|
U0005 SARS-CoV-2 T2 SO
|
Facility
|
OP
|
$64.00
|
|
|
Service Code
|
HCPCS U0005
|
| Hospital Charge Code |
8698565
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.70 |
| Max. Negotiated Rate |
$41.60 |
| Rate for Payer: Aetna Commercial |
$35.20
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$25.00
|
| Rate for Payer: BCBS of TX Blue Advantage |
$19.20
|
| Rate for Payer: BCBS of TX Blue Essentials |
$23.04
|
| Rate for Payer: BCBS of TX PPO |
$25.60
|
| Rate for Payer: Cash Price |
$56.32
|
| Rate for Payer: Cash Price |
$56.32
|
| Rate for Payer: Multiplan Auto |
$41.60
|
| Rate for Payer: Multiplan Commercial |
$41.60
|
| Rate for Payer: Multiplan Workers Comp |
$41.60
|
| Rate for Payer: Scott and White EPO/PPO |
$32.00
|
| Rate for Payer: Superior Health Plan EPO |
$8.70
|
|
|
U Creatinine BCE
|
Facility
|
OP
|
$96.00
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
4102573
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.02 |
| Max. Negotiated Rate |
$62.40 |
| Rate for Payer: Aetna Commercial |
$5.44
|
| Rate for Payer: Aetna Medicare |
$7.77
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2.02
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$5.18
|
| Rate for Payer: Amerigroup Medicare |
$5.18
|
| Rate for Payer: BCBS of TX Blue Advantage |
$8.55
|
| Rate for Payer: BCBS of TX Blue Essentials |
$10.26
|
| Rate for Payer: BCBS of TX Medicare |
$5.18
|
| Rate for Payer: BCBS of TX PPO |
$11.45
|
| Rate for Payer: Cash Price |
$84.48
|
| Rate for Payer: Cash Price |
$84.48
|
| Rate for Payer: Cigna Medicaid |
$5.18
|
| Rate for Payer: Cigna Medicare |
$5.18
|
| Rate for Payer: Employer Direct Commercial |
$5.18
|
| Rate for Payer: Humana Medicare/TRICARE |
$5.18
|
| Rate for Payer: Molina CHIP/Medicaid |
$5.18
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$5.18
|
| Rate for Payer: Molina Medicare |
$5.18
|
| Rate for Payer: Multiplan Auto |
$62.40
|
| Rate for Payer: Multiplan Commercial |
$62.40
|
| Rate for Payer: Multiplan Workers Comp |
$62.40
|
| Rate for Payer: Parkland Medicaid |
$5.18
|
| Rate for Payer: Scott and White EPO/PPO |
$6.48
|
| Rate for Payer: Scott and White Medicare |
$5.18
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$5.18
|
| Rate for Payer: Superior Health Plan EPO |
$5.18
|
| Rate for Payer: Superior Health Plan Medicare |
$5.18
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$5.18
|
| Rate for Payer: Universal American Medicare |
$5.18
|
| Rate for Payer: Wellcare Medicare |
$5.18
|
| Rate for Payer: Wellmed Medicare |
$5.18
|
|
|
ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS OF PERIPHERAL VASCULAR STRUCTURES WITH MCC
|
Facility
|
IP
|
$84,747.60
|
|
|
Service Code
|
MSDRG 278
|
| Min. Negotiated Rate |
$34,684.46 |
| Max. Negotiated Rate |
$84,747.60 |
| Rate for Payer: Aetna Commercial |
$50,179.50
|
| Rate for Payer: Aetna Medicare |
$52,026.69
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$34,684.46
|
| Rate for Payer: Amerigroup Medicare |
$34,684.46
|
| Rate for Payer: BCBS of TX Medicare |
$34,684.46
|
| Rate for Payer: Cigna Commercial |
$57,449.95
|
| Rate for Payer: Cigna Medicare |
$34,684.46
|
| Rate for Payer: Employer Direct Commercial |
$34,684.46
|
| Rate for Payer: Humana Medicare/TRICARE |
$34,684.46
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$34,684.46
|
| Rate for Payer: Molina Medicare |
$34,684.46
|
| Rate for Payer: Multiplan Auto |
$84,747.60
|
| Rate for Payer: Multiplan Commercial |
$84,747.60
|
| Rate for Payer: Multiplan Workers Comp |
$84,747.60
|
| Rate for Payer: Scott and White EPO/PPO |
$39,028.50
|
| Rate for Payer: Scott and White Medicare |
$34,684.46
|
| Rate for Payer: Superior Health Plan EPO |
$34,684.46
|
