|
CHED Fracture Site Phalangeal, Distal w/ manipulation BCE
|
Facility
|
OP
|
$1,056.25
|
|
|
Service Code
|
HCPCS 26755
|
| Hospital Charge Code |
8910617
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$95.06 |
| Max. Negotiated Rate |
$760.50 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$95.06
|
| 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 |
$718.25
|
| Rate for Payer: Cash Price |
$718.25
|
| Rate for Payer: Cash Price |
$718.25
|
| Rate for Payer: Cigna Commercial |
$523.79
|
| Rate for Payer: Cigna Medicaid |
$760.50
|
| 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 |
$760.50
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$247.79
|
| Rate for Payer: Molina Medicare |
$247.79
|
| Rate for Payer: Multiplan Auto |
$686.56
|
| Rate for Payer: Multiplan Commercial |
$686.56
|
| Rate for Payer: Multiplan Workers Comp |
$686.56
|
| Rate for Payer: Parkland Medicaid |
$760.50
|
| Rate for Payer: Scott and White EPO/PPO |
$350.35
|
| Rate for Payer: Scott and White Medicare |
$247.79
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$760.50
|
| 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 Phalangeal, Distal w/ manipulation BCE
|
Facility
|
IP
|
$1,056.25
|
|
|
Service Code
|
HCPCS 26755
|
| Hospital Charge Code |
8910617
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$718.25
|
|
|
CHED Fracture Site Phalangeal, finger or thumb w/ manipulation BCE
|
Facility
|
IP
|
$1,126.00
|
|
|
Service Code
|
HCPCS 26725
|
| Hospital Charge Code |
8910618
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$765.68
|
|
|
CHED Fracture Site Phalangeal, finger or thumb w/ manipulation BCE
|
Facility
|
OP
|
$1,126.00
|
|
|
Service Code
|
HCPCS 26725
|
| Hospital Charge Code |
8910618
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$101.34 |
| Max. Negotiated Rate |
$810.72 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$101.34
|
| 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 |
$765.68
|
| Rate for Payer: Cash Price |
$765.68
|
| Rate for Payer: Cash Price |
$765.68
|
| Rate for Payer: Cigna Commercial |
$523.79
|
| Rate for Payer: Cigna Medicaid |
$810.72
|
| 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 |
$810.72
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$247.79
|
| Rate for Payer: Molina Medicare |
$247.79
|
| Rate for Payer: Multiplan Auto |
$731.90
|
| Rate for Payer: Multiplan Commercial |
$731.90
|
| Rate for Payer: Multiplan Workers Comp |
$731.90
|
| Rate for Payer: Parkland Medicaid |
$810.72
|
| Rate for Payer: Scott and White EPO/PPO |
$389.70
|
| Rate for Payer: Scott and White Medicare |
$247.79
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$810.72
|
| 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 Radius/Ulna fx, distal, w/ manipulation BCE
|
Facility
|
IP
|
$2,496.25
|
|
|
Service Code
|
HCPCS 25605
|
| Hospital Charge Code |
8914595
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$1,697.45
|
|
|
CHED Fracture Site Radius/Ulna fx, distal, w/ manipulation BCE
|
Facility
|
OP
|
$2,496.25
|
|
|
Service Code
|
HCPCS 25605
|
| Hospital Charge Code |
8914595
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$224.66 |
| Max. Negotiated Rate |
$3,415.58 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$224.66
|
| 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 |
$1,697.45
|
| Rate for Payer: Cash Price |
$1,697.45
|
| Rate for Payer: Cash Price |
$1,697.45
|
| Rate for Payer: Cigna Commercial |
$3,414.49
|
| Rate for Payer: Cigna Medicaid |
$1,797.30
|
| 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 |
$1,797.30
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,615.32
|
