|
SYNCOPE & COLLAPSE
|
Facility
|
IP
|
$16,560.40
|
|
|
Service Code
|
MSDRG 312
|
| Min. Negotiated Rate |
$6,892.90 |
| Max. Negotiated Rate |
$16,560.40 |
| Rate for Payer: BCBS of TX Blue Advantage |
$6,892.90
|
| Rate for Payer: BCBS of TX Blue Essentials |
$8,270.68
|
| Rate for Payer: BCBS of TX PPO |
$9,190.00
|
|
|
Syndactylization, toes (eg, webbing or Kelikian type procedure)
|
Facility
|
OP
|
$11,906.64
|
|
|
Service Code
|
HCPCS 28280
|
| Hospital Charge Code |
9900497
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,088.27 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,088.27
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3,286.91
|
| Rate for Payer: Amerigroup Medicare |
$3,286.91
|
| Rate for Payer: BCBS of TX Blue Advantage |
$4,571.54
|
| Rate for Payer: BCBS of TX Blue Essentials |
$5,474.90
|
| Rate for Payer: BCBS of TX Medicare |
$3,286.91
|
| Rate for Payer: BCBS of TX PPO |
$6,898.37
|
| Rate for Payer: Cash Price |
$8,096.52
|
| Rate for Payer: Cash Price |
$8,096.52
|
| Rate for Payer: Cash Price |
$8,096.52
|
| Rate for Payer: Cigna Commercial |
$6,947.94
|
| Rate for Payer: Cigna Medicaid |
$8,572.78
|
| Rate for Payer: Cigna Medicare |
$3,286.91
|
| Rate for Payer: Employer Direct Commercial |
$3,286.91
|
| Rate for Payer: Humana Medicare/TRICARE |
$3,286.91
|
| Rate for Payer: Molina CHIP/Medicaid |
$8,572.78
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3,286.91
|
| Rate for Payer: Molina Medicare |
$3,286.91
|
| 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 |
$8,572.78
|
| Rate for Payer: Scott and White EPO/PPO |
$6,080.78
|
| Rate for Payer: Scott and White Medicare |
$3,286.91
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$8,572.78
|
| Rate for Payer: Superior Health Plan EPO |
$3,286.91
|
| Rate for Payer: Superior Health Plan Medicare |
$3,286.91
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3,286.91
|
| Rate for Payer: Universal American Medicare |
$3,286.91
|
| Rate for Payer: Wellcare Medicare |
$3,286.91
|
| Rate for Payer: Wellmed Medicare |
$3,286.91
|
|
|
Syndactylization, toes (eg, webbing or Kelikian type procedure)
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 28280
|
| Hospital Charge Code |
36028280
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,088.27 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,088.27
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3,286.91
|
| Rate for Payer: Amerigroup Medicare |
$3,286.91
|
| Rate for Payer: BCBS of TX Blue Advantage |
$4,571.54
|
| Rate for Payer: BCBS of TX Blue Essentials |
$5,474.90
|
| Rate for Payer: BCBS of TX Medicare |
$3,286.91
|
| Rate for Payer: BCBS of TX PPO |
$6,898.37
|
| Rate for Payer: Cigna Commercial |
$6,947.94
|
| Rate for Payer: Cigna Medicare |
$3,286.91
|
| Rate for Payer: Employer Direct Commercial |
$3,286.91
|
| Rate for Payer: Humana Medicare/TRICARE |
$3,286.91
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3,286.91
|
| Rate for Payer: Molina Medicare |
$3,286.91
|
| 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 |
$6,080.78
|
| Rate for Payer: Scott and White Medicare |
$3,286.91
|
| Rate for Payer: Superior Health Plan EPO |
$3,286.91
|
| Rate for Payer: Superior Health Plan Medicare |
$3,286.91
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3,286.91
|
| Rate for Payer: Universal American Medicare |
$3,286.91
|
| Rate for Payer: Wellcare Medicare |
$3,286.91
|
| Rate for Payer: Wellmed Medicare |
$3,286.91
|
|
|
Syndactylization, toes (eg, webbing or Kelikian type procedure)
|
Facility
|
IP
|
$11,906.64
|
|
|
Service Code
|
HCPCS 28280
|
