|
Unlisted procedure, nervous system
|
Facility
|
OP
|
$1,567.02
|
|
|
Service Code
|
HCPCS 64999
|
| Hospital Charge Code |
9900857
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$308.35 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$308.35
|
| Rate for Payer: Amerigroup Medicare |
$308.35
|
| Rate for Payer: BCBS of TX Blue Advantage |
$437.16
|
| Rate for Payer: BCBS of TX Blue Essentials |
$523.54
|
| Rate for Payer: BCBS of TX Medicare |
$308.35
|
| Rate for Payer: BCBS of TX PPO |
$659.66
|
| Rate for Payer: Cash Price |
$1,065.57
|
| Rate for Payer: Cash Price |
$1,065.57
|
| Rate for Payer: Cash Price |
$1,065.57
|
| Rate for Payer: Cigna Commercial |
$651.79
|
| Rate for Payer: Cigna Medicaid |
$1,128.25
|
| Rate for Payer: Cigna Medicare |
$308.35
|
| Rate for Payer: Employer Direct Commercial |
$308.35
|
| Rate for Payer: Humana Medicare/TRICARE |
$308.35
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,128.25
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$308.35
|
| Rate for Payer: Molina Medicare |
$308.35
|
| 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 |
$1,128.25
|
| Rate for Payer: Scott and White EPO/PPO |
$501.11
|
| Rate for Payer: Scott and White Medicare |
$308.35
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,128.25
|
| Rate for Payer: Superior Health Plan EPO |
$308.35
|
| Rate for Payer: Superior Health Plan Medicare |
$308.35
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$308.35
|
| Rate for Payer: Universal American Medicare |
$308.35
|
| Rate for Payer: Wellcare Medicare |
$308.35
|
| Rate for Payer: Wellmed Medicare |
$308.35
|
|
|
Unlisted procedure, nervous system
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 64999
|
| Hospital Charge Code |
36064999
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$308.35 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$308.35
|
| Rate for Payer: Amerigroup Medicare |
$308.35
|
| Rate for Payer: BCBS of TX Blue Advantage |
$437.16
|
| Rate for Payer: BCBS of TX Blue Essentials |
$523.54
|
| Rate for Payer: BCBS of TX Medicare |
$308.35
|
| Rate for Payer: BCBS of TX PPO |
$659.66
|
| Rate for Payer: Cigna Commercial |
$651.79
|
| Rate for Payer: Cigna Medicare |
$308.35
|
| Rate for Payer: Employer Direct Commercial |
$308.35
|
| Rate for Payer: Humana Medicare/TRICARE |
$308.35
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$308.35
|
| Rate for Payer: Molina Medicare |
$308.35
|
| 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 |
$501.11
|
| Rate for Payer: Scott and White Medicare |
$308.35
|
| Rate for Payer: Superior Health Plan EPO |
$308.35
|
| Rate for Payer: Superior Health Plan Medicare |
$308.35
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$308.35
|
| Rate for Payer: Universal American Medicare |
$308.35
|
| Rate for Payer: Wellcare Medicare |
$308.35
|
| Rate for Payer: Wellmed Medicare |
$308.35
|
|
|
Unlisted procedure, pelvis or hip joint
|
Facility
|
OP
|
$1,649.52
|
|
|
Service Code
|
HCPCS 27299
|
| Hospital Charge Code |
9900388
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$247.79 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$247.79
|
| Rate for Payer: Amerigroup Medicare |
$247.79
|
| Rate for Payer: BCBS of TX Blue Advantage |
$360.12
|
| Rate for Payer: BCBS of TX Blue Essentials |
$431.28
|
| Rate for Payer: BCBS of TX Medicare |
$247.79
|
| Rate for Payer: BCBS of TX PPO |
$543.41
|
| Rate for Payer: Cash Price |
$1,121.67
|
| Rate for Payer: Cash Price |
$1,121.67
|
| Rate for Payer: Cash Price |
$1,121.67
|
| Rate for Payer: Cigna Commercial |
$523.79
|
