|
REVISION OF HIP OR KNEE REPLACEMENT WITHOUT CC/MCC
|
Facility
|
IP
|
$52,996.70
|
|
|
Service Code
|
MSDRG 468
|
| Min. Negotiated Rate |
$24,006.04 |
| Max. Negotiated Rate |
$52,996.70 |
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$24,900.25
|
| Rate for Payer: Amerigroup Medicare |
$24,900.25
|
| Rate for Payer: BCBS of TX Medicare |
$24,900.25
|
| Rate for Payer: Cigna Commercial |
$35,394.24
|
| Rate for Payer: Cigna Medicare |
$24,900.25
|
| Rate for Payer: Employer Direct Commercial |
$24,900.25
|
| Rate for Payer: Humana Medicare/TRICARE |
$24,900.25
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$24,900.25
|
| Rate for Payer: Molina Medicare |
$24,900.25
|
| Rate for Payer: Multiplan Auto |
$52,996.70
|
| Rate for Payer: Multiplan Commercial |
$52,996.70
|
| Rate for Payer: Multiplan Workers Comp |
$52,996.70
|
| Rate for Payer: Scott and White EPO/PPO |
$24,406.38
|
| Rate for Payer: Scott and White Medicare |
$24,900.25
|
| Rate for Payer: Superior Health Plan EPO |
$24,900.25
|
| Rate for Payer: Superior Health Plan Medicare |
$24,900.25
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$24,900.25
|
| Rate for Payer: Universal American Medicare |
$24,900.25
|
| Rate for Payer: Wellcare Medicare |
$24,900.25
|
| Rate for Payer: Wellmed Medicare |
$24,900.25
|
|
|
REVISION OF HIP OR KNEE REPLACEMENT W MCC
|
Facility
|
IP
|
$99,656.90
|
|
|
Service Code
|
MSDRG 466
|
| Min. Negotiated Rate |
$42,910.59 |
| Max. Negotiated Rate |
$99,656.90 |
| Rate for Payer: BCBS of TX Blue Advantage |
$43,973.52
|
| Rate for Payer: BCBS of TX Blue Essentials |
$52,763.11
|
| Rate for Payer: BCBS of TX PPO |
$58,627.95
|
|
|
REVISION OF HIP OR KNEE REPLACEMENT W/O CC/MCC
|
Facility
|
IP
|
$52,996.70
|
|
|
Service Code
|
MSDRG 468
|
| Min. Negotiated Rate |
$24,006.04 |
| Max. Negotiated Rate |
$52,996.70 |
| Rate for Payer: BCBS of TX Blue Advantage |
$24,006.04
|
| Rate for Payer: BCBS of TX Blue Essentials |
$28,804.46
|
| Rate for Payer: BCBS of TX PPO |
$32,006.19
|
|
|
Revision of peri-implant capsule, breast, including capsulotomy, capsulorrhaphy, and/or partial caps
|
Facility
|
OP
|
$19,370.00
|
|
|
Service Code
|
HCPCS 19370
|
| Hospital Charge Code |
9900163
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$963.66 |
| Max. Negotiated Rate |
$13,946.40 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$963.66
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3,933.28
|
| Rate for Payer: Amerigroup Medicare |
$3,933.28
|
| Rate for Payer: BCBS of TX Blue Advantage |
$5,059.35
|
| Rate for Payer: BCBS of TX Blue Essentials |
$6,059.10
|
| Rate for Payer: BCBS of TX Medicare |
$3,933.28
|
| Rate for Payer: BCBS of TX PPO |
$7,634.47
|
| Rate for Payer: Cash Price |
$13,171.60
|
| Rate for Payer: Cash Price |
$13,171.60
|
| Rate for Payer: Cash Price |
$13,171.60
|
| Rate for Payer: Cigna Commercial |
$8,314.23
|
| Rate for Payer: Cigna Medicaid |
$13,946.40
|
| Rate for Payer: Cigna Medicare |
$3,933.28
|
| Rate for Payer: Employer Direct Commercial |
$3,933.28
|
| Rate for Payer: Humana Medicare/TRICARE |
$3,933.28
|
| Rate for Payer: Molina CHIP/Medicaid |
$13,946.40
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3,933.28
|
| Rate for Payer: Molina Medicare |
$3,933.28
|
| 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 |
$13,946.40
|
| Rate for Payer: Scott and White EPO/PPO |
$6,449.12
|
| Rate for Payer: Scott and White Medicare |
