|
PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT INTRALUMINAL DEVICE WITHOUT MCC
|
Facility
|
IP
|
$28,395.50
|
|
|
Service Code
|
MSDRG 251
|
| Min. Negotiated Rate |
$13,076.88 |
| Max. Negotiated Rate |
$28,395.50 |
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$15,713.31
|
| Rate for Payer: Amerigroup Medicare |
$15,713.31
|
| Rate for Payer: BCBS of TX Medicare |
$15,713.31
|
| Rate for Payer: Cigna Commercial |
$19,249.16
|
| Rate for Payer: Cigna Medicare |
$15,713.31
|
| Rate for Payer: Employer Direct Commercial |
$15,713.31
|
| Rate for Payer: Humana Medicare/TRICARE |
$15,713.31
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$15,713.31
|
| Rate for Payer: Molina Medicare |
$15,713.31
|
| Rate for Payer: Multiplan Auto |
$28,395.50
|
| Rate for Payer: Multiplan Commercial |
$28,395.50
|
| Rate for Payer: Multiplan Workers Comp |
$28,395.50
|
| Rate for Payer: Scott and White EPO/PPO |
$13,076.88
|
| Rate for Payer: Scott and White Medicare |
$15,713.31
|
| Rate for Payer: Superior Health Plan EPO |
$15,713.31
|
| Rate for Payer: Superior Health Plan Medicare |
$15,713.31
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$15,713.31
|
| Rate for Payer: Universal American Medicare |
$15,713.31
|
| Rate for Payer: Wellcare Medicare |
$15,713.31
|
| Rate for Payer: Wellmed Medicare |
$15,713.31
|
|
|
PERCUTANEOUS CARDIOVASCULAR PROCEDURES W NON-DRUG-ELUTING STENT W MCC OR 4+ ARTERIES OR STENTS
|
Facility
|
IP
|
$36,377.03
|
|
|
Service Code
|
MSDRG 248
|
| Min. Negotiated Rate |
$27,284.36 |
| Max. Negotiated Rate |
$36,377.03 |
| Rate for Payer: BCBS of TX Blue Advantage |
$27,284.36
|
| Rate for Payer: BCBS of TX Blue Essentials |
$32,738.06
|
| Rate for Payer: BCBS of TX PPO |
$36,377.03
|
|
|
PERCUTANEOUS CORONARY ATHERECTOMY WITH INTRALUMINAL DEVICE WITH MCC
|
Facility
|
IP
|
$65,333.40
|
|
|
Service Code
|
MSDRG 359
|
| Min. Negotiated Rate |
$29,961.67 |
| Max. Negotiated Rate |
$65,333.40 |
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$29,961.67
|
| Rate for Payer: Amerigroup Medicare |
$29,961.67
|
| Rate for Payer: BCBS of TX Medicare |
$29,961.67
|
| Rate for Payer: Cigna Commercial |
$44,289.17
|
| Rate for Payer: Cigna Medicare |
$29,961.67
|
| Rate for Payer: Employer Direct Commercial |
$29,961.67
|
| Rate for Payer: Humana Medicare/TRICARE |
$29,961.67
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$29,961.67
|
| Rate for Payer: Molina Medicare |
$29,961.67
|
| Rate for Payer: Multiplan Auto |
$65,333.40
|
| Rate for Payer: Multiplan Commercial |
$65,333.40
|
| Rate for Payer: Multiplan Workers Comp |
$65,333.40
|
| Rate for Payer: Scott and White EPO/PPO |
$30,087.75
|
| Rate for Payer: Scott and White Medicare |
$29,961.67
|
| Rate for Payer: Superior Health Plan EPO |
$29,961.67
|
| Rate for Payer: Superior Health Plan Medicare |
$29,961.67
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$29,961.67
|
| Rate for Payer: Universal American Medicare |
$29,961.67
|
| Rate for Payer: Wellcare Medicare |
$29,961.67
|
| Rate for Payer: Wellmed Medicare |
$29,961.67
|
|
|
PERCUTANEOUS CORONARY ATHERECTOMY WITH INTRALUMINAL DEVICE WITHOUT MCC
|
Facility
|
IP
|
$45,871.70
|
|
|
Service Code
|
MSDRG 360
|
| Min. Negotiated Rate |
$21,125.12 |
| Max. Negotiated Rate |
$45,871.70 |
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$22,454.56
|
| Rate for Payer: Amerigroup Medicare |
$22,454.56
|
| Rate for Payer: BCBS of TX Medicare |
$22,454.56
|
| Rate for Payer: Cigna Commercial |
$31,096.18
|
| Rate for Payer: Cigna Medicare |
$22,454.56
|
| Rate for Payer: Employer Direct Commercial |
$22,454.56
|
| Rate for Payer: Humana Medicare/TRICARE |
$22,454.56
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$22,454.56
|
| Rate for Payer: Molina Medicare |
$22,454.56
|
| Rate for Payer: Multiplan Auto |
