|
ED CONTROL NASAL HEMORRHAGE ANTERIOR CMPLX BCE
|
Facility
|
IP
|
$995.00
|
|
|
Service Code
|
CPT 30903
|
| Hospital Charge Code |
8734587
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$875.60
|
|
|
ED CONTROL NASAL HEMORRHAGE ANTERIOR CMPLX BCE
|
Facility
|
OP
|
$995.00
|
|
|
Service Code
|
CPT 30903
|
| Hospital Charge Code |
8734587
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2.09 |
| Max. Negotiated Rate |
$646.75 |
| Rate for Payer: Aetna Commercial |
$547.25
|
| Rate for Payer: Aetna Medicare |
$175.23
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$89.55
|
| 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 |
$875.60
|
| Rate for Payer: Cash Price |
$875.60
|
| Rate for Payer: Cash Price |
$875.60
|
| Rate for Payer: Cigna Commercial |
$264.63
|
| Rate for Payer: Cigna Medicaid |
$46.68
|
| 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 CHIP/Medicaid |
$46.68
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$116.82
|
| Rate for Payer: Molina Medicare |
$116.82
|
| Rate for Payer: Multiplan Auto |
$646.75
|
| Rate for Payer: Multiplan Commercial |
$646.75
|
| Rate for Payer: Multiplan Workers Comp |
$646.75
|
| Rate for Payer: Parkland Medicaid |
$46.68
|
| 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 CHIP/Medicaid |
$46.68
|
| 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 CTRL NSL HEMRRG PST NASAL PACKS&/CAUTERY 1ST BCE
|
Facility
|
IP
|
$372.00
|
|
|
Service Code
|
CPT 30905
|
| Hospital Charge Code |
8734588
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$327.36
|
|
|
ED CTRL NSL HEMRRG PST NASAL PACKS&/CAUTERY 1ST BCE
|
Facility
|
OP
|
$372.00
|
|
|
Service Code
|
CPT 30905
|
| Hospital Charge Code |
8734588
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2.09 |
| Max. Negotiated Rate |
$274.76 |
| Rate for Payer: Aetna Commercial |
$204.60
|
| Rate for Payer: Aetna Medicare |
$175.23
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$33.48
|
| 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 |
$327.36
|
| Rate for Payer: Cash Price |
$327.36
|
| Rate for Payer: Cash Price |
$327.36
|
| Rate for Payer: Cigna Commercial |
$264.63
|
| Rate for Payer: Cigna Medicaid |
$46.68
|
| 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 CHIP/Medicaid |
$46.68
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$116.82
|
| Rate for Payer: Molina Medicare |
$116.82
|
| Rate for Payer: Multiplan Auto |
$241.80
|
| Rate for Payer: Multiplan Commercial |
$241.80
|
| Rate for Payer: Multiplan Workers Comp |
$241.80
|
| Rate for Payer: Parkland Medicaid |
$46.68
|
| 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 CHIP/Medicaid |
$46.68
|
| 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 CYSTO CALIBRATION DILAT URTL STRIX/STENOSIS BCE
|
Facility
|
IP
|
$8,291.00
|
|
|
Service Code
|
CPT 52281
|
| Hospital Charge Code |
8582478
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$7,296.08
|
|
|
ED CYSTO CALIBRATION DILAT URTL STRIX/STENOSIS BCE
|
Facility
|
OP
|
$8,291.00
|
|
|
Service Code
|
CPT 52281
|
| Hospital Charge Code |
8582478
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$33.31 |
| Max. Negotiated Rate |
$5,389.15 |
| Rate for Payer: Aetna Commercial |
$2,200.00
|
| Rate for Payer: Aetna Medicare |
$2,794.14
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$746.19
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,862.76
|
| Rate for Payer: Amerigroup Medicare |
$1,862.76
|
