|
Ostectomy, complete excision first metatarsal head
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 28111
|
| Hospital Charge Code |
36028111
|
|
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
|
|
|
Ostectomy, complete excision; other metatarsal head (second, third or fourth)
|
Facility
|
IP
|
$16,228.62
|
|
|
Service Code
|
HCPCS 28112
|
| Hospital Charge Code |
9900475
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$11,035.46
|
|
|
Ostectomy, complete excision; other metatarsal head (second, third or fourth)
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 28112
|
| Hospital Charge Code |
36028112
|
|
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
|
|
|
Ostectomy, complete excision; other metatarsal head (second, third or fourth)
|
Facility
|
OP
|
$16,228.62
|
|
|
Service Code
|
HCPCS 28112
|
| Hospital Charge Code |
9900475
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,088.27 |
| Max. Negotiated Rate |
$11,684.61 |
| 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 |
$11,035.46
|
| Rate for Payer: Cash Price |
$11,035.46
|
| Rate for Payer: Cash Price |
$11,035.46
|
| Rate for Payer: Cigna Commercial |
$6,947.94
|
| Rate for Payer: Cigna Medicaid |
$11,684.61
|
| 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 |
$11,684.61
|
| 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 |
$11,684.61
|
| 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 |
$11,684.61
|
| 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
|
|
|
Ostectomy, excision of tarsal coalition
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 28116
|
| Hospital Charge Code |
36028116
|
|
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
|
|
|
Ostectomy, excision of tarsal coalition
|
Facility
|
IP
|
$16,982.40
|
|
|
Service Code
|
HCPCS 28116
|
| Hospital Charge Code |
9900478
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$11,548.03
|
|
|
Ostectomy, excision of tarsal coalition
|
Facility
|
OP
|
$16,982.40
|
|
|
Service Code
|
HCPCS 28116
|
| Hospital Charge Code |
9900478
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,088.27 |
| Max. Negotiated Rate |
$12,227.33 |
| 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 |
$11,548.03
|
| Rate for Payer: Cash Price |
$11,548.03
|
| Rate for Payer: Cash Price |
$11,548.03
|
| Rate for Payer: Cigna Commercial |
$6,947.94
|
| Rate for Payer: Cigna Medicaid |
$12,227.33
|
| 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 |
$12,227.33
|
| 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 |
$12,227.33
|
| 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 |
$12,227.33
|
| 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
|
|
|
Ostectomy, partial excision, fifth metatarsal head (bunionette) (separate procedure)
|
Facility
|
IP
|
$7,076.00
|
|
|
Service Code
|
HCPCS 28110
|
| Hospital Charge Code |
9900473
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$4,811.68
|
|
|
Ostectomy, partial excision, fifth metatarsal head (bunionette) (separate procedure)
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 28110
|
| Hospital Charge Code |
36028110
|
|
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
|
|
|
Ostectomy, partial excision, fifth metatarsal head (bunionette) (separate procedure)
|
Facility
|
OP
|
$7,076.00
|
|
|
Service Code
|
HCPCS 28110
|
| Hospital Charge Code |
9900473
|
|
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 |
$4,811.68
|
| Rate for Payer: Cash Price |
$4,811.68
|
| Rate for Payer: Cash Price |
$4,811.68
|
| Rate for Payer: Cigna Commercial |
$6,947.94
|
| Rate for Payer: Cigna Medicaid |
$5,094.72
|
| 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 |
$5,094.72
|
| 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 |
$5,094.72
|