| Rate for Payer: Superior Health Plan Medicare |
$34,684.46
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$34,684.46
|
| Rate for Payer: Universal American Medicare |
$34,684.46
|
| Rate for Payer: Wellcare Medicare |
$34,684.46
|
| Rate for Payer: Wellmed Medicare |
$34,684.46
|
|
|
ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS OF PERIPHERAL VASCULAR STRUCTURES WITHOUT MCC
|
Facility
|
IP
|
$60,811.40
|
|
|
Service Code
|
MSDRG 279
|
| Min. Negotiated Rate |
$25,694.45 |
| Max. Negotiated Rate |
$60,811.40 |
| Rate for Payer: Aetna Commercial |
$36,006.75
|
| Rate for Payer: Aetna Medicare |
$38,541.68
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$25,694.45
|
| Rate for Payer: Amerigroup Medicare |
$25,694.45
|
| Rate for Payer: BCBS of TX Medicare |
$25,694.45
|
| Rate for Payer: Cigna Commercial |
$41,223.73
|
| Rate for Payer: Cigna Medicare |
$25,694.45
|
| Rate for Payer: Employer Direct Commercial |
$25,694.45
|
| Rate for Payer: Humana Medicare/TRICARE |
$25,694.45
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$25,694.45
|
| Rate for Payer: Molina Medicare |
$25,694.45
|
| Rate for Payer: Multiplan Auto |
$60,811.40
|
| Rate for Payer: Multiplan Commercial |
$60,811.40
|
| Rate for Payer: Multiplan Workers Comp |
$60,811.40
|
| Rate for Payer: Scott and White EPO/PPO |
$28,005.25
|
| Rate for Payer: Scott and White Medicare |
$25,694.45
|
| Rate for Payer: Superior Health Plan EPO |
$25,694.45
|
| Rate for Payer: Superior Health Plan Medicare |
$25,694.45
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$25,694.45
|
| Rate for Payer: Universal American Medicare |
$25,694.45
|
| Rate for Payer: Wellcare Medicare |
$25,694.45
|
| Rate for Payer: Wellmed Medicare |
$25,694.45
|
|
|
ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS WITH PRINCIPAL DIAGNOSIS PULMONARY EMBOLISM
|
Facility
|
IP
|
$58,425.00
|
|
|
Service Code
|
MSDRG 173
|
| Min. Negotiated Rate |
$24,798.17 |
| Max. Negotiated Rate |
$58,425.00 |
| Rate for Payer: Aetna Commercial |
$34,593.75
|
| Rate for Payer: Aetna Medicare |
$37,197.26
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$24,798.17
|
| Rate for Payer: Amerigroup Medicare |
$24,798.17
|
| Rate for Payer: BCBS of TX Medicare |
$24,798.17
|
| Rate for Payer: Cigna Commercial |
$39,606.00
|
| Rate for Payer: Cigna Medicare |
$24,798.17
|
| Rate for Payer: Employer Direct Commercial |
$24,798.17
|
| Rate for Payer: Humana Medicare/TRICARE |
$24,798.17
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$24,798.17
|
| Rate for Payer: Molina Medicare |
$24,798.17
|
| Rate for Payer: Multiplan Auto |
$58,425.00
|
| Rate for Payer: Multiplan Commercial |
$58,425.00
|
| Rate for Payer: Multiplan Workers Comp |
$58,425.00
|
| Rate for Payer: Scott and White EPO/PPO |
$26,906.25
|
| Rate for Payer: Scott and White Medicare |
$24,798.17
|
| Rate for Payer: Superior Health Plan EPO |
$24,798.17
|
| Rate for Payer: Superior Health Plan Medicare |
$24,798.17
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$24,798.17
|
| Rate for Payer: Universal American Medicare |
$24,798.17
|
| Rate for Payer: Wellcare Medicare |
$24,798.17
|
| Rate for Payer: Wellmed Medicare |
$24,798.17
|
|
|
U Microalbumin
|
Facility
|
OP
|
$226.00
|
|
|
Service Code
|
CPT 82043
|
| Hospital Charge Code |
4152044
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.25 |
| Max. Negotiated Rate |
$146.90 |
| Rate for Payer: Aetna Commercial |
$6.07
|
| Rate for Payer: Aetna Medicare |
$8.67
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2.25
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$5.78
|
| Rate for Payer: Amerigroup Medicare |
$5.78
|
| Rate for Payer: BCBS of TX Blue Advantage |
$9.54
|
