|
Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat
|
Facility
|
IP
|
$12,014.10
|
|
|
Service Code
|
HCPCS 67908
|
| Hospital Charge Code |
9900877
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$8,169.59
|
|
|
Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 67908
|
| Hospital Charge Code |
36067908
|
|
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: Cigna Commercial |
$5,048.47
|
| 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 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: Scott and White EPO/PPO |
$3,953.65
|
| Rate for Payer: Scott and White Medicare |
$2,388.32
|
| 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
|
|
|
Repair of blepharoptosis (tarso) levator resection or advancement, external approach
|
Facility
|
OP
|
$12,014.10
|
|
|
Service Code
|
HCPCS 67904
|
| Hospital Charge Code |
9900876
|
|
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
|
|
|
Repair of blepharoptosis (tarso) levator resection or advancement, external approach
|
Facility
|
IP
|
$12,014.10
|
|
|
Service Code
|
HCPCS 67904
|
| Hospital Charge Code |
9900876
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$8,169.59
|
|
|
Repair of blepharoptosis (tarso) levator resection or advancement, external approach
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 67904
|
| Hospital Charge Code |
36067904
|
|
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: Cigna Commercial |
$5,048.47
|
| 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 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: Scott and White EPO/PPO |
$3,953.65
|
| Rate for Payer: Scott and White Medicare |
$2,388.32
|
| 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
|
|
|
Repair of ectropion; extensive (eg, tarsal strip operations)
|
Facility
|
OP
|
$20,712.00
|
|
|
Service Code
|
HCPCS 67917
|
| Hospital Charge Code |
9900878
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$698.30 |
| Max. Negotiated Rate |
$14,912.64 |
| 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 |
$14,084.16
|
| Rate for Payer: Cash Price |
$14,084.16
|
| Rate for Payer: Cash Price |
$14,084.16
|
| Rate for Payer: Cigna Commercial |
$5,048.47
|
| Rate for Payer: Cigna Medicaid |
$14,912.64
|
| 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 |
$14,912.64
|
| 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 |
$14,912.64
|
| 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 |
$14,912.64
|
| 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
|
|
|
Repair of ectropion; extensive (eg, tarsal strip operations)
|
Facility
|
IP
|
$20,712.00
|
|
|
Service Code
|
HCPCS 67917
|
| Hospital Charge Code |
9900878
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$14,084.16
|
|
|
Repair of ectropion; extensive (eg, tarsal strip operations)
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 67917
|
| Hospital Charge Code |
36067917
|
|
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: Cigna Commercial |
$5,048.47
|
| 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 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: Scott and White EPO/PPO |
$3,953.65
|
| Rate for Payer: Scott and White Medicare |
$2,388.32
|
| 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
|
|
|
Repair of extensor tendon, central slip, secondary (eg, boutonniere deformity) using local tissue(s
|
Facility
|
OP
|
$7,783.60
|
|
|
Service Code
|
HCPCS 26426
|
| Hospital Charge Code |
9900337
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,088.27 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,088.27
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3,286.91
|
| Rate for Payer: Amerigroup Medicare |
$3,286.91
|
| Rate for Payer: BCBS of TX Blue Advantage |
$4,571.54
|
| Rate for Payer: BCBS of TX Blue Essentials |
$5,474.90
|
| Rate for Payer: BCBS of TX Medicare |
$3,286.91
|
| Rate for Payer: BCBS of TX PPO |
$6,898.37
|
| Rate for Payer: Cash Price |
$5,292.85
|
| Rate for Payer: Cash Price |
$5,292.85
|
| Rate for Payer: Cash Price |
$5,292.85
|
| Rate for Payer: Cigna Commercial |
$6,947.94
|
| Rate for Payer: Cigna Medicaid |
$5,604.19
|
| Rate for Payer: Cigna Medicare |
$3,286.91
|
| Rate for Payer: Employer Direct Commercial |
$3,286.91
|
| Rate for Payer: Humana Medicare/TRICARE |
