|
Open implantation of hypoglossal nerve neurostimulator array, pulse generator, and distal respirator
|
Facility
|
OP
|
$75,759.97
|
|
|
Service Code
|
CPT 64582
|
| Hospital Charge Code |
36064582
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$10,000.00 |
| Max. Negotiated Rate |
$75,759.97 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$19,861.72
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$30,998.31
|
| Rate for Payer: Amerigroup Medicare |
$30,998.31
|
| Rate for Payer: BCBS of TX Blue Advantage |
$50,206.01
|
| Rate for Payer: BCBS of TX Blue Essentials |
$60,126.96
|
| Rate for Payer: BCBS of TX Medicare |
$30,998.31
|
| Rate for Payer: BCBS of TX PPO |
$75,759.97
|
| Rate for Payer: Cigna Commercial |
$65,524.82
|
| Rate for Payer: Cigna Medicare |
$30,998.31
|
| Rate for Payer: Employer Direct Commercial |
$30,998.31
|
| Rate for Payer: Humana Medicare/TRICARE |
$30,998.31
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$30,998.31
|
| Rate for Payer: Molina Medicare |
$30,998.31
|
| 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 |
$57,346.87
|
| Rate for Payer: Scott and White Medicare |
$30,998.31
|
| Rate for Payer: Superior Health Plan EPO |
$30,998.31
|
| Rate for Payer: Superior Health Plan Medicare |
$30,998.31
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$30,998.31
|
| Rate for Payer: Universal American Medicare |
$30,998.31
|
| Rate for Payer: Wellcare Medicare |
$30,998.31
|
| Rate for Payer: Wellmed Medicare |
$30,998.31
|
|
|
Open implantation of hypoglossal nerve neurostimulator array, pulse generator, and distal respirator
|
Facility
|
OP
|
$180,380.88
|
|
|
Service Code
|
HCPCS 64582
|
| Hospital Charge Code |
9900815
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$10,000.00 |
| Max. Negotiated Rate |
$129,874.23 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$19,861.72
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$30,998.31
|
| Rate for Payer: Amerigroup Medicare |
$30,998.31
|
| Rate for Payer: BCBS of TX Blue Advantage |
$50,206.01
|
| Rate for Payer: BCBS of TX Blue Essentials |
$60,126.96
|
| Rate for Payer: BCBS of TX Medicare |
$30,998.31
|
| Rate for Payer: BCBS of TX PPO |
$75,759.97
|
| Rate for Payer: Cash Price |
$122,659.00
|
| Rate for Payer: Cash Price |
$122,659.00
|
| Rate for Payer: Cash Price |
$122,659.00
|
| Rate for Payer: Cigna Commercial |
$65,524.82
|
| Rate for Payer: Cigna Medicaid |
$129,874.23
|
| Rate for Payer: Cigna Medicare |
$30,998.31
|
| Rate for Payer: Employer Direct Commercial |
$30,998.31
|
| Rate for Payer: Humana Medicare/TRICARE |
$30,998.31
|
| Rate for Payer: Molina CHIP/Medicaid |
$129,874.23
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$30,998.31
|
| Rate for Payer: Molina Medicare |
$30,998.31
|
| 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 |
$129,874.23
|
| Rate for Payer: Scott and White EPO/PPO |
$57,346.87
|
| Rate for Payer: Scott and White Medicare |
$30,998.31
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$129,874.23
|
| Rate for Payer: Superior Health Plan EPO |
$30,998.31
|
| Rate for Payer: Superior Health Plan Medicare |
$30,998.31
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$30,998.31
|
| Rate for Payer: Universal American Medicare |
$30,998.31
|
| Rate for Payer: Wellcare Medicare |
$30,998.31
|
| Rate for Payer: Wellmed Medicare |
$30,998.31
|
|
|
Opening Drill DIA 5.5mm
|
Facility
|
OP
|
$2,556.02
|
|
| Hospital Charge Code |
993381
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$230.04 |
| Max. Negotiated Rate |
$1,840.33 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$230.04
|
| Rate for Payer: BCBS of TX Blue Advantage |
$766.81
|
| Rate for Payer: BCBS of TX Blue Essentials |
$920.17
|
| Rate for Payer: BCBS of TX PPO |
$1,022.41
|
| Rate for Payer: Cash Price |
$1,738.09
|
| Rate for Payer: Cigna Medicaid |
$1,840.33
