|
ED Airway/Intubation Procedures Cricothyrotomy BCE
|
Facility
|
OP
|
$1,090.00
|
|
|
Service Code
|
CPT 31605
|
| Hospital Charge Code |
5202589
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$708.50 |
| Rate for Payer: Aetna Commercial |
$599.50
|
| Rate for Payer: Aetna Medicare |
$335.08
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$98.10
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$223.39
|
| Rate for Payer: Amerigroup Medicare |
$223.39
|
| Rate for Payer: BCBS of TX Blue Advantage |
$340.08
|
| Rate for Payer: BCBS of TX Blue Essentials |
$407.28
|
| Rate for Payer: BCBS of TX Medicare |
$223.39
|
| Rate for Payer: BCBS of TX PPO |
$513.17
|
| Rate for Payer: Cash Price |
$959.20
|
| Rate for Payer: Cash Price |
$959.20
|
| Rate for Payer: Cash Price |
$959.20
|
| Rate for Payer: Cigna Commercial |
$506.05
|
| Rate for Payer: Cigna Medicaid |
$87.58
|
| Rate for Payer: Cigna Medicare |
$223.39
|
| Rate for Payer: Employer Direct Commercial |
$223.39
|
| Rate for Payer: Humana Medicare/TRICARE |
$223.39
|
| Rate for Payer: Molina CHIP/Medicaid |
$87.58
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$223.39
|
| Rate for Payer: Molina Medicare |
$223.39
|
| Rate for Payer: Multiplan Auto |
$708.50
|
| Rate for Payer: Multiplan Commercial |
$708.50
|
| Rate for Payer: Multiplan Workers Comp |
$708.50
|
| Rate for Payer: Parkland Medicaid |
$87.58
|
| Rate for Payer: Scott and White EPO/PPO |
$4.00
|
| Rate for Payer: Scott and White Medicare |
$223.39
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$87.58
|
| Rate for Payer: Superior Health Plan EPO |
$223.39
|
| Rate for Payer: Superior Health Plan Medicare |
$223.39
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$223.39
|
| Rate for Payer: Universal American Medicare |
$223.39
|
| Rate for Payer: Wellcare Medicare |
$223.39
|
| Rate for Payer: Wellmed Medicare |
$223.39
|
|
|
ED Airway/Intubation Procedures Endotracheal Intubation BCE
|
Facility
|
IP
|
$1,049.00
|
|
|
Service Code
|
CPT 31500
|
| Hospital Charge Code |
300533
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$923.12
|
|
|
ED Airway/Intubation Procedures Endotracheal Intubation BCE
|
Facility
|
OP
|
$1,049.00
|
|
|
Service Code
|
CPT 31500
|
| Hospital Charge Code |
300533
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$681.85 |
| Rate for Payer: Aetna Commercial |
$576.95
|
| Rate for Payer: Aetna Medicare |
$335.08
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$94.41
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$223.39
|
| Rate for Payer: Amerigroup Medicare |
$223.39
|
| Rate for Payer: BCBS of TX Blue Advantage |
$340.08
|
| Rate for Payer: BCBS of TX Blue Essentials |
$407.28
|
| Rate for Payer: BCBS of TX Medicare |
$223.39
|
| Rate for Payer: BCBS of TX PPO |
$513.17
|
| Rate for Payer: Cash Price |
$923.12
|
| Rate for Payer: Cash Price |
$923.12
|
| Rate for Payer: Cash Price |
$923.12
|
| Rate for Payer: Cigna Commercial |
$506.05
|
| Rate for Payer: Cigna Medicaid |
$87.58
|
| Rate for Payer: Cigna Medicare |
$223.39
|
| Rate for Payer: Employer Direct Commercial |
$223.39
|
| Rate for Payer: Humana Medicare/TRICARE |
$223.39
|
| Rate for Payer: Molina CHIP/Medicaid |
$87.58
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$223.39
|
| Rate for Payer: Molina Medicare |
$223.39
|
| Rate for Payer: Multiplan Auto |
$681.85
|
| Rate for Payer: Multiplan Commercial |
$681.85
|
| Rate for Payer: Multiplan Workers Comp |
$681.85
|
| Rate for Payer: Parkland Medicaid |
$87.58
|
| Rate for Payer: Scott and White EPO/PPO |
$4.00
|
| Rate for Payer: Scott and White Medicare |
$223.39
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$87.58
|
| Rate for Payer: Superior Health Plan EPO |
$223.39
|
| Rate for Payer: Superior Health Plan Medicare |
$223.39
