|
ED Foreign Body Removal Site: Skin, Subcutaneous Simple FB
|
Facility
|
OP
|
$1,029.00
|
|
|
Service Code
|
CPT 10120
|
| Hospital Charge Code |
7150139
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$6.52 |
| Max. Negotiated Rate |
$826.08 |
| Rate for Payer: Aetna Commercial |
$565.95
|
| Rate for Payer: Aetna Medicare |
$547.00
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$92.61
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$364.67
|
| Rate for Payer: Amerigroup Medicare |
$364.67
|
| Rate for Payer: BCBS of TX Blue Advantage |
$178.41
|
| Rate for Payer: BCBS of TX Blue Essentials |
$213.66
|
| Rate for Payer: BCBS of TX Medicare |
$364.67
|
| Rate for Payer: BCBS of TX PPO |
$269.21
|
| Rate for Payer: Cash Price |
$905.52
|
| Rate for Payer: Cash Price |
$905.52
|
| Rate for Payer: Cash Price |
$905.52
|
| Rate for Payer: Cigna Commercial |
$826.08
|
| Rate for Payer: Cigna Medicaid |
$86.38
|
| 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 |
$86.38
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$364.67
|
| Rate for Payer: Molina Medicare |
$364.67
|
| Rate for Payer: Multiplan Auto |
$668.85
|
| Rate for Payer: Multiplan Commercial |
$668.85
|
| Rate for Payer: Multiplan Workers Comp |
$668.85
|
| Rate for Payer: Parkland Medicaid |
$86.38
|
| 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 |
$86.38
|
| 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 Foreign Body Removal Site: Skin, Subcutaneous Simple FB
|
Facility
|
IP
|
$1,029.00
|
|
|
Service Code
|
CPT 10120
|
| Hospital Charge Code |
7150139
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$905.52
|
|
|
ED Foreign Body Removal Site Skin, Subcutaneous Simple FB BCE
|
Facility
|
OP
|
$1,029.00
|
|
|
Service Code
|
CPT 10120
|
| Hospital Charge Code |
7150139
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$6.52 |
| Max. Negotiated Rate |
$826.08 |
| Rate for Payer: Aetna Commercial |
$565.95
|
| Rate for Payer: Aetna Medicare |
$547.00
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$92.61
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$364.67
|
| Rate for Payer: Amerigroup Medicare |
$364.67
|
| Rate for Payer: BCBS of TX Blue Advantage |
$178.41
|
| Rate for Payer: BCBS of TX Blue Essentials |
$213.66
|
| Rate for Payer: BCBS of TX Medicare |
$364.67
|
| Rate for Payer: BCBS of TX PPO |
$269.21
|
| Rate for Payer: Cash Price |
$905.52
|
| Rate for Payer: Cash Price |
$905.52
|
| Rate for Payer: Cash Price |
$905.52
|
| Rate for Payer: Cigna Commercial |
$826.08
|
| Rate for Payer: Cigna Medicaid |
$86.38
|
| 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 |
$86.38
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$364.67
|
| Rate for Payer: Molina Medicare |
$364.67
|
| Rate for Payer: Multiplan Auto |
$668.85
|
| Rate for Payer: Multiplan Commercial |
$668.85
|
| Rate for Payer: Multiplan Workers Comp |
$668.85
|
| Rate for Payer: Parkland Medicaid |
$86.38
|
| 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 |
$86.38
|
| 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 Foreign Body Removal Site: Upper Arm/Elbow
|
Facility
|
IP
|
$2,714.00
|
|
|
Service Code
|
CPT 24200
|
| Hospital Charge Code |
5202520
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$2,388.32
|
|
|
ED Foreign Body Removal Site: Upper Arm/Elbow
|
Facility
|
OP
|
$2,714.00
|
|
|
Service Code
|
CPT 24200
|
| Hospital Charge Code |
5202520
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$26.52 |
| Max. Negotiated Rate |
$3,358.84 |
| Rate for Payer: Aetna Commercial |
$1,400.00
|
| Rate for Payer: Aetna Medicare |
$2,224.11
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$244.26
|
| 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 |
$245.91
|
| Rate for Payer: BCBS of TX Blue Essentials |
$294.50
|
| Rate for Payer: BCBS of TX Medicare |
$1,482.74
|
| Rate for Payer: BCBS of TX PPO |
$371.07
|
| Rate for Payer: Cash Price |
$2,388.32
|
| Rate for Payer: Cash Price |
$2,388.32
|
| Rate for Payer: Cash Price |
$2,388.32
|
| Rate for Payer: Cigna Commercial |
$3,358.84
|
| Rate for Payer: Cigna Medicaid |
$123.47
|
| 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 |