$3,933.28
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$13,946.40
|
| Rate for Payer: Superior Health Plan EPO |
$3,933.28
|
| Rate for Payer: Superior Health Plan Medicare |
$3,933.28
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3,933.28
|
| Rate for Payer: Universal American Medicare |
$3,933.28
|
| Rate for Payer: Wellcare Medicare |
$3,933.28
|
| Rate for Payer: Wellmed Medicare |
$3,933.28
|
|
|
Revision of peri-implant capsule, breast, including capsulotomy, capsulorrhaphy, and/or partial caps
|
Facility
|
IP
|
$19,370.00
|
|
|
Service Code
|
HCPCS 19370
|
| Hospital Charge Code |
9900163
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$13,171.60
|
|
|
Revision of peri-implant capsule, breast, including capsulotomy, capsulorrhaphy, and/or partial caps
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 19370
|
| Hospital Charge Code |
36019370
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$963.66 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$963.66
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3,933.28
|
| Rate for Payer: Amerigroup Medicare |
$3,933.28
|
| Rate for Payer: BCBS of TX Blue Advantage |
$5,059.35
|
| Rate for Payer: BCBS of TX Blue Essentials |
$6,059.10
|
| Rate for Payer: BCBS of TX Medicare |
$3,933.28
|
| Rate for Payer: BCBS of TX PPO |
$7,634.47
|
| Rate for Payer: Cigna Commercial |
$8,314.23
|
| Rate for Payer: Cigna Medicare |
$3,933.28
|
| Rate for Payer: Employer Direct Commercial |
$3,933.28
|
| Rate for Payer: Humana Medicare/TRICARE |
$3,933.28
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3,933.28
|
| Rate for Payer: Molina Medicare |
$3,933.28
|
| 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 |
$6,449.12
|
| Rate for Payer: Scott and White Medicare |
$3,933.28
|
| Rate for Payer: Superior Health Plan EPO |
$3,933.28
|
| Rate for Payer: Superior Health Plan Medicare |
$3,933.28
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3,933.28
|
| Rate for Payer: Universal American Medicare |
$3,933.28
|
| Rate for Payer: Wellcare Medicare |
$3,933.28
|
| Rate for Payer: Wellmed Medicare |
$3,933.28
|
|
|
Revision of reconstructed breast (eg, significant removal of tissue, re-advancement and/or re-inset
|
Facility
|
OP
|
$33,203.64
|
|
|
Service Code
|
HCPCS 19380
|
| Hospital Charge Code |
9900165
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,845.21 |
| Max. Negotiated Rate |
$23,906.62 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,845.21
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$6,670.43
|
| Rate for Payer: Amerigroup Medicare |
$6,670.43
|
| Rate for Payer: BCBS of TX Blue Advantage |
$8,746.27
|
| Rate for Payer: BCBS of TX Blue Essentials |
$10,474.58
|
| Rate for Payer: BCBS of TX Medicare |
$6,670.43
|
| Rate for Payer: BCBS of TX PPO |
$13,197.97
|
| Rate for Payer: Cash Price |
$22,578.48
|
| Rate for Payer: Cash Price |
$22,578.48
|
| Rate for Payer: Cash Price |
$22,578.48
|
| Rate for Payer: Cigna Commercial |
$14,100.07
|
| Rate for Payer: Cigna Medicaid |
$23,906.62
|
| Rate for Payer: Cigna Medicare |
$6,670.43
|
| Rate for Payer: Employer Direct Commercial |
$6,670.43
|
| Rate for Payer: Humana Medicare/TRICARE |
$6,670.43
|
| Rate for Payer: Molina CHIP/Medicaid |
$23,906.62
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$6,670.43
|
| Rate for Payer: Molina Medicare |
$6,670.43
|
| 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 |