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$223.39
|
| Rate for Payer: Universal American Medicare |
$223.39
|
| Rate for Payer: Wellcare Medicare |
$223.39
|
| Rate for Payer: Wellmed Medicare |
$223.39
|
|
|
ED Airway/Intubation Procedures Insert pleural catheter w/ imaging BCE
|
Facility
|
OP
|
$6,427.00
|
|
|
Service Code
|
CPT 32550
|
| Hospital Charge Code |
2151249
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$56.58 |
| Max. Negotiated Rate |
$7,835.54 |
| Rate for Payer: Aetna Commercial |
$4,635.00
|
| Rate for Payer: Aetna Medicare |
$4,746.03
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$578.43
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3,164.02
|
| Rate for Payer: Amerigroup Medicare |
$3,164.02
|
| Rate for Payer: BCBS of TX Blue Advantage |
$5,192.60
|
| Rate for Payer: BCBS of TX Blue Essentials |
$6,218.68
|
| Rate for Payer: BCBS of TX Medicare |
$3,164.02
|
| Rate for Payer: BCBS of TX PPO |
$7,835.54
|
| Rate for Payer: Cash Price |
$5,655.76
|
| Rate for Payer: Cash Price |
$5,655.76
|
| Rate for Payer: Cash Price |
$5,655.76
|
| Rate for Payer: Cigna Commercial |
$7,167.43
|
| Rate for Payer: Cigna Medicaid |
$1,551.50
|
| Rate for Payer: Cigna Medicare |
$3,164.02
|
| Rate for Payer: Employer Direct Commercial |
$3,164.02
|
| Rate for Payer: Humana Medicare/TRICARE |
$3,164.02
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,551.50
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3,164.02
|
| Rate for Payer: Molina Medicare |
$3,164.02
|
| Rate for Payer: Multiplan Auto |
$4,177.55
|
| Rate for Payer: Multiplan Commercial |
$4,177.55
|
| Rate for Payer: Multiplan Workers Comp |
$4,177.55
|
| Rate for Payer: Parkland Medicaid |
$1,551.50
|
| Rate for Payer: Scott and White EPO/PPO |
$56.58
|
| Rate for Payer: Scott and White Medicare |
$3,164.02
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,551.50
|
| Rate for Payer: Superior Health Plan EPO |
$3,164.02
|
| Rate for Payer: Superior Health Plan Medicare |
$3,164.02
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3,164.02
|
| Rate for Payer: Universal American Medicare |
$3,164.02
|
| Rate for Payer: Wellcare Medicare |
$3,164.02
|
| Rate for Payer: Wellmed Medicare |
$3,164.02
|
|
|
ED Airway/Intubation Procedures Insert pleural catheter w/ imaging BCE
|
Facility
|
IP
|
$6,427.00
|
|
|
Service Code
|
CPT 32550
|
| Hospital Charge Code |
2151249
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$5,655.76
|
|
|
ED Airway/Intubation Procedures Laryngoscopy, direct BCE
|
Facility
|
IP
|
$5,290.00
|
|
|
Service Code
|
CPT 31525
|
| Hospital Charge Code |
3301019
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$4,655.20
|
|
|
ED Airway/Intubation Procedures Laryngoscopy, direct BCE
|
Facility
|
OP
|
$5,290.00
|
|
|
Service Code
|
CPT 31525
|
| Hospital Charge Code |
3301019
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$27.76 |
| Max. Negotiated Rate |
$3,605.14 |
| Rate for Payer: Aetna Commercial |
$2,200.00
|
| Rate for Payer: Aetna Medicare |
$2,328.34
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$476.10
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,552.23
|
| Rate for Payer: Amerigroup Medicare |
$1,552.23
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,389.12
|
| Rate for Payer: BCBS of TX Blue Essentials |
$2,861.22
|
| Rate for Payer: BCBS of TX Medicare |
$1,552.23
|
| Rate for Payer: BCBS of TX PPO |
$3,605.14
|
| Rate for Payer: Cash Price |
$4,655.20
|
| Rate for Payer: Cash Price |
$4,655.20
|
| Rate for Payer: Cash Price |
$4,655.20
|
| Rate for Payer: Cigna Commercial |
$3,516.25
|
| Rate for Payer: Cigna Medicaid |
$525.71
|
| Rate for Payer: Cigna Medicare |
$1,552.23
|
| Rate for Payer: Employer Direct Commercial |
$1,552.23
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,552.23
|
| Rate for Payer: Molina CHIP/Medicaid |
