|
clonazePAM 0.5 mg tablet
|
Facility
|
IP
|
$8.00
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
77475449
|
|
Hospital Revenue Code
|
250
|
| Rate for Payer: Cash Price |
$5.44
|
|
|
clonazePAM 0.5 mg tablet
|
Facility
|
OP
|
$8.00
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
77475449
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.72 |
| Max. Negotiated Rate |
$5.76 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$0.72
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2.40
|
| Rate for Payer: BCBS of TX Blue Essentials |
$2.88
|
| Rate for Payer: BCBS of TX PPO |
$3.20
|
| Rate for Payer: Cash Price |
$5.44
|
| Rate for Payer: Cigna Medicaid |
$5.76
|
| Rate for Payer: Molina CHIP/Medicaid |
$5.76
|
| Rate for Payer: Multiplan Auto |
$5.20
|
| Rate for Payer: Multiplan Commercial |
$5.20
|
| Rate for Payer: Multiplan Workers Comp |
$5.20
|
| Rate for Payer: Parkland Medicaid |
$5.76
|
| Rate for Payer: Scott and White EPO/PPO |
$4.00
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$5.76
|
| Rate for Payer: Superior Health Plan EPO |
$1.09
|
|
|
cloNIDine 0.1 mg/24 hr TD Film, ER
|
Facility
|
OP
|
$56.00
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
77475822
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.04 |
| Max. Negotiated Rate |
$40.32 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$5.04
|
| Rate for Payer: BCBS of TX Blue Advantage |
$16.80
|
| Rate for Payer: BCBS of TX Blue Essentials |
$20.16
|
| Rate for Payer: BCBS of TX PPO |
$22.40
|
| Rate for Payer: Cash Price |
$38.08
|
| Rate for Payer: Cigna Medicaid |
$40.32
|
| Rate for Payer: Molina CHIP/Medicaid |
$40.32
|
| Rate for Payer: Multiplan Auto |
$36.40
|
| Rate for Payer: Multiplan Commercial |
$36.40
|
| Rate for Payer: Multiplan Workers Comp |
$36.40
|
| Rate for Payer: Parkland Medicaid |
$40.32
|
| Rate for Payer: Scott and White EPO/PPO |
$28.00
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$40.32
|
| Rate for Payer: Superior Health Plan EPO |
$7.62
|
|
|
cloNIDine 0.1 mg/24 hr TD Film, ER
|
Facility
|
IP
|
$56.00
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
77475822
|
|
Hospital Revenue Code
|
250
|
| Rate for Payer: Cash Price |
$38.08
|
|
|
cloNIDine 0.1 mg Tab
|
Facility
|
OP
|
$7.65
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
77475718
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.69 |
| Max. Negotiated Rate |
$5.51 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$0.69
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2.29
|
| Rate for Payer: BCBS of TX Blue Essentials |
$2.75
|
| Rate for Payer: BCBS of TX PPO |
$3.06
|
| Rate for Payer: Cash Price |
$5.20
|
| Rate for Payer: Cigna Medicaid |
$5.51
|
| Rate for Payer: Molina CHIP/Medicaid |
$5.51
|
| Rate for Payer: Multiplan Auto |
$4.97
|
| Rate for Payer: Multiplan Commercial |
$4.97
|
| Rate for Payer: Multiplan Workers Comp |
$4.97
|
| Rate for Payer: Parkland Medicaid |
$5.51
|
| Rate for Payer: Scott and White EPO/PPO |
$3.83
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$5.51
|
| Rate for Payer: Superior Health Plan EPO |
$1.04
|
|
|
cloNIDine 0.1 mg Tab
|
Facility
|
IP
|
$7.65
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
77475718
|
|
Hospital Revenue Code
|
250
|
| Rate for Payer: Cash Price |
$5.20
|
|
|
clopidogrel 75 mg Tab
|
Facility
|
OP
|
$18.95
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
77476250
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.71 |
| Max. Negotiated Rate |
$13.64 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1.71
|
| Rate for Payer: BCBS of TX Blue Advantage |
$5.68
|
| Rate for Payer: BCBS of TX Blue Essentials |
$6.82
|
| Rate for Payer: BCBS of TX PPO |
$7.58
|
