|
Radical resection of tumor (eg, sarcoma), soft tissue of forearm and/or wrist area 3 cm or greater
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 25078
|
| Hospital Charge Code |
36025078
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$815.20 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$815.20
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$2,917.95
|
| Rate for Payer: Amerigroup Medicare |
$2,917.95
|
| 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 |
$2,917.95
|
| Rate for Payer: BCBS of TX PPO |
$5,843.60
|
| Rate for Payer: Cigna Commercial |
$6,168.03
|
| Rate for Payer: Cigna Medicare |
$2,917.95
|
| Rate for Payer: Employer Direct Commercial |
$2,917.95
|
| Rate for Payer: Humana Medicare/TRICARE |
$2,917.95
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$2,917.95
|
| Rate for Payer: Molina Medicare |
$2,917.95
|
| 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 |
$4,807.56
|
| Rate for Payer: Scott and White Medicare |
$2,917.95
|
| Rate for Payer: Superior Health Plan EPO |
$2,917.95
|
| Rate for Payer: Superior Health Plan Medicare |
$2,917.95
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$2,917.95
|
| Rate for Payer: Universal American Medicare |
$2,917.95
|
| Rate for Payer: Wellcare Medicare |
$2,917.95
|
| Rate for Payer: Wellmed Medicare |
$2,917.95
|
|
|
Radical resection of tumor (eg, sarcoma), soft tissue of forearm and/or wrist area 3 cm or greater
|
Facility
|
OP
|
$18,960.08
|
|
|
Service Code
|
HCPCS 25078
|
| Hospital Charge Code |
9900268
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$815.20 |
| Max. Negotiated Rate |
$13,651.26 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$815.20
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$2,917.95
|
| Rate for Payer: Amerigroup Medicare |
$2,917.95
|
| 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 |
$2,917.95
|
| Rate for Payer: BCBS of TX PPO |
$5,843.60
|
| Rate for Payer: Cash Price |
$12,892.85
|
| Rate for Payer: Cash Price |
$12,892.85
|
| Rate for Payer: Cash Price |
$12,892.85
|
| Rate for Payer: Cigna Commercial |
$6,168.03
|
| Rate for Payer: Cigna Medicaid |
$13,651.26
|
| Rate for Payer: Cigna Medicare |
$2,917.95
|
| Rate for Payer: Employer Direct Commercial |
$2,917.95
|
| Rate for Payer: Humana Medicare/TRICARE |
$2,917.95
|
| Rate for Payer: Molina CHIP/Medicaid |
$13,651.26
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$2,917.95
|
| Rate for Payer: Molina Medicare |
$2,917.95
|
| 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 |
$13,651.26
|
| Rate for Payer: Scott and White EPO/PPO |
$4,807.56
|
| Rate for Payer: Scott and White Medicare |
$2,917.95
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$13,651.26
|
| Rate for Payer: Superior Health Plan EPO |
$2,917.95
|
| Rate for Payer: Superior Health Plan Medicare |
$2,917.95
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$2,917.95
|
| Rate for Payer: Universal American Medicare |
$2,917.95
|
| Rate for Payer: Wellcare Medicare |
$2,917.95
|
| Rate for Payer: Wellmed Medicare |
$2,917.95
|
|
|
Radical resection of tumor (eg, sarcoma), soft tissue of hand or finger 3 cm or greater
|
Facility
|
IP
|
$8,295.04
|
|
|
Service Code
|
HCPCS 26118
|
| Hospital Charge Code |
9900318
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$5,640.63
|
|
|
Radical resection of tumor (eg, sarcoma), soft tissue of hand or finger 3 cm or greater
|
Facility
|
OP
|
$8,295.04
|
|
|
Service Code
|
HCPCS 26118
|
| Hospital Charge Code |
9900318
