|
ED CLOSED TX FEMORAL SHAFT FX W/O MANIPULATION BCE
|
Facility
|
OP
|
$1,220.00
|
|
|
Service Code
|
CPT 27500
|
| Hospital Charge Code |
8498466
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3.86 |
| Max. Negotiated Rate |
$793.00 |
| Rate for Payer: Aetna Commercial |
$671.00
|
| Rate for Payer: Aetna Medicare |
$323.50
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$109.80
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$215.67
|
| Rate for Payer: Amerigroup Medicare |
$215.67
|
| 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 |
$215.67
|
| Rate for Payer: BCBS of TX PPO |
$543.41
|
| Rate for Payer: Cash Price |
$1,073.60
|
| Rate for Payer: Cash Price |
$1,073.60
|
| Rate for Payer: Cash Price |
$1,073.60
|
| Rate for Payer: Cigna Commercial |
$488.55
|
| Rate for Payer: Cigna Medicaid |
$85.32
|
| Rate for Payer: Cigna Medicare |
$215.67
|
| Rate for Payer: Employer Direct Commercial |
$215.67
|
| Rate for Payer: Humana Medicare/TRICARE |
$215.67
|
| Rate for Payer: Molina CHIP/Medicaid |
$85.32
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$215.67
|
| Rate for Payer: Molina Medicare |
$215.67
|
| Rate for Payer: Multiplan Auto |
$793.00
|
| Rate for Payer: Multiplan Commercial |
$793.00
|
| Rate for Payer: Multiplan Workers Comp |
$793.00
|
| Rate for Payer: Parkland Medicaid |
$85.32
|
| Rate for Payer: Scott and White EPO/PPO |
$3.86
|
| Rate for Payer: Scott and White Medicare |
$215.67
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$85.32
|
| Rate for Payer: Superior Health Plan EPO |
$215.67
|
| Rate for Payer: Superior Health Plan Medicare |
$215.67
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$215.67
|
| Rate for Payer: Universal American Medicare |
$215.67
|
| Rate for Payer: Wellcare Medicare |
$215.67
|
| Rate for Payer: Wellmed Medicare |
$215.67
|
|
|
ED CLOSED TX NASAL FRACTURE W/O STABILIZATION BCE
|
Facility
|
OP
|
$5,101.00
|
|
|
Service Code
|
CPT 21315
|
| Hospital Charge Code |
8474494
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$24.94 |
| Max. Negotiated Rate |
$3,400.34 |
| Rate for Payer: Aetna Commercial |
$2,200.00
|
| Rate for Payer: Aetna Medicare |
$2,092.08
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$459.09
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,394.72
|
| Rate for Payer: Amerigroup Medicare |
$1,394.72
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,253.40
|
| Rate for Payer: BCBS of TX Blue Essentials |
$2,698.68
|
| Rate for Payer: BCBS of TX Medicare |
$1,394.72
|
| Rate for Payer: BCBS of TX PPO |
$3,400.34
|
| Rate for Payer: Cash Price |
$4,488.88
|
| Rate for Payer: Cash Price |
$4,488.88
|
| Rate for Payer: Cash Price |
$4,488.88
|
| Rate for Payer: Cigna Commercial |
$3,159.45
|
| Rate for Payer: Cigna Medicaid |
$420.64
|
| Rate for Payer: Cigna Medicare |
$1,394.72
|
| Rate for Payer: Employer Direct Commercial |
$1,394.72
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,394.72
|
| Rate for Payer: Molina CHIP/Medicaid |
$420.64
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,394.72
|
| Rate for Payer: Molina Medicare |
$1,394.72
|
| Rate for Payer: Multiplan Auto |
$3,315.65
|
| Rate for Payer: Multiplan Commercial |
$3,315.65
|
| Rate for Payer: Multiplan Workers Comp |
$3,315.65
|
| Rate for Payer: Parkland Medicaid |
$420.64
|
| Rate for Payer: Scott and White EPO/PPO |