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,840.33
|
| Rate for Payer: Multiplan Auto |
$1,661.41
|
| Rate for Payer: Multiplan Commercial |
$1,661.41
|
| Rate for Payer: Multiplan Workers Comp |
$1,661.41
|
| Rate for Payer: Parkland Medicaid |
$1,840.33
|
| Rate for Payer: Scott and White EPO/PPO |
$1,278.01
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,840.33
|
| Rate for Payer: Superior Health Plan EPO |
$347.62
|
|
|
Opening Drill DIA 5.5mm
|
Facility
|
IP
|
$2,556.02
|
|
| Hospital Charge Code |
993381
|
|
Hospital Revenue Code
|
272
|
| Rate for Payer: Cash Price |
$1,738.09
|
|
|
OPEN/PERQ PLACE STENT SAME BCE
|
Facility
|
IP
|
$34,432.50
|
|
|
Service Code
|
HCPCS 37238
|
| Hospital Charge Code |
9010984
|
|
Hospital Revenue Code
|
481
|
| Rate for Payer: Cash Price |
$23,414.10
|
|
|
OPEN/PERQ PLACE STENT SAME BCE
|
Facility
|
OP
|
$34,432.50
|
|
|
Service Code
|
HCPCS 37238
|
| Hospital Charge Code |
9010984
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,098.93 |
| Max. Negotiated Rate |
$24,969.37 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$3,098.93
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$11,596.79
|
| Rate for Payer: Amerigroup Medicare |
$11,596.79
|
| Rate for Payer: BCBS of TX Blue Advantage |
$16,547.16
|
| Rate for Payer: BCBS of TX Blue Essentials |
$19,816.96
|
| Rate for Payer: BCBS of TX Medicare |
$11,596.79
|
| Rate for Payer: BCBS of TX PPO |
$24,969.37
|
| Rate for Payer: Cash Price |
$23,414.10
|
| Rate for Payer: Cash Price |
$23,414.10
|
| Rate for Payer: Cash Price |
$23,414.10
|
| Rate for Payer: Cigna Commercial |
$24,513.51
|
| Rate for Payer: Cigna Medicaid |
$24,791.40
|
| Rate for Payer: Cigna Medicare |
$11,596.79
|
| Rate for Payer: Employer Direct Commercial |
$11,596.79
|
| Rate for Payer: Humana Medicare/TRICARE |
$11,596.79
|
| Rate for Payer: Molina CHIP/Medicaid |
$24,791.40
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$11,596.79
|
| Rate for Payer: Molina Medicare |
$11,596.79
|
| Rate for Payer: Multiplan Auto |
$22,381.12
|
| Rate for Payer: Multiplan Commercial |
$22,381.12
|
| Rate for Payer: Multiplan Workers Comp |
$22,381.12
|
| Rate for Payer: Parkland Medicaid |
$24,791.40
|
| Rate for Payer: Scott and White EPO/PPO |
$17,216.25
|
| Rate for Payer: Scott and White Medicare |
$11,596.79
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$24,791.40
|
| Rate for Payer: Superior Health Plan EPO |
$11,596.79
|
| Rate for Payer: Superior Health Plan Medicare |
$11,596.79
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$11,596.79
|
| Rate for Payer: Universal American Medicare |
$11,596.79
|
| Rate for Payer: Wellcare Medicare |
$11,596.79
|
| Rate for Payer: Wellmed Medicare |
$11,596.79
|
|
|
OPEN RING DIA 155 mm - ALUMINIUM
|
Facility
|
IP
|
$8,530.66
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
993428
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,132.66 |
| Max. Negotiated Rate |
$4,265.33 |
| Rate for Payer: Cash Price |
$5,800.85
|
| Rate for Payer: Cigna Commercial |
$2,132.66
|
| Rate for Payer: Multiplan Auto |
$4,265.33
|
| Rate for Payer: Multiplan Commercial |
$4,265.33
|
| Rate for Payer: Multiplan Workers Comp |
$4,265.33
|
| Rate for Payer: Scott and White EPO/PPO |
$4,265.33
|
|
|
OPEN RING DIA 155 mm - ALUMINIUM
|
Facility
|
OP
|
$8,530.66
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
993428
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$767.76 |
| Max. Negotiated Rate |
$6,142.08 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$767.76
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,559.20
|
| Rate for Payer: BCBS of TX Blue Essentials |
$3,071.04
|
| Rate for Payer: BCBS of TX PPO |
$3,412.26
|
| Rate for Payer: Cash Price |
$5,800.85
|
| Rate for Payer: Cigna Medicaid |
$6,142.08
|
| Rate for Payer: Molina CHIP/Medicaid |
$6,142.08
|
| Rate for Payer: Multiplan Auto |