$3,286.91
|
| Rate for Payer: Molina CHIP/Medicaid |
$5,604.19
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3,286.91
|
| Rate for Payer: Molina Medicare |
$3,286.91
|
| 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
|
| Rate for Payer: Parkland Medicaid |
$5,604.19
|
| Rate for Payer: Scott and White EPO/PPO |
$5,476.44
|
| Rate for Payer: Scott and White Medicare |
$3,286.91
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$5,604.19
|
| Rate for Payer: Superior Health Plan EPO |
$3,286.91
|
| Rate for Payer: Superior Health Plan Medicare |
$3,286.91
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3,286.91
|
| Rate for Payer: Universal American Medicare |
$3,286.91
|
| Rate for Payer: Wellcare Medicare |
$3,286.91
|
| Rate for Payer: Wellmed Medicare |
$3,286.91
|
|
|
Repair of extensor tendon, central slip, secondary (eg, boutonniere deformity) using local tissue(s
|
Facility
|
IP
|
$7,783.60
|
|
|
Service Code
|
HCPCS 26426
|
| Hospital Charge Code |
9900337
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$5,292.85
|
|
|
Repair of extensor tendon, central slip, secondary (eg, boutonniere deformity) using local tissue(s
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 26426
|
| Hospital Charge Code |
36026426
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,088.27 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,088.27
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3,286.91
|
| Rate for Payer: Amerigroup Medicare |
$3,286.91
|
| Rate for Payer: BCBS of TX Blue Advantage |
$4,571.54
|
| Rate for Payer: BCBS of TX Blue Essentials |
$5,474.90
|
| Rate for Payer: BCBS of TX Medicare |
$3,286.91
|
| Rate for Payer: BCBS of TX PPO |
$6,898.37
|
| Rate for Payer: Cigna Commercial |
$6,947.94
|
| Rate for Payer: Cigna Medicare |
$3,286.91
|
| Rate for Payer: Employer Direct Commercial |
$3,286.91
|
| Rate for Payer: Humana Medicare/TRICARE |
$3,286.91
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3,286.91
|
| Rate for Payer: Molina Medicare |
$3,286.91
|
| 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
|
| Rate for Payer: Scott and White EPO/PPO |
$5,476.44
|
| Rate for Payer: Scott and White Medicare |
$3,286.91
|
| Rate for Payer: Superior Health Plan EPO |
$3,286.91
|
| Rate for Payer: Superior Health Plan Medicare |
$3,286.91
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3,286.91
|
| Rate for Payer: Universal American Medicare |
$3,286.91
|
| Rate for Payer: Wellcare Medicare |
$3,286.91
|
| Rate for Payer: Wellmed Medicare |
$3,286.91
|
|
|
Repair of extensor tendon, distal insertion, primary or secondary; with free graft (includes obtaini
|
Facility
|
IP
|
$12,736.80
|
|
|
Service Code
|
HCPCS 26434
|
| Hospital Charge Code |
9900339
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$8,661.02
|
|
|
Repair of extensor tendon, distal insertion, primary or secondary; with free graft (includes obtaini
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 26434
|
| Hospital Charge Code |
36026434
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,088.27 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,088.27
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3,286.91
|
| Rate for Payer: Amerigroup Medicare |
$3,286.91
|
| Rate for Payer: BCBS of TX Blue Advantage |
$4,571.54
|
| Rate for Payer: BCBS of TX Blue Essentials |
$5,474.90
|
| Rate for Payer: BCBS of TX Medicare |
$3,286.91
|
| Rate for Payer: BCBS of TX PPO |
$6,898.37
|
| Rate for Payer: Cigna Commercial |
$6,947.94
|
| Rate for Payer: Cigna Medicare |
$3,286.91
|
| Rate for Payer: Employer Direct Commercial |
$3,286.91
|
| Rate for Payer: Humana Medicare/TRICARE |
$3,286.91
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3,286.91
|
| Rate for Payer: Molina Medicare |
$3,286.91
|
| 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
|
| Rate for Payer: Scott and White EPO/PPO |
$5,476.44
|
| Rate for Payer: Scott and White Medicare |
$3,286.91
|
| Rate for Payer: Superior Health Plan EPO |
$3,286.91
|
| Rate for Payer: Superior Health Plan Medicare |
$3,286.91
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3,286.91
|
| Rate for Payer: Universal American Medicare |
$3,286.91
|
| Rate for Payer: Wellcare Medicare |