$24.94
|
| Rate for Payer: Scott and White Medicare |
$1,394.72
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$420.64
|
| Rate for Payer: Superior Health Plan EPO |
$1,394.72
|
| Rate for Payer: Superior Health Plan Medicare |
$1,394.72
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,394.72
|
| Rate for Payer: Universal American Medicare |
$1,394.72
|
| Rate for Payer: Wellcare Medicare |
$1,394.72
|
| Rate for Payer: Wellmed Medicare |
$1,394.72
|
|
|
ED CLOSED TX NASAL FRACTURE W/O STABILIZATION BCE
|
Facility
|
IP
|
$5,101.00
|
|
|
Service Code
|
CPT 21315
|
| Hospital Charge Code |
8474494
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$4,488.88
|
|
|
ED CLOSED TX RADIAL SHAFT FX AND CLOSED TX DISLOCATION DISTA
|
Facility
|
OP
|
$3,323.00
|
|
|
Service Code
|
CPT 25520
|
| Hospital Charge Code |
8546479
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$26.29 |
| Max. Negotiated Rate |
$3,415.58 |
| Rate for Payer: Aetna Commercial |
$1,827.65
|
| Rate for Payer: Aetna Medicare |
$2,204.79
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$299.07
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,469.86
|
| Rate for Payer: Amerigroup Medicare |
$1,469.86
|
| 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 |
$1,469.86
|
| Rate for Payer: BCBS of TX PPO |
$3,415.58
|
| Rate for Payer: Cash Price |
$2,924.24
|
| Rate for Payer: Cash Price |
$2,924.24
|
| Rate for Payer: Cash Price |
$2,924.24
|
| Rate for Payer: Cigna Commercial |
$3,329.66
|
| Rate for Payer: Cigna Medicaid |
$593.04
|
| Rate for Payer: Cigna Medicare |
$1,469.86
|
| Rate for Payer: Employer Direct Commercial |
$1,469.86
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,469.86
|
| Rate for Payer: Molina CHIP/Medicaid |
$593.04
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,469.86
|
| Rate for Payer: Molina Medicare |
$1,469.86
|
| Rate for Payer: Multiplan Auto |
$2,159.95
|
| Rate for Payer: Multiplan Commercial |
$2,159.95
|
| Rate for Payer: Multiplan Workers Comp |
$2,159.95
|
| Rate for Payer: Parkland Medicaid |
$593.04
|
| Rate for Payer: Scott and White EPO/PPO |
$26.29
|
| Rate for Payer: Scott and White Medicare |
$1,469.86
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$593.04
|
| Rate for Payer: Superior Health Plan EPO |
$1,469.86
|
| Rate for Payer: Superior Health Plan Medicare |
$1,469.86
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,469.86
|
| Rate for Payer: Universal American Medicare |
$1,469.86
|
| Rate for Payer: Wellcare Medicare |
$1,469.86
|
| Rate for Payer: Wellmed Medicare |
$1,469.86
|
|
|
ED CLOSED TX TRANS-SCAPHOPERILUNAR TYPE FX DISLC W/MANIPULAT
|
Facility
|
IP
|
$1,356.00
|
|
|
Service Code
|
CPT 25680
|
| Hospital Charge Code |
8472466
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$1,193.28
|
|
|
ED CLOSED TX TRANS-SCAPHOPERILUNAR TYPE FX DISLC W/MANIPULAT
|
Facility
|
OP
|
$1,356.00
|
|
|
Service Code
|
CPT 25680
|
| Hospital Charge Code |
8472466
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3.86 |
| Max. Negotiated Rate |
$881.40 |
| Rate for Payer: Aetna Commercial |
$745.80
|
| Rate for Payer: Aetna Medicare |
$323.50
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$122.04
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$215.67
|
| Rate for Payer: Amerigroup Medicare |
$215.67
|