| 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 |
$1,862.76
|
| Rate for Payer: BCBS of TX PPO |
$4,464.31
|
| Rate for Payer: Cash Price |
$7,296.08
|
| Rate for Payer: Cash Price |
$7,296.08
|
| Rate for Payer: Cash Price |
$7,296.08
|
| Rate for Payer: Cigna Commercial |
$4,219.69
|
| Rate for Payer: Cigna Medicaid |
$652.80
|
| Rate for Payer: Cigna Medicare |
$1,862.76
|
| Rate for Payer: Employer Direct Commercial |
$1,862.76
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,862.76
|
| Rate for Payer: Molina CHIP/Medicaid |
$652.80
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,862.76
|
| Rate for Payer: Molina Medicare |
$1,862.76
|
| Rate for Payer: Multiplan Auto |
$5,389.15
|
| Rate for Payer: Multiplan Commercial |
$5,389.15
|
| Rate for Payer: Multiplan Workers Comp |
$5,389.15
|
| Rate for Payer: Parkland Medicaid |
$652.80
|
| Rate for Payer: Scott and White EPO/PPO |
$33.31
|
| Rate for Payer: Scott and White Medicare |
$1,862.76
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$652.80
|
| Rate for Payer: Superior Health Plan EPO |
$1,862.76
|
| Rate for Payer: Superior Health Plan Medicare |
$1,862.76
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,862.76
|
| Rate for Payer: Universal American Medicare |
$1,862.76
|
| Rate for Payer: Wellcare Medicare |
$1,862.76
|
| Rate for Payer: Wellmed Medicare |
$1,862.76
|
|
|
ED CYSTO W/IRRIG & EVAC MULTPLE OBSTRUCTING CLOTS BCE
|
Facility
|
OP
|
$5,979.00
|
|
|
Service Code
|
CPT 52001
|
| Hospital Charge Code |
8862559
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$57.02 |
| Max. Negotiated Rate |
$7,606.72 |
| Rate for Payer: Aetna Commercial |
$2,200.00
|
| Rate for Payer: Aetna Medicare |
$4,782.38
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$538.11
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3,188.25
|
| Rate for Payer: Amerigroup Medicare |
$3,188.25
|
| Rate for Payer: BCBS of TX Blue Advantage |
$5,040.96
|
| Rate for Payer: BCBS of TX Blue Essentials |
$6,037.08
|
| Rate for Payer: BCBS of TX Medicare |
$3,188.25
|
| Rate for Payer: BCBS of TX PPO |
$7,606.72
|
| Rate for Payer: Cash Price |
$5,261.52
|
| Rate for Payer: Cash Price |
$5,261.52
|
| Rate for Payer: Cash Price |
$5,261.52
|
| Rate for Payer: Cigna Commercial |
$7,222.32
|
| Rate for Payer: Cigna Medicaid |
$1,142.90
|
| Rate for Payer: Cigna Medicare |
$3,188.25
|
| Rate for Payer: Employer Direct Commercial |
$3,188.25
|
| Rate for Payer: Humana Medicare/TRICARE |
$3,188.25
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,142.90
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3,188.25
|
| Rate for Payer: Molina Medicare |
$3,188.25
|
| Rate for Payer: Multiplan Auto |
$3,886.35
|
| Rate for Payer: Multiplan Commercial |
$3,886.35
|
| Rate for Payer: Multiplan Workers Comp |
$3,886.35
|
| Rate for Payer: Parkland Medicaid |
$1,142.90
|
| Rate for Payer: Scott and White EPO/PPO |
$57.02
|
| Rate for Payer: Scott and White Medicare |
$3,188.25
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,142.90
|
| Rate for Payer: Superior Health Plan EPO |
$3,188.25
|
| Rate for Payer: Superior Health Plan Medicare |
$3,188.25
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3,188.25
|
| Rate for Payer: Universal American Medicare |
$3,188.25
|
| Rate for Payer: Wellcare Medicare |
$3,188.25
|
| Rate for Payer: Wellmed Medicare |
$3,188.25
|
|
|
ED CYSTO W/IRRIG & EVAC MULTPLE OBSTRUCTING CLOTS BCE