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$815.20 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$815.20
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$2,917.95
|
| Rate for Payer: Amerigroup Medicare |
$2,917.95
|
| 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 |
$2,917.95
|
| Rate for Payer: BCBS of TX PPO |
$5,843.60
|
| Rate for Payer: Cash Price |
$5,640.63
|
| Rate for Payer: Cash Price |
$5,640.63
|
| Rate for Payer: Cash Price |
$5,640.63
|
| Rate for Payer: Cigna Commercial |
$6,168.03
|
| Rate for Payer: Cigna Medicaid |
$5,972.43
|
| Rate for Payer: Cigna Medicare |
$2,917.95
|
| Rate for Payer: Employer Direct Commercial |
$2,917.95
|
| Rate for Payer: Humana Medicare/TRICARE |
$2,917.95
|
| Rate for Payer: Molina CHIP/Medicaid |
$5,972.43
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$2,917.95
|
| Rate for Payer: Molina Medicare |
$2,917.95
|
| 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 |
$5,972.43
|
| Rate for Payer: Scott and White EPO/PPO |
$4,807.56
|
| Rate for Payer: Scott and White Medicare |
$2,917.95
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$5,972.43
|
| Rate for Payer: Superior Health Plan EPO |
$2,917.95
|
| Rate for Payer: Superior Health Plan Medicare |
$2,917.95
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$2,917.95
|
| Rate for Payer: Universal American Medicare |
$2,917.95
|
| Rate for Payer: Wellcare Medicare |
$2,917.95
|
| Rate for Payer: Wellmed Medicare |
$2,917.95
|
|
|
Radical resection of tumor (eg, sarcoma), soft tissue of hand or finger 3 cm or greater
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 26118
|
| Hospital Charge Code |
36026118
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$815.20 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$815.20
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$2,917.95
|
| Rate for Payer: Amerigroup Medicare |
$2,917.95
|
| 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 |
$2,917.95
|
| Rate for Payer: BCBS of TX PPO |
$5,843.60
|
| Rate for Payer: Cigna Commercial |
$6,168.03
|
| Rate for Payer: Cigna Medicare |
$2,917.95
|
| Rate for Payer: Employer Direct Commercial |
$2,917.95
|
| Rate for Payer: Humana Medicare/TRICARE |
$2,917.95
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$2,917.95
|
| Rate for Payer: Molina Medicare |
$2,917.95
|
| 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 |
$4,807.56
|
| Rate for Payer: Scott and White Medicare |
$2,917.95
|
| Rate for Payer: Superior Health Plan EPO |
$2,917.95
|
| Rate for Payer: Superior Health Plan Medicare |
$2,917.95
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$2,917.95
|
| Rate for Payer: Universal American Medicare |
$2,917.95
|
| Rate for Payer: Wellcare Medicare |
$2,917.95
|
| Rate for Payer: Wellmed Medicare |
$2,917.95
|
|
|
Radical resection of tumor (eg, sarcoma), soft tissue of neck or anterior thorax 5 cm or greater
|
Facility
|
IP
|
$13,913.34
|
|
|
Service Code
|
HCPCS 21558
|
| Hospital Charge Code |
9900200
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$9,461.07
|
|
|
Radical resection of tumor (eg, sarcoma), soft tissue of neck or anterior thorax 5 cm or greater
|
Facility
|
OP
|
$13,913.34
|
|
|
Service Code
|
HCPCS 21558
|
| Hospital Charge Code |
9900200
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$815.20 |
| Max. Negotiated Rate |
$10,017.60 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$815.20
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$2,917.95
|
| Rate for Payer: Amerigroup Medicare |
$2,917.95
|
| 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 |