| Rate for Payer: Cigna Medicaid |
$1,187.65
|
| Rate for Payer: Cigna Medicare |
$247.79
|
| Rate for Payer: Employer Direct Commercial |
$247.79
|
| Rate for Payer: Humana Medicare/TRICARE |
$247.79
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,187.65
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$247.79
|
| Rate for Payer: Molina Medicare |
$247.79
|
| 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 |
$1,187.65
|
| Rate for Payer: Scott and White EPO/PPO |
$398.99
|
| Rate for Payer: Scott and White Medicare |
$247.79
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,187.65
|
| Rate for Payer: Superior Health Plan EPO |
$247.79
|
| Rate for Payer: Superior Health Plan Medicare |
$247.79
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$247.79
|
| Rate for Payer: Universal American Medicare |
$247.79
|
| Rate for Payer: Wellcare Medicare |
$247.79
|
| Rate for Payer: Wellmed Medicare |
$247.79
|
|
|
Unlisted procedure, pelvis or hip joint
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 27299
|
| Hospital Charge Code |
36027299
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$247.79 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$247.79
|
| Rate for Payer: Amerigroup Medicare |
$247.79
|
| Rate for Payer: BCBS of TX Blue Advantage |
$360.12
|
| Rate for Payer: BCBS of TX Blue Essentials |
$431.28
|
| Rate for Payer: BCBS of TX Medicare |
$247.79
|
| Rate for Payer: BCBS of TX PPO |
$543.41
|
| Rate for Payer: Cigna Commercial |
$523.79
|
| Rate for Payer: Cigna Medicare |
$247.79
|
| Rate for Payer: Employer Direct Commercial |
$247.79
|
| Rate for Payer: Humana Medicare/TRICARE |
$247.79
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$247.79
|
| Rate for Payer: Molina Medicare |
$247.79
|
| 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 |
$398.99
|
| Rate for Payer: Scott and White Medicare |
$247.79
|
| Rate for Payer: Superior Health Plan EPO |
$247.79
|
| Rate for Payer: Superior Health Plan Medicare |
$247.79
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$247.79
|
| Rate for Payer: Universal American Medicare |
$247.79
|
| Rate for Payer: Wellcare Medicare |
$247.79
|
| Rate for Payer: Wellmed Medicare |
$247.79
|
|
|
Unlisted procedure, pelvis or hip joint
|
Facility
|
IP
|
$1,649.52
|
|
|
Service Code
|
HCPCS 27299
|
| Hospital Charge Code |
9900388
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$1,121.67
|
|
|
Unlisted procedure, skin, mucous membrane and subcutaneous tissue
|
Facility
|
OP
|
$6,111.23
|
|
|
Service Code
|
HCPCS 17999
|
| Hospital Charge Code |
9900151
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$201.55 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$550.01
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$201.55
|
| Rate for Payer: Amerigroup Medicare |
$201.55
|
| Rate for Payer: BCBS of TX Blue Advantage |
$291.80
|
| Rate for Payer: BCBS of TX Blue Essentials |
$349.46
|
| Rate for Payer: BCBS of TX Medicare |
$201.55
|
| Rate for Payer: BCBS of TX PPO |
$440.32
|
| Rate for Payer: Cash Price |
$4,155.64
|
| Rate for Payer: Cash Price |
$4,155.64
|
| Rate for Payer: Cash Price |
$4,155.64
|
| Rate for Payer: Cigna Commercial |
$426.04
|
| Rate for Payer: Cigna Medicaid |
$4,400.09
|
| Rate for Payer: Cigna Medicare |
$201.55
|
| Rate for Payer: Employer Direct Commercial |
$201.55
|
| Rate for Payer: Humana Medicare/TRICARE |
$201.55
|
| Rate for Payer: Molina CHIP/Medicaid |
$4,400.09
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$201.55
|
| Rate for Payer: Molina Medicare |
$201.55
|
| 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 |
