|
SUTURE, MONODERM CLR 3-0 7 X 7CML DE12 NDL ABSRB -- DHF
|
Facility
|
OP
|
$124.04
|
|
| Hospital Charge Code |
81943557
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.16 |
| Max. Negotiated Rate |
$80.63 |
| Rate for Payer: Aetna Commercial |
$68.22
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$11.16
|
| Rate for Payer: BCBS of TX Blue Advantage |
$37.21
|
| Rate for Payer: BCBS of TX Blue Essentials |
$44.65
|
| Rate for Payer: BCBS of TX PPO |
$49.62
|
| Rate for Payer: Cash Price |
$109.16
|
| Rate for Payer: Multiplan Auto |
$80.63
|
| Rate for Payer: Multiplan Commercial |
$80.63
|
| Rate for Payer: Multiplan Workers Comp |
$80.63
|
| Rate for Payer: Scott and White EPO/PPO |
$62.02
|
| Rate for Payer: Superior Health Plan EPO |
$16.87
|
|
|
SUTURE, NUROLON BLK BR 0 CLSR 8-18'''' CR MO-7 COMPRT -- DHF
|
Facility
|
OP
|
$642.60
|
|
| Hospital Charge Code |
8194155
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.83 |
| Max. Negotiated Rate |
$417.69 |
| Rate for Payer: Aetna Commercial |
$353.43
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$57.83
|
| Rate for Payer: BCBS of TX Blue Advantage |
$192.78
|
| Rate for Payer: BCBS of TX Blue Essentials |
$231.34
|
| Rate for Payer: BCBS of TX PPO |
$257.04
|
| Rate for Payer: Cash Price |
$565.49
|
| Rate for Payer: Multiplan Auto |
$417.69
|
| Rate for Payer: Multiplan Commercial |
$417.69
|
| Rate for Payer: Multiplan Workers Comp |
$417.69
|
| Rate for Payer: Scott and White EPO/PPO |
$321.30
|
| Rate for Payer: Superior Health Plan EPO |
$87.39
|
|
|
SUTURE, NUROLON BLK BR 0 CLSR 8-18'''' CR MO-7 COMPRT -- DHF
|
Facility
|
IP
|
$642.60
|
|
| Hospital Charge Code |
8194155
|
|
Hospital Revenue Code
|
272
|
| Rate for Payer: Cash Price |
$565.49
|
|
|
SUTURE NYLON 2-0 PS 585H
|
Facility
|
IP
|
$11.09
|
|
| Hospital Charge Code |
121521
|
|
Hospital Revenue Code
|
272
|
| Rate for Payer: Cash Price |
$9.76
|
|
|
SUTURE NYLON 2-0 PS 585H
|
Facility
|
OP
|
$11.09
|
|
| Hospital Charge Code |
121521
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$7.21 |
| Rate for Payer: Aetna Commercial |
$6.10
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1.00
|
| Rate for Payer: BCBS of TX Blue Advantage |
$3.33
|
| Rate for Payer: BCBS of TX Blue Essentials |
$3.99
|
| Rate for Payer: BCBS of TX PPO |
$4.44
|
| Rate for Payer: Cash Price |
$9.76
|
| Rate for Payer: Multiplan Auto |
$7.21
|
| Rate for Payer: Multiplan Commercial |
$7.21
|
| Rate for Payer: Multiplan Workers Comp |
$7.21
|
| Rate for Payer: Scott and White EPO/PPO |
$5.54
|
| Rate for Payer: Superior Health Plan EPO |
$1.51
|
|
|
Suture of 1 nerve; hand or foot, common sensory nerve
|
Facility
|
OP
|
$13,882.71
|
|
|
Service Code
|
CPT 64834
|
| Hospital Charge Code |
36064834
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$134.37 |
| Max. Negotiated Rate |
$13,882.71 |
| Rate for Payer: Aetna Commercial |
$6,077.00
|
| Rate for Payer: Aetna Medicare |
$9,138.30
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,996.58
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$6,092.20
|
| Rate for Payer: Amerigroup Medicare |
$6,092.20
|
| Rate for Payer: BCBS of TX Blue Advantage |
$9,200.05
|
| Rate for Payer: BCBS of TX Blue Essentials |
$11,018.02
|
| Rate for Payer: BCBS of TX Medicare |
$6,092.20
|
| Rate for Payer: BCBS of TX PPO |
$13,882.71
|
| Rate for Payer: Cigna Commercial |
$13,800.59
|
| Rate for Payer: Cigna Medicaid |
$1,996.58
|
| Rate for Payer: Cigna Medicare |
$6,092.20
|
| Rate for Payer: Employer Direct Commercial |
$6,092.20
|
| Rate for Payer: Humana Medicare/TRICARE |
$6,092.20
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,996.58