$2,917.95
|
| Rate for Payer: BCBS of TX PPO |
$5,843.60
|
| Rate for Payer: Cash Price |
$9,461.07
|
| Rate for Payer: Cash Price |
$9,461.07
|
| Rate for Payer: Cash Price |
$9,461.07
|
| Rate for Payer: Cigna Commercial |
$6,168.03
|
| Rate for Payer: Cigna Medicaid |
$10,017.60
|
| Rate for Payer: Cigna Medicare |
$2,917.95
|
| Rate for Payer: Employer Direct Commercial |
$2,917.95
|
| Rate for Payer: Humana Medicare/TRICARE |
$2,917.95
|
| Rate for Payer: Molina CHIP/Medicaid |
$10,017.60
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$2,917.95
|
| Rate for Payer: Molina Medicare |
$2,917.95
|
| 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 |
$10,017.60
|
| Rate for Payer: Scott and White EPO/PPO |
$4,807.56
|
| Rate for Payer: Scott and White Medicare |
$2,917.95
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$10,017.60
|
| Rate for Payer: Superior Health Plan EPO |
$2,917.95
|
| Rate for Payer: Superior Health Plan Medicare |
$2,917.95
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$2,917.95
|
| Rate for Payer: Universal American Medicare |
$2,917.95
|
| Rate for Payer: Wellcare Medicare |
$2,917.95
|
| Rate for Payer: Wellmed Medicare |
$2,917.95
|
|
|
Radical resection of tumor (eg, sarcoma), soft tissue of neck or anterior thorax 5 cm or greater
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 21558
|
| Hospital Charge Code |
36021558
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$815.20 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$815.20
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$2,917.95
|
| Rate for Payer: Amerigroup Medicare |
$2,917.95
|
| 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 |
$2,917.95
|
| Rate for Payer: BCBS of TX PPO |
$5,843.60
|
| Rate for Payer: Cigna Commercial |
$6,168.03
|
| Rate for Payer: Cigna Medicare |
$2,917.95
|
| Rate for Payer: Employer Direct Commercial |
$2,917.95
|
| Rate for Payer: Humana Medicare/TRICARE |
$2,917.95
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$2,917.95
|
| Rate for Payer: Molina Medicare |
$2,917.95
|
| 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 |
$4,807.56
|
| Rate for Payer: Scott and White Medicare |
$2,917.95
|
| Rate for Payer: Superior Health Plan EPO |
$2,917.95
|
| Rate for Payer: Superior Health Plan Medicare |
$2,917.95
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$2,917.95
|
| Rate for Payer: Universal American Medicare |
$2,917.95
|
| Rate for Payer: Wellcare Medicare |
$2,917.95
|
| Rate for Payer: Wellmed Medicare |
$2,917.95
|
|
|
Radical resection of tumor (eg, sarcoma), soft tissue of upper arm or elbow area 5 cm or greater
|
Facility
|
OP
|
$7,110.03
|
|
|
Service Code
|
HCPCS 24079
|
| Hospital Charge Code |
9900240
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$815.20 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$815.20
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$2,917.95
|
| Rate for Payer: Amerigroup Medicare |
$2,917.95
|
| 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 |
$2,917.95
|
| Rate for Payer: BCBS of TX PPO |
$5,843.60
|
| Rate for Payer: Cash Price |
$4,834.82
|
| Rate for Payer: Cash Price |
$4,834.82
|
| Rate for Payer: Cash Price |
$4,834.82
|
| Rate for Payer: Cigna Commercial |
$6,168.03
|
| Rate for Payer: Cigna Medicaid |
$5,119.22
|
| Rate for Payer: Cigna Medicare |
$2,917.95
|
| Rate for Payer: Employer Direct Commercial |
$2,917.95
|
| Rate for Payer: Humana Medicare/TRICARE |
$2,917.95
|
| Rate for Payer: Molina CHIP/Medicaid |
$5,119.22
