|
Suture of iris, ciliary body (separate procedure) with retrieval of suture through small incision (e
|
Facility
|
IP
|
$5,717.69
|
|
|
Service Code
|
HCPCS 66682
|
| Hospital Charge Code |
9900866
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$3,888.03
|
|
|
Suture of iris, ciliary body (separate procedure) with retrieval of suture through small incision (e
|
Facility
|
OP
|
$5,717.69
|
|
|
Service Code
|
HCPCS 66682
|
| Hospital Charge Code |
9900866
|
|
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
|
|
|
Suture of iris, ciliary body (separate procedure) with retrieval of suture through small incision (e
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 66682
|
| Hospital Charge Code |
36066682
|
|
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
|
|
|
Suture of major peripheral nerve, arm or leg, except sciatic including transposition
|
Facility
|
OP
|
$46,642.30
|
|
|
Service Code
|
HCPCS 64856
|
| Hospital Charge Code |
9900854
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,996.58 |
| Max. Negotiated Rate |
$33,582.46 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,996.58
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$8,815.84
|
| Rate for Payer: Amerigroup Medicare |
$8,815.84
|
| 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 |
$8,815.84
|
| Rate for Payer: BCBS of TX PPO |
$13,882.71
|
| Rate for Payer: Cash Price |
$31,716.76
|
| Rate for Payer: Cash Price |
$31,716.76
|
| Rate for Payer: Cash Price |
$31,716.76
|
| Rate for Payer: Cigna Commercial |
$18,635.09
|
| Rate for Payer: Cigna Medicaid |
$33,582.46
|
| Rate for Payer: Cigna Medicare |
$8,815.84
|
| Rate for Payer: Employer Direct Commercial |
$8,815.84
|
| Rate for Payer: Humana Medicare/TRICARE |
$8,815.84
|
| Rate for Payer: Molina CHIP/Medicaid |
$33,582.46
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$8,815.84
|
| Rate for Payer: Molina Medicare |
$8,815.84
|
| 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 |
$33,582.46
|
| Rate for Payer: Scott and White EPO/PPO |
$11,270.57
|
| Rate for Payer: Scott and White Medicare |
$8,815.84
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$33,582.46
|
| Rate for Payer: Superior Health Plan EPO |
$8,815.84
|
| Rate for Payer: Superior Health Plan Medicare |
$8,815.84
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$8,815.84
|
| Rate for Payer: Universal American Medicare |
$8,815.84
|
| Rate for Payer: Wellcare Medicare |
$8,815.84
|
| Rate for Payer: Wellmed Medicare |
$8,815.84
|
|
|
Suture of major peripheral nerve, arm or leg, except sciatic including transposition
|
Facility
|
IP
|
$46,642.30
|
|
|
Service Code
|
HCPCS 64856
|
| Hospital Charge Code |
9900854
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$31,716.76
|
|
|
Suture of major peripheral nerve, arm or leg, except sciatic including transposition
|
Facility
|
OP
|
$18,635.09
|
|
|
Service Code
|
CPT 64856
|
| Hospital Charge Code |
36064856
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,996.58 |
| Max. Negotiated Rate |
$18,635.09 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,996.58
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$8,815.84
|
| Rate for Payer: Amerigroup Medicare |
$8,815.84
|
| 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 |
$8,815.84
|
| Rate for Payer: BCBS of TX PPO |
$13,882.71
|
| Rate for Payer: Cigna Commercial |
$18,635.09
|
| Rate for Payer: Cigna Medicare |
$8,815.84
|
| Rate for Payer: Employer Direct Commercial |
$8,815.84
|
| Rate for Payer: Humana Medicare/TRICARE |
$8,815.84
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$8,815.84
|
| Rate for Payer: Molina Medicare |
$8,815.84
|
| 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: Scott and White EPO/PPO |
$11,270.57
|
| Rate for Payer: Scott and White Medicare |
$8,815.84
|
| Rate for Payer: Superior Health Plan EPO |
$8,815.84
|
| Rate for Payer: Superior Health Plan Medicare |
$8,815.84
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$8,815.84
