|
Repair lip, full thickness; over one-half vertical height, or complex
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 40654
|
| Hospital Charge Code |
36040654
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$420.64 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$420.64
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,558.65
|
| Rate for Payer: Amerigroup Medicare |
$1,558.65
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,253.40
|
| Rate for Payer: BCBS of TX Blue Essentials |
$2,698.68
|
| Rate for Payer: BCBS of TX Medicare |
$1,558.65
|
| Rate for Payer: BCBS of TX PPO |
$3,400.34
|
| Rate for Payer: Cigna Commercial |
$3,294.71
|
| Rate for Payer: Cigna Medicare |
$1,558.65
|
| Rate for Payer: Employer Direct Commercial |
$1,558.65
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,558.65
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,558.65
|
| Rate for Payer: Molina Medicare |
$1,558.65
|
| 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 |
$2,580.23
|
| Rate for Payer: Scott and White Medicare |
$1,558.65
|
| Rate for Payer: Superior Health Plan EPO |
$1,558.65
|
| Rate for Payer: Superior Health Plan Medicare |
$1,558.65
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,558.65
|
| Rate for Payer: Universal American Medicare |
$1,558.65
|
| Rate for Payer: Wellcare Medicare |
$1,558.65
|
| Rate for Payer: Wellmed Medicare |
$1,558.65
|
|
|
Repair lip, full thickness; over one-half vertical height, or complex
|
Facility
|
OP
|
$5,526.16
|
|
|
Service Code
|
HCPCS 40654
|
| Hospital Charge Code |
9900640
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$420.64 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$420.64
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,558.65
|
| Rate for Payer: Amerigroup Medicare |
$1,558.65
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,253.40
|
| Rate for Payer: BCBS of TX Blue Essentials |
$2,698.68
|
| Rate for Payer: BCBS of TX Medicare |
$1,558.65
|
| Rate for Payer: BCBS of TX PPO |
$3,400.34
|
| Rate for Payer: Cash Price |
$3,757.79
|
| Rate for Payer: Cash Price |
$3,757.79
|
| Rate for Payer: Cash Price |
$3,757.79
|
| Rate for Payer: Cigna Commercial |
$3,294.71
|
| Rate for Payer: Cigna Medicaid |
$3,978.84
|
| Rate for Payer: Cigna Medicare |
$1,558.65
|
| Rate for Payer: Employer Direct Commercial |
$1,558.65
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,558.65
|
| Rate for Payer: Molina CHIP/Medicaid |
$3,978.84
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,558.65
|
| Rate for Payer: Molina Medicare |
$1,558.65
|
| 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 |
$3,978.84
|
| Rate for Payer: Scott and White EPO/PPO |
$2,580.23
|
| Rate for Payer: Scott and White Medicare |
$1,558.65
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$3,978.84
|
| Rate for Payer: Superior Health Plan EPO |
$1,558.65
|
| Rate for Payer: Superior Health Plan Medicare |
$1,558.65
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,558.65
|
| Rate for Payer: Universal American Medicare |
$1,558.65
|
| Rate for Payer: Wellcare Medicare |
$1,558.65
|
| Rate for Payer: Wellmed Medicare |
$1,558.65
|
|
|
Repair non-union, metacarpal or phalanx (includes obtaining bone graft with or without external or i
|
Facility
|
IP
|
$14,640.00
|
|
|
Service Code
|
HCPCS 26546
|
| Hospital Charge Code |
9900357
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$9,955.20
|
|
|
Repair non-union, metacarpal or phalanx (includes obtaining bone graft with or without external or i
|
Facility
|
OP
|
$15,408.22
|
|
|
Service Code
|
CPT 26546
|
| Hospital Charge Code |
36026546
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,398.52 |
| Max. Negotiated Rate |
