|
ED DISLOCATION REPAIR SITE NURSEMAID ELBOW W/MAINIPLATION BC
|
Facility
|
OP
|
$777.00
|
|
|
Service Code
|
CPT 24640
|
| Hospital Charge Code |
8398504
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$49.00 |
| Max. Negotiated Rate |
$505.05 |
| Rate for Payer: Aetna Commercial |
$427.35
|
| Rate for Payer: Aetna Medicare |
$323.50
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$69.93
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$215.67
|
| Rate for Payer: Amerigroup Medicare |
$215.67
|
| Rate for Payer: BCBS of TX Blue Advantage |
$93.42
|
| Rate for Payer: BCBS of TX Blue Essentials |
$111.88
|
| Rate for Payer: BCBS of TX Medicare |
$215.67
|
| Rate for Payer: BCBS of TX PPO |
$140.97
|
| Rate for Payer: Cash Price |
$683.76
|
| Rate for Payer: Cash Price |
$683.76
|
| Rate for Payer: Cash Price |
$683.76
|
| Rate for Payer: Cigna Commercial |
$488.55
|
| Rate for Payer: Cigna Medicaid |
$49.00
|
| 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 |
$49.00
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$215.67
|
| Rate for Payer: Molina Medicare |
$215.67
|
| Rate for Payer: Multiplan Auto |
$505.05
|
| Rate for Payer: Multiplan Commercial |
$505.05
|
| Rate for Payer: Multiplan Workers Comp |
$505.05
|
| Rate for Payer: Parkland Medicaid |
$49.00
|
| Rate for Payer: Scott and White EPO/PPO |
$99.47
|
| Rate for Payer: Scott and White Medicare |
$215.67
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$49.00
|
| 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: Shoulder w/ Anesthesia
|
Facility
|
OP
|
$2,762.00
|
|
|
Service Code
|
CPT 23655
|
| Hospital Charge Code |
5202505
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$248.58 |
| 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 |
$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 |
$514.95
|
| 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 Dislocation Repair Site: Shoulder w/ Anesthesia
|
Facility
|
IP
|
$2,762.00
|
|
|
Service Code
|
CPT 23655
|
| Hospital Charge Code |
5202505
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$2,430.56
|
|
|
ED Dislocation Repair Site Shoulder w/ Anesthesia BCE
|
Facility
|
OP
|
$2,762.00
|
|
|
Service Code
|
CPT 23655
|
| Hospital Charge Code |
5202505
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$248.58 |
| 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 |
$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 |
$514.95
|
| 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 Dislocation Repair Site: Shoulder w/o Anesthesia
|
Facility
|
IP
|
$1,737.00
|
|
|
Service Code
|
CPT 23650
|
| Hospital Charge Code |
9220198
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$1,528.56
|
|
|
ED Dislocation Repair Site: Shoulder w/o Anesthesia
|
Facility
|
OP
|
$1,737.00
|
|
|
Service Code
|
CPT 23650
|
| Hospital Charge Code |
9220198
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$85.32 |
| Max. Negotiated Rate |
$1,129.05 |
| Rate for Payer: Aetna Commercial |
$955.35
|
| Rate for Payer: Aetna Medicare |
$323.50
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$156.33
|
| 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 |
$1,528.56
|
| Rate for Payer: Cash Price |
$1,528.56
|
| Rate for Payer: Cash Price |
$1,528.56
|
| 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 |
$1,129.05
|
| Rate for Payer: Multiplan Commercial |
$1,129.05
|
| Rate for Payer: Multiplan Workers Comp |
$1,129.05
|
| Rate for Payer: Parkland Medicaid |
$85.32
|
| Rate for Payer: Scott and White EPO/PPO |
$384.12
|
| 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 Shoulder w/o Anesthesia BCE
|