$23,906.62
|
| Rate for Payer: Scott and White EPO/PPO |
$11,033.10
|
| Rate for Payer: Scott and White Medicare |
$6,670.43
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$23,906.62
|
| Rate for Payer: Superior Health Plan EPO |
$6,670.43
|
| Rate for Payer: Superior Health Plan Medicare |
$6,670.43
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$6,670.43
|
| Rate for Payer: Universal American Medicare |
$6,670.43
|
| Rate for Payer: Wellcare Medicare |
$6,670.43
|
| Rate for Payer: Wellmed Medicare |
$6,670.43
|
|
|
Revision of reconstructed breast (eg, significant removal of tissue, re-advancement and/or re-inset
|
Facility
|
IP
|
$33,203.64
|
|
|
Service Code
|
HCPCS 19380
|
| Hospital Charge Code |
9900165
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$22,578.48
|
|
|
Revision of reconstructed breast (eg, significant removal of tissue, re-advancement and/or re-inset
|
Facility
|
OP
|
$14,100.07
|
|
|
Service Code
|
CPT 19380
|
| Hospital Charge Code |
36019380
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,845.21 |
| Max. Negotiated Rate |
$14,100.07 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,845.21
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$6,670.43
|
| Rate for Payer: Amerigroup Medicare |
$6,670.43
|
| Rate for Payer: BCBS of TX Blue Advantage |
$8,746.27
|
| Rate for Payer: BCBS of TX Blue Essentials |
$10,474.58
|
| Rate for Payer: BCBS of TX Medicare |
$6,670.43
|
| Rate for Payer: BCBS of TX PPO |
$13,197.97
|
| Rate for Payer: Cigna Commercial |
$14,100.07
|
| Rate for Payer: Cigna Medicare |
$6,670.43
|
| Rate for Payer: Employer Direct Commercial |
$6,670.43
|
| Rate for Payer: Humana Medicare/TRICARE |
$6,670.43
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$6,670.43
|
| Rate for Payer: Molina Medicare |
$6,670.43
|
| 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 |
$11,033.10
|
| Rate for Payer: Scott and White Medicare |
$6,670.43
|
| Rate for Payer: Superior Health Plan EPO |
$6,670.43
|
| Rate for Payer: Superior Health Plan Medicare |
$6,670.43
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$6,670.43
|
| Rate for Payer: Universal American Medicare |
$6,670.43
|
| Rate for Payer: Wellcare Medicare |
$6,670.43
|
| Rate for Payer: Wellmed Medicare |
$6,670.43
|
|
|
Revision of total knee arthroplasty, with or without allograft; femoral and entire tibial component
|
Facility
|
OP
|
$20,024.00
|
|
|
Service Code
|
HCPCS 27487
|
| Hospital Charge Code |
9900411
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,802.16 |
| Max. Negotiated Rate |
$37,232.21 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,802.16
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$17,613.72
|
| Rate for Payer: Amerigroup Medicare |
$17,613.72
|
| Rate for Payer: BCBS of TX Blue Advantage |
$3,053.19
|
| Rate for Payer: BCBS of TX Blue Essentials |
$3,656.52
|
| Rate for Payer: BCBS of TX Medicare |
$17,613.72
|
| Rate for Payer: BCBS of TX PPO |
$4,607.22
|
| Rate for Payer: Cash Price |
$13,616.32
|
| Rate for Payer: Cash Price |
$13,616.32
|
| Rate for Payer: Cash Price |
$13,616.32
|
| Rate for Payer: Cigna Commercial |
$37,232.21
|
| Rate for Payer: Cigna Medicaid |
$14,417.28
|
| Rate for Payer: Cigna Medicare |
$17,613.72
|
| Rate for Payer: Employer Direct Commercial |
$17,613.72
|
| Rate for Payer: Humana Medicare/TRICARE |
$17,613.72
|
| Rate for Payer: Molina CHIP/Medicaid |