| 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 |
$5,094.72
|
| 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
|
|
|
Ostectomy, partial, exostectomy or condylectomy, metatarsal head, each metatarsal head
|
Facility
|
OP
|
$7,076.00
|
|
|
Service Code
|
HCPCS 28288
|
| Hospital Charge Code |
9900499
|
|
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 |
$4,811.68
|
| Rate for Payer: Cash Price |
$4,811.68
|
| Rate for Payer: Cash Price |
$4,811.68
|
| Rate for Payer: Cigna Commercial |
$6,947.94
|
| Rate for Payer: Cigna Medicaid |
$5,094.72
|
| 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 |
$5,094.72
|
| 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 |
$5,094.72
|
| 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 |
$5,094.72
|
| 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
|
|
|
Ostectomy, partial, exostectomy or condylectomy, metatarsal head, each metatarsal head
|
Facility
|
IP
|
$7,076.00
|
|
|
Service Code
|
HCPCS 28288
|
| Hospital Charge Code |
9900499
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$4,811.68
|
|
|
Ostectomy, partial, exostectomy or condylectomy, metatarsal head, each metatarsal head
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 28288
|
| Hospital Charge Code |
36028288
|
|
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
|
|
|
Osteochondral allograft, knee, open
|
Facility
|
OP
|
$78,288.48
|
|
|
Service Code
|
HCPCS 27415
|
| Hospital Charge Code |
9900403
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$8,311.46 |
| Max. Negotiated Rate |
$56,367.71 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$8,311.46
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$12,897.19
|
| Rate for Payer: Amerigroup Medicare |
$12,897.19
|
| Rate for Payer: BCBS of TX Blue Advantage |
$19,874.19
|
| Rate for Payer: BCBS of TX Blue Essentials |
$23,801.42
|
| Rate for Payer: BCBS of TX Medicare |
$12,897.19
|
| Rate for Payer: BCBS of TX PPO |
$29,989.79
|
| Rate for Payer: Cash Price |
$53,236.17
|
| Rate for Payer: Cash Price |
$53,236.17
|
| Rate for Payer: Cash Price |
$53,236.17
|
| Rate for Payer: Cigna Commercial |
$27,262.32
|
| Rate for Payer: Cigna Medicaid |
$56,367.71
|
| Rate for Payer: Cigna Medicare |
$12,897.19
|
| Rate for Payer: Employer Direct Commercial |
$12,897.19
|
| Rate for Payer: Humana Medicare/TRICARE |
$12,897.19
|
| Rate for Payer: Molina CHIP/Medicaid |
$56,367.71
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$12,897.19
|
| Rate for Payer: Molina Medicare |
$12,897.19
|
| 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 |
$56,367.71
|
| Rate for Payer: Scott and White EPO/PPO |
$23,859.80
|
| Rate for Payer: Scott and White Medicare |
$12,897.19
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$56,367.71
|
| Rate for Payer: Superior Health Plan EPO |
$12,897.19
|
| Rate for Payer: Superior Health Plan Medicare |
$12,897.19
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$12,897.19
|
| Rate for Payer: Universal American Medicare |
$12,897.19
|
| Rate for Payer: Wellcare Medicare |
$12,897.19
|
| Rate for Payer: Wellmed Medicare |
$12,897.19
|
|
|
Osteochondral allograft, knee, open
|
Facility
|
OP
|
$29,989.79
|
|
|
Service Code
|
CPT 27415
|
| Hospital Charge Code |
36027415
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$8,311.46 |
| Max. Negotiated Rate |
$29,989.79 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$8,311.46
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$12,897.19
|
| Rate for Payer: Amerigroup Medicare |
$12,897.19
|
| Rate for Payer: BCBS of TX Blue Advantage |
$19,874.19
|
| Rate for Payer: BCBS of TX Blue Essentials |
$23,801.42
|
| Rate for Payer: BCBS of TX Medicare |
$12,897.19
|
| Rate for Payer: BCBS of TX PPO |
