|
ED Injections/Nerve Block: Lumbar puncture - Diagnostic
|
Facility
|
IP
|
$1,261.00
|
|
|
Service Code
|
CPT 62270
|
| Hospital Charge Code |
315358
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$1,109.68
|
|
|
ED Injections/Nerve Block: Lumbar puncture - Diagnostic
|
Facility
|
OP
|
$1,261.00
|
|
|
Service Code
|
CPT 62270
|
| Hospital Charge Code |
315358
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$11.31 |
| Max. Negotiated Rate |
$1,575.13 |
| Rate for Payer: Aetna Commercial |
$1,400.00
|
| Rate for Payer: Aetna Medicare |
$948.68
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$113.49
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$632.45
|
| Rate for Payer: Amerigroup Medicare |
$632.45
|
| Rate for Payer: BCBS of TX Blue Advantage |
$1,043.83
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,250.10
|
| Rate for Payer: BCBS of TX Medicare |
$632.45
|
| Rate for Payer: BCBS of TX PPO |
$1,575.13
|
| Rate for Payer: Cash Price |
$1,109.68
|
| Rate for Payer: Cash Price |
$1,109.68
|
| Rate for Payer: Cash Price |
$1,109.68
|
| Rate for Payer: Cigna Commercial |
$1,432.68
|
| Rate for Payer: Cigna Medicaid |
$262.86
|
| Rate for Payer: Cigna Medicare |
$632.45
|
| Rate for Payer: Employer Direct Commercial |
$632.45
|
| Rate for Payer: Humana Medicare/TRICARE |
$632.45
|
| Rate for Payer: Molina CHIP/Medicaid |
$262.86
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$632.45
|
| Rate for Payer: Molina Medicare |
$632.45
|
| Rate for Payer: Multiplan Auto |
$819.65
|
| Rate for Payer: Multiplan Commercial |
$819.65
|
| Rate for Payer: Multiplan Workers Comp |
$819.65
|
| Rate for Payer: Parkland Medicaid |
$262.86
|
| Rate for Payer: Scott and White EPO/PPO |
$11.31
|
| Rate for Payer: Scott and White Medicare |
$632.45
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$262.86
|
| Rate for Payer: Superior Health Plan EPO |
$632.45
|
| Rate for Payer: Superior Health Plan Medicare |
$632.45
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$632.45
|
| Rate for Payer: Universal American Medicare |
$632.45
|
| Rate for Payer: Wellcare Medicare |
$632.45
|
| Rate for Payer: Wellmed Medicare |
$632.45
|
|
|
ED Injections/Nerve Block Lumbar puncture - Diagnostic BCE
|
Facility
|
OP
|
$1,261.00
|
|
|
Service Code
|
CPT 62270
|
| Hospital Charge Code |
315358
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$11.31 |
| Max. Negotiated Rate |
$1,575.13 |
| Rate for Payer: Aetna Commercial |
$1,400.00
|
| Rate for Payer: Aetna Medicare |
$948.68
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$113.49
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$632.45
|
| Rate for Payer: Amerigroup Medicare |
$632.45
|
| Rate for Payer: BCBS of TX Blue Advantage |
$1,043.83
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,250.10
|
| Rate for Payer: BCBS of TX Medicare |
$632.45
|
| Rate for Payer: BCBS of TX PPO |
$1,575.13
|
| Rate for Payer: Cash Price |
$1,109.68
|
| Rate for Payer: Cash Price |
$1,109.68
|
| Rate for Payer: Cash Price |
$1,109.68
|
| Rate for Payer: Cigna Commercial |
$1,432.68
|
| Rate for Payer: Cigna Medicaid |
$262.86
|
| Rate for Payer: Cigna Medicare |
$632.45
|
| Rate for Payer: Employer Direct Commercial |
$632.45
|
| Rate for Payer: Humana Medicare/TRICARE |
$632.45
|
