|
Repair umbilical hernia, age 5 years or older reducible
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 49585
|
| Hospital Charge Code |
36049585
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,192.60 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: BCBS of TX Blue Advantage |
$5,192.60
|
| Rate for Payer: BCBS of TX Blue Essentials |
$6,218.68
|
| Rate for Payer: BCBS of TX PPO |
$7,835.54
|
| 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
|
|
|
Replacement of a tunneled centrally inserted w/out subcutaneous port or pump
|
Facility
|
IP
|
$12,148.04
|
|
|
Service Code
|
HCPCS 36581
|
| Hospital Charge Code |
991054
|
|
Hospital Revenue Code
|
480
|
| Rate for Payer: Cash Price |
$8,260.67
|
|
|
Replacement of a tunneled centrally inserted w/out subcutaneous port or pump
|
Facility
|
OP
|
$12,148.04
|
|
|
Service Code
|
HCPCS 36581
|
| Hospital Charge Code |
991054
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$220.04 |
| Max. Negotiated Rate |
$8,746.59 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,093.32
|
| 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 |
$8,260.67
|
| Rate for Payer: Cash Price |
$8,260.67
|
| Rate for Payer: Cash Price |
$8,260.67
|
| Rate for Payer: Cigna Commercial |
$6,704.76
|
| Rate for Payer: Cigna Medicaid |
$8,746.59
|
| 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 |
$8,746.59
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3,171.87
|
| Rate for Payer: Molina Medicare |
$3,171.87
|
| Rate for Payer: Multiplan Auto |
$7,896.23
|
| Rate for Payer: Multiplan Commercial |
$7,896.23
|
| Rate for Payer: Multiplan Workers Comp |
$7,896.23
|
| Rate for Payer: Parkland Medicaid |
$8,746.59
|
| Rate for Payer: Scott and White EPO/PPO |
$220.04
|
| Rate for Payer: Scott and White Medicare |
$3,171.87
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$8,746.59
|
| 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
|
|
|
Replacement of tissue expander with permanent implant
|
Facility
|
OP
|
$15,408.22
|
|
|
Service Code
|
CPT 11970
|
| Hospital Charge Code |
36011970
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,108.99 |
| Max. Negotiated Rate |
$15,408.22 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$3,108.99
|
| 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
|
|
|
Replacement of tissue expander with permanent implant
|
Facility
|
IP
|
$14,602.61
|
|
|
Service Code
|
HCPCS 11970
|
| Hospital Charge Code |
9900105
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$9,929.77
|
|
|
Replacement of tissue expander with permanent implant
|
Facility
|
OP
|
$14,602.61
|
|
|
Service Code
|
HCPCS 11970
|
| Hospital Charge Code |
9900105
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,108.99 |
| Max. Negotiated Rate |
$15,408.22 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$3,108.99
|
| 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 |
$9,929.77
|
| Rate for Payer: Cash Price |
$9,929.77
|
| Rate for Payer: Cash Price |
$9,929.77
|
| Rate for Payer: Cigna Commercial |
$15,408.22
|
| Rate for Payer: Cigna Medicaid |
$10,513.88
|
| 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 |
$10,513.88
|
| 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 |
$10,513.88
|
| 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 |
$10,513.88
|
| 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
|
|
|
reporting injection of platelet rich plasma to a targeted site
|
Facility
|
OP
|
$1,575.00
|
|
|
Service Code
|
HCPCS 0232T
|
| Hospital Charge Code |
9900913
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$141.75 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$141.75
|
| 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 |
$1,071.00
|
| Rate for Payer: Cash Price |
$1,071.00
|
| Rate for Payer: Cash Price |
$1,071.00
|
| Rate for Payer: Cigna Commercial |
$948.59
|
| Rate for Payer: Cigna Medicaid |
$1,134.00
|
| 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 |
$1,134.00
|
| 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 |
$1,134.00
|
| Rate for Payer: Scott and White EPO/PPO |
$787.50
|
| Rate for Payer: Scott and White Medicare |
$448.76
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,134.00
|
| 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
|
|
|
reporting injection of platelet rich plasma to a targeted site
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 0232T
|
| Hospital Charge Code |
3600232T
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$448.76 |
| Max. Negotiated Rate |
$10,000.00 |
| 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: Cigna Commercial |
$948.59
|
| 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 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: Scott and White Medicare |
