|
SUTURE HI-FI SZ 2
|
Facility
|
OP
|
$128.85
|
|
| Hospital Charge Code |
145527
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.60 |
| Max. Negotiated Rate |
$92.77 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$11.60
|
| Rate for Payer: BCBS of TX Blue Advantage |
$38.66
|
| Rate for Payer: BCBS of TX Blue Essentials |
$46.39
|
| Rate for Payer: BCBS of TX PPO |
$51.54
|
| Rate for Payer: Cash Price |
$87.62
|
| Rate for Payer: Cigna Medicaid |
$92.77
|
| Rate for Payer: Molina CHIP/Medicaid |
$92.77
|
| Rate for Payer: Multiplan Auto |
$83.75
|
| Rate for Payer: Multiplan Commercial |
$83.75
|
| Rate for Payer: Multiplan Workers Comp |
$83.75
|
| Rate for Payer: Parkland Medicaid |
$92.77
|
| Rate for Payer: Scott and White EPO/PPO |
$64.42
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$92.77
|
| Rate for Payer: Superior Health Plan EPO |
$17.52
|
|
|
SUTURE, MONOCRYL, 0, CT-1, 36, UNDYED
|
Facility
|
IP
|
$8.05
|
|
| Hospital Charge Code |
993802
|
|
Hospital Revenue Code
|
272
|
| Rate for Payer: Cash Price |
$5.47
|
|
|
SUTURE, MONOCRYL, 0, CT-1, 36, UNDYED
|
Facility
|
OP
|
$8.05
|
|
| Hospital Charge Code |
993802
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.72 |
| Max. Negotiated Rate |
$5.80 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$0.72
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2.42
|
| Rate for Payer: BCBS of TX Blue Essentials |
$2.90
|
| Rate for Payer: BCBS of TX PPO |
$3.22
|
| Rate for Payer: Cash Price |
$5.47
|
| Rate for Payer: Cigna Medicaid |
$5.80
|
| Rate for Payer: Molina CHIP/Medicaid |
$5.80
|
| Rate for Payer: Multiplan Auto |
$5.23
|
| Rate for Payer: Multiplan Commercial |
$5.23
|
| Rate for Payer: Multiplan Workers Comp |
$5.23
|
| Rate for Payer: Parkland Medicaid |
$5.80
|
| Rate for Payer: Scott and White EPO/PPO |
$4.03
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$5.80
|
| Rate for Payer: Superior Health Plan EPO |
$1.09
|
|
|
SUTURE, MONOCRYL UND MONO 4-0 PLASTIC 18' P-3 -- DHF
|
Facility
|
IP
|
$285.37
|
|
| Hospital Charge Code |
81941403
|
|
Hospital Revenue Code
|
272
|
| Rate for Payer: Cash Price |
$194.05
|
|
|
SUTURE, MONOCRYL UND MONO 4-0 PLASTIC 18' P-3 -- DHF
|
Facility
|
OP
|
$285.37
|
|
| Hospital Charge Code |
81941403
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$25.68 |
| Max. Negotiated Rate |
$205.47 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$25.68
|
| Rate for Payer: BCBS of TX Blue Advantage |
$85.61
|
| Rate for Payer: BCBS of TX Blue Essentials |
$102.73
|
| Rate for Payer: BCBS of TX PPO |
$114.15
|
| Rate for Payer: Cash Price |
$194.05
|
| Rate for Payer: Cigna Medicaid |
$205.47
|
| Rate for Payer: Molina CHIP/Medicaid |
$205.47
|
| Rate for Payer: Multiplan Auto |
$185.49
|
| Rate for Payer: Multiplan Commercial |
$185.49
|
| Rate for Payer: Multiplan Workers Comp |
$185.49
|
| Rate for Payer: Parkland Medicaid |
$205.47
|
| Rate for Payer: Scott and White EPO/PPO |
$142.69
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$205.47
|
| Rate for Payer: Superior Health Plan EPO |
$38.81
|
|
|
SUTURE MONODERM CLR 3-0 3.5X3.5CML DE12 NDL ABSRB
|
Facility
|
IP
|
$19.58
|
|
| Hospital Charge Code |
993641
|
|
Hospital Revenue Code
|
270
|
| Rate for Payer: Cash Price |
$13.31
|
|
|
SUTURE MONODERM CLR 3-0 3.5X3.5CML DE12 NDL ABSRB
|
