|
ED Laceration Complex - Eye/Ear/Nose/Lip 1.1 to 2.5 cm BCE
|
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: 2.6 to 7.5 cm
|
Facility
|
OP
|
$1,597.00
|
|
|
Service Code
|
CPT 13152
|
| Hospital Charge Code |
9250777
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$10.27 |
| Max. Negotiated Rate |
$1,301.14 |
| Rate for Payer: Aetna Commercial |
$878.35
|
| Rate for Payer: Aetna Medicare |
$861.57
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$143.73
|
| 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 |
$1,405.36
|
| Rate for Payer: Cash Price |
$1,405.36
|
| Rate for Payer: Cash Price |
$1,405.36
|
| 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 |
$1,038.05
|
| Rate for Payer: Multiplan Commercial |
$1,038.05
|
| Rate for Payer: Multiplan Workers Comp |
$1,038.05
|
| 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: 2.6 to 7.5 cm
|
Facility
|
IP
|
$1,597.00
|
|
|
Service Code
|
CPT 13152
|
| Hospital Charge Code |
9250777
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$1,405.36
|
|
|
ED Laceration Complex - Eye/Ear/Nose/Lip 2.6 to 7.5 cm BCE
|
Facility
|
OP
|
$1,597.00
|
|
|
Service Code
|
CPT 13152
|
| Hospital Charge Code |
9250777
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$10.27 |
| Max. Negotiated Rate |
$1,301.14 |
| Rate for Payer: Aetna Commercial |
$878.35
|
| Rate for Payer: Aetna Medicare |
$861.57
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$143.73
|
| 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 |
$1,405.36
|
| Rate for Payer: Cash Price |
$1,405.36
|
| Rate for Payer: Cash Price |
$1,405.36
|
| 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 |
$1,038.05
|
| Rate for Payer: Multiplan Commercial |
$1,038.05
|
| Rate for Payer: Multiplan Workers Comp |
$1,038.05
|
| 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: Each Addl 5 cm
|
Facility
|
IP
|
$2,381.00
|
|
|
Service Code
|
CPT 13153
|
| Hospital Charge Code |
5202550
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$2,095.28
|
|
|
ED Laceration Complex - Eye/Ear/Nose/Lip: Each Addl 5 cm
|
Facility
|
OP
|
$2,381.00
|
|
|
Service Code
|
CPT 13153
|
| Hospital Charge Code |
5202550
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$214.29 |
| Max. Negotiated Rate |
$1,547.65 |
| Rate for Payer: Aetna Commercial |
$1,309.55
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$214.29
|
| Rate for Payer: Cash Price |
$2,095.28
|
| Rate for Payer: Multiplan Auto |
$1,547.65
|
| Rate for Payer: Multiplan Commercial |
$1,547.65
|
| Rate for Payer: Multiplan Workers Comp |
$1,547.65
|
| Rate for Payer: Scott and White EPO/PPO |
$1,190.50
|
| Rate for Payer: Superior Health Plan EPO |
$323.82
|
|
|
ED Laceration Complex - Eye/Ear/Nose/Lip Each Addl 5 cm BCE
|
Facility
|
OP
|
$2,381.00
|
|
|
Service Code
|
CPT 13153
|
| Hospital Charge Code |
5202550
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$214.29 |
| Max. Negotiated Rate |
$1,547.65 |
| Rate for Payer: Aetna Commercial |
$1,309.55
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$214.29
|
| Rate for Payer: Cash Price |
$2,095.28
|
| Rate for Payer: Multiplan Auto |
$1,547.65
|
| Rate for Payer: Multiplan Commercial |
$1,547.65
|
| Rate for Payer: Multiplan Workers Comp |
$1,547.65
|
| Rate for Payer: Scott and White EPO/PPO |
$1,190.50
|
| Rate for Payer: Superior Health Plan EPO |
$323.82
|
|
|
ED LACERATION COMPLEX F/C/C/M/N/AX/G/H/F EA ADDL 5 CM/< BCE
|
Facility
|
IP
|
$2,545.00
|
|
|
Service Code
|
CPT 13133
|
| Hospital Charge Code |
8810574
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$2,239.60
|
|
|