$4,400.09
|
| Rate for Payer: Scott and White EPO/PPO |
$338.72
|
| Rate for Payer: Scott and White Medicare |
$201.55
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$4,400.09
|
| Rate for Payer: Superior Health Plan EPO |
$201.55
|
| Rate for Payer: Superior Health Plan Medicare |
$201.55
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$201.55
|
| Rate for Payer: Universal American Medicare |
$201.55
|
| Rate for Payer: Wellcare Medicare |
$201.55
|
| Rate for Payer: Wellmed Medicare |
$201.55
|
|
|
Unlisted procedure, skin, mucous membrane and subcutaneous tissue
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 17999
|
| Hospital Charge Code |
36017999
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$201.55 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$201.55
|
| Rate for Payer: Amerigroup Medicare |
$201.55
|
| Rate for Payer: BCBS of TX Blue Advantage |
$291.80
|
| Rate for Payer: BCBS of TX Blue Essentials |
$349.46
|
| Rate for Payer: BCBS of TX Medicare |
$201.55
|
| Rate for Payer: BCBS of TX PPO |
$440.32
|
| Rate for Payer: Cigna Commercial |
$426.04
|
| Rate for Payer: Cigna Medicare |
$201.55
|
| Rate for Payer: Employer Direct Commercial |
$201.55
|
| Rate for Payer: Humana Medicare/TRICARE |
$201.55
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$201.55
|
| Rate for Payer: Molina Medicare |
$201.55
|
| 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 |
$338.72
|
| Rate for Payer: Scott and White Medicare |
$201.55
|
| Rate for Payer: Superior Health Plan EPO |
$201.55
|
| Rate for Payer: Superior Health Plan Medicare |
$201.55
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$201.55
|
| Rate for Payer: Universal American Medicare |
$201.55
|
| Rate for Payer: Wellcare Medicare |
$201.55
|
| Rate for Payer: Wellmed Medicare |
$201.55
|
|
|
Unlisted procedure, skin, mucous membrane and subcutaneous tissue
|
Facility
|
IP
|
$6,111.23
|
|
|
Service Code
|
HCPCS 17999
|
| Hospital Charge Code |
9900151
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$4,155.64
|
|
|
Unlisted procedure, small intestine - Graham Patch
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 44799
|
| Hospital Charge Code |
36044799
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$911.12 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$911.12
|
| Rate for Payer: Amerigroup Medicare |
$911.12
|
| Rate for Payer: BCBS of TX Blue Advantage |
$1,312.49
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,571.84
|
| Rate for Payer: BCBS of TX Medicare |
$911.12
|
| Rate for Payer: BCBS of TX PPO |
$1,980.52
|
| Rate for Payer: Cigna Commercial |
$1,925.93
|
| Rate for Payer: Cigna Medicare |
$911.12
|
| Rate for Payer: Employer Direct Commercial |
$911.12
|
| Rate for Payer: Humana Medicare/TRICARE |
$911.12
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$911.12
|
| Rate for Payer: Molina Medicare |
$911.12
|
| 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 |
$1,533.69
|
| Rate for Payer: Scott and White Medicare |
$911.12
|
| Rate for Payer: Superior Health Plan EPO |
$911.12
|
| Rate for Payer: Superior Health Plan Medicare |
$911.12
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$911.12
|
| Rate for Payer: Universal American Medicare |
$911.12
|
| Rate for Payer: Wellcare Medicare |
$911.12
|
| Rate for Payer: Wellmed Medicare |
$911.12
|
|
|
Unlisted procedure, small intestine - Graham Patch
|
Facility
|
OP
|
$3,302.04
|
|
|
Service Code
|
HCPCS 44799
|
| Hospital Charge Code |
9900697
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$911.12 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$911.12