| 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 |
$215.67
|
| Rate for Payer: BCBS of TX PPO |
$543.41
|
| Rate for Payer: Cash Price |
$1,193.28
|
| Rate for Payer: Cash Price |
$1,193.28
|
| Rate for Payer: Cash Price |
$1,193.28
|
| Rate for Payer: Cigna Commercial |
$488.55
|
| Rate for Payer: Cigna Medicaid |
$85.32
|
| Rate for Payer: Cigna Medicare |
$215.67
|
| Rate for Payer: Employer Direct Commercial |
$215.67
|
| Rate for Payer: Humana Medicare/TRICARE |
$215.67
|
| Rate for Payer: Molina CHIP/Medicaid |
$85.32
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$215.67
|
| Rate for Payer: Molina Medicare |
$215.67
|
| Rate for Payer: Multiplan Auto |
$881.40
|
| Rate for Payer: Multiplan Commercial |
$881.40
|
| Rate for Payer: Multiplan Workers Comp |
$881.40
|
| Rate for Payer: Parkland Medicaid |
$85.32
|
| Rate for Payer: Scott and White EPO/PPO |
$3.86
|
| Rate for Payer: Scott and White Medicare |
$215.67
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$85.32
|
| Rate for Payer: Superior Health Plan EPO |
$215.67
|
| Rate for Payer: Superior Health Plan Medicare |
$215.67
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$215.67
|
| Rate for Payer: Universal American Medicare |
$215.67
|
| Rate for Payer: Wellcare Medicare |
$215.67
|
| Rate for Payer: Wellmed Medicare |
$215.67
|
|
|
ED CLOSURE LACERATION VESTIBULE MOUTH 2.5 CM/< BCE
|
Facility
|
OP
|
$815.00
|
|
|
Service Code
|
CPT 40830
|
| Hospital Charge Code |
8704536
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$529.75 |
| Rate for Payer: Aetna Commercial |
$448.25
|
| Rate for Payer: Aetna Medicare |
$335.08
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$73.35
|
| 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 |
$717.20
|
| Rate for Payer: Cash Price |
$717.20
|
| Rate for Payer: Cash Price |
$717.20
|
| 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 |
$529.75
|
| Rate for Payer: Multiplan Commercial |
$529.75
|
| Rate for Payer: Multiplan Workers Comp |
$529.75
|
| 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 CLOSURE LACERATION VESTIBULE MOUTH 2.5 CM/< BCE
|
Facility
|
IP
|
$815.00
|
|
|
Service Code
|
CPT 40830
|
| Hospital Charge Code |
8704536
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$717.20
|
|
|
ED CLSD TX BIMALLEOLAR ANKLE FX W/MANJ BCE
|
Facility
|
OP
|
$2,770.75
|
|
|
Service Code
|
CPT 27810
|
| Hospital Charge Code |
8840544
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$26.29 |
| Max. Negotiated Rate |
$3,415.58 |
| Rate for Payer: Aetna Commercial |
$1,400.00
|
| Rate for Payer: Aetna Medicare |
$2,204.79
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$249.37
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,469.86
|
| Rate for Payer: Amerigroup Medicare |
$1,469.86
|
| 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 |
$1,469.86
|
| Rate for Payer: BCBS of TX PPO |
$3,415.58
|
| Rate for Payer: Cash Price |
$2,438.26
|
| Rate for Payer: Cash Price |
$2,438.26
|
| Rate for Payer: Cash Price |
$2,438.26
|
| Rate for Payer: Cigna Commercial |
$3,329.66
|
| Rate for Payer: Cigna Medicaid |
$593.04
|
| Rate for Payer: Cigna Medicare |
$1,469.86
|
| Rate for Payer: Employer Direct Commercial |
$1,469.86
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,469.86
|
| Rate for Payer: Molina CHIP/Medicaid |
$593.04