Facility
|
OP
|
$1,737.00
|
|
|
Service Code
|
CPT 23650
|
| Hospital Charge Code |
9220198
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$85.32 |
| Max. Negotiated Rate |
$1,129.05 |
| Rate for Payer: Aetna Commercial |
$955.35
|
| Rate for Payer: Aetna Medicare |
$323.50
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$156.33
|
| 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 |
$1,528.56
|
| Rate for Payer: Cash Price |
$1,528.56
|
| Rate for Payer: Cash Price |
$1,528.56
|
| 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 |
$1,129.05
|
| Rate for Payer: Multiplan Commercial |
$1,129.05
|
| Rate for Payer: Multiplan Workers Comp |
$1,129.05
|
| Rate for Payer: Parkland Medicaid |
$85.32
|
| Rate for Payer: Scott and White EPO/PPO |
$384.12
|
| 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: Thumb
|
Facility
|
IP
|
$986.00
|
|
|
Service Code
|
CPT 26641
|
| Hospital Charge Code |
5202508
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$867.68
|
|
|
ED Dislocation Repair Site: Thumb
|
Facility
|
OP
|
$986.00
|
|
|
Service Code
|
CPT 26641
|
| Hospital Charge Code |
5202508
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$85.32 |
| Max. Negotiated Rate |
$640.90 |
| Rate for Payer: Aetna Commercial |
$542.30
|
| Rate for Payer: Aetna Medicare |
$323.50
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$88.74
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$215.67
|
| Rate for Payer: Amerigroup Medicare |
$215.67
|
| 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 |
$215.67
|
| Rate for Payer: BCBS of TX PPO |
$274.58
|
| Rate for Payer: Cash Price |
$867.68
|
| Rate for Payer: Cash Price |
$867.68
|
| Rate for Payer: Cash Price |
$867.68
|
| 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 |
$640.90
|
| Rate for Payer: Multiplan Commercial |
$640.90
|
| Rate for Payer: Multiplan Workers Comp |
$640.90
|
| Rate for Payer: Parkland Medicaid |
$85.32
|
| Rate for Payer: Scott and White EPO/PPO |
$487.40
|
| 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 Thumb BCE
|
Facility
|
OP
|
$986.00
|
|
|
Service Code
|
CPT 26641
|
| Hospital Charge Code |
5202508
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$85.32 |
| Max. Negotiated Rate |
$640.90 |
| Rate for Payer: Aetna Commercial |
$542.30
|
| Rate for Payer: Aetna Medicare |
$323.50
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$88.74
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$215.67
|
| Rate for Payer: Amerigroup Medicare |
$215.67
|
| 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 |
$215.67
|
| Rate for Payer: BCBS of TX PPO |
$274.58
|
| Rate for Payer: Cash Price |
$867.68
|
| Rate for Payer: Cash Price |
$867.68
|
| Rate for Payer: Cash Price |
$867.68
|
| 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 |
$640.90
|
| Rate for Payer: Multiplan Commercial |
$640.90
|
| Rate for Payer: Multiplan Workers Comp |
$640.90
|
| Rate for Payer: Parkland Medicaid |
$85.32
|
| Rate for Payer: Scott and White EPO/PPO |
$487.40
|
| 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: Toe, Interphalangeal w/o Anes
|
Facility
|
OP
|
$328.00
|
|
|
Service Code
|
CPT 28660
|
| Hospital Charge Code |
5202516
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$29.52 |
| Max. Negotiated Rate |
$488.55 |
| Rate for Payer: Aetna Commercial |
$180.40
|
| Rate for Payer: Aetna Medicare |
$323.50
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$29.52
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$215.67
|
| Rate for Payer: Amerigroup Medicare |
$215.67
|
| Rate for Payer: BCBS of TX Blue Advantage |
$115.11
|