|
| Rate for Payer: Amerigroup Medicare |
$911.12
|
| Rate for Payer: BCBS of TX Blue Advantage |
$1,312.49
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,571.84
|
| Rate for Payer: BCBS of TX Medicare |
$911.12
|
| Rate for Payer: BCBS of TX PPO |
$1,980.52
|
| Rate for Payer: Cash Price |
$2,245.39
|
| Rate for Payer: Cash Price |
$2,245.39
|
| Rate for Payer: Cash Price |
$2,245.39
|
| Rate for Payer: Cigna Commercial |
$1,925.93
|
| Rate for Payer: Cigna Medicaid |
$2,377.47
|
| Rate for Payer: Cigna Medicare |
$911.12
|
| Rate for Payer: Employer Direct Commercial |
$911.12
|
| Rate for Payer: Humana Medicare/TRICARE |
$911.12
|
| Rate for Payer: Molina CHIP/Medicaid |
$2,377.47
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$911.12
|
| Rate for Payer: Molina Medicare |
$911.12
|
| 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 |
$2,377.47
|
| Rate for Payer: Scott and White EPO/PPO |
$1,533.69
|
| Rate for Payer: Scott and White Medicare |
$911.12
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$2,377.47
|
| Rate for Payer: Superior Health Plan EPO |
$911.12
|
| Rate for Payer: Superior Health Plan Medicare |
$911.12
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$911.12
|
| Rate for Payer: Universal American Medicare |
$911.12
|
| Rate for Payer: Wellcare Medicare |
$911.12
|
| Rate for Payer: Wellmed Medicare |
$911.12
|
|
|
Unlisted procedure, small intestine - Graham Patch
|
Facility
|
IP
|
$3,302.04
|
|
|
Service Code
|
HCPCS 44799
|
| Hospital Charge Code |
9900697
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$2,245.39
|
|
|
Unlisted procedure, stomach
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 43999
|
| Hospital Charge Code |
36043999
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$911.12 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$911.12
|
| Rate for Payer: Amerigroup Medicare |
$911.12
|
| Rate for Payer: BCBS of TX Blue Advantage |
$1,312.49
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,571.84
|
| Rate for Payer: BCBS of TX Medicare |
$911.12
|
| Rate for Payer: BCBS of TX PPO |
$1,980.52
|
| Rate for Payer: Cigna Commercial |
$1,925.93
|
| Rate for Payer: Cigna Medicare |
$911.12
|
| Rate for Payer: Employer Direct Commercial |
$911.12
|
| Rate for Payer: Humana Medicare/TRICARE |
$911.12
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$911.12
|
| Rate for Payer: Molina Medicare |
$911.12
|
| 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 |
$1,533.69
|
| Rate for Payer: Scott and White Medicare |
$911.12
|
| Rate for Payer: Superior Health Plan EPO |
$911.12
|
| Rate for Payer: Superior Health Plan Medicare |
$911.12
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$911.12
|
| Rate for Payer: Universal American Medicare |
$911.12
|
| Rate for Payer: Wellcare Medicare |
$911.12
|
| Rate for Payer: Wellmed Medicare |
$911.12
|
|
|
Unlisted procedure, stomach
|
Facility
|
IP
|
$5,500.00
|
|
|
Service Code
|
HCPCS 43999
|
| Hospital Charge Code |
8968558
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$3,740.00
|
|
|
Unlisted procedure, stomach
|
Facility
|
OP
|
$5,500.00
|
|
|
Service Code
|
HCPCS 43999
|
| Hospital Charge Code |
8968558
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$911.12 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$911.12
|
| Rate for Payer: Amerigroup Medicare |
$911.12
|
| Rate for Payer: BCBS of TX Blue Advantage |
$1,312.49
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,571.84
|
| Rate for Payer: BCBS of TX Medicare |
$911.12
|
| Rate for Payer: BCBS of TX PPO |
$1,980.52
|
