|
ED Ear Procedure: Cerumen w/ Instrumentation
|
Facility
|
IP
|
$1,639.00
|
|
|
Service Code
|
CPT 69210
|
| Hospital Charge Code |
7150378
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$1,442.32
|
|
|
ED Ear Procedures Cerumen Irrigation/Lavage BCE
|
Facility
|
OP
|
$484.00
|
|
|
Service Code
|
CPT 69209
|
| Hospital Charge Code |
5202517
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| 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 |
$1.00
|
| 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 Procedures Cerumen w/ Instrumentation BCE
|
Facility
|
OP
|
$1,639.00
|
|
|
Service Code
|
CPT 69210
|
| Hospital Charge Code |
7150378
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| 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 |
$1.00
|
| 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 EGD PLACE GASTROSTOMY TUBE BCE
|
Facility
|
OP
|
$5,390.12
|
|
|
Service Code
|
CPT 43246
|
| Hospital Charge Code |
8796540
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$31.12 |
| Max. Negotiated Rate |
$3,942.10 |
| Rate for Payer: Aetna Commercial |
$2,200.00
|
| Rate for Payer: Aetna Medicare |
$2,610.33
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$485.11
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,740.22
|
| Rate for Payer: Amerigroup Medicare |
$1,740.22
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,600.86
|
| Rate for Payer: BCBS of TX Blue Essentials |
$3,114.80
|
| Rate for Payer: BCBS of TX Medicare |
$1,740.22
|
| Rate for Payer: BCBS of TX PPO |
$3,924.65
|
| Rate for Payer: Cash Price |
$4,743.31
|
| Rate for Payer: Cash Price |
$4,743.31
|
| Rate for Payer: Cash Price |
$4,743.31
|
| Rate for Payer: Cigna Commercial |
$3,942.10
|
| Rate for Payer: Cigna Medicaid |
$564.97
|
| Rate for Payer: Cigna Medicare |
$1,740.22
|
| Rate for Payer: Employer Direct Commercial |
$1,740.22
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,740.22
|
| Rate for Payer: Molina CHIP/Medicaid |
$564.97
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,740.22
|
| Rate for Payer: Molina Medicare |
$1,740.22
|
| Rate for Payer: Multiplan Auto |
$3,503.58
|
| Rate for Payer: Multiplan Commercial |
$3,503.58
|
| Rate for Payer: Multiplan Workers Comp |
$3,503.58
|
| Rate for Payer: Parkland Medicaid |
$564.97
|
| Rate for Payer: Scott and White EPO/PPO |
$31.12
|
| Rate for Payer: Scott and White Medicare |
$1,740.22
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$564.97
|
| Rate for Payer: Superior Health Plan EPO |
$1,740.22
|
| Rate for Payer: Superior Health Plan Medicare |
$1,740.22
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,740.22
|
| Rate for Payer: Universal American Medicare |
$1,740.22
|
| Rate for Payer: Wellcare Medicare |
$1,740.22
|
| Rate for Payer: Wellmed Medicare |
$1,740.22
|
|
|
ED EGD PLACE GASTROSTOMY TUBE BCE
|
Facility
|
IP
|
$5,390.12
|
|
|
Service Code
|
CPT 43246
|
| Hospital Charge Code |
8796540
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$4,743.31
|
|
|
ED EXC B9 LES MRGN 3.1 TO 4.0CM BCE
|
Facility
|
OP
|
$5,911.00
|
|
|
Service Code
|
CPT 11424
|
| Hospital Charge Code |
8402469
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$26.52 |
| Max. Negotiated Rate |
$3,842.15 |
| Rate for Payer: Aetna Commercial |
$2,200.00
|
| Rate for Payer: Aetna Medicare |
$2,224.11
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$531.99
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,482.74
|
| Rate for Payer: Amerigroup Medicare |
$1,482.74
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,292.24
|
| Rate for Payer: BCBS of TX Blue Essentials |
$2,745.20
|
| Rate for Payer: BCBS of TX Medicare |
