|
Removal of foreign body, deep, thigh region or knee area
|
Facility
|
IP
|
$15,499.50
|
|
|
Service Code
|
HCPCS 27372
|
| Hospital Charge Code |
9900399
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$10,539.66
|
|
|
Removal of foreign body, foot; complicated
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 28193
|
| Hospital Charge Code |
36028193
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$486.45 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$486.45
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,659.12
|
| Rate for Payer: Amerigroup Medicare |
$1,659.12
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,292.24
|
| Rate for Payer: BCBS of TX Blue Essentials |
$2,745.20
|
| Rate for Payer: BCBS of TX Medicare |
$1,659.12
|
| Rate for Payer: BCBS of TX PPO |
$3,458.95
|
| Rate for Payer: Cigna Commercial |
$3,507.10
|
| Rate for Payer: Cigna Medicare |
$1,659.12
|
| Rate for Payer: Employer Direct Commercial |
$1,659.12
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,659.12
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,659.12
|
| Rate for Payer: Molina Medicare |
$1,659.12
|
| 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 |
$2,743.07
|
| Rate for Payer: Scott and White Medicare |
$1,659.12
|
| Rate for Payer: Superior Health Plan EPO |
$1,659.12
|
| Rate for Payer: Superior Health Plan Medicare |
$1,659.12
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,659.12
|
| Rate for Payer: Universal American Medicare |
$1,659.12
|
| Rate for Payer: Wellcare Medicare |
$1,659.12
|
| Rate for Payer: Wellmed Medicare |
$1,659.12
|
|
|
Removal of foreign body, foot; complicated
|
Facility
|
IP
|
$6,331.50
|
|
|
Service Code
|
HCPCS 28193
|
| Hospital Charge Code |
9900487
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$4,305.42
|
|
|
Removal of foreign body, foot; complicated
|
Facility
|
OP
|
$6,331.50
|
|
|
Service Code
|
HCPCS 28193
|
| Hospital Charge Code |
9900487
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$486.45 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$486.45
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,659.12
|
| Rate for Payer: Amerigroup Medicare |
$1,659.12
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,292.24
|
| Rate for Payer: BCBS of TX Blue Essentials |
$2,745.20
|
| Rate for Payer: BCBS of TX Medicare |
$1,659.12
|
| Rate for Payer: BCBS of TX PPO |
$3,458.95
|
| Rate for Payer: Cash Price |
$4,305.42
|
| Rate for Payer: Cash Price |
$4,305.42
|
| Rate for Payer: Cash Price |
$4,305.42
|
| Rate for Payer: Cigna Commercial |
$3,507.10
|
| Rate for Payer: Cigna Medicaid |
$4,558.68
|
| Rate for Payer: Cigna Medicare |
$1,659.12
|
| Rate for Payer: Employer Direct Commercial |
$1,659.12
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,659.12
|
| Rate for Payer: Molina CHIP/Medicaid |
$4,558.68
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,659.12
|
| Rate for Payer: Molina Medicare |
$1,659.12
|
| 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 |
$4,558.68
|
| Rate for Payer: Scott and White EPO/PPO |
$2,743.07
|
| Rate for Payer: Scott and White Medicare |
$1,659.12
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$4,558.68
|
| Rate for Payer: Superior Health Plan EPO |
$1,659.12
|
| Rate for Payer: Superior Health Plan Medicare |
$1,659.12
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,659.12
|
| Rate for Payer: Universal American Medicare |
$1,659.12
|
| Rate for Payer: Wellcare Medicare |
$1,659.12
|
| Rate for Payer: Wellmed Medicare |
$1,659.12
|
|
|
Removal of foreign body, foot deep
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 28192
|
| Hospital Charge Code |
36028192
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$486.45 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$486.45
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,659.12
|
| Rate for Payer: Amerigroup Medicare |
$1,659.12
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,292.24
|
| Rate for Payer: BCBS of TX Blue Essentials |
$2,745.20
|
| Rate for Payer: BCBS of TX Medicare |
$1,659.12
|
| Rate for Payer: BCBS of TX PPO |
$3,458.95
|
| Rate for Payer: Cigna Commercial |
$3,507.10
|
| Rate for Payer: Cigna Medicare |
$1,659.12
|
| Rate for Payer: Employer Direct Commercial |
$1,659.12
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,659.12