| Rate for Payer: Molina Medicare |
$1,615.32
|
| Rate for Payer: Multiplan Auto |
$1,622.56
|
| Rate for Payer: Multiplan Commercial |
$1,622.56
|
| Rate for Payer: Multiplan Workers Comp |
$1,622.56
|
| Rate for Payer: Parkland Medicaid |
$1,797.30
|
| Rate for Payer: Scott and White EPO/PPO |
$646.26
|
| Rate for Payer: Scott and White Medicare |
$1,615.32
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,797.30
|
| 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 Radius/Ulna fx, distal, w/o manipulation BCE
|
Facility
|
OP
|
$837.00
|
|
|
Service Code
|
HCPCS 25600
|
| Hospital Charge Code |
8912605
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$75.33 |
| Max. Negotiated Rate |
$602.64 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$75.33
|
| 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 |
$569.16
|
| Rate for Payer: Cash Price |
$569.16
|
| Rate for Payer: Cash Price |
$569.16
|
| Rate for Payer: Cigna Commercial |
$523.79
|
| Rate for Payer: Cigna Medicaid |
$602.64
|
| 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 |
$602.64
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$247.79
|
| Rate for Payer: Molina Medicare |
$247.79
|
| Rate for Payer: Multiplan Auto |
$544.05
|
| Rate for Payer: Multiplan Commercial |
$544.05
|
| Rate for Payer: Multiplan Workers Comp |
$544.05
|
| Rate for Payer: Parkland Medicaid |
$602.64
|
| Rate for Payer: Scott and White EPO/PPO |
$417.16
|
| Rate for Payer: Scott and White Medicare |
$247.79
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$602.64
|
| 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 Radius/Ulna fx, distal, w/o manipulation BCE
|
Facility
|
IP
|
$837.00
|
|
|
Service Code
|
HCPCS 25600
|
| Hospital Charge Code |
8912605
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$569.16
|
|
|
CHED Fracture Site Radius/Ulna fx, shaft, w/ manipulation BCE
|
Facility
|
OP
|
$658.75
|
|
|
Service Code
|
HCPCS 25565
|
| Hospital Charge Code |
5202525
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$59.29 |
| Max. Negotiated Rate |
$3,415.58 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$59.29
|
| 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 |
$447.95
|
| Rate for Payer: Cash Price |
$447.95
|
| Rate for Payer: Cash Price |
$447.95
|
| Rate for Payer: Cigna Commercial |
$3,414.49
|
| Rate for Payer: Cigna Medicaid |
$474.30
|
| 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 |
$474.30
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,615.32
|
| Rate for Payer: Molina Medicare |
$1,615.32
|
| Rate for Payer: Multiplan Auto |
$428.19
|
| Rate for Payer: Multiplan Commercial |
$428.19
|
| Rate for Payer: Multiplan Workers Comp |
$428.19
|
| Rate for Payer: Parkland Medicaid |
$474.30
|
| Rate for Payer: Scott and White EPO/PPO |
$588.45
|
| Rate for Payer: Scott and White Medicare |
$1,615.32
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$474.30
|
| 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 Radius/Ulna fx, shaft, w/ manipulation BCE
|
Facility
|
IP
|
$658.75
|
|
|
Service Code
|
HCPCS 25565
|
| Hospital Charge Code |
5202525
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$447.95
|
|
|
CHED Fracture Site Radius/Ulna fx, shaft, w/ manipulation BCE
|
Facility
|
IP
|
$658.75
|
|
|
Service Code
|
HCPCS 25565
|
| Hospital Charge Code |
8912606
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$447.95
|
|
|
CHED Fracture Site Radius/Ulna fx, shaft, w/ manipulation BCE
|
Facility
|
OP
|
$658.75
|
|
|
Service Code
|
HCPCS 25565
|
| Hospital Charge Code |
8912606
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$59.29 |
| Max. Negotiated Rate |
$3,415.58 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$59.29