|
Facility
|
IP
|
$5,979.00
|
|
|
Service Code
|
CPT 52001
|
| Hospital Charge Code |
8862559
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$5,261.52
|
|
|
ED Debridement: Addl 10% infected skin
|
Facility
|
OP
|
$72.00
|
|
|
Service Code
|
CPT 11001
|
| Hospital Charge Code |
5202503
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$6.48 |
| Max. Negotiated Rate |
$46.80 |
| Rate for Payer: Aetna Commercial |
$39.60
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$6.48
|
| Rate for Payer: Cash Price |
$63.36
|
| Rate for Payer: Multiplan Auto |
$46.80
|
| Rate for Payer: Multiplan Commercial |
$46.80
|
| Rate for Payer: Multiplan Workers Comp |
$46.80
|
| Rate for Payer: Scott and White EPO/PPO |
$36.00
|
| Rate for Payer: Superior Health Plan EPO |
$9.79
|
|
|
ED Debridement Addl 10% infected skin BCE
|
Facility
|
IP
|
$72.00
|
|
|
Service Code
|
CPT 11001
|
| Hospital Charge Code |
5202503
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$63.36
|
|
|
ED Debridement Addl 10% infected skin BCE
|
Facility
|
OP
|
$72.00
|
|
|
Service Code
|
CPT 11001
|
| Hospital Charge Code |
5202503
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$6.48 |
| Max. Negotiated Rate |
$46.80 |
| Rate for Payer: Aetna Commercial |
$39.60
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$6.48
|
| Rate for Payer: Cash Price |
$63.36
|
| Rate for Payer: Multiplan Auto |
$46.80
|
| Rate for Payer: Multiplan Commercial |
$46.80
|
| Rate for Payer: Multiplan Workers Comp |
$46.80
|
| Rate for Payer: Scott and White EPO/PPO |
$36.00
|
| Rate for Payer: Superior Health Plan EPO |
$9.79
|
|
|
ED Debridement: To devitalized tissue, <= 20 sq cm
|
Facility
|
OP
|
$399.00
|
|
|
Service Code
|
CPT 97597
|
| Hospital Charge Code |
7150659
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3.27 |
| Max. Negotiated Rate |
$414.75 |
| Rate for Payer: Aetna Commercial |
$219.45
|
| Rate for Payer: Aetna Medicare |
$274.64
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$35.91
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$183.09
|
| Rate for Payer: Amerigroup Medicare |
$183.09
|
| Rate for Payer: BCBS of TX Blue Advantage |
$42.65
|
| Rate for Payer: BCBS of TX Blue Essentials |
$50.98
|
| Rate for Payer: BCBS of TX Medicare |
$183.09
|
| Rate for Payer: BCBS of TX PPO |
$56.86
|
| Rate for Payer: Cash Price |
$351.12
|
| Rate for Payer: Cash Price |
$351.12
|
| Rate for Payer: Cash Price |
$351.12
|
| Rate for Payer: Cigna Commercial |
$414.75
|
| Rate for Payer: Cigna Medicare |
$183.09
|
| Rate for Payer: Employer Direct Commercial |
$183.09
|
| Rate for Payer: Humana Medicare/TRICARE |
$183.09
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$183.09
|
| Rate for Payer: Molina Medicare |
$183.09
|
| Rate for Payer: Multiplan Auto |
$259.35
|
| Rate for Payer: Multiplan Commercial |
$259.35
|
| Rate for Payer: Multiplan Workers Comp |
$259.35
|
| Rate for Payer: Scott and White EPO/PPO |
$3.27
|
| Rate for Payer: Scott and White Medicare |
$183.09
|
| Rate for Payer: Superior Health Plan EPO |
$183.09
|
| Rate for Payer: Superior Health Plan Medicare |
$183.09
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$183.09
|
| Rate for Payer: Universal American Medicare |
$183.09
|
| Rate for Payer: Wellcare Medicare |
$183.09
|
| Rate for Payer: Wellmed Medicare |
$183.09
|
|
|
ED Debridement To devitalized tissue, <= 20 sq cm BCE
|
Facility
|
IP
|
$399.00
|
|
|
Service Code
