|
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 |
$4,288.93
|
| 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 |
$4,288.93
|
| 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 posterior nonsegmental instrumentation (eg, Harrington rod)
|
Facility
|
OP
|
$15,408.22
|
|
|
Service Code
|
CPT 22850
|
| Hospital Charge Code |
36022850
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,266.29 |
| Max. Negotiated Rate |
$15,408.22 |
| 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: Cigna Commercial |
$15,408.22
|
| Rate for Payer: Cigna Medicare |
$7,289.28
|
| Rate for Payer: Employer Direct Commercial |
$7,289.28
|
| Rate for Payer: Humana Medicare/TRICARE |
$7,289.28
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$7,289.28
|
| Rate for Payer: Molina Medicare |
$7,289.28
|
| Rate for Payer: Multiplan Auto |
$10,000.00
|
| Rate for Payer: Multiplan Commercial |
$10,000.00
|
| Rate for Payer: Multiplan Workers Comp |
$10,000.00
|
| Rate for Payer: Scott and White EPO/PPO |
$13,485.17
|
| Rate for Payer: Scott and White Medicare |
$7,289.28
|
| Rate for Payer: Superior Health Plan EPO |
$7,289.28
|
| Rate for Payer: Superior Health Plan Medicare |
$7,289.28
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$7,289.28
|
| Rate for Payer: Universal American Medicare |
$7,289.28
|
| Rate for Payer: Wellcare Medicare |
$7,289.28
|
| Rate for Payer: Wellmed Medicare |
$7,289.28
|
|
|
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 |
$13,485.17
|
| 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
|
|
|
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 previously implanted intrathecal or epidural catheter
|
Facility
|
OP
|
$6,140.37
|
|
|
Service Code
|
HCPCS 62355
|
| Hospital Charge Code |
9900754
|
|
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 |
$4,175.45
|
| Rate for Payer: Cash Price |
$4,175.45
|
| Rate for Payer: Cash Price |
$4,175.45
|
| Rate for Payer: Cigna Commercial |
$4,146.52
|
| Rate for Payer: Cigna Medicaid |
$4,421.07
|
| 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 |
$4,421.07
|
| 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 |
$4,421.07
|
| Rate for Payer: Scott and White EPO/PPO |
$3,629.00
|
| Rate for Payer: Scott and White Medicare |
$1,961.62
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$4,421.07
|
| 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
|
|
|
Removal of previously implanted intrathecal or epidural catheter
|
Facility
|
IP
|
$6,140.37
|
|
|
Service Code
|
HCPCS 62355
|
| Hospital Charge Code |
9900754
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$4,175.45
|
|
|
Removal of previously implanted intrathecal or epidural catheter
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 62355
|
| Hospital Charge Code |
36062355
|
|
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 |
$3,629.00
|
| 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
|
|
|
Removal of prosthesis, includes debridement and synovectomy when performed humeral and glenoid comp
|
Facility
|
OP
|
$8,295.04
|
|
|
Service Code
|
HCPCS 23335
|
| Hospital Charge Code |
9900219
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$746.55 |
| Max. Negotiated Rate |
$15,408.22 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$746.55
|
| 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 |
$2,218.43
|
| Rate for Payer: BCBS of TX Blue Essentials |
$2,656.80
|
| Rate for Payer: BCBS of TX Medicare |
$7,289.28
|
| Rate for Payer: BCBS of TX PPO |
$3,347.57
|
| 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 |
$15,408.22
|
| Rate for Payer: Cigna Medicaid |
$5,972.43
|
| 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 |
$5,972.43
|
| 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 |
$5,972.43
|
| Rate for Payer: Scott and White EPO/PPO |