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,469.86
|
| Rate for Payer: Molina Medicare |
$1,469.86
|
| Rate for Payer: Multiplan Auto |
$1,800.99
|
| Rate for Payer: Multiplan Commercial |
$1,800.99
|
| Rate for Payer: Multiplan Workers Comp |
$1,800.99
|
| Rate for Payer: Parkland Medicaid |
$593.04
|
| Rate for Payer: Scott and White EPO/PPO |
$26.29
|
| Rate for Payer: Scott and White Medicare |
$1,469.86
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$593.04
|
| Rate for Payer: Superior Health Plan EPO |
$1,469.86
|
| Rate for Payer: Superior Health Plan Medicare |
$1,469.86
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,469.86
|
| Rate for Payer: Universal American Medicare |
$1,469.86
|
| Rate for Payer: Wellcare Medicare |
$1,469.86
|
| Rate for Payer: Wellmed Medicare |
$1,469.86
|
|
|
ED CLSD TX BIMALLEOLAR ANKLE FX W/MANJ BCE
|
Facility
|
IP
|
$2,770.75
|
|
|
Service Code
|
CPT 27810
|
| Hospital Charge Code |
8840544
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$2,438.26
|
|
|
ED CLSD TX SHLDR DISLC W/FX HUM TUBRST W/MAN BCE
|
Facility
|
OP
|
$2,762.00
|
|
|
Service Code
|
CPT 23665
|
| Hospital Charge Code |
8430475
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$26.29 |
| Max. Negotiated Rate |
$3,415.58 |
| Rate for Payer: Aetna Commercial |
$1,400.00
|
| Rate for Payer: Aetna Medicare |
$2,204.79
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$248.58
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,469.86
|
| Rate for Payer: Amerigroup Medicare |
$1,469.86
|
| 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 |
$1,469.86
|
| Rate for Payer: BCBS of TX PPO |
$3,415.58
|
| Rate for Payer: Cash Price |
$2,430.56
|
| Rate for Payer: Cash Price |
$2,430.56
|
| Rate for Payer: Cash Price |
$2,430.56
|
| Rate for Payer: Cigna Commercial |
$3,329.66
|
| Rate for Payer: Cigna Medicaid |
$593.04
|
| Rate for Payer: Cigna Medicare |
$1,469.86
|
| Rate for Payer: Employer Direct Commercial |
$1,469.86
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,469.86
|
| Rate for Payer: Molina CHIP/Medicaid |
$593.04
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,469.86
|
| Rate for Payer: Molina Medicare |
$1,469.86
|
| Rate for Payer: Multiplan Auto |
$1,795.30
|
| Rate for Payer: Multiplan Commercial |
$1,795.30
|
| Rate for Payer: Multiplan Workers Comp |
$1,795.30
|
| Rate for Payer: Parkland Medicaid |
$593.04
|
| Rate for Payer: Scott and White EPO/PPO |
$26.29
|
| Rate for Payer: Scott and White Medicare |
$1,469.86
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$593.04
|
| Rate for Payer: Superior Health Plan EPO |
$1,469.86
|
| Rate for Payer: Superior Health Plan Medicare |
$1,469.86
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,469.86
|
| Rate for Payer: Universal American Medicare |
$1,469.86
|
| Rate for Payer: Wellcare Medicare |
$1,469.86
|
| Rate for Payer: Wellmed Medicare |
$1,469.86
|
|
|
ED CLSD TX SHLDR DISLC W/FX HUM TUBRST W/MAN BCE
|
Facility
|
IP
|
$2,762.00
|
|
|
Service Code
|
CPT 23665
|
| Hospital Charge Code |
8430475
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$2,430.56
|
|
|
ED CLTX CARPO/METACARPAL FX DISLC THUMB W/MANJ BCE
|
Facility
|
IP
|
$2,762.00
|
|
|
Service Code
|
CPT 26645
|
| Hospital Charge Code |
8664505
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$2,430.56
|
|
|
