|
Toxoplasma gondii Ab,IgM SO
|
Facility
|
IP
|
$90.00
|
|
|
Service Code
|
CPT 86778
|
| Hospital Charge Code |
1703024
|
|
Hospital Revenue Code
|
302
|
| Rate for Payer: Cash Price |
$79.20
|
|
|
T pallidum Ab (FTA-Ab) SO
|
Facility
|
OP
|
$243.00
|
|
|
Service Code
|
CPT 86780
|
| Hospital Charge Code |
1606045
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.16 |
| Max. Negotiated Rate |
$157.95 |
| Rate for Payer: Aetna Commercial |
$13.90
|
| Rate for Payer: Aetna Medicare |
$19.86
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$5.16
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$13.24
|
| Rate for Payer: Amerigroup Medicare |
$13.24
|
| Rate for Payer: BCBS of TX Blue Advantage |
$21.85
|
| Rate for Payer: BCBS of TX Blue Essentials |
$26.22
|
| Rate for Payer: BCBS of TX Medicare |
$13.24
|
| Rate for Payer: BCBS of TX PPO |
$29.26
|
| Rate for Payer: Cash Price |
$213.84
|
| Rate for Payer: Cash Price |
$213.84
|
| Rate for Payer: Cigna Medicaid |
$13.24
|
| Rate for Payer: Cigna Medicare |
$13.24
|
| Rate for Payer: Employer Direct Commercial |
$13.24
|
| Rate for Payer: Humana Medicare/TRICARE |
$13.24
|
| Rate for Payer: Molina CHIP/Medicaid |
$13.24
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$13.24
|
| Rate for Payer: Molina Medicare |
$13.24
|
| Rate for Payer: Multiplan Auto |
$157.95
|
| Rate for Payer: Multiplan Commercial |
$157.95
|
| Rate for Payer: Multiplan Workers Comp |
$157.95
|
| Rate for Payer: Parkland Medicaid |
$13.24
|
| Rate for Payer: Scott and White EPO/PPO |
$16.55
|
| Rate for Payer: Scott and White Medicare |
$13.24
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$13.24
|
| Rate for Payer: Superior Health Plan EPO |
$13.24
|
| Rate for Payer: Superior Health Plan Medicare |
$13.24
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$13.24
|
| Rate for Payer: Universal American Medicare |
$13.24
|
| Rate for Payer: Wellcare Medicare |
$13.24
|
| Rate for Payer: Wellmed Medicare |
$13.24
|
|
|
TPE Complete
|
Facility
|
OP
|
$3,926.00
|
|
|
Service Code
|
CPT 36514
|
| Hospital Charge Code |
810005
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$25.09 |
| Max. Negotiated Rate |
$3,335.52 |
| Rate for Payer: Aetna Commercial |
$2,200.00
|
| Rate for Payer: Aetna Medicare |
$2,104.82
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$353.34
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,403.21
|
| Rate for Payer: Amerigroup Medicare |
$1,403.21
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,210.45
|
| Rate for Payer: BCBS of TX Blue Essentials |
$2,647.24
|
| Rate for Payer: BCBS of TX Medicare |
$1,403.21
|
| Rate for Payer: BCBS of TX PPO |
$3,335.52
|
| Rate for Payer: Cash Price |
$3,454.88
|
| Rate for Payer: Cash Price |
$3,454.88
|
| Rate for Payer: Cash Price |
$3,454.88
|
| Rate for Payer: Cigna Commercial |
$3,178.68
|
| Rate for Payer: Cigna Medicaid |
$564.62
|
| Rate for Payer: Cigna Medicare |
$1,403.21
|
| Rate for Payer: Employer Direct Commercial |
$1,403.21
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,403.21
|
| Rate for Payer: Molina CHIP/Medicaid |
$564.62
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,403.21
|
| Rate for Payer: Molina Medicare |
$1,403.21
|
| Rate for Payer: Multiplan Auto |
$2,551.90
|
| Rate for Payer: Multiplan Commercial |
$2,551.90
|
| Rate for Payer: Multiplan Workers Comp |
$2,551.90
|
| Rate for Payer: Parkland Medicaid |
$564.62
|
| Rate for Payer: Scott and White EPO/PPO |