$525.71
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,552.23
|
| Rate for Payer: Molina Medicare |
$1,552.23
|
| Rate for Payer: Multiplan Auto |
$3,438.50
|
| Rate for Payer: Multiplan Commercial |
$3,438.50
|
| Rate for Payer: Multiplan Workers Comp |
$3,438.50
|
| Rate for Payer: Parkland Medicaid |
$525.71
|
| Rate for Payer: Scott and White EPO/PPO |
$27.76
|
| Rate for Payer: Scott and White Medicare |
$1,552.23
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$525.71
|
| Rate for Payer: Superior Health Plan EPO |
$1,552.23
|
| Rate for Payer: Superior Health Plan Medicare |
$1,552.23
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,552.23
|
| Rate for Payer: Universal American Medicare |
$1,552.23
|
| Rate for Payer: Wellcare Medicare |
$1,552.23
|
| Rate for Payer: Wellmed Medicare |
$1,552.23
|
|
|
ED Airway/Intubation Procedures Laryngoscopy, flexible BCE
|
Facility
|
IP
|
$707.00
|
|
|
Service Code
|
CPT 31575
|
| Hospital Charge Code |
4010017
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$622.16
|
|
|
ED Airway/Intubation Procedures Laryngoscopy, flexible BCE
|
Facility
|
OP
|
$707.00
|
|
|
Service Code
|
CPT 31575
|
| Hospital Charge Code |
4010017
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3.24 |
| Max. Negotiated Rate |
$459.55 |
| Rate for Payer: Aetna Commercial |
$388.85
|
| Rate for Payer: Aetna Medicare |
$271.72
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$63.63
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$181.15
|
| Rate for Payer: Amerigroup Medicare |
$181.15
|
| Rate for Payer: BCBS of TX Blue Advantage |
$132.10
|
| Rate for Payer: BCBS of TX Blue Essentials |
$158.20
|
| Rate for Payer: BCBS of TX Medicare |
$181.15
|
| Rate for Payer: BCBS of TX PPO |
$199.33
|
| Rate for Payer: Cash Price |
$622.16
|
| Rate for Payer: Cash Price |
$622.16
|
| Rate for Payer: Cash Price |
$622.16
|
| Rate for Payer: Cigna Commercial |
$410.36
|
| Rate for Payer: Cigna Medicaid |
$68.14
|
| Rate for Payer: Cigna Medicare |
$181.15
|
| Rate for Payer: Employer Direct Commercial |
$181.15
|
| Rate for Payer: Humana Medicare/TRICARE |
$181.15
|
| Rate for Payer: Molina CHIP/Medicaid |
$68.14
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$181.15
|
| Rate for Payer: Molina Medicare |
$181.15
|
| Rate for Payer: Multiplan Auto |
$459.55
|
| Rate for Payer: Multiplan Commercial |
$459.55
|
| Rate for Payer: Multiplan Workers Comp |
$459.55
|
| Rate for Payer: Parkland Medicaid |
$68.14
|
| Rate for Payer: Scott and White EPO/PPO |
$3.24
|
| Rate for Payer: Scott and White Medicare |
$181.15
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$68.14
|
| Rate for Payer: Superior Health Plan EPO |
$181.15
|
| Rate for Payer: Superior Health Plan Medicare |
$181.15
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$181.15
|
| Rate for Payer: Universal American Medicare |
$181.15
|
| Rate for Payer: Wellcare Medicare |
$181.15
|
| Rate for Payer: Wellmed Medicare |
$181.15
|
|
|
ED Airway/Intubation Procedures Thoracentesis w/ Imaging BCE
|
Facility
|
IP
|
$1,959.00
|
|
|
Service Code
|
CPT 32555
|
| Hospital Charge Code |
2180027
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$1,723.92
|
|
|
ED Airway/Intubation Procedures Thoracentesis w/ Imaging BCE
|
Facility
|
OP
|
$1,959.00
|
|
|
Service Code
|
CPT 32555
|
| Hospital Charge Code |
2180027
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$10.27 |
| Max. Negotiated Rate |
$1,588.89 |
| Rate for Payer: Aetna Commercial |
$1,400.00
|
| Rate for Payer: Aetna Medicare |
$861.78
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$176.31
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$574.52
|
| Rate for Payer: Amerigroup Medicare |
$574.52
|
| Rate for Payer: BCBS of TX Blue Advantage |
$1,052.95