Facility
|
OP
|
$19.58
|
|
| Hospital Charge Code |
993641
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.76 |
| Max. Negotiated Rate |
$14.10 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1.76
|
| Rate for Payer: BCBS of TX Blue Advantage |
$5.87
|
| Rate for Payer: BCBS of TX Blue Essentials |
$7.05
|
| Rate for Payer: BCBS of TX PPO |
$7.83
|
| Rate for Payer: Cash Price |
$13.31
|
| Rate for Payer: Cigna Medicaid |
$14.10
|
| Rate for Payer: Molina CHIP/Medicaid |
$14.10
|
| Rate for Payer: Multiplan Auto |
$12.73
|
| Rate for Payer: Multiplan Commercial |
$12.73
|
| Rate for Payer: Multiplan Workers Comp |
$12.73
|
| Rate for Payer: Parkland Medicaid |
$14.10
|
| Rate for Payer: Scott and White EPO/PPO |
$9.79
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$14.10
|
| Rate for Payer: Superior Health Plan EPO |
$2.66
|
|
|
SUTURE, MONODERM CLR 3-0 3.5X3.5CML DE12 NDL ABSRB -- DHF
|
Facility
|
IP
|
$115.36
|
|
| Hospital Charge Code |
81943656
|
|
Hospital Revenue Code
|
272
|
| Rate for Payer: Cash Price |
$78.44
|
|
|
SUTURE, MONODERM CLR 3-0 3.5X3.5CML DE12 NDL ABSRB -- DHF
|
Facility
|
OP
|
$115.36
|
|
| Hospital Charge Code |
81943656
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.38 |
| Max. Negotiated Rate |
$83.06 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$10.38
|
| Rate for Payer: BCBS of TX Blue Advantage |
$34.61
|
| Rate for Payer: BCBS of TX Blue Essentials |
$41.53
|
| Rate for Payer: BCBS of TX PPO |
$46.14
|
| Rate for Payer: Cash Price |
$78.44
|
| Rate for Payer: Cigna Medicaid |
$83.06
|
| Rate for Payer: Molina CHIP/Medicaid |
$83.06
|
| Rate for Payer: Multiplan Auto |
$74.98
|
| Rate for Payer: Multiplan Commercial |
$74.98
|
| Rate for Payer: Multiplan Workers Comp |
$74.98
|
| Rate for Payer: Parkland Medicaid |
$83.06
|
| Rate for Payer: Scott and White EPO/PPO |
$57.68
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$83.06
|
| Rate for Payer: Superior Health Plan EPO |
$15.69
|
|
|
SUTURE, MONODERM CLR 3-0 7 X 7CML DE12 NDL ABSRB -- DHF
|
Facility
|
IP
|
$124.04
|
|
| Hospital Charge Code |
81943557
|
|
Hospital Revenue Code
|
272
|
| Rate for Payer: Cash Price |
$84.35
|
|
|
SUTURE, MONODERM CLR 3-0 7 X 7CML DE12 NDL ABSRB -- DHF
|
Facility
|
OP
|
$124.04
|
|
| Hospital Charge Code |
81943557
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.16 |
| Max. Negotiated Rate |
$89.31 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$11.16
|
| Rate for Payer: BCBS of TX Blue Advantage |
$37.21
|
| Rate for Payer: BCBS of TX Blue Essentials |
$44.65
|
| Rate for Payer: BCBS of TX PPO |
$49.62
|
| Rate for Payer: Cash Price |
$84.35
|
| Rate for Payer: Cigna Medicaid |
$89.31
|
| Rate for Payer: Molina CHIP/Medicaid |
$89.31
|
| Rate for Payer: Multiplan Auto |
$80.63
|
| Rate for Payer: Multiplan Commercial |
$80.63
|
| Rate for Payer: Multiplan Workers Comp |
$80.63
|
| Rate for Payer: Parkland Medicaid |
$89.31
|
| Rate for Payer: Scott and White EPO/PPO |
$62.02
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$89.31
|
| Rate for Payer: Superior Health Plan EPO |
$16.87
|
|
|
SUTURE, NUROLON, BLACK, 0, 8-18, MO-7
|
Facility
|
IP
|
$84.97
|
|
| Hospital Charge Code |
993796
|
|
Hospital Revenue Code
|
272
|
| Rate for Payer: Cash Price |
$57.78
|
|
|
SUTURE, NUROLON, BLACK, 0, 8-18, MO-7
|
Facility
|
