|
Closed treatment of phalangeal shaft fracture, proximal or middle phalanx, finger or thumb; without
|
Facility
|
IP
|
$4,000.00
|
|
|
Service Code
|
HCPCS 26720
|
| Hospital Charge Code |
9220212
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$2,720.00
|
|
|
Closed treatment of phalangeal shaft fracture, proximal or middle phalanx, finger or thumb; without
|
Facility
|
IP
|
$4,000.00
|
|
|
Service Code
|
HCPCS 26720
|
| Hospital Charge Code |
9900364
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$2,720.00
|
|
|
Closed treatment of phalangeal shaft fracture, proximal or middle phalanx, finger or thumb; without
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 26720
|
| Hospital Charge Code |
36026720
|
|
Hospital Revenue Code
|
360
|
| 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: Cigna Commercial |
$523.79
|
| 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 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: Scott and White EPO/PPO |
$398.99
|
| Rate for Payer: Scott and White Medicare |
$247.79
|
| 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 phalangeal shaft fracture, proximal or middle phalanx, finger or thumb; without
|
Facility
|
OP
|
$4,000.00
|
|
|
Service Code
|
HCPCS 26720
|
| Hospital Charge Code |
9220212
|
|
Hospital Revenue Code
|
360
|
| 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 |
$2,720.00
|
| Rate for Payer: Cash Price |
$2,720.00
|
| Rate for Payer: Cash Price |
$2,720.00
|
| Rate for Payer: Cigna Commercial |
$523.79
|
| Rate for Payer: Cigna Medicaid |
$2,880.00
|
| 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 |
$2,880.00
|
| 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 |
$2,880.00
|
| 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 |
$2,880.00
|
| 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 phalangeal shaft fracture, proximal or middle phalanx, finger or thumb; without
|
Facility
|
OP
|
$4,000.00
|
|
|
Service Code
|
HCPCS 26720
|
| Hospital Charge Code |
9900364
|
|
Hospital Revenue Code
|
360
|
| 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 |
$2,720.00
|
| Rate for Payer: Cash Price |
$2,720.00
|
| Rate for Payer: Cash Price |
$2,720.00
|
| Rate for Payer: Cigna Commercial |
$523.79
|
| Rate for Payer: Cigna Medicaid |
$2,880.00
|
| 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 |
$2,880.00
|
| 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 |
$2,880.00
|
| 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 |
$2,880.00
|
| 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 radial head or neck fracture; with manipulation
|
Facility
|
IP
|
$6,401.64
|
|
|
Service Code
|
HCPCS 24655
|
| Hospital Charge Code |
994160
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$4,353.12
|
|
|
Closed treatment of radial head or neck fracture; with manipulation
|
Facility
|
OP
|
$6,401.64
|
|
|
Service Code
|
HCPCS 24655
|
| Hospital Charge Code |
994160
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$517.50 |
| Max. Negotiated Rate |
$4,609.18 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$576.15
|
| 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 |
$4,161.07
|
| Rate for Payer: Multiplan Commercial |
$4,161.07
|
| Rate for Payer: Multiplan Workers Comp |
$4,161.07
|
| Rate for Payer: Parkland Medicaid |
$4,609.18
|
| Rate for Payer: Scott and White EPO/PPO |
$517.50
|
| 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 supracondylar or transcondylar humeral fracture
|
Facility
|
OP
|
$6,571.28
|
|
|
Service Code
|
HCPCS 24535
|
| Hospital Charge Code |
994174
|
|
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 |
$4,468.47
|
| Rate for Payer: Cash Price |
$4,468.47
|
| Rate for Payer: Cash Price |
$4,468.47
|
| Rate for Payer: Cigna Commercial |
$3,414.49
|
| Rate for Payer: Cigna Medicaid |
$4,731.32
|
| 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 |