$448.76
|
| 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
|
|
|
reporting injection of platelet rich plasma to a targeted site
|
Facility
|
IP
|
$1,575.00
|
|
|
Service Code
|
HCPCS 0232T
|
| Hospital Charge Code |
9900913
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$1,071.00
|
|
|
REPOS ENDO VENACAVA FILT
|
Facility
|
OP
|
$17,664.00
|
|
|
Service Code
|
HCPCS 37192
|
| Hospital Charge Code |
4617192
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,589.76 |
| Max. Negotiated Rate |
$12,718.08 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,589.76
|
| 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 |
$12,011.52
|
| Rate for Payer: Cash Price |
$12,011.52
|
| Rate for Payer: Cash Price |
$12,011.52
|
| Rate for Payer: Cigna Commercial |
$6,704.76
|
| Rate for Payer: Cigna Medicaid |
$12,718.08
|
| 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 |
$12,718.08
|
| 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 |
$12,718.08
|
| 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 |
$12,718.08
|
| 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
|
|
|
REPOS ENDO VENACAVA FILT
|
Facility
|
IP
|
$17,664.00
|
|
|
Service Code
|
HCPCS 37192
|
| Hospital Charge Code |
4617192
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$12,011.52
|
|
|
REPOSITION 1 VENTRIC LEAD
|
Facility
|
OP
|
$9,924.00
|
|
|
Service Code
|
HCPCS 33226
|
| Hospital Charge Code |
2303329
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$582.24 |
| Max. Negotiated Rate |
$7,145.28 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$893.16
|
| 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 |
$6,748.32
|
| Rate for Payer: Cash Price |
$6,748.32
|
| Rate for Payer: Cash Price |
$6,748.32
|
| Rate for Payer: Cigna Commercial |
$6,704.76
|
| Rate for Payer: Cigna Medicaid |
$7,145.28
|
| 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 |
$7,145.28
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3,171.87
|
| Rate for Payer: Molina Medicare |
$3,171.87
|
| Rate for Payer: Multiplan Auto |
$6,450.60
|
| Rate for Payer: Multiplan Commercial |
$6,450.60
|
| Rate for Payer: Multiplan Workers Comp |
$6,450.60
|
| Rate for Payer: Parkland Medicaid |
$7,145.28
|
| Rate for Payer: Scott and White EPO/PPO |
$582.24
|
| Rate for Payer: Scott and White Medicare |
$3,171.87
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$7,145.28
|
| 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
|
|
|
REPOSITION 1 VENTRIC LEAD
|
Facility
|
IP
|
$9,924.00
|
|
|
Service Code
|
HCPCS 33226
|
| Hospital Charge Code |
2303329
|
|
Hospital Revenue Code
|
481
|
| Rate for Payer: Cash Price |
$6,748.32
|
|
|
Repositioning of intraocular lens prosthesis, requiring an incision (separate procedure)
|
Facility
|
IP
|
$5,717.69
|
|
|
Service Code
|
HCPCS 66825
|
| Hospital Charge Code |
9900867
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$3,888.03
|
|
|
Repositioning of intraocular lens prosthesis, requiring an incision (separate procedure)
|
Facility
|
OP
|
$5,717.69
|
|
|
Service Code
|
HCPCS 66825
|
| Hospital Charge Code |
9900867
|
|
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
|
|
|
Repositioning of intraocular lens prosthesis, requiring an incision (separate procedure)
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 66825
|
| Hospital Charge Code |
36066825
|
|
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
|
|
|
repositioning sleeve
|
Facility
|
IP
|
$53.34
|
|
| Hospital Charge Code |
993561
|
|
Hospital Revenue Code
|
270
|
| Rate for Payer: Cash Price |
$36.27
|
|
|
repositioning sleeve
|
Facility
|
OP
|
$53.34
|
|
| Hospital Charge Code |
993561
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$38.40 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$4.80
|
| Rate for Payer: BCBS of TX Blue Advantage |
$16.00
|
| Rate for Payer: BCBS of TX Blue Essentials |
$19.20
|
| Rate for Payer: BCBS of TX PPO |
$21.34
|
| Rate for Payer: Cash Price |
$36.27
|
| Rate for Payer: Cigna Medicaid |
$38.40
|
| Rate for Payer: Molina CHIP/Medicaid |
$38.40
|
| Rate for Payer: Multiplan Auto |
$34.67
|
| Rate for Payer: Multiplan Commercial |
$34.67
|
| Rate for Payer: Multiplan Workers Comp |
$34.67
|
| Rate for Payer: Parkland Medicaid |
$38.40
|
| Rate for Payer: Scott and White EPO/PPO |
$26.67
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$38.40
|
| Rate for Payer: Superior Health Plan EPO |
$7.25
|
|
|
REPOSITN CV CATH W/FLURO
|
Facility
|
OP
|
$1,788.00
|
|
|
Service Code
|
HCPCS 36597
|
| Hospital Charge Code |
4614241
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$446.27 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$446.27
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,581.33
|
| Rate for Payer: Amerigroup Medicare |
