|
CHED Foreign Body Removal Site Scrotum BCE
|
Facility
|
OP
|
$8,880.13
|
|
|
Service Code
|
HCPCS 55120
|
| Hospital Charge Code |
5202522
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$439.05 |
| Max. Negotiated Rate |
$6,393.69 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$799.21
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$2,099.91
|
| Rate for Payer: Amerigroup Medicare |
$2,099.91
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,958.49
|
| Rate for Payer: BCBS of TX Blue Essentials |
$3,543.10
|
| Rate for Payer: BCBS of TX Medicare |
$2,099.91
|
| Rate for Payer: BCBS of TX PPO |
$4,464.31
|
| Rate for Payer: Cash Price |
$6,038.49
|
| Rate for Payer: Cash Price |
$6,038.49
|
| Rate for Payer: Cash Price |
$6,038.49
|
| Rate for Payer: Cigna Commercial |
$4,438.84
|
| Rate for Payer: Cigna Medicaid |
$6,393.69
|
| Rate for Payer: Cigna Medicare |
$2,099.91
|
| Rate for Payer: Employer Direct Commercial |
$2,099.91
|
| Rate for Payer: Humana Medicare/TRICARE |
$2,099.91
|
| Rate for Payer: Molina CHIP/Medicaid |
$6,393.69
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$2,099.91
|
| Rate for Payer: Molina Medicare |
$2,099.91
|
| Rate for Payer: Multiplan Auto |
$5,772.08
|
| Rate for Payer: Multiplan Commercial |
$5,772.08
|
| Rate for Payer: Multiplan Workers Comp |
$5,772.08
|
| Rate for Payer: Parkland Medicaid |
$6,393.69
|
| Rate for Payer: Scott and White EPO/PPO |
$439.05
|
| Rate for Payer: Scott and White Medicare |
$2,099.91
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$6,393.69
|
| Rate for Payer: Superior Health Plan EPO |
$2,099.91
|
| Rate for Payer: Superior Health Plan Medicare |
$2,099.91
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$2,099.91
|
| Rate for Payer: Universal American Medicare |
$2,099.91
|
| Rate for Payer: Wellcare Medicare |
$2,099.91
|
| Rate for Payer: Wellmed Medicare |
$2,099.91
|
|
|
CHED Foreign Body Removal Site Skin, Subcutaneous Complex FB BCE
|
Facility
|
OP
|
$3,692.25
|
|
|
Service Code
|
HCPCS 10121
|
| Hospital Charge Code |
8914590
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$225.84 |
| Max. Negotiated Rate |
$3,507.10 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$332.30
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,659.12
|
| Rate for Payer: Amerigroup Medicare |
$1,659.12
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,292.24
|
| Rate for Payer: BCBS of TX Blue Essentials |
$2,745.20
|
| Rate for Payer: BCBS of TX Medicare |
$1,659.12
|
| Rate for Payer: BCBS of TX PPO |
$3,458.95
|
| Rate for Payer: Cash Price |
$2,510.73
|
| Rate for Payer: Cash Price |
$2,510.73
|
| Rate for Payer: Cash Price |
$2,510.73
|
| Rate for Payer: Cigna Commercial |
$3,507.10
|
| Rate for Payer: Cigna Medicaid |
$2,658.42
|
| Rate for Payer: Cigna Medicare |
$1,659.12
|
| Rate for Payer: Employer Direct Commercial |
$1,659.12
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,659.12
|
| Rate for Payer: Molina CHIP/Medicaid |
$2,658.42
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,659.12
|
| Rate for Payer: Molina Medicare |
$1,659.12
|
| Rate for Payer: Multiplan Auto |
$2,399.96
|
| Rate for Payer: Multiplan Commercial |
$2,399.96
|
| Rate for Payer: Multiplan Workers Comp |
$2,399.96
|
| Rate for Payer: Parkland Medicaid |
$2,658.42
|
| Rate for Payer: Scott and White EPO/PPO |
$225.84
|
| Rate for Payer: Scott and White Medicare |
$1,659.12
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$2,658.42
|
| Rate for Payer: Superior Health Plan EPO |
$1,659.12
|
| Rate for Payer: Superior Health Plan Medicare |
$1,659.12
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,659.12
|
| Rate for Payer: Universal American Medicare |
$1,659.12
|
| Rate for Payer: Wellcare Medicare |
$1,659.12
|
| Rate for Payer: Wellmed Medicare |
$1,659.12
|
|
|
CHED Foreign Body Removal Site Skin, Subcutaneous Complex FB BCE
|
Facility
|
IP
|
$3,692.25
|
|
|
Service Code
|
HCPCS 10121
|
| Hospital Charge Code |
8914590
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$2,510.73
|
|
|
CHED Foreign Body Removal Site Skin, Subcutaneous Simple FB BCE
|
Facility
|
OP
|
$2,057.12
|
|
|
Service Code
|
HCPCS 10120
|
| Hospital Charge Code |