$15,408.22 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2,398.52
|
| 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 |
$9,989.86
|
| Rate for Payer: BCBS of TX Blue Essentials |
$11,963.90
|
| Rate for Payer: BCBS of TX Medicare |
$7,289.28
|
| Rate for Payer: BCBS of TX PPO |
$15,074.51
|
| 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 |
$12,104.03
|
| 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
|
|
|
Repair non-union, metacarpal or phalanx (includes obtaining bone graft with or without external or i
|
Facility
|
OP
|
$14,640.00
|
|
|
Service Code
|
HCPCS 26546
|
| Hospital Charge Code |
9900357
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,398.52 |
| Max. Negotiated Rate |
$15,408.22 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2,398.52
|
| 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 |
$9,989.86
|
| Rate for Payer: BCBS of TX Blue Essentials |
$11,963.90
|
| Rate for Payer: BCBS of TX Medicare |
$7,289.28
|
| Rate for Payer: BCBS of TX PPO |
$15,074.51
|
| Rate for Payer: Cash Price |
$9,955.20
|
| Rate for Payer: Cash Price |
$9,955.20
|
| Rate for Payer: Cash Price |
$9,955.20
|
| Rate for Payer: Cigna Commercial |
$15,408.22
|
| Rate for Payer: Cigna Medicaid |
$10,540.80
|
| 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 |
$10,540.80
|
| 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 |
$10,540.80
|
| Rate for Payer: Scott and White EPO/PPO |
$12,104.03
|
| Rate for Payer: Scott and White Medicare |
$7,289.28
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$10,540.80
|
| 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
|
|
|
Repair, nonunion or malunion; metatarsal, with or without bone graft (includes obtaining graft)
|
Facility
|
IP
|
$27,265.32
|
|
|
Service Code
|
HCPCS 28322
|
| Hospital Charge Code |
991018
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$18,540.42
|
|
|
Repair, nonunion or malunion; metatarsal, with or without bone graft (includes obtaining graft)
|
Facility
|
OP
|
$27,265.32
|
|
|
Service Code
|
HCPCS 28322
|
| Hospital Charge Code |
991018
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,336.71 |
| Max. Negotiated Rate |
$19,631.03 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$3,336.71
|
| 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 |
$9,989.86
|
| Rate for Payer: BCBS of TX Blue Essentials |
$11,963.90
|
| Rate for Payer: BCBS of TX Medicare |
$7,289.28
|
| Rate for Payer: BCBS of TX PPO |
$15,074.51
|
| Rate for Payer: Cash Price |
$18,540.42
|
| Rate for Payer: Cash Price |
$18,540.42
|
| Rate for Payer: Cash Price |
$18,540.42
|
| Rate for Payer: Cigna Commercial |
$15,408.22
|
| Rate for Payer: Cigna Medicaid |
$19,631.03
|
| 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 |
$19,631.03
|
| 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 |
$19,631.03
|
| Rate for Payer: Scott and White EPO/PPO |
$12,104.03
|
| Rate for Payer: Scott and White Medicare |
$7,289.28
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$19,631.03
|
| 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
|
|
|
Repair of anterior abdominal hernia any approach , initial, including implantation of mesh or other prosthesis when performed, total length of defect(s); 3 cm to 10 cm, incarcerated or strangulated
|
Facility
|
OP
|
$23,337.44
|
|
|
Service Code
|
HCPCS 49594
|
| Hospital Charge Code |
994072
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,151.54 |
| Max. Negotiated Rate |
$16,802.96 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,151.54
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$6,073.08
|
| Rate for Payer: Amerigroup Medicare |
$6,073.08
|
| Rate for Payer: BCBS of TX Blue Advantage |
$8,704.29
|
| Rate for Payer: BCBS of TX Blue Essentials |
$10,424.30
|