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$2,917.95
|
| Rate for Payer: Molina Medicare |
$2,917.95
|
| 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 |
$5,119.22
|
| Rate for Payer: Scott and White EPO/PPO |
$4,807.56
|
| Rate for Payer: Scott and White Medicare |
$2,917.95
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$5,119.22
|
| Rate for Payer: Superior Health Plan EPO |
$2,917.95
|
| Rate for Payer: Superior Health Plan Medicare |
$2,917.95
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$2,917.95
|
| Rate for Payer: Universal American Medicare |
$2,917.95
|
| Rate for Payer: Wellcare Medicare |
$2,917.95
|
| Rate for Payer: Wellmed Medicare |
$2,917.95
|
|
|
Radical resection of tumor (eg, sarcoma), soft tissue of upper arm or elbow area 5 cm or greater
|
Facility
|
IP
|
$7,110.03
|
|
|
Service Code
|
HCPCS 24079
|
| Hospital Charge Code |
9900240
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$4,834.82
|
|
|
Radical resection of tumor (eg, sarcoma), soft tissue of upper arm or elbow area 5 cm or greater
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 24079
|
| Hospital Charge Code |
36024079
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$815.20 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$815.20
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$2,917.95
|
| Rate for Payer: Amerigroup Medicare |
$2,917.95
|
| 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 |
$2,917.95
|
| Rate for Payer: BCBS of TX PPO |
$5,843.60
|
| Rate for Payer: Cigna Commercial |
$6,168.03
|
| Rate for Payer: Cigna Medicare |
$2,917.95
|
| Rate for Payer: Employer Direct Commercial |
$2,917.95
|
| Rate for Payer: Humana Medicare/TRICARE |
$2,917.95
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$2,917.95
|
| Rate for Payer: Molina Medicare |
$2,917.95
|
| 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 |
$4,807.56
|
| Rate for Payer: Scott and White Medicare |
$2,917.95
|
| Rate for Payer: Superior Health Plan EPO |
$2,917.95
|
| Rate for Payer: Superior Health Plan Medicare |
$2,917.95
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$2,917.95
|
| Rate for Payer: Universal American Medicare |
$2,917.95
|
| Rate for Payer: Wellcare Medicare |
$2,917.95
|
| Rate for Payer: Wellmed Medicare |
$2,917.95
|
|
|
RADIFOCUS GUIDEWIRE TORQUE DEVICE
|
Facility
|
OP
|
$58.57
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
992477
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.27 |
| Max. Negotiated Rate |
$42.17 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$5.27
|
| Rate for Payer: BCBS of TX Blue Advantage |
$17.57
|
| Rate for Payer: BCBS of TX Blue Essentials |
$21.09
|
| Rate for Payer: BCBS of TX PPO |
$23.43
|
| Rate for Payer: Cash Price |
$39.83
|
| Rate for Payer: Cigna Medicaid |
$42.17
|
| Rate for Payer: Molina CHIP/Medicaid |
$42.17
|
| Rate for Payer: Multiplan Auto |
$38.07
|
| Rate for Payer: Multiplan Commercial |
$38.07
|
| Rate for Payer: Multiplan Workers Comp |
$38.07
|
| Rate for Payer: Parkland Medicaid |
$42.17
|
| Rate for Payer: Scott and White EPO/PPO |
$29.29
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$42.17
|
| Rate for Payer: Superior Health Plan EPO |
$7.97
|
|
|
RADIFOCUS GUIDEWIRE TORQUE DEVICE
|
Facility
|
IP
|
$58.57
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
992477
|
|
Hospital Revenue Code
|
272
|
| Rate for Payer: Cash Price |
$39.83
|
|
|
Radiofrequency ablation, nerves innervating the sacroiliac joint, with image guidance
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 64625