|
CPT 97597
|
| Hospital Charge Code |
7150659
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$351.12
|
|
|
ED Debridement To devitalized tissue, <= 20 sq cm BCE
|
Facility
|
OP
|
$399.00
|
|
|
Service Code
|
CPT 97597
|
| Hospital Charge Code |
7150659
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3.27 |
| Max. Negotiated Rate |
$414.75 |
| Rate for Payer: Aetna Commercial |
$219.45
|
| Rate for Payer: Aetna Medicare |
$274.64
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$35.91
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$183.09
|
| Rate for Payer: Amerigroup Medicare |
$183.09
|
| Rate for Payer: BCBS of TX Blue Advantage |
$42.65
|
| Rate for Payer: BCBS of TX Blue Essentials |
$50.98
|
| Rate for Payer: BCBS of TX Medicare |
$183.09
|
| Rate for Payer: BCBS of TX PPO |
$56.86
|
| Rate for Payer: Cash Price |
$351.12
|
| Rate for Payer: Cash Price |
$351.12
|
| Rate for Payer: Cash Price |
$351.12
|
| Rate for Payer: Cigna Commercial |
$414.75
|
| Rate for Payer: Cigna Medicare |
$183.09
|
| Rate for Payer: Employer Direct Commercial |
$183.09
|
| Rate for Payer: Humana Medicare/TRICARE |
$183.09
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$183.09
|
| Rate for Payer: Molina Medicare |
$183.09
|
| Rate for Payer: Multiplan Auto |
$259.35
|
| Rate for Payer: Multiplan Commercial |
$259.35
|
| Rate for Payer: Multiplan Workers Comp |
$259.35
|
| Rate for Payer: Scott and White EPO/PPO |
$3.27
|
| Rate for Payer: Scott and White Medicare |
$183.09
|
| Rate for Payer: Superior Health Plan EPO |
$183.09
|
| Rate for Payer: Superior Health Plan Medicare |
$183.09
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$183.09
|
| Rate for Payer: Universal American Medicare |
$183.09
|
| Rate for Payer: Wellcare Medicare |
$183.09
|
| Rate for Payer: Wellmed Medicare |
$183.09
|
|
|
ED Debridement: To muscle/fascia, <= 20 sq cm
|
Facility
|
OP
|
$2,376.00
|
|
|
Service Code
|
CPT 11043
|
| Hospital Charge Code |
7150170
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$10.27 |
| Max. Negotiated Rate |
$1,544.40 |
| Rate for Payer: Aetna Commercial |
$1,306.80
|
| Rate for Payer: Aetna Medicare |
$861.57
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$213.84
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$574.38
|
| Rate for Payer: Amerigroup Medicare |
$574.38
|
| Rate for Payer: BCBS of TX Blue Advantage |
$830.02
|
| Rate for Payer: BCBS of TX Blue Essentials |
$994.04
|
| Rate for Payer: BCBS of TX Medicare |
$574.38
|
| Rate for Payer: BCBS of TX PPO |
$1,252.49
|
| Rate for Payer: Cash Price |
$2,090.88
|
| Rate for Payer: Cash Price |
$2,090.88
|
| Rate for Payer: Cash Price |
$2,090.88
|
| Rate for Payer: Cigna Commercial |
$1,301.14
|
| Rate for Payer: Cigna Medicaid |
$216.80
|
| Rate for Payer: Cigna Medicare |
$574.38
|
| Rate for Payer: Employer Direct Commercial |
$574.38
|
| Rate for Payer: Humana Medicare/TRICARE |
$574.38
|
| Rate for Payer: Molina CHIP/Medicaid |
$216.80
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$574.38
|
| Rate for Payer: Molina Medicare |
$574.38
|
| Rate for Payer: Multiplan Auto |
$1,544.40
|
| Rate for Payer: Multiplan Commercial |
$1,544.40
|
| Rate for Payer: Multiplan Workers Comp |
$1,544.40
|
| Rate for Payer: Parkland Medicaid |
$216.80
|
| Rate for Payer: Scott and White EPO/PPO |
$10.27
|
| Rate for Payer: Scott and White Medicare |
$574.38
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$216.80