$3,286.91
|
| Rate for Payer: Wellmed Medicare |
$3,286.91
|
|
|
Repair of extensor tendon, distal insertion, primary or secondary; with free graft (includes obtaini
|
Facility
|
OP
|
$12,736.80
|
|
|
Service Code
|
HCPCS 26434
|
| Hospital Charge Code |
9900339
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,088.27 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,088.27
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3,286.91
|
| Rate for Payer: Amerigroup Medicare |
$3,286.91
|
| Rate for Payer: BCBS of TX Blue Advantage |
$4,571.54
|
| Rate for Payer: BCBS of TX Blue Essentials |
$5,474.90
|
| Rate for Payer: BCBS of TX Medicare |
$3,286.91
|
| Rate for Payer: BCBS of TX PPO |
$6,898.37
|
| Rate for Payer: Cash Price |
$8,661.02
|
| Rate for Payer: Cash Price |
$8,661.02
|
| Rate for Payer: Cash Price |
$8,661.02
|
| Rate for Payer: Cigna Commercial |
$6,947.94
|
| Rate for Payer: Cigna Medicaid |
$9,170.50
|
| Rate for Payer: Cigna Medicare |
$3,286.91
|
| Rate for Payer: Employer Direct Commercial |
$3,286.91
|
| Rate for Payer: Humana Medicare/TRICARE |
$3,286.91
|
| Rate for Payer: Molina CHIP/Medicaid |
$9,170.50
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3,286.91
|
| Rate for Payer: Molina Medicare |
$3,286.91
|
| 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
|
| Rate for Payer: Parkland Medicaid |
$9,170.50
|
| Rate for Payer: Scott and White EPO/PPO |
$5,476.44
|
| Rate for Payer: Scott and White Medicare |
$3,286.91
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$9,170.50
|
| Rate for Payer: Superior Health Plan EPO |
$3,286.91
|
| Rate for Payer: Superior Health Plan Medicare |
$3,286.91
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3,286.91
|
| Rate for Payer: Universal American Medicare |
$3,286.91
|
| Rate for Payer: Wellcare Medicare |
$3,286.91
|
| Rate for Payer: Wellmed Medicare |
$3,286.91
|
|
|
Repair of nail bed
|
Facility
|
IP
|
$5,241.70
|
|
|
Service Code
|
HCPCS 11760
|
| Hospital Charge Code |
9900101
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$3,564.36
|
|
|
Repair of nail bed
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 11760
|
| Hospital Charge Code |
36011760
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$105.20 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$105.20
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$742.44
|
| Rate for Payer: Amerigroup Medicare |
$742.44
|
| Rate for Payer: BCBS of TX Blue Advantage |
$830.02
|
| Rate for Payer: BCBS of TX Blue Essentials |
$994.04
|
| Rate for Payer: BCBS of TX Medicare |
$742.44
|
| Rate for Payer: BCBS of TX PPO |
$1,252.49
|
| Rate for Payer: Cigna Commercial |
$1,569.38
|
| Rate for Payer: Cigna Medicare |
$742.44
|
| Rate for Payer: Employer Direct Commercial |
$742.44
|
| Rate for Payer: Humana Medicare/TRICARE |
$742.44
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$742.44
|
| Rate for Payer: Molina Medicare |
$742.44
|
| 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 |
$1,062.60
|
| Rate for Payer: Scott and White Medicare |
$742.44
|
| Rate for Payer: Superior Health Plan EPO |
$742.44
|
| Rate for Payer: Superior Health Plan Medicare |
$742.44
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$742.44
|
| Rate for Payer: Universal American Medicare |
$742.44
|
| Rate for Payer: Wellcare Medicare |
$742.44
|
| Rate for Payer: Wellmed Medicare |
$742.44
|
|
|
Repair of nail bed
|
Facility
|
OP
|
$5,241.70
|
|
|
Service Code
|
HCPCS 11760
|
| Hospital Charge Code |
9900101
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$105.20 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$105.20
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$742.44
|
| Rate for Payer: Amerigroup Medicare |
$742.44
|
| Rate for Payer: BCBS of TX Blue Advantage |
$830.02
|
| Rate for Payer: BCBS of TX Blue Essentials |
$994.04
|
| Rate for Payer: BCBS of TX Medicare |
$742.44
|
| Rate for Payer: BCBS of TX PPO |
$1,252.49
|
| Rate for Payer: Cash Price |
$3,564.36
|
| Rate for Payer: Cash Price |
$3,564.36
|
| Rate for Payer: Cash Price |
$3,564.36
|
| Rate for Payer: Cigna Commercial |
$1,569.38
|
| Rate for Payer: Cigna Medicaid |
$3,774.02
|
| Rate for Payer: Cigna Medicare |
$742.44