| Rate for Payer: BCBS of TX Blue Essentials |
$137.86
|
| Rate for Payer: BCBS of TX Medicare |
$215.67
|
| Rate for Payer: BCBS of TX PPO |
$173.70
|
| Rate for Payer: Cash Price |
$288.64
|
| Rate for Payer: Cash Price |
$288.64
|
| Rate for Payer: Cash Price |
$288.64
|
| Rate for Payer: Cigna Commercial |
$488.55
|
| Rate for Payer: Cigna Medicaid |
$59.25
|
| 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 |
$59.25
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$215.67
|
| Rate for Payer: Molina Medicare |
$215.67
|
| Rate for Payer: Multiplan Auto |
$213.20
|
| Rate for Payer: Multiplan Commercial |
$213.20
|
| Rate for Payer: Multiplan Workers Comp |
$213.20
|
| Rate for Payer: Parkland Medicaid |
$59.25
|
| Rate for Payer: Scott and White EPO/PPO |
$117.64
|
| Rate for Payer: Scott and White Medicare |
$215.67
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$59.25
|
| 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: Toe, Interphalangeal w/o Anes
|
Facility
|
IP
|
$328.00
|
|
|
Service Code
|
CPT 28660
|
| Hospital Charge Code |
5202516
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$288.64
|
|
|
ED Dislocation Repair Site Toe, Interphalangeal w/o Anes BCE
|
Facility
|
OP
|
$328.00
|
|
|
Service Code
|
CPT 28660
|
| Hospital Charge Code |
5202516
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$29.52 |
| Max. Negotiated Rate |
$488.55 |
| Rate for Payer: Aetna Commercial |
$180.40
|
| Rate for Payer: Aetna Medicare |
$323.50
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$29.52
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$215.67
|
| Rate for Payer: Amerigroup Medicare |
$215.67
|
| Rate for Payer: BCBS of TX Blue Advantage |
$115.11
|
| Rate for Payer: BCBS of TX Blue Essentials |
$137.86
|
| Rate for Payer: BCBS of TX Medicare |
$215.67
|
| Rate for Payer: BCBS of TX PPO |
$173.70
|
| Rate for Payer: Cash Price |
$288.64
|
| Rate for Payer: Cash Price |
$288.64
|
| Rate for Payer: Cash Price |
$288.64
|
| Rate for Payer: Cigna Commercial |
$488.55
|
| Rate for Payer: Cigna Medicaid |
$59.25
|
| 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 |
$59.25
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$215.67
|
| Rate for Payer: Molina Medicare |
$215.67
|
| Rate for Payer: Multiplan Auto |
$213.20
|
| Rate for Payer: Multiplan Commercial |
$213.20
|
| Rate for Payer: Multiplan Workers Comp |
$213.20
|
| Rate for Payer: Parkland Medicaid |
$59.25
|
| Rate for Payer: Scott and White EPO/PPO |
$117.64
|
| Rate for Payer: Scott and White Medicare |
$215.67
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$59.25
|
| 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: Toe, Metatarsophalangeal w/o Anesthesia
|
Facility
|
IP
|
$480.00
|
|
|
Service Code
|
CPT 28630
|
| Hospital Charge Code |
5202515
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$422.40
|
|
|
ED Dislocation Repair Site: Toe, Metatarsophalangeal w/o Anesthesia
|
Facility
|
OP
|
$480.00
|
|
|
Service Code
|
CPT 28630
|
| Hospital Charge Code |
5202515
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$43.20 |
| Max. Negotiated Rate |
$488.55 |
| Rate for Payer: Aetna Commercial |
$264.00
|
| Rate for Payer: Aetna Medicare |
$323.50
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$43.20
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$215.67
|
| Rate for Payer: Amerigroup Medicare |
$215.67
|
| Rate for Payer: BCBS of TX Blue Advantage |
$148.86
|
| Rate for Payer: BCBS of TX Blue Essentials |
$178.28
|
| Rate for Payer: BCBS of TX Medicare |
$215.67
|
| Rate for Payer: BCBS of TX PPO |
$224.63
|
| Rate for Payer: Cash Price |