|
| 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 |
$447.95
|
| Rate for Payer: Cash Price |
$447.95
|
| Rate for Payer: Cash Price |
$447.95
|
| Rate for Payer: Cigna Commercial |
$3,414.49
|
| Rate for Payer: Cigna Medicaid |
$474.30
|
| 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 |
$474.30
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,615.32
|
| Rate for Payer: Molina Medicare |
$1,615.32
|
| Rate for Payer: Multiplan Auto |
$428.19
|
| Rate for Payer: Multiplan Commercial |
$428.19
|
| Rate for Payer: Multiplan Workers Comp |
$428.19
|
| Rate for Payer: Parkland Medicaid |
$474.30
|
| Rate for Payer: Scott and White EPO/PPO |
$588.45
|
| Rate for Payer: Scott and White Medicare |
$1,615.32
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$474.30
|
| 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 Radius/Ulna fx, shaft, w/o manipulation BCE
|
Facility
|
OP
|
$791.40
|
|
|
Service Code
|
HCPCS 25560
|
| Hospital Charge Code |
9220206
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$71.23 |
| Max. Negotiated Rate |
$569.81 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$71.23
|
| 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 |
$538.15
|
| Rate for Payer: Cash Price |
$538.15
|
| Rate for Payer: Cash Price |
$538.15
|
| Rate for Payer: Cigna Commercial |
$523.79
|
| Rate for Payer: Cigna Medicaid |
$569.81
|
| 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 |
$569.81
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$247.79
|
| Rate for Payer: Molina Medicare |
$247.79
|
| Rate for Payer: Multiplan Auto |
$514.41
|
| Rate for Payer: Multiplan Commercial |
$514.41
|
| Rate for Payer: Multiplan Workers Comp |
$514.41
|
| Rate for Payer: Parkland Medicaid |
$569.81
|
| Rate for Payer: Scott and White EPO/PPO |
$333.62
|
| Rate for Payer: Scott and White Medicare |
$247.79
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$569.81
|
| 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 Radius/Ulna fx, shaft, w/o manipulation BCE
|
Facility
|
IP
|
$791.40
|
|
|
Service Code
|
HCPCS 25560
|
| Hospital Charge Code |
9220206
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$538.15
|
|
|
CHED Fracture Site Radius w/o manipulation BCE
|
Facility
|
IP
|
$699.48
|
|
|
Service Code
|
HCPCS 25500
|
| Hospital Charge Code |
8910619
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$475.65
|
|
|
CHED Fracture Site Radius w/o manipulation BCE
|
Facility
|
OP
|
$699.48
|
|
|
Service Code
|
HCPCS 25500
|
| Hospital Charge Code |
8910619
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$62.95 |
| Max. Negotiated Rate |
$523.79 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$62.95
|
| 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 |
$475.65
|
| Rate for Payer: Cash Price |
$475.65
|
| Rate for Payer: Cash Price |
$475.65
|
| Rate for Payer: Cigna Commercial |
$523.79
|
| Rate for Payer: Cigna Medicaid |
$503.63
|
| 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 |
$503.63
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$247.79
|
| Rate for Payer: Molina Medicare |
$247.79
|
| Rate for Payer: Multiplan Auto |
$454.66
|
| Rate for Payer: Multiplan Commercial |
$454.66
|
| Rate for Payer: Multiplan Workers Comp |
$454.66
|
| Rate for Payer: Parkland Medicaid |
$503.63
|
| Rate for Payer: Scott and White EPO/PPO |
$332.04
|
| Rate for Payer: Scott and White Medicare |
$247.79
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$503.63
|
| 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 Tibia fx, Distal, w/ manipulation BCE
|
Facility
|
OP
|
$4,765.00
|
|
|
Service Code
|
HCPCS 27825
|
| Hospital Charge Code |