ED LACERATION COMPLEX F/C/C/M/N/AX/G/H/F EA ADDL 5 CM/< BCE
|
Facility
|
OP
|
$2,545.00
|
|
|
Service Code
|
CPT 13133
|
| Hospital Charge Code |
8810574
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$229.05 |
| Max. Negotiated Rate |
$1,654.25 |
| Rate for Payer: Aetna Commercial |
$1,399.75
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$229.05
|
| Rate for Payer: Cash Price |
$2,239.60
|
| Rate for Payer: Multiplan Auto |
$1,654.25
|
| Rate for Payer: Multiplan Commercial |
$1,654.25
|
| Rate for Payer: Multiplan Workers Comp |
$1,654.25
|
| Rate for Payer: Scott and White EPO/PPO |
$1,272.50
|
| Rate for Payer: Superior Health Plan EPO |
$346.12
|
|
|
ED Laceration Complex - F/N/H/F/G: 2.6 to 7.5 cm
|
Facility
|
OP
|
$1,041.00
|
|
|
Service Code
|
CPT 13132
|
| Hospital Charge Code |
5202551
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$10.27 |
| Max. Negotiated Rate |
$1,301.14 |
| Rate for Payer: Aetna Commercial |
$572.55
|
| Rate for Payer: Aetna Medicare |
$861.57
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$93.69
|
| 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 |
$916.08
|
| Rate for Payer: Cash Price |
$916.08
|
| Rate for Payer: Cash Price |
$916.08
|
| 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 |
$676.65
|
| Rate for Payer: Multiplan Commercial |
$676.65
|
| Rate for Payer: Multiplan Workers Comp |
$676.65
|
| 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 - F/N/H/F/G: 2.6 to 7.5 cm
|
Facility
|
IP
|
$1,041.00
|
|
|
Service Code
|
CPT 13132
|
| Hospital Charge Code |
5202551
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$916.08
|
|
|
ED Laceration Complex - F/N/H/F/G 2.6 to 7.5 cm BCE
|
Facility
|
OP
|
$1,041.00
|
|
|
Service Code
|
CPT 13132
|
| Hospital Charge Code |
5202551
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$10.27 |
| Max. Negotiated Rate |
$1,301.14 |
| Rate for Payer: Aetna Commercial |
$572.55
|
| Rate for Payer: Aetna Medicare |
$861.57
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$93.69
|
| 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 |
$916.08
|
| Rate for Payer: Cash Price |
$916.08
|
| Rate for Payer: Cash Price |
$916.08
|
| 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 |
$676.65
|
| Rate for Payer: Multiplan Commercial |
$676.65
|
| Rate for Payer: Multiplan Workers Comp |
$676.65
|
| 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 - Trunk: 2.6 to 7.5 cm
|
Facility
|
OP
|
$2,250.00
|
|
|
Service Code
|
CPT 13101
|
| Hospital Charge Code |
5202552
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$10.27 |
| Max. Negotiated Rate |
$1,462.50 |
| Rate for Payer: Aetna Commercial |
$1,237.50
|
| Rate for Payer: Aetna Medicare |
$861.57
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$202.50
|
| 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 |
$1,980.00
|
| Rate for Payer: Cash Price |
$1,980.00
|
| Rate for Payer: Cash Price |
$1,980.00
|
| 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 |
$1,462.50
|
| Rate for Payer: Multiplan Commercial |
$1,462.50
|
| Rate for Payer: Multiplan Workers Comp |
$1,462.50
|
| 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 - Trunk: 2.6 to 7.5 cm
|
Facility
|
IP
|
$2,250.00
|
|
|
Service Code
|
CPT 13101
|
| Hospital Charge Code |
5202552
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$1,980.00
|
|
|
ED Laceration Complex - Trunk 2.6 to 7.5 cm BCE
|
Facility
|
OP
|
$2,250.00
|
|
|
Service Code
|
CPT 13101
|
| Hospital Charge Code |
5202552
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$10.27 |
| Max. Negotiated Rate |
$1,462.50 |
| Rate for Payer: Aetna Commercial |
