|
Ultrasound, retroperitoneal real time with image documentation; limited
|
Facility
|
IP
|
$425.36
|
|
|
Service Code
|
HCPCS 76775
|
| Hospital Charge Code |
994100
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$289.24
|
|
|
Ultrasound, retroperitoneal real time with image documentation; limited
|
Facility
|
OP
|
$425.36
|
|
|
Service Code
|
HCPCS 76775
|
| Hospital Charge Code |
994100
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$59.81 |
| Max. Negotiated Rate |
$306.26 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$59.81
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$105.02
|
| Rate for Payer: Amerigroup Medicare |
$105.02
|
| Rate for Payer: BCBS of TX Blue Advantage |
$184.93
|
| Rate for Payer: BCBS of TX Blue Essentials |
$221.92
|
| Rate for Payer: BCBS of TX Medicare |
$105.02
|
| Rate for Payer: BCBS of TX PPO |
$247.70
|
| Rate for Payer: Cash Price |
$289.24
|
| Rate for Payer: Cash Price |
$289.24
|
| Rate for Payer: Cash Price |
$289.24
|
| Rate for Payer: Cigna Commercial |
$222.00
|
| Rate for Payer: Cigna Medicaid |
$306.26
|
| Rate for Payer: Cigna Medicare |
$105.02
|
| Rate for Payer: Employer Direct Commercial |
$105.02
|
| Rate for Payer: Humana Medicare/TRICARE |
$105.02
|
| Rate for Payer: Molina CHIP/Medicaid |
$306.26
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$105.02
|
| Rate for Payer: Molina Medicare |
$105.02
|
| Rate for Payer: Multiplan Auto |
$276.48
|
| Rate for Payer: Multiplan Commercial |
$276.48
|
| Rate for Payer: Multiplan Workers Comp |
$276.48
|
| Rate for Payer: Parkland Medicaid |
$306.26
|
| Rate for Payer: Scott and White EPO/PPO |
$73.66
|
| Rate for Payer: Scott and White Medicare |
$105.02
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$306.26
|
| Rate for Payer: Superior Health Plan EPO |
$105.02
|
| Rate for Payer: Superior Health Plan Medicare |
$105.02
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$105.02
|
| Rate for Payer: Universal American Medicare |
$105.02
|
| Rate for Payer: Wellcare Medicare |
$105.02
|
| Rate for Payer: Wellmed Medicare |
$105.02
|
|
|
UMBILICAL MEMBRANE 3X3
|
Facility
|
OP
|
$837.00
|
|
|
Service Code
|
HCPCS Q4205
|
| Hospital Charge Code |
145682
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$14.83 |
| Max. Negotiated Rate |
$602.64 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$75.33
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$125.01
|
| Rate for Payer: Amerigroup Medicare |
$125.01
|
| Rate for Payer: BCBS of TX Blue Advantage |
$14.83
|
| Rate for Payer: BCBS of TX Blue Essentials |
$17.80
|
| Rate for Payer: BCBS of TX Medicare |
$125.01
|
| Rate for Payer: BCBS of TX PPO |
$19.74
|
| Rate for Payer: Cash Price |
$569.16
|
| Rate for Payer: Cash Price |
$569.16
|
| Rate for Payer: Cash Price |
$569.16
|
| Rate for Payer: Cigna Commercial |
$264.25
|
| Rate for Payer: Cigna Medicaid |
$602.64
|
| Rate for Payer: Cigna Medicare |
$125.01
|
| Rate for Payer: Employer Direct Commercial |
$125.01
|
| Rate for Payer: Humana Medicare/TRICARE |
$125.01
|
| Rate for Payer: Molina CHIP/Medicaid |
$602.64
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$125.01
|
| Rate for Payer: Molina Medicare |
$125.01
|
| Rate for Payer: Multiplan Auto |
$418.50
|
| Rate for Payer: Multiplan Commercial |
$418.50
|
| Rate for Payer: Multiplan Workers Comp |
$418.50
|
| Rate for Payer: Parkland Medicaid |
$602.64
|
| Rate for Payer: Scott and White EPO/PPO |
$418.50
|
| Rate for Payer: Scott and White Medicare |
$125.01
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$602.64