| Hospital Charge Code |
9900497
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$8,096.52
|
|
|
Synovectomy, extensor tendon sheath, wrist, single compartment
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 25118
|
| Hospital Charge Code |
36025118
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$593.04 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$593.04
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,615.32
|
| Rate for Payer: Amerigroup Medicare |
$1,615.32
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,263.50
|
| Rate for Payer: BCBS of TX Blue Essentials |
$2,710.78
|
| Rate for Payer: BCBS of TX Medicare |
$1,615.32
|
| Rate for Payer: BCBS of TX PPO |
$3,415.58
|
| Rate for Payer: Cigna Commercial |
$3,414.49
|
| Rate for Payer: Cigna Medicare |
$1,615.32
|
| Rate for Payer: Employer Direct Commercial |
$1,615.32
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,615.32
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,615.32
|
| Rate for Payer: Molina Medicare |
$1,615.32
|
| 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 |
$2,988.34
|
| Rate for Payer: Scott and White Medicare |
$1,615.32
|
| Rate for Payer: Superior Health Plan EPO |
$1,615.32
|
| Rate for Payer: Superior Health Plan Medicare |
$1,615.32
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,615.32
|
| Rate for Payer: Universal American Medicare |
$1,615.32
|
| Rate for Payer: Wellcare Medicare |
$1,615.32
|
| Rate for Payer: Wellmed Medicare |
$1,615.32
|
|
|
Synovectomy, extensor tendon sheath, wrist, single compartment
|
Facility
|
IP
|
$6,776.95
|
|
|
Service Code
|
HCPCS 25118
|
| Hospital Charge Code |
9900274
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$4,608.33
|
|
|
Synovectomy, extensor tendon sheath, wrist, single compartment
|
Facility
|
OP
|
$6,776.95
|
|
|
Service Code
|
HCPCS 25118
|
| Hospital Charge Code |
9900274
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$593.04 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$593.04
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,615.32
|
| Rate for Payer: Amerigroup Medicare |
$1,615.32
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,263.50
|
| Rate for Payer: BCBS of TX Blue Essentials |
$2,710.78
|
| Rate for Payer: BCBS of TX Medicare |
$1,615.32
|
| Rate for Payer: BCBS of TX PPO |
$3,415.58
|
| Rate for Payer: Cash Price |
$4,608.33
|
| Rate for Payer: Cash Price |
$4,608.33
|
| Rate for Payer: Cash Price |
$4,608.33
|
| Rate for Payer: Cigna Commercial |
$3,414.49
|
| Rate for Payer: Cigna Medicaid |
$4,879.40
|
| Rate for Payer: Cigna Medicare |
$1,615.32
|
| Rate for Payer: Employer Direct Commercial |
$1,615.32
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,615.32
|
| Rate for Payer: Molina CHIP/Medicaid |
$4,879.40
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,615.32
|
| Rate for Payer: Molina Medicare |
$1,615.32
|
| 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 |
$4,879.40
|
| Rate for Payer: Scott and White EPO/PPO |
$2,988.34
|
| Rate for Payer: Scott and White Medicare |
$1,615.32
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$4,879.40
|
| Rate for Payer: Superior Health Plan EPO |
$1,615.32
|
| Rate for Payer: Superior Health Plan Medicare |
$1,615.32
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,615.32
|
| Rate for Payer: Universal American Medicare |
$1,615.32
|
| Rate for Payer: Wellcare Medicare |
$1,615.32
|
| Rate for Payer: Wellmed Medicare |
$1,615.32
|
|
|
Synovectomy, metacarpophalangeal joint including intrinsic release and extensor hood reconstruction,
|
Facility
|
OP
|
$13,200.00
