|
Revascularization, endovascular, open or percutaneous, femoral, popliteal artery(s), unilateral; wit
|
Facility
|
OP
|
$137,420.80
|
|
|
Service Code
|
HCPCS 37227
|
| Hospital Charge Code |
2320539
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$10,000.00 |
| Max. Negotiated Rate |
$98,942.98 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$12,367.87
|
| Rate for Payer: BCBS of TX Blue Advantage |
$26,619.75
|
| Rate for Payer: BCBS of TX Blue Essentials |
$31,879.94
|
| Rate for Payer: BCBS of TX PPO |
$40,168.72
|
| Rate for Payer: Cash Price |
$93,446.14
|
| Rate for Payer: Cash Price |
$93,446.14
|
| Rate for Payer: Cash Price |
$93,446.14
|
| Rate for Payer: Cigna Medicaid |
$98,942.98
|
| Rate for Payer: Molina CHIP/Medicaid |
$98,942.98
|
| 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 |
$98,942.98
|
| Rate for Payer: Scott and White EPO/PPO |
$68,710.40
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$98,942.98
|
| Rate for Payer: Superior Health Plan EPO |
$18,689.23
|
|
|
Revascularization,endovascular,open or percutaneous, tibial and peroneal vascular territory, with transluminal angioplasty,
|
Facility
|
IP
|
$47,176.92
|
|
|
Service Code
|
HCPCS 37280
|
| Hospital Charge Code |
994227
|
|
Hospital Revenue Code
|
480
|
| Rate for Payer: Cash Price |
$32,080.31
|
|
|
Revascularization,endovascular,open or percutaneous, tibial and peroneal vascular territory, with transluminal angioplasty,
|
Facility
|
OP
|
$47,176.92
|
|
|
Service Code
|
HCPCS 37280
|
| Hospital Charge Code |
994227
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$4,245.92 |
| Max. Negotiated Rate |
$33,967.38 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$4,245.92
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$11,596.79
|
| Rate for Payer: Amerigroup Medicare |
$11,596.79
|
| Rate for Payer: BCBS of TX Blue Advantage |
$14,153.08
|
| Rate for Payer: BCBS of TX Blue Essentials |
$16,983.69
|
| Rate for Payer: BCBS of TX Medicare |
$11,596.79
|
| Rate for Payer: BCBS of TX PPO |
$18,870.77
|
| Rate for Payer: Cash Price |
$32,080.31
|
| Rate for Payer: Cash Price |
$32,080.31
|
| Rate for Payer: Cash Price |
$32,080.31
|
| Rate for Payer: Cigna Commercial |
$24,513.51
|
| Rate for Payer: Cigna Medicaid |
$33,967.38
|
| Rate for Payer: Cigna Medicare |
$11,596.79
|
| Rate for Payer: Employer Direct Commercial |
$11,596.79
|
| Rate for Payer: Humana Medicare/TRICARE |
$11,596.79
|
| Rate for Payer: Molina CHIP/Medicaid |
$33,967.38
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$11,596.79
|
| Rate for Payer: Molina Medicare |
$11,596.79
|
| Rate for Payer: Multiplan Auto |
$30,665.00
|
| Rate for Payer: Multiplan Commercial |
$30,665.00
|
| Rate for Payer: Multiplan Workers Comp |
$30,665.00
|
| Rate for Payer: Parkland Medicaid |
$33,967.38
|
| Rate for Payer: Scott and White EPO/PPO |
$23,588.46
|
| Rate for Payer: Scott and White Medicare |
$11,596.79
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$33,967.38
|
| Rate for Payer: Superior Health Plan EPO |
$11,596.79
|
| Rate for Payer: Superior Health Plan Medicare |
$11,596.79
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$11,596.79
|
| Rate for Payer: Universal American Medicare |
$11,596.79
|
| Rate for Payer: Wellcare Medicare |
$11,596.79
|
| Rate for Payer: Wellmed Medicare |
$11,596.79
|
|
|
Revascularization, endovascular, open or percutaneous, tibial, peroneal artery, unilateral, initial
|
Facility
|
OP
|
$40,168.72
|
|
|
Service Code
|
CPT 37231
|
| Hospital Charge Code |
36037231
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$10,000.00 |
| Max. Negotiated Rate |
$40,168.72 |