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,659.12
|
| Rate for Payer: Molina Medicare |
$1,659.12
|
| 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 |
$2,743.07
|
| Rate for Payer: Scott and White Medicare |
$1,659.12
|
| Rate for Payer: Superior Health Plan EPO |
$1,659.12
|
| Rate for Payer: Superior Health Plan Medicare |
$1,659.12
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,659.12
|
| Rate for Payer: Universal American Medicare |
$1,659.12
|
| Rate for Payer: Wellcare Medicare |
$1,659.12
|
| Rate for Payer: Wellmed Medicare |
$1,659.12
|
|
|
Removal of foreign body, foot deep
|
Facility
|
OP
|
$4,924.50
|
|
|
Service Code
|
HCPCS 28192
|
| Hospital Charge Code |
9900486
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$486.45 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$486.45
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,659.12
|
| Rate for Payer: Amerigroup Medicare |
$1,659.12
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,292.24
|
| Rate for Payer: BCBS of TX Blue Essentials |
$2,745.20
|
| Rate for Payer: BCBS of TX Medicare |
$1,659.12
|
| Rate for Payer: BCBS of TX PPO |
$3,458.95
|
| Rate for Payer: Cash Price |
$3,348.66
|
| Rate for Payer: Cash Price |
$3,348.66
|
| Rate for Payer: Cash Price |
$3,348.66
|
| Rate for Payer: Cigna Commercial |
$3,507.10
|
| Rate for Payer: Cigna Medicaid |
$3,545.64
|
| Rate for Payer: Cigna Medicare |
$1,659.12
|
| Rate for Payer: Employer Direct Commercial |
$1,659.12
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,659.12
|
| Rate for Payer: Molina CHIP/Medicaid |
$3,545.64
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,659.12
|
| Rate for Payer: Molina Medicare |
$1,659.12
|
| 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 |
$3,545.64
|
| Rate for Payer: Scott and White EPO/PPO |
$2,743.07
|
| Rate for Payer: Scott and White Medicare |
$1,659.12
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$3,545.64
|
| Rate for Payer: Superior Health Plan EPO |
$1,659.12
|
| Rate for Payer: Superior Health Plan Medicare |
$1,659.12
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,659.12
|
| Rate for Payer: Universal American Medicare |
$1,659.12
|
| Rate for Payer: Wellcare Medicare |
$1,659.12
|
| Rate for Payer: Wellmed Medicare |
$1,659.12
|
|
|
Removal of foreign body, foot deep
|
Facility
|
IP
|
$4,924.50
|
|
|
Service Code
|
HCPCS 28192
|
| Hospital Charge Code |
9900486
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$3,348.66
|
|
|
Removal of foreign body, foot; subcutaneous
|
Facility
|
OP
|
$2,814.36
|
|
|
Service Code
|
HCPCS 28190
|
| Hospital Charge Code |
994159
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$164.14 |
| Max. Negotiated Rate |
$2,026.34 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$253.29
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$711.36
|
| Rate for Payer: Amerigroup Medicare |
$711.36
|
| Rate for Payer: BCBS of TX Blue Advantage |
$304.36
|
| Rate for Payer: BCBS of TX Blue Essentials |
$364.50
|
| Rate for Payer: BCBS of TX Medicare |
$711.36
|
| Rate for Payer: BCBS of TX PPO |
$459.27
|
| Rate for Payer: Cash Price |
$1,913.76
|
| Rate for Payer: Cash Price |
$1,913.76
|
| Rate for Payer: Cash Price |
$1,913.76
|
| Rate for Payer: Cigna Commercial |
$1,503.68
|
| Rate for Payer: Cigna Medicaid |
$2,026.34
|
| Rate for Payer: Cigna Medicare |
$711.36
|
| Rate for Payer: Employer Direct Commercial |
$711.36
|
| Rate for Payer: Humana Medicare/TRICARE |
$711.36
|
| Rate for Payer: Molina CHIP/Medicaid |
$2,026.34
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$711.36
|
| Rate for Payer: Molina Medicare |
$711.36
|
| Rate for Payer: Multiplan Auto |
$1,829.33
|
| Rate for Payer: Multiplan Commercial |
$1,829.33
|
| Rate for Payer: Multiplan Workers Comp |
$1,829.33
|
| Rate for Payer: Parkland Medicaid |
$2,026.34
|
| Rate for Payer: Scott and White EPO/PPO |
$164.14
|
| Rate for Payer: Scott and White Medicare |
$711.36
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$2,026.34
|
| Rate for Payer: Superior Health Plan EPO |
$711.36
|
| Rate for Payer: Superior Health Plan Medicare |
$711.36
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$711.36
|
| Rate for Payer: Universal American Medicare |
$711.36
|
| Rate for Payer: Wellcare Medicare |