|
| Rate for Payer: Superior Health Plan EPO |
$574.38
|
| Rate for Payer: Superior Health Plan Medicare |
$574.38
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$574.38
|
| Rate for Payer: Universal American Medicare |
$574.38
|
| Rate for Payer: Wellcare Medicare |
$574.38
|
| Rate for Payer: Wellmed Medicare |
$574.38
|
|
|
ED Debridement To muscle/fascia, <= 20 sq cm BCE
|
Facility
|
OP
|
$2,376.00
|
|
|
Service Code
|
CPT 11043
|
| Hospital Charge Code |
7150170
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$10.27 |
| Max. Negotiated Rate |
$1,544.40 |
| Rate for Payer: Aetna Commercial |
$1,306.80
|
| Rate for Payer: Aetna Medicare |
$861.57
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$213.84
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$574.38
|
| Rate for Payer: Amerigroup Medicare |
$574.38
|
| Rate for Payer: BCBS of TX Blue Advantage |
$830.02
|
| Rate for Payer: BCBS of TX Blue Essentials |
$994.04
|
| Rate for Payer: BCBS of TX Medicare |
$574.38
|
| Rate for Payer: BCBS of TX PPO |
$1,252.49
|
| Rate for Payer: Cash Price |
$2,090.88
|
| Rate for Payer: Cash Price |
$2,090.88
|
| Rate for Payer: Cash Price |
$2,090.88
|
| Rate for Payer: Cigna Commercial |
$1,301.14
|
| Rate for Payer: Cigna Medicaid |
$216.80
|
| Rate for Payer: Cigna Medicare |
$574.38
|
| Rate for Payer: Employer Direct Commercial |
$574.38
|
| Rate for Payer: Humana Medicare/TRICARE |
$574.38
|
| Rate for Payer: Molina CHIP/Medicaid |
$216.80
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$574.38
|
| Rate for Payer: Molina Medicare |
$574.38
|
| Rate for Payer: Multiplan Auto |
$1,544.40
|
| Rate for Payer: Multiplan Commercial |
$1,544.40
|
| Rate for Payer: Multiplan Workers Comp |
$1,544.40
|
| Rate for Payer: Parkland Medicaid |
$216.80
|
| Rate for Payer: Scott and White EPO/PPO |
$10.27
|
| Rate for Payer: Scott and White Medicare |
$574.38
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$216.80
|
| Rate for Payer: Superior Health Plan EPO |
$574.38
|
| Rate for Payer: Superior Health Plan Medicare |
$574.38
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$574.38
|
| Rate for Payer: Universal American Medicare |
$574.38
|
| Rate for Payer: Wellcare Medicare |
$574.38
|
| Rate for Payer: Wellmed Medicare |
$574.38
|
|
|
ED Debridement To muscle/fascia, <= 20 sq cm BCE
|
Facility
|
IP
|
$2,376.00
|
|
|
Service Code
|
CPT 11043
|
| Hospital Charge Code |
7150170
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$2,090.88
|
|
|
ED Debridement: To subcutaneous tissue, <= 20 sq cm
|
Facility
|
OP
|
$1,546.00
|
|
|
Service Code
|
CPT 11042
|
| Hospital Charge Code |
7150162
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$6.52 |
| Max. Negotiated Rate |
$1,004.90 |
| Rate for Payer: Aetna Commercial |
$850.30
|
| Rate for Payer: Aetna Medicare |
$547.00
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$139.14
|
| 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 |
$1,360.48
|
| Rate for Payer: Cash Price |
$1,360.48
|
| Rate for Payer: Cash Price |
$1,360.48
|
| 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 |
$1,004.90
|
| Rate for Payer: Multiplan Commercial |
$1,004.90
|
| Rate for Payer: Multiplan Workers Comp |
$1,004.90
|
| 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
|
|
|
ED Debridement To subcutaneous tissue, <= 20 sq cm BCE
|
Facility
|
OP
|
$1,546.00
|
|
|
Service Code
|
CPT 11042
|