$4,265.33
|
| Rate for Payer: Multiplan Commercial |
$4,265.33
|
| Rate for Payer: Multiplan Workers Comp |
$4,265.33
|
| Rate for Payer: Parkland Medicaid |
$6,142.08
|
| Rate for Payer: Scott and White EPO/PPO |
$4,265.33
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$6,142.08
|
| Rate for Payer: Superior Health Plan EPO |
$1,160.17
|
|
|
Open thrombect av fistula
|
Facility
|
OP
|
$20,943.68
|
|
|
Service Code
|
HCPCS 36831
|
| Hospital Charge Code |
991310
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,939.15 |
| Max. Negotiated Rate |
$15,079.45 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,939.15
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$5,589.84
|
| Rate for Payer: Amerigroup Medicare |
$5,589.84
|
| Rate for Payer: BCBS of TX Blue Advantage |
$7,675.64
|
| Rate for Payer: BCBS of TX Blue Essentials |
$9,192.38
|
| Rate for Payer: BCBS of TX Medicare |
$5,589.84
|
| Rate for Payer: BCBS of TX PPO |
$11,582.40
|
| Rate for Payer: Cash Price |
$14,241.70
|
| Rate for Payer: Cash Price |
$14,241.70
|
| Rate for Payer: Cash Price |
$14,241.70
|
| Rate for Payer: Cigna Commercial |
$11,815.91
|
| Rate for Payer: Cigna Medicaid |
$15,079.45
|
| Rate for Payer: Cigna Medicare |
$5,589.84
|
| Rate for Payer: Employer Direct Commercial |
$5,589.84
|
| Rate for Payer: Humana Medicare/TRICARE |
$5,589.84
|
| Rate for Payer: Molina CHIP/Medicaid |
$15,079.45
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$5,589.84
|
| Rate for Payer: Molina Medicare |
$5,589.84
|
| Rate for Payer: Multiplan Auto |
$10,000.00
|
| Rate for Payer: Multiplan Commercial |
$10,000.00
|
| Rate for Payer: Multiplan Workers Comp |
$10,000.00
|
| Rate for Payer: Parkland Medicaid |
$15,079.45
|
| Rate for Payer: Scott and White EPO/PPO |
$10,341.20
|
| Rate for Payer: Scott and White Medicare |
$5,589.84
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$15,079.45
|
| Rate for Payer: Superior Health Plan EPO |
$5,589.84
|
| Rate for Payer: Superior Health Plan Medicare |
$5,589.84
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$5,589.84
|
| Rate for Payer: Universal American Medicare |
$5,589.84
|
| Rate for Payer: Wellcare Medicare |
$5,589.84
|
| Rate for Payer: Wellmed Medicare |
$5,589.84
|
|
|
Open thrombect av fistula
|
Facility
|
IP
|
$20,943.68
|
|
|
Service Code
|
HCPCS 36831
|
| Hospital Charge Code |
991310
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$14,241.70
|
|
|
Open treatment of acromioclavicular dislocation, acute or chronic with fascial graft (includes obta
|
Facility
|
OP
|
$15,408.22
|
|
|
Service Code
|
CPT 23552
|
| Hospital Charge Code |
36023552
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,196.82 |
| Max. Negotiated Rate |
$15,408.22 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$3,196.82
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$7,289.28
|
| Rate for Payer: Amerigroup Medicare |
$7,289.28
|
| 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 |
$7,289.28
|
| Rate for Payer: BCBS of TX PPO |
$15,074.51
|
| Rate for Payer: Cigna Commercial |
$15,408.22
|
| Rate for Payer: Cigna Medicare |
$7,289.28
|
| Rate for Payer: Employer Direct Commercial |
$7,289.28
|
| Rate for Payer: Humana Medicare/TRICARE |
$7,289.28
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$7,289.28
|
| Rate for Payer: Molina Medicare |
$7,289.28
|
| 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 |
$13,485.17
|
| Rate for Payer: Scott and White Medicare |
$7,289.28
|
| Rate for Payer: Superior Health Plan EPO |
$7,289.28
|
| Rate for Payer: Superior Health Plan Medicare |
$7,289.28
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$7,289.28
|
| Rate for Payer: Universal American Medicare |
$7,289.28
|
| Rate for Payer: Wellcare Medicare |
$7,289.28
|
| Rate for Payer: Wellmed Medicare |
$7,289.28
|
|
|
Open treatment of acromioclavicular dislocation, acute or chronic with fascial graft (includes obta