|
| Rate for Payer: Universal American Medicare |
$8,815.84
|
| Rate for Payer: Wellcare Medicare |
$8,815.84
|
| Rate for Payer: Wellmed Medicare |
$8,815.84
|
|
|
Suture of major peripheral nerve, arm or leg, except sciatic without transposition
|
Facility
|
IP
|
$45,602.32
|
|
|
Service Code
|
HCPCS 64857
|
| Hospital Charge Code |
9900855
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$31,009.58
|
|
|
Suture of major peripheral nerve, arm or leg, except sciatic without transposition
|
Facility
|
OP
|
$45,602.32
|
|
|
Service Code
|
HCPCS 64857
|
| Hospital Charge Code |
9900855
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,996.58 |
| Max. Negotiated Rate |
$32,833.67 |
| 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 |
$31,009.58
|
| Rate for Payer: Cash Price |
$31,009.58
|
| Rate for Payer: Cash Price |
$31,009.58
|
| Rate for Payer: Cigna Commercial |
$7,254.03
|
| Rate for Payer: Cigna Medicaid |
$32,833.67
|
| 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 |
$32,833.67
|
| 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 |
$32,833.67
|
| Rate for Payer: Scott and White EPO/PPO |
$11,270.57
|
| Rate for Payer: Scott and White Medicare |
$3,431.72
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$32,833.67
|
| 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 major peripheral nerve, arm or leg, except sciatic without transposition
|
Facility
|
OP
|
$13,882.71
|
|
|
Service Code
|
CPT 64857
|
| Hospital Charge Code |
36064857
|
|
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 |
$11,270.57
|
| 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 mesentery (separate procedure)
|
Facility
|
IP
|
$10,016.90
|
|
|
Service Code
|
HCPCS 44850
|
| Hospital Charge Code |
9900698
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$6,811.49
|
|
|
Suture of mesentery (separate procedure)
|
Facility
|
OP
|
$10,016.90
|
|
|
Service Code
|
HCPCS 44850
|
| Hospital Charge Code |
9900698
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$901.52 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$901.52
|
| Rate for Payer: BCBS of TX Blue Advantage |
$1,306.02
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,564.10
|
| Rate for Payer: BCBS of TX PPO |
$1,970.77
|
| Rate for Payer: Cash Price |
$6,811.49
|
| Rate for Payer: Cash Price |
$6,811.49
|
| Rate for Payer: Cash Price |
$6,811.49
|
| Rate for Payer: Cigna Medicaid |
$7,212.17
|
| Rate for Payer: Molina CHIP/Medicaid |
$7,212.17
|
| 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 |
$7,212.17
|
| Rate for Payer: Scott and White EPO/PPO |
$5,008.45
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$7,212.17
|
| Rate for Payer: Superior Health Plan EPO |
$1,362.30
|
|
|
Suture of mesentery (separate procedure)
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 44850
|
| Hospital Charge Code |
36044850
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$914.55 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: BCBS of TX Blue Advantage |
$1,306.02
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,564.10
|
| Rate for Payer: BCBS of TX PPO |
$1,970.77
|
| 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 |
$914.55
|
|
|
Suture of quadriceps or hamstring muscle rupture; primary
|
Facility
|
IP
|
$18,794.85
|
|
|
Service Code
|
HCPCS 27385
|
| Hospital Charge Code |
9900401
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$12,780.50
|
|
|
Suture of quadriceps or hamstring muscle rupture; primary
|
Facility
|
OP
|
$18,794.85
|
|
|
Service Code
|
HCPCS 27385
|
| Hospital Charge Code |
9900401
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,398.52 |
| Max. Negotiated Rate |
$15,408.22 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2,398.52
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$7,289.28
|
| Rate for Payer: Amerigroup Medicare |
$7,289.28
|
| Rate for Payer: BCBS of TX Blue Advantage |
$9,989.86
|
| Rate for Payer: BCBS of TX Blue Essentials |
$11,963.90
|
| Rate for Payer: BCBS of TX Medicare |