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$6,092.20
|
| Rate for Payer: Molina Medicare |
$6,092.20
|
| Rate for Payer: Multiplan Auto |
$10,000.00
|
| Rate for Payer: Multiplan Commercial |
$10,000.00
|
| Rate for Payer: Multiplan Workers Comp |
$10,000.00
|
| Rate for Payer: Parkland Medicaid |
$1,996.58
|
| Rate for Payer: Scott and White EPO/PPO |
$134.37
|
| Rate for Payer: Scott and White Medicare |
$6,092.20
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,996.58
|
| Rate for Payer: Superior Health Plan EPO |
$6,092.20
|
| Rate for Payer: Superior Health Plan Medicare |
$6,092.20
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$6,092.20
|
| Rate for Payer: Universal American Medicare |
$6,092.20
|
| Rate for Payer: Wellcare Medicare |
$6,092.20
|
| Rate for Payer: Wellmed Medicare |
$6,092.20
|
|
|
Suture of 1 nerve; median motor thenar
|
Facility
|
OP
|
$13,882.71
|
|
|
Service Code
|
CPT 64835
|
| Hospital Charge Code |
36064835
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$134.37 |
| Max. Negotiated Rate |
$13,882.71 |
| Rate for Payer: Aetna Commercial |
$6,077.00
|
| Rate for Payer: Aetna Medicare |
$9,138.30
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,996.58
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$6,092.20
|
| Rate for Payer: Amerigroup Medicare |
$6,092.20
|
| Rate for Payer: BCBS of TX Blue Advantage |
$9,200.05
|
| Rate for Payer: BCBS of TX Blue Essentials |
$11,018.02
|
| Rate for Payer: BCBS of TX Medicare |
$6,092.20
|
| Rate for Payer: BCBS of TX PPO |
$13,882.71
|
| Rate for Payer: Cigna Commercial |
$13,800.59
|
| Rate for Payer: Cigna Medicaid |
$1,996.58
|
| Rate for Payer: Cigna Medicare |
$6,092.20
|
| Rate for Payer: Employer Direct Commercial |
$6,092.20
|
| Rate for Payer: Humana Medicare/TRICARE |
$6,092.20
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,996.58
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$6,092.20
|
| Rate for Payer: Molina Medicare |
$6,092.20
|
| Rate for Payer: Multiplan Auto |
$10,000.00
|
| Rate for Payer: Multiplan Commercial |
$10,000.00
|
| Rate for Payer: Multiplan Workers Comp |
$10,000.00
|
| Rate for Payer: Parkland Medicaid |
$1,996.58
|
| Rate for Payer: Scott and White EPO/PPO |
$134.37
|
| Rate for Payer: Scott and White Medicare |
$6,092.20
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,996.58
|
| Rate for Payer: Superior Health Plan EPO |
$6,092.20
|
| Rate for Payer: Superior Health Plan Medicare |
$6,092.20
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$6,092.20
|
| Rate for Payer: Universal American Medicare |
$6,092.20
|
| Rate for Payer: Wellcare Medicare |
$6,092.20
|
| Rate for Payer: Wellmed Medicare |
$6,092.20
|
|
|
Suture of 1 nerve; ulnar motor
|
Facility
|
OP
|
$13,882.71
|
|
|
Service Code
|
CPT 64836
|
| Hospital Charge Code |
36064836
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$134.37 |
| Max. Negotiated Rate |
$13,882.71 |
| Rate for Payer: Aetna Commercial |
$6,077.00
|
| Rate for Payer: Aetna Medicare |
$9,138.30
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,996.58
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$6,092.20
|
| Rate for Payer: Amerigroup Medicare |
$6,092.20
|
| Rate for Payer: BCBS of TX Blue Advantage |
$9,200.05
|
| Rate for Payer: BCBS of TX Blue Essentials |
$11,018.02
|
| Rate for Payer: BCBS of TX Medicare |
$6,092.20
|
| Rate for Payer: BCBS of TX PPO |
$13,882.71
|
| Rate for Payer: Cigna Commercial |
$13,800.59
|
| Rate for Payer: Cigna Medicaid |
$1,996.58
|
| Rate for Payer: Cigna Medicare |
$6,092.20
|
| Rate for Payer: Employer Direct Commercial |
$6,092.20
|
| Rate for Payer: Humana Medicare/TRICARE |
