|
ED Orthopedic Splinting Site: Posterior Long Arm Splint
|
Facility
|
OP
|
$490.00
|
|
|
Service Code
|
CPT 29105
|
| Hospital Charge Code |
5202580
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2.58 |
| Max. Negotiated Rate |
$326.44 |
| Rate for Payer: Aetna Commercial |
$269.50
|
| Rate for Payer: Aetna Medicare |
$216.15
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$44.10
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$144.10
|
| Rate for Payer: Amerigroup Medicare |
$144.10
|
| Rate for Payer: BCBS of TX Blue Advantage |
$83.17
|
| Rate for Payer: BCBS of TX Blue Essentials |
$99.60
|
| Rate for Payer: BCBS of TX Medicare |
$144.10
|
| Rate for Payer: BCBS of TX PPO |
$125.50
|
| Rate for Payer: Cash Price |
$431.20
|
| Rate for Payer: Cash Price |
$431.20
|
| Rate for Payer: Cash Price |
$431.20
|
| Rate for Payer: Cigna Commercial |
$326.44
|
| Rate for Payer: Cigna Medicaid |
$40.14
|
| Rate for Payer: Cigna Medicare |
$144.10
|
| Rate for Payer: Employer Direct Commercial |
$144.10
|
| Rate for Payer: Humana Medicare/TRICARE |
$144.10
|
| Rate for Payer: Molina CHIP/Medicaid |
$40.14
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$144.10
|
| Rate for Payer: Molina Medicare |
$144.10
|
| Rate for Payer: Multiplan Auto |
$318.50
|
| Rate for Payer: Multiplan Commercial |
$318.50
|
| Rate for Payer: Multiplan Workers Comp |
$318.50
|
| Rate for Payer: Parkland Medicaid |
$40.14
|
| Rate for Payer: Scott and White EPO/PPO |
$2.58
|
| Rate for Payer: Scott and White Medicare |
$144.10
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$40.14
|
| Rate for Payer: Superior Health Plan EPO |
$144.10
|
| Rate for Payer: Superior Health Plan Medicare |
$144.10
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$144.10
|
| Rate for Payer: Universal American Medicare |
$144.10
|
| Rate for Payer: Wellcare Medicare |
$144.10
|
| Rate for Payer: Wellmed Medicare |
$144.10
|
|
|
ED Orthopedic Splinting Site Posterior Long Arm Splint BCE
|
Facility
|
OP
|
$490.00
|
|
|
Service Code
|
CPT 29105
|
| Hospital Charge Code |
5202580
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2.58 |
| Max. Negotiated Rate |
$326.44 |
| Rate for Payer: Aetna Commercial |
$269.50
|
| Rate for Payer: Aetna Medicare |
$216.15
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$44.10
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$144.10
|
| Rate for Payer: Amerigroup Medicare |
$144.10
|
| Rate for Payer: BCBS of TX Blue Advantage |
$83.17
|
| Rate for Payer: BCBS of TX Blue Essentials |
$99.60
|
| Rate for Payer: BCBS of TX Medicare |
$144.10
|
| Rate for Payer: BCBS of TX PPO |
$125.50
|
| Rate for Payer: Cash Price |
$431.20
|
| Rate for Payer: Cash Price |
$431.20
|
| Rate for Payer: Cash Price |
$431.20
|
| Rate for Payer: Cigna Commercial |
$326.44
|
| Rate for Payer: Cigna Medicaid |
$40.14
|
| Rate for Payer: Cigna Medicare |
$144.10
|
| Rate for Payer: Employer Direct Commercial |
$144.10
|
| Rate for Payer: Humana Medicare/TRICARE |
$144.10
|
| Rate for Payer: Molina CHIP/Medicaid |
$40.14
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$144.10
|
| Rate for Payer: Molina Medicare |
$144.10
|
| Rate for Payer: Multiplan Auto |
$318.50
|
| Rate for Payer: Multiplan Commercial |
$318.50
|
| Rate for Payer: Multiplan Workers Comp |
$318.50
|
| Rate for Payer: Parkland Medicaid |
$40.14
|
| Rate for Payer: Scott and White EPO/PPO |
$2.58
|
| Rate for Payer: Scott and White Medicare |
$144.10
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$40.14
|
| Rate for Payer: Superior Health Plan EPO |
$144.10
|
| Rate for Payer: Superior Health Plan Medicare |
$144.10
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$144.10
|
| Rate for Payer: Universal American Medicare |
$144.10
|
| Rate for Payer: Wellcare Medicare |
$144.10
|
| Rate for Payer: Wellmed Medicare |
$144.10
|
|
|
ED Orthopedic Splinting Site: Posterior Long Leg Splint
|
Facility
|
OP
|
$841.00
|
|
|