8914591
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$130.89 |
| Max. Negotiated Rate |
$1,481.13 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$185.14
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$408.37
|
| Rate for Payer: Amerigroup Medicare |
$408.37
|
| Rate for Payer: BCBS of TX Blue Advantage |
$178.41
|
| Rate for Payer: BCBS of TX Blue Essentials |
$213.66
|
| Rate for Payer: BCBS of TX Medicare |
$408.37
|
| Rate for Payer: BCBS of TX PPO |
$269.21
|
| Rate for Payer: Cash Price |
$1,398.84
|
| Rate for Payer: Cash Price |
$1,398.84
|
| Rate for Payer: Cash Price |
$1,398.84
|
| Rate for Payer: Cigna Commercial |
$863.21
|
| Rate for Payer: Cigna Medicaid |
$1,481.13
|
| Rate for Payer: Cigna Medicare |
$408.37
|
| Rate for Payer: Employer Direct Commercial |
$408.37
|
| Rate for Payer: Humana Medicare/TRICARE |
$408.37
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,481.13
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$408.37
|
| Rate for Payer: Molina Medicare |
$408.37
|
| Rate for Payer: Multiplan Auto |
$1,337.13
|
| Rate for Payer: Multiplan Commercial |
$1,337.13
|
| Rate for Payer: Multiplan Workers Comp |
$1,337.13
|
| Rate for Payer: Parkland Medicaid |
$1,481.13
|
| Rate for Payer: Scott and White EPO/PPO |
$130.89
|
| Rate for Payer: Scott and White Medicare |
$408.37
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,481.13
|
| Rate for Payer: Superior Health Plan EPO |
$408.37
|
| Rate for Payer: Superior Health Plan Medicare |
$408.37
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$408.37
|
| Rate for Payer: Universal American Medicare |
$408.37
|
| Rate for Payer: Wellcare Medicare |
$408.37
|
| Rate for Payer: Wellmed Medicare |
$408.37
|
|
|
CHED Foreign Body Removal Site Skin, Subcutaneous Simple FB BCE
|
Facility
|
IP
|
$2,057.12
|
|
|
Service Code
|
HCPCS 10120
|
| Hospital Charge Code |
8914591
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$1,398.84
|
|
|
CHED Foreign Body Removal Site Upper Arm/Elbow BCE
|
Facility
|
IP
|
$2,440.57
|
|
|
Service Code
|
HCPCS 24200
|
| Hospital Charge Code |
8912599
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$1,659.59
|
|
|
CHED Foreign Body Removal Site Upper Arm/Elbow BCE
|
Facility
|
OP
|
$2,440.57
|
|
|
Service Code
|
HCPCS 24200
|
| Hospital Charge Code |
8912599
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$175.78 |
| Max. Negotiated Rate |
$3,507.10 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$219.65
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,659.12
|
| Rate for Payer: Amerigroup Medicare |
$1,659.12
|
| Rate for Payer: BCBS of TX Blue Advantage |
$245.91
|
| Rate for Payer: BCBS of TX Blue Essentials |
$294.50
|
| Rate for Payer: BCBS of TX Medicare |
$1,659.12
|
| Rate for Payer: BCBS of TX PPO |
$371.07
|
| Rate for Payer: Cash Price |
$1,659.59
|
| Rate for Payer: Cash Price |
$1,659.59
|
| Rate for Payer: Cash Price |
$1,659.59
|
| Rate for Payer: Cigna Commercial |
$3,507.10
|
| Rate for Payer: Cigna Medicaid |
$1,757.21
|
| Rate for Payer: Cigna Medicare |
$1,659.12
|
| Rate for Payer: Employer Direct Commercial |
$1,659.12
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,659.12
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,757.21
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,659.12
|
| Rate for Payer: Molina Medicare |
$1,659.12
|
| Rate for Payer: Multiplan Auto |
$1,586.37
|
| Rate for Payer: Multiplan Commercial |
$1,586.37
|
| Rate for Payer: Multiplan Workers Comp |
$1,586.37
|
| Rate for Payer: Parkland Medicaid |
$1,757.21
|
| Rate for Payer: Scott and White EPO/PPO |
$175.78
|
| Rate for Payer: Scott and White Medicare |
$1,659.12
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,757.21
|
| Rate for Payer: Superior Health Plan EPO |
$1,659.12
|
| Rate for Payer: Superior Health Plan Medicare |
$1,659.12
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,659.12
|
| Rate for Payer: Universal American Medicare |
$1,659.12
|
| Rate for Payer: Wellcare Medicare |
$1,659.12
|
| Rate for Payer: Wellmed Medicare |
$1,659.12
|
|
|
CHED Fracture Site Bimalleolar Fx, w/o Manipulation BCE
|
Facility
|
OP
|
$1,058.75
|
|
|
Service Code
|
HCPCS 27808
|