|
|
|
Service Code
|
HCPCS 26135
|
| Hospital Charge Code |
9900322
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,088.27 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,088.27
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3,286.91
|
| Rate for Payer: Amerigroup Medicare |
$3,286.91
|
| Rate for Payer: BCBS of TX Blue Advantage |
$4,571.54
|
| Rate for Payer: BCBS of TX Blue Essentials |
$5,474.90
|
| Rate for Payer: BCBS of TX Medicare |
$3,286.91
|
| Rate for Payer: BCBS of TX PPO |
$6,898.37
|
| Rate for Payer: Cash Price |
$8,976.00
|
| Rate for Payer: Cash Price |
$8,976.00
|
| Rate for Payer: Cash Price |
$8,976.00
|
| Rate for Payer: Cigna Commercial |
$6,947.94
|
| Rate for Payer: Cigna Medicaid |
$9,504.00
|
| Rate for Payer: Cigna Medicare |
$3,286.91
|
| Rate for Payer: Employer Direct Commercial |
$3,286.91
|
| Rate for Payer: Humana Medicare/TRICARE |
$3,286.91
|
| Rate for Payer: Molina CHIP/Medicaid |
$9,504.00
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3,286.91
|
| Rate for Payer: Molina Medicare |
$3,286.91
|
| 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 |
$9,504.00
|
| Rate for Payer: Scott and White EPO/PPO |
$6,080.78
|
| Rate for Payer: Scott and White Medicare |
$3,286.91
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$9,504.00
|
| Rate for Payer: Superior Health Plan EPO |
$3,286.91
|
| Rate for Payer: Superior Health Plan Medicare |
$3,286.91
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3,286.91
|
| Rate for Payer: Universal American Medicare |
$3,286.91
|
| Rate for Payer: Wellcare Medicare |
$3,286.91
|
| Rate for Payer: Wellmed Medicare |
$3,286.91
|
|
|
Synovectomy, metacarpophalangeal joint including intrinsic release and extensor hood reconstruction,
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 26135
|
| Hospital Charge Code |
36026135
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,088.27 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,088.27
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3,286.91
|
| Rate for Payer: Amerigroup Medicare |
$3,286.91
|
| Rate for Payer: BCBS of TX Blue Advantage |
$4,571.54
|
| Rate for Payer: BCBS of TX Blue Essentials |
$5,474.90
|
| Rate for Payer: BCBS of TX Medicare |
$3,286.91
|
| Rate for Payer: BCBS of TX PPO |
$6,898.37
|
| Rate for Payer: Cigna Commercial |
$6,947.94
|
| Rate for Payer: Cigna Medicare |
$3,286.91
|
| Rate for Payer: Employer Direct Commercial |
$3,286.91
|
| Rate for Payer: Humana Medicare/TRICARE |
$3,286.91
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3,286.91
|
| Rate for Payer: Molina Medicare |
$3,286.91
|
| 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 |
$6,080.78
|
| Rate for Payer: Scott and White Medicare |
$3,286.91
|
| Rate for Payer: Superior Health Plan EPO |
$3,286.91
|
| Rate for Payer: Superior Health Plan Medicare |
$3,286.91
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3,286.91
|
| Rate for Payer: Universal American Medicare |
$3,286.91
|
| Rate for Payer: Wellcare Medicare |
$3,286.91
|
| Rate for Payer: Wellmed Medicare |
$3,286.91
|
|
|
Synovectomy, metacarpophalangeal joint including intrinsic release and extensor hood reconstruction,
|
Facility
|
IP
|
$13,200.00
|
|
|
Service Code
|
HCPCS 26135
|
| Hospital Charge Code |
9900322
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$8,976.00
|
|
|
Synovectomy, tendon sheath, foot; flexor
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 28086
|
| Hospital Charge Code |
36028086
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,088.27 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,088.27