$29,989.79
|
| Rate for Payer: Cigna Commercial |
$27,262.32
|
| Rate for Payer: Cigna Medicare |
$12,897.19
|
| Rate for Payer: Employer Direct Commercial |
$12,897.19
|
| Rate for Payer: Humana Medicare/TRICARE |
$12,897.19
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$12,897.19
|
| Rate for Payer: Molina Medicare |
$12,897.19
|
| 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 |
$23,859.80
|
| Rate for Payer: Scott and White Medicare |
$12,897.19
|
| Rate for Payer: Superior Health Plan EPO |
$12,897.19
|
| Rate for Payer: Superior Health Plan Medicare |
$12,897.19
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$12,897.19
|
| Rate for Payer: Universal American Medicare |
$12,897.19
|
| Rate for Payer: Wellcare Medicare |
$12,897.19
|
| Rate for Payer: Wellmed Medicare |
$12,897.19
|
|
|
Osteochondral allograft, knee, open
|
Facility
|
IP
|
$78,288.48
|
|
|
Service Code
|
HCPCS 27415
|
| Hospital Charge Code |
9900403
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$53,236.17
|
|
|
OSTEOMYELITIS, SEPTIC ARTHRITIS AND OTHER MUSCULOSKELETAL INFECTIONS
|
Facility
|
IP
|
$11,916.91
|
|
|
Service Code
|
APR-DRG 3444
|
| Min. Negotiated Rate |
$11,235.68 |
| Max. Negotiated Rate |
$11,916.91 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$11,235.68
|
| Rate for Payer: Cigna Medicaid |
$11,235.68
|
| Rate for Payer: Molina CHIP/Medicaid |
$11,235.68
|
| Rate for Payer: Parkland Medicaid |
$11,235.68
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$11,916.91
|
|
|
OSTEOMYELITIS, SEPTIC ARTHRITIS AND OTHER MUSCULOSKELETAL INFECTIONS
|
Facility
|
IP
|
$6,224.37
|
|
|
Service Code
|
APR-DRG 3443
|
| Min. Negotiated Rate |
$5,868.56 |
| Max. Negotiated Rate |
$6,224.37 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$5,868.56
|
| Rate for Payer: Cigna Medicaid |
$5,868.56
|
| Rate for Payer: Molina CHIP/Medicaid |
$5,868.56
|
| Rate for Payer: Parkland Medicaid |
$5,868.56
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$6,224.37
|
|
|
OSTEOMYELITIS, SEPTIC ARTHRITIS AND OTHER MUSCULOSKELETAL INFECTIONS
|
Facility
|
IP
|
$4,464.79
|
|
|
Service Code
|
APR-DRG 3442
|
| Min. Negotiated Rate |
$4,209.56 |
| Max. Negotiated Rate |
$4,464.79 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$4,209.56
|
| Rate for Payer: Cigna Medicaid |
$4,209.56
|
| Rate for Payer: Molina CHIP/Medicaid |
$4,209.56
|
| Rate for Payer: Parkland Medicaid |
$4,209.56
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$4,464.79
|
|
|
OSTEOMYELITIS, SEPTIC ARTHRITIS AND OTHER MUSCULOSKELETAL INFECTIONS
|
Facility
|
IP
|
$3,534.26
|
|
|
Service Code
|
APR-DRG 3441
|
| Min. Negotiated Rate |
$3,332.22 |
| Max. Negotiated Rate |
$3,534.26 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$3,332.22
|
| Rate for Payer: Cigna Medicaid |
$3,332.22
|
| Rate for Payer: Molina CHIP/Medicaid |
$3,332.22
|
| Rate for Payer: Parkland Medicaid |
$3,332.22
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$3,534.26
|
|
|
OSTEOMYELITIS W CC
|
Facility
|
IP
|
$24,629.70
|
|
|
Service Code
|
MSDRG 540
|
| Min. Negotiated Rate |
$11,153.34 |
| Max. Negotiated Rate |
$24,629.70 |
| Rate for Payer: BCBS of TX Blue Advantage |
$11,153.34
|
| Rate for Payer: BCBS of TX Blue Essentials |
$13,382.71
|
| Rate for Payer: BCBS of TX PPO |
$14,870.26
|
|
|
OSTEOMYELITIS WITH CC
|
Facility
|
IP
|
$24,629.70
|
|
|
Service Code
|
MSDRG 540
|
| Min. Negotiated Rate |
$11,153.34 |
| Max. Negotiated Rate |
$24,629.70 |
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$14,260.69
|
| Rate for Payer: Amerigroup Medicare |
$14,260.69
|
| Rate for Payer: BCBS of TX Medicare |
$14,260.69
|
| Rate for Payer: Cigna Commercial |
$16,696.34
|
| Rate for Payer: Cigna Medicare |
$14,260.69
|