| Rate for Payer: Cash Price |
$12.89
|
| Rate for Payer: Cigna Medicaid |
$13.64
|
| Rate for Payer: Molina CHIP/Medicaid |
$13.64
|
| Rate for Payer: Multiplan Auto |
$12.32
|
| Rate for Payer: Multiplan Commercial |
$12.32
|
| Rate for Payer: Multiplan Workers Comp |
$12.32
|
| Rate for Payer: Parkland Medicaid |
$13.64
|
| Rate for Payer: Scott and White EPO/PPO |
$9.47
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$13.64
|
| Rate for Payer: Superior Health Plan EPO |
$2.58
|
|
|
clopidogrel 75 mg Tab
|
Facility
|
IP
|
$18.95
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
77476250
|
|
Hospital Revenue Code
|
250
|
| Rate for Payer: Cash Price |
$12.89
|
|
|
Closed treatment of carpometacarpal dislocation, other than thumb, with manipulation, each joint; requiring anesthesia
|
Facility
|
OP
|
$6,401.64
|
|
|
Service Code
|
HCPCS 26675
|
| Hospital Charge Code |
994039
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$593.04 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$593.04
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,615.32
|
| Rate for Payer: Amerigroup Medicare |
$1,615.32
|
| 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 |
$1,615.32
|
| Rate for Payer: BCBS of TX PPO |
$3,415.58
|
| Rate for Payer: Cash Price |
$4,353.12
|
| Rate for Payer: Cash Price |
$4,353.12
|
| Rate for Payer: Cash Price |
$4,353.12
|
| Rate for Payer: Cigna Commercial |
$3,414.49
|
| Rate for Payer: Cigna Medicaid |
$4,609.18
|
| Rate for Payer: Cigna Medicare |
$1,615.32
|
| Rate for Payer: Employer Direct Commercial |
$1,615.32
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,615.32
|
| Rate for Payer: Molina CHIP/Medicaid |
$4,609.18
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,615.32
|
| Rate for Payer: Molina Medicare |
$1,615.32
|
| 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 |
$4,609.18
|
| Rate for Payer: Scott and White EPO/PPO |
$2,719.24
|
| Rate for Payer: Scott and White Medicare |
$1,615.32
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$4,609.18
|
| Rate for Payer: Superior Health Plan EPO |
$1,615.32
|
| Rate for Payer: Superior Health Plan Medicare |
$1,615.32
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,615.32
|
| Rate for Payer: Universal American Medicare |
$1,615.32
|
| Rate for Payer: Wellcare Medicare |
$1,615.32
|
| Rate for Payer: Wellmed Medicare |
$1,615.32
|
|
|
Closed treatment of carpometacarpal dislocation, other than thumb, with manipulation, each joint; requiring anesthesia
|
Facility
|
IP
|
$6,401.64
|
|
|
Service Code
|
HCPCS 26675
|
| Hospital Charge Code |
994039
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$4,353.12
|
|
|
Closed treatment of distal radial fracture (eg, Colles or Smith type) or epiphyseal separation, incl
|
Facility
|
IP
|
$5,690.04
|
|
|
Service Code
|
HCPCS 25605
|
| Hospital Charge Code |
9900301
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$3,869.23
|
|
|
Closed treatment of distal radial fracture (eg, Colles or Smith type) or epiphyseal separation, incl
|
Facility
|
OP
|
$5,690.04
|
|
|
Service Code
|
HCPCS 25605
|
| Hospital Charge Code |
9900301
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$593.04 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$593.04
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,615.32
|
| Rate for Payer: Amerigroup Medicare |
$1,615.32
|
| 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 |
$1,615.32
|
| Rate for Payer: BCBS of TX PPO |
$3,415.58
|
| Rate for Payer: Cash Price |
$3,869.23
|
| Rate for Payer: Cash Price |
$3,869.23
|
| Rate for Payer: Cash Price |
$3,869.23
|
| Rate for Payer: Cigna Commercial |
$3,414.49
|
| Rate for Payer: Cigna Medicaid |
$4,096.83
|
| Rate for Payer: Cigna Medicare |