$25.09
|
| Rate for Payer: Scott and White Medicare |
$1,403.21
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$564.62
|
| Rate for Payer: Superior Health Plan EPO |
$1,403.21
|
| Rate for Payer: Superior Health Plan Medicare |
$1,403.21
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,403.21
|
| Rate for Payer: Universal American Medicare |
$1,403.21
|
| Rate for Payer: Wellcare Medicare |
$1,403.21
|
| Rate for Payer: Wellmed Medicare |
$1,403.21
|
|
|
TPE Complete
|
Facility
|
IP
|
$3,926.00
|
|
|
Service Code
|
CPT 36514
|
| Hospital Charge Code |
810005
|
|
Hospital Revenue Code
|
940
|
| Rate for Payer: Cash Price |
$3,454.88
|
|
|
T-PORT ADPT -- DHF
|
Facility
|
OP
|
$51.74
|
|
| Hospital Charge Code |
80345606
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.66 |
| Max. Negotiated Rate |
$33.63 |
| Rate for Payer: Aetna Commercial |
$28.46
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$4.66
|
| Rate for Payer: BCBS of TX Blue Advantage |
$15.52
|
| Rate for Payer: BCBS of TX Blue Essentials |
$18.63
|
| Rate for Payer: BCBS of TX PPO |
$20.70
|
| Rate for Payer: Cash Price |
$45.53
|
| Rate for Payer: Multiplan Auto |
$33.63
|
| Rate for Payer: Multiplan Commercial |
$33.63
|
| Rate for Payer: Multiplan Workers Comp |
$33.63
|
| Rate for Payer: Scott and White EPO/PPO |
$25.87
|
| Rate for Payer: Superior Health Plan EPO |
$7.04
|
|
|
T-PORT ADPT -- DHF
|
Facility
|
IP
|
$51.74
|
|
| Hospital Charge Code |
80345606
|
|
Hospital Revenue Code
|
270
|
| Rate for Payer: Cash Price |
$45.53
|
|
|
TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH CC
|
Facility
|
IP
|
$76,093.10
|
|
|
Service Code
|
MSDRG 012
|
| Min. Negotiated Rate |
$29,977.88 |
| Max. Negotiated Rate |
$76,093.10 |
| Rate for Payer: Aetna Commercial |
$45,055.12
|
| Rate for Payer: Aetna Medicare |
$47,150.97
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$31,433.98
|
| Rate for Payer: Amerigroup Medicare |
$31,433.98
|
| Rate for Payer: BCBS of TX Blue Advantage |
$29,977.88
|
| Rate for Payer: BCBS of TX Blue Essentials |
$39,353.57
|
| Rate for Payer: BCBS of TX Medicare |
$31,433.98
|
| Rate for Payer: BCBS of TX PPO |
$43,727.88
|
| Rate for Payer: Cigna Commercial |
$51,583.11
|
| Rate for Payer: Cigna Medicare |
$31,433.98
|
| Rate for Payer: Employer Direct Commercial |
$31,433.98
|
| Rate for Payer: Humana Medicare/TRICARE |
$31,433.98
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$31,433.98
|
| Rate for Payer: Molina Medicare |
$31,433.98
|
| Rate for Payer: Multiplan Auto |
$76,093.10
|
| Rate for Payer: Multiplan Commercial |
$76,093.10
|
| Rate for Payer: Multiplan Workers Comp |
$76,093.10
|
| Rate for Payer: Scott and White EPO/PPO |
$35,042.88
|
| Rate for Payer: Scott and White Medicare |
$31,433.98
|
| Rate for Payer: Superior Health Plan EPO |
$31,433.98
|
| Rate for Payer: Superior Health Plan Medicare |
$31,433.98
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$31,433.98
|
| Rate for Payer: Universal American Medicare |
$31,433.98
|
| Rate for Payer: Wellcare Medicare |
$31,433.98
|
| Rate for Payer: Wellmed Medicare |
$31,433.98
|
|
|
TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH MCC
|
Facility
|
IP
|
$97,969.70
|
|
|
Service Code
|
MSDRG 011
|
| Min. Negotiated Rate |
$39,650.44 |
| Max. Negotiated Rate |
$97,969.70 |
| Rate for Payer: Aetna Commercial |
$58,008.38
|
| Rate for Payer: Aetna Medicare |
$59,475.66
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$39,650.44