$13,485.17
|
| Rate for Payer: Scott and White Medicare |
$7,289.28
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$5,972.43
|
| 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
|
|
|
Removal of prosthesis, includes debridement and synovectomy when performed humeral and glenoid comp
|
Facility
|
OP
|
$15,408.22
|
|
|
Service Code
|
CPT 23335
|
| Hospital Charge Code |
36023335
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,218.43 |
| Max. Negotiated Rate |
$15,408.22 |
| 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 |
$2,218.43
|
| Rate for Payer: BCBS of TX Blue Essentials |
$2,656.80
|
| Rate for Payer: BCBS of TX Medicare |
$7,289.28
|
| Rate for Payer: BCBS of TX PPO |
$3,347.57
|
| Rate for Payer: Cigna Commercial |
$15,408.22
|
| Rate for Payer: Cigna Medicare |
$7,289.28
|
| Rate for Payer: Employer Direct Commercial |
$7,289.28
|
| Rate for Payer: Humana Medicare/TRICARE |
$7,289.28
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$7,289.28
|
| Rate for Payer: Molina Medicare |
$7,289.28
|
| Rate for Payer: Multiplan Auto |
$10,000.00
|
| Rate for Payer: Multiplan Commercial |
$10,000.00
|
| Rate for Payer: Multiplan Workers Comp |
$10,000.00
|
| Rate for Payer: Scott and White EPO/PPO |
$13,485.17
|
| Rate for Payer: Scott and White Medicare |
$7,289.28
|
| Rate for Payer: Superior Health Plan EPO |
$7,289.28
|
| Rate for Payer: Superior Health Plan Medicare |
$7,289.28
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$7,289.28
|
| Rate for Payer: Universal American Medicare |
$7,289.28
|
| Rate for Payer: Wellcare Medicare |
$7,289.28
|
| Rate for Payer: Wellmed Medicare |
$7,289.28
|
|
|
Removal of prosthesis, includes debridement and synovectomy when performed humeral and glenoid comp
|
Facility
|
IP
|
$8,295.04
|
|
|
Service Code
|
HCPCS 23335
|
| Hospital Charge Code |
9900219
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$5,640.63
|
|
|
Removal of prosthetic material or mesh, abdominal wall for infection (eg, for chronic or recurrent m
|
Facility
|
OP
|
$1,285.52
|
|
|
Service Code
|
HCPCS 11008
|
| Hospital Charge Code |
9900080
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$115.70 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$115.70
|
| Rate for Payer: BCBS of TX Blue Advantage |
$479.07
|
| Rate for Payer: BCBS of TX Blue Essentials |
$573.74
|
| Rate for Payer: BCBS of TX PPO |
$722.91
|
| Rate for Payer: Cash Price |
$874.15
|
| Rate for Payer: Cash Price |
$874.15
|
| Rate for Payer: Cash Price |
$874.15
|
| Rate for Payer: Cigna Medicaid |
$925.57
|
| Rate for Payer: Molina CHIP/Medicaid |
$925.57
|
| 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 |
$925.57
|
| Rate for Payer: Scott and White EPO/PPO |
$642.76
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$925.57
|
| Rate for Payer: Superior Health Plan EPO |
$174.83
|
|
|
Removal of prosthetic material or mesh, abdominal wall for infection (eg, for chronic or recurrent m
|
Facility
|
IP
|
$1,285.52
|
|
|
Service Code
|
HCPCS 11008
|
| Hospital Charge Code |
9900080
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$874.15
|
|
|
Removal of prosthetic material or mesh, abdominal wall for infection (eg, for chronic or recurrent m
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 11008
|
| Hospital Charge Code |
36011008
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$479.07 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: BCBS of TX Blue Advantage |
$479.07
|
| Rate for Payer: BCBS of TX Blue Essentials |
$573.74
|
| Rate for Payer: BCBS of TX PPO |
$722.91
|
| 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
|
|
|
Removal of ruptured breast implant, including implant contents (eg, saline, silicone gel)
|
Facility
|
OP
|
$12,900.00
|
|
|
Service Code
|