| Rate for Payer: BCBS of TX Medicare |
$6,073.08
|
| Rate for Payer: BCBS of TX PPO |
$13,134.62
|
| Rate for Payer: Cash Price |
$15,869.46
|
| Rate for Payer: Cash Price |
$15,869.46
|
| Rate for Payer: Cash Price |
$15,869.46
|
| Rate for Payer: Cigna Commercial |
$12,837.39
|
| Rate for Payer: Cigna Medicaid |
$16,802.96
|
| Rate for Payer: Cigna Medicare |
$6,073.08
|
| Rate for Payer: Employer Direct Commercial |
$6,073.08
|
| Rate for Payer: Humana Medicare/TRICARE |
$6,073.08
|
| Rate for Payer: Molina CHIP/Medicaid |
$16,802.96
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$6,073.08
|
| Rate for Payer: Molina Medicare |
$6,073.08
|
| 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 |
$16,802.96
|
| Rate for Payer: Scott and White EPO/PPO |
$9,762.30
|
| Rate for Payer: Scott and White Medicare |
$6,073.08
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$16,802.96
|
| Rate for Payer: Superior Health Plan EPO |
$6,073.08
|
| Rate for Payer: Superior Health Plan Medicare |
$6,073.08
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$6,073.08
|
| Rate for Payer: Universal American Medicare |
$6,073.08
|
| Rate for Payer: Wellcare Medicare |
$6,073.08
|
| Rate for Payer: Wellmed Medicare |
$6,073.08
|
|
|
Repair of anterior abdominal hernia any approach , initial, including implantation of mesh or other prosthesis when performed, total length of defect(s); 3 cm to 10 cm, incarcerated or strangulated
|
Facility
|
IP
|
$23,337.44
|
|
|
Service Code
|
HCPCS 49594
|
| Hospital Charge Code |
994072
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$15,869.46
|
|
|
Repair of anterior abdominal hernia any approachrecurrent, including implantation of mesh or other prosthesis ); 3 cm to 10 cm, incarcerated or strangulated
|
Facility
|
OP
|
$64,200.00
|
|
|
Service Code
|
HCPCS 49616
|
| Hospital Charge Code |
994048
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,541.34 |
| Max. Negotiated Rate |
$46,224.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$5,778.00
|
| Rate for Payer: BCBS of TX Blue Advantage |
$1,541.34
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,845.92
|
| Rate for Payer: BCBS of TX PPO |
$2,325.86
|
| Rate for Payer: Cash Price |
$43,656.00
|
| Rate for Payer: Cash Price |
$43,656.00
|
| Rate for Payer: Cash Price |
$43,656.00
|
| Rate for Payer: Cigna Medicaid |
$46,224.00
|
| Rate for Payer: Molina CHIP/Medicaid |
$46,224.00
|
| 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 |
$46,224.00
|
| Rate for Payer: Scott and White EPO/PPO |
$32,100.00
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$46,224.00
|
| Rate for Payer: Superior Health Plan EPO |
$8,731.20
|
|
|
Repair of anterior abdominal hernia any approachrecurrent, including implantation of mesh or other prosthesis ); 3 cm to 10 cm, incarcerated or strangulated
|
Facility
|
IP
|
$64,200.00
|
|
|
Service Code
|
HCPCS 49616
|
| Hospital Charge Code |
994048
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$43,656.00
|
|
|
Repair of anterior abdominal hernia recurrent, including implantation of mesh greater than 10 cm
|
Facility
|
IP
|
$24,200.00
|
|
|
Service Code
|
HCPCS 49618
|
| Hospital Charge Code |
994172
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$16,456.00
|
|
|
Repair of anterior abdominal hernia recurrent, including implantation of mesh greater than 10 cm
|
Facility
|
OP
|
$24,200.00
|
|
|
Service Code
|
HCPCS 49618
|
| Hospital Charge Code |
994172
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,178.00 |
| Max. Negotiated Rate |
$17,424.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2,178.00
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,224.46
|
| Rate for Payer: BCBS of TX Blue Essentials |
$2,664.02
|
| Rate for Payer: BCBS of TX PPO |