5202529
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$428.85 |
| Max. Negotiated Rate |
$3,430.80 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$428.85
|
| 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 |
$3,240.20
|
| Rate for Payer: Cash Price |
$3,240.20
|
| Rate for Payer: Cash Price |
$3,240.20
|
| Rate for Payer: Cigna Commercial |
$3,414.49
|
| Rate for Payer: Cigna Medicaid |
$3,430.80
|
| 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 |
$3,430.80
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,615.32
|
| Rate for Payer: Molina Medicare |
$1,615.32
|
| Rate for Payer: Multiplan Auto |
$3,097.25
|
| Rate for Payer: Multiplan Commercial |
$3,097.25
|
| Rate for Payer: Multiplan Workers Comp |
$3,097.25
|
| Rate for Payer: Parkland Medicaid |
$3,430.80
|
| Rate for Payer: Scott and White EPO/PPO |
$617.69
|
| Rate for Payer: Scott and White Medicare |
$1,615.32
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$3,430.80
|
| 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 Tibia fx, Distal, w/ manipulation BCE
|
Facility
|
IP
|
$4,765.00
|
|
|
Service Code
|
HCPCS 27825
|
| Hospital Charge Code |
5202529
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$3,240.20
|
|
|
CHED Fracture Site Toe w/ manipulation BCE
|
Facility
|
IP
|
$1,000.75
|
|
|
Service Code
|
HCPCS 28515
|
| Hospital Charge Code |
8912607
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$680.51
|
|
|
CHED Fracture Site Toe w/ manipulation BCE
|
Facility
|
OP
|
$1,000.75
|
|
|
Service Code
|
HCPCS 28515
|
| Hospital Charge Code |
8912607
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$90.07 |
| Max. Negotiated Rate |
$720.54 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$90.07
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$247.79
|
| Rate for Payer: Amerigroup Medicare |
$247.79
|
| Rate for Payer: BCBS of TX Blue Advantage |
$176.59
|
| Rate for Payer: BCBS of TX Blue Essentials |
$211.48
|
| Rate for Payer: BCBS of TX Medicare |
$247.79
|
| Rate for Payer: BCBS of TX PPO |
$266.46
|
| Rate for Payer: Cash Price |
$680.51
|
| Rate for Payer: Cash Price |
$680.51
|
| Rate for Payer: Cash Price |
$680.51
|
| Rate for Payer: Cigna Commercial |
$523.79
|
| Rate for Payer: Cigna Medicaid |
$720.54
|
| 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 |
$720.54
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$247.79
|
| Rate for Payer: Molina Medicare |
$247.79
|
| Rate for Payer: Multiplan Auto |
$650.49
|
| Rate for Payer: Multiplan Commercial |
$650.49
|
| Rate for Payer: Multiplan Workers Comp |
$650.49
|
| Rate for Payer: Parkland Medicaid |
$720.54
|
| Rate for Payer: Scott and White EPO/PPO |
$182.76
|
| Rate for Payer: Scott and White Medicare |
$247.79
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$720.54
|
| 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 Trimalleolar fx, w/ manipulation BCE
|
Facility
|
IP
|
$2,376.64
|
|
|
Service Code
|
HCPCS 27818
|
| Hospital Charge Code |
8914597
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$1,616.12
|
|
|
CHED Fracture Site Trimalleolar fx, w/ manipulation BCE
|
Facility
|
OP
|
$2,376.64
|
|
|
Service Code
|
HCPCS 27818
|
| Hospital Charge Code |
8914597
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$213.90 |
| Max. Negotiated Rate |
$3,415.58 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$213.90
|
| 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 |
$1,616.12
|
| Rate for Payer: Cash Price |
$1,616.12
|
| Rate for Payer: Cash Price |
$1,616.12
|
| Rate for Payer: Cigna Commercial |
$3,414.49
|
| Rate for Payer: Cigna Medicaid |
$1,711.18
|