ED CLTX CARPO/METACARPAL FX DISLC THUMB W/MANJ BCE
|
Facility
|
OP
|
$2,762.00
|
|
|
Service Code
|
CPT 26645
|
| Hospital Charge Code |
8664505
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$26.29 |
| Max. Negotiated Rate |
$3,415.58 |
| Rate for Payer: Aetna Commercial |
$1,519.10
|
| Rate for Payer: Aetna Medicare |
$2,204.79
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$248.58
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,469.86
|
| Rate for Payer: Amerigroup Medicare |
$1,469.86
|
| 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 |
$1,469.86
|
| Rate for Payer: BCBS of TX PPO |
$3,415.58
|
| Rate for Payer: Cash Price |
$2,430.56
|
| Rate for Payer: Cash Price |
$2,430.56
|
| Rate for Payer: Cash Price |
$2,430.56
|
| Rate for Payer: Cigna Commercial |
$3,329.66
|
| Rate for Payer: Cigna Medicaid |
$593.04
|
| Rate for Payer: Cigna Medicare |
$1,469.86
|
| Rate for Payer: Employer Direct Commercial |
$1,469.86
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,469.86
|
| Rate for Payer: Molina CHIP/Medicaid |
$593.04
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,469.86
|
| Rate for Payer: Molina Medicare |
$1,469.86
|
| Rate for Payer: Multiplan Auto |
$1,795.30
|
| Rate for Payer: Multiplan Commercial |
$1,795.30
|
| Rate for Payer: Multiplan Workers Comp |
$1,795.30
|
| Rate for Payer: Parkland Medicaid |
$593.04
|
| Rate for Payer: Scott and White EPO/PPO |
$26.29
|
| Rate for Payer: Scott and White Medicare |
$1,469.86
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$593.04
|
| Rate for Payer: Superior Health Plan EPO |
$1,469.86
|
| Rate for Payer: Superior Health Plan Medicare |
$1,469.86
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,469.86
|
| Rate for Payer: Universal American Medicare |
$1,469.86
|
| Rate for Payer: Wellcare Medicare |
$1,469.86
|
| Rate for Payer: Wellmed Medicare |
$1,469.86
|
|
|
ED CLTX FX PHLX/PHLG OTH/THN GRT TOE W/O MANIP BCE
|
Facility
|
OP
|
$579.00
|
|
|
Service Code
|
CPT 28510
|
| Hospital Charge Code |
8544471
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3.86 |
| Max. Negotiated Rate |
$488.55 |
| Rate for Payer: Aetna Commercial |
$318.45
|
| Rate for Payer: Aetna Medicare |
$323.50
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$52.11
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$215.67
|
| Rate for Payer: Amerigroup Medicare |
$215.67
|
| Rate for Payer: BCBS of TX Blue Advantage |
$130.78
|
| Rate for Payer: BCBS of TX Blue Essentials |
$156.62
|
| Rate for Payer: BCBS of TX Medicare |
$215.67
|
| Rate for Payer: BCBS of TX PPO |
$197.34
|
| Rate for Payer: Cash Price |
$509.52
|
| Rate for Payer: Cash Price |
$509.52
|
| Rate for Payer: Cash Price |
$509.52
|
| Rate for Payer: Cigna Commercial |
$488.55
|
| Rate for Payer: Cigna Medicaid |
$62.85
|
| Rate for Payer: Cigna Medicare |
$215.67
|
| Rate for Payer: Employer Direct Commercial |
$215.67
|
| Rate for Payer: Humana Medicare/TRICARE |
$215.67
|
| Rate for Payer: Molina CHIP/Medicaid |
$62.85
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$215.67
|
| Rate for Payer: Molina Medicare |
$215.67
|
| Rate for Payer: Multiplan Auto |
$376.35
|
| Rate for Payer: Multiplan Commercial |
$376.35
|
| Rate for Payer: Multiplan Workers Comp |
$376.35
|
| Rate for Payer: Parkland Medicaid |
$62.85
|
| Rate for Payer: Scott and White EPO/PPO |
$3.86
|
