|
ED Fracture Site Radius/Ulna fx, shaft, w/ manipulation BCE
|
Facility
|
OP
|
$988.00
|
|
|
Service Code
|
CPT 25565
|
| Hospital Charge Code |
5202525
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$26.29 |
| Max. Negotiated Rate |
$3,415.58 |
| Rate for Payer: Aetna Commercial |
$543.40
|
| Rate for Payer: Aetna Medicare |
$2,204.79
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$88.92
|
| 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 |
$869.44
|
| Rate for Payer: Cash Price |
$869.44
|
| Rate for Payer: Cash Price |
$869.44
|
| 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 |
$642.20
|
| Rate for Payer: Multiplan Commercial |
$642.20
|
| Rate for Payer: Multiplan Workers Comp |
$642.20
|
| 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: Radius/Ulna fx, shaft, w/o manipulation
|
Facility
|
OP
|
$791.00
|
|
|
Service Code
|
CPT 25560
|
| Hospital Charge Code |
9220206
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3.86 |
| Max. Negotiated Rate |
$514.15 |
| Rate for Payer: Aetna Commercial |
$435.05
|
| Rate for Payer: Aetna Medicare |
$323.50
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$71.19
|
| 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 |
$696.08
|
| Rate for Payer: Cash Price |
$696.08
|
| Rate for Payer: Cash Price |
$696.08
|
| 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 |
$514.15
|
| Rate for Payer: Multiplan Commercial |
$514.15
|
| Rate for Payer: Multiplan Workers Comp |
$514.15
|
| 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 Radius/Ulna fx, shaft, w/o manipulation BCE
|
Facility
|
IP
|
$791.00
|
|
|
Service Code
|
CPT 25560
|
| Hospital Charge Code |
9220206
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$696.08
|
|
|
ED Fracture Site Radius/Ulna fx, shaft, w/o manipulation BCE
|
Facility
|
OP
|
$791.00
|
|
|
Service Code
|
CPT 25560
|
| Hospital Charge Code |
9220206
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3.86 |
| Max. Negotiated Rate |
$514.15 |
| Rate for Payer: Aetna Commercial |
$435.05
|
| Rate for Payer: Aetna Medicare |
$323.50
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$71.19
|
| 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 |
$696.08
|
| Rate for Payer: Cash Price |
$696.08
|
| Rate for Payer: Cash Price |
$696.08
|
| 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 |
$514.15
|
| Rate for Payer: Multiplan Commercial |
$514.15
|
| Rate for Payer: Multiplan Workers Comp |
$514.15
|
| 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: Radius w/o manipulation
|
Facility
|
OP
|
$699.00
|
|
|
Service Code
|
CPT 25500
|
| Hospital Charge Code |
9220204
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3.86 |
| Max. Negotiated Rate |
$488.55 |
| Rate for Payer: Aetna Commercial |
$384.45
|
| Rate for Payer: Aetna Medicare |
$323.50
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$62.91
|
| 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 |
$615.12
|
| Rate for Payer: Cash Price |
$615.12
|
| Rate for Payer: Cash Price |
$615.12
|
| 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 |
$454.35
|
| Rate for Payer: Multiplan Commercial |
$454.35
|
| Rate for Payer: Multiplan Workers Comp |
$454.35
|
| 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 Radius w/o manipulation BCE
|
Facility
|
IP
|
$699.00
|
|
|
Service Code
|
CPT 25500
|
| Hospital Charge Code |
9220204
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$615.12
|
|
|
ED Fracture Site Radius w/o manipulation BCE