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3,286.91
|
| Rate for Payer: Amerigroup Medicare |
$3,286.91
|
| Rate for Payer: BCBS of TX Blue Advantage |
$4,571.54
|
| Rate for Payer: BCBS of TX Blue Essentials |
$5,474.90
|
| Rate for Payer: BCBS of TX Medicare |
$3,286.91
|
| Rate for Payer: BCBS of TX PPO |
$6,898.37
|
| Rate for Payer: Cigna Commercial |
$6,947.94
|
| Rate for Payer: Cigna Medicare |
$3,286.91
|
| Rate for Payer: Employer Direct Commercial |
$3,286.91
|
| Rate for Payer: Humana Medicare/TRICARE |
$3,286.91
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3,286.91
|
| Rate for Payer: Molina Medicare |
$3,286.91
|
| 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 |
$6,080.78
|
| Rate for Payer: Scott and White Medicare |
$3,286.91
|
| Rate for Payer: Superior Health Plan EPO |
$3,286.91
|
| Rate for Payer: Superior Health Plan Medicare |
$3,286.91
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3,286.91
|
| Rate for Payer: Universal American Medicare |
$3,286.91
|
| Rate for Payer: Wellcare Medicare |
$3,286.91
|
| Rate for Payer: Wellmed Medicare |
$3,286.91
|
|
|
Synovectomy, tendon sheath, foot; flexor
|
Facility
|
OP
|
$7,783.60
|
|
|
Service Code
|
HCPCS 28086
|
| Hospital Charge Code |
9900468
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,088.27 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,088.27
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3,286.91
|
| Rate for Payer: Amerigroup Medicare |
$3,286.91
|
| Rate for Payer: BCBS of TX Blue Advantage |
$4,571.54
|
| Rate for Payer: BCBS of TX Blue Essentials |
$5,474.90
|
| Rate for Payer: BCBS of TX Medicare |
$3,286.91
|
| Rate for Payer: BCBS of TX PPO |
$6,898.37
|
| Rate for Payer: Cash Price |
$5,292.85
|
| Rate for Payer: Cash Price |
$5,292.85
|
| Rate for Payer: Cash Price |
$5,292.85
|
| Rate for Payer: Cigna Commercial |
$6,947.94
|
| Rate for Payer: Cigna Medicaid |
$5,604.19
|
| Rate for Payer: Cigna Medicare |
$3,286.91
|
| Rate for Payer: Employer Direct Commercial |
$3,286.91
|
| Rate for Payer: Humana Medicare/TRICARE |
$3,286.91
|
| Rate for Payer: Molina CHIP/Medicaid |
$5,604.19
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3,286.91
|
| Rate for Payer: Molina Medicare |
$3,286.91
|
| 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 |
$5,604.19
|
| Rate for Payer: Scott and White EPO/PPO |
$6,080.78
|
| Rate for Payer: Scott and White Medicare |
$3,286.91
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$5,604.19
|
| Rate for Payer: Superior Health Plan EPO |
$3,286.91
|
| Rate for Payer: Superior Health Plan Medicare |
$3,286.91
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3,286.91
|
| Rate for Payer: Universal American Medicare |
$3,286.91
|
| Rate for Payer: Wellcare Medicare |
$3,286.91
|
| Rate for Payer: Wellmed Medicare |
$3,286.91
|
|
|
Synovectomy, tendon sheath, foot; flexor
|
Facility
|
IP
|
$7,783.60
|
|
|
Service Code
|
HCPCS 28086
|
| Hospital Charge Code |
9900468
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$5,292.85
|
|
|
Synovectomy, tendon sheath, radical (tenosynovectomy), flexor tendon, palm and/or finger, each tendo
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 26145
|
| Hospital Charge Code |
36026145
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$593.04 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$593.04
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,615.32
|
| Rate for Payer: Amerigroup Medicare |
$1,615.32
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,263.50
|
| Rate for Payer: BCBS of TX Blue Essentials |