| Rate for Payer: Molina CHIP/Medicaid |
$262.86
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$632.45
|
| Rate for Payer: Molina Medicare |
$632.45
|
| Rate for Payer: Multiplan Auto |
$819.65
|
| Rate for Payer: Multiplan Commercial |
$819.65
|
| Rate for Payer: Multiplan Workers Comp |
$819.65
|
| Rate for Payer: Parkland Medicaid |
$262.86
|
| Rate for Payer: Scott and White EPO/PPO |
$11.31
|
| Rate for Payer: Scott and White Medicare |
$632.45
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$262.86
|
| Rate for Payer: Superior Health Plan EPO |
$632.45
|
| Rate for Payer: Superior Health Plan Medicare |
$632.45
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$632.45
|
| Rate for Payer: Universal American Medicare |
$632.45
|
| Rate for Payer: Wellcare Medicare |
$632.45
|
| Rate for Payer: Wellmed Medicare |
$632.45
|
|
|
ED Injections/Nerve Block: Nerve block, peripheral
|
Facility
|
IP
|
$1,261.00
|
|
|
Service Code
|
CPT 64450
|
| Hospital Charge Code |
6110415
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$1,109.68
|
|
|
ED Injections/Nerve Block: Nerve block, peripheral
|
Facility
|
OP
|
$1,261.00
|
|
|
Service Code
|
CPT 64450
|
| Hospital Charge Code |
6110415
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$11.31 |
| Max. Negotiated Rate |
$1,432.68 |
| Rate for Payer: Aetna Commercial |
$1,400.00
|
| Rate for Payer: Aetna Medicare |
$948.68
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$113.49
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$632.45
|
| Rate for Payer: Amerigroup Medicare |
$632.45
|
| Rate for Payer: BCBS of TX Blue Advantage |
$80.76
|
| Rate for Payer: BCBS of TX Blue Essentials |
$96.72
|
| Rate for Payer: BCBS of TX Medicare |
$632.45
|
| Rate for Payer: BCBS of TX PPO |
$121.87
|
| Rate for Payer: Cash Price |
$1,109.68
|
| Rate for Payer: Cash Price |
$1,109.68
|
| Rate for Payer: Cash Price |
$1,109.68
|
| Rate for Payer: Cigna Commercial |
$1,432.68
|
| Rate for Payer: Cigna Medicaid |
$39.31
|
| Rate for Payer: Cigna Medicare |
$632.45
|
| Rate for Payer: Employer Direct Commercial |
$632.45
|
| Rate for Payer: Humana Medicare/TRICARE |
$632.45
|
| Rate for Payer: Molina CHIP/Medicaid |
$39.31
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$632.45
|
| Rate for Payer: Molina Medicare |
$632.45
|
| Rate for Payer: Multiplan Auto |
$819.65
|
| Rate for Payer: Multiplan Commercial |
$819.65
|
| Rate for Payer: Multiplan Workers Comp |
$819.65
|
| Rate for Payer: Parkland Medicaid |
$39.31
|
| Rate for Payer: Scott and White EPO/PPO |
$11.31
|
| Rate for Payer: Scott and White Medicare |
$632.45
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$39.31
|
| Rate for Payer: Superior Health Plan EPO |
$632.45
|
| Rate for Payer: Superior Health Plan Medicare |
$632.45
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$632.45
|
| Rate for Payer: Universal American Medicare |
$632.45
|
| Rate for Payer: Wellcare Medicare |
$632.45
|
| Rate for Payer: Wellmed Medicare |
$632.45
|
|
|
ED Injections/Nerve Block Nerve block, peripheral BCE
|
Facility
|
OP
|
$1,261.00
|
|
|
Service Code
|
CPT 64450
|
| Hospital Charge Code |
6110415
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$11.31 |
| Max. Negotiated Rate |
$1,432.68 |
| Rate for Payer: Aetna Commercial |
$1,400.00