$123.47
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,482.74
|
| Rate for Payer: Molina Medicare |
$1,482.74
|
| Rate for Payer: Multiplan Auto |
$1,764.10
|
| Rate for Payer: Multiplan Commercial |
$1,764.10
|
| Rate for Payer: Multiplan Workers Comp |
$1,764.10
|
| Rate for Payer: Parkland Medicaid |
$123.47
|
| 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 |
$123.47
|
| 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 Upper Arm/Elbow BCE
|
Facility
|
OP
|
$2,714.00
|
|
|
Service Code
|
CPT 24200
|
| Hospital Charge Code |
5202520
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$26.52 |
| Max. Negotiated Rate |
$3,358.84 |
| Rate for Payer: Aetna Commercial |
$1,400.00
|
| Rate for Payer: Aetna Medicare |
$2,224.11
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$244.26
|
| 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 |
$245.91
|
| Rate for Payer: BCBS of TX Blue Essentials |
$294.50
|
| Rate for Payer: BCBS of TX Medicare |
$1,482.74
|
| Rate for Payer: BCBS of TX PPO |
$371.07
|
| Rate for Payer: Cash Price |
$2,388.32
|
| Rate for Payer: Cash Price |
$2,388.32
|
| Rate for Payer: Cash Price |
$2,388.32
|
| Rate for Payer: Cigna Commercial |
$3,358.84
|
| Rate for Payer: Cigna Medicaid |
$123.47
|
| 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 |
$123.47
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,482.74
|
| Rate for Payer: Molina Medicare |
$1,482.74
|
| Rate for Payer: Multiplan Auto |
$1,764.10
|
| Rate for Payer: Multiplan Commercial |
$1,764.10
|
| Rate for Payer: Multiplan Workers Comp |
$1,764.10
|
| Rate for Payer: Parkland Medicaid |
$123.47
|
| 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 |
$123.47
|
| 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 Fracture Site: Bimalleolar Fx, w/o Manipulation
|
Facility
|
OP
|
$1,059.00
|
|
|
Service Code
|
CPT 27808
|
| Hospital Charge Code |
9220225
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3.86 |
| Max. Negotiated Rate |
$688.35 |
| Rate for Payer: Aetna Commercial |
$582.45
|
| Rate for Payer: Aetna Medicare |
$323.50
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$95.31
|
| 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 |
$931.92
|
| Rate for Payer: Cash Price |
$931.92
|
| Rate for Payer: Cash Price |
$931.92
|
| 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 |
$688.35
|
| Rate for Payer: Multiplan Commercial |
$688.35
|
| Rate for Payer: Multiplan Workers Comp |
$688.35
|
| 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 Fracture Site Bimalleolar Fx, w/o Manipulation BCE
|
Facility
|
IP
|
$1,059.00
|
|
|
Service Code
|
CPT 27808
|
| Hospital Charge Code |
9220225
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$931.92
|
|
|
ED Fracture Site Bimalleolar Fx, w/o Manipulation BCE
|
Facility
|
OP
|
$1,059.00
|
|
|
Service Code
|
CPT 27808
|
| Hospital Charge Code |
9220225
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3.86 |
| Max. Negotiated Rate |
$688.35 |
| Rate for Payer: Aetna Commercial |
$582.45
|
| Rate for Payer: Aetna Medicare |
$323.50
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$95.31
|
| 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 |
$931.92
|
| Rate for Payer: Cash Price |
$931.92
|
| Rate for Payer: Cash Price |
$931.92
|
| 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 |
$688.35
|
| Rate for Payer: Multiplan Commercial |
$688.35
|
| Rate for Payer: Multiplan Workers Comp |
$688.35
|
| 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 Fracture Site: Elbow/ Monteggia w/ manipulation
|
Facility
|
OP
|
$3,361.00
|
|
|
Service Code
|
CPT 24620
|
| Hospital Charge Code |
9220202
|
|
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 |
$302.49
|
| 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 |
$2,957.68
|
| Rate for Payer: Cash Price |
$2,957.68
|
| Rate for Payer: Cash Price |
$2,957.68
|
| 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 |
$2,184.65
|
| Rate for Payer: Multiplan Commercial |
$2,184.65
|
| Rate for Payer: Multiplan Workers Comp |
$2,184.65
|
| Rate for Payer: Parkland Medicaid |
$593.04
|