Service Code
|
CPT 29505
|
| Hospital Charge Code |
9220240
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2.58 |
| Max. Negotiated Rate |
$546.65 |
| Rate for Payer: Aetna Commercial |
$462.55
|
| Rate for Payer: Aetna Medicare |
$216.15
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$75.69
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$144.10
|
| Rate for Payer: Amerigroup Medicare |
$144.10
|
| Rate for Payer: BCBS of TX Blue Advantage |
$97.03
|
| Rate for Payer: BCBS of TX Blue Essentials |
$116.20
|
| Rate for Payer: BCBS of TX Medicare |
$144.10
|
| Rate for Payer: BCBS of TX PPO |
$146.41
|
| Rate for Payer: Cash Price |
$740.08
|
| Rate for Payer: Cash Price |
$740.08
|
| Rate for Payer: Cash Price |
$740.08
|
| Rate for Payer: Cigna Commercial |
$326.44
|
| Rate for Payer: Cigna Medicaid |
$48.45
|
| Rate for Payer: Cigna Medicare |
$144.10
|
| Rate for Payer: Employer Direct Commercial |
$144.10
|
| Rate for Payer: Humana Medicare/TRICARE |
$144.10
|
| Rate for Payer: Molina CHIP/Medicaid |
$48.45
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$144.10
|
| Rate for Payer: Molina Medicare |
$144.10
|
| Rate for Payer: Multiplan Auto |
$546.65
|
| Rate for Payer: Multiplan Commercial |
$546.65
|
| Rate for Payer: Multiplan Workers Comp |
$546.65
|
| Rate for Payer: Parkland Medicaid |
$48.45
|
| Rate for Payer: Scott and White EPO/PPO |
$2.58
|
| Rate for Payer: Scott and White Medicare |
$144.10
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$48.45
|
| Rate for Payer: Superior Health Plan EPO |
$144.10
|
| Rate for Payer: Superior Health Plan Medicare |
$144.10
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$144.10
|
| Rate for Payer: Universal American Medicare |
$144.10
|
| Rate for Payer: Wellcare Medicare |
$144.10
|
| Rate for Payer: Wellmed Medicare |
$144.10
|
|
|
ED Orthopedic Splinting Site: Posterior Long Leg Splint
|
Facility
|
IP
|
$841.00
|
|
|
Service Code
|
CPT 29505
|
| Hospital Charge Code |
9220240
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$740.08
|
|
|
ED Orthopedic Splinting Site Posterior Long Leg Splint BCE
|
Facility
|
OP
|
$841.00
|
|
|
Service Code
|
CPT 29505
|
| Hospital Charge Code |
9220240
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2.58 |
| Max. Negotiated Rate |
$546.65 |
| Rate for Payer: Aetna Commercial |
$462.55
|
| Rate for Payer: Aetna Medicare |
$216.15
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$75.69
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$144.10
|
| Rate for Payer: Amerigroup Medicare |
$144.10
|
| Rate for Payer: BCBS of TX Blue Advantage |
$97.03
|
| Rate for Payer: BCBS of TX Blue Essentials |
$116.20
|
| Rate for Payer: BCBS of TX Medicare |
$144.10
|
| Rate for Payer: BCBS of TX PPO |
$146.41
|
| Rate for Payer: Cash Price |
$740.08
|
| Rate for Payer: Cash Price |
$740.08
|
| Rate for Payer: Cash Price |
$740.08
|
| Rate for Payer: Cigna Commercial |
$326.44
|
| Rate for Payer: Cigna Medicaid |
$48.45
|
| Rate for Payer: Cigna Medicare |
$144.10
|
| Rate for Payer: Employer Direct Commercial |
$144.10
|
| Rate for Payer: Humana Medicare/TRICARE |
$144.10
|
| Rate for Payer: Molina CHIP/Medicaid |
$48.45
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$144.10
|
| Rate for Payer: Molina Medicare |
$144.10
|
| Rate for Payer: Multiplan Auto |
$546.65
|
| Rate for Payer: Multiplan Commercial |
$546.65
|
| Rate for Payer: Multiplan Workers Comp |
$546.65
|
| Rate for Payer: Parkland Medicaid |
$48.45
|
| Rate for Payer: Scott and White EPO/PPO |
$2.58
|
| Rate for Payer: Scott and White Medicare |
$144.10
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$48.45
|
| Rate for Payer: Superior Health Plan EPO |
$144.10
|
| Rate for Payer: Superior Health Plan Medicare |
$144.10
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$144.10
|
| Rate for Payer: Universal American Medicare |
$144.10
|
| Rate for Payer: Wellcare Medicare |
$144.10
|