| Rate for Payer: Scott and White Medicare |
$215.67
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$62.85
|
| Rate for Payer: Superior Health Plan EPO |
$215.67
|
| Rate for Payer: Superior Health Plan Medicare |
$215.67
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$215.67
|
| Rate for Payer: Universal American Medicare |
$215.67
|
| Rate for Payer: Wellcare Medicare |
$215.67
|
| Rate for Payer: Wellmed Medicare |
$215.67
|
|
|
ED CLTX HUMERAL SHFT FX W/MANJ W/WO SKELETAL TRACJ BCE
|
Facility
|
OP
|
$2,762.00
|
|
|
Service Code
|
CPT 24505
|
| Hospital Charge Code |
8662520
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$26.29 |
| Max. Negotiated Rate |
$3,415.58 |
| Rate for Payer: Aetna Commercial |
$1,519.10
|
| Rate for Payer: Aetna Medicare |
$2,204.79
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$248.58
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,469.86
|
| Rate for Payer: Amerigroup Medicare |
$1,469.86
|
| 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 |
$1,469.86
|
| Rate for Payer: BCBS of TX PPO |
$3,415.58
|
| Rate for Payer: Cash Price |
$2,430.56
|
| Rate for Payer: Cash Price |
$2,430.56
|
| Rate for Payer: Cash Price |
$2,430.56
|
| Rate for Payer: Cigna Commercial |
$3,329.66
|
| Rate for Payer: Cigna Medicaid |
$593.04
|
| Rate for Payer: Cigna Medicare |
$1,469.86
|
| Rate for Payer: Employer Direct Commercial |
$1,469.86
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,469.86
|
| Rate for Payer: Molina CHIP/Medicaid |
$593.04
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,469.86
|
| Rate for Payer: Molina Medicare |
$1,469.86
|
| Rate for Payer: Multiplan Auto |
$1,795.30
|
| Rate for Payer: Multiplan Commercial |
$1,795.30
|
| Rate for Payer: Multiplan Workers Comp |
$1,795.30
|
| Rate for Payer: Parkland Medicaid |
$593.04
|
| Rate for Payer: Scott and White EPO/PPO |
$26.29
|
| Rate for Payer: Scott and White Medicare |
$1,469.86
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$593.04
|
| Rate for Payer: Superior Health Plan EPO |
$1,469.86
|
| Rate for Payer: Superior Health Plan Medicare |
$1,469.86
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,469.86
|
| Rate for Payer: Universal American Medicare |
$1,469.86
|
| Rate for Payer: Wellcare Medicare |
$1,469.86
|
| Rate for Payer: Wellmed Medicare |
$1,469.86
|
|
|
ED CLTX HUMERAL SHFT FX W/MANJ W/WO SKELETAL TRACJ BCE
|
Facility
|
IP
|
$2,762.00
|
|
|
Service Code
|
CPT 24505
|
| Hospital Charge Code |
8662520
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$2,430.56
|
|
|
ED CLTX MEDIAL MALLEOLUS FX W/O MANIP BCE
|
Facility
|
IP
|
$840.00
|
|
|
Service Code
|
CPT 27760
|
| Hospital Charge Code |
8726548
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$739.20
|
|
|
ED CLTX MEDIAL MALLEOLUS FX W/O MANIP BCE
|
Facility
|
OP
|
$840.00
|
|
|
Service Code
|
CPT 27760
|
| Hospital Charge Code |
8726548
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3.86 |
| Max. Negotiated Rate |
$546.00 |
| Rate for Payer: Aetna Commercial |
$462.00
|
| Rate for Payer: Aetna Medicare |
$323.50
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$75.60
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$215.67
|
| Rate for Payer: Amerigroup Medicare |
$215.67
|
| 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 |
$215.67
|
| Rate for Payer: BCBS of TX PPO |