| Rate for Payer: BCBS of TX Blue Advantage |
$26,619.75
|
| Rate for Payer: BCBS of TX Blue Essentials |
$31,879.94
|
| Rate for Payer: BCBS of TX PPO |
$40,168.72
|
| 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
|
|
|
Revascularization, endovascular, open or percutaneous, tibial, peroneal artery, unilateral, initial
|
Facility
|
OP
|
$137,420.80
|
|
|
Service Code
|
HCPCS 37231
|
| Hospital Charge Code |
2320543
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$10,000.00 |
| Max. Negotiated Rate |
$98,942.98 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$12,367.87
|
| Rate for Payer: BCBS of TX Blue Advantage |
$26,619.75
|
| Rate for Payer: BCBS of TX Blue Essentials |
$31,879.94
|
| Rate for Payer: BCBS of TX PPO |
$40,168.72
|
| Rate for Payer: Cash Price |
$93,446.14
|
| Rate for Payer: Cash Price |
$93,446.14
|
| Rate for Payer: Cash Price |
$93,446.14
|
| Rate for Payer: Cigna Medicaid |
$98,942.98
|
| Rate for Payer: Molina CHIP/Medicaid |
$98,942.98
|
| 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 |
$98,942.98
|
| Rate for Payer: Scott and White EPO/PPO |
$68,710.40
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$98,942.98
|
| Rate for Payer: Superior Health Plan EPO |
$18,689.23
|
|
|
Revascularization, endovascular, open or percutaneous, tibial, peroneal artery, unilateral, initial
|
Facility
|
IP
|
$137,420.80
|
|
|
Service Code
|
HCPCS 37231
|
| Hospital Charge Code |
2320543
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$93,446.14
|
|
|
Revascularization, endovascular, open or percutaneous, tibial, peroneal artery, unilateral, initial
|
Facility
|
OP
|
$137,420.80
|
|
|
Service Code
|
HCPCS 37231
|
| Hospital Charge Code |
9900630
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$10,000.00 |
| Max. Negotiated Rate |
$98,942.98 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$12,367.87
|
| Rate for Payer: BCBS of TX Blue Advantage |
$26,619.75
|
| Rate for Payer: BCBS of TX Blue Essentials |
$31,879.94
|
| Rate for Payer: BCBS of TX PPO |
$40,168.72
|
| Rate for Payer: Cash Price |
$93,446.14
|
| Rate for Payer: Cash Price |
$93,446.14
|
| Rate for Payer: Cash Price |
$93,446.14
|
| Rate for Payer: Cigna Medicaid |
$98,942.98
|
| Rate for Payer: Molina CHIP/Medicaid |
$98,942.98
|
| 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 |
$98,942.98
|
| Rate for Payer: Scott and White EPO/PPO |
$68,710.40
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$98,942.98
|
| Rate for Payer: Superior Health Plan EPO |
$18,689.23
|
|
|
Revascularization, endovascular, open or percutaneous, tibial, peroneal artery, unilateral, initial
|
Facility
|
IP
|
$137,420.80
|
|
|
Service Code
|
HCPCS 37231
|
| Hospital Charge Code |
9900630
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$93,446.14
|
|
|
Revascularization, unilateral; complex lesion, initial vessel
|
Facility
|
OP
|
$47,176.92
|
|
|
Service Code
|
HCPCS 37260
|
| Hospital Charge Code |
994224
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$4,245.92 |
| Max. Negotiated Rate |
$33,967.38 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$4,245.92
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$11,596.79
|
| Rate for Payer: Amerigroup Medicare |
$11,596.79
|
| Rate for Payer: BCBS of TX Blue Advantage |
$14,153.08
|
| Rate for Payer: BCBS of TX Blue Essentials |
$16,983.69
|
| Rate for Payer: BCBS of TX Medicare |
$11,596.79
|
| Rate for Payer: BCBS of TX PPO |
$18,870.77
|
| Rate for Payer: Cash Price |
$32,080.31
|
| Rate for Payer: Cash Price |
$32,080.31
|
| Rate for Payer: Cash Price |
$32,080.31
|
| Rate for Payer: Cigna Commercial |
$24,513.51