|
| Hospital Charge Code |
36064625
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$659.94 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$659.94
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,961.62
|
| Rate for Payer: Amerigroup Medicare |
$1,961.62
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,871.31
|
| Rate for Payer: BCBS of TX Blue Essentials |
$3,438.70
|
| Rate for Payer: BCBS of TX Medicare |
$1,961.62
|
| Rate for Payer: BCBS of TX PPO |
$4,332.76
|
| Rate for Payer: Cigna Commercial |
$4,146.52
|
| Rate for Payer: Cigna Medicare |
$1,961.62
|
| Rate for Payer: Employer Direct Commercial |
$1,961.62
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,961.62
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,961.62
|
| Rate for Payer: Molina Medicare |
$1,961.62
|
| 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 |
$3,266.71
|
| Rate for Payer: Scott and White Medicare |
$1,961.62
|
| Rate for Payer: Superior Health Plan EPO |
$1,961.62
|
| Rate for Payer: Superior Health Plan Medicare |
$1,961.62
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,961.62
|
| Rate for Payer: Universal American Medicare |
$1,961.62
|
| Rate for Payer: Wellcare Medicare |
$1,961.62
|
| Rate for Payer: Wellmed Medicare |
$1,961.62
|
|
|
Radiofrequency ablation, nerves innervating the sacroiliac joint, with image guidance
|
Facility
|
OP
|
$7,894.76
|
|
|
Service Code
|
HCPCS 64625
|
| Hospital Charge Code |
9900824
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$659.94 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$659.94
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,961.62
|
| Rate for Payer: Amerigroup Medicare |
$1,961.62
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,871.31
|
| Rate for Payer: BCBS of TX Blue Essentials |
$3,438.70
|
| Rate for Payer: BCBS of TX Medicare |
$1,961.62
|
| Rate for Payer: BCBS of TX PPO |
$4,332.76
|
| Rate for Payer: Cash Price |
$5,368.44
|
| Rate for Payer: Cash Price |
$5,368.44
|
| Rate for Payer: Cash Price |
$5,368.44
|
| Rate for Payer: Cigna Commercial |
$4,146.52
|
| Rate for Payer: Cigna Medicaid |
$5,684.23
|
| Rate for Payer: Cigna Medicare |
$1,961.62
|
| Rate for Payer: Employer Direct Commercial |
$1,961.62
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,961.62
|
| Rate for Payer: Molina CHIP/Medicaid |
$5,684.23
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,961.62
|
| Rate for Payer: Molina Medicare |
$1,961.62
|
| 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 |
$5,684.23
|
| Rate for Payer: Scott and White EPO/PPO |
$3,266.71
|
| Rate for Payer: Scott and White Medicare |
$1,961.62
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$5,684.23
|
| Rate for Payer: Superior Health Plan EPO |
$1,961.62
|
| Rate for Payer: Superior Health Plan Medicare |
$1,961.62
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,961.62
|
| Rate for Payer: Universal American Medicare |
$1,961.62
|
| Rate for Payer: Wellcare Medicare |
$1,961.62
|
| Rate for Payer: Wellmed Medicare |
$1,961.62
|
|
|
Radiofrequency ablation, nerves innervating the sacroiliac joint, with image guidance
|
Facility
|
IP
|
$7,894.76
|
|
|
Service Code
|
HCPCS 64625
|
| Hospital Charge Code |
9900824
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$5,368.44
|
|
|
Radiologic examination, abdomen; 2 views
|
Facility
|
OP
|
$808.00
|
|
|
Service Code
|
HCPCS 74019
|
| Hospital Charge Code |
3181558
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$36.75 |
| Max. Negotiated Rate |