| Rate for Payer: Wellmed Medicare |
$144.10
|
|
|
ED Orthopedic Splinting Site: Posterior Short Arm Splint
|
Facility
|
IP
|
$618.00
|
|
|
Service Code
|
CPT 29125
|
| Hospital Charge Code |
4272026
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$543.84
|
|
|
ED Orthopedic Splinting Site: Posterior Short Arm Splint
|
Facility
|
OP
|
$618.00
|
|
|
Service Code
|
CPT 29125
|
| Hospital Charge Code |
4272026
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2.09 |
| Max. Negotiated Rate |
$401.70 |
| Rate for Payer: Aetna Commercial |
$339.90
|
| Rate for Payer: Aetna Medicare |
$175.23
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$55.62
|
| 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 |
$543.84
|
| Rate for Payer: Cash Price |
$543.84
|
| Rate for Payer: Cash Price |
$543.84
|
| 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 |
$401.70
|
| Rate for Payer: Multiplan Commercial |
$401.70
|
| Rate for Payer: Multiplan Workers Comp |
$401.70
|
| 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 Orthopedic Splinting Site Posterior Short Arm Splint BCE
|
Facility
|
OP
|
$618.00
|
|
|
Service Code
|
CPT 29125
|
| Hospital Charge Code |
4272026
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2.09 |
| Max. Negotiated Rate |
$401.70 |
| Rate for Payer: Aetna Commercial |
$339.90
|
| Rate for Payer: Aetna Medicare |
$175.23
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$55.62
|
| 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 |
$543.84
|
| Rate for Payer: Cash Price |
$543.84
|
| Rate for Payer: Cash Price |
$543.84
|
| 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 |
$401.70
|
| Rate for Payer: Multiplan Commercial |
$401.70
|
| Rate for Payer: Multiplan Workers Comp |
$401.70
|
| 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 Orthopedic Splinting Site: Posterior Short Leg Splint
|
Facility
|
OP
|
$569.00
|
|
|
Service Code
|
CPT 29515
|
| Hospital Charge Code |
9220241
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2.58 |
| Max. Negotiated Rate |
$369.85 |
| Rate for Payer: Aetna Commercial |
$312.95
|
| Rate for Payer: Aetna Medicare |
$216.15
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$51.21
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$144.10
|
| Rate for Payer: Amerigroup Medicare |
$144.10
|
| Rate for Payer: BCBS of TX Blue Advantage |
$70.51
|
| Rate for Payer: BCBS of TX Blue Essentials |
$84.44
|
| Rate for Payer: BCBS of TX Medicare |
$144.10
|
| Rate for Payer: BCBS of TX PPO |
$106.39
|
| Rate for Payer: Cash Price |
$500.72
|
| Rate for Payer: Cash Price |
$500.72
|
| Rate for Payer: Cash Price |
$500.72
|
| Rate for Payer: Cigna Commercial |
$326.44
|
| Rate for Payer: Cigna Medicaid |
$34.33
|
| Rate for Payer: Cigna Medicare |
$144.10
|
| Rate for Payer: Employer Direct Commercial |
$144.10
|
| Rate for Payer: Humana Medicare/TRICARE |
$144.10
|
| Rate for Payer: Molina CHIP/Medicaid |
$34.33
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$144.10
|
| Rate for Payer: Molina Medicare |
$144.10
|
| Rate for Payer: Multiplan Auto |
$369.85
|
| Rate for Payer: Multiplan Commercial |
$369.85
|
| Rate for Payer: Multiplan Workers Comp |
$369.85
|
| Rate for Payer: Parkland Medicaid |
$34.33
|
| Rate for Payer: Scott and White EPO/PPO |
$2.58
|
| Rate for Payer: Scott and White Medicare |
$144.10
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$34.33
|
| Rate for Payer: Superior Health Plan EPO |
$144.10
|
| Rate for Payer: Superior Health Plan Medicare |
$144.10
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$144.10
|
| Rate for Payer: Universal American Medicare |
$144.10
|
| Rate for Payer: Wellcare Medicare |
$144.10
|
| Rate for Payer: Wellmed Medicare |
$144.10
|
|
|
ED Orthopedic Splinting Site: Posterior Short Leg Splint
|
Facility
|
IP
|
$569.00
|
|
|
Service Code
|
CPT 29515
|
| Hospital Charge Code |
9220241
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$500.72
|
|
|