$1,482.74
|
| Rate for Payer: BCBS of TX PPO |
$3,458.95
|
| Rate for Payer: Cash Price |
$5,201.68
|
| Rate for Payer: Cash Price |
$5,201.68
|
| Rate for Payer: Cash Price |
$5,201.68
|
| Rate for Payer: Cigna Commercial |
$3,358.84
|
| Rate for Payer: Cigna Medicaid |
$486.45
|
| Rate for Payer: Cigna Medicare |
$1,482.74
|
| Rate for Payer: Employer Direct Commercial |
$1,482.74
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,482.74
|
| Rate for Payer: Molina CHIP/Medicaid |
$486.45
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,482.74
|
| Rate for Payer: Molina Medicare |
$1,482.74
|
| Rate for Payer: Multiplan Auto |
$3,842.15
|
| Rate for Payer: Multiplan Commercial |
$3,842.15
|
| Rate for Payer: Multiplan Workers Comp |
$3,842.15
|
| Rate for Payer: Parkland Medicaid |
$486.45
|
| Rate for Payer: Scott and White EPO/PPO |
$26.52
|
| Rate for Payer: Scott and White Medicare |
$1,482.74
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$486.45
|
| Rate for Payer: Superior Health Plan EPO |
$1,482.74
|
| Rate for Payer: Superior Health Plan Medicare |
$1,482.74
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,482.74
|
| Rate for Payer: Universal American Medicare |
$1,482.74
|
| Rate for Payer: Wellcare Medicare |
$1,482.74
|
| Rate for Payer: Wellmed Medicare |
$1,482.74
|
|
|
ED EXC B9 LES MRGN 3.1 TO 4.0CM BCE
|
Facility
|
IP
|
$5,911.00
|
|
|
Service Code
|
CPT 11424
|
| Hospital Charge Code |
8402469
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$5,201.68
|
|
|
ED Eye Procedure: Corneal w/o Slit Lamp
|
Facility
|
IP
|
$923.00
|
|
|
Service Code
|
CPT 65220
|
| Hospital Charge Code |
5202518
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$812.24
|
|
|
ED Eye Procedure: Corneal w/o Slit Lamp
|
Facility
|
OP
|
$923.00
|
|
|
Service Code
|
CPT 65220
|
| Hospital Charge Code |
5202518
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$6.52 |
| Max. Negotiated Rate |
$916.25 |
| Rate for Payer: Aetna Commercial |
$507.65
|
| Rate for Payer: Aetna Medicare |
$546.58
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$83.07
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$364.39
|
| Rate for Payer: Amerigroup Medicare |
$364.39
|
| Rate for Payer: BCBS of TX Blue Advantage |
$607.20
|
| Rate for Payer: BCBS of TX Blue Essentials |
$727.18
|
| Rate for Payer: BCBS of TX Medicare |
$364.39
|
| Rate for Payer: BCBS of TX PPO |
$916.25
|
| Rate for Payer: Cash Price |
$812.24
|
| Rate for Payer: Cash Price |
$812.24
|
| Rate for Payer: Cash Price |
$812.24
|
| Rate for Payer: Cigna Commercial |
$825.46
|
| Rate for Payer: Cigna Medicare |
$364.39
|
| Rate for Payer: Employer Direct Commercial |
$364.39
|
| Rate for Payer: Humana Medicare/TRICARE |
$364.39
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$364.39
|
| Rate for Payer: Molina Medicare |
$364.39
|
| Rate for Payer: Multiplan Auto |
$599.95
|
| Rate for Payer: Multiplan Commercial |
$599.95
|
| Rate for Payer: Multiplan Workers Comp |
$599.95
|
| Rate for Payer: Scott and White EPO/PPO |
$6.52
|
| Rate for Payer: Scott and White Medicare |
$364.39
|
| Rate for Payer: Superior Health Plan EPO |
$364.39
|
| Rate for Payer: Superior Health Plan Medicare |
$364.39
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$364.39
|
| Rate for Payer: Universal American Medicare |
$364.39
|
| Rate for Payer: Wellcare Medicare |
$364.39
|
| Rate for Payer: Wellmed Medicare |
$364.39
|
|
|
ED Eye Procedures Corneal w/o Slit Lamp BCE
|
Facility
|
OP
|
$923.00
|
|
|
Service Code
|
CPT 65220
|
| Hospital Charge Code |
5202518
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$6.52 |