|
| Rate for Payer: Amerigroup Medicare |
$39,650.44
|
| Rate for Payer: BCBS of TX Blue Advantage |
$43,011.18
|
| Rate for Payer: BCBS of TX Blue Essentials |
$50,691.06
|
| Rate for Payer: BCBS of TX Medicare |
$39,650.44
|
| Rate for Payer: BCBS of TX PPO |
$56,325.58
|
| Rate for Payer: Cigna Commercial |
$66,413.14
|
| Rate for Payer: Cigna Medicare |
$39,650.44
|
| Rate for Payer: Employer Direct Commercial |
$39,650.44
|
| Rate for Payer: Humana Medicare/TRICARE |
$39,650.44
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$39,650.44
|
| Rate for Payer: Molina Medicare |
$39,650.44
|
| Rate for Payer: Multiplan Auto |
$97,969.70
|
| Rate for Payer: Multiplan Commercial |
$97,969.70
|
| Rate for Payer: Multiplan Workers Comp |
$97,969.70
|
| Rate for Payer: Scott and White EPO/PPO |
$45,117.62
|
| Rate for Payer: Scott and White Medicare |
$39,650.44
|
| Rate for Payer: Superior Health Plan EPO |
$39,650.44
|
| Rate for Payer: Superior Health Plan Medicare |
$39,650.44
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$39,650.44
|
| Rate for Payer: Universal American Medicare |
$39,650.44
|
| Rate for Payer: Wellcare Medicare |
$39,650.44
|
| Rate for Payer: Wellmed Medicare |
$39,650.44
|
|
|
TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITHOUT CC/MCC
|
Facility
|
IP
|
$51,028.30
|
|
|
Service Code
|
MSDRG 013
|
| Min. Negotiated Rate |
$19,502.22 |
| Max. Negotiated Rate |
$51,028.30 |
| Rate for Payer: Aetna Commercial |
$30,214.12
|
| Rate for Payer: Aetna Medicare |
$33,030.16
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$22,020.11
|
| Rate for Payer: Amerigroup Medicare |
$22,020.11
|
| Rate for Payer: BCBS of TX Blue Advantage |
$19,502.22
|
| Rate for Payer: BCBS of TX Blue Essentials |
$24,007.15
|
| Rate for Payer: BCBS of TX Medicare |
$22,020.11
|
| Rate for Payer: BCBS of TX PPO |
$26,675.65
|
| Rate for Payer: Cigna Commercial |
$34,591.82
|
| Rate for Payer: Cigna Medicare |
$22,020.11
|
| Rate for Payer: Employer Direct Commercial |
$22,020.11
|
| Rate for Payer: Humana Medicare/TRICARE |
$22,020.11
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$22,020.11
|
| Rate for Payer: Molina Medicare |
$22,020.11
|
| Rate for Payer: Multiplan Auto |
$51,028.30
|
| Rate for Payer: Multiplan Commercial |
$51,028.30
|
| Rate for Payer: Multiplan Workers Comp |
$51,028.30
|
| Rate for Payer: Scott and White EPO/PPO |
$23,499.88
|
| Rate for Payer: Scott and White Medicare |
$22,020.11
|
| Rate for Payer: Superior Health Plan EPO |
$22,020.11
|
| Rate for Payer: Superior Health Plan Medicare |
$22,020.11
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$22,020.11
|
| Rate for Payer: Universal American Medicare |
$22,020.11
|
| Rate for Payer: Wellcare Medicare |
$22,020.11
|
| Rate for Payer: Wellmed Medicare |
$22,020.11
|
|
|
TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITHOUT MAJOR O.R. PROCEDURES
|
Facility
|
IP
|
$279,300.00
|
|
|
Service Code
|
MSDRG 004
|
| Min. Negotiated Rate |
$93,961.02 |
| Max. Negotiated Rate |
$279,300.00 |
| Rate for Payer: Aetna Commercial |
$165,375.00
|
| Rate for Payer: Aetna Medicare |
$161,632.30
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$107,754.87
|
| Rate for Payer: Amerigroup Medicare |
$107,754.87
|
| Rate for Payer: BCBS of TX Blue Advantage |
$93,961.02
|
| Rate for Payer: BCBS of TX Blue Essentials |
$117,834.72
|
| Rate for Payer: BCBS of TX Medicare |
$107,754.87
|