$711.36
|
| Rate for Payer: Wellmed Medicare |
$711.36
|
|
|
Removal of foreign body, foot; subcutaneous
|
Facility
|
IP
|
$2,814.36
|
|
|
Service Code
|
HCPCS 28190
|
| Hospital Charge Code |
994159
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$1,913.76
|
|
|
Removal of foreign body in muscle or tendon sheath deep or complicated
|
Facility
|
IP
|
$22,800.00
|
|
|
Service Code
|
HCPCS 20525
|
| Hospital Charge Code |
9900168
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$15,504.00
|
|
|
Removal of foreign body in muscle or tendon sheath deep or complicated
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 20525
|
| Hospital Charge Code |
36020525
|
|
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
|
|
|
Removal of foreign body in muscle or tendon sheath deep or complicated
|
Facility
|
OP
|
$22,800.00
|
|
|
Service Code
|
HCPCS 20525
|
| Hospital Charge Code |
9900168
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$815.20 |
| Max. Negotiated Rate |
$16,416.00 |
| 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 |
$15,504.00
|
| Rate for Payer: Cash Price |
$15,504.00
|
| Rate for Payer: Cash Price |
$15,504.00
|
| Rate for Payer: Cigna Commercial |
$6,168.03
|
| Rate for Payer: Cigna Medicaid |
$16,416.00
|
| 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 |
$16,416.00
|
| 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 |
$16,416.00
|
| 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 CHIP/Medicaid |
$16,416.00
|
| 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
|
|
|
Removal of foreign body in muscle or tendon sheath; simple
|
Facility
|
IP
|
$6,480.96
|
|
|
Service Code
|
HCPCS 20520
|
| Hospital Charge Code |
991180
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$4,407.05
|
|
|
Removal of foreign body in muscle or tendon sheath; simple
|
Facility
|
OP
|
$6,480.96
|
|
|
Service Code
|
HCPCS 20520
|
| Hospital Charge Code |
991180
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$119.87 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$119.87
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,659.12
|
| Rate for Payer: Amerigroup Medicare |
$1,659.12
|
| Rate for Payer: BCBS of TX Blue Advantage |
$232.03
|
| Rate for Payer: BCBS of TX Blue Essentials |
$277.88
|
| Rate for Payer: BCBS of TX Medicare |
$1,659.12
|
| Rate for Payer: BCBS of TX PPO |
$350.13
|
| Rate for Payer: Cash Price |
$4,407.05
|
| Rate for Payer: Cash Price |
$4,407.05
|
| Rate for Payer: Cash Price |
$4,407.05
|
| Rate for Payer: Cigna Commercial |
$3,507.10
|
| Rate for Payer: Cigna Medicaid |
$4,666.29
|
| Rate for Payer: Cigna Medicare |
$1,659.12
|
| Rate for Payer: Employer Direct Commercial |
$1,659.12
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,659.12
|
| Rate for Payer: Molina CHIP/Medicaid |
$4,666.29
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,659.12
|
| Rate for Payer: Molina Medicare |
$1,659.12
|
| 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 |
$4,666.29
|
| Rate for Payer: Scott and White EPO/PPO |
$2,743.07
|
| Rate for Payer: Scott and White Medicare |
$1,659.12
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$4,666.29
|
| Rate for Payer: Superior Health Plan EPO |
$1,659.12
|
| Rate for Payer: Superior Health Plan Medicare |
$1,659.12
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,659.12
|
| Rate for Payer: Universal American Medicare |
$1,659.12
|
| Rate for Payer: Wellcare Medicare |
$1,659.12
|
| Rate for Payer: Wellmed Medicare |
$1,659.12
|
|
|
Removal of implant deep (eg, buried wire, pin, screw, metal band, nail, rod or plate)
|
Facility
|
IP
|
$11,850.05
|
|
|
Service Code
|
HCPCS 20680
|
| Hospital Charge Code |
9900180
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$8,058.03
|
|
|
Removal of implant deep (eg, buried wire, pin, screw, metal band, nail, rod or plate)
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 20680
|
| Hospital Charge Code |
36020680
|
|
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
|
|
|
Removal of implant deep (eg, buried wire, pin, screw, metal band, nail, rod or plate)
|
Facility
|
OP
|
$11,850.05
|
|
|
Service Code
|
HCPCS 20680
|
| Hospital Charge Code |
9900180
|
|
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 |
$8,058.03
|
| Rate for Payer: Cash Price |
$8,058.03
|