$581.76 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$36.75
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$105.02
|
| Rate for Payer: Amerigroup Medicare |
$105.02
|
| Rate for Payer: BCBS of TX Blue Advantage |
$184.93
|
| Rate for Payer: BCBS of TX Blue Essentials |
$221.92
|
| Rate for Payer: BCBS of TX Medicare |
$105.02
|
| Rate for Payer: BCBS of TX PPO |
$247.70
|
| Rate for Payer: Cash Price |
$549.44
|
| Rate for Payer: Cash Price |
$549.44
|
| Rate for Payer: Cash Price |
$549.44
|
| Rate for Payer: Cigna Commercial |
$222.00
|
| Rate for Payer: Cigna Medicaid |
$581.76
|
| Rate for Payer: Cigna Medicare |
$105.02
|
| Rate for Payer: Employer Direct Commercial |
$105.02
|
| Rate for Payer: Humana Medicare/TRICARE |
$105.02
|
| Rate for Payer: Molina CHIP/Medicaid |
$581.76
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$105.02
|
| Rate for Payer: Molina Medicare |
$105.02
|
| Rate for Payer: Multiplan Auto |
$525.20
|
| Rate for Payer: Multiplan Commercial |
$525.20
|
| Rate for Payer: Multiplan Workers Comp |
$525.20
|
| Rate for Payer: Parkland Medicaid |
$581.76
|
| Rate for Payer: Scott and White EPO/PPO |
$45.27
|
| Rate for Payer: Scott and White Medicare |
$105.02
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$581.76
|
| Rate for Payer: Superior Health Plan EPO |
$105.02
|
| Rate for Payer: Superior Health Plan Medicare |
$105.02
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$105.02
|
| Rate for Payer: Universal American Medicare |
$105.02
|
| Rate for Payer: Wellcare Medicare |
$105.02
|
| Rate for Payer: Wellmed Medicare |
$105.02
|
|
|
Radiologic examination, abdomen; 2 views
|
Facility
|
IP
|
$808.00
|
|
|
Service Code
|
HCPCS 74019
|
| Hospital Charge Code |
3181558
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$549.44
|
|
|
Radiologic examination, hip, unilateral, with pelvis when performed; minimum of 4 views
|
Facility
|
OP
|
$425.36
|
|
|
Service Code
|
HCPCS 73503
|
| Hospital Charge Code |
994034
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$60.14 |
| Max. Negotiated Rate |
$306.26 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$60.14
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$105.02
|
| Rate for Payer: Amerigroup Medicare |
$105.02
|
| Rate for Payer: BCBS of TX Blue Advantage |
$184.93
|
| Rate for Payer: BCBS of TX Blue Essentials |
$221.92
|
| Rate for Payer: BCBS of TX Medicare |
$105.02
|
| Rate for Payer: BCBS of TX PPO |
$247.70
|
| Rate for Payer: Cash Price |
$289.24
|
| Rate for Payer: Cash Price |
$289.24
|
| Rate for Payer: Cash Price |
$289.24
|
| Rate for Payer: Cigna Commercial |
$222.00
|
| Rate for Payer: Cigna Medicaid |
$306.26
|
| Rate for Payer: Cigna Medicare |
$105.02
|
| Rate for Payer: Employer Direct Commercial |
$105.02
|
| Rate for Payer: Humana Medicare/TRICARE |
$105.02
|
| Rate for Payer: Molina CHIP/Medicaid |
$306.26
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$105.02
|
| Rate for Payer: Molina Medicare |
$105.02
|
| Rate for Payer: Multiplan Auto |
$276.48
|
| Rate for Payer: Multiplan Commercial |
$276.48
|
| Rate for Payer: Multiplan Workers Comp |
$276.48
|
| Rate for Payer: Parkland Medicaid |
$306.26
|
| Rate for Payer: Scott and White EPO/PPO |
$74.12
|
| Rate for Payer: Scott and White Medicare |
$105.02
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$306.26
|
| Rate for Payer: Superior Health Plan EPO |
$105.02
|
| Rate for Payer: Superior Health Plan Medicare |
$105.02
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$105.02
|