$543.41
|
| Rate for Payer: Cash Price |
$739.20
|
| Rate for Payer: Cash Price |
$739.20
|
| Rate for Payer: Cash Price |
$739.20
|
| Rate for Payer: Cigna Commercial |
$488.55
|
| Rate for Payer: Cigna Medicaid |
$85.32
|
| Rate for Payer: Cigna Medicare |
$215.67
|
| Rate for Payer: Employer Direct Commercial |
$215.67
|
| Rate for Payer: Humana Medicare/TRICARE |
$215.67
|
| Rate for Payer: Molina CHIP/Medicaid |
$85.32
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$215.67
|
| Rate for Payer: Molina Medicare |
$215.67
|
| Rate for Payer: Multiplan Auto |
$546.00
|
| Rate for Payer: Multiplan Commercial |
$546.00
|
| Rate for Payer: Multiplan Workers Comp |
$546.00
|
| Rate for Payer: Parkland Medicaid |
$85.32
|
| Rate for Payer: Scott and White EPO/PPO |
$3.86
|
| Rate for Payer: Scott and White Medicare |
$215.67
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$85.32
|
| Rate for Payer: Superior Health Plan EPO |
$215.67
|
| Rate for Payer: Superior Health Plan Medicare |
$215.67
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$215.67
|
| Rate for Payer: Universal American Medicare |
$215.67
|
| Rate for Payer: Wellcare Medicare |
$215.67
|
| Rate for Payer: Wellmed Medicare |
$215.67
|
|
|
ED CLTX SHOULDER DISLC W/SURG/ANTMCL NECK FX W/MANJ BCE
|
Facility
|
IP
|
$2,762.00
|
|
|
Service Code
|
CPT 23675
|
| Hospital Charge Code |
8652508
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$2,430.56
|
|
|
ED CLTX SHOULDER DISLC W/SURG/ANTMCL NECK FX W/MANJ BCE
|
Facility
|
OP
|
$2,762.00
|
|
|
Service Code
|
CPT 23675
|
| Hospital Charge Code |
8652508
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$26.29 |
| Max. Negotiated Rate |
$3,415.58 |
| Rate for Payer: Aetna Commercial |
$1,519.10
|
| Rate for Payer: Aetna Medicare |
$2,204.79
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$248.58
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,469.86
|
| Rate for Payer: Amerigroup Medicare |
$1,469.86
|
| 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 |
$1,469.86
|
| Rate for Payer: BCBS of TX PPO |
$3,415.58
|
| Rate for Payer: Cash Price |
$2,430.56
|
| Rate for Payer: Cash Price |
$2,430.56
|
| Rate for Payer: Cash Price |
$2,430.56
|
| Rate for Payer: Cigna Commercial |
$3,329.66
|
| Rate for Payer: Cigna Medicaid |
$593.04
|
| Rate for Payer: Cigna Medicare |
$1,469.86
|
| Rate for Payer: Employer Direct Commercial |
$1,469.86
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,469.86
|
| Rate for Payer: Molina CHIP/Medicaid |
$593.04
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,469.86
|
| Rate for Payer: Molina Medicare |
$1,469.86
|
| Rate for Payer: Multiplan Auto |
$1,795.30
|
| Rate for Payer: Multiplan Commercial |
$1,795.30
|
| Rate for Payer: Multiplan Workers Comp |
$1,795.30
|
| Rate for Payer: Parkland Medicaid |
$593.04
|
| Rate for Payer: Scott and White EPO/PPO |
$26.29
|
| Rate for Payer: Scott and White Medicare |
$1,469.86
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$593.04
|
| Rate for Payer: Superior Health Plan EPO |
$1,469.86
|
| Rate for Payer: Superior Health Plan Medicare |
$1,469.86
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,469.86
|
| Rate for Payer: Universal American Medicare |
$1,469.86
|
| Rate for Payer: Wellcare Medicare |
$1,469.86
|
| Rate for Payer: Wellmed Medicare |
$1,469.86
|