| Hospital Charge Code |
7150162
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$6.52 |
| Max. Negotiated Rate |
$1,004.90 |
| Rate for Payer: Aetna Commercial |
$850.30
|
| Rate for Payer: Aetna Medicare |
$547.00
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$139.14
|
| 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 |
$1,360.48
|
| Rate for Payer: Cash Price |
$1,360.48
|
| Rate for Payer: Cash Price |
$1,360.48
|
| 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 |
$1,004.90
|
| Rate for Payer: Multiplan Commercial |
$1,004.90
|
| Rate for Payer: Multiplan Workers Comp |
$1,004.90
|
| 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
|
|
|
ED Debridement To subcutaneous tissue, <= 20 sq cm BCE
|
Facility
|
IP
|
$1,546.00
|
|
|
Service Code
|
CPT 11042
|
| Hospital Charge Code |
7150162
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$1,360.48
|
|
|
ED Dislocation Repair Site: Ankle w/o Anesthesia
|
Facility
|
IP
|
$978.00
|
|
|
Service Code
|
CPT 27840
|
| Hospital Charge Code |
5202514
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$860.64
|
|
|
ED Dislocation Repair Site: Ankle w/o Anesthesia
|
Facility
|
OP
|
$978.00
|
|
|
Service Code
|
CPT 27840
|
| Hospital Charge Code |
5202514
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3.86 |
| Max. Negotiated Rate |
$635.70 |
| Rate for Payer: Aetna Commercial |
$537.90
|
| Rate for Payer: Aetna Medicare |
$323.50
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$88.02
|
| 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 |
$860.64
|
| Rate for Payer: Cash Price |
$860.64
|
| Rate for Payer: Cash Price |
$860.64
|
| 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 |
$635.70
|
| Rate for Payer: Multiplan Commercial |
$635.70
|
| Rate for Payer: Multiplan Workers Comp |
$635.70
|
| 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 Dislocation Repair Site Ankle w/o Anesthesia BCE
|
Facility
|
OP
|
$978.00
|
|
|
Service Code
|
CPT 27840
|
| Hospital Charge Code |
5202514
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3.86 |
| Max. Negotiated Rate |
$635.70 |
| Rate for Payer: Aetna Commercial |
$537.90
|
| Rate for Payer: Aetna Medicare |
$323.50
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$88.02
|
| 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 |
$860.64
|
| Rate for Payer: Cash Price |
$860.64
|
| Rate for Payer: Cash Price |
$860.64
|
| 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 |
$635.70
|
| Rate for Payer: Multiplan Commercial |
$635.70
|
| Rate for Payer: Multiplan Workers Comp |
$635.70
|
| 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 Dislocation Repair Site: Elbow w/ Anesthesia
|
Facility
|
IP
|
$4,544.00
|
|
|
Service Code
|
CPT 24605
|
| Hospital Charge Code |
5202507
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$3,998.72
|
|
|
ED Dislocation Repair Site: Elbow w/ Anesthesia
|
Facility
|
OP
|
$4,544.00
|
|
|
Service Code
|
CPT 24605
|
| Hospital Charge Code |
5202507
|
|
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 |
$408.96
|
| 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 |
$3,998.72
|
| Rate for Payer: Cash Price |
$3,998.72
|
| Rate for Payer: Cash Price |
$3,998.72
|
| 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 |
$2,953.60
|
| Rate for Payer: Multiplan Commercial |
$2,953.60
|
| Rate for Payer: Multiplan Workers Comp |
$2,953.60
|
| 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
|
|