|
Facility
|
OP
|
$699.00
|
|
|
Service Code
|
CPT 25500
|
| Hospital Charge Code |
9220204
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3.86 |
| Max. Negotiated Rate |
$488.55 |
| Rate for Payer: Aetna Commercial |
$384.45
|
| Rate for Payer: Aetna Medicare |
$323.50
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$62.91
|
| 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 |
$615.12
|
| Rate for Payer: Cash Price |
$615.12
|
| Rate for Payer: Cash Price |
$615.12
|
| 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 |
$454.35
|
| Rate for Payer: Multiplan Commercial |
$454.35
|
| Rate for Payer: Multiplan Workers Comp |
$454.35
|
| 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: Tibia fx, Distal, w/ manipulation
|
Facility
|
OP
|
$4,765.00
|
|
|
Service Code
|
CPT 27825
|
| Hospital Charge Code |
5202529
|
|
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 |
$428.85
|
| 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 |
$4,193.20
|
| Rate for Payer: Cash Price |
$4,193.20
|
| Rate for Payer: Cash Price |
$4,193.20
|
| 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 |
$3,097.25
|
| Rate for Payer: Multiplan Commercial |
$3,097.25
|
| Rate for Payer: Multiplan Workers Comp |
$3,097.25
|
| Rate for Payer: Parkland Medicaid |
$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 Tibia fx, Distal, w/ manipulation BCE
|
Facility
|
IP
|
$4,765.00
|
|
|
Service Code
|
CPT 27825
|
| Hospital Charge Code |
5202529
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$4,193.20
|
|
|
ED Fracture Site Tibia fx, Distal, w/ manipulation BCE
|
Facility
|
OP
|
$4,765.00
|
|
|
Service Code
|
CPT 27825
|
| Hospital Charge Code |
5202529
|
|
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 |
$428.85
|
| 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 |
$4,193.20
|
| Rate for Payer: Cash Price |
$4,193.20
|
| Rate for Payer: Cash Price |
$4,193.20
|
| 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 |
$3,097.25
|
| Rate for Payer: Multiplan Commercial |
$3,097.25
|
| Rate for Payer: Multiplan Workers Comp |
$3,097.25
|
| Rate for Payer: Parkland Medicaid |
$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: Toe w/ manipulation
|
Facility
|
OP
|
$1,001.00
|
|
|
Service Code
|
CPT 28515
|
| Hospital Charge Code |
5202530
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3.86 |
| Max. Negotiated Rate |
$650.65 |
| Rate for Payer: Aetna Commercial |
$550.55
|
| Rate for Payer: Aetna Medicare |
$323.50
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$90.09
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$215.67
|
| Rate for Payer: Amerigroup Medicare |
$215.67
|
| Rate for Payer: BCBS of TX Blue Advantage |
$176.59
|
| Rate for Payer: BCBS of TX Blue Essentials |
$211.48
|
| Rate for Payer: BCBS of TX Medicare |
$215.67
|
| Rate for Payer: BCBS of TX PPO |
$266.46
|
| Rate for Payer: Cash Price |
$880.88
|
| Rate for Payer: Cash Price |
$880.88
|
| Rate for Payer: Cash Price |
$880.88
|
| 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 |
$650.65
|
| Rate for Payer: Multiplan Commercial |
$650.65
|
| Rate for Payer: Multiplan Workers Comp |
$650.65
|
| 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 Toe w/ manipulation BCE
|
Facility
|
IP
|
$1,001.00
|
|
|
Service Code
|
CPT 28515
|
| Hospital Charge Code |
5202530
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$880.88
|
|
|
ED Fracture Site Toe w/ manipulation BCE
|
Facility
|
OP
|
$1,001.00
|
|
|
Service Code