|
|
ED CLTX TIBIAL SHAFT FX W/MANJ W/WO SKEL TRACJ BCE
|
Facility
|
OP
|
$3,682.70
|
|
|
Service Code
|
CPT 27752
|
| Hospital Charge Code |
8846848
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$26.29 |
| Max. Negotiated Rate |
$3,415.58 |
| Rate for Payer: Aetna Commercial |
$2,200.00
|
| Rate for Payer: Aetna Medicare |
$2,204.79
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$331.44
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,469.86
|
| Rate for Payer: Amerigroup Medicare |
$1,469.86
|
| 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 |
$1,469.86
|
| Rate for Payer: BCBS of TX PPO |
$3,415.58
|
| Rate for Payer: Cash Price |
$3,240.78
|
| Rate for Payer: Cash Price |
$3,240.78
|
| Rate for Payer: Cash Price |
$3,240.78
|
| Rate for Payer: Cigna Commercial |
$3,329.66
|
| Rate for Payer: Cigna Medicaid |
$593.04
|
| Rate for Payer: Cigna Medicare |
$1,469.86
|
| Rate for Payer: Employer Direct Commercial |
$1,469.86
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,469.86
|
| Rate for Payer: Molina CHIP/Medicaid |
$593.04
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,469.86
|
| Rate for Payer: Molina Medicare |
$1,469.86
|
| Rate for Payer: Multiplan Auto |
$2,393.76
|
| Rate for Payer: Multiplan Commercial |
$2,393.76
|
| Rate for Payer: Multiplan Workers Comp |
$2,393.76
|
| Rate for Payer: Parkland Medicaid |
$593.04
|
| Rate for Payer: Scott and White EPO/PPO |
$26.29
|
| Rate for Payer: Scott and White Medicare |
$1,469.86
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$593.04
|
| Rate for Payer: Superior Health Plan EPO |
$1,469.86
|
| Rate for Payer: Superior Health Plan Medicare |
$1,469.86
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,469.86
|
| Rate for Payer: Universal American Medicare |
$1,469.86
|
| Rate for Payer: Wellcare Medicare |
$1,469.86
|
| Rate for Payer: Wellmed Medicare |
$1,469.86
|
|
|
ED CLTX TIBIAL SHAFT FX W/MANJ W/WO SKEL TRACJ BCE
|
Facility
|
IP
|
$3,682.70
|
|
|
Service Code
|
CPT 27752
|
| Hospital Charge Code |
8846848
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$3,240.78
|
|
|
ED Collect Blood Port/Access Device BCE
|
Facility
|
OP
|
$225.00
|
|
|
Service Code
|
CPT 36591
|
| Hospital Charge Code |
7003494
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2.09 |
| Max. Negotiated Rate |
$264.63 |
| Rate for Payer: Aetna Commercial |
$123.75
|
| Rate for Payer: Aetna Medicare |
$175.23
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$20.25
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$116.82
|
| Rate for Payer: Amerigroup Medicare |
$116.82
|
| Rate for Payer: BCBS of TX Blue Advantage |
$179.90
|
| Rate for Payer: BCBS of TX Blue Essentials |
$215.88
|
| Rate for Payer: BCBS of TX Medicare |
$116.82
|
| Rate for Payer: BCBS of TX PPO |
$240.96
|
| Rate for Payer: Cash Price |
$198.00
|
| Rate for Payer: Cash Price |
$198.00
|
| Rate for Payer: Cash Price |
$198.00
|
| 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 |
$146.25
|
| Rate for Payer: Multiplan Commercial |
$146.25
|
| Rate for Payer: Multiplan Workers Comp |
$146.25
|
| 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 Collect Blood Port/Access Device BCE
|
Facility
|
IP
|
$225.00
|
|
|
Service Code
|
CPT 36591
|
| Hospital Charge Code |
7003494
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$198.00
|
|
