|
Removal of sutures or staples not requiring anesthesia (List separately in addition to E/M code)
|
Facility
|
IP
|
$7,316.92
|
|
|
Service Code
|
HCPCS 15853
|
| Hospital Charge Code |
994057
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$4,975.51
|
|
|
Removal of tunneled intraperitoneal catheter
|
Facility
|
IP
|
$12,903.48
|
|
|
Service Code
|
HCPCS 49422
|
| Hospital Charge Code |
994170
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$8,774.37
|
|
|
Removal of tunneled intraperitoneal catheter
|
Facility
|
OP
|
$12,903.48
|
|
|
Service Code
|
HCPCS 49422
|
| Hospital Charge Code |
994170
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,118.22 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,118.22
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3,171.87
|
| Rate for Payer: Amerigroup Medicare |
$3,171.87
|
| Rate for Payer: BCBS of TX Blue Advantage |
$4,628.04
|
| Rate for Payer: BCBS of TX Blue Essentials |
$5,542.56
|
| Rate for Payer: BCBS of TX Medicare |
$3,171.87
|
| Rate for Payer: BCBS of TX PPO |
$6,983.63
|
| Rate for Payer: Cash Price |
$8,774.37
|
| Rate for Payer: Cash Price |
$8,774.37
|
| Rate for Payer: Cash Price |
$8,774.37
|
| Rate for Payer: Cigna Commercial |
$6,704.76
|
| Rate for Payer: Cigna Medicaid |
$9,290.51
|
| Rate for Payer: Cigna Medicare |
$3,171.87
|
| Rate for Payer: Employer Direct Commercial |
$3,171.87
|
| Rate for Payer: Humana Medicare/TRICARE |
$3,171.87
|
| Rate for Payer: Molina CHIP/Medicaid |
$9,290.51
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3,171.87
|
| Rate for Payer: Molina Medicare |
$3,171.87
|
| 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 |
$9,290.51
|
| Rate for Payer: Scott and White EPO/PPO |
$5,392.94
|
| Rate for Payer: Scott and White Medicare |
$3,171.87
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$9,290.51
|
| Rate for Payer: Superior Health Plan EPO |
$3,171.87
|
| Rate for Payer: Superior Health Plan Medicare |
$3,171.87
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3,171.87
|
| Rate for Payer: Universal American Medicare |
$3,171.87
|
| Rate for Payer: Wellcare Medicare |
$3,171.87
|
| Rate for Payer: Wellmed Medicare |
$3,171.87
|
|
|
Removal of vitreous, anterior approach (open sky technique or limbal incision); partial removal
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 67005
|
| Hospital Charge Code |
36067005
|
|
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 vitreous, anterior approach (open sky technique or limbal incision); partial removal
|
Facility
|
OP
|
$8,483.44
|
|
|
Service Code
|
HCPCS 67005
|
| Hospital Charge Code |
9900873
|
|
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 |
$5,768.74
|
| Rate for Payer: Cash Price |
$5,768.74
|
| Rate for Payer: Cash Price |
$5,768.74
|
| Rate for Payer: Cigna Commercial |
$4,900.56
|
| Rate for Payer: Cigna Medicaid |
$6,108.08
|
| 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 |
$6,108.08
|
| 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 |
$6,108.08
|
| 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 |
$6,108.08
|
| 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 vitreous, anterior approach (open sky technique or limbal incision); partial removal
|
Facility
|
IP
|
$8,483.44
|
|
|
Service Code
|
HCPCS 67005
|
| Hospital Charge Code |
9900873
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$5,768.74
|
|
|
Removal of vitreous, anterior approach (open sky technique or limbal incision); subtotal removal wit
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 67010
|
| Hospital Charge Code |
36067010
|
|
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 vitreous, anterior approach (open sky technique or limbal incision); subtotal removal wit
|
Facility
|
OP
|
$5,717.69
|
|
|
Service Code
|
HCPCS 67010
|
| Hospital Charge Code |
9900874
|
|
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 |
$3,888.03
|
| Rate for Payer: Cash Price |
$3,888.03
|
| Rate for Payer: Cash Price |
$3,888.03
|
| Rate for Payer: Cigna Commercial |
$4,900.56
|