| Rate for Payer: Employer Direct Commercial |
$14,260.69
|
| Rate for Payer: Humana Medicare/TRICARE |
$14,260.69
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$14,260.69
|
| Rate for Payer: Molina Medicare |
$14,260.69
|
| Rate for Payer: Multiplan Auto |
$24,629.70
|
| Rate for Payer: Multiplan Commercial |
$24,629.70
|
| Rate for Payer: Multiplan Workers Comp |
$24,629.70
|
| Rate for Payer: Scott and White EPO/PPO |
$11,342.62
|
| Rate for Payer: Scott and White Medicare |
$14,260.69
|
| Rate for Payer: Superior Health Plan EPO |
$14,260.69
|
| Rate for Payer: Superior Health Plan Medicare |
$14,260.69
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$14,260.69
|
| Rate for Payer: Universal American Medicare |
$14,260.69
|
| Rate for Payer: Wellcare Medicare |
$14,260.69
|
| Rate for Payer: Wellmed Medicare |
$14,260.69
|
|
|
OSTEOMYELITIS WITH MCC
|
Facility
|
IP
|
$37,424.30
|
|
|
Service Code
|
MSDRG 539
|
| Min. Negotiated Rate |
$17,234.88 |
| Max. Negotiated Rate |
$37,424.30 |
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$19,196.06
|
| Rate for Payer: Amerigroup Medicare |
$19,196.06
|
| Rate for Payer: BCBS of TX Medicare |
$19,196.06
|
| Rate for Payer: Cigna Commercial |
$25,369.74
|
| Rate for Payer: Cigna Medicare |
$19,196.06
|
| Rate for Payer: Employer Direct Commercial |
$19,196.06
|
| Rate for Payer: Humana Medicare/TRICARE |
$19,196.06
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$19,196.06
|
| Rate for Payer: Molina Medicare |
$19,196.06
|
| Rate for Payer: Multiplan Auto |
$37,424.30
|
| Rate for Payer: Multiplan Commercial |
$37,424.30
|
| Rate for Payer: Multiplan Workers Comp |
$37,424.30
|
| Rate for Payer: Scott and White EPO/PPO |
$17,234.88
|
| Rate for Payer: Scott and White Medicare |
$19,196.06
|
| Rate for Payer: Superior Health Plan EPO |
$19,196.06
|
| Rate for Payer: Superior Health Plan Medicare |
$19,196.06
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$19,196.06
|
| Rate for Payer: Universal American Medicare |
$19,196.06
|
| Rate for Payer: Wellcare Medicare |
$19,196.06
|
| Rate for Payer: Wellmed Medicare |
$19,196.06
|
|
|
OSTEOMYELITIS WITHOUT CC/MCC
|
Facility
|
IP
|
$14,658.50
|
|
|
Service Code
|
MSDRG 541
|
| Min. Negotiated Rate |
$6,750.62 |
| Max. Negotiated Rate |
$14,658.50 |
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$10,530.95
|
| Rate for Payer: Amerigroup Medicare |
$10,530.95
|
| Rate for Payer: BCBS of TX Medicare |
$10,530.95
|
| Rate for Payer: Cigna Commercial |
$9,936.92
|
| Rate for Payer: Cigna Medicare |
$10,530.95
|
| Rate for Payer: Employer Direct Commercial |
$10,530.95
|
| Rate for Payer: Humana Medicare/TRICARE |
$10,530.95
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$10,530.95
|
| Rate for Payer: Molina Medicare |
$10,530.95
|
| Rate for Payer: Multiplan Auto |
$14,658.50
|
| Rate for Payer: Multiplan Commercial |
$14,658.50
|
| Rate for Payer: Multiplan Workers Comp |
$14,658.50
|
| Rate for Payer: Scott and White EPO/PPO |
$6,750.62
|
| Rate for Payer: Scott and White Medicare |
$10,530.95
|
| Rate for Payer: Superior Health Plan EPO |
$10,530.95
|
| Rate for Payer: Superior Health Plan Medicare |
$10,530.95
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$10,530.95
|
| Rate for Payer: Universal American Medicare |
$10,530.95
|
| Rate for Payer: Wellcare Medicare |
$10,530.95
|
| Rate for Payer: Wellmed Medicare |
$10,530.95
|
|
|
OSTEOMYELITIS W MCC
|
Facility
|
IP
|
$37,424.30
|
|
|
Service Code
|
MSDRG 539
|
| Min. Negotiated Rate |
$17,234.88 |
| Max. Negotiated Rate |
$37,424.30 |
| Rate for Payer: BCBS of TX Blue Advantage |
$17,365.12
|
| Rate for Payer: BCBS of TX Blue Essentials |
$20,836.12
|
| Rate for Payer: BCBS of TX PPO |
$23,152.15
|
|