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,261.02
|
| Rate for Payer: BCBS of TX Medicare |
$574.52
|
| Rate for Payer: BCBS of TX PPO |
$1,588.89
|
| Rate for Payer: Cash Price |
$1,723.92
|
| Rate for Payer: Cash Price |
$1,723.92
|
| Rate for Payer: Cash Price |
$1,723.92
|
| Rate for Payer: Cigna Commercial |
$1,301.46
|
| Rate for Payer: Cigna Medicaid |
$223.75
|
| Rate for Payer: Cigna Medicare |
$574.52
|
| Rate for Payer: Employer Direct Commercial |
$574.52
|
| Rate for Payer: Humana Medicare/TRICARE |
$574.52
|
| Rate for Payer: Molina CHIP/Medicaid |
$223.75
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$574.52
|
| Rate for Payer: Molina Medicare |
$574.52
|
| Rate for Payer: Multiplan Auto |
$1,273.35
|
| Rate for Payer: Multiplan Commercial |
$1,273.35
|
| Rate for Payer: Multiplan Workers Comp |
$1,273.35
|
| Rate for Payer: Parkland Medicaid |
$223.75
|
| Rate for Payer: Scott and White EPO/PPO |
$10.27
|
| Rate for Payer: Scott and White Medicare |
$574.52
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$223.75
|
| Rate for Payer: Superior Health Plan EPO |
$574.52
|
| Rate for Payer: Superior Health Plan Medicare |
$574.52
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$574.52
|
| Rate for Payer: Universal American Medicare |
$574.52
|
| Rate for Payer: Wellcare Medicare |
$574.52
|
| Rate for Payer: Wellmed Medicare |
$574.52
|
|
|
ED Airway/Intubation Procedures Thoracentesis w/o Imaging BCE
|
Facility
|
OP
|
$1,590.00
|
|
|
Service Code
|
CPT 32554
|
| Hospital Charge Code |
2180026
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$10.27 |
| Max. Negotiated Rate |
$1,588.89 |
| Rate for Payer: Aetna Commercial |
$1,400.00
|
| Rate for Payer: Aetna Medicare |
$861.78
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$143.10
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$574.52
|
| Rate for Payer: Amerigroup Medicare |
$574.52
|
| Rate for Payer: BCBS of TX Blue Advantage |
$1,052.95
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,261.02
|
| Rate for Payer: BCBS of TX Medicare |
$574.52
|
| Rate for Payer: BCBS of TX PPO |
$1,588.89
|
| Rate for Payer: Cash Price |
$1,399.20
|
| Rate for Payer: Cash Price |
$1,399.20
|
| Rate for Payer: Cash Price |
$1,399.20
|
| Rate for Payer: Cigna Commercial |
$1,301.46
|
| Rate for Payer: Cigna Medicaid |
$223.75
|
| Rate for Payer: Cigna Medicare |
$574.52
|
| Rate for Payer: Employer Direct Commercial |
$574.52
|
| Rate for Payer: Humana Medicare/TRICARE |
$574.52
|
| Rate for Payer: Molina CHIP/Medicaid |
$223.75
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$574.52
|
| Rate for Payer: Molina Medicare |
$574.52
|
| Rate for Payer: Multiplan Auto |
$1,033.50
|
| Rate for Payer: Multiplan Commercial |
$1,033.50
|
| Rate for Payer: Multiplan Workers Comp |
$1,033.50
|
| Rate for Payer: Parkland Medicaid |
$223.75
|
| Rate for Payer: Scott and White EPO/PPO |
$10.27
|
| Rate for Payer: Scott and White Medicare |
$574.52
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$223.75
|
| Rate for Payer: Superior Health Plan EPO |
$574.52
|
| Rate for Payer: Superior Health Plan Medicare |
$574.52
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$574.52
|
| Rate for Payer: Universal American Medicare |
$574.52
|
| Rate for Payer: Wellcare Medicare |
$574.52
|
| Rate for Payer: Wellmed Medicare |
$574.52
|
|
|
ED Airway/Intubation Procedures Thoracentesis w/o Imaging BCE
|
Facility
|
IP
|
$1,590.00
|
|
|
Service Code
|
CPT 32554
|
| Hospital Charge Code |
2180026
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$1,399.20
|
|
|
ED Airway/Intubation Procedure: Thoracentesis w/ Imaging
|
Facility
|
OP
|
$1,959.00
|
|
|
Service Code
|
CPT 32555
|
| Hospital Charge Code |
2180027
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$10.27 |
| Max. Negotiated Rate |
$1,588.89 |