$6,092.20
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,996.58
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$6,092.20
|
| Rate for Payer: Molina Medicare |
$6,092.20
|
| Rate for Payer: Multiplan Auto |
$10,000.00
|
| Rate for Payer: Multiplan Commercial |
$10,000.00
|
| Rate for Payer: Multiplan Workers Comp |
$10,000.00
|
| Rate for Payer: Parkland Medicaid |
$1,996.58
|
| Rate for Payer: Scott and White EPO/PPO |
$134.37
|
| Rate for Payer: Scott and White Medicare |
$6,092.20
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,996.58
|
| Rate for Payer: Superior Health Plan EPO |
$6,092.20
|
| Rate for Payer: Superior Health Plan Medicare |
$6,092.20
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$6,092.20
|
| Rate for Payer: Universal American Medicare |
$6,092.20
|
| Rate for Payer: Wellcare Medicare |
$6,092.20
|
| Rate for Payer: Wellmed Medicare |
$6,092.20
|
|
|
Suture of digital nerve, hand or foot
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 64831
|
| Hospital Charge Code |
36064831
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$38.95 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$4,635.00
|
| Rate for Payer: Aetna Medicare |
$2,648.68
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$659.94
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,765.79
|
| Rate for Payer: Amerigroup Medicare |
$1,765.79
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,871.31
|
| Rate for Payer: BCBS of TX Blue Essentials |
$3,438.70
|
| Rate for Payer: BCBS of TX Medicare |
$1,765.79
|
| Rate for Payer: BCBS of TX PPO |
$4,332.76
|
| Rate for Payer: Cigna Commercial |
$4,000.01
|
| Rate for Payer: Cigna Medicaid |
$659.94
|
| Rate for Payer: Cigna Medicare |
$1,765.79
|
| Rate for Payer: Employer Direct Commercial |
$1,765.79
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,765.79
|
| Rate for Payer: Molina CHIP/Medicaid |
$659.94
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,765.79
|
| Rate for Payer: Molina Medicare |
$1,765.79
|
| Rate for Payer: Multiplan Auto |
$10,000.00
|
| Rate for Payer: Multiplan Commercial |
$10,000.00
|
| Rate for Payer: Multiplan Workers Comp |
$10,000.00
|
| Rate for Payer: Parkland Medicaid |
$659.94
|
| Rate for Payer: Scott and White EPO/PPO |
$38.95
|
| Rate for Payer: Scott and White Medicare |
$1,765.79
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$659.94
|
| Rate for Payer: Superior Health Plan EPO |
$1,765.79
|
| Rate for Payer: Superior Health Plan Medicare |
$1,765.79
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,765.79
|
| Rate for Payer: Universal American Medicare |
$1,765.79
|
| Rate for Payer: Wellcare Medicare |
$1,765.79
|
| Rate for Payer: Wellmed Medicare |
$1,765.79
|
|
|
Suture of infrapatellar tendon; primary
|
Facility
|
OP
|
$15,074.51
|
|
|
Service Code
|
CPT 27380
|
| Hospital Charge Code |
36027380
|
|
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
|
|
|
Suture of iris, ciliary body (separate procedure) with retrieval of suture through small incision (e
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 66682
|
| Hospital Charge Code |
36066682
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$47.01 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$3,090.00
|
| Rate for Payer: Aetna Medicare |
$3,196.84
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$849.94
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$2,131.23
|
| Rate for Payer: Amerigroup Medicare |
$2,131.23
|
| Rate for Payer: BCBS of TX Blue Advantage |
$3,376.51
|
| Rate for Payer: BCBS of TX Blue Essentials |
$4,043.72
|
| Rate for Payer: BCBS of TX Medicare |
$2,131.23
|
| Rate for Payer: BCBS of TX PPO |