$2,710.78
|
| Rate for Payer: BCBS of TX Medicare |
$1,615.32
|
| Rate for Payer: BCBS of TX PPO |
$3,415.58
|
| Rate for Payer: Cigna Commercial |
$3,414.49
|
| Rate for Payer: Cigna Medicare |
$1,615.32
|
| Rate for Payer: Employer Direct Commercial |
$1,615.32
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,615.32
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,615.32
|
| Rate for Payer: Molina Medicare |
$1,615.32
|
| 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 |
$2,988.34
|
| Rate for Payer: Scott and White Medicare |
$1,615.32
|
| Rate for Payer: Superior Health Plan EPO |
$1,615.32
|
| Rate for Payer: Superior Health Plan Medicare |
$1,615.32
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,615.32
|
| Rate for Payer: Universal American Medicare |
$1,615.32
|
| Rate for Payer: Wellcare Medicare |
$1,615.32
|
| Rate for Payer: Wellmed Medicare |
$1,615.32
|
|
|
Synovectomy, tendon sheath, radical (tenosynovectomy), flexor tendon, palm and/or finger, each tendo
|
Facility
|
IP
|
$8,354.10
|
|
|
Service Code
|
HCPCS 26145
|
| Hospital Charge Code |
9900323
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$5,680.79
|
|
|
Synovectomy, tendon sheath, radical (tenosynovectomy), flexor tendon, palm and/or finger, each tendo
|
Facility
|
OP
|
$8,354.10
|
|
|
Service Code
|
HCPCS 26145
|
| Hospital Charge Code |
9900323
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$593.04 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$593.04
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,615.32
|
| Rate for Payer: Amerigroup Medicare |
$1,615.32
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,263.50
|
| Rate for Payer: BCBS of TX Blue Essentials |
$2,710.78
|
| Rate for Payer: BCBS of TX Medicare |
$1,615.32
|
| Rate for Payer: BCBS of TX PPO |
$3,415.58
|
| Rate for Payer: Cash Price |
$5,680.79
|
| Rate for Payer: Cash Price |
$5,680.79
|
| Rate for Payer: Cash Price |
$5,680.79
|
| Rate for Payer: Cigna Commercial |
$3,414.49
|
| Rate for Payer: Cigna Medicaid |
$6,014.95
|
| Rate for Payer: Cigna Medicare |
$1,615.32
|
| Rate for Payer: Employer Direct Commercial |
$1,615.32
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,615.32
|
| Rate for Payer: Molina CHIP/Medicaid |
$6,014.95
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,615.32
|
| Rate for Payer: Molina Medicare |
$1,615.32
|
| 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 |
$6,014.95
|
| Rate for Payer: Scott and White EPO/PPO |
$2,988.34
|
| Rate for Payer: Scott and White Medicare |
$1,615.32
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$6,014.95
|
| Rate for Payer: Superior Health Plan EPO |
$1,615.32
|
| Rate for Payer: Superior Health Plan Medicare |
$1,615.32
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,615.32
|
| Rate for Payer: Universal American Medicare |
$1,615.32
|
| Rate for Payer: Wellcare Medicare |
$1,615.32
|
| Rate for Payer: Wellmed Medicare |
$1,615.32
|
|
|
Synthetic undercast
|
Facility
|
OP
|
$5.50
|
|
| Hospital Charge Code |
993753
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$3.96 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$0.50
|
| Rate for Payer: BCBS of TX Blue Advantage |
$1.65
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1.98
|
| Rate for Payer: BCBS of TX PPO |
$2.20
|
| Rate for Payer: Cash Price |
$3.74
|
| Rate for Payer: Cigna Medicaid |
$3.96
|
| Rate for Payer: Molina CHIP/Medicaid |
$3.96
|
| Rate for Payer: Multiplan Auto |
$3.58
|
| Rate for Payer: Multiplan Commercial |
$3.58
|
| Rate for Payer: Multiplan Workers Comp |
$3.58
|
| Rate for Payer: Parkland Medicaid |