$45,871.70
|
| Rate for Payer: Multiplan Commercial |
$45,871.70
|
| Rate for Payer: Multiplan Workers Comp |
$45,871.70
|
| Rate for Payer: Scott and White EPO/PPO |
$21,125.12
|
| Rate for Payer: Scott and White Medicare |
$22,454.56
|
| Rate for Payer: Superior Health Plan EPO |
$22,454.56
|
| Rate for Payer: Superior Health Plan Medicare |
$22,454.56
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$22,454.56
|
| Rate for Payer: Universal American Medicare |
$22,454.56
|
| Rate for Payer: Wellcare Medicare |
$22,454.56
|
| Rate for Payer: Wellmed Medicare |
$22,454.56
|
|
|
PERCUTANEOUS CORONARY ATHERECTOMY WITHOUT INTRALUMINAL DEVICE
|
Facility
|
IP
|
$46,021.80
|
|
|
Service Code
|
MSDRG 318
|
| Min. Negotiated Rate |
$21,194.25 |
| Max. Negotiated Rate |
$46,021.80 |
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$22,512.45
|
| Rate for Payer: Amerigroup Medicare |
$22,512.45
|
| Rate for Payer: BCBS of TX Medicare |
$22,512.45
|
| Rate for Payer: Cigna Commercial |
$31,197.94
|
| Rate for Payer: Cigna Medicare |
$22,512.45
|
| Rate for Payer: Employer Direct Commercial |
$22,512.45
|
| Rate for Payer: Humana Medicare/TRICARE |
$22,512.45
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$22,512.45
|
| Rate for Payer: Molina Medicare |
$22,512.45
|
| Rate for Payer: Multiplan Auto |
$46,021.80
|
| Rate for Payer: Multiplan Commercial |
$46,021.80
|
| Rate for Payer: Multiplan Workers Comp |
$46,021.80
|
| Rate for Payer: Scott and White EPO/PPO |
$21,194.25
|
| Rate for Payer: Scott and White Medicare |
$22,512.45
|
| Rate for Payer: Superior Health Plan EPO |
$22,512.45
|
| Rate for Payer: Superior Health Plan Medicare |
$22,512.45
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$22,512.45
|
| Rate for Payer: Universal American Medicare |
$22,512.45
|
| Rate for Payer: Wellcare Medicare |
$22,512.45
|
| Rate for Payer: Wellmed Medicare |
$22,512.45
|
|
|
Percutaneous implantation of neurostimulator electrode array, epidural
|
Facility
|
IP
|
$55,446.12
|
|
|
Service Code
|
HCPCS 63650
|
| Hospital Charge Code |
9900771
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$37,703.36
|
|
|
Percutaneous implantation of neurostimulator electrode array, epidural
|
Facility
|
OP
|
$55,446.12
|
|
|
Service Code
|
HCPCS 63650
|
| Hospital Charge Code |
9900771
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,656.02 |
| Max. Negotiated Rate |
$39,921.21 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$3,656.02
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$6,402.04
|
| Rate for Payer: Amerigroup Medicare |
$6,402.04
|
| Rate for Payer: BCBS of TX Blue Advantage |
$10,332.51
|
| Rate for Payer: BCBS of TX Blue Essentials |
$12,374.26
|
| Rate for Payer: BCBS of TX Medicare |
$6,402.04
|
| Rate for Payer: BCBS of TX PPO |
$15,591.57
|
| Rate for Payer: Cash Price |
$37,703.36
|
| Rate for Payer: Cash Price |
$37,703.36
|
| Rate for Payer: Cash Price |
$37,703.36
|
| Rate for Payer: Cigna Commercial |
$13,532.75
|
| Rate for Payer: Cigna Medicaid |
$39,921.21
|
| Rate for Payer: Cigna Medicare |
$6,402.04
|
| Rate for Payer: Employer Direct Commercial |
$6,402.04
|
| Rate for Payer: Humana Medicare/TRICARE |
$6,402.04
|
| Rate for Payer: Molina CHIP/Medicaid |
$39,921.21
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$6,402.04
|
| Rate for Payer: Molina Medicare |
$6,402.04
|
| 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 |
$39,921.21
|
| Rate for Payer: Scott and White EPO/PPO |
$11,843.77
|
| Rate for Payer: Scott and White Medicare |
$6,402.04
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$39,921.21
|
| Rate for Payer: Superior Health Plan EPO |
$6,402.04
|
| Rate for Payer: Superior Health Plan Medicare |
$6,402.04
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$6,402.04
|