$422.40
|
| Rate for Payer: Cash Price |
$422.40
|
| Rate for Payer: Cash Price |
$422.40
|
| Rate for Payer: Cigna Commercial |
$488.55
|
| Rate for Payer: Cigna Medicaid |
$70.60
|
| 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 |
$70.60
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$215.67
|
| Rate for Payer: Molina Medicare |
$215.67
|
| Rate for Payer: Multiplan Auto |
$312.00
|
| Rate for Payer: Multiplan Commercial |
$312.00
|
| Rate for Payer: Multiplan Workers Comp |
$312.00
|
| Rate for Payer: Parkland Medicaid |
$70.60
|
| Rate for Payer: Scott and White EPO/PPO |
$137.75
|
| Rate for Payer: Scott and White Medicare |
$215.67
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$70.60
|
| 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 Toe, Metatarsophalangeal w/o Anesthesia BCE
|
Facility
|
OP
|
$480.00
|
|
|
Service Code
|
CPT 28630
|
| Hospital Charge Code |
5202515
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$43.20 |
| Max. Negotiated Rate |
$488.55 |
| Rate for Payer: Aetna Commercial |
$264.00
|
| Rate for Payer: Aetna Medicare |
$323.50
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$43.20
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$215.67
|
| Rate for Payer: Amerigroup Medicare |
$215.67
|
| Rate for Payer: BCBS of TX Blue Advantage |
$148.86
|
| Rate for Payer: BCBS of TX Blue Essentials |
$178.28
|
| Rate for Payer: BCBS of TX Medicare |
$215.67
|
| Rate for Payer: BCBS of TX PPO |
$224.63
|
| Rate for Payer: Cash Price |
$422.40
|
| Rate for Payer: Cash Price |
$422.40
|
| Rate for Payer: Cash Price |
$422.40
|
| Rate for Payer: Cigna Commercial |
$488.55
|
| Rate for Payer: Cigna Medicaid |
$70.60
|
| 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 |
$70.60
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$215.67
|
| Rate for Payer: Molina Medicare |
$215.67
|
| Rate for Payer: Multiplan Auto |
$312.00
|
| Rate for Payer: Multiplan Commercial |
$312.00
|
| Rate for Payer: Multiplan Workers Comp |
$312.00
|
| Rate for Payer: Parkland Medicaid |
$70.60
|
| Rate for Payer: Scott and White EPO/PPO |
$137.75
|
| Rate for Payer: Scott and White Medicare |
$215.67
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$70.60
|
| 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 DRAINAGE EXTERNAL EAR ABSCESS/HEMATOMA SIMPLE BCE
|
Facility
|
OP
|
$1,518.43
|
|
|
Service Code
|
CPT 69000
|
| Hospital Charge Code |
8772540
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$107.14 |
| Max. Negotiated Rate |
$1,457.60 |
| Rate for Payer: Aetna Commercial |
$1,400.00
|
| Rate for Payer: Aetna Medicare |
$965.17
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$136.66
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$643.45
|
| Rate for Payer: Amerigroup Medicare |
$643.45
|
| Rate for Payer: BCBS of TX Blue Advantage |
$217.57
|
| Rate for Payer: BCBS of TX Blue Essentials |
$260.56
|
| Rate for Payer: BCBS of TX Medicare |
$643.45
|
| Rate for Payer: BCBS of TX PPO |
$328.31
|
| Rate for Payer: Cash Price |
$1,336.22
|
| Rate for Payer: Cash Price |
$1,336.22
|
| Rate for Payer: Cash Price |
$1,336.22
|
| Rate for Payer: Cigna Commercial |
$1,457.60
|
| Rate for Payer: Cigna Medicaid |
$107.14
|
| Rate for Payer: Cigna Medicare |
$643.45
|
| Rate for Payer: Employer Direct Commercial |
$643.45
|
| Rate for Payer: Humana Medicare/TRICARE |
$643.45
|
| Rate for Payer: Molina CHIP/Medicaid |
$107.14
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$643.45
|
| Rate for Payer: Molina Medicare |
$643.45
|
| Rate for Payer: Multiplan Auto |
$986.98
|
| Rate for Payer: Multiplan Commercial |