| Rate for Payer: Aetna Commercial |
$1,400.00
|
| Rate for Payer: Aetna Medicare |
$861.78
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$176.31
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$574.52
|
| Rate for Payer: Amerigroup Medicare |
$574.52
|
| Rate for Payer: BCBS of TX Blue Advantage |
$1,052.95
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,261.02
|
| Rate for Payer: BCBS of TX Medicare |
$574.52
|
| Rate for Payer: BCBS of TX PPO |
$1,588.89
|
| Rate for Payer: Cash Price |
$1,723.92
|
| Rate for Payer: Cash Price |
$1,723.92
|
| Rate for Payer: Cash Price |
$1,723.92
|
| Rate for Payer: Cigna Commercial |
$1,301.46
|
| Rate for Payer: Cigna Medicaid |
$223.75
|
| Rate for Payer: Cigna Medicare |
$574.52
|
| Rate for Payer: Employer Direct Commercial |
$574.52
|
| Rate for Payer: Humana Medicare/TRICARE |
$574.52
|
| Rate for Payer: Molina CHIP/Medicaid |
$223.75
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$574.52
|
| Rate for Payer: Molina Medicare |
$574.52
|
| Rate for Payer: Multiplan Auto |
$1,273.35
|
| Rate for Payer: Multiplan Commercial |
$1,273.35
|
| Rate for Payer: Multiplan Workers Comp |
$1,273.35
|
| Rate for Payer: Parkland Medicaid |
$223.75
|
| Rate for Payer: Scott and White EPO/PPO |
$10.27
|
| Rate for Payer: Scott and White Medicare |
$574.52
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$223.75
|
| Rate for Payer: Superior Health Plan EPO |
$574.52
|
| Rate for Payer: Superior Health Plan Medicare |
$574.52
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$574.52
|
| Rate for Payer: Universal American Medicare |
$574.52
|
| Rate for Payer: Wellcare Medicare |
$574.52
|
| Rate for Payer: Wellmed Medicare |
$574.52
|
|
|
ED Airway/Intubation Procedure: Thoracentesis w/o Imaging
|
Facility
|
OP
|
$1,590.00
|
|
|
Service Code
|
CPT 32554
|
| Hospital Charge Code |
2180026
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$10.27 |
| Max. Negotiated Rate |
$1,588.89 |
| Rate for Payer: Aetna Commercial |
$1,400.00
|
| Rate for Payer: Aetna Medicare |
$861.78
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$143.10
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$574.52
|
| Rate for Payer: Amerigroup Medicare |
$574.52
|
| Rate for Payer: BCBS of TX Blue Advantage |
$1,052.95
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,261.02
|
| Rate for Payer: BCBS of TX Medicare |
$574.52
|
| Rate for Payer: BCBS of TX PPO |
$1,588.89
|
| Rate for Payer: Cash Price |
$1,399.20
|
| Rate for Payer: Cash Price |
$1,399.20
|
| Rate for Payer: Cash Price |
$1,399.20
|
| Rate for Payer: Cigna Commercial |
$1,301.46
|
| Rate for Payer: Cigna Medicaid |
$223.75
|
| Rate for Payer: Cigna Medicare |
$574.52
|
| Rate for Payer: Employer Direct Commercial |
$574.52
|
| Rate for Payer: Humana Medicare/TRICARE |
$574.52
|
| Rate for Payer: Molina CHIP/Medicaid |
$223.75
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$574.52
|
| Rate for Payer: Molina Medicare |
$574.52
|
| Rate for Payer: Multiplan Auto |
$1,033.50
|
| Rate for Payer: Multiplan Commercial |
$1,033.50
|
| Rate for Payer: Multiplan Workers Comp |
$1,033.50
|
| Rate for Payer: Parkland Medicaid |
$223.75
|
| Rate for Payer: Scott and White EPO/PPO |
$10.27
|
| Rate for Payer: Scott and White Medicare |
$574.52
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$223.75
|
| Rate for Payer: Superior Health Plan EPO |
$574.52
|
| Rate for Payer: Superior Health Plan Medicare |
$574.52
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$574.52
|
| Rate for Payer: Universal American Medicare |
$574.52
|
| Rate for Payer: Wellcare Medicare |
$574.52
|
| Rate for Payer: Wellmed Medicare |
$574.52
|
|
|
ED APPLICATION FINGER SPLINT DYNAMIC BCE
|
Facility
|
IP
|
$493.00
|
|
|
Service Code
|
CPT 29131
|
| Hospital Charge Code |
8478520