$1,615.32
|
| Rate for Payer: Employer Direct Commercial |
$1,615.32
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,615.32
|
| Rate for Payer: Molina CHIP/Medicaid |
$4,096.83
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,615.32
|
| Rate for Payer: Molina Medicare |
$1,615.32
|
| 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 |
$4,096.83
|
| Rate for Payer: Scott and White EPO/PPO |
$2,719.24
|
| Rate for Payer: Scott and White Medicare |
$1,615.32
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$4,096.83
|
| Rate for Payer: Superior Health Plan EPO |
$1,615.32
|
| Rate for Payer: Superior Health Plan Medicare |
$1,615.32
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,615.32
|
| Rate for Payer: Universal American Medicare |
$1,615.32
|
| Rate for Payer: Wellcare Medicare |
$1,615.32
|
| Rate for Payer: Wellmed Medicare |
$1,615.32
|
|
|
Closed treatment of distal radial fracture (eg, Colles or Smith type) or epiphyseal separation, incl
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 25605
|
| Hospital Charge Code |
36025605
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$593.04 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$593.04
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,615.32
|
| Rate for Payer: Amerigroup Medicare |
$1,615.32
|
| 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 |
$1,615.32
|
| Rate for Payer: BCBS of TX PPO |
$3,415.58
|
| Rate for Payer: Cigna Commercial |
$3,414.49
|
| Rate for Payer: Cigna Medicare |
$1,615.32
|
| Rate for Payer: Employer Direct Commercial |
$1,615.32
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,615.32
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,615.32
|
| Rate for Payer: Molina Medicare |
$1,615.32
|
| 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: Scott and White EPO/PPO |
$2,719.24
|
| Rate for Payer: Scott and White Medicare |
$1,615.32
|
| Rate for Payer: Superior Health Plan EPO |
$1,615.32
|
| Rate for Payer: Superior Health Plan Medicare |
$1,615.32
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,615.32
|
| Rate for Payer: Universal American Medicare |
$1,615.32
|
| Rate for Payer: Wellcare Medicare |
$1,615.32
|
| Rate for Payer: Wellmed Medicare |
$1,615.32
|
|
|
Closed treatment of femoral shaft fracture, with manipulation, with or without skin or skeletal traction
|
Facility
|
OP
|
$6,401.64
|
|
|
Service Code
|
HCPCS 27502
|
| Hospital Charge Code |
994121
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$593.04 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$593.04
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,615.32
|
| Rate for Payer: Amerigroup Medicare |
$1,615.32
|
| 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 |
$1,615.32
|
| Rate for Payer: BCBS of TX PPO |
$3,415.58
|
| Rate for Payer: Cash Price |
$4,353.12
|
| Rate for Payer: Cash Price |
$4,353.12
|
| Rate for Payer: Cash Price |
$4,353.12
|
| Rate for Payer: Cigna Commercial |
$3,414.49
|
| Rate for Payer: Cigna Medicaid |
$4,609.18
|
| Rate for Payer: Cigna Medicare |
$1,615.32
|
| Rate for Payer: Employer Direct Commercial |
$1,615.32
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,615.32
|
| Rate for Payer: Molina CHIP/Medicaid |
$4,609.18
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,615.32
|
| Rate for Payer: Molina Medicare |
$1,615.32
|
| 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 |
$4,609.18
|
| Rate for Payer: Scott and White EPO/PPO |
$2,719.24
|
| Rate for Payer: Scott and White Medicare |
$1,615.32
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$4,609.18
|
| Rate for Payer: Superior Health Plan EPO |
$1,615.32
|
| Rate for Payer: Superior Health Plan Medicare |
$1,615.32