|
| Rate for Payer: Superior Health Plan EPO |
$125.01
|
| Rate for Payer: Superior Health Plan Medicare |
$125.01
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$125.01
|
| Rate for Payer: Universal American Medicare |
$125.01
|
| Rate for Payer: Wellcare Medicare |
$125.01
|
| Rate for Payer: Wellmed Medicare |
$125.01
|
|
|
UMBILICAL MEMBRANE 3X3
|
Facility
|
IP
|
$837.00
|
|
|
Service Code
|
HCPCS Q4205
|
| Hospital Charge Code |
145682
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$209.25 |
| Max. Negotiated Rate |
$418.50 |
| Rate for Payer: Cash Price |
$569.16
|
| Rate for Payer: Cigna Commercial |
$209.25
|
| Rate for Payer: Multiplan Auto |
$418.50
|
| Rate for Payer: Multiplan Commercial |
$418.50
|
| Rate for Payer: Multiplan Workers Comp |
$418.50
|
| Rate for Payer: Scott and White EPO/PPO |
$418.50
|
|
|
U Microalbumin
|
Facility
|
OP
|
$226.00
|
|
|
Service Code
|
HCPCS 82043
|
| Hospital Charge Code |
1603281
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.25 |
| Max. Negotiated Rate |
$162.72 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2.25
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$5.78
|
| Rate for Payer: Amerigroup Medicare |
$5.78
|
| Rate for Payer: BCBS of TX Blue Advantage |
$67.80
|
| Rate for Payer: BCBS of TX Blue Essentials |
$81.36
|
| Rate for Payer: BCBS of TX Medicare |
$5.78
|
| Rate for Payer: BCBS of TX PPO |
$90.40
|
| Rate for Payer: Cash Price |
$153.68
|
| Rate for Payer: Cash Price |
$153.68
|
| Rate for Payer: Cigna Medicaid |
$162.72
|
| Rate for Payer: Cigna Medicare |
$5.78
|
| Rate for Payer: Employer Direct Commercial |
$5.78
|
| Rate for Payer: Humana Medicare/TRICARE |
$5.78
|
| Rate for Payer: Molina CHIP/Medicaid |
$162.72
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$5.78
|
| Rate for Payer: Molina Medicare |
$5.78
|
| Rate for Payer: Multiplan Auto |
$146.90
|
| Rate for Payer: Multiplan Commercial |
$146.90
|
| Rate for Payer: Multiplan Workers Comp |
$146.90
|
| Rate for Payer: Parkland Medicaid |
$162.72
|
| Rate for Payer: Scott and White EPO/PPO |
$7.22
|
| Rate for Payer: Scott and White Medicare |
$5.78
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$162.72
|
| Rate for Payer: Superior Health Plan EPO |
$5.78
|
| Rate for Payer: Superior Health Plan Medicare |
$5.78
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$5.78
|
| Rate for Payer: Universal American Medicare |
$5.78
|
| Rate for Payer: Wellcare Medicare |
$5.78
|
| Rate for Payer: Wellmed Medicare |
$5.78
|
|
|
U Microalbumin
|
Facility
|
IP
|
$226.00
|
|
|
Service Code
|
HCPCS 82043
|
| Hospital Charge Code |
1603281
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$153.68
|
|
|
UNCOMPLICATED PEPTIC ULCER WITH MCC
|
Facility
|
IP
|
$25,840.00
|
|
|
Service Code
|
MSDRG 383
|
| Min. Negotiated Rate |
$11,618.60 |
| Max. Negotiated Rate |
$25,840.00 |
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$14,879.26
|
| Rate for Payer: Amerigroup Medicare |
$14,879.26
|
| Rate for Payer: BCBS of TX Medicare |
$14,879.26
|
| Rate for Payer: Cigna Commercial |
$17,783.42
|
| Rate for Payer: Cigna Medicare |
$14,879.26
|
| Rate for Payer: Employer Direct Commercial |
$14,879.26
|
| Rate for Payer: Humana Medicare/TRICARE |
$14,879.26
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$14,879.26
|
| Rate for Payer: Molina Medicare |
$14,879.26
|
| Rate for Payer: Multiplan Auto |
$25,840.00
|
| Rate for Payer: Multiplan Commercial |
$25,840.00
|
| Rate for Payer: Multiplan Workers Comp |
$25,840.00
|