| Rate for Payer: BCBS of TX Blue Essentials |
$11.44
|
| Rate for Payer: BCBS of TX Medicare |
$5.78
|
| Rate for Payer: BCBS of TX PPO |
$12.77
|
| Rate for Payer: Cash Price |
$198.88
|
| Rate for Payer: Cash Price |
$198.88
|
| Rate for Payer: Cigna Medicaid |
$5.78
|
| Rate for Payer: Cigna Medicare |
$5.78
|
| Rate for Payer: Employer Direct Commercial |
$5.78
|
| Rate for Payer: Humana Medicare/TRICARE |
$5.78
|
| Rate for Payer: Molina CHIP/Medicaid |
$5.78
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$5.78
|
| Rate for Payer: Molina Medicare |
$5.78
|
| Rate for Payer: Multiplan Auto |
$146.90
|
| Rate for Payer: Multiplan Commercial |
$146.90
|
| Rate for Payer: Multiplan Workers Comp |
$146.90
|
| Rate for Payer: Parkland Medicaid |
$5.78
|
| Rate for Payer: Scott and White EPO/PPO |
$7.22
|
| Rate for Payer: Scott and White Medicare |
$5.78
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$5.78
|
| Rate for Payer: Superior Health Plan EPO |
$5.78
|
| Rate for Payer: Superior Health Plan Medicare |
$5.78
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$5.78
|
| Rate for Payer: Universal American Medicare |
$5.78
|
| Rate for Payer: Wellcare Medicare |
$5.78
|
| Rate for Payer: Wellmed Medicare |
$5.78
|
|
|
U Microalbumin BCE
|
Facility
|
IP
|
$226.00
|
|
|
Service Code
|
CPT 82043
|
| Hospital Charge Code |
4152044
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$198.88
|
|
|
U Microalbumin BCE
|
Facility
|
OP
|
$226.00
|
|
|
Service Code
|
CPT 82043
|
| Hospital Charge Code |
4152044
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.25 |
| Max. Negotiated Rate |
$146.90 |
| Rate for Payer: Aetna Commercial |
$6.07
|
| Rate for Payer: Aetna Medicare |
$8.67
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2.25
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$5.78
|
| Rate for Payer: Amerigroup Medicare |
$5.78
|
| Rate for Payer: BCBS of TX Blue Advantage |
$9.54
|
| Rate for Payer: BCBS of TX Blue Essentials |
$11.44
|
| Rate for Payer: BCBS of TX Medicare |
$5.78
|
| Rate for Payer: BCBS of TX PPO |
$12.77
|
| Rate for Payer: Cash Price |
$198.88
|
| Rate for Payer: Cash Price |
$198.88
|
| Rate for Payer: Cigna Medicaid |
$5.78
|
| Rate for Payer: Cigna Medicare |
$5.78
|
| Rate for Payer: Employer Direct Commercial |
$5.78
|
| Rate for Payer: Humana Medicare/TRICARE |
$5.78
|
| Rate for Payer: Molina CHIP/Medicaid |
$5.78
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$5.78
|
| Rate for Payer: Molina Medicare |
$5.78
|
| Rate for Payer: Multiplan Auto |
$146.90
|
| Rate for Payer: Multiplan Commercial |
$146.90
|
| Rate for Payer: Multiplan Workers Comp |
$146.90
|
| Rate for Payer: Parkland Medicaid |
$5.78
|
| Rate for Payer: Scott and White EPO/PPO |
$7.22
|
| Rate for Payer: Scott and White Medicare |
$5.78
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$5.78
|
| Rate for Payer: Superior Health Plan EPO |
$5.78
|
| Rate for Payer: Superior Health Plan Medicare |
$5.78
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$5.78
|
| Rate for Payer: Universal American Medicare |
$5.78
|
| Rate for Payer: Wellcare Medicare |
$5.78
|
| Rate for Payer: Wellmed Medicare |
$5.78
|
|
|
UNCOMPLICATED PEPTIC ULCER WITH MCC
|
Facility
|
IP
|
$26,565.80
|
|
|
Service Code
|
MSDRG 383
|
| Min. Negotiated Rate |
$11,381.24 |
| Max. Negotiated Rate |
$26,565.80 |
| Rate for Payer: Aetna Commercial |
$15,729.75
|
| Rate for Payer: Aetna Medicare |
$19,248.64
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$12,832.43
|
| Rate for Payer: Amerigroup Medicare |
$12,832.43
|
| Rate for Payer: BCBS of TX Blue Advantage |
$11,381.24
|
| Rate for Payer: BCBS of TX Blue Essentials |
$13,940.97
|
| Rate for Payer: BCBS of TX Medicare |