| Rate for Payer: Scott and White EPO/PPO |
$26.29
|
| Rate for Payer: Scott and White Medicare |
$1,469.86
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$593.04
|
| Rate for Payer: Superior Health Plan EPO |
$1,469.86
|
| Rate for Payer: Superior Health Plan Medicare |
$1,469.86
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,469.86
|
| Rate for Payer: Universal American Medicare |
$1,469.86
|
| Rate for Payer: Wellcare Medicare |
$1,469.86
|
| Rate for Payer: Wellmed Medicare |
$1,469.86
|
|
|
ED Fracture Site Elbow/ Monteggia w/ manipulation BCE
|
Facility
|
OP
|
$3,361.00
|
|
|
Service Code
|
CPT 24620
|
| Hospital Charge Code |
9220202
|
|
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 |
$302.49
|
| 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 |
$2,957.68
|
| Rate for Payer: Cash Price |
$2,957.68
|
| Rate for Payer: Cash Price |
$2,957.68
|
| 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 |
$2,184.65
|
| Rate for Payer: Multiplan Commercial |
$2,184.65
|
| Rate for Payer: Multiplan Workers Comp |
$2,184.65
|
| Rate for Payer: Parkland Medicaid |
$593.04
|
| Rate for Payer: Scott and White EPO/PPO |
$26.29
|
| Rate for Payer: Scott and White Medicare |
$1,469.86
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$593.04
|
| Rate for Payer: Superior Health Plan EPO |
$1,469.86
|
| Rate for Payer: Superior Health Plan Medicare |
$1,469.86
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,469.86
|
| Rate for Payer: Universal American Medicare |
$1,469.86
|
| Rate for Payer: Wellcare Medicare |
$1,469.86
|
| Rate for Payer: Wellmed Medicare |
$1,469.86
|
|
|
ED Fracture Site Elbow/ Monteggia w/ manipulation BCE
|
Facility
|
IP
|
$3,361.00
|
|
|
Service Code
|
CPT 24620
|
| Hospital Charge Code |
9220202
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$2,957.68
|
|
|
ED Fracture Site: Fibula Fx, Distal, w/ manipulation
|
Facility
|
OP
|
$323.00
|
|
|
Service Code
|
CPT 27788
|
| Hospital Charge Code |
5202527
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3.86 |
| Max. Negotiated Rate |
$543.41 |
| Rate for Payer: Aetna Commercial |
$177.65
|
| Rate for Payer: Aetna Medicare |
$323.50
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$29.07
|
| 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 |
$284.24
|
| Rate for Payer: Cash Price |
$284.24
|
| Rate for Payer: Cash Price |
$284.24
|
| 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 |
$209.95
|
| Rate for Payer: Multiplan Commercial |
$209.95
|
| Rate for Payer: Multiplan Workers Comp |
$209.95
|
| 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 Fracture Site Fibula Fx, Distal, w/ manipulation BCE
|
Facility
|
OP
|
$323.00
|
|
|
Service Code
|
CPT 27788
|
| Hospital Charge Code |
5202527
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3.86 |
| Max. Negotiated Rate |
$543.41 |
| Rate for Payer: Aetna Commercial |
$177.65
|
| Rate for Payer: Aetna Medicare |
$323.50
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$29.07
|
| 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 |
$284.24
|
| Rate for Payer: Cash Price |
$284.24
|
| Rate for Payer: Cash Price |
$284.24
|
| 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 |
$209.95
|
| Rate for Payer: Multiplan Commercial |
$209.95
|
| Rate for Payer: Multiplan Workers Comp |
$209.95
|
| 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 Fracture Site Fibula Fx, Distal, w/ manipulation BCE
|
Facility
|
IP
|
$323.00
|
|
|
Service Code
|
CPT 27788
|
| Hospital Charge Code |
5202527
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$284.24
|
|
|
ED Fracture Site: Fibula Fx, Distal, w/o manipulation
|
Facility
|
OP
|
$243.00
|
|
|
Service Code
|
CPT 27786
|
| Hospital Charge Code |
9220224
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3.86 |
| Max. Negotiated Rate |
$543.41 |
| Rate for Payer: Aetna Commercial |
$133.65
|
| Rate for Payer: Aetna Medicare |
$323.50
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$21.87
|
| 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 |
$213.84
|
| Rate for Payer: Cash Price |
$213.84
|
| Rate for Payer: Cash Price |
$213.84
|