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$433.84
|
|
|
ED APPLICATION FINGER SPLINT DYNAMIC BCE
|
Facility
|
OP
|
$493.00
|
|
|
Service Code
|
CPT 29131
|
| Hospital Charge Code |
8478520
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$320.45 |
| Rate for Payer: Aetna Commercial |
$271.15
|
| Rate for Payer: Aetna Medicare |
$83.91
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$44.37
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$55.94
|
| Rate for Payer: Amerigroup Medicare |
$55.94
|
| Rate for Payer: BCBS of TX Blue Advantage |
$91.87
|
| Rate for Payer: BCBS of TX Blue Essentials |
$110.02
|
| Rate for Payer: BCBS of TX Medicare |
$55.94
|
| Rate for Payer: BCBS of TX PPO |
$138.63
|
| Rate for Payer: Cash Price |
$433.84
|
| Rate for Payer: Cash Price |
$433.84
|
| Rate for Payer: Cash Price |
$433.84
|
| Rate for Payer: Cigna Commercial |
$126.71
|
| Rate for Payer: Cigna Medicare |
$55.94
|
| Rate for Payer: Employer Direct Commercial |
$55.94
|
| Rate for Payer: Humana Medicare/TRICARE |
$55.94
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$55.94
|
| Rate for Payer: Molina Medicare |
$55.94
|
| Rate for Payer: Multiplan Auto |
$320.45
|
| Rate for Payer: Multiplan Commercial |
$320.45
|
| Rate for Payer: Multiplan Workers Comp |
$320.45
|
| Rate for Payer: Scott and White EPO/PPO |
$1.00
|
| Rate for Payer: Scott and White Medicare |
$55.94
|
| Rate for Payer: Superior Health Plan EPO |
$55.94
|
| Rate for Payer: Superior Health Plan Medicare |
$55.94
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$55.94
|
| Rate for Payer: Universal American Medicare |
$55.94
|
| Rate for Payer: Wellcare Medicare |
$55.94
|
| Rate for Payer: Wellmed Medicare |
$55.94
|
|
|
ED APPLICATION SHORT ARM SPLINT DYNAMIC BCE
|
Facility
|
IP
|
$625.00
|
|
|
Service Code
|
CPT 29126
|
| Hospital Charge Code |
8478471
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$550.00
|
|
|
ED APPLICATION SHORT ARM SPLINT DYNAMIC BCE
|
Facility
|
OP
|
$625.00
|
|
|
Service Code
|
CPT 29126
|
| Hospital Charge Code |
8478471
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2.09 |
| Max. Negotiated Rate |
$406.25 |
| Rate for Payer: Aetna Commercial |
$343.75
|
| Rate for Payer: Aetna Medicare |
$175.23
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$56.25
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$116.82
|
| Rate for Payer: Amerigroup Medicare |
$116.82
|
| Rate for Payer: BCBS of TX Blue Advantage |
$182.08
|
| Rate for Payer: BCBS of TX Blue Essentials |
$218.06
|
| Rate for Payer: BCBS of TX Medicare |
$116.82
|
| Rate for Payer: BCBS of TX PPO |
$274.76
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cigna Commercial |
$264.63
|
| Rate for Payer: Cigna Medicare |
$116.82
|
| Rate for Payer: Employer Direct Commercial |
$116.82
|
| Rate for Payer: Humana Medicare/TRICARE |
$116.82
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$116.82
|
| Rate for Payer: Molina Medicare |
$116.82
|
| Rate for Payer: Multiplan Auto |
$406.25
|
| Rate for Payer: Multiplan Commercial |
$406.25
|
| Rate for Payer: Multiplan Workers Comp |
$406.25
|
| Rate for Payer: Scott and White EPO/PPO |
$2.09
|
| Rate for Payer: Scott and White Medicare |
$116.82
|
| Rate for Payer: Superior Health Plan EPO |
$116.82
|
| Rate for Payer: Superior Health Plan Medicare |
$116.82
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$116.82
|
| Rate for Payer: Universal American Medicare |
$116.82
|
| Rate for Payer: Wellcare Medicare |
$116.82
|
| Rate for Payer: Wellmed Medicare |
$116.82
|
|
|
ED Arterial Line Activity Blood Drawn BCE
|
Facility
|
OP
|
$153.00
|
|
|
Service Code
|
CPT 36600
|
| Hospital Charge Code |
4000345
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$2.09 |
| Max. Negotiated Rate |
$274.76 |
| Rate for Payer: Aetna Commercial |