| Rate for Payer: Scott and White EPO/PPO |
$11,900.00
|
| Rate for Payer: Scott and White Medicare |
$14,879.26
|
| Rate for Payer: Superior Health Plan EPO |
$14,879.26
|
| Rate for Payer: Superior Health Plan Medicare |
$14,879.26
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$14,879.26
|
| Rate for Payer: Universal American Medicare |
$14,879.26
|
| Rate for Payer: Wellcare Medicare |
$14,879.26
|
| Rate for Payer: Wellmed Medicare |
$14,879.26
|
|
|
UNCOMPLICATED PEPTIC ULCER WITHOUT MCC
|
Facility
|
IP
|
$17,130.40
|
|
|
Service Code
|
MSDRG 384
|
| Min. Negotiated Rate |
$7,355.58 |
| Max. Negotiated Rate |
$17,130.40 |
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$11,024.92
|
| Rate for Payer: Amerigroup Medicare |
$11,024.92
|
| Rate for Payer: BCBS of TX Medicare |
$11,024.92
|
| Rate for Payer: Cigna Commercial |
$11,009.82
|
| Rate for Payer: Cigna Medicare |
$11,024.92
|
| Rate for Payer: Employer Direct Commercial |
$11,024.92
|
| Rate for Payer: Humana Medicare/TRICARE |
$11,024.92
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$11,024.92
|
| Rate for Payer: Molina Medicare |
$11,024.92
|
| Rate for Payer: Multiplan Auto |
$17,130.40
|
| Rate for Payer: Multiplan Commercial |
$17,130.40
|
| Rate for Payer: Multiplan Workers Comp |
$17,130.40
|
| Rate for Payer: Scott and White EPO/PPO |
$7,889.00
|
| Rate for Payer: Scott and White Medicare |
$11,024.92
|
| Rate for Payer: Superior Health Plan EPO |
$11,024.92
|
| Rate for Payer: Superior Health Plan Medicare |
$11,024.92
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$11,024.92
|
| Rate for Payer: Universal American Medicare |
$11,024.92
|
| Rate for Payer: Wellcare Medicare |
$11,024.92
|
| Rate for Payer: Wellmed Medicare |
$11,024.92
|
|
|
UNCOMPLICATED PEPTIC ULCER W MCC
|
Facility
|
IP
|
$25,840.00
|
|
|
Service Code
|
MSDRG 383
|
| Min. Negotiated Rate |
$11,618.60 |
| Max. Negotiated Rate |
$25,840.00 |
| Rate for Payer: BCBS of TX Blue Advantage |
$11,618.60
|
| Rate for Payer: BCBS of TX Blue Essentials |
$13,940.97
|
| Rate for Payer: BCBS of TX PPO |
$15,490.57
|
|
|
UNCOMPLICATED PEPTIC ULCER W/O MCC
|
Facility
|
IP
|
$17,130.40
|
|
|
Service Code
|
MSDRG 384
|
| Min. Negotiated Rate |
$7,355.58 |
| Max. Negotiated Rate |
$17,130.40 |
| Rate for Payer: BCBS of TX Blue Advantage |
$7,355.58
|
| Rate for Payer: BCBS of TX Blue Essentials |
$8,825.84
|
| Rate for Payer: BCBS of TX PPO |
$9,806.87
|
|
|
Under Anterior or Anterolateral Approach for Extradural Exploration/Decompression Procedures on the
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 63076
|
| Hospital Charge Code |
36063076
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$291.96 |
| Max. Negotiated Rate |
$10,000.00 |
| 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 |
$291.96
|
|
|
Under Anterior or Anterolateral Approach for Extradural Exploration/Decompression Procedures on the
|
Facility
|
OP
|
$39,687.78
|
|
|
Service Code
|
HCPCS 63076
|
| Hospital Charge Code |
9900769
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,571.90 |
| Max. Negotiated Rate |
$28,575.20 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$3,571.90
|
| Rate for Payer: BCBS of TX Blue Advantage |
$11,906.33
|
| Rate for Payer: BCBS of TX Blue Essentials |
$14,287.60
|
| Rate for Payer: BCBS of TX PPO |
$15,875.11
|
| Rate for Payer: Cash Price |
$26,987.69
|
| Rate for Payer: Cash Price |
$26,987.69
|
| Rate for Payer: Cigna Medicaid |
$28,575.20
|
| Rate for Payer: Molina CHIP/Medicaid |
$28,575.20
|
| 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 |