|
Facility
|
IP
|
$23,096.00
|
|
|
Service Code
|
HCPCS 23552
|
| Hospital Charge Code |
9900230
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$15,705.28
|
|
|
Open treatment of acromioclavicular dislocation, acute or chronic with fascial graft (includes obta
|
Facility
|
OP
|
$23,096.00
|
|
|
Service Code
|
HCPCS 23552
|
| Hospital Charge Code |
9900230
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,196.82 |
| Max. Negotiated Rate |
$16,629.12 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$3,196.82
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$7,289.28
|
| Rate for Payer: Amerigroup Medicare |
$7,289.28
|
| 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 |
$7,289.28
|
| Rate for Payer: BCBS of TX PPO |
$15,074.51
|
| Rate for Payer: Cash Price |
$15,705.28
|
| Rate for Payer: Cash Price |
$15,705.28
|
| Rate for Payer: Cash Price |
$15,705.28
|
| Rate for Payer: Cigna Commercial |
$15,408.22
|
| Rate for Payer: Cigna Medicaid |
$16,629.12
|
| Rate for Payer: Cigna Medicare |
$7,289.28
|
| Rate for Payer: Employer Direct Commercial |
$7,289.28
|
| Rate for Payer: Humana Medicare/TRICARE |
$7,289.28
|
| Rate for Payer: Molina CHIP/Medicaid |
$16,629.12
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$7,289.28
|
| Rate for Payer: Molina Medicare |
$7,289.28
|
| Rate for Payer: Multiplan Auto |
$10,000.00
|
| Rate for Payer: Multiplan Commercial |
$10,000.00
|
| Rate for Payer: Multiplan Workers Comp |
$10,000.00
|
| Rate for Payer: Parkland Medicaid |
$16,629.12
|
| Rate for Payer: Scott and White EPO/PPO |
$13,485.17
|
| Rate for Payer: Scott and White Medicare |
$7,289.28
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$16,629.12
|
| Rate for Payer: Superior Health Plan EPO |
$7,289.28
|
| Rate for Payer: Superior Health Plan Medicare |
$7,289.28
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$7,289.28
|
| Rate for Payer: Universal American Medicare |
$7,289.28
|
| Rate for Payer: Wellcare Medicare |
$7,289.28
|
| Rate for Payer: Wellmed Medicare |
$7,289.28
|
|
|
Open treatment of articular fracture, involving metacarpophalangeal or interphalangeal joint, includ
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 26746
|
| Hospital Charge Code |
36026746
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,088.27 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,088.27
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3,286.91
|
| Rate for Payer: Amerigroup Medicare |
$3,286.91
|
| 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 |
$3,286.91
|
| Rate for Payer: BCBS of TX PPO |
$6,898.37
|
| Rate for Payer: Cigna Commercial |
$6,947.94
|
| Rate for Payer: Cigna Medicare |
$3,286.91
|
| Rate for Payer: Employer Direct Commercial |
$3,286.91
|
| Rate for Payer: Humana Medicare/TRICARE |
$3,286.91
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3,286.91
|
| Rate for Payer: Molina Medicare |
$3,286.91
|
| 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 |
$6,080.78
|
| Rate for Payer: Scott and White Medicare |
$3,286.91
|
| Rate for Payer: Superior Health Plan EPO |
$3,286.91
|
| Rate for Payer: Superior Health Plan Medicare |
$3,286.91
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3,286.91
|
| Rate for Payer: Universal American Medicare |
$3,286.91
|
| Rate for Payer: Wellcare Medicare |
$3,286.91
|
| Rate for Payer: Wellmed Medicare |
$3,286.91
|
|
|
Open treatment of articular fracture, involving metacarpophalangeal or interphalangeal joint, includ
|
Facility
|
IP
|
$7,783.60
|
|
|
Service Code
|
HCPCS 26746
|
| Hospital Charge Code |
9900367
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$5,292.85
|
|
|
Open treatment of articular fracture, involving metacarpophalangeal or interphalangeal joint, includ
|
Facility
|
OP
|
$7,783.60
|
|
|
Service Code
|
HCPCS 26746
|
| Hospital Charge Code |
9900367