$3,356.67
|
| Rate for Payer: Cash Price |
$16,456.00
|
| Rate for Payer: Cash Price |
$16,456.00
|
| Rate for Payer: Cash Price |
$16,456.00
|
| Rate for Payer: Cigna Medicaid |
$17,424.00
|
| Rate for Payer: Molina CHIP/Medicaid |
$17,424.00
|
| 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 |
$17,424.00
|
| Rate for Payer: Scott and White EPO/PPO |
$12,100.00
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$17,424.00
|
| Rate for Payer: Superior Health Plan EPO |
$3,291.20
|
|
|
Repair of anterior abdominal hernia(s) (ie, epigastric, incisional, ventral, umbilical, spigelian),
|
Facility
|
IP
|
$17,709.65
|
|
|
Service Code
|
HCPCS 49591
|
| Hospital Charge Code |
9900723
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$12,042.56
|
|
|
Repair of anterior abdominal hernia(s) (ie, epigastric, incisional, ventral, umbilical, spigelian),
|
Facility
|
OP
|
$17,709.65
|
|
|
Service Code
|
HCPCS 49591
|
| Hospital Charge Code |
9900723
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,151.54 |
| Max. Negotiated Rate |
$12,750.95 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,151.54
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3,596.72
|
| Rate for Payer: Amerigroup Medicare |
$3,596.72
|
| Rate for Payer: BCBS of TX Blue Advantage |
$5,915.02
|
| Rate for Payer: BCBS of TX Blue Essentials |
$7,083.86
|
| Rate for Payer: BCBS of TX Medicare |
$3,596.72
|
| Rate for Payer: BCBS of TX PPO |
$8,925.66
|
| Rate for Payer: Cash Price |
$12,042.56
|
| Rate for Payer: Cash Price |
$12,042.56
|
| Rate for Payer: Cash Price |
$12,042.56
|
| Rate for Payer: Cigna Commercial |
$7,602.81
|
| Rate for Payer: Cigna Medicaid |
$12,750.95
|
| Rate for Payer: Cigna Medicare |
$3,596.72
|
| Rate for Payer: Employer Direct Commercial |
$3,596.72
|
| Rate for Payer: Humana Medicare/TRICARE |
$3,596.72
|
| Rate for Payer: Molina CHIP/Medicaid |
$12,750.95
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3,596.72
|
| Rate for Payer: Molina Medicare |
$3,596.72
|
| 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 |
$12,750.95
|
| Rate for Payer: Scott and White EPO/PPO |
$5,853.44
|
| Rate for Payer: Scott and White Medicare |
$3,596.72
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$12,750.95
|
| Rate for Payer: Superior Health Plan EPO |
$3,596.72
|
| Rate for Payer: Superior Health Plan Medicare |
$3,596.72
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3,596.72
|
| Rate for Payer: Universal American Medicare |
$3,596.72
|
| Rate for Payer: Wellcare Medicare |
$3,596.72
|
| Rate for Payer: Wellmed Medicare |
$3,596.72
|
|
|
Repair of anterior abdominal hernia(s) (ie, epigastric, incisional, ventral, umbilical, spigelian),
|
Facility
|
OP
|
$13,746.84
|
|
|
Service Code
|
CPT 49593
|
| Hospital Charge Code |
36049593
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,151.54 |
| Max. Negotiated Rate |
$13,746.84 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,151.54
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$6,503.32
|
| Rate for Payer: Amerigroup Medicare |
$6,503.32
|
| Rate for Payer: BCBS of TX Blue Advantage |
$5,915.02
|
| Rate for Payer: BCBS of TX Blue Essentials |
$7,083.86
|
| Rate for Payer: BCBS of TX Medicare |
$6,503.32
|
| Rate for Payer: BCBS of TX PPO |
$8,925.66
|
| Rate for Payer: Cigna Commercial |
$13,746.84
|
| Rate for Payer: Cigna Medicare |
$6,503.32
|
| Rate for Payer: Employer Direct Commercial |
$6,503.32
|
| Rate for Payer: Humana Medicare/TRICARE |
$6,503.32
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$6,503.32
|
| Rate for Payer: Molina Medicare |
$6,503.32
|
| 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 |
$5,853.44
|
| Rate for Payer: Scott and White Medicare |
$6,503.32
|
| Rate for Payer: Superior Health Plan EPO |