$14,417.28
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$17,613.72
|
| Rate for Payer: Molina Medicare |
$17,613.72
|
| 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 |
$14,417.28
|
| Rate for Payer: Scott and White EPO/PPO |
$10,012.00
|
| Rate for Payer: Scott and White Medicare |
$17,613.72
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$14,417.28
|
| Rate for Payer: Superior Health Plan EPO |
$17,613.72
|
| Rate for Payer: Superior Health Plan Medicare |
$17,613.72
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$17,613.72
|
| Rate for Payer: Universal American Medicare |
$17,613.72
|
| Rate for Payer: Wellcare Medicare |
$17,613.72
|
| Rate for Payer: Wellmed Medicare |
$17,613.72
|
|
|
Revision of total knee arthroplasty, with or without allograft; femoral and entire tibial component
|
Facility
|
IP
|
$20,024.00
|
|
|
Service Code
|
HCPCS 27487
|
| Hospital Charge Code |
9900411
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$13,616.32
|
|
|
Revision of total knee arthroplasty, with or without allograft; femoral and entire tibial component
|
Facility
|
OP
|
$37,232.21
|
|
|
Service Code
|
CPT 27487
|
| Hospital Charge Code |
36027487
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,143.16 |
| Max. Negotiated Rate |
$37,232.21 |
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$17,613.72
|
| Rate for Payer: Amerigroup Medicare |
$17,613.72
|
| Rate for Payer: BCBS of TX Blue Advantage |
$3,053.19
|
| Rate for Payer: BCBS of TX Blue Essentials |
$3,656.52
|
| Rate for Payer: BCBS of TX Medicare |
$17,613.72
|
| Rate for Payer: BCBS of TX PPO |
$4,607.22
|
| Rate for Payer: Cigna Commercial |
$37,232.21
|
| Rate for Payer: Cigna Medicare |
$17,613.72
|
| Rate for Payer: Employer Direct Commercial |
$17,613.72
|
| Rate for Payer: Humana Medicare/TRICARE |
$17,613.72
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$17,613.72
|
| Rate for Payer: Molina Medicare |
$17,613.72
|
| 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 |
$2,143.16
|
| Rate for Payer: Scott and White Medicare |
$17,613.72
|
| Rate for Payer: Superior Health Plan EPO |
$17,613.72
|
| Rate for Payer: Superior Health Plan Medicare |
$17,613.72
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$17,613.72
|
| Rate for Payer: Universal American Medicare |
$17,613.72
|
| Rate for Payer: Wellcare Medicare |
$17,613.72
|
| Rate for Payer: Wellmed Medicare |
$17,613.72
|
|
|
Revision, open, arteriovenous fistula
|
Facility
|
IP
|
$20,943.68
|
|
|
Service Code
|
HCPCS 36832
|
| Hospital Charge Code |
991149
|
|
Hospital Revenue Code
|
480
|
| Rate for Payer: Cash Price |
$14,241.70
|
|
|
Revision, open, arteriovenous fistula
|
Facility
|
OP
|
$20,943.68
|
|
|
Service Code
|
HCPCS 36832
|
| Hospital Charge Code |
991149
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$900.69 |
| Max. Negotiated Rate |
$15,079.45 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,884.93
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$5,589.84
|
| Rate for Payer: Amerigroup Medicare |
$5,589.84
|
| Rate for Payer: BCBS of TX Blue Advantage |
$7,675.64
|
| Rate for Payer: BCBS of TX Blue Essentials |
$9,192.38
|
| Rate for Payer: BCBS of TX Medicare |
$5,589.84
|
| Rate for Payer: BCBS of TX PPO |
$11,582.40
|
| Rate for Payer: Cash Price |
$14,241.70
|
| Rate for Payer: Cash Price |
$14,241.70
|
| Rate for Payer: Cash Price |
$14,241.70
|
| Rate for Payer: Cigna Commercial |