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,088.27 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,088.27
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3,286.91
|
| Rate for Payer: Amerigroup Medicare |
$3,286.91
|
| 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 |
$3,286.91
|
| Rate for Payer: BCBS of TX PPO |
$6,898.37
|
| Rate for Payer: Cash Price |
$5,292.85
|
| Rate for Payer: Cash Price |
$5,292.85
|
| Rate for Payer: Cash Price |
$5,292.85
|
| Rate for Payer: Cigna Commercial |
$6,947.94
|
| Rate for Payer: Cigna Medicaid |
$5,604.19
|
| Rate for Payer: Cigna Medicare |
$3,286.91
|
| Rate for Payer: Employer Direct Commercial |
$3,286.91
|
| Rate for Payer: Humana Medicare/TRICARE |
$3,286.91
|
| Rate for Payer: Molina CHIP/Medicaid |
$5,604.19
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3,286.91
|
| Rate for Payer: Molina Medicare |
$3,286.91
|
| 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 |
$5,604.19
|
| Rate for Payer: Scott and White EPO/PPO |
$6,080.78
|
| Rate for Payer: Scott and White Medicare |
$3,286.91
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$5,604.19
|
| Rate for Payer: Superior Health Plan EPO |
$3,286.91
|
| Rate for Payer: Superior Health Plan Medicare |
$3,286.91
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3,286.91
|
| Rate for Payer: Universal American Medicare |
$3,286.91
|
| Rate for Payer: Wellcare Medicare |
$3,286.91
|
| Rate for Payer: Wellmed Medicare |
$3,286.91
|
|
|
Open treatment of bimalleolar ankle fracture (eg, lateral and medial malleoli, or lateral and poster
|
Facility
|
OP
|
$18,453.00
|
|
|
Service Code
|
HCPCS 27814
|
| Hospital Charge Code |
9900446
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,221.80 |
| Max. Negotiated Rate |
$15,408.22 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$3,221.80
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$7,289.28
|
| Rate for Payer: Amerigroup Medicare |
$7,289.28
|
| 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 |
$7,289.28
|
| Rate for Payer: BCBS of TX PPO |
$15,074.51
|
| Rate for Payer: Cash Price |
$12,548.04
|
| Rate for Payer: Cash Price |
$12,548.04
|
| Rate for Payer: Cash Price |
$12,548.04
|
| Rate for Payer: Cigna Commercial |
$15,408.22
|
| Rate for Payer: Cigna Medicaid |
$13,286.16
|
| Rate for Payer: Cigna Medicare |
$7,289.28
|
| Rate for Payer: Employer Direct Commercial |
$7,289.28
|
| Rate for Payer: Humana Medicare/TRICARE |
$7,289.28
|
| Rate for Payer: Molina CHIP/Medicaid |
$13,286.16
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$7,289.28
|
| Rate for Payer: Molina Medicare |
$7,289.28
|
| 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 |
$13,286.16
|
| Rate for Payer: Scott and White EPO/PPO |
$13,485.17
|
| Rate for Payer: Scott and White Medicare |
$7,289.28
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$13,286.16
|
| Rate for Payer: Superior Health Plan EPO |
$7,289.28
|
| Rate for Payer: Superior Health Plan Medicare |
$7,289.28
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$7,289.28
|
| Rate for Payer: Universal American Medicare |
$7,289.28
|
| Rate for Payer: Wellcare Medicare |
$7,289.28
|
| Rate for Payer: Wellmed Medicare |
$7,289.28
|
|
|
Open treatment of bimalleolar ankle fracture (eg, lateral and medial malleoli, or lateral and poster
|
Facility
|
OP
|
$15,408.22
|
|
|
Service Code
|
CPT 27814
|
| Hospital Charge Code |
36027814
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,221.80 |
| Max. Negotiated Rate |
$15,408.22 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$3,221.80
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$7,289.28
|
| Rate for Payer: Amerigroup Medicare |
$7,289.28
|
| 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 |
$7,289.28
|
| Rate for Payer: BCBS of TX PPO |
$15,074.51
|
| Rate for Payer: Cigna Commercial |
$15,408.22
|
| Rate for Payer: Cigna Medicare |