$7,289.28
|
| Rate for Payer: BCBS of TX PPO |
$15,074.51
|
| Rate for Payer: Cash Price |
$12,780.50
|
| Rate for Payer: Cash Price |
$12,780.50
|
| Rate for Payer: Cash Price |
$12,780.50
|
| Rate for Payer: Cigna Commercial |
$15,408.22
|
| Rate for Payer: Cigna Medicaid |
$13,532.29
|
| 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 |
$13,532.29
|
| 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 |
$13,532.29
|
| 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 |
$13,532.29
|
| 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
|
|
|
Suture of quadriceps or hamstring muscle rupture; primary
|
Facility
|
OP
|
$15,408.22
|
|
|
Service Code
|
CPT 27385
|
| Hospital Charge Code |
36027385
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,398.52 |
| Max. Negotiated Rate |
$15,408.22 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2,398.52
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$7,289.28
|
| Rate for Payer: Amerigroup Medicare |
$7,289.28
|
| Rate for Payer: BCBS of TX Blue Advantage |
$9,989.86
|
| Rate for Payer: BCBS of TX Blue Essentials |
$11,963.90
|
| Rate for Payer: BCBS of TX Medicare |
$7,289.28
|
| Rate for Payer: BCBS of TX PPO |
$15,074.51
|
| Rate for Payer: Cigna Commercial |
$15,408.22
|
| Rate for Payer: Cigna Medicare |
$7,289.28
|
| Rate for Payer: Employer Direct Commercial |
$7,289.28
|
| Rate for Payer: Humana Medicare/TRICARE |
$7,289.28
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$7,289.28
|
| Rate for Payer: Molina Medicare |
$7,289.28
|
| Rate for Payer: Multiplan Auto |
$10,000.00
|
| Rate for Payer: Multiplan Commercial |
$10,000.00
|
| Rate for Payer: Multiplan Workers Comp |
$10,000.00
|
| Rate for Payer: Scott and White EPO/PPO |
$12,104.03
|
| Rate for Payer: Scott and White Medicare |
$7,289.28
|
| Rate for Payer: Superior Health Plan EPO |
$7,289.28
|
| Rate for Payer: Superior Health Plan Medicare |
$7,289.28
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$7,289.28
|
| Rate for Payer: Universal American Medicare |
$7,289.28
|
| Rate for Payer: Wellcare Medicare |
$7,289.28
|
| Rate for Payer: Wellmed Medicare |
$7,289.28
|
|
|
Suture of quadriceps or hamstring muscle rupture; secondary reconstruction, including fascial or tendon graft
|
Facility
|
IP
|
$27,265.32
|
|
|
Service Code
|
HCPCS 27386
|
| Hospital Charge Code |
991329
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$18,540.42
|
|
|
Suture of quadriceps or hamstring muscle rupture; secondary reconstruction, including fascial or tendon graft
|
Facility
|
OP
|
$27,265.32
|
|
|
Service Code
|
HCPCS 27386
|
| Hospital Charge Code |
991329
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,398.52 |
| Max. Negotiated Rate |
$19,631.03 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2,398.52
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$7,289.28
|
| Rate for Payer: Amerigroup Medicare |
$7,289.28
|
| Rate for Payer: BCBS of TX Blue Advantage |
$9,989.86
|
| Rate for Payer: BCBS of TX Blue Essentials |
$11,963.90
|
| Rate for Payer: BCBS of TX Medicare |
$7,289.28
|
| Rate for Payer: BCBS of TX PPO |
$15,074.51
|
| Rate for Payer: Cash Price |
$18,540.42
|
| Rate for Payer: Cash Price |
$18,540.42
|
| Rate for Payer: Cash Price |
$18,540.42
|
| Rate for Payer: Cigna Commercial |
$15,408.22
|
| Rate for Payer: Cigna Medicaid |
$19,631.03
|
| 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 |
$19,631.03
|
| 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 |
$19,631.03
|
| 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 |
$19,631.03
|
| 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
|
|
|
SUTURE ORTHOCORD #2 MO-7
|
Facility
|
OP
|
$295.87
|
|
| Hospital Charge Code |
121483
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$26.63 |
| Max. Negotiated Rate |
$213.03 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$26.63
|
| Rate for Payer: BCBS of TX Blue Advantage |
$88.76
|
| Rate for Payer: BCBS of TX Blue Essentials |