| Rate for Payer: Universal American Medicare |
$6,402.04
|
| Rate for Payer: Wellcare Medicare |
$6,402.04
|
| Rate for Payer: Wellmed Medicare |
$6,402.04
|
|
|
Percutaneous implantation of neurostimulator electrode array, epidural
|
Facility
|
OP
|
$15,591.57
|
|
|
Service Code
|
CPT 63650
|
| Hospital Charge Code |
36063650
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,656.02 |
| Max. Negotiated Rate |
$15,591.57 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$3,656.02
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$6,402.04
|
| Rate for Payer: Amerigroup Medicare |
$6,402.04
|
| Rate for Payer: BCBS of TX Blue Advantage |
$10,332.51
|
| Rate for Payer: BCBS of TX Blue Essentials |
$12,374.26
|
| Rate for Payer: BCBS of TX Medicare |
$6,402.04
|
| Rate for Payer: BCBS of TX PPO |
$15,591.57
|
| Rate for Payer: Cigna Commercial |
$13,532.75
|
| Rate for Payer: Cigna Medicare |
$6,402.04
|
| Rate for Payer: Employer Direct Commercial |
$6,402.04
|
| Rate for Payer: Humana Medicare/TRICARE |
$6,402.04
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$6,402.04
|
| Rate for Payer: Molina Medicare |
$6,402.04
|
| 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 |
$11,843.77
|
| Rate for Payer: Scott and White Medicare |
$6,402.04
|
| Rate for Payer: Superior Health Plan EPO |
$6,402.04
|
| Rate for Payer: Superior Health Plan Medicare |
$6,402.04
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$6,402.04
|
| Rate for Payer: Universal American Medicare |
$6,402.04
|
| Rate for Payer: Wellcare Medicare |
$6,402.04
|
| Rate for Payer: Wellmed Medicare |
$6,402.04
|
|
|
Percutaneous implantation of neurostimulator electrode array peripheral nerve (excludes sacral nerv
|
Facility
|
IP
|
$27,723.06
|
|
|
Service Code
|
HCPCS 64555
|
| Hospital Charge Code |
9900812
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$18,851.68
|
|
|
Percutaneous implantation of neurostimulator electrode array peripheral nerve (excludes sacral nerv
|
Facility
|
OP
|
$27,723.06
|
|
|
Service Code
|
HCPCS 64555
|
| Hospital Charge Code |
9900812
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,908.38 |
| Max. Negotiated Rate |
$19,960.60 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$3,908.38
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$6,402.04
|
| Rate for Payer: Amerigroup Medicare |
$6,402.04
|
| Rate for Payer: BCBS of TX Blue Advantage |
$10,332.51
|
| Rate for Payer: BCBS of TX Blue Essentials |
$12,374.26
|
| Rate for Payer: BCBS of TX Medicare |
$6,402.04
|
| Rate for Payer: BCBS of TX PPO |
$15,591.57
|
| Rate for Payer: Cash Price |
$18,851.68
|
| Rate for Payer: Cash Price |
$18,851.68
|
| Rate for Payer: Cash Price |
$18,851.68
|
| Rate for Payer: Cigna Commercial |
$13,532.75
|
| Rate for Payer: Cigna Medicaid |
$19,960.60
|
| Rate for Payer: Cigna Medicare |
$6,402.04
|
| Rate for Payer: Employer Direct Commercial |
$6,402.04
|
| Rate for Payer: Humana Medicare/TRICARE |
$6,402.04
|
| Rate for Payer: Molina CHIP/Medicaid |
$19,960.60
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$6,402.04
|
| Rate for Payer: Molina Medicare |
$6,402.04
|
| 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 |
$19,960.60
|
| Rate for Payer: Scott and White EPO/PPO |
$11,843.77
|
| Rate for Payer: Scott and White Medicare |
$6,402.04
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$19,960.60
|
| Rate for Payer: Superior Health Plan EPO |
$6,402.04
|
| Rate for Payer: Superior Health Plan Medicare |
$6,402.04
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$6,402.04
|
| Rate for Payer: Universal American Medicare |
$6,402.04
|
| Rate for Payer: Wellcare Medicare |
$6,402.04
|
| Rate for Payer: Wellmed Medicare |
$6,402.04
|
|
|
Percutaneous implantation of neurostimulator electrode array peripheral nerve (excludes sacral nerv