| 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 |
$1,711.18
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,615.32
|
| Rate for Payer: Molina Medicare |
$1,615.32
|
| Rate for Payer: Multiplan Auto |
$1,544.82
|
| Rate for Payer: Multiplan Commercial |
$1,544.82
|
| Rate for Payer: Multiplan Workers Comp |
$1,544.82
|
| Rate for Payer: Parkland Medicaid |
$1,711.18
|
| Rate for Payer: Scott and White EPO/PPO |
$556.49
|
| Rate for Payer: Scott and White Medicare |
$1,615.32
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,711.18
|
| 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 Ulnar Shaft, w/ manipulation BCE
|
Facility
|
OP
|
$5,129.15
|
|
|
Service Code
|
HCPCS 25535
|
| Hospital Charge Code |
8910621
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$247.79 |
| Max. Negotiated Rate |
$3,692.99 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$461.62
|
| 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 |
$3,487.82
|
| Rate for Payer: Cash Price |
$3,487.82
|
| Rate for Payer: Cash Price |
$3,487.82
|
| Rate for Payer: Cigna Commercial |
$523.79
|
| Rate for Payer: Cigna Medicaid |
$3,692.99
|
| 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 |
$3,692.99
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$247.79
|
| Rate for Payer: Molina Medicare |
$247.79
|
| Rate for Payer: Multiplan Auto |
$3,333.95
|
| Rate for Payer: Multiplan Commercial |
$3,333.95
|
| Rate for Payer: Multiplan Workers Comp |
$3,333.95
|
| Rate for Payer: Parkland Medicaid |
$3,692.99
|
| Rate for Payer: Scott and White EPO/PPO |
$580.46
|
| Rate for Payer: Scott and White Medicare |
$247.79
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$3,692.99
|
| 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 Ulnar Shaft, w/ manipulation BCE
|
Facility
|
IP
|
$5,129.15
|
|
|
Service Code
|
HCPCS 25535
|
| Hospital Charge Code |
8910621
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$3,487.82
|
|
|
CHED GI/GU/Rectal Procedures Anoscopy BCE
|
Facility
|
OP
|
$712.00
|
|
|
Service Code
|
HCPCS 46600
|
| Hospital Charge Code |
8912612
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$50.73 |
| Max. Negotiated Rate |
$512.64 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$64.08
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$133.65
|
| Rate for Payer: Amerigroup Medicare |
$133.65
|
| 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 |
$133.65
|
| Rate for Payer: BCBS of TX PPO |
$274.76
|
| Rate for Payer: Cash Price |
$484.16
|
| Rate for Payer: Cash Price |
$484.16
|
| Rate for Payer: Cash Price |
$484.16
|
| Rate for Payer: Cigna Commercial |
$282.53
|
| Rate for Payer: Cigna Medicaid |
$512.64
|
| Rate for Payer: Cigna Medicare |
$133.65
|
| Rate for Payer: Employer Direct Commercial |
$133.65
|
| Rate for Payer: Humana Medicare/TRICARE |
$133.65
|
| Rate for Payer: Molina CHIP/Medicaid |
$512.64
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$133.65
|
| Rate for Payer: Molina Medicare |
$133.65
|
| Rate for Payer: Multiplan Auto |
$462.80
|
| Rate for Payer: Multiplan Commercial |
$462.80
|
| Rate for Payer: Multiplan Workers Comp |
$462.80
|
| Rate for Payer: Parkland Medicaid |
$512.64
|
| Rate for Payer: Scott and White EPO/PPO |
$50.73
|
| Rate for Payer: Scott and White Medicare |
$133.65
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$512.64
|
| Rate for Payer: Superior Health Plan EPO |
$133.65
|
| Rate for Payer: Superior Health Plan Medicare |
$133.65
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$133.65
|
| Rate for Payer: Universal American Medicare |
$133.65
|
| Rate for Payer: Wellcare Medicare |
$133.65
|
| Rate for Payer: Wellmed Medicare |
$133.65
|
|