|
| Rate for Payer: Cigna Medicaid |
$33,967.38
|
| Rate for Payer: Cigna Medicare |
$11,596.79
|
| Rate for Payer: Employer Direct Commercial |
$11,596.79
|
| Rate for Payer: Humana Medicare/TRICARE |
$11,596.79
|
| Rate for Payer: Molina CHIP/Medicaid |
$33,967.38
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$11,596.79
|
| Rate for Payer: Molina Medicare |
$11,596.79
|
| Rate for Payer: Multiplan Auto |
$30,665.00
|
| Rate for Payer: Multiplan Commercial |
$30,665.00
|
| Rate for Payer: Multiplan Workers Comp |
$30,665.00
|
| Rate for Payer: Parkland Medicaid |
$33,967.38
|
| Rate for Payer: Scott and White EPO/PPO |
$23,588.46
|
| Rate for Payer: Scott and White Medicare |
$11,596.79
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$33,967.38
|
| Rate for Payer: Superior Health Plan EPO |
$11,596.79
|
| Rate for Payer: Superior Health Plan Medicare |
$11,596.79
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$11,596.79
|
| Rate for Payer: Universal American Medicare |
$11,596.79
|
| Rate for Payer: Wellcare Medicare |
$11,596.79
|
| Rate for Payer: Wellmed Medicare |
$11,596.79
|
|
|
Revascularization, unilateral; complex lesion, initial vessel
|
Facility
|
IP
|
$47,176.92
|
|
|
Service Code
|
HCPCS 37260
|
| Hospital Charge Code |
994224
|
|
Hospital Revenue Code
|
480
|
| Rate for Payer: Cash Price |
$32,080.31
|
|
|
REVAS PERC TRANS TOT OCC
|
Facility
|
IP
|
$17,676.00
|
|
|
Service Code
|
HCPCS 92943
|
| Hospital Charge Code |
2350041
|
|
Hospital Revenue Code
|
480
|
| Rate for Payer: Cash Price |
$12,019.68
|
|
|
REVAS PERC TRANS TOT OCC
|
Facility
|
OP
|
$17,676.00
|
|
|
Service Code
|
HCPCS 92943
|
| Hospital Charge Code |
2350041
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,590.84 |
| Max. Negotiated Rate |
$24,969.37 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,590.84
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$11,596.79
|
| Rate for Payer: Amerigroup Medicare |
$11,596.79
|
| Rate for Payer: BCBS of TX Blue Advantage |
$16,547.16
|
| Rate for Payer: BCBS of TX Blue Essentials |
$19,816.96
|
| Rate for Payer: BCBS of TX Medicare |
$11,596.79
|
| Rate for Payer: BCBS of TX PPO |
$24,969.37
|
| Rate for Payer: Cash Price |
$12,019.68
|
| Rate for Payer: Cash Price |
$12,019.68
|
| Rate for Payer: Cash Price |
$12,019.68
|
| Rate for Payer: Cigna Commercial |
$24,513.51
|
| Rate for Payer: Cigna Medicaid |
$12,726.72
|
| Rate for Payer: Cigna Medicare |
$11,596.79
|
| Rate for Payer: Employer Direct Commercial |
$11,596.79
|
| Rate for Payer: Humana Medicare/TRICARE |
$11,596.79
|
| Rate for Payer: Molina CHIP/Medicaid |
$12,726.72
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$11,596.79
|
| Rate for Payer: Molina Medicare |
$11,596.79
|
| Rate for Payer: Multiplan Auto |
$11,489.40
|
| Rate for Payer: Multiplan Commercial |
$11,489.40
|
| Rate for Payer: Multiplan Workers Comp |
$11,489.40
|
| Rate for Payer: Parkland Medicaid |
$12,726.72
|
| Rate for Payer: Scott and White EPO/PPO |
$8,838.00
|
| Rate for Payer: Scott and White Medicare |
$11,596.79
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$12,726.72
|
| Rate for Payer: Superior Health Plan EPO |
$11,596.79
|
| Rate for Payer: Superior Health Plan Medicare |
$11,596.79
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$11,596.79
|
| Rate for Payer: Universal American Medicare |
$11,596.79
|
| Rate for Payer: Wellcare Medicare |
$11,596.79
|
| Rate for Payer: Wellmed Medicare |
$11,596.79
|
|
|
Reverse T3, Serum SO
|
Facility
|
OP
|
$121.00
|
|
|
Service Code
|
HCPCS 84482
|
| Hospital Charge Code |
1707470
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.15 |