$12,832.43
|
| Rate for Payer: BCBS of TX PPO |
$15,490.57
|
| Rate for Payer: Cigna Commercial |
$18,008.82
|
| Rate for Payer: Cigna Medicare |
$12,832.43
|
| Rate for Payer: Employer Direct Commercial |
$12,832.43
|
| Rate for Payer: Humana Medicare/TRICARE |
$12,832.43
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$12,832.43
|
| Rate for Payer: Molina Medicare |
$12,832.43
|
| Rate for Payer: Multiplan Auto |
$26,565.80
|
| Rate for Payer: Multiplan Commercial |
$26,565.80
|
| Rate for Payer: Multiplan Workers Comp |
$26,565.80
|
| Rate for Payer: Scott and White EPO/PPO |
$12,234.25
|
| Rate for Payer: Scott and White Medicare |
$12,832.43
|
| Rate for Payer: Superior Health Plan EPO |
$12,832.43
|
| Rate for Payer: Superior Health Plan Medicare |
$12,832.43
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$12,832.43
|
| Rate for Payer: Universal American Medicare |
$12,832.43
|
| Rate for Payer: Wellcare Medicare |
$12,832.43
|
| Rate for Payer: Wellmed Medicare |
$12,832.43
|
|
|
UNCOMPLICATED PEPTIC ULCER WITHOUT MCC
|
Facility
|
IP
|
$16,638.30
|
|
|
Service Code
|
MSDRG 384
|
| Min. Negotiated Rate |
$7,417.50 |
| Max. Negotiated Rate |
$16,638.30 |
| Rate for Payer: Aetna Commercial |
$9,851.62
|
| Rate for Payer: Aetna Medicare |
$13,655.73
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$9,103.82
|
| Rate for Payer: Amerigroup Medicare |
$9,103.82
|
| Rate for Payer: BCBS of TX Blue Advantage |
$7,417.50
|
| Rate for Payer: BCBS of TX Blue Essentials |
$8,825.84
|
| Rate for Payer: BCBS of TX Medicare |
$9,103.82
|
| Rate for Payer: BCBS of TX PPO |
$9,806.87
|
| Rate for Payer: Cigna Commercial |
$11,279.02
|
| Rate for Payer: Cigna Medicare |
$9,103.82
|
| Rate for Payer: Employer Direct Commercial |
$9,103.82
|
| Rate for Payer: Humana Medicare/TRICARE |
$9,103.82
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$9,103.82
|
| Rate for Payer: Molina Medicare |
$9,103.82
|
| Rate for Payer: Multiplan Auto |
$16,638.30
|
| Rate for Payer: Multiplan Commercial |
$16,638.30
|
| Rate for Payer: Multiplan Workers Comp |
$16,638.30
|
| Rate for Payer: Scott and White EPO/PPO |
$7,662.38
|
| Rate for Payer: Scott and White Medicare |
$9,103.82
|
| Rate for Payer: Superior Health Plan EPO |
$9,103.82
|
| Rate for Payer: Superior Health Plan Medicare |
$9,103.82
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$9,103.82
|
| Rate for Payer: Universal American Medicare |
$9,103.82
|
| Rate for Payer: Wellcare Medicare |
$9,103.82
|
| Rate for Payer: Wellmed Medicare |
$9,103.82
|
|
|
Under Anterior or Anterolateral Approach for Extradural Exploration/Decompression Procedures on the
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 63076
|
| Hospital Charge Code |
36063076
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$10,000.00 |
| Max. Negotiated Rate |
$10,000.00 |
| 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
|
|
|
Under Anterior or Anterolateral Approach for Extradural Exploration/Decompression Procedures on the
|
Facility
|
OP
|
$15,074.51
|
|
|
Service Code
|
CPT 63075
|
| Hospital Charge Code |
36063075
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$144.31 |
| Max. Negotiated Rate |
$15,074.51 |
| Rate for Payer: Aetna Commercial |
$7,210.00
|
| Rate for Payer: Aetna Medicare |
$9,814.08
|
| 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 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 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: Scott and White EPO/PPO |
$144.31
|
| Rate for Payer: Scott and White Medicare |
$6,542.72
|
| 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
|
|
|
Under Destruction by Neurolyt..
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 64642
|