$1,237.50
|
| Rate for Payer: Aetna Medicare |
$861.57
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$202.50
|
| 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 |
$1,980.00
|
| Rate for Payer: Cash Price |
$1,980.00
|
| Rate for Payer: Cash Price |
$1,980.00
|
| 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 |
$1,462.50
|
| Rate for Payer: Multiplan Commercial |
$1,462.50
|
| Rate for Payer: Multiplan Workers Comp |
$1,462.50
|
| 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 - Trunk: Each Addl 5 cm
|
Facility
|
OP
|
$3,409.00
|
|
|
Service Code
|
CPT 13102
|
| Hospital Charge Code |
5202553
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$306.81 |
| Max. Negotiated Rate |
$2,215.85 |
| Rate for Payer: Aetna Commercial |
$1,874.95
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$306.81
|
| Rate for Payer: Cash Price |
$2,999.92
|
| Rate for Payer: Multiplan Auto |
$2,215.85
|
| Rate for Payer: Multiplan Commercial |
$2,215.85
|
| Rate for Payer: Multiplan Workers Comp |
$2,215.85
|
| Rate for Payer: Scott and White EPO/PPO |
$1,704.50
|
| Rate for Payer: Superior Health Plan EPO |
$463.62
|
|
|
ED Laceration Complex - Trunk: Each Addl 5 cm
|
Facility
|
IP
|
$3,409.00
|
|
|
Service Code
|
CPT 13102
|
| Hospital Charge Code |
5202553
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$2,999.92
|
|
|
ED Laceration Complex - Trunk Each Addl 5 cm BCE
|
Facility
|
OP
|
$3,409.00
|
|
|
Service Code
|
CPT 13102
|
| Hospital Charge Code |
5202553
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$306.81 |
| Max. Negotiated Rate |
$2,215.85 |
| Rate for Payer: Aetna Commercial |
$1,874.95
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$306.81
|
| Rate for Payer: Cash Price |
$2,999.92
|
| Rate for Payer: Multiplan Auto |
$2,215.85
|
| Rate for Payer: Multiplan Commercial |
$2,215.85
|
| Rate for Payer: Multiplan Workers Comp |
$2,215.85
|
| Rate for Payer: Scott and White EPO/PPO |
$1,704.50
|
| Rate for Payer: Superior Health Plan EPO |
$463.62
|
|
|
ED Laceration Intermediate - Face: 20.1 to 30.0 cm
|
Facility
|
OP
|
$2,839.00
|
|
|
Service Code
|
CPT 12056
|
| Hospital Charge Code |
5202556
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$6.52 |
| Max. Negotiated Rate |
$1,845.35 |
| Rate for Payer: Aetna Commercial |
$1,561.45
|
| Rate for Payer: Aetna Medicare |
$547.00
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$255.51
|
| 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 |
$2,498.32
|
| Rate for Payer: Cash Price |
$2,498.32
|
| Rate for Payer: Cash Price |
$2,498.32
|
| 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 |
$1,845.35
|
| Rate for Payer: Multiplan Commercial |
$1,845.35
|
| Rate for Payer: Multiplan Workers Comp |
$1,845.35
|
| 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 Laceration Intermediate - Face 20.1 to 30.0 cm BCE
|
Facility
|
OP
|
$2,839.00
|
|
|
Service Code
|
CPT 12056
|
| Hospital Charge Code |
5202556
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$6.52 |
| Max. Negotiated Rate |
$1,845.35 |
| Rate for Payer: Aetna Commercial |
$1,561.45
|
| Rate for Payer: Aetna Medicare |
$547.00
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$255.51
|
| 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 |
$2,498.32
|
| Rate for Payer: Cash Price |
$2,498.32
|
| Rate for Payer: Cash Price |
$2,498.32
|
| 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 |
$1,845.35
|
| Rate for Payer: Multiplan Commercial |
$1,845.35
|
| Rate for Payer: Multiplan Workers Comp |
$1,845.35
|