| Rate for Payer: BCBS of TX PPO |
$130,932.55
|
| Rate for Payer: Cigna Commercial |
$189,336.00
|
| Rate for Payer: Cigna Medicare |
$107,754.87
|
| Rate for Payer: Employer Direct Commercial |
$107,754.87
|
| Rate for Payer: Humana Medicare/TRICARE |
$107,754.87
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$107,754.87
|
| Rate for Payer: Molina Medicare |
$107,754.87
|
| Rate for Payer: Multiplan Auto |
$279,300.00
|
| Rate for Payer: Multiplan Commercial |
$279,300.00
|
| Rate for Payer: Multiplan Workers Comp |
$279,300.00
|
| Rate for Payer: Scott and White EPO/PPO |
$128,625.00
|
| Rate for Payer: Scott and White Medicare |
$107,754.87
|
| Rate for Payer: Superior Health Plan EPO |
$107,754.87
|
| Rate for Payer: Superior Health Plan Medicare |
$107,754.87
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$107,754.87
|
| Rate for Payer: Universal American Medicare |
$107,754.87
|
| Rate for Payer: Wellcare Medicare |
$107,754.87
|
| Rate for Payer: Wellmed Medicare |
$107,754.87
|
|
|
TRACH HL -- DHF
|
Facility
|
OP
|
$33.10
|
|
| Hospital Charge Code |
80349855
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.98 |
| Max. Negotiated Rate |
$21.52 |
| Rate for Payer: Aetna Commercial |
$18.20
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2.98
|
| Rate for Payer: BCBS of TX Blue Advantage |
$9.93
|
| Rate for Payer: BCBS of TX Blue Essentials |
$11.92
|
| Rate for Payer: BCBS of TX PPO |
$13.24
|
| Rate for Payer: Cash Price |
$29.13
|
| Rate for Payer: Multiplan Auto |
$21.52
|
| Rate for Payer: Multiplan Commercial |
$21.52
|
| Rate for Payer: Multiplan Workers Comp |
$21.52
|
| Rate for Payer: Scott and White EPO/PPO |
$16.55
|
| Rate for Payer: Superior Health Plan EPO |
$4.50
|
|
|
TRACH HL -- DHF
|
Facility
|
IP
|
$33.10
|
|
| Hospital Charge Code |
80349855
|
|
Hospital Revenue Code
|
270
|
| Rate for Payer: Cash Price |
$29.13
|
|
|
TRACH SUCT CATH -- DHF
|
Facility
|
OP
|
$542.49
|
|
| Hospital Charge Code |
82073958
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$48.82 |
| Max. Negotiated Rate |
$352.62 |
| Rate for Payer: Aetna Commercial |
$298.37
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$48.82
|
| Rate for Payer: BCBS of TX Blue Advantage |
$162.75
|
| Rate for Payer: BCBS of TX Blue Essentials |
$195.30
|
| Rate for Payer: BCBS of TX PPO |
$217.00
|
| Rate for Payer: Cash Price |
$477.39
|
| Rate for Payer: Multiplan Auto |
$352.62
|
| Rate for Payer: Multiplan Commercial |
$352.62
|
| Rate for Payer: Multiplan Workers Comp |
$352.62
|
| Rate for Payer: Scott and White EPO/PPO |
$271.24
|
| Rate for Payer: Superior Health Plan EPO |
$73.78
|
|
|
TRACH SUCT CATH -- DHF
|
Facility
|
IP
|
$542.49
|
|
| Hospital Charge Code |
82073958
|
|
Hospital Revenue Code
|
270
|
| Rate for Payer: Cash Price |
$477.39
|
|
|
TRACH TB HOLDER -- DHF
|
Facility
|
IP
|
$18.44
|
|
| Hospital Charge Code |
82073941
|
|
Hospital Revenue Code
|
271
|
| Rate for Payer: Cash Price |
$16.23
|
|
|
TRACH TB HOLDER -- DHF
|
Facility
|
OP
|
$18.44
|
|
| Hospital Charge Code |
82073941
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.66 |
| Max. Negotiated Rate |
$11.99 |
| Rate for Payer: Aetna Commercial |
$10.14
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1.66
|
| Rate for Payer: BCBS of TX Blue Advantage |
$5.53
|
| Rate for Payer: BCBS of TX Blue Essentials |
$6.64
|
| Rate for Payer: BCBS of TX PPO |
$7.38
|
| Rate for Payer: Cash Price |
$16.23
|
| Rate for Payer: Multiplan Auto |