| Max. Negotiated Rate |
$916.25 |
| Rate for Payer: Aetna Commercial |
$507.65
|
| Rate for Payer: Aetna Medicare |
$546.58
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$83.07
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$364.39
|
| Rate for Payer: Amerigroup Medicare |
$364.39
|
| Rate for Payer: BCBS of TX Blue Advantage |
$607.20
|
| Rate for Payer: BCBS of TX Blue Essentials |
$727.18
|
| Rate for Payer: BCBS of TX Medicare |
$364.39
|
| Rate for Payer: BCBS of TX PPO |
$916.25
|
| Rate for Payer: Cash Price |
$812.24
|
| Rate for Payer: Cash Price |
$812.24
|
| Rate for Payer: Cash Price |
$812.24
|
| Rate for Payer: Cigna Commercial |
$825.46
|
| Rate for Payer: Cigna Medicare |
$364.39
|
| Rate for Payer: Employer Direct Commercial |
$364.39
|
| Rate for Payer: Humana Medicare/TRICARE |
$364.39
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$364.39
|
| Rate for Payer: Molina Medicare |
$364.39
|
| Rate for Payer: Multiplan Auto |
$599.95
|
| Rate for Payer: Multiplan Commercial |
$599.95
|
| Rate for Payer: Multiplan Workers Comp |
$599.95
|
| Rate for Payer: Scott and White EPO/PPO |
$6.52
|
| Rate for Payer: Scott and White Medicare |
$364.39
|
| Rate for Payer: Superior Health Plan EPO |
$364.39
|
| Rate for Payer: Superior Health Plan Medicare |
$364.39
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$364.39
|
| Rate for Payer: Universal American Medicare |
$364.39
|
| Rate for Payer: Wellcare Medicare |
$364.39
|
| Rate for Payer: Wellmed Medicare |
$364.39
|
|
|
ED Flu Initial Admin Charge 90471/G0008 BCE
|
Facility
|
OP
|
$124.00
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
5200043
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$1.15 |
| Max. Negotiated Rate |
$145.94 |
| Rate for Payer: Aetna Commercial |
$68.20
|
| Rate for Payer: Aetna Medicare |
$96.64
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$11.16
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$64.43
|
| Rate for Payer: Amerigroup Medicare |
$64.43
|
| Rate for Payer: BCBS of TX Blue Advantage |
$105.22
|
| Rate for Payer: BCBS of TX Blue Essentials |
$125.78
|
| Rate for Payer: BCBS of TX Medicare |
$64.43
|
| Rate for Payer: BCBS of TX PPO |
$140.29
|
| Rate for Payer: Cash Price |
$109.12
|
| Rate for Payer: Cash Price |
$109.12
|
| Rate for Payer: Cash Price |
$109.12
|
| Rate for Payer: Cigna Commercial |
$145.94
|
| Rate for Payer: Cigna Medicare |
$64.43
|
| Rate for Payer: Employer Direct Commercial |
$64.43
|
| Rate for Payer: Humana Medicare/TRICARE |
$64.43
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$64.43
|
| Rate for Payer: Molina Medicare |
$64.43
|
| Rate for Payer: Multiplan Auto |
$80.60
|
| Rate for Payer: Multiplan Commercial |
$80.60
|
| Rate for Payer: Multiplan Workers Comp |
$80.60
|
| Rate for Payer: Scott and White EPO/PPO |
$1.15
|
| Rate for Payer: Scott and White Medicare |
$64.43
|
| Rate for Payer: Superior Health Plan EPO |
$64.43
|
| Rate for Payer: Superior Health Plan Medicare |
$64.43
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$64.43
|
| Rate for Payer: Universal American Medicare |
$64.43
|
| Rate for Payer: Wellcare Medicare |
$64.43
|
| Rate for Payer: Wellmed Medicare |
$64.43
|
|
|
ED - Flu Vaccine Adm G0008
|
Facility
|
IP
|
$124.00
|
|
|
Service Code
|
HCPCS G0008
|
| Hospital Charge Code |
5200043
|
|
Hospital Revenue Code
|
771
|
| Rate for Payer: Cash Price |
$109.12
|
|
|
ED - Flu Vaccine Adm G0008
|
Facility
|
OP
|
$124.00
|
|
|
Service Code
|
HCPCS G0008
|
| Hospital Charge Code |
5200043
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$0.78 |
| Max. Negotiated Rate |
$98.40 |