OP
|
$84.97
|
|
| Hospital Charge Code |
993796
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.65 |
| Max. Negotiated Rate |
$61.18 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$7.65
|
| Rate for Payer: BCBS of TX Blue Advantage |
$25.49
|
| Rate for Payer: BCBS of TX Blue Essentials |
$30.59
|
| Rate for Payer: BCBS of TX PPO |
$33.99
|
| Rate for Payer: Cash Price |
$57.78
|
| Rate for Payer: Cigna Medicaid |
$61.18
|
| Rate for Payer: Molina CHIP/Medicaid |
$61.18
|
| Rate for Payer: Multiplan Auto |
$55.23
|
| Rate for Payer: Multiplan Commercial |
$55.23
|
| Rate for Payer: Multiplan Workers Comp |
$55.23
|
| Rate for Payer: Parkland Medicaid |
$61.18
|
| Rate for Payer: Scott and White EPO/PPO |
$42.48
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$61.18
|
| Rate for Payer: Superior Health Plan EPO |
$11.56
|
|
|
SUTURE, NUROLON BLK BR 0 CLSR 8-18' CR MO-7 COMPRT -- DHF
|
Facility
|
OP
|
$642.60
|
|
| Hospital Charge Code |
8194155
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.83 |
| Max. Negotiated Rate |
$462.67 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$57.83
|
| Rate for Payer: BCBS of TX Blue Advantage |
$192.78
|
| Rate for Payer: BCBS of TX Blue Essentials |
$231.34
|
| Rate for Payer: BCBS of TX PPO |
$257.04
|
| Rate for Payer: Cash Price |
$436.97
|
| Rate for Payer: Cigna Medicaid |
$462.67
|
| Rate for Payer: Molina CHIP/Medicaid |
$462.67
|
| Rate for Payer: Multiplan Auto |
$417.69
|
| Rate for Payer: Multiplan Commercial |
$417.69
|
| Rate for Payer: Multiplan Workers Comp |
$417.69
|
| Rate for Payer: Parkland Medicaid |
$462.67
|
| Rate for Payer: Scott and White EPO/PPO |
$321.30
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$462.67
|
| Rate for Payer: Superior Health Plan EPO |
$87.39
|
|
|
SUTURE, NUROLON BLK BR 0 CLSR 8-18' CR MO-7 COMPRT -- DHF
|
Facility
|
IP
|
$642.60
|
|
| Hospital Charge Code |
8194155
|
|
Hospital Revenue Code
|
272
|
| Rate for Payer: Cash Price |
$436.97
|
|
|
SUTURE NYL ETH 2-0 PS 18IN MFL BLK NABS
|
Facility
|
IP
|
$11.09
|
|
| Hospital Charge Code |
121521
|
|
Hospital Revenue Code
|
272
|
| Rate for Payer: Cash Price |
$7.54
|
|
|
SUTURE NYL ETH 2-0 PS 18IN MFL BLK NABS
|
Facility
|
OP
|
$11.09
|
|
| Hospital Charge Code |
121521
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$7.98 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1.00
|
| Rate for Payer: BCBS of TX Blue Advantage |
$3.33
|
| Rate for Payer: BCBS of TX Blue Essentials |
$3.99
|
| Rate for Payer: BCBS of TX PPO |
$4.44
|
| Rate for Payer: Cash Price |
$7.54
|
| Rate for Payer: Cigna Medicaid |
$7.98
|
| Rate for Payer: Molina CHIP/Medicaid |
$7.98
|
| Rate for Payer: Multiplan Auto |
$7.21
|
| Rate for Payer: Multiplan Commercial |
$7.21
|
| Rate for Payer: Multiplan Workers Comp |
$7.21
|
| Rate for Payer: Parkland Medicaid |
$7.98
|
| Rate for Payer: Scott and White EPO/PPO |
$5.54
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$7.98
|
| Rate for Payer: Superior Health Plan EPO |
$1.51
|
|
|
Suture of 1 nerve; hand or foot, common sensory nerve
|
Facility
|
IP
|
$17,471.85
|
|
|
Service Code
|
HCPCS 64834
|
| Hospital Charge Code |
9900851
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$11,880.86
|
|
|
Suture of 1 nerve; hand or foot, common sensory nerve
|
Facility
|
OP
|
$17,471.85