| Rate for Payer: Cash Price |
$3,740.00
|
| Rate for Payer: Cash Price |
$3,740.00
|
| Rate for Payer: Cash Price |
$3,740.00
|
| Rate for Payer: Cigna Commercial |
$1,925.93
|
| Rate for Payer: Cigna Medicaid |
$3,960.00
|
| Rate for Payer: Cigna Medicare |
$911.12
|
| Rate for Payer: Employer Direct Commercial |
$911.12
|
| Rate for Payer: Humana Medicare/TRICARE |
$911.12
|
| Rate for Payer: Molina CHIP/Medicaid |
$3,960.00
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$911.12
|
| Rate for Payer: Molina Medicare |
$911.12
|
| 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 |
$3,960.00
|
| Rate for Payer: Scott and White EPO/PPO |
$1,533.69
|
| Rate for Payer: Scott and White Medicare |
$911.12
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$3,960.00
|
| Rate for Payer: Superior Health Plan EPO |
$911.12
|
| Rate for Payer: Superior Health Plan Medicare |
$911.12
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$911.12
|
| Rate for Payer: Universal American Medicare |
$911.12
|
| Rate for Payer: Wellcare Medicare |
$911.12
|
| Rate for Payer: Wellmed Medicare |
$911.12
|
|
|
*Unna Boot
|
Facility
|
IP
|
$993.50
|
|
|
Service Code
|
HCPCS 29580
|
| Hospital Charge Code |
7150794
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$675.58
|
|
|
*Unna Boot
|
Facility
|
OP
|
$993.50
|
|
|
Service Code
|
HCPCS 29580
|
| Hospital Charge Code |
7150794
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$33.12 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$33.12
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$163.24
|
| Rate for Payer: Amerigroup Medicare |
$163.24
|
| Rate for Payer: BCBS of TX Blue Advantage |
$70.51
|
| Rate for Payer: BCBS of TX Blue Essentials |
$84.44
|
| Rate for Payer: BCBS of TX Medicare |
$163.24
|
| Rate for Payer: BCBS of TX PPO |
$106.39
|
| Rate for Payer: Cash Price |
$675.58
|
| Rate for Payer: Cash Price |
$675.58
|
| Rate for Payer: Cash Price |
$675.58
|
| Rate for Payer: Cigna Commercial |
$345.06
|
| Rate for Payer: Cigna Medicaid |
$715.32
|
| Rate for Payer: Cigna Medicare |
$163.24
|
| Rate for Payer: Employer Direct Commercial |
$163.24
|
| Rate for Payer: Humana Medicare/TRICARE |
$163.24
|
| Rate for Payer: Molina CHIP/Medicaid |
$715.32
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$163.24
|
| Rate for Payer: Molina Medicare |
$163.24
|
| 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 |
$715.32
|
| Rate for Payer: Scott and White EPO/PPO |
$266.58
|
| Rate for Payer: Scott and White Medicare |
$163.24
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$715.32
|
| Rate for Payer: Superior Health Plan EPO |
$163.24
|
| Rate for Payer: Superior Health Plan Medicare |
$163.24
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$163.24
|
| Rate for Payer: Universal American Medicare |
$163.24
|
| Rate for Payer: Wellcare Medicare |
$163.24
|
| Rate for Payer: Wellmed Medicare |
$163.24
|
|
|
UNTHREADED GUIDE WIRE ?2.0mm x 150mm
|
Facility
|
OP
|
$603.82
|
|
| Hospital Charge Code |
993365
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$54.34 |
| Max. Negotiated Rate |
$434.75 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$54.34
|
| Rate for Payer: BCBS of TX Blue Advantage |
$181.15
|
| Rate for Payer: BCBS of TX Blue Essentials |
$217.38
|
| Rate for Payer: BCBS of TX PPO |
$241.53
|
| Rate for Payer: Cash Price |
$410.60
|
| Rate for Payer: Cigna Medicaid |
$434.75
|
| Rate for Payer: Molina CHIP/Medicaid |
$434.75
|
| Rate for Payer: Multiplan Auto |
$392.48
|
| Rate for Payer: Multiplan Commercial |
$392.48
|
| Rate for Payer: Multiplan Workers Comp |