$11,815.91
|
| Rate for Payer: Cigna Medicaid |
$15,079.45
|
| Rate for Payer: Cigna Medicare |
$5,589.84
|
| Rate for Payer: Employer Direct Commercial |
$5,589.84
|
| Rate for Payer: Humana Medicare/TRICARE |
$5,589.84
|
| Rate for Payer: Molina CHIP/Medicaid |
$15,079.45
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$5,589.84
|
| Rate for Payer: Molina Medicare |
$5,589.84
|
| Rate for Payer: Multiplan Auto |
$13,613.39
|
| Rate for Payer: Multiplan Commercial |
$13,613.39
|
| Rate for Payer: Multiplan Workers Comp |
$13,613.39
|
| Rate for Payer: Parkland Medicaid |
$15,079.45
|
| Rate for Payer: Scott and White EPO/PPO |
$900.69
|
| Rate for Payer: Scott and White Medicare |
$5,589.84
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$15,079.45
|
| Rate for Payer: Superior Health Plan EPO |
$5,589.84
|
| Rate for Payer: Superior Health Plan Medicare |
$5,589.84
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$5,589.84
|
| Rate for Payer: Universal American Medicare |
$5,589.84
|
| Rate for Payer: Wellcare Medicare |
$5,589.84
|
| Rate for Payer: Wellmed Medicare |
$5,589.84
|
|
|
Revision, open, arteriovenous fistula; with thrombectomy, autogenous or nonautogenous dialysis graft (separate procedure)
|
Facility
|
IP
|
$21,622.80
|
|
|
Service Code
|
HCPCS 36833
|
| Hospital Charge Code |
994068
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$14,703.50
|
|
|
Revision, open, arteriovenous fistula; with thrombectomy, autogenous or nonautogenous dialysis graft (separate procedure)
|
Facility
|
OP
|
$21,622.80
|
|
|
Service Code
|
HCPCS 36833
|
| Hospital Charge Code |
994068
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,939.15 |
| Max. Negotiated Rate |
$15,568.42 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,939.15
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$5,589.84
|
| Rate for Payer: Amerigroup Medicare |
$5,589.84
|
| Rate for Payer: BCBS of TX Blue Advantage |
$7,675.64
|
| Rate for Payer: BCBS of TX Blue Essentials |
$9,192.38
|
| Rate for Payer: BCBS of TX Medicare |
$5,589.84
|
| Rate for Payer: BCBS of TX PPO |
$11,582.40
|
| Rate for Payer: Cash Price |
$14,703.50
|
| Rate for Payer: Cash Price |
$14,703.50
|
| Rate for Payer: Cash Price |
$14,703.50
|
| Rate for Payer: Cigna Commercial |
$11,815.91
|
| Rate for Payer: Cigna Medicaid |
$15,568.42
|
| Rate for Payer: Cigna Medicare |
$5,589.84
|
| Rate for Payer: Employer Direct Commercial |
$5,589.84
|
| Rate for Payer: Humana Medicare/TRICARE |
$5,589.84
|
| Rate for Payer: Molina CHIP/Medicaid |
$15,568.42
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$5,589.84
|
| Rate for Payer: Molina Medicare |
$5,589.84
|
| 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 |
$15,568.42
|
| Rate for Payer: Scott and White EPO/PPO |
$9,297.64
|
| Rate for Payer: Scott and White Medicare |
$5,589.84
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$15,568.42
|
| Rate for Payer: Superior Health Plan EPO |
$5,589.84
|
| Rate for Payer: Superior Health Plan Medicare |
$5,589.84
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$5,589.84
|
| Rate for Payer: Universal American Medicare |
$5,589.84
|
| Rate for Payer: Wellcare Medicare |
$5,589.84
|
| Rate for Payer: Wellmed Medicare |
$5,589.84
|
|
|
Revision or removal of implanted spinal neurostimulator pulse generator or receiver
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 63688
|