|
|
|
Service Code
|
HCPCS 64834
|
| Hospital Charge Code |
9900851
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,996.58 |
| Max. Negotiated Rate |
$13,882.71 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,996.58
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3,431.72
|
| Rate for Payer: Amerigroup Medicare |
$3,431.72
|
| Rate for Payer: BCBS of TX Blue Advantage |
$9,200.05
|
| Rate for Payer: BCBS of TX Blue Essentials |
$11,018.02
|
| Rate for Payer: BCBS of TX Medicare |
$3,431.72
|
| Rate for Payer: BCBS of TX PPO |
$13,882.71
|
| Rate for Payer: Cash Price |
$11,880.86
|
| Rate for Payer: Cash Price |
$11,880.86
|
| Rate for Payer: Cash Price |
$11,880.86
|
| Rate for Payer: Cigna Commercial |
$7,254.03
|
| Rate for Payer: Cigna Medicaid |
$12,579.73
|
| Rate for Payer: Cigna Medicare |
$3,431.72
|
| Rate for Payer: Employer Direct Commercial |
$3,431.72
|
| Rate for Payer: Humana Medicare/TRICARE |
$3,431.72
|
| Rate for Payer: Molina CHIP/Medicaid |
$12,579.73
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3,431.72
|
| Rate for Payer: Molina Medicare |
$3,431.72
|
| Rate for Payer: Multiplan Auto |
$10,000.00
|
| Rate for Payer: Multiplan Commercial |
$10,000.00
|
| Rate for Payer: Multiplan Workers Comp |
$10,000.00
|
| Rate for Payer: Parkland Medicaid |
$12,579.73
|
| Rate for Payer: Scott and White EPO/PPO |
$6,348.68
|
| Rate for Payer: Scott and White Medicare |
$3,431.72
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$12,579.73
|
| Rate for Payer: Superior Health Plan EPO |
$3,431.72
|
| Rate for Payer: Superior Health Plan Medicare |
$3,431.72
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3,431.72
|
| Rate for Payer: Universal American Medicare |
$3,431.72
|
| Rate for Payer: Wellcare Medicare |
$3,431.72
|
| Rate for Payer: Wellmed Medicare |
$3,431.72
|
|
|
Suture of 1 nerve; hand or foot, common sensory nerve
|
Facility
|
OP
|
$13,882.71
|
|
|
Service Code
|
CPT 64834
|
| Hospital Charge Code |
36064834
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,996.58 |
| Max. Negotiated Rate |
$13,882.71 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,996.58
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3,431.72
|
| Rate for Payer: Amerigroup Medicare |
$3,431.72
|
| Rate for Payer: BCBS of TX Blue Advantage |
$9,200.05
|
| Rate for Payer: BCBS of TX Blue Essentials |
$11,018.02
|
| Rate for Payer: BCBS of TX Medicare |
$3,431.72
|
| Rate for Payer: BCBS of TX PPO |
$13,882.71
|
| Rate for Payer: Cigna Commercial |
$7,254.03
|
| Rate for Payer: Cigna Medicare |
$3,431.72
|
| Rate for Payer: Employer Direct Commercial |
$3,431.72
|
| Rate for Payer: Humana Medicare/TRICARE |
$3,431.72
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3,431.72
|
| Rate for Payer: Molina Medicare |
$3,431.72
|
| 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 |
$6,348.68
|
| Rate for Payer: Scott and White Medicare |
$3,431.72
|
| Rate for Payer: Superior Health Plan EPO |
$3,431.72
|
| Rate for Payer: Superior Health Plan Medicare |
$3,431.72
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3,431.72
|
| Rate for Payer: Universal American Medicare |
$3,431.72
|
| Rate for Payer: Wellcare Medicare |
$3,431.72
|
| Rate for Payer: Wellmed Medicare |
$3,431.72
|
|
|
Suture of 1 nerve; median motor thenar
|
Facility
|