$7,289.28
|
| Rate for Payer: Employer Direct Commercial |
$7,289.28
|
| Rate for Payer: Humana Medicare/TRICARE |
$7,289.28
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$7,289.28
|
| Rate for Payer: Molina Medicare |
$7,289.28
|
| 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 |
$13,485.17
|
| Rate for Payer: Scott and White Medicare |
$7,289.28
|
| Rate for Payer: Superior Health Plan EPO |
$7,289.28
|
| Rate for Payer: Superior Health Plan Medicare |
$7,289.28
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$7,289.28
|
| Rate for Payer: Universal American Medicare |
$7,289.28
|
| Rate for Payer: Wellcare Medicare |
$7,289.28
|
| Rate for Payer: Wellmed Medicare |
$7,289.28
|
|
|
Open treatment of bimalleolar ankle fracture (eg, lateral and medial malleoli, or lateral and poster
|
Facility
|
IP
|
$18,453.00
|
|
|
Service Code
|
HCPCS 27814
|
| Hospital Charge Code |
9900446
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$12,548.04
|
|
|
Open treatment of calcaneal fracture, includes internal fixation, when performed
|
Facility
|
IP
|
$35,891.70
|
|
|
Service Code
|
HCPCS 28415
|
| Hospital Charge Code |
9900516
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$24,406.36
|
|
|
Open treatment of calcaneal fracture, includes internal fixation, when performed
|
Facility
|
OP
|
$15,408.22
|
|
|
Service Code
|
CPT 28415
|
| Hospital Charge Code |
36028415
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,381.79 |
| Max. Negotiated Rate |
$15,408.22 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$3,381.79
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$7,289.28
|
| Rate for Payer: Amerigroup Medicare |
$7,289.28
|
| 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 |
$7,289.28
|
| Rate for Payer: BCBS of TX PPO |
$15,074.51
|
| Rate for Payer: Cigna Commercial |
$15,408.22
|
| Rate for Payer: Cigna Medicare |
$7,289.28
|
| Rate for Payer: Employer Direct Commercial |
$7,289.28
|
| Rate for Payer: Humana Medicare/TRICARE |
$7,289.28
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$7,289.28
|
| Rate for Payer: Molina Medicare |
$7,289.28
|
| 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 |
$13,485.17
|
| Rate for Payer: Scott and White Medicare |
$7,289.28
|
| Rate for Payer: Superior Health Plan EPO |
$7,289.28
|
| Rate for Payer: Superior Health Plan Medicare |
$7,289.28
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$7,289.28
|
| Rate for Payer: Universal American Medicare |
$7,289.28
|
| Rate for Payer: Wellcare Medicare |
$7,289.28
|
| Rate for Payer: Wellmed Medicare |
$7,289.28
|
|
|
Open treatment of calcaneal fracture, includes internal fixation, when performed
|
Facility
|
OP
|
$35,891.70
|
|
|
Service Code
|
HCPCS 28415
|
| Hospital Charge Code |
9900516
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,381.79 |
| Max. Negotiated Rate |
$25,842.02 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$3,381.79
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$7,289.28
|
| Rate for Payer: Amerigroup Medicare |
$7,289.28
|
| 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 |
$7,289.28
|
| Rate for Payer: BCBS of TX PPO |
$15,074.51
|
| Rate for Payer: Cash Price |
$24,406.36
|
| Rate for Payer: Cash Price |
$24,406.36
|
| Rate for Payer: Cash Price |
$24,406.36
|
| Rate for Payer: Cigna Commercial |
$15,408.22
|
| Rate for Payer: Cigna Medicaid |
$25,842.02
|
| Rate for Payer: Cigna Medicare |
$7,289.28
|
| Rate for Payer: Employer Direct Commercial |
$7,289.28
|
| Rate for Payer: Humana Medicare/TRICARE |
$7,289.28
|
| Rate for Payer: Molina CHIP/Medicaid |
$25,842.02
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$7,289.28
|
| Rate for Payer: Molina Medicare |
$7,289.28
|
| 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 |
$25,842.02
|
| Rate for Payer: Scott and White EPO/PPO |
$13,485.17
|
| Rate for Payer: Scott and White Medicare |