$1,581.33
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,723.99
|
| Rate for Payer: BCBS of TX Blue Essentials |
$3,262.26
|
| Rate for Payer: BCBS of TX Medicare |
$1,581.33
|
| Rate for Payer: BCBS of TX PPO |
$4,110.45
|
| Rate for Payer: Cash Price |
$1,215.84
|
| Rate for Payer: Cash Price |
$1,215.84
|
| Rate for Payer: Cash Price |
$1,215.84
|
| Rate for Payer: Cigna Commercial |
$3,342.63
|
| Rate for Payer: Cigna Medicaid |
$1,287.36
|
| Rate for Payer: Cigna Medicare |
$1,581.33
|
| Rate for Payer: Employer Direct Commercial |
$1,581.33
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,581.33
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,287.36
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,581.33
|
| Rate for Payer: Molina Medicare |
$1,581.33
|
| 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 |
$1,287.36
|
| Rate for Payer: Scott and White EPO/PPO |
$2,709.66
|
| Rate for Payer: Scott and White Medicare |
$1,581.33
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,287.36
|
| Rate for Payer: Superior Health Plan EPO |
$1,581.33
|
| Rate for Payer: Superior Health Plan Medicare |
$1,581.33
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,581.33
|
| Rate for Payer: Universal American Medicare |
$1,581.33
|
| Rate for Payer: Wellcare Medicare |
$1,581.33
|
| Rate for Payer: Wellmed Medicare |
$1,581.33
|
|
|
REPOSITN CV CATH W/FLURO
|
Facility
|
IP
|
$1,788.00
|
|
|
Service Code
|
HCPCS 36597
|
| Hospital Charge Code |
4614241
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$1,215.84
|
|
|
REPROCESSED HARMONIC ACE+7 SHEARS WITH ADV. HEMOSTASIS, USE ONLY WITH GEN11 SW V2018-1.1 AND LOWER 5 MM X 23 CM (ETHICON HARH23)
|
Facility
|
OP
|
$6,377.17
|
|
| Hospital Charge Code |
993109
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$573.95 |
| Max. Negotiated Rate |
$4,591.56 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$573.95
|
| Rate for Payer: BCBS of TX Blue Advantage |
$1,913.15
|
| Rate for Payer: BCBS of TX Blue Essentials |
$2,295.78
|
| Rate for Payer: BCBS of TX PPO |
$2,550.87
|
| Rate for Payer: Cash Price |
$4,336.48
|
| Rate for Payer: Cigna Medicaid |
$4,591.56
|
| Rate for Payer: Molina CHIP/Medicaid |
$4,591.56
|
| Rate for Payer: Multiplan Auto |
$4,145.16
|
| Rate for Payer: Multiplan Commercial |
$4,145.16
|
| Rate for Payer: Multiplan Workers Comp |
$4,145.16
|
| Rate for Payer: Parkland Medicaid |
$4,591.56
|
| Rate for Payer: Scott and White EPO/PPO |
$3,188.59
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$4,591.56
|
| Rate for Payer: Superior Health Plan EPO |
$867.30
|
|
|
REPROCESSED HARMONIC ACE+7 SHEARS WITH ADV. HEMOSTASIS, USE ONLY WITH GEN11 SW V2018-1.1 AND LOWER 5 MM X 23 CM (ETHICON HARH23)
|
Facility
|
IP
|
$6,377.17
|
|
| Hospital Charge Code |
993109
|
|
Hospital Revenue Code
|
270
|
| Rate for Payer: Cash Price |
$4,336.48
|
|
|
REPS TRNSV LD RT ATR/VNT
|
Facility
|
OP
|
$6,691.00
|
|
|
Service Code
|
HCPCS 33215
|
| Hospital Charge Code |
2312932
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$372.75 |
| Max. Negotiated Rate |
$6,983.63 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$602.19
|
| 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 |
$4,549.88
|
| Rate for Payer: Cash Price |
$4,549.88
|
| Rate for Payer: Cash Price |
$4,549.88
|
| Rate for Payer: Cigna Commercial |
$6,704.76
|
| Rate for Payer: Cigna Medicaid |
$4,817.52
|
| 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 |
$4,817.52
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3,171.87
|
| Rate for Payer: Molina Medicare |
$3,171.87
|
| Rate for Payer: Multiplan Auto |
$4,349.15
|
| Rate for Payer: Multiplan Commercial |
$4,349.15
|
| Rate for Payer: Multiplan Workers Comp |
$4,349.15
|
| Rate for Payer: Parkland Medicaid |
$4,817.52
|
| Rate for Payer: Scott and White EPO/PPO |
$372.75
|
| Rate for Payer: Scott and White Medicare |
$3,171.87
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$4,817.52
|
| 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
|
|
|
REPS TRNSV LD RT ATR/VNT
|
Facility
|
IP
|
$6,691.00
|
|
|
Service Code
|
HCPCS 33215
|
| Hospital Charge Code |
2312932
|
|
Hospital Revenue Code
|
481
|
| Rate for Payer: Cash Price |
$4,549.88
|
|
|
Rescue Fixed Screw, 4.5x14mm
|
Facility
|
IP
|
$903.61
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
992221
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$225.90 |
| Max. Negotiated Rate |
$451.81 |
| Rate for Payer: Cash Price |
$614.45
|
| Rate for Payer: Cigna Commercial |
$225.90
|
| Rate for Payer: Multiplan Auto |
$451.81
|
| Rate for Payer: Multiplan Commercial |
$451.81
|
| Rate for Payer: Multiplan Workers Comp |
$451.81
|
| Rate for Payer: Scott and White EPO/PPO |
$451.81
|
|