|
CPT 28515
|
| Hospital Charge Code |
5202530
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3.86 |
| Max. Negotiated Rate |
$650.65 |
| Rate for Payer: Aetna Commercial |
$550.55
|
| Rate for Payer: Aetna Medicare |
$323.50
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$90.09
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$215.67
|
| Rate for Payer: Amerigroup Medicare |
$215.67
|
| Rate for Payer: BCBS of TX Blue Advantage |
$176.59
|
| Rate for Payer: BCBS of TX Blue Essentials |
$211.48
|
| Rate for Payer: BCBS of TX Medicare |
$215.67
|
| Rate for Payer: BCBS of TX PPO |
$266.46
|
| Rate for Payer: Cash Price |
$880.88
|
| Rate for Payer: Cash Price |
$880.88
|
| Rate for Payer: Cash Price |
$880.88
|
| 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 |
$650.65
|
| Rate for Payer: Multiplan Commercial |
$650.65
|
| Rate for Payer: Multiplan Workers Comp |
$650.65
|
| 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: Trimalleolar fx, w/ manipulation
|
Facility
|
OP
|
$2,762.00
|
|
|
Service Code
|
CPT 27818
|
| Hospital Charge Code |
5202528
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$26.29 |
| Max. Negotiated Rate |
$3,415.58 |
| Rate for Payer: Aetna Commercial |
$1,400.00
|
| 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 Trimalleolar fx, w/ manipulation BCE
|
Facility
|
OP
|
$2,762.00
|
|
|
Service Code
|
CPT 27818
|
| Hospital Charge Code |
5202528
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$26.29 |
| Max. Negotiated Rate |
$3,415.58 |
| Rate for Payer: Aetna Commercial |
$1,400.00
|
| 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 Trimalleolar fx, w/ manipulation BCE
|
Facility
|
IP
|
$2,762.00
|
|
|
Service Code
|
CPT 27818
|
| Hospital Charge Code |
5202528
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$2,430.56
|
|
|
ED Fracture Site: Ulnar Shaft, w/ manipulation
|
Facility
|
OP
|
$5,129.00
|
|
|
Service Code
|
CPT 25535
|
| Hospital Charge Code |
5202524
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3.86 |
| Max. Negotiated Rate |
$3,333.85 |
| Rate for Payer: Aetna Commercial |
$2,820.95
|
| Rate for Payer: Aetna Medicare |
$323.50
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$461.61
|
| 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 |
$4,513.52
|
| Rate for Payer: Cash Price |
$4,513.52
|
| Rate for Payer: Cash Price |
$4,513.52
|
| 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 |
$3,333.85
|
| Rate for Payer: Multiplan Commercial |
$3,333.85
|
| Rate for Payer: Multiplan Workers Comp |
$3,333.85
|
| 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 Ulnar Shaft, w/ manipulation BCE
|
Facility
|
OP
|
$5,129.00
|
|
|
Service Code
|
CPT 25535
|
| Hospital Charge Code |
5202524
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3.86 |
| Max. Negotiated Rate |
$3,333.85 |
| Rate for Payer: Aetna Commercial |
$2,820.95
|
| Rate for Payer: Aetna Medicare |
$323.50
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$461.61
|
| 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 |
$4,513.52
|
| Rate for Payer: Cash Price |
$4,513.52
|
| Rate for Payer: Cash Price |
$4,513.52
|
| 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 |
$3,333.85
|
| Rate for Payer: Multiplan Commercial |
$3,333.85
|
| Rate for Payer: Multiplan Workers Comp |
$3,333.85
|
| 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 Ulnar Shaft, w/ manipulation BCE
|
Facility
|
IP
|
$5,129.00
|
|
|
Service Code
|
CPT 25535
|
