health Plan Medicare |
$1,788.01
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,788.01
|
| Rate for Payer: Universal American Medicare |
$1,788.01
|
| Rate for Payer: Wellcare Medicare |
$1,788.01
|
| Rate for Payer: Wellmed Medicare |
$1,788.01
|
|
|
Laryngoscopy direct, with or without tracheoscopy diagnostic, except newborn
|
Facility
|
OP
|
$3,740.98
|
|
|
Service Code
|
HCPCS 31525
|
| Hospital Charge Code |
9900613
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$525.71 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$525.71
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,788.01
|
| Rate for Payer: Amerigroup Medicare |
$1,788.01
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,389.12
|
| Rate for Payer: BCBS of TX Blue Essentials |
$2,861.22
|
| Rate for Payer: BCBS of TX Medicare |
$1,788.01
|
| Rate for Payer: BCBS of TX PPO |
$3,605.14
|
| Rate for Payer: Cash Price |
$2,543.87
|
| Rate for Payer: Cash Price |
$2,543.87
|
| Rate for Payer: Cash Price |
$2,543.87
|
| Rate for Payer: Cigna Commercial |
$3,779.52
|
| Rate for Payer: Cigna Medicaid |
$2,693.51
|
| Rate for Payer: Cigna Medicare |
$1,788.01
|
| Rate for Payer: Employer Direct Commercial |
$1,788.01
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,788.01
|
| Rate for Payer: Molina CHIP/Medicaid |
$2,693.51
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,788.01
|
| Rate for Payer: Molina Medicare |
$1,788.01
|
| Rate for Payer: Multiplan Auto |
$10,000.00
|
| Rate for Payer: Multiplan Commercial |
$10,000.00
|
| Rate for Payer: Multiplan Workers Comp |
$10,000.00
|
| Rate for Payer: Parkland Medicaid |
$2,693.51
|
| Rate for Payer: Scott and White EPO/PPO |
$2,871.63
|
| Rate for Payer: Scott and White Medicare |
$1,788.01
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$2,693.51
|
| Rate for Payer: Superior Health Plan EPO |
$1,788.01
|
| Rate for Payer: Superior Health Plan Medicare |
$1,788.01
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,788.01
|
| Rate for Payer: Universal American Medicare |
$1,788.01
|
| Rate for Payer: Wellcare Medicare |
$1,788.01
|
| Rate for Payer: Wellmed Medicare |
$1,788.01
|
|