| Hospital Charge Code |
36064642
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$13.95 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$1,400.00
|
| Rate for Payer: Aetna Medicare |
$948.68
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$68.66
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$632.45
|
| Rate for Payer: Amerigroup Medicare |
$632.45
|
| Rate for Payer: BCBS of TX Blue Advantage |
$132.00
|
| Rate for Payer: BCBS of TX Blue Essentials |
$158.08
|
| Rate for Payer: BCBS of TX Medicare |
$632.45
|
| Rate for Payer: BCBS of TX PPO |
$199.18
|
| Rate for Payer: Cigna Commercial |
$1,432.68
|
| Rate for Payer: Cigna Medicaid |
$68.66
|
| Rate for Payer: Cigna Medicare |
$632.45
|
| Rate for Payer: Employer Direct Commercial |
$632.45
|
| Rate for Payer: Humana Medicare/TRICARE |
$632.45
|
| Rate for Payer: Molina CHIP/Medicaid |
$68.66
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$632.45
|
| Rate for Payer: Molina Medicare |
$632.45
|
| 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 |
$68.66
|
| Rate for Payer: Scott and White EPO/PPO |
$13.95
|
| Rate for Payer: Scott and White Medicare |
$632.45
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$68.66
|
| Rate for Payer: Superior Health Plan EPO |
$632.45
|
| Rate for Payer: Superior Health Plan Medicare |
$632.45
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$632.45
|
| Rate for Payer: Universal American Medicare |
$632.45
|
| Rate for Payer: Wellcare Medicare |
$632.45
|
| Rate for Payer: Wellmed Medicare |
$632.45
|
|
|
Under Endoscopy/Arthroscopy Procedures on the Musculoskeletal System
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 29874
|
| Hospital Charge Code |
36029874
|
|
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
|
|
|
Under Endoscopy/Arthroscopy Procedures on the Musculoskeletal System
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 29837
|
| Hospital Charge Code |
36029837
|
|
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
|
|
|
Under Endoscopy Procedures on the Accessory Sinuses
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 31237
|
| Hospital Charge Code |
36031237
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$34.24 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$2,200.00
|
| Rate for Payer: Aetna Medicare |
$2,328.34
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$525.71
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,552.23
|
| Rate for Payer: Amerigroup Medicare |
$1,552.23
|
| 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 |
$1,552.23
|
| Rate for Payer: BCBS of TX PPO |
$3,605.14
|
| Rate for Payer: Cigna Commercial |
$3,516.25
|
| Rate for Payer: Cigna Medicaid |
$525.71
|
| Rate for Payer: Cigna Medicare |
$1,552.23
|
| Rate for Payer: Employer Direct Commercial |
$1,552.23
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,552.23
|
| Rate for Payer: Molina CHIP/Medicaid |
$525.71
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,552.23
|
| Rate for Payer: Molina Medicare |
$1,552.23
|
| 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 |
$525.71
|
| Rate for Payer: Scott and White EPO/PPO |
$34.24
|
| Rate for Payer: Scott and White Medicare |
$1,552.23
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$525.71
|
| Rate for Payer: Superior Health Plan EPO |
$1,552.23
|
| Rate for Payer: Superior Health Plan Medicare |
$1,552.23
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,552.23
|
| Rate for Payer: Universal American Medicare |
$1,552.23
|
| Rate for Payer: Wellcare Medicare |
$1,552.23
|
| Rate for Payer: Wellmed Medicare |
$1,552.23
|
|
|
Under Excision and Destruction Procedures on the Pharynx, Adenoids, and Tonsils
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 42830