$986.98
|
| Rate for Payer: Multiplan Workers Comp |
$986.98
|
| Rate for Payer: Parkland Medicaid |
$107.14
|
| Rate for Payer: Scott and White EPO/PPO |
$155.65
|
| Rate for Payer: Scott and White Medicare |
$643.45
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$107.14
|
| Rate for Payer: Superior Health Plan EPO |
$643.45
|
| Rate for Payer: Superior Health Plan Medicare |
$643.45
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$643.45
|
| Rate for Payer: Universal American Medicare |
$643.45
|
| Rate for Payer: Wellcare Medicare |
$643.45
|
| Rate for Payer: Wellmed Medicare |
$643.45
|
|
|
ED DRAINAGE EXTERNAL EAR ABSCESS/HEMATOMA SIMPLE BCE
|
Facility
|
IP
|
$1,518.43
|
|
|
Service Code
|
CPT 69000
|
| Hospital Charge Code |
8772540
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$1,336.22
|
|
|
ED Drainage of abscess, cyst, hematoma from dentoalveolar st
|
Facility
|
OP
|
$413.00
|
|
|
Service Code
|
CPT 41800
|
| Hospital Charge Code |
8640516
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$37.17 |
| Max. Negotiated Rate |
$274.76 |
| Rate for Payer: Aetna Commercial |
$227.15
|
| Rate for Payer: Aetna Medicare |
$175.23
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$37.17
|
| 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 |
$363.44
|
| Rate for Payer: Cash Price |
$363.44
|
| Rate for Payer: Cash Price |
$363.44
|
| 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 |
$268.45
|
| Rate for Payer: Multiplan Commercial |
$268.45
|
| Rate for Payer: Multiplan Workers Comp |
$268.45
|
| Rate for Payer: Scott and White EPO/PPO |
$191.11
|
| 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 Drainage of abscess, cyst, hematoma from dentoalveolar st
|
Facility
|
IP
|
$413.00
|
|
|
Service Code
|
CPT 41800
|
| Hospital Charge Code |
8640516
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$363.44
|
|
|
ED DRAINAGE OF FINGER ABSCESS SIMPLE BCE
|
Facility
|
OP
|
$533.00
|
|
|
Service Code
|
CPT 26010
|
| Hospital Charge Code |
8418454
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$47.97 |
| Max. Negotiated Rate |
$414.75 |
| Rate for Payer: Aetna Commercial |
$293.15
|
| Rate for Payer: Aetna Medicare |
$274.63
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$47.97
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$183.09
|
| Rate for Payer: Amerigroup Medicare |
$183.09
|
| Rate for Payer: BCBS of TX Blue Advantage |
$147.44
|
| Rate for Payer: BCBS of TX Blue Essentials |
$176.58
|
| Rate for Payer: BCBS of TX Medicare |
$183.09
|
| Rate for Payer: BCBS of TX PPO |
$222.49
|
| Rate for Payer: Cash Price |
$469.04
|
| Rate for Payer: Cash Price |
$469.04
|
| Rate for Payer: Cash Price |
$469.04
|
| Rate for Payer: Cigna Commercial |
$414.75
|
| Rate for Payer: Cigna Medicaid |
$74.34
|
| 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 CHIP/Medicaid |
$74.34
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$183.09
|
| Rate for Payer: Molina Medicare |
$183.09
|
| Rate for Payer: Multiplan Auto |
$346.45
|
| Rate for Payer: Multiplan Commercial |
$346.45
|
| Rate for Payer: Multiplan Workers Comp |
$346.45
|
| Rate for Payer: Parkland Medicaid |
$74.34
|
| Rate for Payer: Scott and White EPO/PPO |
$176.05
|
| Rate for Payer: Scott and White Medicare |
$183.09
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$74.34
|
| 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 DRAINAGE OF FINGER ABSCESS SIMPLE BCE
|
Facility
|
IP
|
$533.00
|
|
|
Service Code
|
CPT 26010
|
| Hospital Charge Code |
8418454
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$469.04
|
|
|