ED Orthopedic Splinting Site Posterior Short Leg Splint BCE
|
Facility
|
OP
|
$569.00
|
|
|
Service Code
|
CPT 29515
|
| Hospital Charge Code |
9220241
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2.58 |
| Max. Negotiated Rate |
$369.85 |
| Rate for Payer: Aetna Commercial |
$312.95
|
| Rate for Payer: Aetna Medicare |
$216.15
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$51.21
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$144.10
|
| Rate for Payer: Amerigroup Medicare |
$144.10
|
| Rate for Payer: BCBS of TX Blue Advantage |
$70.51
|
| Rate for Payer: BCBS of TX Blue Essentials |
$84.44
|
| Rate for Payer: BCBS of TX Medicare |
$144.10
|
| Rate for Payer: BCBS of TX PPO |
$106.39
|
| Rate for Payer: Cash Price |
$500.72
|
| Rate for Payer: Cash Price |
$500.72
|
| Rate for Payer: Cash Price |
$500.72
|
| Rate for Payer: Cigna Commercial |
$326.44
|
| Rate for Payer: Cigna Medicaid |
$34.33
|
| Rate for Payer: Cigna Medicare |
$144.10
|
| Rate for Payer: Employer Direct Commercial |
$144.10
|
| Rate for Payer: Humana Medicare/TRICARE |
$144.10
|
| Rate for Payer: Molina CHIP/Medicaid |
$34.33
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$144.10
|
| Rate for Payer: Molina Medicare |
$144.10
|
| Rate for Payer: Multiplan Auto |
$369.85
|
| Rate for Payer: Multiplan Commercial |
$369.85
|
| Rate for Payer: Multiplan Workers Comp |
$369.85
|
| Rate for Payer: Parkland Medicaid |
$34.33
|
| Rate for Payer: Scott and White EPO/PPO |
$2.58
|
| Rate for Payer: Scott and White Medicare |
$144.10
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$34.33
|
| Rate for Payer: Superior Health Plan EPO |
$144.10
|
| Rate for Payer: Superior Health Plan Medicare |
$144.10
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$144.10
|
| Rate for Payer: Universal American Medicare |
$144.10
|
| Rate for Payer: Wellcare Medicare |
$144.10
|
| Rate for Payer: Wellmed Medicare |
$144.10
|
|
|
ED Orthopedic Strapping Site: Toes
|
Facility
|
OP
|
$329.00
|
|
|
Service Code
|
CPT 29550
|
| Hospital Charge Code |
5202581
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$213.85 |
| Rate for Payer: Aetna Commercial |
$180.95
|
| Rate for Payer: Aetna Medicare |
$83.91
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$29.61
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$55.94
|
| Rate for Payer: Amerigroup Medicare |
$55.94
|
| Rate for Payer: BCBS of TX Blue Advantage |
$91.87
|
| Rate for Payer: BCBS of TX Blue Essentials |
$110.02
|
| Rate for Payer: BCBS of TX Medicare |
$55.94
|
| Rate for Payer: BCBS of TX PPO |
$138.63
|
| Rate for Payer: Cash Price |
$289.52
|
| Rate for Payer: Cash Price |
$289.52
|
| Rate for Payer: Cash Price |
$289.52
|
| Rate for Payer: Cigna Commercial |
$126.71
|
| Rate for Payer: Cigna Medicare |
$55.94
|
| Rate for Payer: Employer Direct Commercial |
$55.94
|
| Rate for Payer: Humana Medicare/TRICARE |
$55.94
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$55.94
|
| Rate for Payer: Molina Medicare |
$55.94
|
| Rate for Payer: Multiplan Auto |
$213.85
|
| Rate for Payer: Multiplan Commercial |
$213.85
|
| Rate for Payer: Multiplan Workers Comp |
$213.85
|
| Rate for Payer: Scott and White EPO/PPO |
$1.00
|
| Rate for Payer: Scott and White Medicare |
$55.94
|
| Rate for Payer: Superior Health Plan EPO |
$55.94
|
| Rate for Payer: Superior Health Plan Medicare |
$55.94
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$55.94
|
| Rate for Payer: Universal American Medicare |
$55.94
|
| Rate for Payer: Wellcare Medicare |
$55.94
|
| Rate for Payer: Wellmed Medicare |
$55.94
|
|
|
ED Orthopedic Strapping Site Toes BCE
|
Facility
|
OP
|
$329.00
|
|
|
Service Code
|
CPT 29550
|
| Hospital Charge Code |
5202581
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$213.85 |
| Rate for Payer: Aetna Commercial |
$180.95
|
| Rate for Payer: Aetna Medicare |
$83.91
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$29.61
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$55.94