| 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 |
$157.95
|
| Rate for Payer: Multiplan Commercial |
$157.95
|
| Rate for Payer: Multiplan Workers Comp |
$157.95
|
| 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 Fracture Site Fibula Fx, Distal, w/o manipulation BCE
|
Facility
|
OP
|
$243.00
|
|
|
Service Code
|
CPT 27786
|
| Hospital Charge Code |
9220224
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3.86 |
| Max. Negotiated Rate |
$543.41 |
| Rate for Payer: Aetna Commercial |
$133.65
|
| Rate for Payer: Aetna Medicare |
$323.50
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$21.87
|
| 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 |
$213.84
|
| Rate for Payer: Cash Price |
$213.84
|
| Rate for Payer: Cash Price |
$213.84
|
| 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 |
$157.95
|
| Rate for Payer: Multiplan Commercial |
$157.95
|
| Rate for Payer: Multiplan Workers Comp |
$157.95
|
| 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 Fracture Site Fibula Fx, Distal, w/o manipulation BCE
|
Facility
|
IP
|
$243.00
|
|
|
Service Code
|
CPT 27786
|
| Hospital Charge Code |
9220224
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$213.84
|
|
|
ED Fracture Site: Great Toe w/ manipulation
|
Facility
|
OP
|
$1,117.00
|
|
|
Service Code
|
CPT 28495
|
| Hospital Charge Code |
9220229
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3.86 |
| Max. Negotiated Rate |
$726.05 |
| Rate for Payer: Aetna Commercial |
$614.35
|
| Rate for Payer: Aetna Medicare |
$323.50
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$100.53
|
| 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 |
$982.96
|
| Rate for Payer: Cash Price |
$982.96
|
| Rate for Payer: Cash Price |
$982.96
|
| 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 |
$726.05
|
| Rate for Payer: Multiplan Commercial |
$726.05
|
| Rate for Payer: Multiplan Workers Comp |
$726.05
|
| 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 Fracture Site Great Toe w/ manipulation BCE
|
Facility
|
OP
|
$1,117.00
|
|
|
Service Code
|
CPT 28495
|
| Hospital Charge Code |
9220229
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3.86 |
| Max. Negotiated Rate |
$726.05 |
| Rate for Payer: Aetna Commercial |
$614.35
|
| Rate for Payer: Aetna Medicare |
$323.50
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$100.53
|
| 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 |
$982.96
|
| Rate for Payer: Cash Price |
$982.96
|
| Rate for Payer: Cash Price |
$982.96
|
| 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 |
$726.05
|
| Rate for Payer: Multiplan Commercial |
$726.05
|
| Rate for Payer: Multiplan Workers Comp |
$726.05
|
| 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 Fracture Site Great Toe w/ manipulation BCE
|
Facility
|
IP
|
$1,117.00
|
|
|
Service Code
|
CPT 28495
|
| Hospital Charge Code |
9220229
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$982.96
|
|
|
ED Fracture Site: Humerus, proximal, w/ manipulation
|
Facility
|
OP
|
$2,762.00
|
|
|
Service Code
|
CPT 23605
|
| Hospital Charge Code |
5202523
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$26.29 |
| Max. Negotiated Rate |
$3,415.58 |
| Rate for Payer: Aetna Commercial |
$3,090.00
|
| Rate for Payer: Aetna Medicare |
$2,204.79
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$248.58
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,469.86
|
| Rate for Payer: Amerigroup Medicare |
$1,469.86
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,263.50
|
| Rate for Payer: BCBS of TX Blue Essentials |
$2,710.78
|
| Rate for Payer: BCBS of TX Medicare |
$1,469.86
|
| Rate for Payer: BCBS of TX PPO |
$3,415.58
|
| Rate for Payer: Cash Price |
$2,430.56
|
| Rate for Payer: Cash Price |
$2,430.56
|
| Rate for Payer: Cash Price |
$2,430.56
|
| Rate for Payer: Cigna Commercial |
$3,329.66
|
| Rate for Payer: Cigna Medicaid |
$593.04
|
| Rate for Payer: Cigna Medicare |
$1,469.86
|
| Rate for Payer: Employer Direct Commercial |
$1,469.86
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,469.86
|
| Rate for Payer: Molina CHIP/Medicaid |
$593.04
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,469.86
|