| Rate for Payer: Universal American Medicare |
$105.02
|
| Rate for Payer: Wellcare Medicare |
$105.02
|
| Rate for Payer: Wellmed Medicare |
$105.02
|
|
|
Radiologic examination, hip, unilateral, with pelvis when performed; minimum of 4 views
|
Facility
|
IP
|
$425.36
|
|
|
Service Code
|
HCPCS 73503
|
| Hospital Charge Code |
994034
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$289.24
|
|
|
RADIOTHERAPY
|
Facility
|
IP
|
$44,439.10
|
|
|
Service Code
|
MSDRG 849
|
| Min. Negotiated Rate |
$16,943.72 |
| Max. Negotiated Rate |
$44,439.10 |
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$24,618.08
|
| Rate for Payer: Amerigroup Medicare |
$24,618.08
|
| Rate for Payer: BCBS of TX Blue Advantage |
$16,943.72
|
| Rate for Payer: BCBS of TX Blue Essentials |
$20,330.49
|
| Rate for Payer: BCBS of TX Medicare |
$24,618.08
|
| Rate for Payer: BCBS of TX PPO |
$22,590.31
|
| Rate for Payer: Cigna Commercial |
$34,898.36
|
| Rate for Payer: Cigna Medicare |
$24,618.08
|
| Rate for Payer: Employer Direct Commercial |
$24,618.08
|
| Rate for Payer: Humana Medicare/TRICARE |
$24,618.08
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$24,618.08
|
| Rate for Payer: Molina Medicare |
$24,618.08
|
| Rate for Payer: Multiplan Auto |
$44,439.10
|
| Rate for Payer: Multiplan Commercial |
$44,439.10
|
| Rate for Payer: Multiplan Workers Comp |
$44,439.10
|
| Rate for Payer: Scott and White EPO/PPO |
$20,465.38
|
| Rate for Payer: Scott and White Medicare |
$24,618.08
|
| Rate for Payer: Superior Health Plan EPO |
$24,618.08
|
| Rate for Payer: Superior Health Plan Medicare |
$24,618.08
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$24,618.08
|
| Rate for Payer: Universal American Medicare |
$24,618.08
|
| Rate for Payer: Wellcare Medicare |
$24,618.08
|
| Rate for Payer: Wellmed Medicare |
$24,618.08
|
|
|
RADIOTHERAPY
|
Facility
|
IP
|
$5,095.07
|
|
|
Service Code
|
APR-DRG 6921
|
| Min. Negotiated Rate |
$4,803.81 |
| Max. Negotiated Rate |
$5,095.07 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$4,803.81
|
| Rate for Payer: Cigna Medicaid |
$4,803.81
|
| Rate for Payer: Molina CHIP/Medicaid |
$4,803.81
|
| Rate for Payer: Parkland Medicaid |
$4,803.81
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$5,095.07
|
|
|
RADIOTHERAPY
|
Facility
|
IP
|
$24,313.23
|
|
|
Service Code
|
APR-DRG 6924
|
| Min. Negotiated Rate |
$22,923.36 |
| Max. Negotiated Rate |
$24,313.23 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$22,923.36
|
| Rate for Payer: Cigna Medicaid |
$22,923.36
|
| Rate for Payer: Molina CHIP/Medicaid |
$22,923.36
|
| Rate for Payer: Parkland Medicaid |
$22,923.36
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$24,313.23
|
|
|
RADIOTHERAPY
|
Facility
|
IP
|
$13,059.41
|
|
|
Service Code
|
APR-DRG 6923
|
| Min. Negotiated Rate |
$12,312.87 |
| Max. Negotiated Rate |
$13,059.41 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$12,312.87
|
| Rate for Payer: Cigna Medicaid |
$12,312.87
|
| Rate for Payer: Molina CHIP/Medicaid |
$12,312.87
|
| Rate for Payer: Parkland Medicaid |
$12,312.87
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$13,059.41
|
|
|
RADIOTHERAPY
|
Facility
|
IP
|
$8,866.58
|
|
|
Service Code
|
APR-DRG 6922
|
| Min. Negotiated Rate |
$8,359.72 |
| Max. Negotiated Rate |
$8,866.58 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$8,359.72
|
| Rate for Payer: Cigna Medicaid |
$8,359.72
|
| Rate for Payer: Molina CHIP/Medicaid |
$8,359.72
|
| Rate for Payer: Parkland Medicaid |
$8,359.72
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$8,866.58
|
|