|
Facility
|
OP
|
$15,591.57
|
|
|
Service Code
|
CPT 64555
|
| Hospital Charge Code |
36064555
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,908.38 |
| Max. Negotiated Rate |
$15,591.57 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$3,908.38
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$6,402.04
|
| Rate for Payer: Amerigroup Medicare |
$6,402.04
|
| Rate for Payer: BCBS of TX Blue Advantage |
$10,332.51
|
| Rate for Payer: BCBS of TX Blue Essentials |
$12,374.26
|
| Rate for Payer: BCBS of TX Medicare |
$6,402.04
|
| Rate for Payer: BCBS of TX PPO |
$15,591.57
|
| Rate for Payer: Cigna Commercial |
$13,532.75
|
| Rate for Payer: Cigna Medicare |
$6,402.04
|
| Rate for Payer: Employer Direct Commercial |
$6,402.04
|
| Rate for Payer: Humana Medicare/TRICARE |
$6,402.04
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$6,402.04
|
| Rate for Payer: Molina Medicare |
$6,402.04
|
| 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 |
$11,843.77
|
| Rate for Payer: Scott and White Medicare |
$6,402.04
|
| Rate for Payer: Superior Health Plan EPO |
$6,402.04
|
| Rate for Payer: Superior Health Plan Medicare |
$6,402.04
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$6,402.04
|
| Rate for Payer: Universal American Medicare |
$6,402.04
|
| Rate for Payer: Wellcare Medicare |
$6,402.04
|
| Rate for Payer: Wellmed Medicare |
$6,402.04
|
|
|
PERCUTANEOUS INTRACARDIAC PROCEDURES W MCC
|
Facility
|
IP
|
$78,384.50
|
|
|
Service Code
|
MSDRG 273
|
| Min. Negotiated Rate |
$31,411.50 |
| Max. Negotiated Rate |
$78,384.50 |
| Rate for Payer: BCBS of TX Blue Advantage |
$31,411.50
|
| Rate for Payer: BCBS of TX Blue Essentials |
$37,690.15
|
| Rate for Payer: BCBS of TX PPO |
$41,879.57
|
|
|
PERCUTANEOUS INTRACARDIAC PROCEDURES W/O MCC
|
Facility
|
IP
|
$62,542.30
|
|
|
Service Code
|
MSDRG 274
|
| Min. Negotiated Rate |
$25,613.38 |
| Max. Negotiated Rate |
$62,542.30 |
| Rate for Payer: BCBS of TX Blue Advantage |
$25,613.38
|
| Rate for Payer: BCBS of TX Blue Essentials |
$30,733.08
|
| Rate for Payer: BCBS of TX PPO |
$34,149.19
|
|
|
PERCUTANEOUS INTRACRANIAL AND EXTRACRANIAL VASCULAR PROCEDURES
|
Facility
|
IP
|
$18,139.77
|
|
|
Service Code
|
APR-DRG 0303
|
| Min. Negotiated Rate |
$17,102.81 |
| Max. Negotiated Rate |
$18,139.77 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$17,102.81
|
| Rate for Payer: Cigna Medicaid |
$17,102.81
|
| Rate for Payer: Molina CHIP/Medicaid |
$17,102.81
|
| Rate for Payer: Parkland Medicaid |
$17,102.81
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$18,139.77
|
|
|
PERCUTANEOUS INTRACRANIAL AND EXTRACRANIAL VASCULAR PROCEDURES
|
Facility
|
IP
|
$25,409.34
|
|
|
Service Code
|
APR-DRG 0304
|
| Min. Negotiated Rate |
$23,956.81 |
| Max. Negotiated Rate |
$25,409.34 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$23,956.81
|
| Rate for Payer: Cigna Medicaid |
$23,956.81
|
| Rate for Payer: Molina CHIP/Medicaid |
$23,956.81
|
| Rate for Payer: Parkland Medicaid |
$23,956.81
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$25,409.34
|
|
|
PERCUTANEOUS INTRACRANIAL AND EXTRACRANIAL VASCULAR PROCEDURES
|
Facility
|
IP
|
$10,139.59
|
|
|
Service Code
|
APR-DRG 0301
|
| Min. Negotiated Rate |
$9,559.97 |
| Max. Negotiated Rate |
$10,139.59 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$9,559.97
|
| Rate for Payer: Cigna Medicaid |
$9,559.97
|
| Rate for Payer: Molina CHIP/Medicaid |
$9,559.97
|
| Rate for Payer: Parkland Medicaid |
$9,559.97
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$10,139.59
|
|
|
PERCUTANEOUS INTRACRANIAL AND EXTRACRANIAL VASCULAR PROCEDURES
|
Facility
|
IP
|
$13,360.79
|
|
|
Service Code
|
APR-DRG 0302
|
| Min. Negotiated Rate |
$12,597.02 |
| Max. Negotiated Rate |
$13,360.79 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$12,597.02