| Hospital Charge Code |
8910615
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$95.29 |
| Max. Negotiated Rate |
$762.30 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$95.29
|
| 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 |
$719.95
|
| Rate for Payer: Cash Price |
$719.95
|
| Rate for Payer: Cash Price |
$719.95
|
| Rate for Payer: Cigna Commercial |
$523.79
|
| Rate for Payer: Cigna Medicaid |
$762.30
|
| 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 |
$762.30
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$247.79
|
| Rate for Payer: Molina Medicare |
$247.79
|
| Rate for Payer: Multiplan Auto |
$688.19
|
| Rate for Payer: Multiplan Commercial |
$688.19
|
| Rate for Payer: Multiplan Workers Comp |
$688.19
|
| Rate for Payer: Parkland Medicaid |
$762.30
|
| Rate for Payer: Scott and White EPO/PPO |
$391.91
|
| Rate for Payer: Scott and White Medicare |
$247.79
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$762.30
|
| 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
|
|
|
CHED Fracture Site Bimalleolar Fx, w/o Manipulation BCE
|
Facility
|
IP
|
$1,058.75
|
|
|
Service Code
|
HCPCS 27808
|
| Hospital Charge Code |
8910615
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$719.95
|
|
|
CHED Fracture Site Elbow/ Monteggia w/ manipulation BCE
|
Facility
|
OP
|
$3,361.17
|
|
|
Service Code
|
HCPCS 24620
|
| Hospital Charge Code |
8912600
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$302.51 |
| Max. Negotiated Rate |
$3,415.58 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$302.51
|
| 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 |
$2,285.60
|
| Rate for Payer: Cash Price |
$2,285.60
|
| Rate for Payer: Cash Price |
$2,285.60
|
| Rate for Payer: Cigna Commercial |
$3,414.49
|
| Rate for Payer: Cigna Medicaid |
$2,420.04
|
| 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 |
$2,420.04
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,615.32
|
| Rate for Payer: Molina Medicare |
$1,615.32
|
| Rate for Payer: Multiplan Auto |
$2,184.76
|
| Rate for Payer: Multiplan Commercial |
$2,184.76
|
| Rate for Payer: Multiplan Workers Comp |
$2,184.76
|
| Rate for Payer: Parkland Medicaid |
$2,420.04
|
| Rate for Payer: Scott and White EPO/PPO |
$738.81
|
| Rate for Payer: Scott and White Medicare |
$1,615.32
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$2,420.04
|
| 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
|
|
|
CHED Fracture Site Elbow/ Monteggia w/ manipulation BCE
|
Facility
|
IP
|
$3,361.17
|
|
|
Service Code
|
HCPCS 24620
|
| Hospital Charge Code |
8912600
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$2,285.60
|
|
|
CHED Fracture Site Fibula Fx, Distal, w/ manipulation BCE
|
Facility
|
OP
|
$215.64
|
|
|
Service Code
|
HCPCS 27788
|
| Hospital Charge Code |
8914592
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$19.41 |
| Max. Negotiated Rate |
$543.41 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$19.41
|
| 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 |
$146.64
|
| Rate for Payer: Cash Price |
$146.64
|
| Rate for Payer: Cash Price |
$146.64
|
| Rate for Payer: Cigna Commercial |
$523.79
|
| Rate for Payer: Cigna Medicaid |
$155.26
|
| 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 |
$155.26
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$247.79
|
| Rate for Payer: Molina Medicare |
$247.79
|
| Rate for Payer: Multiplan Auto |
$140.17
|
| Rate for Payer: Multiplan Commercial |
$140.17
|
| Rate for Payer: Multiplan Workers Comp |
$140.17
|
| Rate for Payer: Parkland Medicaid |
$155.26
|
| Rate for Payer: Scott and White EPO/PPO |
$488.46
|
| Rate for Payer: Scott and White Medicare |
$247.79
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$155.26
|
| 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
|
|
|
CHED Fracture Site Fibula Fx, Distal, w/ manipulation BCE
|
Facility
|
IP
|
$215.64
|
|
|
Service Code
|
HCPCS 27788
|
| Hospital Charge Code |
8914592
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$146.64
|
|
|
CHED Fracture Site Fibula Fx, Distal, w/o manipulation BCE
|
Facility
|
IP
|
$753.08
|
|
|
Service Code
|
HCPCS 27786
|
| Hospital Charge Code |
8914593
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$512.09