$5,095.09
|
| Rate for Payer: Cigna Commercial |
$4,827.84
|
| Rate for Payer: Cigna Medicaid |
$849.94
|
| Rate for Payer: Cigna Medicare |
$2,131.23
|
| Rate for Payer: Employer Direct Commercial |
$2,131.23
|
| Rate for Payer: Humana Medicare/TRICARE |
$2,131.23
|
| Rate for Payer: Molina CHIP/Medicaid |
$849.94
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$2,131.23
|
| Rate for Payer: Molina Medicare |
$2,131.23
|
| Rate for Payer: Multiplan Auto |
$10,000.00
|
| Rate for Payer: Multiplan Commercial |
$10,000.00
|
| Rate for Payer: Multiplan Workers Comp |
$10,000.00
|
| Rate for Payer: Parkland Medicaid |
$849.94
|
| Rate for Payer: Scott and White EPO/PPO |
$47.01
|
| Rate for Payer: Scott and White Medicare |
$2,131.23
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$849.94
|
| Rate for Payer: Superior Health Plan EPO |
$2,131.23
|
| Rate for Payer: Superior Health Plan Medicare |
$2,131.23
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$2,131.23
|
| Rate for Payer: Universal American Medicare |
$2,131.23
|
| Rate for Payer: Wellcare Medicare |
$2,131.23
|
| Rate for Payer: Wellmed Medicare |
$2,131.23
|
|
|
Suture of major peripheral nerve, arm or leg, except sciatic including transposition
|
Facility
|
OP
|
$13,882.71
|
|
|
Service Code
|
CPT 64856
|
| Hospital Charge Code |
36064856
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$134.37 |
| Max. Negotiated Rate |
$13,882.71 |
| Rate for Payer: Aetna Commercial |
$6,077.00
|
| Rate for Payer: Aetna Medicare |
$9,138.30
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,996.58
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$6,092.20
|
| Rate for Payer: Amerigroup Medicare |
$6,092.20
|
| Rate for Payer: BCBS of TX Blue Advantage |
$9,200.05
|
| Rate for Payer: BCBS of TX Blue Essentials |
$11,018.02
|
| Rate for Payer: BCBS of TX Medicare |
$6,092.20
|
| Rate for Payer: BCBS of TX PPO |
$13,882.71
|
| Rate for Payer: Cigna Commercial |
$13,800.59
|
| Rate for Payer: Cigna Medicaid |
$1,996.58
|
| Rate for Payer: Cigna Medicare |
$6,092.20
|
| Rate for Payer: Employer Direct Commercial |
$6,092.20
|
| Rate for Payer: Humana Medicare/TRICARE |
$6,092.20
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,996.58
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$6,092.20
|
| Rate for Payer: Molina Medicare |
$6,092.20
|
| Rate for Payer: Multiplan Auto |
$10,000.00
|
| Rate for Payer: Multiplan Commercial |
$10,000.00
|
| Rate for Payer: Multiplan Workers Comp |
$10,000.00
|
| Rate for Payer: Parkland Medicaid |
$1,996.58
|
| Rate for Payer: Scott and White EPO/PPO |
$134.37
|
| Rate for Payer: Scott and White Medicare |
$6,092.20
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,996.58
|
| Rate for Payer: Superior Health Plan EPO |
$6,092.20
|
| Rate for Payer: Superior Health Plan Medicare |
$6,092.20
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$6,092.20
|
| Rate for Payer: Universal American Medicare |
$6,092.20
|
| Rate for Payer: Wellcare Medicare |
$6,092.20
|
| Rate for Payer: Wellmed Medicare |
$6,092.20
|
|
|
Suture of major peripheral nerve, arm or leg, except sciatic without transposition
|
Facility
|
OP
|
$13,882.71
|
|
|
Service Code
|
CPT 64857
|
| Hospital Charge Code |
36064857
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$134.37 |
| Max. Negotiated Rate |
$13,882.71 |
| Rate for Payer: Aetna Commercial |
$6,077.00
|
| Rate for Payer: Aetna Medicare |
$9,138.30
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,996.58
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$6,092.20
|
| Rate for Payer: Amerigroup Medicare |
$6,092.20
|
| Rate for Payer: BCBS of TX Blue Advantage |