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,615.32
|
| Rate for Payer: Universal American Medicare |
$1,615.32
|
| Rate for Payer: Wellcare Medicare |
$1,615.32
|
| Rate for Payer: Wellmed Medicare |
$1,615.32
|
|
|
Closed treatment of femoral shaft fracture, with manipulation, with or without skin or skeletal traction
|
Facility
|
IP
|
$6,401.64
|
|
|
Service Code
|
HCPCS 27502
|
| Hospital Charge Code |
994121
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$4,353.12
|
|
|
Closed treatment of metacarpal fracture, with manipulation, with external fixation, each bone
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 26607
|
| Hospital Charge Code |
36026607
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,088.27 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,088.27
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3,286.91
|
| Rate for Payer: Amerigroup Medicare |
$3,286.91
|
| Rate for Payer: BCBS of TX Blue Advantage |
$4,571.54
|
| Rate for Payer: BCBS of TX Blue Essentials |
$5,474.90
|
| Rate for Payer: BCBS of TX Medicare |
$3,286.91
|
| Rate for Payer: BCBS of TX PPO |
$6,898.37
|
| Rate for Payer: Cigna Commercial |
$6,947.94
|
| Rate for Payer: Cigna Medicare |
$3,286.91
|
| Rate for Payer: Employer Direct Commercial |
$3,286.91
|
| Rate for Payer: Humana Medicare/TRICARE |
$3,286.91
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3,286.91
|
| Rate for Payer: Molina Medicare |
$3,286.91
|
| 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: Scott and White EPO/PPO |
$5,476.44
|
| Rate for Payer: Scott and White Medicare |
$3,286.91
|
| Rate for Payer: Superior Health Plan EPO |
$3,286.91
|
| Rate for Payer: Superior Health Plan Medicare |
$3,286.91
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3,286.91
|
| Rate for Payer: Universal American Medicare |
$3,286.91
|
| Rate for Payer: Wellcare Medicare |
$3,286.91
|
| Rate for Payer: Wellmed Medicare |
$3,286.91
|
|
|
Closed treatment of metacarpal fracture, with manipulation, with external fixation, each bone
|
Facility
|
OP
|
$17,353.68
|
|
|
Service Code
|
HCPCS 26607
|
| Hospital Charge Code |
9900359
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,088.27 |
| Max. Negotiated Rate |
$12,494.65 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,088.27
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3,286.91
|
| Rate for Payer: Amerigroup Medicare |
$3,286.91
|
| Rate for Payer: BCBS of TX Blue Advantage |
$4,571.54
|
| Rate for Payer: BCBS of TX Blue Essentials |
$5,474.90
|
| Rate for Payer: BCBS of TX Medicare |
$3,286.91
|
| Rate for Payer: BCBS of TX PPO |
$6,898.37
|
| Rate for Payer: Cash Price |
$11,800.50
|
| Rate for Payer: Cash Price |
$11,800.50
|
| Rate for Payer: Cash Price |
$11,800.50
|
| Rate for Payer: Cigna Commercial |
$6,947.94
|
| Rate for Payer: Cigna Medicaid |
$12,494.65
|
| Rate for Payer: Cigna Medicare |
$3,286.91
|
| Rate for Payer: Employer Direct Commercial |
$3,286.91
|
| Rate for Payer: Humana Medicare/TRICARE |
$3,286.91
|
| Rate for Payer: Molina CHIP/Medicaid |
$12,494.65
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3,286.91
|
| Rate for Payer: Molina Medicare |
$3,286.91
|
| 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 |
$12,494.65
|
| Rate for Payer: Scott and White EPO/PPO |
$5,476.44
|
| Rate for Payer: Scott and White Medicare |
$3,286.91
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$12,494.65
|
| Rate for Payer: Superior Health Plan EPO |
$3,286.91
|
| Rate for Payer: Superior Health Plan Medicare |
$3,286.91
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3,286.91
|
| Rate for Payer: Universal American Medicare |
$3,286.91
|
| Rate for Payer: Wellcare Medicare |
$3,286.91
|
| Rate for Payer: Wellmed Medicare |