| Rate for Payer: Aetna Commercial |
$68.20
|
| Rate for Payer: Aetna Medicare |
$65.16
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$11.16
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$43.44
|
| Rate for Payer: Amerigroup Medicare |
$43.44
|
| Rate for Payer: BCBS of TX Blue Advantage |
$41.39
|
| Rate for Payer: BCBS of TX Blue Essentials |
$49.48
|
| Rate for Payer: BCBS of TX Medicare |
$43.44
|
| Rate for Payer: BCBS of TX PPO |
$55.19
|
| Rate for Payer: Cash Price |
$109.12
|
| Rate for Payer: Cash Price |
$109.12
|
| Rate for Payer: Cash Price |
$109.12
|
| Rate for Payer: Cigna Commercial |
$98.40
|
| Rate for Payer: Cigna Medicare |
$43.44
|
| Rate for Payer: Employer Direct Commercial |
$43.44
|
| Rate for Payer: Humana Medicare/TRICARE |
$43.44
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$43.44
|
| Rate for Payer: Molina Medicare |
$43.44
|
| Rate for Payer: Multiplan Auto |
$80.60
|
| Rate for Payer: Multiplan Commercial |
$80.60
|
| Rate for Payer: Multiplan Workers Comp |
$80.60
|
| Rate for Payer: Scott and White EPO/PPO |
$0.78
|
| Rate for Payer: Scott and White Medicare |
$43.44
|
| Rate for Payer: Superior Health Plan EPO |
$43.44
|
| Rate for Payer: Superior Health Plan Medicare |
$43.44
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$43.44
|
| Rate for Payer: Universal American Medicare |
$43.44
|
| Rate for Payer: Wellcare Medicare |
$43.44
|
| Rate for Payer: Wellmed Medicare |
$43.44
|
|
|
ED Foreign Body Removal Site: Auditory canal, external w/o anesthesia
|
Facility
|
OP
|
$476.00
|
|
|
Service Code
|
CPT 69200
|
| Hospital Charge Code |
9250012
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2.09 |
| Max. Negotiated Rate |
$309.40 |
| Rate for Payer: Aetna Commercial |
$261.80
|
| Rate for Payer: Aetna Medicare |
$175.23
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$42.84
|
| 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 |
$418.88
|
| Rate for Payer: Cash Price |
$418.88
|
| Rate for Payer: Cash Price |
$418.88
|
| 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 |
$309.40
|
| Rate for Payer: Multiplan Commercial |
$309.40
|
| Rate for Payer: Multiplan Workers Comp |
$309.40
|
| 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 Foreign Body Removal Site: Auditory canal, external w/o anesthesia
|
Facility
|
IP
|
$476.00
|
|
|
Service Code
|
CPT 69200
|
| Hospital Charge Code |
9250012
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$418.88
|
|
|
ED Foreign Body Removal Site Auditory canal, external w/o anesthesia BCE
|
Facility
|
OP
|
$476.00
|
|
|
Service Code
|
CPT 69200
|
| Hospital Charge Code |
9250012
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2.09 |
| Max. Negotiated Rate |
$309.40 |
| Rate for Payer: Aetna Commercial |
$261.80
|
| Rate for Payer: Aetna Medicare |
$175.23
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$42.84
|
| 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 |
$418.88
|
| Rate for Payer: Cash Price |
$418.88
|
| Rate for Payer: Cash Price |
$418.88
|
| 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 |
$309.40
|
| Rate for Payer: Multiplan Commercial |
$309.40
|
| Rate for Payer: Multiplan Workers Comp |
$309.40
|
| 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 Foreign Body Removal Site: Intranasal
|
Facility
|
IP
|
$323.00
|
|
|
Service Code
|
CPT 30300
|
| Hospital Charge Code |
5202521
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$284.24
|
|
|
ED Foreign Body Removal Site: Intranasal
|
Facility
|
OP
|
$323.00
|
|
|
Service Code
|
CPT 30300
|
| Hospital Charge Code |
5202521
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2.09 |