$7,289.28
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$25,842.02
|
| Rate for Payer: Superior Health Plan EPO |
$7,289.28
|
| Rate for Payer: Superior Health Plan Medicare |
$7,289.28
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$7,289.28
|
| Rate for Payer: Universal American Medicare |
$7,289.28
|
| Rate for Payer: Wellcare Medicare |
$7,289.28
|
| Rate for Payer: Wellmed Medicare |
$7,289.28
|
|
|
Open treatment of carpal bone fracture (other than carpal scaphoid [navicular]), each bone
|
Facility
|
OP
|
$22,566.55
|
|
|
Service Code
|
HCPCS 25645
|
| Hospital Charge Code |
9900306
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,088.27 |
| Max. Negotiated Rate |
$16,247.92 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,088.27
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3,286.91
|
| Rate for Payer: Amerigroup Medicare |
$3,286.91
|
| 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 |
$3,286.91
|
| Rate for Payer: BCBS of TX PPO |
$6,898.37
|
| Rate for Payer: Cash Price |
$15,345.25
|
| Rate for Payer: Cash Price |
$15,345.25
|
| Rate for Payer: Cash Price |
$15,345.25
|
| Rate for Payer: Cigna Commercial |
$6,947.94
|
| Rate for Payer: Cigna Medicaid |
$16,247.92
|
| Rate for Payer: Cigna Medicare |
$3,286.91
|
| Rate for Payer: Employer Direct Commercial |
$3,286.91
|
| Rate for Payer: Humana Medicare/TRICARE |
$3,286.91
|
| Rate for Payer: Molina CHIP/Medicaid |
$16,247.92
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3,286.91
|
| Rate for Payer: Molina Medicare |
$3,286.91
|
| Rate for Payer: Multiplan Auto |
$10,000.00
|
| Rate for Payer: Multiplan Commercial |
$10,000.00
|
| Rate for Payer: Multiplan Workers Comp |
$10,000.00
|
| Rate for Payer: Parkland Medicaid |
$16,247.92
|
| Rate for Payer: Scott and White EPO/PPO |
$6,080.78
|
| Rate for Payer: Scott and White Medicare |
$3,286.91
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$16,247.92
|
| Rate for Payer: Superior Health Plan EPO |
$3,286.91
|
| Rate for Payer: Superior Health Plan Medicare |
$3,286.91
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3,286.91
|
| Rate for Payer: Universal American Medicare |
$3,286.91
|
| Rate for Payer: Wellcare Medicare |
$3,286.91
|
| Rate for Payer: Wellmed Medicare |
$3,286.91
|
|
|
Open treatment of carpal bone fracture (other than carpal scaphoid [navicular]), each bone
|
Facility
|
IP
|
$22,566.55
|
|
|
Service Code
|
HCPCS 25645
|
| Hospital Charge Code |
9900306
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$15,345.25
|
|
|
Open treatment of carpal bone fracture (other than carpal scaphoid [navicular]), each bone
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 25645
|
| Hospital Charge Code |
36025645
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,088.27 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,088.27
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3,286.91
|
| Rate for Payer: Amerigroup Medicare |
$3,286.91
|
| 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 |
$3,286.91
|
| Rate for Payer: BCBS of TX PPO |
$6,898.37
|
| Rate for Payer: Cigna Commercial |
$6,947.94
|
| Rate for Payer: Cigna Medicare |
$3,286.91
|
| Rate for Payer: Employer Direct Commercial |
$3,286.91
|
| Rate for Payer: Humana Medicare/TRICARE |
$3,286.91
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3,286.91
|
| Rate for Payer: Molina Medicare |
$3,286.91
|
| 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 |
$6,080.78
|
| Rate for Payer: Scott and White Medicare |
$3,286.91
|
| Rate for Payer: Superior Health Plan EPO |
$3,286.91
|
| Rate for Payer: Superior Health Plan Medicare |
$3,286.91
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3,286.91
|
| Rate for Payer: Universal American Medicare |
$3,286.91
|
| Rate for Payer: Wellcare Medicare |
$3,286.91
|
| Rate for Payer: Wellmed Medicare |
$3,286.91
|
|