$28,575.20
|
| Rate for Payer: Scott and White EPO/PPO |
$19,843.89
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$28,575.20
|
| Rate for Payer: Superior Health Plan EPO |
$5,397.54
|
|
|
Under Anterior or Anterolateral Approach for Extradural Exploration/Decompression Procedures on the
|
Facility
|
IP
|
$39,687.78
|
|
|
Service Code
|
HCPCS 63076
|
| Hospital Charge Code |
9900769
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$26,987.69
|
|
|
Under Anterior or Anterolateral Approach for Extradural Exploration/Decompression Procedures on the
|
Facility
|
OP
|
$39,687.78
|
|
|
Service Code
|
HCPCS 63075
|
| Hospital Charge Code |
9900768
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,571.90 |
| Max. Negotiated Rate |
$28,575.20 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$3,571.90
|
| 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 |
$26,987.69
|
| Rate for Payer: Cash Price |
$26,987.69
|
| Rate for Payer: Cash Price |
$26,987.69
|
| Rate for Payer: Cigna Commercial |
$15,408.22
|
| Rate for Payer: Cigna Medicaid |
$28,575.20
|
| 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 |
$28,575.20
|
| 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 |
$28,575.20
|
| 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 |
$28,575.20
|
| 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
|
|
|
Under Anterior or Anterolateral Approach for Extradural Exploration/Decompression Procedures on the
|
Facility
|
OP
|
$15,408.22
|
|
|
Service Code
|
CPT 63075
|
| Hospital Charge Code |
36063075
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$7,289.28 |
| Max. Negotiated Rate |
$15,408.22 |
| 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
|
|
|
Under Anterior or Anterolateral Approach for Extradural Exploration/Decompression Procedures on the
|
Facility
|
IP
|
$39,687.78
|
|
|
Service Code
|
HCPCS 63075
|
| Hospital Charge Code |
9900768
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$26,987.69
|
|
|
Under Destruction by Neurolyt..
|
Facility
|
IP
|
$3,808.00
|
|
|
Service Code
|
HCPCS 64642
|
| Hospital Charge Code |
9900833
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$2,589.44
|
|
|
Under Destruction by Neurolyt..
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 64642
|
| Hospital Charge Code |
36064642
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$68.66 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$68.66
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$709.10
|
| Rate for Payer: Amerigroup Medicare |
$709.10
|
| Rate for Payer: BCBS of TX Blue Advantage |
$132.00
|
| Rate for Payer: BCBS of TX Blue Essentials |
$158.08
|
| Rate for Payer: BCBS of TX Medicare |
$709.10
|
| Rate for Payer: BCBS of TX PPO |
$199.18
|
| Rate for Payer: Cigna Commercial |
$1,498.91
|
| Rate for Payer: Cigna Medicare |
$709.10
|
| Rate for Payer: Employer Direct Commercial |
$709.10
|
| Rate for Payer: Humana Medicare/TRICARE |
$709.10
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$709.10
|
| Rate for Payer: Molina Medicare |
$709.10
|
| 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 |
$1,170.03
|
| Rate for Payer: Scott and White Medicare |
$709.10
|
| Rate for Payer: Superior Health Plan EPO |
$709.10
|
| Rate for Payer: Superior Health Plan Medicare |
$709.10
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$709.10
|
| Rate for Payer: Universal American Medicare |
$709.10
|
| Rate for Payer: Wellcare Medicare |
$709.10
|
| Rate for Payer: Wellmed Medicare |
$709.10
|
|
|
Under Destruction by Neurolyt..