$392.48
|
| Rate for Payer: Parkland Medicaid |
$434.75
|
| Rate for Payer: Scott and White EPO/PPO |
$301.91
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$434.75
|
| Rate for Payer: Superior Health Plan EPO |
$82.12
|
|
|
UNTHREADED GUIDE WIRE ?2.0mm x 150mm
|
Facility
|
IP
|
$603.82
|
|
| Hospital Charge Code |
993365
|
|
Hospital Revenue Code
|
272
|
| Rate for Payer: Cash Price |
$410.60
|
|
|
UPGRADE TO DUAL CHAMBER
|
Facility
|
OP
|
$32,225.00
|
|
|
Service Code
|
HCPCS 33214
|
| Hospital Charge Code |
2302453
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$574.59 |
| Max. Negotiated Rate |
$25,834.89 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2,900.25
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$10,499.62
|
| Rate for Payer: Amerigroup Medicare |
$10,499.62
|
| Rate for Payer: BCBS of TX Blue Advantage |
$17,120.74
|
| Rate for Payer: BCBS of TX Blue Essentials |
$20,503.88
|
| Rate for Payer: BCBS of TX Medicare |
$10,499.62
|
| Rate for Payer: BCBS of TX PPO |
$25,834.89
|
| Rate for Payer: Cash Price |
$21,913.00
|
| Rate for Payer: Cash Price |
$21,913.00
|
| Rate for Payer: Cash Price |
$21,913.00
|
| Rate for Payer: Cigna Commercial |
$22,194.30
|
| Rate for Payer: Cigna Medicaid |
$23,202.00
|
| Rate for Payer: Cigna Medicare |
$10,499.62
|
| Rate for Payer: Employer Direct Commercial |
$10,499.62
|
| Rate for Payer: Humana Medicare/TRICARE |
$10,499.62
|
| Rate for Payer: Molina CHIP/Medicaid |
$23,202.00
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$10,499.62
|
| Rate for Payer: Molina Medicare |
$10,499.62
|
| Rate for Payer: Multiplan Auto |
$20,946.25
|
| Rate for Payer: Multiplan Commercial |
$20,946.25
|
| Rate for Payer: Multiplan Workers Comp |
$20,946.25
|
| Rate for Payer: Parkland Medicaid |
$23,202.00
|
| Rate for Payer: Scott and White EPO/PPO |
$574.59
|
| Rate for Payer: Scott and White Medicare |
$10,499.62
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$23,202.00
|
| Rate for Payer: Superior Health Plan EPO |
$10,499.62
|
| Rate for Payer: Superior Health Plan Medicare |
$10,499.62
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$10,499.62
|
| Rate for Payer: Universal American Medicare |
$10,499.62
|
| Rate for Payer: Wellcare Medicare |
$10,499.62
|
| Rate for Payer: Wellmed Medicare |
$10,499.62
|
|
|
UPGRADE TO DUAL CHAMBER
|
Facility
|
IP
|
$32,225.00
|
|
|
Service Code
|
HCPCS 33214
|
| Hospital Charge Code |
2302453
|
|
Hospital Revenue Code
|
481
|
| Rate for Payer: Cash Price |
$21,913.00
|
|
|
UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH CC
|
Facility
|
IP
|
$31,011.80
|
|
|
Service Code
|
MSDRG 256
|
| Min. Negotiated Rate |
$14,281.75 |
| Max. Negotiated Rate |
$31,011.80 |
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$17,204.03
|
| Rate for Payer: Amerigroup Medicare |
$17,204.03
|
| Rate for Payer: BCBS of TX Medicare |
$17,204.03
|
| Rate for Payer: Cigna Commercial |
$21,868.95
|
| Rate for Payer: Cigna Medicare |
$17,204.03
|
| Rate for Payer: Employer Direct Commercial |
$17,204.03
|
| Rate for Payer: Humana Medicare/TRICARE |
$17,204.03
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$17,204.03
|
| Rate for Payer: Molina Medicare |
$17,204.03
|
| Rate for Payer: Multiplan Auto |
$31,011.80
|
| Rate for Payer: Multiplan Commercial |
$31,011.80
|
| Rate for Payer: Multiplan Workers Comp |
$31,011.80
|
| Rate for Payer: Scott and White EPO/PPO |
$14,281.75
|
| Rate for Payer: Scott and White Medicare |
$17,204.03
|
| Rate for Payer: Superior Health Plan EPO |
$17,204.03
|
| Rate for Payer: Superior Health Plan Medicare |
$17,204.03