ED Ear Procedure: Cerumen Irrigation/Lavage
|
Facility
|
IP
|
$484.00
|
|
|
Service Code
|
CPT 69209
|
| Hospital Charge Code |
5202517
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$425.92
|
|
|
ED Ear Procedure: Cerumen Irrigation/Lavage
|
Facility
|
OP
|
$484.00
|
|
|
Service Code
|
CPT 69209
|
| Hospital Charge Code |
5202517
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$19.73 |
| Max. Negotiated Rate |
$314.60 |
| Rate for Payer: Aetna Commercial |
$266.20
|
| Rate for Payer: Aetna Medicare |
$83.91
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$43.56
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$55.94
|
| Rate for Payer: Amerigroup Medicare |
$55.94
|
| Rate for Payer: BCBS of TX Blue Advantage |
$91.87
|
| Rate for Payer: BCBS of TX Blue Essentials |
$110.02
|
| Rate for Payer: BCBS of TX Medicare |
$55.94
|
| Rate for Payer: BCBS of TX PPO |
$138.63
|
| Rate for Payer: Cash Price |
$425.92
|
| Rate for Payer: Cash Price |
$425.92
|
| Rate for Payer: Cash Price |
$425.92
|
| Rate for Payer: Cigna Commercial |
$126.71
|
| Rate for Payer: Cigna Medicare |
$55.94
|
| Rate for Payer: Employer Direct Commercial |
$55.94
|
| Rate for Payer: Humana Medicare/TRICARE |
$55.94
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$55.94
|
| Rate for Payer: Molina Medicare |
$55.94
|
| Rate for Payer: Multiplan Auto |
$314.60
|
| Rate for Payer: Multiplan Commercial |
$314.60
|
| Rate for Payer: Multiplan Workers Comp |
$314.60
|
| Rate for Payer: Scott and White EPO/PPO |
$19.73
|
| Rate for Payer: Scott and White Medicare |
$55.94
|
| Rate for Payer: Superior Health Plan EPO |
$55.94
|
| Rate for Payer: Superior Health Plan Medicare |
$55.94
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$55.94
|
| Rate for Payer: Universal American Medicare |
$55.94
|
| Rate for Payer: Wellcare Medicare |
$55.94
|
| Rate for Payer: Wellmed Medicare |
$55.94
|
|
|
ED Ear Procedure: Cerumen w/ Instrumentation
|
Facility
|
OP
|
$1,639.00
|
|
|
Service Code
|
CPT 69210
|
| Hospital Charge Code |
7150378
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$39.65 |
| Max. Negotiated Rate |
$1,065.35 |
| Rate for Payer: Aetna Commercial |
$901.45
|
| Rate for Payer: Aetna Medicare |
$83.91
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$147.51
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$55.94
|
| Rate for Payer: Amerigroup Medicare |
$55.94
|
| Rate for Payer: BCBS of TX Blue Advantage |
$91.87
|
| Rate for Payer: BCBS of TX Blue Essentials |
$110.02
|
| Rate for Payer: BCBS of TX Medicare |
$55.94
|
| Rate for Payer: BCBS of TX PPO |
$138.63
|
| Rate for Payer: Cash Price |
$1,442.32
|
| Rate for Payer: Cash Price |
$1,442.32
|
| Rate for Payer: Cash Price |
$1,442.32
|
| Rate for Payer: Cigna Commercial |
$126.71
|
| Rate for Payer: Cigna Medicare |
$55.94
|
| Rate for Payer: Employer Direct Commercial |
$55.94
|
| Rate for Payer: Humana Medicare/TRICARE |
$55.94
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$55.94
|
| Rate for Payer: Molina Medicare |
$55.94
|
| Rate for Payer: Multiplan Auto |
$1,065.35
|
| Rate for Payer: Multiplan Commercial |
$1,065.35
|
| Rate for Payer: Multiplan Workers Comp |
$1,065.35
|
| Rate for Payer: Scott and White EPO/PPO |
$39.65
|
| Rate for Payer: Scott and White Medicare |
$55.94
|
| Rate for Payer: Superior Health Plan EPO |
$55.94
|
| Rate for Payer: Superior Health Plan Medicare |
$55.94
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$55.94
|
| Rate for Payer: Universal American Medicare |
$55.94
|
| Rate for Payer: Wellcare Medicare |
$55.94
|
| Rate for Payer: Wellmed Medicare |
$55.94
|
|