|
Facility
|
OP
|
$3,808.00
|
|
|
Service Code
|
HCPCS 64642
|
| Hospital Charge Code |
9900833
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$68.66 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$68.66
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$709.10
|
| Rate for Payer: Amerigroup Medicare |
$709.10
|
| Rate for Payer: BCBS of TX Blue Advantage |
$132.00
|
| Rate for Payer: BCBS of TX Blue Essentials |
$158.08
|
| Rate for Payer: BCBS of TX Medicare |
$709.10
|
| Rate for Payer: BCBS of TX PPO |
$199.18
|
| Rate for Payer: Cash Price |
$2,589.44
|
| Rate for Payer: Cash Price |
$2,589.44
|
| Rate for Payer: Cash Price |
$2,589.44
|
| Rate for Payer: Cigna Commercial |
$1,498.91
|
| Rate for Payer: Cigna Medicaid |
$2,741.76
|
| Rate for Payer: Cigna Medicare |
$709.10
|
| Rate for Payer: Employer Direct Commercial |
$709.10
|
| Rate for Payer: Humana Medicare/TRICARE |
$709.10
|
| Rate for Payer: Molina CHIP/Medicaid |
$2,741.76
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$709.10
|
| Rate for Payer: Molina Medicare |
$709.10
|
| 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 |
$2,741.76
|
| Rate for Payer: Scott and White EPO/PPO |
$1,170.03
|
| Rate for Payer: Scott and White Medicare |
$709.10
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$2,741.76
|
| Rate for Payer: Superior Health Plan EPO |
$709.10
|
| Rate for Payer: Superior Health Plan Medicare |
$709.10
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$709.10
|
| Rate for Payer: Universal American Medicare |
$709.10
|
| Rate for Payer: Wellcare Medicare |
$709.10
|
| Rate for Payer: Wellmed Medicare |
$709.10
|
|
|
Under Endoscopy/Arthroscopy Procedures on the Musculoskeletal System
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 29837
|
| Hospital Charge Code |
36029837
|
|
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 |
$5,476.44
|
| 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
|
|
|
Under Endoscopy/Arthroscopy Procedures on the Musculoskeletal System
|
Facility
|
OP
|
$36,575.10
|
|
|
Service Code
|
HCPCS 29874
|
| Hospital Charge Code |
9900566
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,088.27 |
| Max. Negotiated Rate |
$26,334.07 |
| 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 |
$24,871.07
|
| Rate for Payer: Cash Price |
$24,871.07
|
| Rate for Payer: Cash Price |
$24,871.07
|
| Rate for Payer: Cigna Commercial |
$6,947.94
|
| Rate for Payer: Cigna Medicaid |
$26,334.07
|
| 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 |
$26,334.07
|
| 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 |
$26,334.07
|
| Rate for Payer: Scott and White EPO/PPO |
$5,476.44
|
| Rate for Payer: Scott and White Medicare |
$3,286.91
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$26,334.07
|
| 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
|
|
|
Under Endoscopy/Arthroscopy Procedures on the Musculoskeletal System
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 29874
|
| Hospital Charge Code |
36029874
|
|
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 |
$5,476.44
|
| 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
|
|
|
Under Endoscopy/Arthroscopy Procedures on the Musculoskeletal System
|
Facility
|
IP
|
$17,353.68
|
|
|
Service Code
|
HCPCS 29837
|
| Hospital Charge Code |
9900555
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$11,800.50
|
|
|
Under Endoscopy/Arthroscopy Procedures on the Musculoskeletal System
|
Facility
|
IP
|
$36,575.10
|
|
|
Service Code
|
HCPCS 29874
|
| Hospital Charge Code |
9900566
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$24,871.07
|
|
|
Under Endoscopy/Arthroscopy Procedures on the Musculoskeletal System
|
Facility
|
OP
|
$17,353.68
|
|
|
Service Code
|
HCPCS 29837
|
| Hospital Charge Code |
9900555
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,088.27 |
| Max. Negotiated Rate |
$12,494.65 |
| 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 |
$11,800.50
|
| Rate for Payer: Cash Price |
$11,800.50
|
| Rate for Payer: Cash Price |
$11,800.50
|
| Rate for Payer: Cigna Commercial |
$6,947.94
|
| Rate for Payer: Cigna Medicaid |
$12,494.65
|
| 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 |
$12,494.65
|
| 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 |
$12,494.65
|
| Rate for Payer: Scott and White EPO/PPO |
$5,476.44
|
| Rate for Payer: Scott and White Medicare |
$3,286.91
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$12,494.65
|
| 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
|
|