$9,200.05
|
| Rate for Payer: BCBS of TX Blue Essentials |
$11,018.02
|
| Rate for Payer: BCBS of TX Medicare |
$6,092.20
|
| Rate for Payer: BCBS of TX PPO |
$13,882.71
|
| Rate for Payer: Cigna Commercial |
$13,800.59
|
| Rate for Payer: Cigna Medicaid |
$1,996.58
|
| Rate for Payer: Cigna Medicare |
$6,092.20
|
| Rate for Payer: Employer Direct Commercial |
$6,092.20
|
| Rate for Payer: Humana Medicare/TRICARE |
$6,092.20
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,996.58
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$6,092.20
|
| Rate for Payer: Molina Medicare |
$6,092.20
|
| Rate for Payer: Multiplan Auto |
$10,000.00
|
| Rate for Payer: Multiplan Commercial |
$10,000.00
|
| Rate for Payer: Multiplan Workers Comp |
$10,000.00
|
| Rate for Payer: Parkland Medicaid |
$1,996.58
|
| Rate for Payer: Scott and White EPO/PPO |
$134.37
|
| Rate for Payer: Scott and White Medicare |
$6,092.20
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,996.58
|
| Rate for Payer: Superior Health Plan EPO |
$6,092.20
|
| Rate for Payer: Superior Health Plan Medicare |
$6,092.20
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$6,092.20
|
| Rate for Payer: Universal American Medicare |
$6,092.20
|
| Rate for Payer: Wellcare Medicare |
$6,092.20
|
| Rate for Payer: Wellmed Medicare |
$6,092.20
|
|
|
Suture of mesentery (separate procedure)
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 44850
|
| Hospital Charge Code |
36044850
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,306.02 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$4,017.00
|
| Rate for Payer: BCBS of TX Blue Advantage |
$1,306.02
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,564.10
|
| Rate for Payer: BCBS of TX PPO |
$1,970.77
|
| 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
|
|
|
Suture of quadriceps or hamstring muscle rupture; primary
|
Facility
|
OP
|
$15,074.51
|
|
|
Service Code
|
CPT 27385
|
| Hospital Charge Code |
36027385
|
|
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
|
|
|
SUTURE ORTHOCORD #2 MO-7
|
Facility
|
OP
|
$295.87
|
|
| Hospital Charge Code |
121483
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$26.63 |
| Max. Negotiated Rate |
$192.32 |
| Rate for Payer: Aetna Commercial |
$162.73
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$26.63
|
| Rate for Payer: BCBS of TX Blue Advantage |
$88.76
|
| Rate for Payer: BCBS of TX Blue Essentials |
$106.51
|
| Rate for Payer: BCBS of TX PPO |
$118.35
|
| Rate for Payer: Cash Price |
$260.37
|
| Rate for Payer: Multiplan Auto |
$192.32
|
| Rate for Payer: Multiplan Commercial |
$192.32
|
| Rate for Payer: Multiplan Workers Comp |
$192.32
|
| Rate for Payer: Scott and White EPO/PPO |
$147.94
|
| Rate for Payer: Superior Health Plan EPO |
$40.24
|
|
|
SUTURE ORTHOCORD #2 MO-7
|
Facility
|
IP
|
$295.87
|
|
| Hospital Charge Code |
121483
|
|
Hospital Revenue Code
|
272
|
| Rate for Payer: Cash Price |
$260.37
|
|
|
SUTURE PASSER SHUTTLE INFINITY
|
Facility
|
IP
|
$236.08
|
|
| Hospital Charge Code |
8406459
|
|
Hospital Revenue Code
|
272
|
| Rate for Payer: Cash Price |
$207.75
|
|
|
SUTURE PASSER SHUTTLE INFINITY
|
Facility
|
OP
|
$236.08
|
|
| Hospital Charge Code |
8406459
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.25 |
| Max. Negotiated Rate |
$153.45 |
| Rate for Payer: Aetna Commercial |
$129.84
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$21.25
|
| Rate for Payer: BCBS of TX Blue Advantage |
$70.82
|
| Rate for Payer: BCBS of TX Blue Essentials |
$84.99
|
| Rate for Payer: BCBS of TX PPO |
$94.43
|
| Rate for Payer: Cash Price |
$207.75
|
| Rate for Payer: Multiplan Auto |
$153.45
|