|
| Hospital Charge Code |
36042830
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$64.95 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$3,090.00
|
| Rate for Payer: Aetna Medicare |
$4,416.74
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$886.62
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$2,944.49
|
| Rate for Payer: Amerigroup Medicare |
$2,944.49
|
| Rate for Payer: BCBS of TX Blue Advantage |
$4,374.21
|
| Rate for Payer: BCBS of TX Blue Essentials |
$5,238.58
|
| Rate for Payer: BCBS of TX Medicare |
$2,944.49
|
| Rate for Payer: BCBS of TX PPO |
$6,600.61
|
| Rate for Payer: Cigna Commercial |
$6,670.12
|
| Rate for Payer: Cigna Medicaid |
$886.62
|
| Rate for Payer: Cigna Medicare |
$2,944.49
|
| Rate for Payer: Employer Direct Commercial |
$2,944.49
|
| Rate for Payer: Humana Medicare/TRICARE |
$2,944.49
|
| Rate for Payer: Molina CHIP/Medicaid |
$886.62
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$2,944.49
|
| Rate for Payer: Molina Medicare |
$2,944.49
|
| 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 |
$886.62
|
| Rate for Payer: Scott and White EPO/PPO |
$64.95
|
| Rate for Payer: Scott and White Medicare |
$2,944.49
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$886.62
|
| Rate for Payer: Superior Health Plan EPO |
$2,944.49
|
| Rate for Payer: Superior Health Plan Medicare |
$2,944.49
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$2,944.49
|
| Rate for Payer: Universal American Medicare |
$2,944.49
|
| Rate for Payer: Wellcare Medicare |
$2,944.49
|
| Rate for Payer: Wellmed Medicare |
$2,944.49
|
|
|
Under Excision-Benign Lesions Procedures on the Skin
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 11402
|
| Hospital Charge Code |
36011402
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$14.19 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$1,400.00
|
| Rate for Payer: Aetna Medicare |
$965.18
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$96.62
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$643.45
|
| Rate for Payer: Amerigroup Medicare |
$643.45
|
| Rate for Payer: BCBS of TX Blue Advantage |
$192.27
|
| Rate for Payer: BCBS of TX Blue Essentials |
$230.26
|
| Rate for Payer: BCBS of TX Medicare |
$643.45
|
| Rate for Payer: BCBS of TX PPO |
$290.13
|
| Rate for Payer: Cigna Commercial |
$1,457.60
|
| Rate for Payer: Cigna Medicaid |
$96.62
|
| Rate for Payer: Cigna Medicare |
$643.45
|
| Rate for Payer: Employer Direct Commercial |
$643.45
|
| Rate for Payer: Humana Medicare/TRICARE |
$643.45
|
| Rate for Payer: Molina CHIP/Medicaid |
$96.62
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$643.45
|
| Rate for Payer: Molina Medicare |
$643.45
|
| 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 |
$96.62
|
| Rate for Payer: Scott and White EPO/PPO |
$14.19
|
| Rate for Payer: Scott and White Medicare |
$643.45
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$96.62
|
| Rate for Payer: Superior Health Plan EPO |
$643.45
|
| Rate for Payer: Superior Health Plan Medicare |
$643.45
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$643.45
|
| Rate for Payer: Universal American Medicare |
$643.45
|
| Rate for Payer: Wellcare Medicare |
$643.45
|
| Rate for Payer: Wellmed Medicare |
$643.45
|
|
|
Under Excision-Benign Lesions Procedures on the Skin
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 11424
|
| Hospital Charge Code |
36011424
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$32.70 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$2,200.00
|
| Rate for Payer: Aetna Medicare |
$2,224.11
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$486.45
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,482.74