|
| Rate for Payer: Amerigroup Medicare |
$55.94
|
| Rate for Payer: BCBS of TX Blue Advantage |
$91.87
|
| Rate for Payer: BCBS of TX Blue Essentials |
$110.02
|
| Rate for Payer: BCBS of TX Medicare |
$55.94
|
| Rate for Payer: BCBS of TX PPO |
$138.63
|
| Rate for Payer: Cash Price |
$289.52
|
| Rate for Payer: Cash Price |
$289.52
|
| Rate for Payer: Cash Price |
$289.52
|
| Rate for Payer: Cigna Commercial |
$126.71
|
| Rate for Payer: Cigna Medicare |
$55.94
|
| Rate for Payer: Employer Direct Commercial |
$55.94
|
| Rate for Payer: Humana Medicare/TRICARE |
$55.94
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$55.94
|
| Rate for Payer: Molina Medicare |
$55.94
|
| Rate for Payer: Multiplan Auto |
$213.85
|
| Rate for Payer: Multiplan Commercial |
$213.85
|
| Rate for Payer: Multiplan Workers Comp |
$213.85
|
| Rate for Payer: Scott and White EPO/PPO |
$1.00
|
| Rate for Payer: Scott and White Medicare |
$55.94
|
| Rate for Payer: Superior Health Plan EPO |
$55.94
|
| Rate for Payer: Superior Health Plan Medicare |
$55.94
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$55.94
|
| Rate for Payer: Universal American Medicare |
$55.94
|
| Rate for Payer: Wellcare Medicare |
$55.94
|
| Rate for Payer: Wellmed Medicare |
$55.94
|
|
|
ED Orthopedic Strapping Site Toes BCE
|
Facility
|
IP
|
$329.00
|
|
|
Service Code
|
CPT 29550
|
| Hospital Charge Code |
5202581
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$289.52
|
|
|
ED Orthopedic Strapping Site: Unna boot
|
Facility
|
OP
|
$353.00
|
|
|
Service Code
|
CPT 29580
|
| Hospital Charge Code |
7150831
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2.58 |
| Max. Negotiated Rate |
$326.44 |
| Rate for Payer: Aetna Commercial |
$194.15
|
| Rate for Payer: Aetna Medicare |
$216.15
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$31.77
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$144.10
|
| Rate for Payer: Amerigroup Medicare |
$144.10
|
| Rate for Payer: BCBS of TX Blue Advantage |
$70.51
|
| Rate for Payer: BCBS of TX Blue Essentials |
$84.44
|
| Rate for Payer: BCBS of TX Medicare |
$144.10
|
| Rate for Payer: BCBS of TX PPO |
$106.39
|
| Rate for Payer: Cash Price |
$310.64
|
| Rate for Payer: Cash Price |
$310.64
|
| Rate for Payer: Cash Price |
$310.64
|
| Rate for Payer: Cigna Commercial |
$326.44
|
| Rate for Payer: Cigna Medicaid |
$35.16
|
| Rate for Payer: Cigna Medicare |
$144.10
|
| Rate for Payer: Employer Direct Commercial |
$144.10
|
| Rate for Payer: Humana Medicare/TRICARE |
$144.10
|
| Rate for Payer: Molina CHIP/Medicaid |
$35.16
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$144.10
|
| Rate for Payer: Molina Medicare |
$144.10
|
| Rate for Payer: Multiplan Auto |
$229.45
|
| Rate for Payer: Multiplan Commercial |
$229.45
|
| Rate for Payer: Multiplan Workers Comp |
$229.45
|
| Rate for Payer: Parkland Medicaid |
$35.16
|
| Rate for Payer: Scott and White EPO/PPO |
$2.58
|
| Rate for Payer: Scott and White Medicare |
$144.10
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$35.16
|
| Rate for Payer: Superior Health Plan EPO |
$144.10
|
| Rate for Payer: Superior Health Plan Medicare |
$144.10
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$144.10
|
| Rate for Payer: Universal American Medicare |
$144.10
|
| Rate for Payer: Wellcare Medicare |
$144.10
|
| Rate for Payer: Wellmed Medicare |
$144.10
|
|
|
ED Orthopedic Strapping Site Unna boot BCE
|
Facility
|
IP
|
$353.00
|
|
|
Service Code
|
CPT 29580
|
| Hospital Charge Code |
7150831
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$310.64
|
|
|
ED Orthopedic Strapping Site Unna boot BCE
|
Facility
|
OP
|
$353.00
|
|
|
Service Code
|
CPT 29580
|
| Hospital Charge Code |
7150831
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2.58 |
| Max. Negotiated Rate |
$326.44 |
| Rate for Payer: Aetna Commercial |
$194.15
|
| Rate for Payer: Aetna Medicare |
$216.15