$11.99
|
| Rate for Payer: Multiplan Commercial |
$11.99
|
| Rate for Payer: Multiplan Workers Comp |
$11.99
|
| Rate for Payer: Scott and White EPO/PPO |
$9.22
|
| Rate for Payer: Superior Health Plan EPO |
$2.51
|
|
|
traMADol 50 mg Tab
|
Facility
|
IP
|
$7.65
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
77853744
|
|
Hospital Revenue Code
|
250
|
| Rate for Payer: Cash Price |
$5.20
|
|
|
traMADol 50 mg Tab
|
Facility
|
OP
|
$7.65
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
77853744
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.69 |
| Max. Negotiated Rate |
$4.97 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$0.69
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2.30
|
| Rate for Payer: BCBS of TX Blue Essentials |
$2.75
|
| Rate for Payer: BCBS of TX PPO |
$3.06
|
| Rate for Payer: Cash Price |
$5.20
|
| Rate for Payer: Multiplan Auto |
$4.97
|
| Rate for Payer: Multiplan Commercial |
$4.97
|
| Rate for Payer: Multiplan Workers Comp |
$4.97
|
| Rate for Payer: Scott and White EPO/PPO |
$3.82
|
| Rate for Payer: Superior Health Plan EPO |
$1.04
|
|
|
tranexamic acid 100 mg/mL IV Soln 10 mL
|
Facility
|
OP
|
$87.77
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
77854252
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.90 |
| Max. Negotiated Rate |
$57.05 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$7.90
|
| Rate for Payer: BCBS of TX Blue Advantage |
$26.33
|
| Rate for Payer: BCBS of TX Blue Essentials |
$31.60
|
| Rate for Payer: BCBS of TX PPO |
$35.11
|
| Rate for Payer: Cash Price |
$59.68
|
| Rate for Payer: Multiplan Auto |
$57.05
|
| Rate for Payer: Multiplan Commercial |
$57.05
|
| Rate for Payer: Multiplan Workers Comp |
$57.05
|
| Rate for Payer: Scott and White EPO/PPO |
$43.88
|
| Rate for Payer: Superior Health Plan EPO |
$11.94
|
|
|
tranexamic acid 100 mg/mL IV Soln 10 mL
|
Facility
|
IP
|
$87.77
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
77854252
|
|
Hospital Revenue Code
|
250
|
| Rate for Payer: Cash Price |
$59.68
|
|
|
Transection or avulsion of; greater occipital nerve
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 64744
|
| Hospital Charge Code |
36064744
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$38.95 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$3,090.00
|
| 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
|
|
|
Transection or avulsion of other spinal nerve, extradural
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 64772
|
| Hospital Charge Code |
36064772
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$38.95 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$3,090.00
|
| 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
|
|
|
Transfer of tendon to restore intrinsic function ring and small finger
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 26497
|
| Hospital Charge Code |
36026497
|
|
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
|
|
|
Transfer or transplant of single tendon (with muscle redirection or rerouting); deep (eg, anterior
|
Facility
|
OP
|
$15,074.51
|
|
|
Service Code
|
CPT 27691
|
| Hospital Charge Code |
36027691
|
|
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
|
|
|
Transfer or transplant of tendon, carpometacarpal area or dorsum of hand without free graft, each t
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 26480
|
| Hospital Charge Code |
36026480
|
|
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
|
|