|
| Rate for Payer: Aetna Medicare |
$948.68
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$113.49
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$632.45
|
| Rate for Payer: Amerigroup Medicare |
$632.45
|
| Rate for Payer: BCBS of TX Blue Advantage |
$80.76
|
| Rate for Payer: BCBS of TX Blue Essentials |
$96.72
|
| Rate for Payer: BCBS of TX Medicare |
$632.45
|
| Rate for Payer: BCBS of TX PPO |
$121.87
|
| Rate for Payer: Cash Price |
$1,109.68
|
| Rate for Payer: Cash Price |
$1,109.68
|
| Rate for Payer: Cash Price |
$1,109.68
|
| Rate for Payer: Cigna Commercial |
$1,432.68
|
| Rate for Payer: Cigna Medicaid |
$39.31
|
| Rate for Payer: Cigna Medicare |
$632.45
|
| Rate for Payer: Employer Direct Commercial |
$632.45
|
| Rate for Payer: Humana Medicare/TRICARE |
$632.45
|
| Rate for Payer: Molina CHIP/Medicaid |
$39.31
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$632.45
|
| Rate for Payer: Molina Medicare |
$632.45
|
| Rate for Payer: Multiplan Auto |
$819.65
|
| Rate for Payer: Multiplan Commercial |
$819.65
|
| Rate for Payer: Multiplan Workers Comp |
$819.65
|
| Rate for Payer: Parkland Medicaid |
$39.31
|
| Rate for Payer: Scott and White EPO/PPO |
$11.31
|
| Rate for Payer: Scott and White Medicare |
$632.45
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$39.31
|
| Rate for Payer: Superior Health Plan EPO |
$632.45
|
| Rate for Payer: Superior Health Plan Medicare |
$632.45
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$632.45
|
| Rate for Payer: Universal American Medicare |
$632.45
|
| Rate for Payer: Wellcare Medicare |
$632.45
|
| Rate for Payer: Wellmed Medicare |
$632.45
|
|
|
ED Injections/Nerve Block: Nerve block, trigeminal
|
Facility
|
IP
|
$535.00
|
|
|
Service Code
|
CPT 64400
|
| Hospital Charge Code |
5202548
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$470.80
|
|
|
ED Injections/Nerve Block: Nerve block, trigeminal
|
Facility
|
OP
|
$535.00
|
|
|
Service Code
|
CPT 64400
|
| Hospital Charge Code |
5202548
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$4.84 |
| Max. Negotiated Rate |
$613.60 |
| Rate for Payer: Aetna Commercial |
$294.25
|
| Rate for Payer: Aetna Medicare |
$406.30
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$48.15
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$270.87
|
| Rate for Payer: Amerigroup Medicare |
$270.87
|
| Rate for Payer: BCBS of TX Blue Advantage |
$127.77
|
| Rate for Payer: BCBS of TX Blue Essentials |
$153.02
|
| Rate for Payer: BCBS of TX Medicare |
$270.87
|
| Rate for Payer: BCBS of TX PPO |
$192.81
|
| Rate for Payer: Cash Price |
$470.80
|
| Rate for Payer: Cash Price |
$470.80
|
| Rate for Payer: Cash Price |
$470.80
|
| Rate for Payer: Cigna Commercial |
$613.60
|
| Rate for Payer: Cigna Medicaid |
$67.55
|
| Rate for Payer: Cigna Medicare |
$270.87
|
| Rate for Payer: Employer Direct Commercial |
$270.87
|
| Rate for Payer: Humana Medicare/TRICARE |
$270.87
|
| Rate for Payer: Molina CHIP/Medicaid |
$67.55
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$270.87
|
| Rate for Payer: Molina Medicare |
$270.87
|
| Rate for Payer: Multiplan Auto |
$347.75
|
| Rate for Payer: Multiplan Commercial |
$347.75
|
| Rate for Payer: Multiplan Workers Comp |
$347.75
|
| Rate for Payer: Parkland Medicaid |
$67.55
|