|
| Rate for Payer: Employer Direct Commercial |
$742.44
|
| Rate for Payer: Humana Medicare/TRICARE |
$742.44
|
| Rate for Payer: Molina CHIP/Medicaid |
$3,774.02
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$742.44
|
| Rate for Payer: Molina Medicare |
$742.44
|
| 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 |
$3,774.02
|
| Rate for Payer: Scott and White EPO/PPO |
$1,062.60
|
| Rate for Payer: Scott and White Medicare |
$742.44
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$3,774.02
|
| Rate for Payer: Superior Health Plan EPO |
$742.44
|
| Rate for Payer: Superior Health Plan Medicare |
$742.44
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$742.44
|
| Rate for Payer: Universal American Medicare |
$742.44
|
| Rate for Payer: Wellcare Medicare |
$742.44
|
| Rate for Payer: Wellmed Medicare |
$742.44
|
|
|
Repair of nasal valve collapse with subcutaneous/submucosal lateral wall implant(s)
|
Facility
|
OP
|
$12,816.85
|
|
|
Service Code
|
CPT 30468
|
| Hospital Charge Code |
36030468
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,843.09 |
| Max. Negotiated Rate |
$12,816.85 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2,843.09
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$5,946.81
|
| Rate for Payer: Amerigroup Medicare |
$5,946.81
|
| Rate for Payer: BCBS of TX Blue Advantage |
$8,493.70
|
| Rate for Payer: BCBS of TX Blue Essentials |
$10,172.10
|
| Rate for Payer: BCBS of TX Medicare |
$5,946.81
|
| Rate for Payer: BCBS of TX PPO |
$12,816.85
|
| Rate for Payer: Cigna Commercial |
$12,570.48
|
| Rate for Payer: Cigna Medicare |
$5,946.81
|
| Rate for Payer: Employer Direct Commercial |
$5,946.81
|
| Rate for Payer: Humana Medicare/TRICARE |
$5,946.81
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$5,946.81
|
| Rate for Payer: Molina Medicare |
$5,946.81
|
| 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 |
$9,908.12
|
| Rate for Payer: Scott and White Medicare |
$5,946.81
|
| Rate for Payer: Superior Health Plan EPO |
$5,946.81
|
| Rate for Payer: Superior Health Plan Medicare |
$5,946.81
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$5,946.81
|
| Rate for Payer: Universal American Medicare |
$5,946.81
|
| Rate for Payer: Wellcare Medicare |
$5,946.81
|
| Rate for Payer: Wellmed Medicare |
$5,946.81
|
|
|
Repair of nasal valve collapse with subcutaneous/submucosal lateral wall implant(s)
|
Facility
|
IP
|
$20,777.08
|
|
|
Service Code
|
HCPCS 30468
|
| Hospital Charge Code |
9900597
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$14,128.41
|
|
|
Repair of nasal valve collapse with subcutaneous/submucosal lateral wall implant(s)
|
Facility
|
OP
|
$20,777.08
|
|
|
Service Code
|
HCPCS 30468
|
| Hospital Charge Code |
9900597
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,843.09 |
| Max. Negotiated Rate |
$14,959.50 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2,843.09
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$5,946.81
|
| Rate for Payer: Amerigroup Medicare |
$5,946.81
|
| Rate for Payer: BCBS of TX Blue Advantage |
$8,493.70
|
| Rate for Payer: BCBS of TX Blue Essentials |
$10,172.10
|
| Rate for Payer: BCBS of TX Medicare |
$5,946.81
|
| Rate for Payer: BCBS of TX PPO |
$12,816.85
|
| Rate for Payer: Cash Price |
$14,128.41
|
| Rate for Payer: Cash Price |
$14,128.41
|
| Rate for Payer: Cash Price |
$14,128.41
|
| Rate for Payer: Cigna Commercial |
$12,570.48
|
| Rate for Payer: Cigna Medicaid |
$14,959.50
|
| Rate for Payer: Cigna Medicare |
$5,946.81
|
| Rate for Payer: Employer Direct Commercial |
$5,946.81
|
| Rate for Payer: Humana Medicare/TRICARE |
$5,946.81
|
| Rate for Payer: Molina CHIP/Medicaid |
$14,959.50
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$5,946.81
|
| Rate for Payer: Molina Medicare |
$5,946.81
|
| 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 |
$14,959.50
|
| Rate for Payer: Scott and White EPO/PPO |
$9,908.12
|
| Rate for Payer: Scott and White Medicare |
$5,946.81
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$14,959.50
|
| Rate for Payer: Superior Health Plan EPO |
$5,946.81
|
| Rate for Payer: Superior Health Plan Medicare |
$5,946.81
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$5,946.81
|