| Rate for Payer: Molina Medicare |
$1,469.86
|
| Rate for Payer: Multiplan Auto |
$1,795.30
|
| Rate for Payer: Multiplan Commercial |
$1,795.30
|
| Rate for Payer: Multiplan Workers Comp |
$1,795.30
|
| Rate for Payer: Parkland Medicaid |
$593.04
|
| Rate for Payer: Scott and White EPO/PPO |
$26.29
|
| Rate for Payer: Scott and White Medicare |
$1,469.86
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$593.04
|
| Rate for Payer: Superior Health Plan EPO |
$1,469.86
|
| Rate for Payer: Superior Health Plan Medicare |
$1,469.86
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,469.86
|
| Rate for Payer: Universal American Medicare |
$1,469.86
|
| Rate for Payer: Wellcare Medicare |
$1,469.86
|
| Rate for Payer: Wellmed Medicare |
$1,469.86
|
|
|
ED Fracture Site Humerus, proximal, w/ manipulation BCE
|
Facility
|
OP
|
$2,762.00
|
|
|
Service Code
|
CPT 23605
|
| Hospital Charge Code |
5202523
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$26.29 |
| Max. Negotiated Rate |
$3,415.58 |
| Rate for Payer: Aetna Commercial |
$3,090.00
|
| Rate for Payer: Aetna Medicare |
$2,204.79
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$248.58
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,469.86
|
| Rate for Payer: Amerigroup Medicare |
$1,469.86
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,263.50
|
| Rate for Payer: BCBS of TX Blue Essentials |
$2,710.78
|
| Rate for Payer: BCBS of TX Medicare |
$1,469.86
|
| Rate for Payer: BCBS of TX PPO |
$3,415.58
|
| Rate for Payer: Cash Price |
$2,430.56
|
| Rate for Payer: Cash Price |
$2,430.56
|
| Rate for Payer: Cash Price |
$2,430.56
|
| Rate for Payer: Cigna Commercial |
$3,329.66
|
| Rate for Payer: Cigna Medicaid |
$593.04
|
| Rate for Payer: Cigna Medicare |
$1,469.86
|
| Rate for Payer: Employer Direct Commercial |
$1,469.86
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,469.86
|
| Rate for Payer: Molina CHIP/Medicaid |
$593.04
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,469.86
|
| Rate for Payer: Molina Medicare |
$1,469.86
|
| Rate for Payer: Multiplan Auto |
$1,795.30
|
| Rate for Payer: Multiplan Commercial |
$1,795.30
|
| Rate for Payer: Multiplan Workers Comp |
$1,795.30
|
| Rate for Payer: Parkland Medicaid |
$593.04
|
| Rate for Payer: Scott and White EPO/PPO |
$26.29
|
| Rate for Payer: Scott and White Medicare |
$1,469.86
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$593.04
|
| Rate for Payer: Superior Health Plan EPO |
$1,469.86
|
| Rate for Payer: Superior Health Plan Medicare |
$1,469.86
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,469.86
|
| Rate for Payer: Universal American Medicare |
$1,469.86
|
| Rate for Payer: Wellcare Medicare |
$1,469.86
|
| Rate for Payer: Wellmed Medicare |
$1,469.86
|
|
|
ED Fracture Site Humerus, proximal, w/ manipulation BCE
|
Facility
|
IP
|
$2,762.00
|
|
|
Service Code
|
CPT 23605
|
| Hospital Charge Code |
5202523
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$2,430.56
|
|
|
ED Fracture Site: Malleolus, Posterior, w/ manipulation
|
Facility
|
OP
|
$4,421.00
|
|
|
Service Code
|
CPT 27768
|
| Hospital Charge Code |
5202526
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$26.29 |
| Max. Negotiated Rate |
$3,415.58 |
| Rate for Payer: Aetna Commercial |
$2,431.55
|
| Rate for Payer: Aetna Medicare |
$2,204.79
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$397.89
|
| 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 |
$3,890.48
|
| Rate for Payer: Cash Price |
$3,890.48
|
| Rate for Payer: Cash Price |
$3,890.48
|
| Rate for Payer: Cigna Commercial |
$3,329.66
|
| Rate for Payer: Cigna Medicaid |
$850.02
|
| 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 |
$850.02
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,469.86
|
| Rate for Payer: Molina Medicare |
$1,469.86
|
| Rate for Payer: Multiplan Auto |
$2,873.65
|
| Rate for Payer: Multiplan Commercial |
$2,873.65
|
| Rate for Payer: Multiplan Workers Comp |
$2,873.65
|
| Rate for Payer: Parkland Medicaid |
$850.02
|
| 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 |
$850.02
|
| 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
|
|