$3.96
|
| Rate for Payer: Scott and White EPO/PPO |
$2.75
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$3.96
|
| Rate for Payer: Superior Health Plan EPO |
$0.75
|
|
|
Synthetic undercast
|
Facility
|
IP
|
$5.50
|
|
| Hospital Charge Code |
993753
|
|
Hospital Revenue Code
|
271
|
| Rate for Payer: Cash Price |
$3.74
|
|
|
SYRGE, MALE, LUER-LOK, 3ML, STERILE DISP
|
Facility
|
IP
|
$0.49
|
|
| Hospital Charge Code |
993234
|
|
Hospital Revenue Code
|
270
|
| Rate for Payer: Cash Price |
$0.33
|
|
|
SYRGE, MALE, LUER-LOK, 3ML, STERILE DISP
|
Facility
|
OP
|
$0.49
|
|
| Hospital Charge Code |
993234
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.35 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$0.04
|
| Rate for Payer: BCBS of TX Blue Advantage |
$0.15
|
| Rate for Payer: BCBS of TX Blue Essentials |
$0.18
|
| Rate for Payer: BCBS of TX PPO |
$0.20
|
| Rate for Payer: Cash Price |
$0.33
|
| Rate for Payer: Cigna Medicaid |
$0.35
|
| Rate for Payer: Molina CHIP/Medicaid |
$0.35
|
| Rate for Payer: Multiplan Auto |
$0.32
|
| Rate for Payer: Multiplan Commercial |
$0.32
|
| Rate for Payer: Multiplan Workers Comp |
$0.32
|
| Rate for Payer: Parkland Medicaid |
$0.35
|
| Rate for Payer: Scott and White EPO/PPO |
$0.25
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$0.35
|
| Rate for Payer: Superior Health Plan EPO |
$0.07
|
|
|
SYRINGE 10ML LF STRL LL TIP DISP MED
|
Facility
|
OP
|
$2.44
|
|
| Hospital Charge Code |
993035
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$1.76 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$0.22
|
| Rate for Payer: BCBS of TX Blue Advantage |
$0.73
|
| Rate for Payer: BCBS of TX Blue Essentials |
$0.88
|
| Rate for Payer: BCBS of TX PPO |
$0.98
|
| Rate for Payer: Cash Price |
$1.66
|
| Rate for Payer: Cigna Medicaid |
$1.76
|
| Rate for Payer: Molina CHIP/Medicaid |
$1.76
|
| Rate for Payer: Multiplan Auto |
$1.59
|
| Rate for Payer: Multiplan Commercial |
$1.59
|
| Rate for Payer: Multiplan Workers Comp |
$1.59
|
| Rate for Payer: Parkland Medicaid |
$1.76
|
| Rate for Payer: Scott and White EPO/PPO |
$1.22
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1.76
|
| Rate for Payer: Superior Health Plan EPO |
$0.33
|
|
|
SYRINGE 10ML LF STRL LL TIP DISP MED
|
Facility
|
IP
|
$2.44
|
|
| Hospital Charge Code |
993035
|
|
Hospital Revenue Code
|
270
|
| Rate for Payer: Cash Price |
$1.66
|
|
|
SYRINGE, 30ML, LUER-LOK TIP, DISPOSABLE
|
Facility
|
OP
|
$1.87
|
|
| Hospital Charge Code |
993747
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$1.35 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$0.17
|
| Rate for Payer: BCBS of TX Blue Advantage |
$0.56
|
| Rate for Payer: BCBS of TX Blue Essentials |
$0.67
|
| Rate for Payer: BCBS of TX PPO |
$0.75
|
| Rate for Payer: Cash Price |
$1.27
|
| Rate for Payer: Cigna Medicaid |
$1.35
|
| Rate for Payer: Molina CHIP/Medicaid |
$1.35
|
| Rate for Payer: Multiplan Auto |
$1.22
|
| Rate for Payer: Multiplan Commercial |
$1.22
|
| Rate for Payer: Multiplan Workers Comp |
$1.22
|
| Rate for Payer: Parkland Medicaid |
$1.35
|
| Rate for Payer: Scott and White EPO/PPO |
$0.94
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1.35
|
| Rate for Payer: Superior Health Plan EPO |
$0.25
|
|
|
SYRINGE, 30ML, LUER-LOK TIP, DISPOSABLE
|
Facility
|
IP
|
$1.87
|
|
| Hospital Charge Code |
993747
|
|
Hospital Revenue Code
|
272
|
| Rate for Payer: Cash Price |
$1.27
|
|
|
SYRINGE, 8ML, PLASTIC, LOR-LUBE SLIP
|
Facility
|
IP
|
$11.18
|
|
| Hospital Charge Code |
992764
|
|
Hospital Revenue Code
|
270
|
| Rate for Payer: Cash Price |
$7.60
|
|