| Hospital Charge Code |
36063688
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,072.02 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2,072.02
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3,512.04
|
| Rate for Payer: Amerigroup Medicare |
$3,512.04
|
| Rate for Payer: BCBS of TX Blue Advantage |
$5,257.99
|
| Rate for Payer: BCBS of TX Blue Essentials |
$6,297.00
|
| Rate for Payer: BCBS of TX Medicare |
$3,512.04
|
| Rate for Payer: BCBS of TX PPO |
$7,934.22
|
| Rate for Payer: Cigna Commercial |
$7,423.81
|
| Rate for Payer: Cigna Medicare |
$3,512.04
|
| Rate for Payer: Employer Direct Commercial |
$3,512.04
|
| Rate for Payer: Humana Medicare/TRICARE |
$3,512.04
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3,512.04
|
| Rate for Payer: Molina Medicare |
$3,512.04
|
| 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 |
$5,756.77
|
| Rate for Payer: Scott and White Medicare |
$3,512.04
|
| Rate for Payer: Superior Health Plan EPO |
$3,512.04
|
| Rate for Payer: Superior Health Plan Medicare |
$3,512.04
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3,512.04
|
| Rate for Payer: Universal American Medicare |
$3,512.04
|
| Rate for Payer: Wellcare Medicare |
$3,512.04
|
| Rate for Payer: Wellmed Medicare |
$3,512.04
|
|
|
Revision or removal of implanted spinal neurostimulator pulse generator or receiver
|
Facility
|
OP
|
$25,090.91
|
|
|
Service Code
|
HCPCS 63688
|
| Hospital Charge Code |
9900777
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,072.02 |
| Max. Negotiated Rate |
$18,065.46 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2,072.02
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3,512.04
|
| Rate for Payer: Amerigroup Medicare |
$3,512.04
|
| Rate for Payer: BCBS of TX Blue Advantage |
$5,257.99
|
| Rate for Payer: BCBS of TX Blue Essentials |
$6,297.00
|
| Rate for Payer: BCBS of TX Medicare |
$3,512.04
|
| Rate for Payer: BCBS of TX PPO |
$7,934.22
|
| Rate for Payer: Cash Price |
$17,061.82
|
| Rate for Payer: Cash Price |
$17,061.82
|
| Rate for Payer: Cash Price |
$17,061.82
|
| Rate for Payer: Cigna Commercial |
$7,423.81
|
| Rate for Payer: Cigna Medicaid |
$18,065.46
|
| Rate for Payer: Cigna Medicare |
$3,512.04
|
| Rate for Payer: Employer Direct Commercial |
$3,512.04
|
| Rate for Payer: Humana Medicare/TRICARE |
$3,512.04
|
| Rate for Payer: Molina CHIP/Medicaid |
$18,065.46
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3,512.04
|
| Rate for Payer: Molina Medicare |
$3,512.04
|
| 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 |
$18,065.46
|
| Rate for Payer: Scott and White EPO/PPO |
$5,756.77
|
| Rate for Payer: Scott and White Medicare |
$3,512.04
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$18,065.46
|
| Rate for Payer: Superior Health Plan EPO |
$3,512.04
|
| Rate for Payer: Superior Health Plan Medicare |
$3,512.04
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3,512.04
|
| Rate for Payer: Universal American Medicare |
$3,512.04
|
| Rate for Payer: Wellcare Medicare |
$3,512.04
|
| Rate for Payer: Wellmed Medicare |
$3,512.04
|
|
|
Revision or removal of implanted spinal neurostimulator pulse generator or receiver
|
Facility
|
IP
|
$25,090.91
|
|
|
Service Code
|
HCPCS 63688
|
| Hospital Charge Code |
9900777
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$17,061.82
|
|
|
Revision or removal of peripheral neurostimulator electrode array
|
Facility
|
IP
|