OP
|
$13,882.71
|
|
|
Service Code
|
CPT 64835
|
| Hospital Charge Code |
36064835
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,996.58 |
| Max. Negotiated Rate |
$13,882.71 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,996.58
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3,431.72
|
| Rate for Payer: Amerigroup Medicare |
$3,431.72
|
| Rate for Payer: BCBS of TX Blue Advantage |
$9,200.05
|
| Rate for Payer: BCBS of TX Blue Essentials |
$11,018.02
|
| Rate for Payer: BCBS of TX Medicare |
$3,431.72
|
| Rate for Payer: BCBS of TX PPO |
$13,882.71
|
| Rate for Payer: Cigna Commercial |
$7,254.03
|
| Rate for Payer: Cigna Medicare |
$3,431.72
|
| Rate for Payer: Employer Direct Commercial |
$3,431.72
|
| Rate for Payer: Humana Medicare/TRICARE |
$3,431.72
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3,431.72
|
| Rate for Payer: Molina Medicare |
$3,431.72
|
| 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 |
$6,348.68
|
| Rate for Payer: Scott and White Medicare |
$3,431.72
|
| Rate for Payer: Superior Health Plan EPO |
$3,431.72
|
| Rate for Payer: Superior Health Plan Medicare |
$3,431.72
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3,431.72
|
| Rate for Payer: Universal American Medicare |
$3,431.72
|
| Rate for Payer: Wellcare Medicare |
$3,431.72
|
| Rate for Payer: Wellmed Medicare |
$3,431.72
|
|
|
Suture of 1 nerve; median motor thenar
|
Facility
|
OP
|
$17,471.85
|
|
|
Service Code
|
HCPCS 64835
|
| Hospital Charge Code |
9900852
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,996.58 |
| Max. Negotiated Rate |
$13,882.71 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,996.58
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3,431.72
|
| Rate for Payer: Amerigroup Medicare |
$3,431.72
|
| Rate for Payer: BCBS of TX Blue Advantage |
$9,200.05
|
| Rate for Payer: BCBS of TX Blue Essentials |
$11,018.02
|
| Rate for Payer: BCBS of TX Medicare |
$3,431.72
|
| Rate for Payer: BCBS of TX PPO |
$13,882.71
|
| Rate for Payer: Cash Price |
$11,880.86
|
| Rate for Payer: Cash Price |
$11,880.86
|
| Rate for Payer: Cash Price |
$11,880.86
|
| Rate for Payer: Cigna Commercial |
$7,254.03
|
| Rate for Payer: Cigna Medicaid |
$12,579.73
|
| Rate for Payer: Cigna Medicare |
$3,431.72
|
| Rate for Payer: Employer Direct Commercial |
$3,431.72
|
| Rate for Payer: Humana Medicare/TRICARE |
$3,431.72
|
| Rate for Payer: Molina CHIP/Medicaid |
$12,579.73
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3,431.72
|
| Rate for Payer: Molina Medicare |
$3,431.72
|
| Rate for Payer: Multiplan Auto |
$10,000.00
|
| Rate for Payer: Multiplan Commercial |
$10,000.00
|
| Rate for Payer: Multiplan Workers Comp |
$10,000.00
|
| Rate for Payer: Parkland Medicaid |
$12,579.73
|
| Rate for Payer: Scott and White EPO/PPO |
$6,348.68
|
| Rate for Payer: Scott and White Medicare |
$3,431.72
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$12,579.73
|
| Rate for Payer: Superior Health Plan EPO |
$3,431.72
|
| Rate for Payer: Superior Health Plan Medicare |
$3,431.72
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3,431.72
|
| Rate for Payer: Universal American Medicare |
$3,431.72
|
| Rate for Payer: Wellcare Medicare |
$3,431.72
|
| Rate for Payer: Wellmed Medicare |
$3,431.72
|
|
|
Suture of 1 nerve; median motor thenar
|
Facility