| Max. Negotiated Rate |
$87.12 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$6.15
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$15.76
|
| Rate for Payer: Amerigroup Medicare |
$15.76
|
| Rate for Payer: BCBS of TX Blue Advantage |
$36.30
|
| Rate for Payer: BCBS of TX Blue Essentials |
$43.56
|
| Rate for Payer: BCBS of TX Medicare |
$15.76
|
| Rate for Payer: BCBS of TX PPO |
$48.40
|
| Rate for Payer: Cash Price |
$82.28
|
| Rate for Payer: Cash Price |
$82.28
|
| Rate for Payer: Cigna Medicaid |
$87.12
|
| Rate for Payer: Cigna Medicare |
$15.76
|
| Rate for Payer: Employer Direct Commercial |
$15.76
|
| Rate for Payer: Humana Medicare/TRICARE |
$15.76
|
| Rate for Payer: Molina CHIP/Medicaid |
$87.12
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$15.76
|
| Rate for Payer: Molina Medicare |
$15.76
|
| Rate for Payer: Multiplan Auto |
$78.65
|
| Rate for Payer: Multiplan Commercial |
$78.65
|
| Rate for Payer: Multiplan Workers Comp |
$78.65
|
| Rate for Payer: Parkland Medicaid |
$87.12
|
| Rate for Payer: Scott and White EPO/PPO |
$19.70
|
| Rate for Payer: Scott and White Medicare |
$15.76
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$87.12
|
| Rate for Payer: Superior Health Plan EPO |
$15.76
|
| Rate for Payer: Superior Health Plan Medicare |
$15.76
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$15.76
|
| Rate for Payer: Universal American Medicare |
$15.76
|
| Rate for Payer: Wellcare Medicare |
$15.76
|
| Rate for Payer: Wellmed Medicare |
$15.76
|
|
|
Reverse T3, Serum SO
|
Facility
|
IP
|
$121.00
|
|
|
Service Code
|
HCPCS 84482
|
| Hospital Charge Code |
1707470
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$82.28
|
|
|
REVISE/RELOCATE PACER SKIN POCKET
|
Facility
|
IP
|
$3,818.00
|
|
|
Service Code
|
HCPCS 33222
|
| Hospital Charge Code |
2302461
|
|
Hospital Revenue Code
|
481
|
| Rate for Payer: Cash Price |
$2,596.24
|
|
|
REVISE/RELOCATE PACER SKIN POCKET
|
Facility
|
OP
|
$3,818.00
|
|
|
Service Code
|
HCPCS 33222
|
| Hospital Charge Code |
2302461
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$343.62 |
| Max. Negotiated Rate |
$4,381.27 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$343.62
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$2,072.68
|
| Rate for Payer: Amerigroup Medicare |
$2,072.68
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,709.98
|
| Rate for Payer: BCBS of TX Blue Essentials |
$3,245.48
|
| Rate for Payer: BCBS of TX Medicare |
$2,072.68
|
| Rate for Payer: BCBS of TX PPO |
$4,089.30
|
| Rate for Payer: Cash Price |
$2,596.24
|
| Rate for Payer: Cash Price |
$2,596.24
|
| Rate for Payer: Cash Price |
$2,596.24
|
| Rate for Payer: Cigna Commercial |
$4,381.27
|
| Rate for Payer: Cigna Medicaid |
$2,748.96
|
| Rate for Payer: Cigna Medicare |
$2,072.68
|
| Rate for Payer: Employer Direct Commercial |
$2,072.68
|
| Rate for Payer: Humana Medicare/TRICARE |
$2,072.68
|
| Rate for Payer: Molina CHIP/Medicaid |
$2,748.96
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$2,072.68
|
| Rate for Payer: Molina Medicare |
$2,072.68
|
| Rate for Payer: Multiplan Auto |
$2,481.70
|
| Rate for Payer: Multiplan Commercial |
$2,481.70
|
| Rate for Payer: Multiplan Workers Comp |
$2,481.70
|
| Rate for Payer: Parkland Medicaid |
$2,748.96
|
| Rate for Payer: Scott and White EPO/PPO |
$1,909.00
|
| Rate for Payer: Scott and White Medicare |
$2,072.68
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$2,748.96
|
| Rate for Payer: Superior Health Plan EPO |
$2,072.68
|
| Rate for Payer: Superior Health Plan Medicare |
$2,072.68
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$2,072.68