$6,503.32
|
| Rate for Payer: Superior Health Plan Medicare |
$6,503.32
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$6,503.32
|
| Rate for Payer: Universal American Medicare |
$6,503.32
|
| Rate for Payer: Wellcare Medicare |
$6,503.32
|
| Rate for Payer: Wellmed Medicare |
$6,503.32
|
|
|
Repair of anterior abdominal hernia(s) (ie, epigastric, incisional, ventral, umbilical, spigelian),
|
Facility
|
OP
|
$13,134.62
|
|
|
Service Code
|
CPT 49592
|
| Hospital Charge Code |
36049592
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,151.54 |
| Max. Negotiated Rate |
$13,134.62 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,151.54
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$6,073.08
|
| Rate for Payer: Amerigroup Medicare |
$6,073.08
|
| Rate for Payer: BCBS of TX Blue Advantage |
$8,704.29
|
| Rate for Payer: BCBS of TX Blue Essentials |
$10,424.30
|
| Rate for Payer: BCBS of TX Medicare |
$6,073.08
|
| Rate for Payer: BCBS of TX PPO |
$13,134.62
|
| Rate for Payer: Cigna Commercial |
$12,837.39
|
| Rate for Payer: Cigna Medicare |
$6,073.08
|
| Rate for Payer: Employer Direct Commercial |
$6,073.08
|
| Rate for Payer: Humana Medicare/TRICARE |
$6,073.08
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$6,073.08
|
| Rate for Payer: Molina Medicare |
$6,073.08
|
| 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 |
$9,762.30
|
| Rate for Payer: Scott and White Medicare |
$6,073.08
|
| Rate for Payer: Superior Health Plan EPO |
$6,073.08
|
| Rate for Payer: Superior Health Plan Medicare |
$6,073.08
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$6,073.08
|
| Rate for Payer: Universal American Medicare |
$6,073.08
|
| Rate for Payer: Wellcare Medicare |
$6,073.08
|
| Rate for Payer: Wellmed Medicare |
$6,073.08
|
|
|
Repair of anterior abdominal hernia(s) (ie, epigastric, incisional, ventral, umbilical, spigelian),
|
Facility
|
OP
|
$10,424.30
|
|
|
Service Code
|
HCPCS 49592
|
| Hospital Charge Code |
9900724
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,151.54 |
| Max. Negotiated Rate |
$13,134.62 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,151.54
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$6,073.08
|
| Rate for Payer: Amerigroup Medicare |
$6,073.08
|
| Rate for Payer: BCBS of TX Blue Advantage |
$8,704.29
|
| Rate for Payer: BCBS of TX Blue Essentials |
$10,424.30
|
| Rate for Payer: BCBS of TX Medicare |
$6,073.08
|
| Rate for Payer: BCBS of TX PPO |
$13,134.62
|
| Rate for Payer: Cash Price |
$7,088.52
|
| Rate for Payer: Cash Price |
$7,088.52
|
| Rate for Payer: Cash Price |
$7,088.52
|
| Rate for Payer: Cigna Commercial |
$12,837.39
|
| Rate for Payer: Cigna Medicaid |
$7,505.50
|
| Rate for Payer: Cigna Medicare |
$6,073.08
|
| Rate for Payer: Employer Direct Commercial |
$6,073.08
|
| Rate for Payer: Humana Medicare/TRICARE |
$6,073.08
|
| Rate for Payer: Molina CHIP/Medicaid |
$7,505.50
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$6,073.08
|
| Rate for Payer: Molina Medicare |
$6,073.08
|
| 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 |
$7,505.50
|
| Rate for Payer: Scott and White EPO/PPO |
$9,762.30
|
| Rate for Payer: Scott and White Medicare |
$6,073.08
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$7,505.50
|
| Rate for Payer: Superior Health Plan EPO |
$6,073.08
|
| Rate for Payer: Superior Health Plan Medicare |
$6,073.08
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$6,073.08
|
| Rate for Payer: Universal American Medicare |
$6,073.08
|
| Rate for Payer: Wellcare Medicare |
$6,073.08
|
| Rate for Payer: Wellmed Medicare |
$6,073.08
|
|
|
Repair of anterior abdominal hernia(s) (ie, epigastric, incisional, ventral, umbilical, spigelian),
|
Facility
|
OP
|
$14,167.72
|