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$31.77
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$144.10
|
| Rate for Payer: Amerigroup Medicare |
$144.10
|
| Rate for Payer: BCBS of TX Blue Advantage |
$70.51
|
| Rate for Payer: BCBS of TX Blue Essentials |
$84.44
|
| Rate for Payer: BCBS of TX Medicare |
$144.10
|
| Rate for Payer: BCBS of TX PPO |
$106.39
|
| Rate for Payer: Cash Price |
$310.64
|
| Rate for Payer: Cash Price |
$310.64
|
| Rate for Payer: Cash Price |
$310.64
|
| Rate for Payer: Cigna Commercial |
$326.44
|
| Rate for Payer: Cigna Medicaid |
$35.16
|
| Rate for Payer: Cigna Medicare |
$144.10
|
| Rate for Payer: Employer Direct Commercial |
$144.10
|
| Rate for Payer: Humana Medicare/TRICARE |
$144.10
|
| Rate for Payer: Molina CHIP/Medicaid |
$35.16
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$144.10
|
| Rate for Payer: Molina Medicare |
$144.10
|
| Rate for Payer: Multiplan Auto |
$229.45
|
| Rate for Payer: Multiplan Commercial |
$229.45
|
| Rate for Payer: Multiplan Workers Comp |
$229.45
|
| Rate for Payer: Parkland Medicaid |
$35.16
|
| Rate for Payer: Scott and White EPO/PPO |
$2.58
|
| Rate for Payer: Scott and White Medicare |
$144.10
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$35.16
|
| Rate for Payer: Superior Health Plan EPO |
$144.10
|
| Rate for Payer: Superior Health Plan Medicare |
$144.10
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$144.10
|
| Rate for Payer: Universal American Medicare |
$144.10
|
| Rate for Payer: Wellcare Medicare |
$144.10
|
| Rate for Payer: Wellmed Medicare |
$144.10
|
|
|
ED Paracentesis: with imaging
|
Facility
|
IP
|
$1,947.00
|
|
|
Service Code
|
CPT 49083
|
| Hospital Charge Code |
2170756
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$1,713.36
|
|
|
ED Paracentesis: with imaging
|
Facility
|
OP
|
$1,947.00
|
|
|
Service Code
|
CPT 49083
|
| Hospital Charge Code |
2170756
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$14.83 |
| Max. Negotiated Rate |
$2,200.00 |
| Rate for Payer: Aetna Commercial |
$2,200.00
|
| Rate for Payer: Aetna Medicare |
$1,243.53
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$175.23
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$829.02
|
| Rate for Payer: Amerigroup Medicare |
$829.02
|
| Rate for Payer: BCBS of TX Blue Advantage |
$1,312.49
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,571.84
|
| Rate for Payer: BCBS of TX Medicare |
$829.02
|
| Rate for Payer: BCBS of TX PPO |
$1,980.52
|
| Rate for Payer: Cash Price |
$1,713.36
|
| Rate for Payer: Cash Price |
$1,713.36
|
| Rate for Payer: Cash Price |
$1,713.36
|
| Rate for Payer: Cigna Commercial |
$1,877.98
|
| Rate for Payer: Cigna Medicaid |
$334.95
|
| Rate for Payer: Cigna Medicare |
$829.02
|
| Rate for Payer: Employer Direct Commercial |
$829.02
|
| Rate for Payer: Humana Medicare/TRICARE |
$829.02
|
| Rate for Payer: Molina CHIP/Medicaid |
$334.95
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$829.02
|
| Rate for Payer: Molina Medicare |
$829.02
|
| Rate for Payer: Multiplan Auto |
$1,265.55
|
| Rate for Payer: Multiplan Commercial |
$1,265.55
|
| Rate for Payer: Multiplan Workers Comp |
$1,265.55
|
| Rate for Payer: Parkland Medicaid |
$334.95
|
| Rate for Payer: Scott and White EPO/PPO |
$14.83
|
| Rate for Payer: Scott and White Medicare |
$829.02
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$334.95
|
| Rate for Payer: Superior Health Plan EPO |
$829.02
|
| Rate for Payer: Superior Health Plan Medicare |
$829.02
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$829.02
|
| Rate for Payer: Universal American Medicare |
$829.02
|
| Rate for Payer: Wellcare Medicare |
$829.02
|
| Rate for Payer: Wellmed Medicare |
$829.02
|
|
|
ED Paracentesis with imaging BCE
|
Facility
|
OP
|
$1,947.00
|
|
|
Service Code
|
CPT 49083
|
| Hospital Charge Code |
2170756
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$14.83 |
| Max. Negotiated Rate |
$2,200.00 |
| Rate for Payer: Aetna Commercial |