|
| Rate for Payer: Universal American Medicare |
$2,072.68
|
| Rate for Payer: Wellcare Medicare |
$2,072.68
|
| Rate for Payer: Wellmed Medicare |
$2,072.68
|
|
|
Revise ulnar nerve at elbow
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 64718
|
| Hospital Charge Code |
36064718
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$659.94 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$659.94
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,961.62
|
| Rate for Payer: Amerigroup Medicare |
$1,961.62
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,871.31
|
| Rate for Payer: BCBS of TX Blue Essentials |
$3,438.70
|
| Rate for Payer: BCBS of TX Medicare |
$1,961.62
|
| Rate for Payer: BCBS of TX PPO |
$4,332.76
|
| Rate for Payer: Cigna Commercial |
$4,146.52
|
| Rate for Payer: Cigna Medicare |
$1,961.62
|
| Rate for Payer: Employer Direct Commercial |
$1,961.62
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,961.62
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,961.62
|
| Rate for Payer: Molina Medicare |
$1,961.62
|
| Rate for Payer: Multiplan Auto |
$10,000.00
|
| Rate for Payer: Multiplan Commercial |
$10,000.00
|
| Rate for Payer: Multiplan Workers Comp |
$10,000.00
|
| Rate for Payer: Scott and White EPO/PPO |
$3,629.00
|
| Rate for Payer: Scott and White Medicare |
$1,961.62
|
| Rate for Payer: Superior Health Plan EPO |
$1,961.62
|
| Rate for Payer: Superior Health Plan Medicare |
$1,961.62
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,961.62
|
| Rate for Payer: Universal American Medicare |
$1,961.62
|
| Rate for Payer: Wellcare Medicare |
$1,961.62
|
| Rate for Payer: Wellmed Medicare |
$1,961.62
|
|
|
Revise ulnar nerve at elbow
|
Facility
|
IP
|
$10,526.34
|
|
|
Service Code
|
HCPCS 64718
|
| Hospital Charge Code |
9900840
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$7,157.91
|
|
|
Revise ulnar nerve at elbow
|
Facility
|
OP
|
$10,526.34
|
|
|
Service Code
|
HCPCS 64718
|
| Hospital Charge Code |
9900840
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$659.94 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$659.94
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,961.62
|
| Rate for Payer: Amerigroup Medicare |
$1,961.62
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,871.31
|
| Rate for Payer: BCBS of TX Blue Essentials |
$3,438.70
|
| Rate for Payer: BCBS of TX Medicare |
$1,961.62
|
| Rate for Payer: BCBS of TX PPO |
$4,332.76
|
| Rate for Payer: Cash Price |
$7,157.91
|
| Rate for Payer: Cash Price |
$7,157.91
|
| Rate for Payer: Cash Price |
$7,157.91
|
| Rate for Payer: Cigna Commercial |
$4,146.52
|
| Rate for Payer: Cigna Medicaid |
$7,578.96
|
| Rate for Payer: Cigna Medicare |
$1,961.62
|
| Rate for Payer: Employer Direct Commercial |
$1,961.62
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,961.62
|
| Rate for Payer: Molina CHIP/Medicaid |
$7,578.96
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,961.62
|
| Rate for Payer: Molina Medicare |
$1,961.62
|
| Rate for Payer: Multiplan Auto |
$10,000.00
|
| Rate for Payer: Multiplan Commercial |
$10,000.00
|
| Rate for Payer: Multiplan Workers Comp |
$10,000.00
|
| Rate for Payer: Parkland Medicaid |
$7,578.96
|
| Rate for Payer: Scott and White EPO/PPO |
$3,629.00
|
| Rate for Payer: Scott and White Medicare |
$1,961.62
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$7,578.96
|
| Rate for Payer: Superior Health Plan EPO |
$1,961.62
|
| Rate for Payer: Superior Health Plan Medicare |
$1,961.62
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,961.62
|
| Rate for Payer: Universal American Medicare |