|
IP
|
$17,471.85
|
|
|
Service Code
|
HCPCS 64835
|
| Hospital Charge Code |
9900852
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$11,880.86
|
|
|
Suture of 1 nerve; ulnar motor
|
Facility
|
OP
|
$23,295.80
|
|
|
Service Code
|
HCPCS 64836
|
| Hospital Charge Code |
9900853
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,996.58 |
| Max. Negotiated Rate |
$16,772.98 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,996.58
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3,431.72
|
| Rate for Payer: Amerigroup Medicare |
$3,431.72
|
| Rate for Payer: BCBS of TX Blue Advantage |
$9,200.05
|
| Rate for Payer: BCBS of TX Blue Essentials |
$11,018.02
|
| Rate for Payer: BCBS of TX Medicare |
$3,431.72
|
| Rate for Payer: BCBS of TX PPO |
$13,882.71
|
| Rate for Payer: Cash Price |
$15,841.14
|
| Rate for Payer: Cash Price |
$15,841.14
|
| Rate for Payer: Cash Price |
$15,841.14
|
| Rate for Payer: Cigna Commercial |
$7,254.03
|
| Rate for Payer: Cigna Medicaid |
$16,772.98
|
| Rate for Payer: Cigna Medicare |
$3,431.72
|
| Rate for Payer: Employer Direct Commercial |
$3,431.72
|
| Rate for Payer: Humana Medicare/TRICARE |
$3,431.72
|
| Rate for Payer: Molina CHIP/Medicaid |
$16,772.98
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3,431.72
|
| Rate for Payer: Molina Medicare |
$3,431.72
|
| 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 |
$16,772.98
|
| Rate for Payer: Scott and White EPO/PPO |
$6,348.68
|
| Rate for Payer: Scott and White Medicare |
$3,431.72
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$16,772.98
|
| Rate for Payer: Superior Health Plan EPO |
$3,431.72
|
| Rate for Payer: Superior Health Plan Medicare |
$3,431.72
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3,431.72
|
| Rate for Payer: Universal American Medicare |
$3,431.72
|
| Rate for Payer: Wellcare Medicare |
$3,431.72
|
| Rate for Payer: Wellmed Medicare |
$3,431.72
|
|
|
Suture of 1 nerve; ulnar motor
|
Facility
|
OP
|
$13,882.71
|
|
|
Service Code
|
CPT 64836
|
| Hospital Charge Code |
36064836
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,996.58 |
| Max. Negotiated Rate |
$13,882.71 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,996.58
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3,431.72
|
| Rate for Payer: Amerigroup Medicare |
$3,431.72
|
| Rate for Payer: BCBS of TX Blue Advantage |
$9,200.05
|
| Rate for Payer: BCBS of TX Blue Essentials |
$11,018.02
|
| Rate for Payer: BCBS of TX Medicare |
$3,431.72
|
| Rate for Payer: BCBS of TX PPO |
$13,882.71
|
| Rate for Payer: Cigna Commercial |
$7,254.03
|
| Rate for Payer: Cigna Medicare |
$3,431.72
|
| Rate for Payer: Employer Direct Commercial |
$3,431.72
|
| Rate for Payer: Humana Medicare/TRICARE |
$3,431.72
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3,431.72
|
| Rate for Payer: Molina Medicare |
$3,431.72
|
| 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 |
$6,348.68
|
| Rate for Payer: Scott and White Medicare |
$3,431.72
|
| Rate for Payer: Superior Health Plan EPO |
$3,431.72
|
| Rate for Payer: Superior Health Plan Medicare |
$3,431.72
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3,431.72
|
| Rate for Payer: Universal American Medicare |
$3,431.72
|
| Rate for Payer: Wellcare Medicare |
$3,431.72
|
| Rate for Payer: Wellmed Medicare |
$3,431.72
|
|