$3,286.91
|
|
|
Closed treatment of metacarpal fracture, with manipulation, with external fixation, each bone
|
Facility
|
IP
|
$17,353.68
|
|
|
Service Code
|
HCPCS 26607
|
| Hospital Charge Code |
9900359
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$11,800.50
|
|
|
Closed treatment of metacarpophalangeal dislocation, single, with manipulation; requiring anesthesia
|
Facility
|
OP
|
$6,401.64
|
|
|
Service Code
|
HCPCS 26705
|
| Hospital Charge Code |
994038
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$593.04 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$593.04
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,615.32
|
| Rate for Payer: Amerigroup Medicare |
$1,615.32
|
| 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 |
$1,615.32
|
| Rate for Payer: BCBS of TX PPO |
$3,415.58
|
| Rate for Payer: Cash Price |
$4,353.12
|
| Rate for Payer: Cash Price |
$4,353.12
|
| Rate for Payer: Cash Price |
$4,353.12
|
| Rate for Payer: Cigna Commercial |
$3,414.49
|
| Rate for Payer: Cigna Medicaid |
$4,609.18
|
| Rate for Payer: Cigna Medicare |
$1,615.32
|
| Rate for Payer: Employer Direct Commercial |
$1,615.32
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,615.32
|
| Rate for Payer: Molina CHIP/Medicaid |
$4,609.18
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,615.32
|
| Rate for Payer: Molina Medicare |
$1,615.32
|
| 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 |
$4,609.18
|
| Rate for Payer: Scott and White EPO/PPO |
$2,719.24
|
| Rate for Payer: Scott and White Medicare |
$1,615.32
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$4,609.18
|
| Rate for Payer: Superior Health Plan EPO |
$1,615.32
|
| Rate for Payer: Superior Health Plan Medicare |
$1,615.32
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,615.32
|
| Rate for Payer: Universal American Medicare |
$1,615.32
|
| Rate for Payer: Wellcare Medicare |
$1,615.32
|
| Rate for Payer: Wellmed Medicare |
$1,615.32
|
|
|
Closed treatment of metacarpophalangeal dislocation, single, with manipulation; requiring anesthesia
|
Facility
|
IP
|
$6,401.64
|
|
|
Service Code
|
HCPCS 26705
|
| Hospital Charge Code |
994038
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$4,353.12
|
|
|
Closed treatment of metatarsal fracture; with manipulation, each
|
Facility
|
OP
|
$959.52
|
|
|
Service Code
|
HCPCS 28475
|
| Hospital Charge Code |
994149
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$85.32 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$85.32
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$247.79
|
| Rate for Payer: Amerigroup Medicare |
$247.79
|
| 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 |
$247.79
|
| Rate for Payer: BCBS of TX PPO |
$274.58
|
| Rate for Payer: Cash Price |
$652.47
|
| Rate for Payer: Cash Price |
$652.47
|
| Rate for Payer: Cash Price |
$652.47
|
| Rate for Payer: Cigna Commercial |
$523.79
|
| Rate for Payer: Cigna Medicaid |
$690.85
|
| Rate for Payer: Cigna Medicare |
$247.79
|
| Rate for Payer: Employer Direct Commercial |
$247.79
|
| Rate for Payer: Humana Medicare/TRICARE |
$247.79
|
| Rate for Payer: Molina CHIP/Medicaid |
$690.85
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$247.79
|
| Rate for Payer: Molina Medicare |
$247.79
|
| 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 |
$690.85
|
| Rate for Payer: Scott and White EPO/PPO |
$398.99
|
| Rate for Payer: Scott and White Medicare |
$247.79
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$690.85
|
| Rate for Payer: Superior Health Plan EPO |
$247.79
|
| Rate for Payer: Superior Health Plan Medicare |
$247.79
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$247.79
|
| Rate for Payer: Universal American Medicare |