| Rate for Payer: Multiplan Commercial |
$153.45
|
| Rate for Payer: Multiplan Workers Comp |
$153.45
|
| Rate for Payer: Scott and White EPO/PPO |
$118.04
|
| Rate for Payer: Superior Health Plan EPO |
$32.11
|
|
|
SUTURE, PDS II VIL MONO 1 CLOSURE 96'''' LP TP-1 -- DHF
|
Facility
|
OP
|
$170.09
|
|
| Hospital Charge Code |
81945008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.31 |
| Max. Negotiated Rate |
$110.56 |
| Rate for Payer: Aetna Commercial |
$93.55
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$15.31
|
| Rate for Payer: BCBS of TX Blue Advantage |
$51.03
|
| Rate for Payer: BCBS of TX Blue Essentials |
$61.23
|
| Rate for Payer: BCBS of TX PPO |
$68.04
|
| Rate for Payer: Cash Price |
$149.68
|
| Rate for Payer: Multiplan Auto |
$110.56
|
| Rate for Payer: Multiplan Commercial |
$110.56
|
| Rate for Payer: Multiplan Workers Comp |
$110.56
|
| Rate for Payer: Scott and White EPO/PPO |
$85.04
|
| Rate for Payer: Superior Health Plan EPO |
$23.13
|
|
|
SUTURE, PDS II VIOLET MONO ENDOLOOP 0 18'''' -- DHF
|
Facility
|
IP
|
$287.25
|
|
| Hospital Charge Code |
81942203
|
|
Hospital Revenue Code
|
272
|
| Rate for Payer: Cash Price |
$252.78
|
|
|
SUTURE, PDS II VIOLET MONO ENDOLOOP 0 18'''' -- DHF
|
Facility
|
OP
|
$287.25
|
|
| Hospital Charge Code |
81942203
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$25.85 |
| Max. Negotiated Rate |
$186.71 |
| Rate for Payer: Aetna Commercial |
$157.99
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$25.85
|
| Rate for Payer: BCBS of TX Blue Advantage |
$86.18
|
| Rate for Payer: BCBS of TX Blue Essentials |
$103.41
|
| Rate for Payer: BCBS of TX PPO |
$114.90
|
| Rate for Payer: Cash Price |
$252.78
|
| Rate for Payer: Multiplan Auto |
$186.71
|
| Rate for Payer: Multiplan Commercial |
$186.71
|
| Rate for Payer: Multiplan Workers Comp |
$186.71
|
| Rate for Payer: Scott and White EPO/PPO |
$143.62
|
| Rate for Payer: Superior Health Plan EPO |
$39.07
|
|
|
SUTURE, PDS VIL MONO 0 CLOSURE 27'''' CT-1 -- DHF
|
Facility
|
OP
|
$170.09
|
|
| Hospital Charge Code |
81945008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.31 |
| Max. Negotiated Rate |
$110.56 |
| Rate for Payer: Aetna Commercial |
$93.55
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$15.31
|
| Rate for Payer: BCBS of TX Blue Advantage |
$51.03
|
| Rate for Payer: BCBS of TX Blue Essentials |
$61.23
|
| Rate for Payer: BCBS of TX PPO |
$68.04
|
| Rate for Payer: Cash Price |
$149.68
|
| Rate for Payer: Multiplan Auto |
$110.56
|
| Rate for Payer: Multiplan Commercial |
$110.56
|
| Rate for Payer: Multiplan Workers Comp |
$110.56
|
| Rate for Payer: Scott and White EPO/PPO |
$85.04
|
| Rate for Payer: Superior Health Plan EPO |
$23.13
|
|
|
SUTURE, PDS VIL MONO 1 OB-GYN 36'''' CT-1 -- DHF
|
Facility
|
OP
|
$170.09
|
|
| Hospital Charge Code |
81945008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.31 |
| Max. Negotiated Rate |
$110.56 |
| Rate for Payer: Aetna Commercial |
$93.55
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$15.31
|
| Rate for Payer: BCBS of TX Blue Advantage |
$51.03
|
| Rate for Payer: BCBS of TX Blue Essentials |
$61.23
|
| Rate for Payer: BCBS of TX PPO |
$68.04
|
| Rate for Payer: Cash Price |
$149.68
|
| Rate for Payer: Multiplan Auto |
$110.56
|
| Rate for Payer: Multiplan Commercial |
$110.56
|
| Rate for Payer: Multiplan Workers Comp |
$110.56
|
| Rate for Payer: Scott and White EPO/PPO |
$85.04
|
| Rate for Payer: Superior Health Plan EPO |
$23.13
|
|
|
SUTURE, PDS VIL MONO 1 OB-GYN 36'''' CT-1 -- DHF
|
Facility
|
IP
|
$170.09
|
|
| Hospital Charge Code |
81945008
|
|
Hospital Revenue Code
|
272
|
| Rate for Payer: Cash Price |
$149.68
|
|