|
|
|
CHED Fracture Site Fibula Fx, Distal, w/o manipulation BCE
|
Facility
|
OP
|
$753.08
|
|
|
Service Code
|
HCPCS 27786
|
| Hospital Charge Code |
8914593
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$67.78 |
| Max. Negotiated Rate |
$543.41 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$67.78
|
| 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 |
$512.09
|
| Rate for Payer: Cash Price |
$512.09
|
| Rate for Payer: Cash Price |
$512.09
|
| Rate for Payer: Cigna Commercial |
$523.79
|
| Rate for Payer: Cigna Medicaid |
$542.22
|
| 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 |
$542.22
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$247.79
|
| Rate for Payer: Molina Medicare |
$247.79
|
| Rate for Payer: Multiplan Auto |
$489.50
|
| Rate for Payer: Multiplan Commercial |
$489.50
|
| Rate for Payer: Multiplan Workers Comp |
$489.50
|
| Rate for Payer: Parkland Medicaid |
$542.22
|
| Rate for Payer: Scott and White EPO/PPO |
$367.34
|
| Rate for Payer: Scott and White Medicare |
$247.79
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$542.22
|
| 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
|
|
|
CHED Fracture Site Great Toe w/ manipulation BCE
|
Facility
|
IP
|
$1,117.44
|
|
|
Service Code
|
HCPCS 28495
|
| Hospital Charge Code |
8912601
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$759.86
|
|
|
CHED Fracture Site Great Toe w/ manipulation BCE
|
Facility
|
OP
|
$1,117.44
|
|
|
Service Code
|
HCPCS 28495
|
| Hospital Charge Code |
8912601
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$100.57 |
| Max. Negotiated Rate |
$804.56 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$100.57
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$247.79
|
| Rate for Payer: Amerigroup Medicare |
$247.79
|
| Rate for Payer: BCBS of TX Blue Advantage |
$181.96
|
| Rate for Payer: BCBS of TX Blue Essentials |
$217.92
|
| Rate for Payer: BCBS of TX Medicare |
$247.79
|
| Rate for Payer: BCBS of TX PPO |
$274.58
|
| Rate for Payer: Cash Price |
$759.86
|
| Rate for Payer: Cash Price |
$759.86
|
| Rate for Payer: Cash Price |
$759.86
|
| Rate for Payer: Cigna Commercial |
$523.79
|
| Rate for Payer: Cigna Medicaid |
$804.56
|
| 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 |
$804.56
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$247.79
|
| Rate for Payer: Molina Medicare |
$247.79
|
| Rate for Payer: Multiplan Auto |
$726.34
|
| Rate for Payer: Multiplan Commercial |
$726.34
|
| Rate for Payer: Multiplan Workers Comp |
$726.34
|
| Rate for Payer: Parkland Medicaid |
$804.56
|
| Rate for Payer: Scott and White EPO/PPO |
$189.69
|
| Rate for Payer: Scott and White Medicare |
$247.79
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$804.56
|
| 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
|
|
|
CHED Fracture Site Humerus, proximal, w/ manipulation BCE
|
Facility
|
OP
|
$2,090.25
|
|
|
Service Code
|
HCPCS 23605
|
| Hospital Charge Code |
8912602
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$188.12 |
| Max. Negotiated Rate |
$3,415.58 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$188.12
|
| 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 |
$1,421.37
|
| Rate for Payer: Cash Price |
$1,421.37
|
| Rate for Payer: Cash Price |
$1,421.37
|
| Rate for Payer: Cigna Commercial |
$3,414.49
|
| Rate for Payer: Cigna Medicaid |
$1,504.98
|
| 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 |
$1,504.98
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,615.32
|
| Rate for Payer: Molina Medicare |
$1,615.32
|
| Rate for Payer: Multiplan Auto |
$1,358.66
|
| Rate for Payer: Multiplan Commercial |
$1,358.66
|
| Rate for Payer: Multiplan Workers Comp |
$1,358.66
|
| Rate for Payer: Parkland Medicaid |
$1,504.98
|
| Rate for Payer: Scott and White EPO/PPO |
$541.77
|
| Rate for Payer: Scott and White Medicare |
$1,615.32
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,504.98
|
| 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
|
|
|
CHED Fracture Site Humerus, proximal, w/ manipulation BCE
|
Facility
|
IP
|
$2,090.25
|
|
|
Service Code
|
HCPCS 23605
|
| Hospital Charge Code |
8912602
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$1,421.37