| Rate for Payer: Cash Price |
$8,058.03
|
| Rate for Payer: Cigna Commercial |
$6,168.03
|
| Rate for Payer: Cigna Medicaid |
$8,532.04
|
| 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 |
$8,532.04
|
| 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 |
$8,532.04
|
| 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 |
$8,532.04
|
| 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
|
|
|
Removal of implant; superficial (eg, buried wire, pin or rod) (separate procedure)
|
Facility
|
IP
|
$3,840.00
|
|
|
Service Code
|
HCPCS 20670
|
| Hospital Charge Code |
9900179
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$2,611.20
|
|
|
Removal of implant; superficial (eg, buried wire, pin or rod) (separate procedure)
|
Facility
|
OP
|
$3,840.00
|
|
|
Service Code
|
HCPCS 20670
|
| Hospital Charge Code |
9900179
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$486.45 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$486.45
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,659.12
|
| Rate for Payer: Amerigroup Medicare |
$1,659.12
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,292.24
|
| Rate for Payer: BCBS of TX Blue Essentials |
$2,745.20
|
| Rate for Payer: BCBS of TX Medicare |
$1,659.12
|
| Rate for Payer: BCBS of TX PPO |
$3,458.95
|
| Rate for Payer: Cash Price |
$2,611.20
|
| Rate for Payer: Cash Price |
$2,611.20
|
| Rate for Payer: Cash Price |
$2,611.20
|
| Rate for Payer: Cigna Commercial |
$3,507.10
|
| Rate for Payer: Cigna Medicaid |
$2,764.80
|
| Rate for Payer: Cigna Medicare |
$1,659.12
|
| Rate for Payer: Employer Direct Commercial |
$1,659.12
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,659.12
|
| Rate for Payer: Molina CHIP/Medicaid |
$2,764.80
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,659.12
|
| Rate for Payer: Molina Medicare |
$1,659.12
|
| 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 |
$2,764.80
|
| Rate for Payer: Scott and White EPO/PPO |
$2,743.07
|
| Rate for Payer: Scott and White Medicare |
$1,659.12
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$2,764.80
|
| Rate for Payer: Superior Health Plan EPO |
$1,659.12
|
| Rate for Payer: Superior Health Plan Medicare |
$1,659.12
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,659.12
|
| Rate for Payer: Universal American Medicare |
$1,659.12
|
| Rate for Payer: Wellcare Medicare |
$1,659.12
|
| Rate for Payer: Wellmed Medicare |
$1,659.12
|
|
|
Removal of implant; superficial (eg, buried wire, pin or rod) (separate procedure)
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 20670
|
| Hospital Charge Code |
36020670
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$486.45 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$486.45
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,659.12
|
| Rate for Payer: Amerigroup Medicare |
$1,659.12
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,292.24
|
| Rate for Payer: BCBS of TX Blue Essentials |
$2,745.20
|
| Rate for Payer: BCBS of TX Medicare |
$1,659.12
|
| Rate for Payer: BCBS of TX PPO |
$3,458.95
|
| Rate for Payer: Cigna Commercial |
$3,507.10
|
| Rate for Payer: Cigna Medicare |
$1,659.12
|
| Rate for Payer: Employer Direct Commercial |
$1,659.12
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,659.12
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,659.12
|
| Rate for Payer: Molina Medicare |
$1,659.12
|
| 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 |
$2,743.07
|
| Rate for Payer: Scott and White Medicare |
$1,659.12
|
| Rate for Payer: Superior Health Plan EPO |
$1,659.12
|
| Rate for Payer: Superior Health Plan Medicare |
$1,659.12
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,659.12
|
| Rate for Payer: Universal American Medicare |
$1,659.12
|
| Rate for Payer: Wellcare Medicare |
$1,659.12
|
| Rate for Payer: Wellmed Medicare |
$1,659.12
|
|
|
Removal of lens material aspiration technique, 1 or more stages
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 66840
|
| Hospital Charge Code |
36066840
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$849.94 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$849.94
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$2,318.34
|
| Rate for Payer: Amerigroup Medicare |
$2,318.34
|
| Rate for Payer: BCBS of TX Blue Advantage |
$3,376.51
|