| Max. Negotiated Rate |
$274.76 |
| Rate for Payer: Aetna Commercial |
$177.65
|
| Rate for Payer: Aetna Medicare |
$175.23
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$29.07
|
| 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 |
$284.24
|
| Rate for Payer: Cash Price |
$284.24
|
| Rate for Payer: Cash Price |
$284.24
|
| 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 |
$209.95
|
| Rate for Payer: Multiplan Commercial |
$209.95
|
| Rate for Payer: Multiplan Workers Comp |
$209.95
|
| 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 Foreign Body Removal Site Intranasal BCE
|
Facility
|
OP
|
$323.00
|
|
|
Service Code
|
CPT 30300
|
| Hospital Charge Code |
5202521
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2.09 |
| Max. Negotiated Rate |
$274.76 |
| Rate for Payer: Aetna Commercial |
$177.65
|
| Rate for Payer: Aetna Medicare |
$175.23
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$29.07
|
| 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 |
$284.24
|
| Rate for Payer: Cash Price |
$284.24
|
| Rate for Payer: Cash Price |
$284.24
|
| 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 |
$209.95
|
| Rate for Payer: Multiplan Commercial |
$209.95
|
| Rate for Payer: Multiplan Workers Comp |
$209.95
|
| 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 Foreign Body Removal Site: Scrotum
|
Facility
|
IP
|
$8,880.00
|
|
|
Service Code
|
CPT 55120
|
| Hospital Charge Code |
5202522
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$7,814.40
|
|
|
ED Foreign Body Removal Site: Scrotum
|
Facility
|
OP
|
$8,880.00
|
|
|
Service Code
|
CPT 55120
|
| Hospital Charge Code |
5202522
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$33.31 |
| Max. Negotiated Rate |
$5,772.00 |
| Rate for Payer: Aetna Commercial |
$3,090.00
|
| Rate for Payer: Aetna Medicare |
$2,794.14
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$799.20
|
| 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 |
$7,814.40
|
| Rate for Payer: Cash Price |
$7,814.40
|
| Rate for Payer: Cash Price |
$7,814.40
|
| 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 |
$5,772.00
|
| Rate for Payer: Multiplan Commercial |
$5,772.00
|
| Rate for Payer: Multiplan Workers Comp |
$5,772.00
|
| 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 Foreign Body Removal Site Scrotum BCE
|
Facility
|
OP
|
$8,880.00
|
|
|
Service Code
|
CPT 55120
|
| Hospital Charge Code |
5202522
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$33.31 |
| Max. Negotiated Rate |
$5,772.00 |
| Rate for Payer: Aetna Commercial |
$3,090.00
|
| Rate for Payer: Aetna Medicare |
$2,794.14
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$799.20
|
| 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 |
$7,814.40
|
| Rate for Payer: Cash Price |
$7,814.40
|
| Rate for Payer: Cash Price |
$7,814.40
|
| 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 |
$5,772.00
|
| Rate for Payer: Multiplan Commercial |
$5,772.00
|
| Rate for Payer: Multiplan Workers Comp |
$5,772.00
|
| 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 Foreign Body Removal Site: Skin, Subcutaneous Complex FB
|
Facility
|
IP
|
$3,692.00
|
|
|
Service Code
|
CPT 10121
|
| Hospital Charge Code |
5202519
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$3,248.96
|
|
|
ED Foreign Body Removal Site: Skin, Subcutaneous Complex FB
|
Facility
|
OP
|
$3,692.00
|
|
|
Service Code
|
CPT 10121
|
| Hospital Charge Code |
5202519
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$26.52 |
| Max. Negotiated Rate |
$3,458.95 |
| Rate for Payer: Aetna Commercial |
$2,200.00
|
| Rate for Payer: Aetna Medicare |
$2,224.11