$84.15
|
| Rate for Payer: Aetna Medicare |
$175.23
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$13.77
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$116.82
|
| Rate for Payer: Amerigroup Medicare |
$116.82
|
| Rate for Payer: BCBS of TX Blue Advantage |
$182.08
|
| Rate for Payer: BCBS of TX Blue Essentials |
$218.06
|
| Rate for Payer: BCBS of TX Medicare |
$116.82
|
| Rate for Payer: BCBS of TX PPO |
$274.76
|
| Rate for Payer: Cash Price |
$134.64
|
| Rate for Payer: Cash Price |
$134.64
|
| Rate for Payer: Cash Price |
$134.64
|
| Rate for Payer: Cigna Commercial |
$264.63
|
| Rate for Payer: Cigna Medicare |
$116.82
|
| Rate for Payer: Employer Direct Commercial |
$116.82
|
| Rate for Payer: Humana Medicare/TRICARE |
$116.82
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$116.82
|
| Rate for Payer: Molina Medicare |
$116.82
|
| Rate for Payer: Multiplan Auto |
$99.45
|
| Rate for Payer: Multiplan Commercial |
$99.45
|
| Rate for Payer: Multiplan Workers Comp |
$99.45
|
| Rate for Payer: Scott and White EPO/PPO |
$2.09
|
| Rate for Payer: Scott and White Medicare |
$116.82
|
| Rate for Payer: Superior Health Plan EPO |
$116.82
|
| Rate for Payer: Superior Health Plan Medicare |
$116.82
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$116.82
|
| Rate for Payer: Universal American Medicare |
$116.82
|
| Rate for Payer: Wellcare Medicare |
$116.82
|
| Rate for Payer: Wellmed Medicare |
$116.82
|
|
|
ED BLADDER IRRIGATION SIMPLE LAVAGE AND OR INSTILLATION BCE
|
Facility
|
IP
|
$907.00
|
|
|
Service Code
|
CPT 51700
|
| Hospital Charge Code |
8438508
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$798.16
|
|
|
ED BLADDER IRRIGATION SIMPLE LAVAGE AND OR INSTILLATION BCE
|
Facility
|
OP
|
$907.00
|
|
|
Service Code
|
CPT 51700
|
| Hospital Charge Code |
8438508
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$4.04 |
| Max. Negotiated Rate |
$589.55 |
| Rate for Payer: Aetna Commercial |
$498.85
|
| Rate for Payer: Aetna Medicare |
$339.04
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$81.63
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$226.03
|
| Rate for Payer: Amerigroup Medicare |
$226.03
|
| Rate for Payer: BCBS of TX Blue Advantage |
$87.39
|
| Rate for Payer: BCBS of TX Blue Essentials |
$104.66
|
| Rate for Payer: BCBS of TX Medicare |
$226.03
|
| Rate for Payer: BCBS of TX PPO |
$131.87
|
| Rate for Payer: Cash Price |
$798.16
|
| Rate for Payer: Cash Price |
$798.16
|
| Rate for Payer: Cash Price |
$798.16
|
| Rate for Payer: Cigna Commercial |
$512.01
|
| Rate for Payer: Cigna Medicaid |
$44.30
|
| Rate for Payer: Cigna Medicare |
$226.03
|
| Rate for Payer: Employer Direct Commercial |
$226.03
|
| Rate for Payer: Humana Medicare/TRICARE |
$226.03
|
| Rate for Payer: Molina CHIP/Medicaid |
$44.30
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$226.03
|
| Rate for Payer: Molina Medicare |
$226.03
|
| Rate for Payer: Multiplan Auto |
$589.55
|
| Rate for Payer: Multiplan Commercial |
$589.55
|
| Rate for Payer: Multiplan Workers Comp |
$589.55
|
| Rate for Payer: Parkland Medicaid |
$44.30
|
| Rate for Payer: Scott and White EPO/PPO |
$4.04
|
| Rate for Payer: Scott and White Medicare |
$226.03
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$44.30
|
| Rate for Payer: Superior Health Plan EPO |
$226.03
|
| Rate for Payer: Superior Health Plan Medicare |
$226.03
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$226.03
|
| Rate for Payer: Universal American Medicare |
$226.03
|
| Rate for Payer: Wellcare Medicare |
$226.03
|
| Rate for Payer: Wellmed Medicare |
$226.03
|
|
|
ED BLOOD TRANSFUSION BCE
|
Facility
|
OP
|
$2,059.00
|
|
|
Service Code
|
CPT 36430
|
| Hospital Charge Code |
8398512
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$7.10 |
| Max. Negotiated Rate |
$1,338.35 |