|
| Rate for Payer: Cigna Medicaid |
$12,597.02
|
| Rate for Payer: Molina CHIP/Medicaid |
$12,597.02
|
| Rate for Payer: Parkland Medicaid |
$12,597.02
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$13,360.79
|
|
|
Percutaneous lysis of epidural adhesions using solution injection (eg, hypertonic saline, enzyme)
|
Facility
|
OP
|
$2,261.77
|
|
|
Service Code
|
HCPCS 62263
|
| Hospital Charge Code |
9900739
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$340.77 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$340.77
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$888.50
|
| Rate for Payer: Amerigroup Medicare |
$888.50
|
| Rate for Payer: BCBS of TX Blue Advantage |
$1,356.12
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,624.10
|
| Rate for Payer: BCBS of TX Medicare |
$888.50
|
| Rate for Payer: BCBS of TX PPO |
$2,046.37
|
| Rate for Payer: Cash Price |
$1,538.00
|
| Rate for Payer: Cash Price |
$1,538.00
|
| Rate for Payer: Cash Price |
$1,538.00
|
| Rate for Payer: Cigna Commercial |
$1,878.13
|
| Rate for Payer: Cigna Medicaid |
$1,628.47
|
| Rate for Payer: Cigna Medicare |
$888.50
|
| Rate for Payer: Employer Direct Commercial |
$888.50
|
| Rate for Payer: Humana Medicare/TRICARE |
$888.50
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,628.47
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$888.50
|
| Rate for Payer: Molina Medicare |
$888.50
|
| 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 |
$1,628.47
|
| Rate for Payer: Scott and White EPO/PPO |
$1,643.72
|
| Rate for Payer: Scott and White Medicare |
$888.50
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,628.47
|
| Rate for Payer: Superior Health Plan EPO |
$888.50
|
| Rate for Payer: Superior Health Plan Medicare |
$888.50
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$888.50
|
| Rate for Payer: Universal American Medicare |
$888.50
|
| Rate for Payer: Wellcare Medicare |
$888.50
|
| Rate for Payer: Wellmed Medicare |
$888.50
|
|
|
Percutaneous lysis of epidural adhesions using solution injection (eg, hypertonic saline, enzyme)
|
Facility
|
IP
|
$2,261.77
|
|
|
Service Code
|
HCPCS 62263
|
| Hospital Charge Code |
9900739
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$1,538.00
|
|
|
Percutaneous lysis of epidural adhesions using solution injection (eg, hypertonic saline, enzyme)
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 62263
|
| Hospital Charge Code |
36062263
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$340.77 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$340.77
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$888.50
|
| Rate for Payer: Amerigroup Medicare |
$888.50
|
| Rate for Payer: BCBS of TX Blue Advantage |
$1,356.12
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,624.10
|
| Rate for Payer: BCBS of TX Medicare |
$888.50
|
| Rate for Payer: BCBS of TX PPO |
$2,046.37
|
| Rate for Payer: Cigna Commercial |
$1,878.13
|
| Rate for Payer: Cigna Medicare |
$888.50
|
| Rate for Payer: Employer Direct Commercial |
$888.50
|
| Rate for Payer: Humana Medicare/TRICARE |
$888.50
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$888.50
|
| Rate for Payer: Molina Medicare |
$888.50
|
| 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 |
$1,643.72
|
| Rate for Payer: Scott and White Medicare |
$888.50
|
| Rate for Payer: Superior Health Plan EPO |
$888.50
|
| Rate for Payer: Superior Health Plan Medicare |
$888.50
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$888.50
|
| Rate for Payer: Universal American Medicare |
$888.50
|
| Rate for Payer: Wellcare Medicare |
$888.50
|
| Rate for Payer: Wellmed Medicare |
$888.50
|
|
|
Percutaneous lysis of epidural adhesions using solution injection (eg, hypertonic saline, enzyme) or
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 62264