| Rate for Payer: BCBS of TX Blue Essentials |
$4,043.72
|
| Rate for Payer: BCBS of TX Medicare |
$2,318.34
|
| Rate for Payer: BCBS of TX PPO |
$5,095.09
|
| Rate for Payer: Cigna Commercial |
$4,900.56
|
| Rate for Payer: Cigna Medicare |
$2,318.34
|
| Rate for Payer: Employer Direct Commercial |
$2,318.34
|
| Rate for Payer: Humana Medicare/TRICARE |
$2,318.34
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$2,318.34
|
| Rate for Payer: Molina Medicare |
$2,318.34
|
| 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 |
$3,942.78
|
| Rate for Payer: Scott and White Medicare |
$2,318.34
|
| Rate for Payer: Superior Health Plan EPO |
$2,318.34
|
| Rate for Payer: Superior Health Plan Medicare |
$2,318.34
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$2,318.34
|
| Rate for Payer: Universal American Medicare |
$2,318.34
|
| Rate for Payer: Wellcare Medicare |
$2,318.34
|
| Rate for Payer: Wellmed Medicare |
$2,318.34
|
|
|
Removal of lens material aspiration technique, 1 or more stages
|
Facility
|
OP
|
$11,600.00
|
|
|
Service Code
|
HCPCS 66840
|
| Hospital Charge Code |
9900868
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$849.94 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$849.94
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$2,318.34
|
| Rate for Payer: Amerigroup Medicare |
$2,318.34
|
| Rate for Payer: BCBS of TX Blue Advantage |
$3,376.51
|
| Rate for Payer: BCBS of TX Blue Essentials |
$4,043.72
|
| Rate for Payer: BCBS of TX Medicare |
$2,318.34
|
| Rate for Payer: BCBS of TX PPO |
$5,095.09
|
| Rate for Payer: Cash Price |
$7,888.00
|
| Rate for Payer: Cash Price |
$7,888.00
|
| Rate for Payer: Cash Price |
$7,888.00
|
| Rate for Payer: Cigna Commercial |
$4,900.56
|
| Rate for Payer: Cigna Medicaid |
$8,352.00
|
| Rate for Payer: Cigna Medicare |
$2,318.34
|
| Rate for Payer: Employer Direct Commercial |
$2,318.34
|
| Rate for Payer: Humana Medicare/TRICARE |
$2,318.34
|
| Rate for Payer: Molina CHIP/Medicaid |
$8,352.00
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$2,318.34
|
| Rate for Payer: Molina Medicare |
$2,318.34
|
| 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 |
$8,352.00
|
| Rate for Payer: Scott and White EPO/PPO |
$3,942.78
|
| Rate for Payer: Scott and White Medicare |
$2,318.34
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$8,352.00
|
| Rate for Payer: Superior Health Plan EPO |
$2,318.34
|
| Rate for Payer: Superior Health Plan Medicare |
$2,318.34
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$2,318.34
|
| Rate for Payer: Universal American Medicare |
$2,318.34
|
| Rate for Payer: Wellcare Medicare |
$2,318.34
|
| Rate for Payer: Wellmed Medicare |
$2,318.34
|
|
|
Removal of lens material aspiration technique, 1 or more stages
|
Facility
|
IP
|
$11,600.00
|
|
|
Service Code
|
HCPCS 66840
|
| Hospital Charge Code |
9900868
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$7,888.00
|
|
|
Removal of posterior nonsegmental instrumentation (eg, Harrington rod)
|
Facility
|
IP
|
$35,100.00
|
|
|
Service Code
|
HCPCS 22850
|
| Hospital Charge Code |
9900207
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$23,868.00
|
|
|
Removal of posterior nonsegmental instrumentation (eg, Harrington rod)
|
Facility
|
OP
|
$35,100.00
|
|
|
Service Code
|
HCPCS 22850
|
| Hospital Charge Code |
9900207
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,266.29 |
| Max. Negotiated Rate |
$25,272.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$3,159.00
|
| 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 |
$1,266.29
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,516.52
|
| Rate for Payer: BCBS of TX Medicare |
$7,289.28
|
| Rate for Payer: BCBS of TX PPO |
$1,910.82
|
| Rate for Payer: Cash Price |
$23,868.00
|
| Rate for Payer: Cash Price |
$23,868.00
|
| Rate for Payer: Cash Price |
$23,868.00
|
| Rate for Payer: Cigna Commercial |
$15,408.22
|
| Rate for Payer: Cigna Medicaid |
$25,272.00
|
| 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 |
$25,272.00
|
| 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 |
$25,272.00
|
| Rate for Payer: Scott and White EPO/PPO |
$17,550.00
|
| Rate for Payer: Scott and White Medicare |
$7,289.28
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$25,272.00
|
| 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
|
|