| Hospital Charge Code |
5202524
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$4,513.52
|
|
|
ED GI/GU/Rectal Procedure: Anoscopy
|
Facility
|
OP
|
$712.00
|
|
|
Service Code
|
CPT 46600
|
| Hospital Charge Code |
9330051
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2.09 |
| Max. Negotiated Rate |
$462.80 |
| Rate for Payer: Aetna Commercial |
$391.60
|
| Rate for Payer: Aetna Medicare |
$175.23
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$64.08
|
| 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 |
$626.56
|
| Rate for Payer: Cash Price |
$626.56
|
| Rate for Payer: Cash Price |
$626.56
|
| 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 |
$462.80
|
| Rate for Payer: Multiplan Commercial |
$462.80
|
| Rate for Payer: Multiplan Workers Comp |
$462.80
|
| 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 GI/GU/Rectal Procedure: Cystostomy/Foley change
|
Facility
|
OP
|
$2,426.00
|
|
|
Service Code
|
CPT 51705
|
| Hospital Charge Code |
5202533
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$4.04 |
| Max. Negotiated Rate |
$1,576.90 |
| Rate for Payer: Aetna Commercial |
$1,334.30
|
| Rate for Payer: Aetna Medicare |
$339.04
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$218.34
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$226.03
|
| Rate for Payer: Amerigroup Medicare |
$226.03
|
| Rate for Payer: BCBS of TX Blue Advantage |
$102.45
|
| Rate for Payer: BCBS of TX Blue Essentials |
$122.70
|
| Rate for Payer: BCBS of TX Medicare |
$226.03
|
| Rate for Payer: BCBS of TX PPO |
$154.60
|
| Rate for Payer: Cash Price |
$2,134.88
|
| Rate for Payer: Cash Price |
$2,134.88
|
| Rate for Payer: Cash Price |
$2,134.88
|
| Rate for Payer: Cigna Commercial |
$512.01
|
| Rate for Payer: Cigna Medicaid |
$51.77
|
| Rate for Payer: Cigna Medicare |
$226.03
|
| Rate for Payer: Employer Direct Commercial |
$226.03
|
| Rate for Payer: Humana Medicare/TRICARE |
$226.03
|
| Rate for Payer: Molina CHIP/Medicaid |
$51.77
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$226.03
|
| Rate for Payer: Molina Medicare |
$226.03
|
| Rate for Payer: Multiplan Auto |
$1,576.90
|
| Rate for Payer: Multiplan Commercial |
$1,576.90
|
| Rate for Payer: Multiplan Workers Comp |
$1,576.90
|
| Rate for Payer: Parkland Medicaid |
$51.77
|
| Rate for Payer: Scott and White EPO/PPO |
$4.04
|
| Rate for Payer: Scott and White Medicare |
$226.03
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$51.77
|
| Rate for Payer: Superior Health Plan EPO |
$226.03
|
| Rate for Payer: Superior Health Plan Medicare |
$226.03
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$226.03
|
| Rate for Payer: Universal American Medicare |
$226.03
|
| Rate for Payer: Wellcare Medicare |
$226.03
|
| Rate for Payer: Wellmed Medicare |
$226.03
|
|
|
ED GI/GU/Rectal Procedure: Gastric Intubation w/ Lavage
|
Facility
|
OP
|
$576.00
|
|
|
Service Code
|
CPT 43753
|
| Hospital Charge Code |
5210316
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$5.13 |
| Max. Negotiated Rate |
$650.28 |
| Rate for Payer: Aetna Commercial |
$316.80
|
| Rate for Payer: Aetna Medicare |
$430.59
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$51.84
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$287.06
|
| Rate for Payer: Amerigroup Medicare |
$287.06
|
| Rate for Payer: BCBS of TX Blue Advantage |
$422.68
|
| Rate for Payer: BCBS of TX Blue Essentials |
$506.20
|
| Rate for Payer: BCBS of TX Medicare |
$287.06
|
| Rate for Payer: BCBS of TX PPO |