| Rate for Payer: Cigna Medicaid |
$4,116.74
|
| 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 |
$4,116.74
|
| 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 |
$4,116.74
|
| 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 |
$4,116.74
|
| 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 vitreous, anterior approach (open sky technique or limbal incision); subtotal removal wit
|
Facility
|
IP
|
$5,717.69
|
|
|
Service Code
|
HCPCS 67010
|
| Hospital Charge Code |
9900874
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$3,888.03
|
|
|
Removal or repair of electromagnetic bone conduction hearing device in temporal bone
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 69711
|
| Hospital Charge Code |
36069711
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$886.62 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$886.62
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3,330.57
|
| Rate for Payer: Amerigroup Medicare |
$3,330.57
|
| Rate for Payer: BCBS of TX Blue Advantage |
$4,374.21
|
| Rate for Payer: BCBS of TX Blue Essentials |
$5,238.58
|
| Rate for Payer: BCBS of TX Medicare |
$3,330.57
|
| Rate for Payer: BCBS of TX PPO |
$6,600.61
|
| Rate for Payer: Cigna Commercial |
$7,040.22
|
| Rate for Payer: Cigna Medicare |
$3,330.57
|
| Rate for Payer: Employer Direct Commercial |
$3,330.57
|
| Rate for Payer: Humana Medicare/TRICARE |
$3,330.57
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3,330.57
|
| Rate for Payer: Molina Medicare |
$3,330.57
|
| 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: Scott and White EPO/PPO |
$5,447.31
|
| Rate for Payer: Scott and White Medicare |
$3,330.57
|
| Rate for Payer: Superior Health Plan EPO |
$3,330.57
|
| Rate for Payer: Superior Health Plan Medicare |
$3,330.57
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3,330.57
|
| Rate for Payer: Universal American Medicare |
$3,330.57
|
| Rate for Payer: Wellcare Medicare |
$3,330.57
|
| Rate for Payer: Wellmed Medicare |
$3,330.57
|
|
|
Removal or repair of electromagnetic bone conduction hearing device in temporal bone
|
Facility
|
OP
|
$14,225.15
|
|
|
Service Code
|
HCPCS 69711
|
| Hospital Charge Code |
9900894
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$886.62 |
| Max. Negotiated Rate |
$10,242.11 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$886.62
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3,330.57
|
| Rate for Payer: Amerigroup Medicare |
$3,330.57
|
| Rate for Payer: BCBS of TX Blue Advantage |
$4,374.21
|
| Rate for Payer: BCBS of TX Blue Essentials |
$5,238.58
|
| Rate for Payer: BCBS of TX Medicare |
$3,330.57
|
| Rate for Payer: BCBS of TX PPO |
$6,600.61
|
| Rate for Payer: Cash Price |
$9,673.10
|
| Rate for Payer: Cash Price |
$9,673.10
|
| Rate for Payer: Cash Price |
$9,673.10
|
| Rate for Payer: Cigna Commercial |
$7,040.22
|
| Rate for Payer: Cigna Medicaid |
$10,242.11
|
| Rate for Payer: Cigna Medicare |
$3,330.57
|
| Rate for Payer: Employer Direct Commercial |
$3,330.57
|
| Rate for Payer: Humana Medicare/TRICARE |
$3,330.57
|
| Rate for Payer: Molina CHIP/Medicaid |
$10,242.11
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3,330.57
|
| Rate for Payer: Molina Medicare |
$3,330.57
|
| 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 |
$10,242.11
|
| Rate for Payer: Scott and White EPO/PPO |
$5,447.31
|
| Rate for Payer: Scott and White Medicare |
$3,330.57
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$10,242.11
|
| Rate for Payer: Superior Health Plan EPO |
$3,330.57
|
| Rate for Payer: Superior Health Plan Medicare |
$3,330.57
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3,330.57
|
| Rate for Payer: Universal American Medicare |
$3,330.57
|
| Rate for Payer: Wellcare Medicare |
$3,330.57
|
| Rate for Payer: Wellmed Medicare |
$3,330.57
|
|
|
Removal or repair of electromagnetic bone conduction hearing device in temporal bone
|
Facility
|
IP
|
$14,225.15
|
|
|
Service Code
|
HCPCS 69711
|
| Hospital Charge Code |
9900894
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$9,673.10