| Rate for Payer: Universal American Medicare |
$5,946.81
|
| Rate for Payer: Wellcare Medicare |
$5,946.81
|
| Rate for Payer: Wellmed Medicare |
$5,946.81
|
|
|
Repair of nasal vestibular stenosis (eg, spreader grafting, lateral nasal wall reconstruction)
|
Facility
|
IP
|
$17,929.40
|
|
|
Service Code
|
HCPCS 30465
|
| Hospital Charge Code |
9900596
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$12,191.99
|
|
|
Repair of nasal vestibular stenosis (eg, spreader grafting, lateral nasal wall reconstruction)
|
Facility
|
OP
|
$17,929.40
|
|
|
Service Code
|
HCPCS 30465
|
| Hospital Charge Code |
9900596
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,954.22 |
| Max. Negotiated Rate |
$12,909.17 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,954.22
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$5,946.81
|
| Rate for Payer: Amerigroup Medicare |
$5,946.81
|
| Rate for Payer: BCBS of TX Blue Advantage |
$8,100.39
|
| Rate for Payer: BCBS of TX Blue Essentials |
$9,701.06
|
| Rate for Payer: BCBS of TX Medicare |
$5,946.81
|
| Rate for Payer: BCBS of TX PPO |
$12,223.34
|
| Rate for Payer: Cash Price |
$12,191.99
|
| Rate for Payer: Cash Price |
$12,191.99
|
| Rate for Payer: Cash Price |
$12,191.99
|
| Rate for Payer: Cigna Commercial |
$12,570.48
|
| Rate for Payer: Cigna Medicaid |
$12,909.17
|
| Rate for Payer: Cigna Medicare |
$5,946.81
|
| Rate for Payer: Employer Direct Commercial |
$5,946.81
|
| Rate for Payer: Humana Medicare/TRICARE |
$5,946.81
|
| Rate for Payer: Molina CHIP/Medicaid |
$12,909.17
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$5,946.81
|
| Rate for Payer: Molina Medicare |
$5,946.81
|
| 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 |
$12,909.17
|
| Rate for Payer: Scott and White EPO/PPO |
$9,908.12
|
| Rate for Payer: Scott and White Medicare |
$5,946.81
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$12,909.17
|
| Rate for Payer: Superior Health Plan EPO |
$5,946.81
|
| Rate for Payer: Superior Health Plan Medicare |
$5,946.81
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$5,946.81
|
| Rate for Payer: Universal American Medicare |
$5,946.81
|
| Rate for Payer: Wellcare Medicare |
$5,946.81
|
| Rate for Payer: Wellmed Medicare |
$5,946.81
|
|
|
Repair of nasal vestibular stenosis (eg, spreader grafting, lateral nasal wall reconstruction)
|
Facility
|
OP
|
$12,570.48
|
|
|
Service Code
|
CPT 30465
|
| Hospital Charge Code |
36030465
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,954.22 |
| Max. Negotiated Rate |
$12,570.48 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,954.22
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$5,946.81
|
| Rate for Payer: Amerigroup Medicare |
$5,946.81
|
| Rate for Payer: BCBS of TX Blue Advantage |
$8,100.39
|
| Rate for Payer: BCBS of TX Blue Essentials |
$9,701.06
|
| Rate for Payer: BCBS of TX Medicare |
$5,946.81
|
| Rate for Payer: BCBS of TX PPO |
$12,223.34
|
| Rate for Payer: Cigna Commercial |
$12,570.48
|
| Rate for Payer: Cigna Medicare |
$5,946.81
|
| Rate for Payer: Employer Direct Commercial |
$5,946.81
|
| Rate for Payer: Humana Medicare/TRICARE |
$5,946.81
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$5,946.81
|
| Rate for Payer: Molina Medicare |
$5,946.81
|
| 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 |
$9,908.12
|
| Rate for Payer: Scott and White Medicare |
$5,946.81
|
| Rate for Payer: Superior Health Plan EPO |
$5,946.81
|
| Rate for Payer: Superior Health Plan Medicare |
$5,946.81
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$5,946.81
|
| Rate for Payer: Universal American Medicare |
$5,946.81
|
| Rate for Payer: Wellcare Medicare |
$5,946.81
|
| Rate for Payer: Wellmed Medicare |
$5,946.81
|
|
|
Repair of nonunion of carpal bone (excluding carpal scaphoid (navicular)) (includes obtaining graft
|
Facility
|
IP
|
$40,897.98
|
|
|
Service Code
|
HCPCS 25431
|
| Hospital Charge Code |
9900294
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$27,810.63
|
|
|
Repair of nonunion of carpal bone (excluding carpal scaphoid (navicular)) (includes obtaining graft
|
Facility
|
OP
|
$15,408.22
|
|
|
Service Code
|
CPT 25431
|
| Hospital Charge Code |
36025431
|
|
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
|
|