$1,961.62
|
| Rate for Payer: Wellcare Medicare |
$1,961.62
|
| Rate for Payer: Wellmed Medicare |
$1,961.62
|
|
|
Revise ulnar nerve at wrist
|
Facility
|
IP
|
$6,140.37
|
|
|
Service Code
|
HCPCS 64719
|
| Hospital Charge Code |
9900841
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$4,175.45
|
|
|
Revise ulnar nerve at wrist
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 64719
|
| Hospital Charge Code |
36064719
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$659.94 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$659.94
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,961.62
|
| Rate for Payer: Amerigroup Medicare |
$1,961.62
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,871.31
|
| Rate for Payer: BCBS of TX Blue Essentials |
$3,438.70
|
| Rate for Payer: BCBS of TX Medicare |
$1,961.62
|
| Rate for Payer: BCBS of TX PPO |
$4,332.76
|
| Rate for Payer: Cigna Commercial |
$4,146.52
|
| Rate for Payer: Cigna Medicare |
$1,961.62
|
| Rate for Payer: Employer Direct Commercial |
$1,961.62
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,961.62
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,961.62
|
| Rate for Payer: Molina Medicare |
$1,961.62
|
| Rate for Payer: Multiplan Auto |
$10,000.00
|
| Rate for Payer: Multiplan Commercial |
$10,000.00
|
| Rate for Payer: Multiplan Workers Comp |
$10,000.00
|
| Rate for Payer: Scott and White EPO/PPO |
$3,629.00
|
| Rate for Payer: Scott and White Medicare |
$1,961.62
|
| Rate for Payer: Superior Health Plan EPO |
$1,961.62
|
| Rate for Payer: Superior Health Plan Medicare |
$1,961.62
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,961.62
|
| Rate for Payer: Universal American Medicare |
$1,961.62
|
| Rate for Payer: Wellcare Medicare |
$1,961.62
|
| Rate for Payer: Wellmed Medicare |
$1,961.62
|
|
|
Revise ulnar nerve at wrist
|
Facility
|
OP
|
$6,140.37
|
|
|
Service Code
|
HCPCS 64719
|
| Hospital Charge Code |
9900841
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$659.94 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$659.94
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,961.62
|
| Rate for Payer: Amerigroup Medicare |
$1,961.62
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,871.31
|
| Rate for Payer: BCBS of TX Blue Essentials |
$3,438.70
|
| Rate for Payer: BCBS of TX Medicare |
$1,961.62
|
| Rate for Payer: BCBS of TX PPO |
$4,332.76
|
| Rate for Payer: Cash Price |
$4,175.45
|
| Rate for Payer: Cash Price |
$4,175.45
|
| Rate for Payer: Cash Price |
$4,175.45
|
| Rate for Payer: Cigna Commercial |
$4,146.52
|
| Rate for Payer: Cigna Medicaid |
$4,421.07
|
| Rate for Payer: Cigna Medicare |
$1,961.62
|
| Rate for Payer: Employer Direct Commercial |
$1,961.62
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,961.62
|
| Rate for Payer: Molina CHIP/Medicaid |
$4,421.07
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,961.62
|
| Rate for Payer: Molina Medicare |
$1,961.62
|
| Rate for Payer: Multiplan Auto |
$10,000.00
|
| Rate for Payer: Multiplan Commercial |
$10,000.00
|
| Rate for Payer: Multiplan Workers Comp |
$10,000.00
|
| Rate for Payer: Parkland Medicaid |
$4,421.07
|
| Rate for Payer: Scott and White EPO/PPO |
$3,629.00
|
| Rate for Payer: Scott and White Medicare |
$1,961.62
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$4,421.07
|
| Rate for Payer: Superior Health Plan EPO |
$1,961.62
|
| Rate for Payer: Superior Health Plan Medicare |
$1,961.62
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,961.62
|
| Rate for Payer: Universal American Medicare |
$1,961.62
|
| Rate for Payer: Wellcare Medicare |
$1,961.62
|