|
|
|
Removal, subcutaneous cardiac rhythm monitor
|
Facility
|
IP
|
$2,814.36
|
|
|
Service Code
|
HCPCS 33286
|
| Hospital Charge Code |
991167
|
|
Hospital Revenue Code
|
480
|
| Rate for Payer: Cash Price |
$1,913.76
|
|
|
Removal, subcutaneous cardiac rhythm monitor
|
Facility
|
OP
|
$2,814.36
|
|
|
Service Code
|
HCPCS 33286
|
| Hospital Charge Code |
991167
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$102.30 |
| 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 |
$1,018.72
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,220.02
|
| Rate for Payer: BCBS of TX Medicare |
$711.36
|
| Rate for Payer: BCBS of TX PPO |
$1,537.23
|
| 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 |
$102.30
|
| 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, under anesthesia, of external fixation system
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 20694
|
| Hospital Charge Code |
36020694
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$593.04 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$593.04
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,615.32
|
| Rate for Payer: Amerigroup Medicare |
$1,615.32
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,263.50
|
| Rate for Payer: BCBS of TX Blue Essentials |
$2,710.78
|
| Rate for Payer: BCBS of TX Medicare |
$1,615.32
|
| Rate for Payer: BCBS of TX PPO |
$3,415.58
|
| Rate for Payer: Cigna Commercial |
$3,414.49
|
| Rate for Payer: Cigna Medicare |
$1,615.32
|
| Rate for Payer: Employer Direct Commercial |
$1,615.32
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,615.32
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,615.32
|
| Rate for Payer: Molina Medicare |
$1,615.32
|
| 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 |
$2,719.24
|
| Rate for Payer: Scott and White Medicare |
$1,615.32
|
| Rate for Payer: Superior Health Plan EPO |
$1,615.32
|
| Rate for Payer: Superior Health Plan Medicare |
$1,615.32
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,615.32
|
| Rate for Payer: Universal American Medicare |
$1,615.32
|
| Rate for Payer: Wellcare Medicare |
$1,615.32
|
| Rate for Payer: Wellmed Medicare |
$1,615.32
|
|
|
Removal, under anesthesia, of external fixation system
|
Facility
|
IP
|
$8,354.10
|
|
|
Service Code
|
HCPCS 20694
|
| Hospital Charge Code |
9900184
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$5,680.79
|
|
|
Removal, under anesthesia, of external fixation system
|
Facility
|
OP
|
$8,354.10
|
|
|
Service Code
|
HCPCS 20694
|
| Hospital Charge Code |
9900184
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$593.04 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$593.04
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,615.32
|
| Rate for Payer: Amerigroup Medicare |
$1,615.32
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,263.50
|
| Rate for Payer: BCBS of TX Blue Essentials |
$2,710.78
|
| Rate for Payer: BCBS of TX Medicare |
$1,615.32
|
| Rate for Payer: BCBS of TX PPO |
$3,415.58
|
| Rate for Payer: Cash Price |
$5,680.79
|
| Rate for Payer: Cash Price |
$5,680.79
|
| Rate for Payer: Cash Price |
$5,680.79
|
| Rate for Payer: Cigna Commercial |
$3,414.49
|
| Rate for Payer: Cigna Medicaid |
$6,014.95
|
| Rate for Payer: Cigna Medicare |
$1,615.32
|
| Rate for Payer: Employer Direct Commercial |
$1,615.32
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,615.32
|
| Rate for Payer: Molina CHIP/Medicaid |
$6,014.95
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,615.32
|
| Rate for Payer: Molina Medicare |
$1,615.32
|
| 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 |
$6,014.95
|
| Rate for Payer: Scott and White EPO/PPO |
$2,719.24
|
| Rate for Payer: Scott and White Medicare |
$1,615.32
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$6,014.95
|
| Rate for Payer: Superior Health Plan EPO |
$1,615.32
|
| Rate for Payer: Superior Health Plan Medicare |
$1,615.32
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,615.32
|
| Rate for Payer: Universal American Medicare |
$1,615.32
|