$2,200.00
|
| Rate for Payer: Aetna Medicare |
$1,243.53
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$175.23
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$829.02
|
| Rate for Payer: Amerigroup Medicare |
$829.02
|
| Rate for Payer: BCBS of TX Blue Advantage |
$1,312.49
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,571.84
|
| Rate for Payer: BCBS of TX Medicare |
$829.02
|
| Rate for Payer: BCBS of TX PPO |
$1,980.52
|
| Rate for Payer: Cash Price |
$1,713.36
|
| Rate for Payer: Cash Price |
$1,713.36
|
| Rate for Payer: Cash Price |
$1,713.36
|
| Rate for Payer: Cigna Commercial |
$1,877.98
|
| Rate for Payer: Cigna Medicaid |
$334.95
|
| Rate for Payer: Cigna Medicare |
$829.02
|
| Rate for Payer: Employer Direct Commercial |
$829.02
|
| Rate for Payer: Humana Medicare/TRICARE |
$829.02
|
| Rate for Payer: Molina CHIP/Medicaid |
$334.95
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$829.02
|
| Rate for Payer: Molina Medicare |
$829.02
|
| Rate for Payer: Multiplan Auto |
$1,265.55
|
| Rate for Payer: Multiplan Commercial |
$1,265.55
|
| Rate for Payer: Multiplan Workers Comp |
$1,265.55
|
| Rate for Payer: Parkland Medicaid |
$334.95
|
| Rate for Payer: Scott and White EPO/PPO |
$14.83
|
| Rate for Payer: Scott and White Medicare |
$829.02
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$334.95
|
| Rate for Payer: Superior Health Plan EPO |
$829.02
|
| Rate for Payer: Superior Health Plan Medicare |
$829.02
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$829.02
|
| Rate for Payer: Universal American Medicare |
$829.02
|
| Rate for Payer: Wellcare Medicare |
$829.02
|
| Rate for Payer: Wellmed Medicare |
$829.02
|
|
|
ED Paracentesis: without imaging
|
Facility
|
OP
|
$1,573.00
|
|
|
Service Code
|
CPT 49082
|
| Hospital Charge Code |
3520069
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$14.83 |
| Max. Negotiated Rate |
$2,200.00 |
| Rate for Payer: Aetna Commercial |
$2,200.00
|
| Rate for Payer: Aetna Medicare |
$1,243.53
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$141.57
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$829.02
|
| Rate for Payer: Amerigroup Medicare |
$829.02
|
| Rate for Payer: BCBS of TX Blue Advantage |
$1,312.49
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,571.84
|
| Rate for Payer: BCBS of TX Medicare |
$829.02
|
| Rate for Payer: BCBS of TX PPO |
$1,980.52
|
| Rate for Payer: Cash Price |
$1,384.24
|
| Rate for Payer: Cash Price |
$1,384.24
|
| Rate for Payer: Cash Price |
$1,384.24
|
| Rate for Payer: Cigna Commercial |
$1,877.98
|
| Rate for Payer: Cigna Medicaid |
$334.95
|
| Rate for Payer: Cigna Medicare |
$829.02
|
| Rate for Payer: Employer Direct Commercial |
$829.02
|
| Rate for Payer: Humana Medicare/TRICARE |
$829.02
|
| Rate for Payer: Molina CHIP/Medicaid |
$334.95
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$829.02
|
| Rate for Payer: Molina Medicare |
$829.02
|
| Rate for Payer: Multiplan Auto |
$1,022.45
|
| Rate for Payer: Multiplan Commercial |
$1,022.45
|
| Rate for Payer: Multiplan Workers Comp |
$1,022.45
|
| Rate for Payer: Parkland Medicaid |
$334.95
|
| Rate for Payer: Scott and White EPO/PPO |
$14.83
|
| Rate for Payer: Scott and White Medicare |
$829.02
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$334.95
|
| Rate for Payer: Superior Health Plan EPO |
$829.02
|
| Rate for Payer: Superior Health Plan Medicare |
$829.02
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$829.02
|
| Rate for Payer: Universal American Medicare |
$829.02
|
| Rate for Payer: Wellcare Medicare |
$829.02
|
| Rate for Payer: Wellmed Medicare |
$829.02
|
|
|
ED Paracentesis: without imaging
|
Facility
|
IP
|
$1,573.00
|
|
|
Service Code
|
CPT 49082
|
| Hospital Charge Code |
3520069
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$1,384.24
|
|
|
ED Paracentesis without imaging BCE
|
Facility
|
OP
|
$1,573.00
|
|
|
Service Code
|
CPT 49082
|
| Hospital Charge Code |