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$17,204.03
|
| Rate for Payer: Universal American Medicare |
$17,204.03
|
| Rate for Payer: Wellcare Medicare |
$17,204.03
|
| Rate for Payer: Wellmed Medicare |
$17,204.03
|
|
|
UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH MCC
|
Facility
|
IP
|
$48,746.40
|
|
|
Service Code
|
MSDRG 255
|
| Min. Negotiated Rate |
$21,846.58 |
| Max. Negotiated Rate |
$48,746.40 |
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$24,529.40
|
| Rate for Payer: Amerigroup Medicare |
$24,529.40
|
| Rate for Payer: BCBS of TX Medicare |
$24,529.40
|
| Rate for Payer: Cigna Commercial |
$34,742.51
|
| Rate for Payer: Cigna Medicare |
$24,529.40
|
| Rate for Payer: Employer Direct Commercial |
$24,529.40
|
| Rate for Payer: Humana Medicare/TRICARE |
$24,529.40
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$24,529.40
|
| Rate for Payer: Molina Medicare |
$24,529.40
|
| Rate for Payer: Multiplan Auto |
$48,746.40
|
| Rate for Payer: Multiplan Commercial |
$48,746.40
|
| Rate for Payer: Multiplan Workers Comp |
$48,746.40
|
| Rate for Payer: Scott and White EPO/PPO |
$22,449.00
|
| Rate for Payer: Scott and White Medicare |
$24,529.40
|
| Rate for Payer: Superior Health Plan EPO |
$24,529.40
|
| Rate for Payer: Superior Health Plan Medicare |
$24,529.40
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$24,529.40
|
| Rate for Payer: Universal American Medicare |
$24,529.40
|
| Rate for Payer: Wellcare Medicare |
$24,529.40
|
| Rate for Payer: Wellmed Medicare |
$24,529.40
|
|
|
UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITHOUT CC/MCC
|
Facility
|
IP
|
$19,925.30
|
|
|
Service Code
|
MSDRG 257
|
| Min. Negotiated Rate |
$9,176.12 |
| Max. Negotiated Rate |
$19,925.30 |
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$12,764.84
|
| Rate for Payer: Amerigroup Medicare |
$12,764.84
|
| Rate for Payer: BCBS of TX Medicare |
$12,764.84
|
| Rate for Payer: Cigna Commercial |
$14,067.54
|
| Rate for Payer: Cigna Medicare |
$12,764.84
|
| Rate for Payer: Employer Direct Commercial |
$12,764.84
|
| Rate for Payer: Humana Medicare/TRICARE |
$12,764.84
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$12,764.84
|
| Rate for Payer: Molina Medicare |
$12,764.84
|
| Rate for Payer: Multiplan Auto |
$19,925.30
|
| Rate for Payer: Multiplan Commercial |
$19,925.30
|
| Rate for Payer: Multiplan Workers Comp |
$19,925.30
|
| Rate for Payer: Scott and White EPO/PPO |
$9,176.12
|
| Rate for Payer: Scott and White Medicare |
$12,764.84
|
| Rate for Payer: Superior Health Plan EPO |
$12,764.84
|
| Rate for Payer: Superior Health Plan Medicare |
$12,764.84
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$12,764.84
|
| Rate for Payer: Universal American Medicare |
$12,764.84
|
| Rate for Payer: Wellcare Medicare |
$12,764.84
|
| Rate for Payer: Wellmed Medicare |
$12,764.84
|
|
|
UPPER LIMB & TOE AMPUTATION FOR CIRC SYSTEM DISORDERS W CC
|
Facility
|
IP
|
$31,011.80
|
|
|
Service Code
|
MSDRG 256
|
| Min. Negotiated Rate |
$14,281.75 |
| Max. Negotiated Rate |
$31,011.80 |
| Rate for Payer: BCBS of TX Blue Advantage |
$15,038.82
|
| Rate for Payer: BCBS of TX Blue Essentials |
$18,044.84
|
| Rate for Payer: BCBS of TX PPO |
$20,050.59
|
|
|
UPPER LIMB & TOE AMPUTATION FOR CIRC SYSTEM DISORDERS W MCC
|
Facility
|
IP
|
$48,746.40
|
|
|
Service Code
|
MSDRG 255
|
| Min. Negotiated Rate |
$21,846.58 |
| Max. Negotiated Rate |
$48,746.40 |
| Rate for Payer: BCBS of TX Blue Advantage |
$21,846.58
|
| Rate for Payer: BCBS of TX Blue Essentials |
$26,213.36
|
| Rate for Payer: BCBS of TX PPO |
$29,127.08
|
|