| Rate for Payer: Wellcare Medicare |
$1,615.32
|
| Rate for Payer: Wellmed Medicare |
$1,615.32
|
|
|
Removal with reinsertion, non-biodegradable drug delivery implant
|
Facility
|
OP
|
$1,518.52
|
|
|
Service Code
|
HCPCS 11983
|
| Hospital Charge Code |
991032
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$76.00 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$76.00
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$448.76
|
| Rate for Payer: Amerigroup Medicare |
$448.76
|
| Rate for Payer: BCBS of TX Blue Advantage |
$607.20
|
| Rate for Payer: BCBS of TX Blue Essentials |
$727.18
|
| Rate for Payer: BCBS of TX Medicare |
$448.76
|
| Rate for Payer: BCBS of TX PPO |
$916.25
|
| Rate for Payer: Cash Price |
$1,032.59
|
| Rate for Payer: Cash Price |
$1,032.59
|
| Rate for Payer: Cash Price |
$1,032.59
|
| Rate for Payer: Cigna Commercial |
$948.59
|
| Rate for Payer: Cigna Medicaid |
$1,093.33
|
| Rate for Payer: Cigna Medicare |
$448.76
|
| Rate for Payer: Employer Direct Commercial |
$448.76
|
| Rate for Payer: Humana Medicare/TRICARE |
$448.76
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,093.33
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$448.76
|
| Rate for Payer: Molina Medicare |
$448.76
|
| 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 |
$1,093.33
|
| Rate for Payer: Scott and White EPO/PPO |
$674.12
|
| Rate for Payer: Scott and White Medicare |
$448.76
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,093.33
|
| Rate for Payer: Superior Health Plan EPO |
$448.76
|
| Rate for Payer: Superior Health Plan Medicare |
$448.76
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$448.76
|
| Rate for Payer: Universal American Medicare |
$448.76
|
| Rate for Payer: Wellcare Medicare |
$448.76
|
| Rate for Payer: Wellmed Medicare |
$448.76
|
|
|
Removal with reinsertion, non-biodegradable drug delivery implant
|
Facility
|
IP
|
$1,518.52
|
|
|
Service Code
|
HCPCS 11983
|
| Hospital Charge Code |
991032
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$1,032.59
|
|
|
REMOVE BILI DRAIN CATH
|
Facility
|
OP
|
$1,937.00
|
|
|
Service Code
|
HCPCS 47537
|
| Hospital Charge Code |
4617537
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$334.95 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$334.95
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$911.12
|
| Rate for Payer: Amerigroup Medicare |
$911.12
|
| Rate for Payer: BCBS of TX Blue Advantage |
$1,312.49
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,571.84
|
| Rate for Payer: BCBS of TX Medicare |
$911.12
|
| Rate for Payer: BCBS of TX PPO |
$1,980.52
|
| Rate for Payer: Cash Price |
$1,317.16
|
| Rate for Payer: Cash Price |
$1,317.16
|
| Rate for Payer: Cash Price |
$1,317.16
|
| Rate for Payer: Cigna Commercial |
$1,925.93
|
| Rate for Payer: Cigna Medicaid |
$1,394.64
|
| Rate for Payer: Cigna Medicare |
$911.12
|
| Rate for Payer: Employer Direct Commercial |
$911.12
|
| Rate for Payer: Humana Medicare/TRICARE |
$911.12
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,394.64
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$911.12
|
| Rate for Payer: Molina Medicare |
$911.12
|
| 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 |
$1,394.64
|
| Rate for Payer: Scott and White EPO/PPO |
$1,533.69
|
| Rate for Payer: Scott and White Medicare |
$911.12
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,394.64
|
| Rate for Payer: Superior Health Plan EPO |
$911.12
|
| Rate for Payer: Superior Health Plan Medicare |
$911.12
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$911.12
|
| Rate for Payer: Universal American Medicare |
$911.12
|
| Rate for Payer: Wellcare Medicare |
$911.12
|
| Rate for Payer: Wellmed Medicare |
$911.12
|
|
|
REMOVE BILI DRAIN CATH
|
Facility
|
IP
|
$1,937.00
|
|
|
Service Code
|
HCPCS 47537
|
| Hospital Charge Code |
4617537
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$1,317.16
|
|
|
REMOVE DUAL LEAD PACER ELECTRODE
|
Facility
|
IP
|
$12,912.00
|
|
|
Service Code
|
HCPCS 33235
|
| Hospital Charge Code |
2302495
|
|
Hospital Revenue Code