| Rate for Payer: Scott and White EPO/PPO |
$4.84
|
| Rate for Payer: Scott and White Medicare |
$270.87
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$67.55
|
| Rate for Payer: Superior Health Plan EPO |
$270.87
|
| Rate for Payer: Superior Health Plan Medicare |
$270.87
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$270.87
|
| Rate for Payer: Universal American Medicare |
$270.87
|
| Rate for Payer: Wellcare Medicare |
$270.87
|
| Rate for Payer: Wellmed Medicare |
$270.87
|
|
|
ED Injections/Nerve Block Nerve block, trigeminal BCE
|
Facility
|
OP
|
$535.00
|
|
|
Service Code
|
CPT 64400
|
| Hospital Charge Code |
5202548
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$4.84 |
| Max. Negotiated Rate |
$613.60 |
| Rate for Payer: Aetna Commercial |
$294.25
|
| Rate for Payer: Aetna Medicare |
$406.30
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$48.15
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$270.87
|
| Rate for Payer: Amerigroup Medicare |
$270.87
|
| Rate for Payer: BCBS of TX Blue Advantage |
$127.77
|
| Rate for Payer: BCBS of TX Blue Essentials |
$153.02
|
| Rate for Payer: BCBS of TX Medicare |
$270.87
|
| Rate for Payer: BCBS of TX PPO |
$192.81
|
| Rate for Payer: Cash Price |
$470.80
|
| Rate for Payer: Cash Price |
$470.80
|
| Rate for Payer: Cash Price |
$470.80
|
| Rate for Payer: Cigna Commercial |
$613.60
|
| Rate for Payer: Cigna Medicaid |
$67.55
|
| Rate for Payer: Cigna Medicare |
$270.87
|
| Rate for Payer: Employer Direct Commercial |
$270.87
|
| Rate for Payer: Humana Medicare/TRICARE |
$270.87
|
| Rate for Payer: Molina CHIP/Medicaid |
$67.55
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$270.87
|
| Rate for Payer: Molina Medicare |
$270.87
|
| Rate for Payer: Multiplan Auto |
$347.75
|
| Rate for Payer: Multiplan Commercial |
$347.75
|
| Rate for Payer: Multiplan Workers Comp |
$347.75
|
| Rate for Payer: Parkland Medicaid |
$67.55
|
| Rate for Payer: Scott and White EPO/PPO |
$4.84
|
| Rate for Payer: Scott and White Medicare |
$270.87
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$67.55
|
| Rate for Payer: Superior Health Plan EPO |
$270.87
|
| Rate for Payer: Superior Health Plan Medicare |
$270.87
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$270.87
|
| Rate for Payer: Universal American Medicare |
$270.87
|
| Rate for Payer: Wellcare Medicare |
$270.87
|
| Rate for Payer: Wellmed Medicare |
$270.87
|
|
|
ED Injections/Nerve Block: Sacroiliac Joint Arthrography
|
Facility
|
IP
|
$2,500.00
|
|
|
Service Code
|
CPT 27096
|
| Hospital Charge Code |
5202549
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$2,200.00
|
|
|
ED Injections/Nerve Block: Sacroiliac Joint Arthrography
|
Facility
|
OP
|
$2,500.00
|
|
|
Service Code
|
CPT 27096
|
| Hospital Charge Code |
5202549
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$143.24 |
| Max. Negotiated Rate |
$1,625.00 |
| Rate for Payer: Aetna Commercial |
$1,375.00
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$225.00
|
| Rate for Payer: BCBS of TX Blue Advantage |
$143.24
|
| Rate for Payer: BCBS of TX Blue Essentials |
$171.54
|
| Rate for Payer: BCBS of TX PPO |
$216.14
|
| Rate for Payer: Cash Price |
$2,200.00
|
| Rate for Payer: Cash Price |
$2,200.00
|
| Rate for Payer: Multiplan Auto |
$1,625.00