| Rate for Payer: Wellmed Medicare |
$1,961.62
|
|
|
Revision including replacement, when performed, of spinal neurostimulator electrode percutaneous arr
|
Facility
|
IP
|
$30,803.40
|
|
|
Service Code
|
HCPCS 63663
|
| Hospital Charge Code |
9900775
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$20,946.31
|
|
|
Revision including replacement, when performed, of spinal neurostimulator electrode percutaneous arr
|
Facility
|
OP
|
$30,803.40
|
|
|
Service Code
|
HCPCS 63663
|
| Hospital Charge Code |
9900775
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,676.17 |
| Max. Negotiated Rate |
$22,178.45 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$3,676.17
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$6,402.04
|
| Rate for Payer: Amerigroup Medicare |
$6,402.04
|
| Rate for Payer: BCBS of TX Blue Advantage |
$10,332.51
|
| Rate for Payer: BCBS of TX Blue Essentials |
$12,374.26
|
| Rate for Payer: BCBS of TX Medicare |
$6,402.04
|
| Rate for Payer: BCBS of TX PPO |
$15,591.57
|
| Rate for Payer: Cash Price |
$20,946.31
|
| Rate for Payer: Cash Price |
$20,946.31
|
| Rate for Payer: Cash Price |
$20,946.31
|
| Rate for Payer: Cigna Commercial |
$13,532.75
|
| Rate for Payer: Cigna Medicaid |
$22,178.45
|
| Rate for Payer: Cigna Medicare |
$6,402.04
|
| Rate for Payer: Employer Direct Commercial |
$6,402.04
|
| Rate for Payer: Humana Medicare/TRICARE |
$6,402.04
|
| Rate for Payer: Molina CHIP/Medicaid |
$22,178.45
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$6,402.04
|
| Rate for Payer: Molina Medicare |
$6,402.04
|
| 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 |
$22,178.45
|
| Rate for Payer: Scott and White EPO/PPO |
$11,843.77
|
| Rate for Payer: Scott and White Medicare |
$6,402.04
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$22,178.45
|
| Rate for Payer: Superior Health Plan EPO |
$6,402.04
|
| Rate for Payer: Superior Health Plan Medicare |
$6,402.04
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$6,402.04
|
| Rate for Payer: Universal American Medicare |
$6,402.04
|
| Rate for Payer: Wellcare Medicare |
$6,402.04
|
| Rate for Payer: Wellmed Medicare |
$6,402.04
|
|
|
Revision including replacement, when performed, of spinal neurostimulator electrode percutaneous arr
|
Facility
|
OP
|
$15,591.57
|
|
|
Service Code
|
CPT 63663
|
| Hospital Charge Code |
36063663
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,676.17 |
| Max. Negotiated Rate |
$15,591.57 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$3,676.17
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$6,402.04
|
| Rate for Payer: Amerigroup Medicare |
$6,402.04
|
| Rate for Payer: BCBS of TX Blue Advantage |
$10,332.51
|
| Rate for Payer: BCBS of TX Blue Essentials |
$12,374.26
|
| Rate for Payer: BCBS of TX Medicare |
$6,402.04
|
| Rate for Payer: BCBS of TX PPO |
$15,591.57
|
| Rate for Payer: Cigna Commercial |
$13,532.75
|
| Rate for Payer: Cigna Medicare |
$6,402.04
|
| Rate for Payer: Employer Direct Commercial |
$6,402.04
|
| Rate for Payer: Humana Medicare/TRICARE |
$6,402.04
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$6,402.04
|
| Rate for Payer: Molina Medicare |
$6,402.04
|
| 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 |
$11,843.77
|
| Rate for Payer: Scott and White Medicare |
$6,402.04
|
| Rate for Payer: Superior Health Plan EPO |
$6,402.04
|
| Rate for Payer: Superior Health Plan Medicare |
$6,402.04
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$6,402.04
|
| Rate for Payer: Universal American Medicare |
$6,402.04
|
| Rate for Payer: Wellcare Medicare |
$6,402.04
|
| Rate for Payer: Wellmed Medicare |
$6,402.04
|
|