$637.81
|
| Rate for Payer: Cash Price |
$506.88
|
| Rate for Payer: Cash Price |
$506.88
|
| Rate for Payer: Cash Price |
$506.88
|
| Rate for Payer: Cigna Commercial |
$650.28
|
| Rate for Payer: Cigna Medicare |
$287.06
|
| Rate for Payer: Employer Direct Commercial |
$287.06
|
| Rate for Payer: Humana Medicare/TRICARE |
$287.06
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$287.06
|
| Rate for Payer: Molina Medicare |
$287.06
|
| Rate for Payer: Multiplan Auto |
$374.40
|
| Rate for Payer: Multiplan Commercial |
$374.40
|
| Rate for Payer: Multiplan Workers Comp |
$374.40
|
| Rate for Payer: Scott and White EPO/PPO |
$5.13
|
| Rate for Payer: Scott and White Medicare |
$287.06
|
| Rate for Payer: Superior Health Plan EPO |
$287.06
|
| Rate for Payer: Superior Health Plan Medicare |
$287.06
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$287.06
|
| Rate for Payer: Universal American Medicare |
$287.06
|
| Rate for Payer: Wellcare Medicare |
$287.06
|
| Rate for Payer: Wellmed Medicare |
$287.06
|
|
|
ED GI/GU/Rectal Procedure: Paraphimosis treatment
|
Facility
|
OP
|
$2,269.00
|
|
|
Service Code
|
CPT 54450
|
| Hospital Charge Code |
5202534
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$4.04 |
| Max. Negotiated Rate |
$1,474.85 |
| Rate for Payer: Aetna Commercial |
$1,247.95
|
| Rate for Payer: Aetna Medicare |
$339.04
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$204.21
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$226.03
|
| Rate for Payer: Amerigroup Medicare |
$226.03
|
| Rate for Payer: BCBS of TX Blue Advantage |
$392.28
|
| Rate for Payer: BCBS of TX Blue Essentials |
$469.80
|
| Rate for Payer: BCBS of TX Medicare |
$226.03
|
| Rate for Payer: BCBS of TX PPO |
$591.95
|
| Rate for Payer: Cash Price |
$1,996.72
|
| Rate for Payer: Cash Price |
$1,996.72
|
| Rate for Payer: Cash Price |
$1,996.72
|
| Rate for Payer: Cigna Commercial |
$512.01
|
| Rate for Payer: Cigna Medicaid |
$110.15
|
| Rate for Payer: Cigna Medicare |
$226.03
|
| Rate for Payer: Employer Direct Commercial |
$226.03
|
| Rate for Payer: Humana Medicare/TRICARE |
$226.03
|
| Rate for Payer: Molina CHIP/Medicaid |
$110.15
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$226.03
|
| Rate for Payer: Molina Medicare |
$226.03
|
| Rate for Payer: Multiplan Auto |
$1,474.85
|
| Rate for Payer: Multiplan Commercial |
$1,474.85
|
| Rate for Payer: Multiplan Workers Comp |
$1,474.85
|
| Rate for Payer: Parkland Medicaid |
$110.15
|
| Rate for Payer: Scott and White EPO/PPO |
$4.04
|
| Rate for Payer: Scott and White Medicare |
$226.03
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$110.15
|
| Rate for Payer: Superior Health Plan EPO |
$226.03
|
| Rate for Payer: Superior Health Plan Medicare |
$226.03
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$226.03
|
| Rate for Payer: Universal American Medicare |
$226.03
|
| Rate for Payer: Wellcare Medicare |
$226.03
|
| Rate for Payer: Wellmed Medicare |
$226.03
|
|
|
ED GI/GU/Rectal Procedure: Removal of hemorrhoid clot
|
Facility
|
OP
|
$6,289.00
|
|
|
Service Code
|
CPT 46320
|
| Hospital Charge Code |
5202532
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$19.30 |
| Max. Negotiated Rate |
$4,087.85 |
| Rate for Payer: Aetna Commercial |
$2,200.00
|
| Rate for Payer: Aetna Medicare |
$1,618.84
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$566.01
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,079.23
|
| Rate for Payer: Amerigroup Medicare |