|
| Rate for Payer: Multiplan Commercial |
$1,625.00
|
| Rate for Payer: Multiplan Workers Comp |
$1,625.00
|
| Rate for Payer: Scott and White EPO/PPO |
$1,250.00
|
| Rate for Payer: Superior Health Plan EPO |
$340.00
|
|
|
ED Injections/Nerve Block Sacroiliac Joint Arthrography BCE
|
Facility
|
OP
|
$2,500.00
|
|
|
Service Code
|
CPT 27096
|
| Hospital Charge Code |
5202549
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$143.24 |
| Max. Negotiated Rate |
$1,625.00 |
| Rate for Payer: Aetna Commercial |
$1,375.00
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$225.00
|
| Rate for Payer: BCBS of TX Blue Advantage |
$143.24
|
| Rate for Payer: BCBS of TX Blue Essentials |
$171.54
|
| Rate for Payer: BCBS of TX PPO |
$216.14
|
| Rate for Payer: Cash Price |
$2,200.00
|
| Rate for Payer: Cash Price |
$2,200.00
|
| Rate for Payer: Multiplan Auto |
$1,625.00
|
| Rate for Payer: Multiplan Commercial |
$1,625.00
|
| Rate for Payer: Multiplan Workers Comp |
$1,625.00
|
| Rate for Payer: Scott and White EPO/PPO |
$1,250.00
|
| Rate for Payer: Superior Health Plan EPO |
$340.00
|
|
|
ED Injections/Nerve Block: Thrombolytic Administration
|
Facility
|
OP
|
$2,917.00
|
|
|
Service Code
|
CPT 37195
|
| Hospital Charge Code |
5202590
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$5.54 |
| Max. Negotiated Rate |
$1,896.05 |
| Rate for Payer: Aetna Commercial |
$1,604.35
|
| Rate for Payer: Aetna Medicare |
$464.60
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$262.53
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$309.73
|
| Rate for Payer: Amerigroup Medicare |
$309.73
|
| Rate for Payer: BCBS of TX Blue Advantage |
$517.03
|
| Rate for Payer: BCBS of TX Blue Essentials |
$619.20
|
| Rate for Payer: BCBS of TX Medicare |
$309.73
|
| Rate for Payer: BCBS of TX PPO |
$780.19
|
| Rate for Payer: Cash Price |
$2,566.96
|
| Rate for Payer: Cash Price |
$2,566.96
|
| Rate for Payer: Cash Price |
$2,566.96
|
| Rate for Payer: Cigna Commercial |
$701.61
|
| Rate for Payer: Cigna Medicare |
$309.73
|
| Rate for Payer: Employer Direct Commercial |
$309.73
|
| Rate for Payer: Humana Medicare/TRICARE |
$309.73
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$309.73
|
| Rate for Payer: Molina Medicare |
$309.73
|
| Rate for Payer: Multiplan Auto |
$1,896.05
|
| Rate for Payer: Multiplan Commercial |
$1,896.05
|
| Rate for Payer: Multiplan Workers Comp |
$1,896.05
|
| Rate for Payer: Scott and White EPO/PPO |
$5.54
|
| Rate for Payer: Scott and White Medicare |
$309.73
|
| Rate for Payer: Superior Health Plan EPO |
$309.73
|
| Rate for Payer: Superior Health Plan Medicare |
$309.73
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$309.73
|
| Rate for Payer: Universal American Medicare |
$309.73
|
| Rate for Payer: Wellcare Medicare |
$309.73
|
| Rate for Payer: Wellmed Medicare |
$309.73
|
|
|
ED Injections/Nerve Block: Thrombolytic Administration
|
Facility
|
IP
|
$2,917.00
|
|
|
Service Code
|
CPT 37195
|
| Hospital Charge Code |
5202590
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$2,566.96
|
|
|
ED Injections/Nerve Block Thrombolytic Administration BCE
|
Facility
|
OP
|
$2,917.00
|
|
|
Service Code
|
CPT 37195
|
| Hospital Charge Code |
5202590
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$5.54 |
| Max. Negotiated Rate |