HCPCS 19330
|
| Hospital Charge Code |
9900159
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$963.66 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$963.66
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3,933.28
|
| Rate for Payer: Amerigroup Medicare |
$3,933.28
|
| Rate for Payer: BCBS of TX Blue Advantage |
$5,059.35
|
| Rate for Payer: BCBS of TX Blue Essentials |
$6,059.10
|
| Rate for Payer: BCBS of TX Medicare |
$3,933.28
|
| Rate for Payer: BCBS of TX PPO |
$7,634.47
|
| Rate for Payer: Cash Price |
$8,772.00
|
| Rate for Payer: Cash Price |
$8,772.00
|
| Rate for Payer: Cash Price |
$8,772.00
|
| Rate for Payer: Cigna Commercial |
$8,314.23
|
| Rate for Payer: Cigna Medicaid |
$9,288.00
|
| Rate for Payer: Cigna Medicare |
$3,933.28
|
| Rate for Payer: Employer Direct Commercial |
$3,933.28
|
| Rate for Payer: Humana Medicare/TRICARE |
$3,933.28
|
| Rate for Payer: Molina CHIP/Medicaid |
$9,288.00
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3,933.28
|
| Rate for Payer: Molina Medicare |
$3,933.28
|
| 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 |
$9,288.00
|
| Rate for Payer: Scott and White EPO/PPO |
$7,276.57
|
| Rate for Payer: Scott and White Medicare |
$3,933.28
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$9,288.00
|
| Rate for Payer: Superior Health Plan EPO |
$3,933.28
|
| Rate for Payer: Superior Health Plan Medicare |
$3,933.28
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3,933.28
|
| Rate for Payer: Universal American Medicare |
$3,933.28
|
| Rate for Payer: Wellcare Medicare |
$3,933.28
|
| Rate for Payer: Wellmed Medicare |
$3,933.28
|
|
|
Removal of ruptured breast implant, including implant contents (eg, saline, silicone gel)
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 19330
|
| Hospital Charge Code |
36019330
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$963.66 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$963.66
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3,933.28
|
| Rate for Payer: Amerigroup Medicare |
$3,933.28
|
| Rate for Payer: BCBS of TX Blue Advantage |
$5,059.35
|
| Rate for Payer: BCBS of TX Blue Essentials |
$6,059.10
|
| Rate for Payer: BCBS of TX Medicare |
$3,933.28
|
| Rate for Payer: BCBS of TX PPO |
$7,634.47
|
| Rate for Payer: Cigna Commercial |
$8,314.23
|
| Rate for Payer: Cigna Medicare |
$3,933.28
|
| Rate for Payer: Employer Direct Commercial |
$3,933.28
|
| Rate for Payer: Humana Medicare/TRICARE |
$3,933.28
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3,933.28
|
| Rate for Payer: Molina Medicare |
$3,933.28
|
| Rate for Payer: Multiplan Auto |
$10,000.00
|
| Rate for Payer: Multiplan Commercial |
$10,000.00
|
| Rate for Payer: Multiplan Workers Comp |
$10,000.00
|
| Rate for Payer: Scott and White EPO/PPO |
$7,276.57
|
| Rate for Payer: Scott and White Medicare |
$3,933.28
|
| Rate for Payer: Superior Health Plan EPO |
$3,933.28
|
| Rate for Payer: Superior Health Plan Medicare |
$3,933.28
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3,933.28
|
| Rate for Payer: Universal American Medicare |
$3,933.28
|
| Rate for Payer: Wellcare Medicare |
$3,933.28
|
| Rate for Payer: Wellmed Medicare |
$3,933.28
|
|
|
Removal of ruptured breast implant, including implant contents (eg, saline, silicone gel)
|
Facility
|
IP
|
$12,900.00
|
|
|
Service Code
|
HCPCS 19330
|
| Hospital Charge Code |
9900159
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$8,772.00
|
|
|
Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions
|
Facility
|
IP
|
$2,477.00
|
|
|
Service Code
|
HCPCS 11200
|
| Hospital Charge Code |
9900085
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$1,684.36
|
|
|
Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions
|
Facility
|
OP
|
$2,477.00
|
|
|
Service Code
|