|
|
|
CHED Fracture Site Malleolus, Posterior, w/ manipulation BCE
|
Facility
|
OP
|
$4,420.75
|
|
|
Service Code
|
HCPCS 27768
|
| Hospital Charge Code |
8910616
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$397.87 |
| Max. Negotiated Rate |
$3,415.58 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$397.87
|
| 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 |
$3,006.11
|
| Rate for Payer: Cash Price |
$3,006.11
|
| Rate for Payer: Cash Price |
$3,006.11
|
| Rate for Payer: Cigna Commercial |
$3,414.49
|
| Rate for Payer: Cigna Medicaid |
$3,182.94
|
| 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 |
$3,182.94
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,615.32
|
| Rate for Payer: Molina Medicare |
$1,615.32
|
| Rate for Payer: Multiplan Auto |
$2,873.49
|
| Rate for Payer: Multiplan Commercial |
$2,873.49
|
| Rate for Payer: Multiplan Workers Comp |
$2,873.49
|
| Rate for Payer: Parkland Medicaid |
$3,182.94
|
| Rate for Payer: Scott and White EPO/PPO |
$567.19
|
| Rate for Payer: Scott and White Medicare |
$1,615.32
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$3,182.94
|
| 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
|
|
|
CHED Fracture Site Malleolus, Posterior, w/ manipulation BCE
|
Facility
|
IP
|
$4,420.75
|
|
|
Service Code
|
HCPCS 27768
|
| Hospital Charge Code |
8910616
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$3,006.11
|
|
|
CHED Fracture Site Metacarpal fx, w/ manipulation BCE
|
Facility
|
OP
|
$1,317.75
|
|
|
Service Code
|
HCPCS 26605
|
| Hospital Charge Code |
9220211
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$118.60 |
| Max. Negotiated Rate |
$948.78 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$118.60
|
| 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 |
$896.07
|
| Rate for Payer: Cash Price |
$896.07
|
| Rate for Payer: Cash Price |
$896.07
|
| Rate for Payer: Cigna Commercial |
$523.79
|
| Rate for Payer: Cigna Medicaid |
$948.78
|
| 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 |
$948.78
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$247.79
|
| Rate for Payer: Molina Medicare |
$247.79
|
| Rate for Payer: Multiplan Auto |
$856.54
|
| Rate for Payer: Multiplan Commercial |
$856.54
|
| Rate for Payer: Multiplan Workers Comp |
$856.54
|
| Rate for Payer: Parkland Medicaid |
$948.78
|
| Rate for Payer: Scott and White EPO/PPO |
$381.09
|
| Rate for Payer: Scott and White Medicare |
$247.79
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$948.78
|
| 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
|
|
|
CHED Fracture Site Metacarpal fx, w/ manipulation BCE
|
Facility
|
IP
|
$1,317.75
|
|
|
Service Code
|
HCPCS 26605
|
| Hospital Charge Code |
9220211
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$896.07
|
|
|
CHED Fracture Site MP/Interphalangeal Joint, w/ manipulation BCE
|
Facility
|
OP
|
$2,607.25
|
|
|
Service Code
|
HCPCS 26742
|
| Hospital Charge Code |
8914594
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$234.65 |
| Max. Negotiated Rate |
$3,415.58 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$234.65
|
| 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 |
$1,772.93
|
| Rate for Payer: Cash Price |
$1,772.93
|
| Rate for Payer: Cash Price |
$1,772.93
|
| Rate for Payer: Cigna Commercial |
$3,414.49
|
| Rate for Payer: Cigna Medicaid |
$1,877.22
|
| 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 |
$1,877.22
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,615.32
|
| Rate for Payer: Molina Medicare |
$1,615.32
|
| Rate for Payer: Multiplan Auto |
$1,694.71
|
| Rate for Payer: Multiplan Commercial |
$1,694.71
|
| Rate for Payer: Multiplan Workers Comp |
$1,694.71
|
| Rate for Payer: Parkland Medicaid |
$1,877.22
|
| Rate for Payer: Scott and White EPO/PPO |
$426.80
|
| Rate for Payer: Scott and White Medicare |
$1,615.32
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,877.22
|
| 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
|
|
|
CHED Fracture Site MP/Interphalangeal Joint, w/ manipulation BCE
|
Facility
|
IP
|
$2,607.25
|
|
|
Service Code
|
HCPCS 26742
|
| Hospital Charge Code |
8914594
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$1,772.93
|
|