|
| Rate for Payer: Amerigroup Medicare |
$1,482.74
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,292.24
|
| Rate for Payer: BCBS of TX Blue Essentials |
$2,745.20
|
| Rate for Payer: BCBS of TX Medicare |
$1,482.74
|
| Rate for Payer: BCBS of TX PPO |
$3,458.95
|
| Rate for Payer: Cigna Commercial |
$3,358.84
|
| Rate for Payer: Cigna Medicaid |
$486.45
|
| Rate for Payer: Cigna Medicare |
$1,482.74
|
| Rate for Payer: Employer Direct Commercial |
$1,482.74
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,482.74
|
| Rate for Payer: Molina CHIP/Medicaid |
$486.45
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,482.74
|
| Rate for Payer: Molina Medicare |
$1,482.74
|
| Rate for Payer: Multiplan Auto |
$10,000.00
|
| Rate for Payer: Multiplan Commercial |
$10,000.00
|
| Rate for Payer: Multiplan Workers Comp |
$10,000.00
|
| Rate for Payer: Parkland Medicaid |
$486.45
|
| Rate for Payer: Scott and White EPO/PPO |
$32.70
|
| Rate for Payer: Scott and White Medicare |
$1,482.74
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$486.45
|
| Rate for Payer: Superior Health Plan EPO |
$1,482.74
|
| Rate for Payer: Superior Health Plan Medicare |
$1,482.74
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,482.74
|
| Rate for Payer: Universal American Medicare |
$1,482.74
|
| Rate for Payer: Wellcare Medicare |
$1,482.74
|
| Rate for Payer: Wellmed Medicare |
$1,482.74
|
|
|
Under Excision Procedures on ..
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 26130
|
| Hospital Charge Code |
36026130
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$65.29 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$2,200.00
|
| 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
|
|
|
Under Excision Procedures on the Foot and Toes
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 28114
|
| Hospital Charge Code |
36028114
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$65.29 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$3,090.00
|
| 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
|
|
|
Under Excision Procedures on the Foot and Toes
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 28108
|
| Hospital Charge Code |
36028108
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$32.42 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$3,090.00
|
| Rate for Payer: Aetna Medicare |
$2,204.79
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$593.04
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,469.86
|
| Rate for Payer: Amerigroup Medicare |
$1,469.86
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,263.50
|
| Rate for Payer: BCBS of TX Blue Essentials |
$2,710.78
|
| Rate for Payer: BCBS of TX Medicare |
$1,469.86
|
| Rate for Payer: BCBS of TX PPO |
$3,415.58
|
| Rate for Payer: Cigna Commercial |
$3,329.66
|
| Rate for Payer: Cigna Medicaid |
$593.04
|
| Rate for Payer: Cigna Medicare |
$1,469.86
|
| Rate for Payer: Employer Direct Commercial |
$1,469.86
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,469.86
|
| Rate for Payer: Molina CHIP/Medicaid |
$593.04
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,469.86
|
| Rate for Payer: Molina Medicare |
$1,469.86
|
| 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 |
$593.04
|
| Rate for Payer: Scott and White EPO/PPO |
$32.42
|
| Rate for Payer: Scott and White Medicare |
$1,469.86
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$593.04
|
| Rate for Payer: Superior Health Plan EPO |
$1,469.86
|
| Rate for Payer: Superior Health Plan Medicare |
$1,469.86
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,469.86
|
| Rate for Payer: Universal American Medicare |
$1,469.86
|
| Rate for Payer: Wellcare Medicare |
$1,469.86
|