|
| Hospital Charge Code |
36062264
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$340.77 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$340.77
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$888.50
|
| Rate for Payer: Amerigroup Medicare |
$888.50
|
| Rate for Payer: BCBS of TX Blue Advantage |
$1,356.12
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,624.10
|
| Rate for Payer: BCBS of TX Medicare |
$888.50
|
| Rate for Payer: BCBS of TX PPO |
$2,046.37
|
| Rate for Payer: Cigna Commercial |
$1,878.13
|
| Rate for Payer: Cigna Medicare |
$888.50
|
| Rate for Payer: Employer Direct Commercial |
$888.50
|
| Rate for Payer: Humana Medicare/TRICARE |
$888.50
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$888.50
|
| Rate for Payer: Molina Medicare |
$888.50
|
| 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 |
$1,643.72
|
| Rate for Payer: Scott and White Medicare |
$888.50
|
| Rate for Payer: Superior Health Plan EPO |
$888.50
|
| Rate for Payer: Superior Health Plan Medicare |
$888.50
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$888.50
|
| Rate for Payer: Universal American Medicare |
$888.50
|
| Rate for Payer: Wellcare Medicare |
$888.50
|
| Rate for Payer: Wellmed Medicare |
$888.50
|
|
|
Percutaneous lysis of epidural adhesions using solution injection (eg, hypertonic saline, enzyme) or
|
Facility
|
IP
|
$4,934.76
|
|
|
Service Code
|
HCPCS 62264
|
| Hospital Charge Code |
9900740
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$3,355.64
|
|
|
Percutaneous lysis of epidural adhesions using solution injection (eg, hypertonic saline, enzyme) or
|
Facility
|
OP
|
$4,934.76
|
|
|
Service Code
|
HCPCS 62264
|
| Hospital Charge Code |
9900740
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$340.77 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$340.77
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$888.50
|
| Rate for Payer: Amerigroup Medicare |
$888.50
|
| Rate for Payer: BCBS of TX Blue Advantage |
$1,356.12
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,624.10
|
| Rate for Payer: BCBS of TX Medicare |
$888.50
|
| Rate for Payer: BCBS of TX PPO |
$2,046.37
|
| Rate for Payer: Cash Price |
$3,355.64
|
| Rate for Payer: Cash Price |
$3,355.64
|
| Rate for Payer: Cash Price |
$3,355.64
|
| Rate for Payer: Cigna Commercial |
$1,878.13
|
| Rate for Payer: Cigna Medicaid |
$3,553.03
|
| Rate for Payer: Cigna Medicare |
$888.50
|
| Rate for Payer: Employer Direct Commercial |
$888.50
|
| Rate for Payer: Humana Medicare/TRICARE |
$888.50
|
| Rate for Payer: Molina CHIP/Medicaid |
$3,553.03
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$888.50
|
| Rate for Payer: Molina Medicare |
$888.50
|
| 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 |
$3,553.03
|
| Rate for Payer: Scott and White EPO/PPO |
$1,643.72
|
| Rate for Payer: Scott and White Medicare |
$888.50
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$3,553.03
|
| Rate for Payer: Superior Health Plan EPO |
$888.50
|
| Rate for Payer: Superior Health Plan Medicare |
$888.50
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$888.50
|
| Rate for Payer: Universal American Medicare |
$888.50
|
| Rate for Payer: Wellcare Medicare |
$888.50
|
| Rate for Payer: Wellmed Medicare |
$888.50
|
|
|
Percutaneous skeletal fixation of carpometacarpal dislocation, other than thumb, with manipulation,
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 26676
|
| Hospital Charge Code |
36026676
|
|
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
|
|
|
Percutaneous skeletal fixation of carpometacarpal dislocation, other than thumb, with manipulation,
|
Facility
|
IP
|
$12,336.12
|
|
|
Service Code
|
HCPCS 26676
|
| Hospital Charge Code |
9900362
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$8,388.56
|
|