$20,074.38
|
|
|
Service Code
|
HCPCS 64585
|
| Hospital Charge Code |
9900816
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$13,650.58
|
|
|
Revision or removal of peripheral neurostimulator electrode array
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 64585
|
| Hospital Charge Code |
36064585
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,499.71 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,499.71
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3,512.04
|
| Rate for Payer: Amerigroup Medicare |
$3,512.04
|
| Rate for Payer: BCBS of TX Blue Advantage |
$5,257.99
|
| Rate for Payer: BCBS of TX Blue Essentials |
$6,297.00
|
| Rate for Payer: BCBS of TX Medicare |
$3,512.04
|
| Rate for Payer: BCBS of TX PPO |
$7,934.22
|
| Rate for Payer: Cigna Commercial |
$7,423.81
|
| Rate for Payer: Cigna Medicare |
$3,512.04
|
| Rate for Payer: Employer Direct Commercial |
$3,512.04
|
| Rate for Payer: Humana Medicare/TRICARE |
$3,512.04
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3,512.04
|
| Rate for Payer: Molina Medicare |
$3,512.04
|
| 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 |
$5,756.77
|
| Rate for Payer: Scott and White Medicare |
$3,512.04
|
| Rate for Payer: Superior Health Plan EPO |
$3,512.04
|
| Rate for Payer: Superior Health Plan Medicare |
$3,512.04
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3,512.04
|
| Rate for Payer: Universal American Medicare |
$3,512.04
|
| Rate for Payer: Wellcare Medicare |
$3,512.04
|
| Rate for Payer: Wellmed Medicare |
$3,512.04
|
|
|
Revision or removal of peripheral neurostimulator electrode array
|
Facility
|
OP
|
$20,074.38
|
|
|
Service Code
|
HCPCS 64585
|
| Hospital Charge Code |
9900816
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,499.71 |
| Max. Negotiated Rate |
$14,453.55 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,499.71
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3,512.04
|
| Rate for Payer: Amerigroup Medicare |
$3,512.04
|
| Rate for Payer: BCBS of TX Blue Advantage |
$5,257.99
|
| Rate for Payer: BCBS of TX Blue Essentials |
$6,297.00
|
| Rate for Payer: BCBS of TX Medicare |
$3,512.04
|
| Rate for Payer: BCBS of TX PPO |
$7,934.22
|
| Rate for Payer: Cash Price |
$13,650.58
|
| Rate for Payer: Cash Price |
$13,650.58
|
| Rate for Payer: Cash Price |
$13,650.58
|
| Rate for Payer: Cigna Commercial |
$7,423.81
|
| Rate for Payer: Cigna Medicaid |
$14,453.55
|
| Rate for Payer: Cigna Medicare |
$3,512.04
|
| Rate for Payer: Employer Direct Commercial |
$3,512.04
|
| Rate for Payer: Humana Medicare/TRICARE |
$3,512.04
|
| Rate for Payer: Molina CHIP/Medicaid |
$14,453.55
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3,512.04
|
| Rate for Payer: Molina Medicare |
$3,512.04
|
| 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 |
$14,453.55
|
| Rate for Payer: Scott and White EPO/PPO |
$5,756.77
|
| Rate for Payer: Scott and White Medicare |
$3,512.04
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$14,453.55
|
| Rate for Payer: Superior Health Plan EPO |
$3,512.04
|
| Rate for Payer: Superior Health Plan Medicare |
$3,512.04
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3,512.04
|
| Rate for Payer: Universal American Medicare |
$3,512.04
|
| Rate for Payer: Wellcare Medicare |
$3,512.04
|
| Rate for Payer: Wellmed Medicare |
$3,512.04
|
|
|
Revision or removal of peripheral or gastric neurostimulator pulse generator or receiver