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$332.28
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,482.74
|
| Rate for Payer: Amerigroup Medicare |
$1,482.74
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,292.24
|
| Rate for Payer: BCBS of TX Blue Essentials |
$2,745.20
|
| Rate for Payer: BCBS of TX Medicare |
$1,482.74
|
| Rate for Payer: BCBS of TX PPO |
$3,458.95
|
| Rate for Payer: Cash Price |
$3,248.96
|
| Rate for Payer: Cash Price |
$3,248.96
|
| Rate for Payer: Cash Price |
$3,248.96
|
| Rate for Payer: Cigna Commercial |
$3,358.84
|
| Rate for Payer: Cigna Medicaid |
$486.45
|
| Rate for Payer: Cigna Medicare |
$1,482.74
|
| Rate for Payer: Employer Direct Commercial |
$1,482.74
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,482.74
|
| Rate for Payer: Molina CHIP/Medicaid |
$486.45
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,482.74
|
| Rate for Payer: Molina Medicare |
$1,482.74
|
| Rate for Payer: Multiplan Auto |
$2,399.80
|
| Rate for Payer: Multiplan Commercial |
$2,399.80
|
| Rate for Payer: Multiplan Workers Comp |
$2,399.80
|
| Rate for Payer: Parkland Medicaid |
$486.45
|
| Rate for Payer: Scott and White EPO/PPO |
$26.52
|
| Rate for Payer: Scott and White Medicare |
$1,482.74
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$486.45
|
| Rate for Payer: Superior Health Plan EPO |
$1,482.74
|
| Rate for Payer: Superior Health Plan Medicare |
$1,482.74
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,482.74
|
| Rate for Payer: Universal American Medicare |
$1,482.74
|
| Rate for Payer: Wellcare Medicare |
$1,482.74
|
| Rate for Payer: Wellmed Medicare |
$1,482.74
|
|
|
ED Foreign Body Removal Site Skin, Subcutaneous Complex FB BCE
|
Facility
|
OP
|
$3,692.00
|
|
|
Service Code
|
CPT 10121
|
| Hospital Charge Code |
5202519
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$26.52 |
| Max. Negotiated Rate |
$3,458.95 |
| Rate for Payer: Aetna Commercial |
$2,200.00
|
| Rate for Payer: Aetna Medicare |
$2,224.11
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$332.28
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,482.74
|
| Rate for Payer: Amerigroup Medicare |
$1,482.74
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,292.24
|
| Rate for Payer: BCBS of TX Blue Essentials |
$2,745.20
|
| Rate for Payer: BCBS of TX Medicare |
$1,482.74
|
| Rate for Payer: BCBS of TX PPO |
$3,458.95
|
| Rate for Payer: Cash Price |
$3,248.96
|
| Rate for Payer: Cash Price |
$3,248.96
|
| Rate for Payer: Cash Price |
$3,248.96
|
| Rate for Payer: Cigna Commercial |
$3,358.84
|
| Rate for Payer: Cigna Medicaid |
$486.45
|
| Rate for Payer: Cigna Medicare |
$1,482.74
|
| Rate for Payer: Employer Direct Commercial |
$1,482.74
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,482.74
|
| Rate for Payer: Molina CHIP/Medicaid |
$486.45
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,482.74
|
| Rate for Payer: Molina Medicare |
$1,482.74
|
| Rate for Payer: Multiplan Auto |
$2,399.80
|
| Rate for Payer: Multiplan Commercial |
$2,399.80
|
| Rate for Payer: Multiplan Workers Comp |
$2,399.80
|
| Rate for Payer: Parkland Medicaid |
$486.45
|
| Rate for Payer: Scott and White EPO/PPO |
$26.52
|
| Rate for Payer: Scott and White Medicare |
$1,482.74
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$486.45
|
| Rate for Payer: Superior Health Plan EPO |
$1,482.74
|
| Rate for Payer: Superior Health Plan Medicare |
$1,482.74
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,482.74
|
| Rate for Payer: Universal American Medicare |
$1,482.74
|
| Rate for Payer: Wellcare Medicare |
$1,482.74
|
| Rate for Payer: Wellmed Medicare |
$1,482.74
|
|