|
481
|
| Rate for Payer: Cash Price |
$8,780.16
|
|
|
REMOVE DUAL LEAD PACER ELECTRODE
|
Facility
|
OP
|
$12,912.00
|
|
|
Service Code
|
HCPCS 33235
|
| Hospital Charge Code |
2302495
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$763.24 |
| Max. Negotiated Rate |
$9,296.64 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,162.08
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3,753.99
|
| Rate for Payer: Amerigroup Medicare |
$3,753.99
|
| Rate for Payer: BCBS of TX Blue Advantage |
$4,983.30
|
| Rate for Payer: BCBS of TX Blue Essentials |
$5,968.02
|
| Rate for Payer: BCBS of TX Medicare |
$3,753.99
|
| Rate for Payer: BCBS of TX PPO |
$7,519.71
|
| Rate for Payer: Cash Price |
$8,780.16
|
| Rate for Payer: Cash Price |
$8,780.16
|
| Rate for Payer: Cash Price |
$8,780.16
|
| Rate for Payer: Cigna Commercial |
$7,935.26
|
| Rate for Payer: Cigna Medicaid |
$9,296.64
|
| Rate for Payer: Cigna Medicare |
$3,753.99
|
| Rate for Payer: Employer Direct Commercial |
$3,753.99
|
| Rate for Payer: Humana Medicare/TRICARE |
$3,753.99
|
| Rate for Payer: Molina CHIP/Medicaid |
$9,296.64
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3,753.99
|
| Rate for Payer: Molina Medicare |
$3,753.99
|
| Rate for Payer: Multiplan Auto |
$8,392.80
|
| Rate for Payer: Multiplan Commercial |
$8,392.80
|
| Rate for Payer: Multiplan Workers Comp |
$8,392.80
|
| Rate for Payer: Parkland Medicaid |
$9,296.64
|
| Rate for Payer: Scott and White EPO/PPO |
$763.24
|
| Rate for Payer: Scott and White Medicare |
$3,753.99
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$9,296.64
|
| Rate for Payer: Superior Health Plan EPO |
$3,753.99
|
| Rate for Payer: Superior Health Plan Medicare |
$3,753.99
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3,753.99
|
| Rate for Payer: Universal American Medicare |
$3,753.99
|
| Rate for Payer: Wellcare Medicare |
$3,753.99
|
| Rate for Payer: Wellmed Medicare |
$3,753.99
|
|
|
REMOVE LEADLESS PACMAKR VENTRICULAR
|
Facility
|
IP
|
$10,428.00
|
|
|
Service Code
|
HCPCS 33275
|
| Hospital Charge Code |
2300305
|
|
Hospital Revenue Code
|
481
|
| Rate for Payer: Cash Price |
$7,091.04
|
|
|
REMOVE LEADLESS PACMAKR VENTRICULAR
|
Facility
|
OP
|
$10,428.00
|
|
|
Service Code
|
HCPCS 33275
|
| Hospital Charge Code |
2300305
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$604.12 |
| Max. Negotiated Rate |
$7,508.16 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$938.52
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3,171.87
|
| Rate for Payer: Amerigroup Medicare |
$3,171.87
|
| Rate for Payer: BCBS of TX Blue Advantage |
$4,628.04
|
| Rate for Payer: BCBS of TX Blue Essentials |
$5,542.56
|
| Rate for Payer: BCBS of TX Medicare |
$3,171.87
|
| Rate for Payer: BCBS of TX PPO |
$6,983.63
|
| Rate for Payer: Cash Price |
$7,091.04
|
| Rate for Payer: Cash Price |
$7,091.04
|
| Rate for Payer: Cash Price |
$7,091.04
|
| Rate for Payer: Cigna Commercial |
$6,704.76
|
| Rate for Payer: Cigna Medicaid |
$7,508.16
|
| Rate for Payer: Cigna Medicare |
$3,171.87
|
| Rate for Payer: Employer Direct Commercial |
$3,171.87
|
| Rate for Payer: Humana Medicare/TRICARE |
$3,171.87
|
| Rate for Payer: Molina CHIP/Medicaid |
$7,508.16
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3,171.87
|
| Rate for Payer: Molina Medicare |
$3,171.87
|
| Rate for Payer: Multiplan Auto |
$6,778.20
|
| Rate for Payer: Multiplan Commercial |
$6,778.20
|
| Rate for Payer: Multiplan Workers Comp |
$6,778.20
|
| Rate for Payer: Parkland Medicaid |
$7,508.16
|
| Rate for Payer: Scott and White EPO/PPO |
$604.12
|
| Rate for Payer: Scott and White Medicare |
$3,171.87
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$7,508.16
|
| Rate for Payer: Superior Health Plan EPO |
$3,171.87
|
| Rate for Payer: Superior Health Plan Medicare |
$3,171.87
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3,171.87
|
| Rate for Payer: Universal American Medicare |
$3,171.87
|
| Rate for Payer: Wellcare Medicare |
$3,171.87
|
| Rate for Payer: Wellmed Medicare |
$3,171.87
|
|