HCPCS 11200
|
| Hospital Charge Code |
9900085
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$201.55 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$222.93
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$201.55
|
| Rate for Payer: Amerigroup Medicare |
$201.55
|
| Rate for Payer: BCBS of TX Blue Advantage |
$291.80
|
| Rate for Payer: BCBS of TX Blue Essentials |
$349.46
|
| Rate for Payer: BCBS of TX Medicare |
$201.55
|
| Rate for Payer: BCBS of TX PPO |
$440.32
|
| Rate for Payer: Cash Price |
$1,684.36
|
| Rate for Payer: Cash Price |
$1,684.36
|
| Rate for Payer: Cash Price |
$1,684.36
|
| Rate for Payer: Cigna Commercial |
$426.04
|
| Rate for Payer: Cigna Medicaid |
$1,783.44
|
| Rate for Payer: Cigna Medicare |
$201.55
|
| Rate for Payer: Employer Direct Commercial |
$201.55
|
| Rate for Payer: Humana Medicare/TRICARE |
$201.55
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,783.44
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$201.55
|
| Rate for Payer: Molina Medicare |
$201.55
|
| 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 |
$1,783.44
|
| Rate for Payer: Scott and White EPO/PPO |
$372.87
|
| Rate for Payer: Scott and White Medicare |
$201.55
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,783.44
|
| Rate for Payer: Superior Health Plan EPO |
$201.55
|
| Rate for Payer: Superior Health Plan Medicare |
$201.55
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$201.55
|
| Rate for Payer: Universal American Medicare |
$201.55
|
| Rate for Payer: Wellcare Medicare |
$201.55
|
| Rate for Payer: Wellmed Medicare |
$201.55
|
|
|
Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 11200
|
| Hospital Charge Code |
36011200
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$201.55 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$201.55
|
| Rate for Payer: Amerigroup Medicare |
$201.55
|
| Rate for Payer: BCBS of TX Blue Advantage |
$291.80
|
| Rate for Payer: BCBS of TX Blue Essentials |
$349.46
|
| Rate for Payer: BCBS of TX Medicare |
$201.55
|
| Rate for Payer: BCBS of TX PPO |
$440.32
|
| Rate for Payer: Cigna Commercial |
$426.04
|
| Rate for Payer: Cigna Medicare |
$201.55
|
| Rate for Payer: Employer Direct Commercial |
$201.55
|
| Rate for Payer: Humana Medicare/TRICARE |
$201.55
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$201.55
|
| Rate for Payer: Molina Medicare |
$201.55
|
| 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 |
$372.87
|
| Rate for Payer: Scott and White Medicare |
$201.55
|
| Rate for Payer: Superior Health Plan EPO |
$201.55
|
| Rate for Payer: Superior Health Plan Medicare |
$201.55
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$201.55
|
| Rate for Payer: Universal American Medicare |
$201.55
|
| Rate for Payer: Wellcare Medicare |
$201.55
|
| Rate for Payer: Wellmed Medicare |
$201.55
|
|
|
Removal of spinal neurostimulator electrode percutaneous array(s)
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 63661
|
| Hospital Charge Code |
36063661
|
|
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 |
$3,629.00
|
| 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
|
|
|
Removal of spinal neurostimulator electrode percutaneous array(s)
|
Facility
|
OP
|
$15,789.51
|
|
|
Service Code
|
HCPCS 63661
|
| Hospital Charge Code |
9900773
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$659.94 |
| Max. Negotiated Rate |
$11,368.45 |
| 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 |
$10,736.87
|
| Rate for Payer: Cash Price |
$10,736.87
|
| Rate for Payer: Cash Price |
$10,736.87
|
| Rate for Payer: Cigna Commercial |
$4,146.52
|
| Rate for Payer: Cigna Medicaid |
$11,368.45
|
| 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 |
$11,368.45
|
| 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 |