|
|
Service Code
|
HCPCS 49593
|
| Hospital Charge Code |
9900725
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,151.54 |
| Max. Negotiated Rate |
$13,746.84 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,151.54
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$6,503.32
|
| Rate for Payer: Amerigroup Medicare |
$6,503.32
|
| Rate for Payer: BCBS of TX Blue Advantage |
$5,915.02
|
| Rate for Payer: BCBS of TX Blue Essentials |
$7,083.86
|
| Rate for Payer: BCBS of TX Medicare |
$6,503.32
|
| Rate for Payer: BCBS of TX PPO |
$8,925.66
|
| Rate for Payer: Cash Price |
$9,634.05
|
| Rate for Payer: Cash Price |
$9,634.05
|
| Rate for Payer: Cash Price |
$9,634.05
|
| Rate for Payer: Cigna Commercial |
$13,746.84
|
| Rate for Payer: Cigna Medicaid |
$10,200.76
|
| Rate for Payer: Cigna Medicare |
$6,503.32
|
| Rate for Payer: Employer Direct Commercial |
$6,503.32
|
| Rate for Payer: Humana Medicare/TRICARE |
$6,503.32
|
| Rate for Payer: Molina CHIP/Medicaid |
$10,200.76
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$6,503.32
|
| Rate for Payer: Molina Medicare |
$6,503.32
|
| 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 |
$10,200.76
|
| Rate for Payer: Scott and White EPO/PPO |
$5,853.44
|
| Rate for Payer: Scott and White Medicare |
$6,503.32
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$10,200.76
|
| Rate for Payer: Superior Health Plan EPO |
$6,503.32
|
| Rate for Payer: Superior Health Plan Medicare |
$6,503.32
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$6,503.32
|
| Rate for Payer: Universal American Medicare |
$6,503.32
|
| Rate for Payer: Wellcare Medicare |
$6,503.32
|
| Rate for Payer: Wellmed Medicare |
$6,503.32
|
|
|
Repair of anterior abdominal hernia(s) (ie, epigastric, incisional, ventral, umbilical, spigelian),
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 49591
|
| Hospital Charge Code |
36049591
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,151.54 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,151.54
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3,596.72
|
| Rate for Payer: Amerigroup Medicare |
$3,596.72
|
| Rate for Payer: BCBS of TX Blue Advantage |
$5,915.02
|
| Rate for Payer: BCBS of TX Blue Essentials |
$7,083.86
|
| Rate for Payer: BCBS of TX Medicare |
$3,596.72
|
| Rate for Payer: BCBS of TX PPO |
$8,925.66
|
| Rate for Payer: Cigna Commercial |
$7,602.81
|
| Rate for Payer: Cigna Medicare |
$3,596.72
|
| Rate for Payer: Employer Direct Commercial |
$3,596.72
|
| Rate for Payer: Humana Medicare/TRICARE |
$3,596.72
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3,596.72
|
| Rate for Payer: Molina Medicare |
$3,596.72
|
| 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 |
$5,853.44
|
| Rate for Payer: Scott and White Medicare |
$3,596.72
|
| Rate for Payer: Superior Health Plan EPO |
$3,596.72
|
| Rate for Payer: Superior Health Plan Medicare |
$3,596.72
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3,596.72
|
| Rate for Payer: Universal American Medicare |
$3,596.72
|
| Rate for Payer: Wellcare Medicare |
$3,596.72
|
| Rate for Payer: Wellmed Medicare |
$3,596.72
|
|
|
Repair of anterior abdominal hernia(s) (ie, epigastric, incisional, ventral, umbilical, spigelian),
|
Facility
|
IP
|
$14,167.72
|
|
|
Service Code
|
HCPCS 49593
|
| Hospital Charge Code |
9900725
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$9,634.05
|
|
|
Repair of anterior abdominal hernia(s) (ie, epigastric, incisional, ventral, umbilical, spigelian),
|
Facility
|
IP
|
$10,424.30
|
|
|
Service Code
|
HCPCS 49592
|
| Hospital Charge Code |
9900724
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$7,088.52
|
|
|
Repair of anterior abdominal hernia(s)recurrent, including implantation of mesh 3 cm to 10 cm, reducible