| Rate for Payer: Wellmed Medicare |
$1,469.86
|
|
|
Under Excision Procedures on the Humerus (Upper Arm) and Elbow
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 24077
|
| Hospital Charge Code |
36024077
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$57.32 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$2,200.00
|
| Rate for Payer: Aetna Medicare |
$3,898.02
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$815.20
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$2,598.68
|
| Rate for Payer: Amerigroup Medicare |
$2,598.68
|
| Rate for Payer: BCBS of TX Blue Advantage |
$3,872.55
|
| Rate for Payer: BCBS of TX Blue Essentials |
$4,637.78
|
| Rate for Payer: BCBS of TX Medicare |
$2,598.68
|
| Rate for Payer: BCBS of TX PPO |
$5,843.60
|
| Rate for Payer: Cigna Commercial |
$5,886.75
|
| Rate for Payer: Cigna Medicaid |
$815.20
|
| Rate for Payer: Cigna Medicare |
$2,598.68
|
| Rate for Payer: Employer Direct Commercial |
$2,598.68
|
| Rate for Payer: Humana Medicare/TRICARE |
$2,598.68
|
| Rate for Payer: Molina CHIP/Medicaid |
$815.20
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$2,598.68
|
| Rate for Payer: Molina Medicare |
$2,598.68
|
| 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 |
$815.20
|
| Rate for Payer: Scott and White EPO/PPO |
$57.32
|
| Rate for Payer: Scott and White Medicare |
$2,598.68
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$815.20
|
| Rate for Payer: Superior Health Plan EPO |
$2,598.68
|
| Rate for Payer: Superior Health Plan Medicare |
$2,598.68
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$2,598.68
|
| Rate for Payer: Universal American Medicare |
$2,598.68
|
| Rate for Payer: Wellcare Medicare |
$2,598.68
|
| Rate for Payer: Wellmed Medicare |
$2,598.68
|
|
|
Under Excision Procedures on the Thyroid Gland
|
Facility
|
OP
|
$12,223.34
|
|
|
Service Code
|
CPT 60252
|
| Hospital Charge Code |
36060252
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$118.13 |
| Max. Negotiated Rate |
$12,223.34 |
| Rate for Payer: Aetna Commercial |
$6,077.00
|
| Rate for Payer: Aetna Medicare |
$8,033.61
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$5,355.74
|
| Rate for Payer: Amerigroup Medicare |
$5,355.74
|
| Rate for Payer: BCBS of TX Blue Advantage |
$8,100.39
|
| Rate for Payer: BCBS of TX Blue Essentials |
$9,701.06
|
| Rate for Payer: BCBS of TX Medicare |
$5,355.74
|
| Rate for Payer: BCBS of TX PPO |
$12,223.34
|
| Rate for Payer: Cigna Commercial |
$12,132.30
|
| Rate for Payer: Cigna Medicare |
$5,355.74
|
| Rate for Payer: Employer Direct Commercial |
$5,355.74
|
| Rate for Payer: Humana Medicare/TRICARE |
$5,355.74
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$5,355.74
|
| Rate for Payer: Molina Medicare |
$5,355.74
|
| Rate for Payer: Multiplan Auto |
$10,000.00
|
| Rate for Payer: Multiplan Commercial |
$10,000.00
|
| Rate for Payer: Multiplan Workers Comp |
$10,000.00
|
| Rate for Payer: Scott and White EPO/PPO |
$118.13
|
| Rate for Payer: Scott and White Medicare |
$5,355.74
|
| Rate for Payer: Superior Health Plan EPO |
$5,355.74
|
| Rate for Payer: Superior Health Plan Medicare |
$5,355.74
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$5,355.74
|
| Rate for Payer: Universal American Medicare |
$5,355.74
|
| Rate for Payer: Wellcare Medicare |
$5,355.74
|
| Rate for Payer: Wellmed Medicare |
$5,355.74
|
|
|
Under Fracture and/or Dislocation Procedures on the Foot and Toes
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 28505
|
| Hospital Charge Code |
36028505
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$65.29 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$3,090.00
|
| 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
|
|