$247.79
|
| Rate for Payer: Wellcare Medicare |
$247.79
|
| Rate for Payer: Wellmed Medicare |
$247.79
|
|
|
Closed treatment of metatarsal fracture; with manipulation, each
|
Facility
|
IP
|
$959.52
|
|
|
Service Code
|
HCPCS 28475
|
| Hospital Charge Code |
994149
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$652.47
|
|
|
Closed treatment of nasal bone fracture; with stabilization
|
Facility
|
OP
|
$9,309.00
|
|
|
Service Code
|
HCPCS 21320
|
| Hospital Charge Code |
9900193
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$886.62 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$886.62
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3,330.57
|
| Rate for Payer: Amerigroup Medicare |
$3,330.57
|
| Rate for Payer: BCBS of TX Blue Advantage |
$4,374.21
|
| Rate for Payer: BCBS of TX Blue Essentials |
$5,238.58
|
| Rate for Payer: BCBS of TX Medicare |
$3,330.57
|
| Rate for Payer: BCBS of TX PPO |
$6,600.61
|
| Rate for Payer: Cash Price |
$6,330.12
|
| Rate for Payer: Cash Price |
$6,330.12
|
| Rate for Payer: Cash Price |
$6,330.12
|
| Rate for Payer: Cigna Commercial |
$7,040.22
|
| Rate for Payer: Cigna Medicaid |
$6,702.48
|
| Rate for Payer: Cigna Medicare |
$3,330.57
|
| Rate for Payer: Employer Direct Commercial |
$3,330.57
|
| Rate for Payer: Humana Medicare/TRICARE |
$3,330.57
|
| Rate for Payer: Molina CHIP/Medicaid |
$6,702.48
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3,330.57
|
| Rate for Payer: Molina Medicare |
$3,330.57
|
| 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 |
$6,702.48
|
| Rate for Payer: Scott and White EPO/PPO |
$5,447.31
|
| Rate for Payer: Scott and White Medicare |
$3,330.57
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$6,702.48
|
| Rate for Payer: Superior Health Plan EPO |
$3,330.57
|
| Rate for Payer: Superior Health Plan Medicare |
$3,330.57
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3,330.57
|
| Rate for Payer: Universal American Medicare |
$3,330.57
|
| Rate for Payer: Wellcare Medicare |
$3,330.57
|
| Rate for Payer: Wellmed Medicare |
$3,330.57
|
|
|
Closed treatment of nasal bone fracture; with stabilization
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 21320
|
| Hospital Charge Code |
36021320
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$886.62 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$886.62
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3,330.57
|
| Rate for Payer: Amerigroup Medicare |
$3,330.57
|
| Rate for Payer: BCBS of TX Blue Advantage |
$4,374.21
|
| Rate for Payer: BCBS of TX Blue Essentials |
$5,238.58
|
| Rate for Payer: BCBS of TX Medicare |
$3,330.57
|
| Rate for Payer: BCBS of TX PPO |
$6,600.61
|
| Rate for Payer: Cigna Commercial |
$7,040.22
|
| Rate for Payer: Cigna Medicare |
$3,330.57
|
| Rate for Payer: Employer Direct Commercial |
$3,330.57
|
| Rate for Payer: Humana Medicare/TRICARE |
$3,330.57
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3,330.57
|
| Rate for Payer: Molina Medicare |
$3,330.57
|
| 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: Scott and White EPO/PPO |
$5,447.31
|
| Rate for Payer: Scott and White Medicare |
$3,330.57
|
| Rate for Payer: Superior Health Plan EPO |
$3,330.57
|
| Rate for Payer: Superior Health Plan Medicare |
$3,330.57
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3,330.57
|
| Rate for Payer: Universal American Medicare |
$3,330.57
|
| Rate for Payer: Wellcare Medicare |
$3,330.57
|
| Rate for Payer: Wellmed Medicare |
$3,330.57
|
|
|
Closed treatment of nasal bone fracture; with stabilization
|
Facility
|
IP
|
$9,309.00
|
|
|
Service Code
|
HCPCS 21320
|
| Hospital Charge Code |
9900193
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$6,330.12
|
|