$1,896.05 |
| Rate for Payer: Aetna Commercial |
$1,604.35
|
| Rate for Payer: Aetna Medicare |
$464.60
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$262.53
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$309.73
|
| Rate for Payer: Amerigroup Medicare |
$309.73
|
| Rate for Payer: BCBS of TX Blue Advantage |
$517.03
|
| Rate for Payer: BCBS of TX Blue Essentials |
$619.20
|
| Rate for Payer: BCBS of TX Medicare |
$309.73
|
| Rate for Payer: BCBS of TX PPO |
$780.19
|
| Rate for Payer: Cash Price |
$2,566.96
|
| Rate for Payer: Cash Price |
$2,566.96
|
| Rate for Payer: Cash Price |
$2,566.96
|
| Rate for Payer: Cigna Commercial |
$701.61
|
| Rate for Payer: Cigna Medicare |
$309.73
|
| Rate for Payer: Employer Direct Commercial |
$309.73
|
| Rate for Payer: Humana Medicare/TRICARE |
$309.73
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$309.73
|
| Rate for Payer: Molina Medicare |
$309.73
|
| Rate for Payer: Multiplan Auto |
$1,896.05
|
| Rate for Payer: Multiplan Commercial |
$1,896.05
|
| Rate for Payer: Multiplan Workers Comp |
$1,896.05
|
| Rate for Payer: Scott and White EPO/PPO |
$5.54
|
| Rate for Payer: Scott and White Medicare |
$309.73
|
| Rate for Payer: Superior Health Plan EPO |
$309.73
|
| Rate for Payer: Superior Health Plan Medicare |
$309.73
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$309.73
|
| Rate for Payer: Universal American Medicare |
$309.73
|
| Rate for Payer: Wellcare Medicare |
$309.73
|
| Rate for Payer: Wellmed Medicare |
$309.73
|
|
|
ED INSJ TEMP NDWELLG BLD CATH SMPL BCE
|
Facility
|
IP
|
$564.00
|
|
|
Service Code
|
CPT 51702
|
| Hospital Charge Code |
8398502
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$496.32
|
|
|
ED INSJ TEMP NDWELLG BLD CATH SMPL BCE
|
Facility
|
OP
|
$564.00
|
|
|
Service Code
|
CPT 51702
|
| Hospital Charge Code |
8398502
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2.09 |
| Max. Negotiated Rate |
$366.60 |
| Rate for Payer: Aetna Commercial |
$310.20
|
| Rate for Payer: Aetna Medicare |
$175.23
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$50.76
|
| 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 |
$496.32
|
| Rate for Payer: Cash Price |
$496.32
|
| Rate for Payer: Cash Price |
$496.32
|
| 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 |
$366.60
|
| Rate for Payer: Multiplan Commercial |
$366.60
|
| Rate for Payer: Multiplan Workers Comp |
$366.60
|
| 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 INTMD RPR FACE/MM 7.6-12.5CM BCE
|
Facility
|
OP
|
$1,763.83
|
|
|
Service Code
|
CPT 12054
|
| Hospital Charge Code |
8846543
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$6.52 |
| Max. Negotiated Rate |
$1,146.49 |
| Rate for Payer: Aetna Commercial |
$970.11
|
| Rate for Payer: Aetna Medicare |
$547.00
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$158.74
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$364.67
|
| Rate for Payer: Amerigroup Medicare |
$364.67
|
| Rate for Payer: BCBS of TX Blue Advantage |
$533.58
|
| Rate for Payer: BCBS of TX Blue Essentials |
$639.02
|
| Rate for Payer: BCBS of TX Medicare |
$364.67
|
| Rate for Payer: BCBS of TX PPO |
$805.17
|
| Rate for Payer: Cash Price |
$1,552.17
|
| Rate for Payer: Cash Price |
$1,552.17
|
| Rate for Payer: Cash Price |