| 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 Laceration Intermediate - Face 20.1 to 30.0 cm BCE
|
Facility
|
IP
|
$2,839.00
|
|
|
Service Code
|
CPT 12056
|
| Hospital Charge Code |
5202556
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$2,498.32
|
|
|
ED Laceration Intermediate - Face: <= 2.5 cm
|
Facility
|
OP
|
$1,065.00
|
|
|
Service Code
|
CPT 12051
|
| Hospital Charge Code |
5202554
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$6.52 |
| Max. Negotiated Rate |
$826.08 |
| Rate for Payer: Aetna Commercial |
$585.75
|
| Rate for Payer: Aetna Medicare |
$547.00
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$95.85
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$364.67
|
| Rate for Payer: Amerigroup Medicare |
$364.67
|
| Rate for Payer: BCBS of TX Blue Advantage |
$269.62
|
| Rate for Payer: BCBS of TX Blue Essentials |
$322.90
|
| Rate for Payer: BCBS of TX Medicare |
$364.67
|
| Rate for Payer: BCBS of TX PPO |
$406.85
|
| Rate for Payer: Cash Price |
$937.20
|
| Rate for Payer: Cash Price |
$937.20
|
| Rate for Payer: Cash Price |
$937.20
|
| 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 |
$692.25
|
| Rate for Payer: Multiplan Commercial |
$692.25
|
| Rate for Payer: Multiplan Workers Comp |
$692.25
|
| 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 Laceration Intermediate - Face <= 2.5 cm BCE
|
Facility
|
IP
|
$1,065.00
|
|
|
Service Code
|
CPT 12051
|
| Hospital Charge Code |
5202554
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$937.20
|
|
|
ED Laceration Intermediate - Face <= 2.5 cm BCE
|
Facility
|
OP
|
$1,065.00
|
|
|
Service Code
|
CPT 12051
|
| Hospital Charge Code |
5202554
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$6.52 |
| Max. Negotiated Rate |
$826.08 |
| Rate for Payer: Aetna Commercial |
$585.75
|
| Rate for Payer: Aetna Medicare |
$547.00
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$95.85
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$364.67
|
| Rate for Payer: Amerigroup Medicare |
$364.67
|
| Rate for Payer: BCBS of TX Blue Advantage |
$269.62
|
| Rate for Payer: BCBS of TX Blue Essentials |
$322.90
|
| Rate for Payer: BCBS of TX Medicare |
$364.67
|
| Rate for Payer: BCBS of TX PPO |
$406.85
|
| Rate for Payer: Cash Price |
$937.20
|
| Rate for Payer: Cash Price |
$937.20
|
| Rate for Payer: Cash Price |
$937.20
|
| 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 |
$692.25
|
| Rate for Payer: Multiplan Commercial |
$692.25
|
| Rate for Payer: Multiplan Workers Comp |
$692.25
|
| 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 Laceration Intermediate - Face: 2.6 to 5.0 cm
|
Facility
|
OP
|
$1,253.00
|
|
|
Service Code
|
CPT 12052
|
| Hospital Charge Code |
5202555
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$6.52 |
| Max. Negotiated Rate |
$826.08 |
| Rate for Payer: Aetna Commercial |
$689.15
|
| Rate for Payer: Aetna Medicare |
$547.00
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$112.77
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$364.67
|
| Rate for Payer: Amerigroup Medicare |
$364.67
|
| Rate for Payer: BCBS of TX Blue Advantage |
$269.62
|
| Rate for Payer: BCBS of TX Blue Essentials |
$322.90
|
| Rate for Payer: BCBS of TX Medicare |
$364.67
|
| Rate for Payer: BCBS of TX PPO |
$406.85
|
| Rate for Payer: Cash Price |
$1,102.64
|
| Rate for Payer: Cash Price |
$1,102.64
|
| Rate for Payer: Cash Price |
$1,102.64
|
| 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 |
$814.45
|
| Rate for Payer: Multiplan Commercial |
$814.45
|
| Rate for Payer: Multiplan Workers Comp |
$814.45
|
| 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
|
|