$11,368.45
|
| Rate for Payer: Scott and White EPO/PPO |
$3,629.00
|
| Rate for Payer: Scott and White Medicare |
$1,961.62
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$11,368.45
|
| 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
|
|
|
Removal of spinal neurostimulator electrode percutaneous array(s)
|
Facility
|
IP
|
$15,789.51
|
|
|
Service Code
|
HCPCS 63661
|
| Hospital Charge Code |
9900773
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$10,736.87
|
|
|
Removal of subcutaneous reservoir or pump, previously implanted for intrathecal or epidural infusion
|
Facility
|
OP
|
$13,882.71
|
|
|
Service Code
|
CPT 62365
|
| Hospital Charge Code |
36062365
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,996.58 |
| Max. Negotiated Rate |
$13,882.71 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,996.58
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3,431.72
|
| Rate for Payer: Amerigroup Medicare |
$3,431.72
|
| Rate for Payer: BCBS of TX Blue Advantage |
$9,200.05
|
| Rate for Payer: BCBS of TX Blue Essentials |
$11,018.02
|
| Rate for Payer: BCBS of TX Medicare |
$3,431.72
|
| Rate for Payer: BCBS of TX PPO |
$13,882.71
|
| Rate for Payer: Cigna Commercial |
$7,254.03
|
| Rate for Payer: Cigna Medicare |
$3,431.72
|
| Rate for Payer: Employer Direct Commercial |
$3,431.72
|
| Rate for Payer: Humana Medicare/TRICARE |
$3,431.72
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3,431.72
|
| Rate for Payer: Molina Medicare |
$3,431.72
|
| 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 |
$6,348.68
|
| Rate for Payer: Scott and White Medicare |
$3,431.72
|
| Rate for Payer: Superior Health Plan EPO |
$3,431.72
|
| Rate for Payer: Superior Health Plan Medicare |
$3,431.72
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3,431.72
|
| Rate for Payer: Universal American Medicare |
$3,431.72
|
| Rate for Payer: Wellcare Medicare |
$3,431.72
|
| Rate for Payer: Wellmed Medicare |
$3,431.72
|
|
|
Removal of subcutaneous reservoir or pump, previously implanted for intrathecal or epidural infusion
|
Facility
|
OP
|
$17,100.87
|
|
|
Service Code
|
HCPCS 62365
|
| Hospital Charge Code |
9900757
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,996.58 |
| Max. Negotiated Rate |
$13,882.71 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,996.58
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3,431.72
|
| Rate for Payer: Amerigroup Medicare |
$3,431.72
|
| Rate for Payer: BCBS of TX Blue Advantage |
$9,200.05
|
| Rate for Payer: BCBS of TX Blue Essentials |
$11,018.02
|
| Rate for Payer: BCBS of TX Medicare |
$3,431.72
|
| Rate for Payer: BCBS of TX PPO |
$13,882.71
|
| Rate for Payer: Cash Price |
$11,628.59
|
| Rate for Payer: Cash Price |
$11,628.59
|
| Rate for Payer: Cash Price |
$11,628.59
|
| Rate for Payer: Cigna Commercial |
$7,254.03
|
| Rate for Payer: Cigna Medicaid |
$12,312.63
|
| Rate for Payer: Cigna Medicare |
$3,431.72
|
| Rate for Payer: Employer Direct Commercial |
$3,431.72
|
| Rate for Payer: Humana Medicare/TRICARE |
$3,431.72
|
| Rate for Payer: Molina CHIP/Medicaid |
$12,312.63
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3,431.72
|
| Rate for Payer: Molina Medicare |
$3,431.72
|
| 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 |
$12,312.63
|
| Rate for Payer: Scott and White EPO/PPO |
$6,348.68
|
| Rate for Payer: Scott and White Medicare |
$3,431.72
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$12,312.63
|
| Rate for Payer: Superior Health Plan EPO |
$3,431.72
|
| Rate for Payer: Superior Health Plan Medicare |
$3,431.72
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3,431.72
|
| Rate for Payer: Universal American Medicare |
$3,431.72
|
| Rate for Payer: Wellcare Medicare |
$3,431.72
|
| Rate for Payer: Wellmed Medicare |
$3,431.72
|
|