$1,552.17
|
| Rate for Payer: Cigna Commercial |
$826.08
|
| Rate for Payer: Cigna Medicaid |
$143.08
|
| Rate for Payer: Cigna Medicare |
$364.67
|
| Rate for Payer: Employer Direct Commercial |
$364.67
|
| Rate for Payer: Humana Medicare/TRICARE |
$364.67
|
| Rate for Payer: Molina CHIP/Medicaid |
$143.08
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$364.67
|
| Rate for Payer: Molina Medicare |
$364.67
|
| Rate for Payer: Multiplan Auto |
$1,146.49
|
| Rate for Payer: Multiplan Commercial |
$1,146.49
|
| Rate for Payer: Multiplan Workers Comp |
$1,146.49
|
| Rate for Payer: Parkland Medicaid |
$143.08
|
| Rate for Payer: Scott and White EPO/PPO |
$6.52
|
| Rate for Payer: Scott and White Medicare |
$364.67
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$143.08
|
| Rate for Payer: Superior Health Plan EPO |
$364.67
|
| Rate for Payer: Superior Health Plan Medicare |
$364.67
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$364.67
|
| Rate for Payer: Universal American Medicare |
$364.67
|
| Rate for Payer: Wellcare Medicare |
$364.67
|
| Rate for Payer: Wellmed Medicare |
$364.67
|
|
|
ED INTMD RPR FACE/MM 7.6-12.5CM BCE
|
Facility
|
IP
|
$1,763.83
|
|
|
Service Code
|
CPT 12054
|
| Hospital Charge Code |
8846543
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$1,552.17
|
|
|
ED INTMD RPR N-HF/GENIT7.6-12.5 BCE
|
Facility
|
IP
|
$3,943.00
|
|
|
Service Code
|
CPT 12044
|
| Hospital Charge Code |
8926659
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$3,469.84
|
|
|
ED INTMD RPR N-HF/GENIT7.6-12.5 BCE
|
Facility
|
OP
|
$3,943.00
|
|
|
Service Code
|
CPT 12044
|
| Hospital Charge Code |
8926659
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$10.27 |
| Max. Negotiated Rate |
$2,562.95 |
| Rate for Payer: Aetna Commercial |
$2,168.65
|
| Rate for Payer: Aetna Medicare |
$861.57
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$354.87
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$574.38
|
| Rate for Payer: Amerigroup Medicare |
$574.38
|
| Rate for Payer: BCBS of TX Blue Advantage |
$830.02
|
| Rate for Payer: BCBS of TX Blue Essentials |
$994.04
|
| Rate for Payer: BCBS of TX Medicare |
$574.38
|
| Rate for Payer: BCBS of TX PPO |
$1,252.49
|
| Rate for Payer: Cash Price |
$3,469.84
|
| Rate for Payer: Cash Price |
$3,469.84
|
| Rate for Payer: Cash Price |
$3,469.84
|
| Rate for Payer: Cigna Commercial |
$1,301.14
|
| Rate for Payer: Cigna Medicaid |
$216.80
|
| Rate for Payer: Cigna Medicare |
$574.38
|
| Rate for Payer: Employer Direct Commercial |
$574.38
|
| Rate for Payer: Humana Medicare/TRICARE |
$574.38
|
| Rate for Payer: Molina CHIP/Medicaid |
$216.80
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$574.38
|
| Rate for Payer: Molina Medicare |
$574.38
|
| Rate for Payer: Multiplan Auto |
$2,562.95
|
| Rate for Payer: Multiplan Commercial |
$2,562.95
|
| Rate for Payer: Multiplan Workers Comp |
$2,562.95
|
| Rate for Payer: Parkland Medicaid |
$216.80
|
| Rate for Payer: Scott and White EPO/PPO |
$10.27
|
| Rate for Payer: Scott and White Medicare |
$574.38
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$216.80
|
| Rate for Payer: Superior Health Plan EPO |
$574.38
|
| Rate for Payer: Superior Health Plan Medicare |
$574.38
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$574.38