| Rate for Payer: Aetna Commercial |
$1,132.45
|
| Rate for Payer: Aetna Medicare |
$595.52
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$185.31
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$397.01
|
| Rate for Payer: Amerigroup Medicare |
$397.01
|
| Rate for Payer: BCBS of TX Blue Advantage |
$58.47
|
| Rate for Payer: BCBS of TX Blue Essentials |
$70.02
|
| Rate for Payer: BCBS of TX Medicare |
$397.01
|
| Rate for Payer: BCBS of TX PPO |
$88.23
|
| Rate for Payer: Cash Price |
$1,811.92
|
| Rate for Payer: Cash Price |
$1,811.92
|
| Rate for Payer: Cash Price |
$1,811.92
|
| Rate for Payer: Cigna Commercial |
$899.35
|
| Rate for Payer: Cigna Medicaid |
$30.73
|
| Rate for Payer: Cigna Medicare |
$397.01
|
| Rate for Payer: Employer Direct Commercial |
$397.01
|
| Rate for Payer: Humana Medicare/TRICARE |
$397.01
|
| Rate for Payer: Molina CHIP/Medicaid |
$30.73
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$397.01
|
| Rate for Payer: Molina Medicare |
$397.01
|
| Rate for Payer: Multiplan Auto |
$1,338.35
|
| Rate for Payer: Multiplan Commercial |
$1,338.35
|
| Rate for Payer: Multiplan Workers Comp |
$1,338.35
|
| Rate for Payer: Parkland Medicaid |
$30.73
|
| Rate for Payer: Scott and White EPO/PPO |
$7.10
|
| Rate for Payer: Scott and White Medicare |
$397.01
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$30.73
|
| Rate for Payer: Superior Health Plan EPO |
$397.01
|
| Rate for Payer: Superior Health Plan Medicare |
$397.01
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$397.01
|
| Rate for Payer: Universal American Medicare |
$397.01
|
| Rate for Payer: Wellcare Medicare |
$397.01
|
| Rate for Payer: Wellmed Medicare |
$397.01
|
|
|
ED BLOOD TRANSFUSION BCE
|
Facility
|
IP
|
$2,059.00
|
|
|
Service Code
|
CPT 36430
|
| Hospital Charge Code |
8398512
|
|
Hospital Revenue Code
|
391
|
| Rate for Payer: Cash Price |
$1,811.92
|
|
|
ED Burns: Dress/Debride Large Burn, >10%
|
Facility
|
OP
|
$922.00
|
|
|
Service Code
|
CPT 16030
|
| Hospital Charge Code |
5202502
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$6.52 |
| Max. Negotiated Rate |
$826.08 |
| Rate for Payer: Aetna Commercial |
$507.10
|
| Rate for Payer: Aetna Medicare |
$547.00
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$82.98
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$364.67
|
| Rate for Payer: Amerigroup Medicare |
$364.67
|
| Rate for Payer: BCBS of TX Blue Advantage |
$533.58
|
| Rate for Payer: BCBS of TX Blue Essentials |
$639.02
|
| Rate for Payer: BCBS of TX Medicare |
$364.67
|
| Rate for Payer: BCBS of TX PPO |
$805.17
|
| Rate for Payer: Cash Price |
$811.36
|
| Rate for Payer: Cash Price |
$811.36
|
| Rate for Payer: Cash Price |
$811.36
|
| Rate for Payer: Cigna Commercial |
$826.08
|
| Rate for Payer: Cigna Medicaid |
$143.08
|
| Rate for Payer: Cigna Medicare |
$364.67
|
| Rate for Payer: Employer Direct Commercial |
$364.67
|
| Rate for Payer: Humana Medicare/TRICARE |
$364.67
|
| Rate for Payer: Molina CHIP/Medicaid |
$143.08
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$364.67
|
| Rate for Payer: Molina Medicare |
$364.67
|
| Rate for Payer: Multiplan Auto |
$599.30
|
| Rate for Payer: Multiplan Commercial |
$599.30
|
| Rate for Payer: Multiplan Workers Comp |
$599.30
|
| Rate for Payer: Parkland Medicaid |
$143.08
|
| Rate for Payer: Scott and White EPO/PPO |
$6.52
|
| Rate for Payer: Scott and White Medicare |
$364.67
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$143.08
|
| Rate for Payer: Superior Health Plan EPO |
$364.67
|
| Rate for Payer: Superior Health Plan Medicare |
$364.67
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$364.67
|
| Rate for Payer: Universal American Medicare |
$364.67
|
| Rate for Payer: Wellcare Medicare |
$364.67
|
| Rate for Payer: Wellmed Medicare |
$364.67
|
|