3520069
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$14.83 |
| Max. Negotiated Rate |
$2,200.00 |
| Rate for Payer: Aetna Commercial |
$2,200.00
|
| Rate for Payer: Aetna Medicare |
$1,243.53
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$141.57
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$829.02
|
| Rate for Payer: Amerigroup Medicare |
$829.02
|
| Rate for Payer: BCBS of TX Blue Advantage |
$1,312.49
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,571.84
|
| Rate for Payer: BCBS of TX Medicare |
$829.02
|
| Rate for Payer: BCBS of TX PPO |
$1,980.52
|
| Rate for Payer: Cash Price |
$1,384.24
|
| Rate for Payer: Cash Price |
$1,384.24
|
| Rate for Payer: Cash Price |
$1,384.24
|
| Rate for Payer: Cigna Commercial |
$1,877.98
|
| Rate for Payer: Cigna Medicaid |
$334.95
|
| Rate for Payer: Cigna Medicare |
$829.02
|
| Rate for Payer: Employer Direct Commercial |
$829.02
|
| Rate for Payer: Humana Medicare/TRICARE |
$829.02
|
| Rate for Payer: Molina CHIP/Medicaid |
$334.95
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$829.02
|
| Rate for Payer: Molina Medicare |
$829.02
|
| Rate for Payer: Multiplan Auto |
$1,022.45
|
| Rate for Payer: Multiplan Commercial |
$1,022.45
|
| Rate for Payer: Multiplan Workers Comp |
$1,022.45
|
| Rate for Payer: Parkland Medicaid |
$334.95
|
| Rate for Payer: Scott and White EPO/PPO |
$14.83
|
| Rate for Payer: Scott and White Medicare |
$829.02
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$334.95
|
| Rate for Payer: Superior Health Plan EPO |
$829.02
|
| Rate for Payer: Superior Health Plan Medicare |
$829.02
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$829.02
|
| Rate for Payer: Universal American Medicare |
$829.02
|
| Rate for Payer: Wellcare Medicare |
$829.02
|
| Rate for Payer: Wellmed Medicare |
$829.02
|
|
|
ED PICC Line Insertion >= 5 Years BCE
|
Facility
|
OP
|
$4,307.00
|
|
|
Service Code
|
CPT 36569
|
| Hospital Charge Code |
2170090
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$32.31 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$1,400.00
|
| Rate for Payer: Aetna Medicare |
$2,197.02
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$446.27
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,464.68
|
| Rate for Payer: Amerigroup Medicare |
$1,464.68
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,723.99
|
| Rate for Payer: BCBS of TX Blue Essentials |
$3,262.26
|
| Rate for Payer: BCBS of TX Medicare |
$1,464.68
|
| Rate for Payer: BCBS of TX PPO |
$4,110.45
|
| Rate for Payer: Cash Price |
$3,790.16
|
| Rate for Payer: Cash Price |
$3,790.16
|
| Rate for Payer: Cigna Commercial |
$3,317.93
|
| Rate for Payer: Cigna Medicaid |
$446.27
|
| Rate for Payer: Cigna Medicare |
$1,464.68
|
| Rate for Payer: Employer Direct Commercial |
$1,464.68
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,464.68
|
| Rate for Payer: Molina CHIP/Medicaid |
$446.27
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,464.68
|
| Rate for Payer: Molina Medicare |
$1,464.68
|
| Rate for Payer: Multiplan Auto |
$10,000.00
|
| Rate for Payer: Multiplan Commercial |
$10,000.00
|
| Rate for Payer: Multiplan Workers Comp |
$10,000.00
|
| Rate for Payer: Parkland Medicaid |
$446.27
|
| Rate for Payer: Scott and White EPO/PPO |
$32.31
|
| Rate for Payer: Scott and White Medicare |
$1,464.68
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$446.27
|
| Rate for Payer: Superior Health Plan EPO |
$1,464.68
|
| Rate for Payer: Superior Health Plan Medicare |
$1,464.68
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,464.68
|
| Rate for Payer: Universal American Medicare |
$1,464.68
|
| Rate for Payer: Wellcare Medicare |
$1,464.68
|
| Rate for Payer: Wellmed Medicare |
$1,464.68
|
|
|
ED PICC Line Insertion >= 5 Years BCE
|
Facility
|
IP
|
$4,307.00
|
|
|
Service Code
|
CPT 36569
|
| Hospital Charge Code |
2170090
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$3,790.16
|
|