|
| Rate for Payer: Universal American Medicare |
$574.38
|
| Rate for Payer: Wellcare Medicare |
$574.38
|
| Rate for Payer: Wellmed Medicare |
$574.38
|
|
|
ED IRRIGATION CORPORA CAVERNOSA PRIAPISM BCE
|
Facility
|
IP
|
$887.00
|
|
|
Service Code
|
CPT 54220
|
| Hospital Charge Code |
8576625
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$780.56
|
|
|
ED IRRIGATION CORPORA CAVERNOSA PRIAPISM BCE
|
Facility
|
OP
|
$887.00
|
|
|
Service Code
|
CPT 54220
|
| Hospital Charge Code |
8576625
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$4.04 |
| Max. Negotiated Rate |
$591.95 |
| Rate for Payer: Aetna Commercial |
$487.85
|
| Rate for Payer: Aetna Medicare |
$339.04
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$79.83
|
| 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 |
$780.56
|
| Rate for Payer: Cash Price |
$780.56
|
| Rate for Payer: Cash Price |
$780.56
|
| 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 |
$576.55
|
| Rate for Payer: Multiplan Commercial |
$576.55
|
| Rate for Payer: Multiplan Workers Comp |
$576.55
|
| 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 Laceration Complex - Eye/Ear/Nose/Lip: 1.1 to 2.5 cm
|
Facility
|
OP
|
$1,558.00
|
|
|
Service Code
|
CPT 13151
|
| Hospital Charge Code |
9250776
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$10.27 |
| Max. Negotiated Rate |
$1,301.14 |
| Rate for Payer: Aetna Commercial |
$856.90
|
| Rate for Payer: Aetna Medicare |
$861.57
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$140.22
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$574.38
|
| Rate for Payer: Amerigroup Medicare |
$574.38
|
| Rate for Payer: BCBS of TX Blue Advantage |
$830.02
|
| Rate for Payer: BCBS of TX Blue Essentials |
$994.04
|
| Rate for Payer: BCBS of TX Medicare |
$574.38
|
| Rate for Payer: BCBS of TX PPO |
$1,252.49
|
| Rate for Payer: Cash Price |
$1,371.04
|
| Rate for Payer: Cash Price |
$1,371.04
|
| Rate for Payer: Cash Price |
$1,371.04
|
| Rate for Payer: Cigna Commercial |
$1,301.14
|
| Rate for Payer: Cigna Medicaid |
$216.80
|
| Rate for Payer: Cigna Medicare |
$574.38
|
| Rate for Payer: Employer Direct Commercial |
$574.38
|
| Rate for Payer: Humana Medicare/TRICARE |
$574.38
|
| Rate for Payer: Molina CHIP/Medicaid |
$216.80
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$574.38
|
| Rate for Payer: Molina Medicare |
$574.38
|
| Rate for Payer: Multiplan Auto |
$1,012.70
|
| Rate for Payer: Multiplan Commercial |
$1,012.70
|
| Rate for Payer: Multiplan Workers Comp |
$1,012.70
|
| Rate for Payer: Parkland Medicaid |
$216.80
|
| Rate for Payer: Scott and White EPO/PPO |
$10.27
|
| Rate for Payer: Scott and White Medicare |
$574.38
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$216.80
|
| Rate for Payer: Superior Health Plan EPO |
$574.38
|
| Rate for Payer: Superior Health Plan Medicare |
$574.38
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$574.38
|
| Rate for Payer: Universal American Medicare |
$574.38
|
| Rate for Payer: Wellcare Medicare |
$574.38
|
| Rate for Payer: Wellmed Medicare |
$574.38
|
|
|
ED Laceration Complex - Eye/Ear/Nose/Lip: 1.1 to 2.5 cm
|
Facility
|
IP
|
$1,558.00
|
|
|
Service Code
|
CPT 13151
|
| Hospital Charge Code |
9250776
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$1,371.04
|
|