$1,079.23
|
| Rate for Payer: BCBS of TX Blue Advantage |
$224.80
|
| Rate for Payer: BCBS of TX Blue Essentials |
$269.22
|
| Rate for Payer: BCBS of TX Medicare |
$1,079.23
|
| Rate for Payer: BCBS of TX PPO |
$339.22
|
| Rate for Payer: Cash Price |
$5,534.32
|
| Rate for Payer: Cash Price |
$5,534.32
|
| Rate for Payer: Cash Price |
$5,534.32
|
| Rate for Payer: Cigna Commercial |
$2,444.77
|
| Rate for Payer: Cigna Medicaid |
$125.69
|
| Rate for Payer: Cigna Medicare |
$1,079.23
|
| Rate for Payer: Employer Direct Commercial |
$1,079.23
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,079.23
|
| Rate for Payer: Molina CHIP/Medicaid |
$125.69
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,079.23
|
| Rate for Payer: Molina Medicare |
$1,079.23
|
| Rate for Payer: Multiplan Auto |
$4,087.85
|
| Rate for Payer: Multiplan Commercial |
$4,087.85
|
| Rate for Payer: Multiplan Workers Comp |
$4,087.85
|
| Rate for Payer: Parkland Medicaid |
$125.69
|
| Rate for Payer: Scott and White EPO/PPO |
$19.30
|
| Rate for Payer: Scott and White Medicare |
$1,079.23
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$125.69
|
| Rate for Payer: Superior Health Plan EPO |
$1,079.23
|
| Rate for Payer: Superior Health Plan Medicare |
$1,079.23
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,079.23
|
| Rate for Payer: Universal American Medicare |
$1,079.23
|
| Rate for Payer: Wellcare Medicare |
$1,079.23
|
| Rate for Payer: Wellmed Medicare |
$1,079.23
|
|
|
ED GI/GU/Rectal Procedure: Removal of rectal obstruction
|
Facility
|
OP
|
$4,010.00
|
|
|
Service Code
|
CPT 45915
|
| Hospital Charge Code |
5202531
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$19.30 |
| Max. Negotiated Rate |
$2,606.50 |
| Rate for Payer: Aetna Commercial |
$2,200.00
|
| Rate for Payer: Aetna Medicare |
$1,618.84
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$360.90
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,079.23
|
| Rate for Payer: Amerigroup Medicare |
$1,079.23
|
| Rate for Payer: BCBS of TX Blue Advantage |
$1,677.05
|
| Rate for Payer: BCBS of TX Blue Essentials |
$2,008.44
|
| Rate for Payer: BCBS of TX Medicare |
$1,079.23
|
| Rate for Payer: BCBS of TX PPO |
$2,530.63
|
| Rate for Payer: Cash Price |
$3,528.80
|
| Rate for Payer: Cash Price |
$3,528.80
|
| Rate for Payer: Cash Price |
$3,528.80
|
| Rate for Payer: Cigna Commercial |
$2,444.77
|
| Rate for Payer: Cigna Medicaid |
$429.26
|
| Rate for Payer: Cigna Medicare |
$1,079.23
|
| Rate for Payer: Employer Direct Commercial |
$1,079.23
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,079.23
|
| Rate for Payer: Molina CHIP/Medicaid |
$429.26
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,079.23
|
| Rate for Payer: Molina Medicare |
$1,079.23
|
| Rate for Payer: Multiplan Auto |
$2,606.50
|
| Rate for Payer: Multiplan Commercial |
$2,606.50
|
| Rate for Payer: Multiplan Workers Comp |
$2,606.50
|
| Rate for Payer: Parkland Medicaid |
$429.26
|
| Rate for Payer: Scott and White EPO/PPO |
$19.30
|
| Rate for Payer: Scott and White Medicare |
$1,079.23
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$429.26
|
| Rate for Payer: Superior Health Plan EPO |
$1,079.23
|
| Rate for Payer: Superior Health Plan Medicare |
$1,079.23
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,079.23
|
| Rate for Payer: Universal American Medicare |
$1,079.23
|
| Rate for Payer: Wellcare Medicare |
$1,079.23
|
| Rate for Payer: Wellmed Medicare |
$1,079.23
|
|