|
Facility
|
IP
|
$20,074.38
|
|
|
Service Code
|
HCPCS 64595
|
| Hospital Charge Code |
9900818
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$13,650.58
|
|
|
Revision or removal of peripheral or gastric neurostimulator pulse generator or receiver
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 64595
|
| Hospital Charge Code |
36064595
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,397.68 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2,397.68
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3,512.04
|
| Rate for Payer: Amerigroup Medicare |
$3,512.04
|
| Rate for Payer: BCBS of TX Blue Advantage |
$5,257.99
|
| Rate for Payer: BCBS of TX Blue Essentials |
$6,297.00
|
| Rate for Payer: BCBS of TX Medicare |
$3,512.04
|
| Rate for Payer: BCBS of TX PPO |
$7,934.22
|
| Rate for Payer: Cigna Commercial |
$7,423.81
|
| Rate for Payer: Cigna Medicare |
$3,512.04
|
| Rate for Payer: Employer Direct Commercial |
$3,512.04
|
| Rate for Payer: Humana Medicare/TRICARE |
$3,512.04
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3,512.04
|
| Rate for Payer: Molina Medicare |
$3,512.04
|
| 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 |
$5,756.77
|
| Rate for Payer: Scott and White Medicare |
$3,512.04
|
| Rate for Payer: Superior Health Plan EPO |
$3,512.04
|
| Rate for Payer: Superior Health Plan Medicare |
$3,512.04
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3,512.04
|
| Rate for Payer: Universal American Medicare |
$3,512.04
|
| Rate for Payer: Wellcare Medicare |
$3,512.04
|
| Rate for Payer: Wellmed Medicare |
$3,512.04
|
|
|
Revision or removal of peripheral or gastric neurostimulator pulse generator or receiver
|
Facility
|
OP
|
$20,074.38
|
|
|
Service Code
|
HCPCS 64595
|
| Hospital Charge Code |
9900818
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,397.68 |
| Max. Negotiated Rate |
$14,453.55 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2,397.68
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3,512.04
|
| Rate for Payer: Amerigroup Medicare |
$3,512.04
|
| Rate for Payer: BCBS of TX Blue Advantage |
$5,257.99
|
| Rate for Payer: BCBS of TX Blue Essentials |
$6,297.00
|
| Rate for Payer: BCBS of TX Medicare |
$3,512.04
|
| Rate for Payer: BCBS of TX PPO |
$7,934.22
|
| Rate for Payer: Cash Price |
$13,650.58
|
| Rate for Payer: Cash Price |
$13,650.58
|
| Rate for Payer: Cash Price |
$13,650.58
|
| Rate for Payer: Cigna Commercial |
$7,423.81
|
| Rate for Payer: Cigna Medicaid |
$14,453.55
|
| Rate for Payer: Cigna Medicare |
$3,512.04
|
| Rate for Payer: Employer Direct Commercial |
$3,512.04
|
| Rate for Payer: Humana Medicare/TRICARE |
$3,512.04
|
| Rate for Payer: Molina CHIP/Medicaid |
$14,453.55
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3,512.04
|
| Rate for Payer: Molina Medicare |
$3,512.04
|
| 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 |
$14,453.55
|
| Rate for Payer: Scott and White EPO/PPO |
$5,756.77
|
| Rate for Payer: Scott and White Medicare |
$3,512.04
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$14,453.55
|
| Rate for Payer: Superior Health Plan EPO |
$3,512.04
|
| Rate for Payer: Superior Health Plan Medicare |
$3,512.04
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3,512.04
|
| Rate for Payer: Universal American Medicare |
$3,512.04
|
| Rate for Payer: Wellcare Medicare |
$3,512.04
|
| Rate for Payer: Wellmed Medicare |
$3,512.04
|
|