$106.51
|
| Rate for Payer: BCBS of TX PPO |
$118.35
|
| Rate for Payer: Cash Price |
$201.19
|
| Rate for Payer: Cigna Medicaid |
$213.03
|
| Rate for Payer: Molina CHIP/Medicaid |
$213.03
|
| Rate for Payer: Multiplan Auto |
$192.32
|
| Rate for Payer: Multiplan Commercial |
$192.32
|
| Rate for Payer: Multiplan Workers Comp |
$192.32
|
| Rate for Payer: Parkland Medicaid |
$213.03
|
| Rate for Payer: Scott and White EPO/PPO |
$147.94
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$213.03
|
| Rate for Payer: Superior Health Plan EPO |
$40.24
|
|
|
SUTURE ORTHOCORD #2 MO-7
|
Facility
|
IP
|
$295.87
|
|
| Hospital Charge Code |
121483
|
|
Hospital Revenue Code
|
272
|
| Rate for Payer: Cash Price |
$201.19
|
|
|
SUTURE PASSER SHUTTLE INFINITY
|
Facility
|
OP
|
$236.08
|
|
| Hospital Charge Code |
8406459
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.25 |
| Max. Negotiated Rate |
$169.98 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$21.25
|
| Rate for Payer: BCBS of TX Blue Advantage |
$70.82
|
| Rate for Payer: BCBS of TX Blue Essentials |
$84.99
|
| Rate for Payer: BCBS of TX PPO |
$94.43
|
| Rate for Payer: Cash Price |
$160.53
|
| Rate for Payer: Cigna Medicaid |
$169.98
|
| Rate for Payer: Molina CHIP/Medicaid |
$169.98
|
| Rate for Payer: Multiplan Auto |
$153.45
|
| Rate for Payer: Multiplan Commercial |
$153.45
|
| Rate for Payer: Multiplan Workers Comp |
$153.45
|
| Rate for Payer: Parkland Medicaid |
$169.98
|
| Rate for Payer: Scott and White EPO/PPO |
$118.04
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$169.98
|
| Rate for Payer: Superior Health Plan EPO |
$32.11
|
|
|
SUTURE PASSER SHUTTLE INFINITY
|
Facility
|
IP
|
$236.08
|
|
| Hospital Charge Code |
8406459
|
|
Hospital Revenue Code
|
272
|
| Rate for Payer: Cash Price |
$160.53
|
|
|
SUTURE, PDS II, 2-0, CT-1, 27, UNDYED
|
Facility
|
IP
|
$8.79
|
|
| Hospital Charge Code |
993812
|
|
Hospital Revenue Code
|
272
|
| Rate for Payer: Cash Price |
$5.98
|
|
|
SUTURE, PDS II, 2-0, CT-1, 27, UNDYED
|
Facility
|
OP
|
$8.79
|
|
| Hospital Charge Code |
993812
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.79 |
| Max. Negotiated Rate |
$6.33 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$0.79
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2.64
|
| Rate for Payer: BCBS of TX Blue Essentials |
$3.16
|
| Rate for Payer: BCBS of TX PPO |
$3.52
|
| Rate for Payer: Cash Price |
$5.98
|
| Rate for Payer: Cigna Medicaid |
$6.33
|
| Rate for Payer: Molina CHIP/Medicaid |
$6.33
|
| Rate for Payer: Multiplan Auto |
$5.71
|
| Rate for Payer: Multiplan Commercial |
$5.71
|
| Rate for Payer: Multiplan Workers Comp |
$5.71
|
| Rate for Payer: Parkland Medicaid |
$6.33
|
| Rate for Payer: Scott and White EPO/PPO |
$4.39
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$6.33
|
| Rate for Payer: Superior Health Plan EPO |
$1.20
|
|
|
SUTURE, PDS II VIL MONO 1 CLOSURE 96' LP TP-1 -- DHF
|
Facility
|
IP
|
$170.09
|
|
| Hospital Charge Code |
81945008
|
|
Hospital Revenue Code
|
272
|
| Rate for Payer: Cash Price |
$115.66
|
|
|
SUTURE, PDS II VIL MONO 1 CLOSURE 96' LP TP-1 -- DHF
|
Facility
|
OP
|
$170.09
|
|
| Hospital Charge Code |
81945008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.31 |
| Max. Negotiated Rate |
$122.46 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$15.31
|
| Rate for Payer: BCBS of TX Blue Advantage |
$51.03
|
| Rate for Payer: BCBS of TX Blue Essentials |
$61.23
|
| Rate for Payer: BCBS of TX PPO |
$68.04
|
| Rate for Payer: Cash Price |
$115.66
|
| Rate for Payer: Cigna Medicaid |
$122.46
|
| Rate for Payer: Molina CHIP/Medicaid |
$122.46
|
| Rate for Payer: Multiplan Auto |
$110.56
|
| Rate for Payer: Multiplan Commercial |
$110.56
|
| Rate for Payer: Multiplan Workers Comp |
$110.56
|
| Rate for Payer: Parkland Medicaid |
$122.46
|
| Rate for Payer: Scott and White EPO/PPO |
$85.05
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$122.46
|
| Rate for Payer: Superior Health Plan EPO |
$23.13
|
|