|
Facility
|
OP
|
$13,185.36
|
|
|
Service Code
|
HCPCS 49615
|
| Hospital Charge Code |
991147
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,888.85 |
| Max. Negotiated Rate |
$13,746.84 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,888.85
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$6,503.32
|
| Rate for Payer: Amerigroup Medicare |
$6,503.32
|
| Rate for Payer: BCBS of TX Blue Advantage |
$5,915.02
|
| Rate for Payer: BCBS of TX Blue Essentials |
$7,083.86
|
| Rate for Payer: BCBS of TX Medicare |
$6,503.32
|
| Rate for Payer: BCBS of TX PPO |
$8,925.66
|
| Rate for Payer: Cash Price |
$8,966.04
|
| Rate for Payer: Cash Price |
$8,966.04
|
| Rate for Payer: Cash Price |
$8,966.04
|
| Rate for Payer: Cigna Commercial |
$13,746.84
|
| Rate for Payer: Cigna Medicaid |
$9,493.46
|
| Rate for Payer: Cigna Medicare |
$6,503.32
|
| Rate for Payer: Employer Direct Commercial |
$6,503.32
|
| Rate for Payer: Humana Medicare/TRICARE |
$6,503.32
|
| Rate for Payer: Molina CHIP/Medicaid |
$9,493.46
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$6,503.32
|
| Rate for Payer: Molina Medicare |
$6,503.32
|
| 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 |
$9,493.46
|
| Rate for Payer: Scott and White EPO/PPO |
$5,853.44
|
| Rate for Payer: Scott and White Medicare |
$6,503.32
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$9,493.46
|
| Rate for Payer: Superior Health Plan EPO |
$6,503.32
|
| Rate for Payer: Superior Health Plan Medicare |
$6,503.32
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$6,503.32
|
| Rate for Payer: Universal American Medicare |
$6,503.32
|
| Rate for Payer: Wellcare Medicare |
$6,503.32
|
| Rate for Payer: Wellmed Medicare |
$6,503.32
|
|
|
Repair of anterior abdominal hernia(s)recurrent, including implantation of mesh 3 cm to 10 cm, reducible
|
Facility
|
IP
|
$13,185.36
|
|
|
Service Code
|
HCPCS 49615
|
| Hospital Charge Code |
991147
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$8,966.04
|
|
|
Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat
|
Facility
|
OP
|
$12,014.10
|
|
|
Service Code
|
HCPCS 67908
|
| Hospital Charge Code |
9900877
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$698.30 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$698.30
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$2,388.32
|
| Rate for Payer: Amerigroup Medicare |
$2,388.32
|
| Rate for Payer: BCBS of TX Blue Advantage |
$3,231.78
|
| Rate for Payer: BCBS of TX Blue Essentials |
$3,870.40
|
| Rate for Payer: BCBS of TX Medicare |
$2,388.32
|
| Rate for Payer: BCBS of TX PPO |
$4,876.70
|
| Rate for Payer: Cash Price |
$8,169.59
|
| Rate for Payer: Cash Price |
$8,169.59
|
| Rate for Payer: Cash Price |
$8,169.59
|
| Rate for Payer: Cigna Commercial |
$5,048.47
|
| Rate for Payer: Cigna Medicaid |
$8,650.15
|
| Rate for Payer: Cigna Medicare |
$2,388.32
|
| Rate for Payer: Employer Direct Commercial |
$2,388.32
|
| Rate for Payer: Humana Medicare/TRICARE |
$2,388.32
|
| Rate for Payer: Molina CHIP/Medicaid |
$8,650.15
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$2,388.32
|
| Rate for Payer: Molina Medicare |
$2,388.32
|
| 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 |
$8,650.15
|
| Rate for Payer: Scott and White EPO/PPO |
$3,953.65
|
| Rate for Payer: Scott and White Medicare |
$2,388.32
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$8,650.15
|
| Rate for Payer: Superior Health Plan EPO |
$2,388.32
|
| Rate for Payer: Superior Health Plan Medicare |
$2,388.32
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$2,388.32
|
| Rate for Payer: Universal American Medicare |
$2,388.32
|
| Rate for Payer: Wellcare Medicare |
$2,388.32
|
| Rate for Payer: Wellmed Medicare |
$2,388.32
|
|