$4,731.32
|
| 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: Parkland Medicaid |
$4,731.32
|
| 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 |
$4,731.32
|
| 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 supracondylar or transcondylar humeral fracture
|
Facility
|
IP
|
$6,571.28
|
|
|
Service Code
|
HCPCS 24535
|
| Hospital Charge Code |
994174
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$4,468.47
|
|
|
Clostridium Difficile GDH Tox
|
Facility
|
OP
|
$479.00
|
|
|
Service Code
|
HCPCS 87324
|
| Hospital Charge Code |
1603927
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.67 |
| Max. Negotiated Rate |
$344.88 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$4.67
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$11.98
|
| Rate for Payer: Amerigroup Medicare |
$11.98
|
| Rate for Payer: BCBS of TX Blue Advantage |
$143.70
|
| Rate for Payer: BCBS of TX Blue Essentials |
$172.44
|
| Rate for Payer: BCBS of TX Medicare |
$11.98
|
| Rate for Payer: BCBS of TX PPO |
$191.60
|
| Rate for Payer: Cash Price |
$325.72
|
| Rate for Payer: Cash Price |
$325.72
|
| Rate for Payer: Cigna Medicaid |
$344.88
|
| Rate for Payer: Cigna Medicare |
$11.98
|
| Rate for Payer: Employer Direct Commercial |
$11.98
|
| Rate for Payer: Humana Medicare/TRICARE |
$11.98
|
| Rate for Payer: Molina CHIP/Medicaid |
$344.88
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$11.98
|
| Rate for Payer: Molina Medicare |
$11.98
|
| Rate for Payer: Multiplan Auto |
$311.35
|
| Rate for Payer: Multiplan Commercial |
$311.35
|
| Rate for Payer: Multiplan Workers Comp |
$311.35
|
| Rate for Payer: Parkland Medicaid |
$344.88
|
| Rate for Payer: Scott and White EPO/PPO |
$14.97
|
| Rate for Payer: Scott and White Medicare |
$11.98
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$344.88
|
| Rate for Payer: Superior Health Plan EPO |
$11.98
|
| Rate for Payer: Superior Health Plan Medicare |
$11.98
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$11.98
|
| Rate for Payer: Universal American Medicare |
$11.98
|
| Rate for Payer: Wellcare Medicare |
$11.98
|
| Rate for Payer: Wellmed Medicare |
$11.98
|
|
|
Clostridium Difficile GDH Tox
|
Facility
|
IP
|
$479.00
|
|
|
Service Code
|
HCPCS 87324
|
| Hospital Charge Code |
1603927
|
|
Hospital Revenue Code
|
306
|
| Rate for Payer: Cash Price |
$325.72
|
|
|
Clostridium difficile PCR
|
Facility
|
IP
|
$380.00
|
|
|
Service Code
|
HCPCS 87493
|
| Hospital Charge Code |
4108751
|
|
Hospital Revenue Code
|
306
|
| Rate for Payer: Cash Price |
$258.40
|
|
|
Clostridium difficile PCR
|
Facility
|
OP
|
$380.00
|
|
|
Service Code
|
HCPCS 87493
|
| Hospital Charge Code |
4108751
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$14.54 |
| Max. Negotiated Rate |
$273.60 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$14.54
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$37.27
|
| Rate for Payer: Amerigroup Medicare |
$37.27
|
| Rate for Payer: BCBS of TX Blue Advantage |
$114.00
|
| Rate for Payer: BCBS of TX Blue Essentials |
$136.80
|
| Rate for Payer: BCBS of TX Medicare |
$37.27
|
| Rate for Payer: BCBS of TX PPO |
$152.00
|
| Rate for Payer: Cash Price |
$258.40
|
| Rate for Payer: Cash Price |
$258.40
|
| Rate for Payer: Cigna Medicaid |
$273.60
|
| Rate for Payer: Cigna Medicare |
$37.27
|
| Rate for Payer: Employer Direct Commercial |
$37.27
|
| Rate for Payer: Humana Medicare/TRICARE |
$37.27
|
| Rate for Payer: Molina CHIP/Medicaid |
$273.60
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$37.27
|
| Rate for Payer: Molina Medicare |
$37.27
|
| Rate for Payer: Multiplan Auto |
$247.00
|
| Rate for Payer: Multiplan Commercial |
$247.00
|
| Rate for Payer: Multiplan Workers Comp |
$247.00
|
| Rate for Payer: Parkland Medicaid |
$273.60
|
| Rate for Payer: Scott and White EPO/PPO |
$46.59
|
| Rate for Payer: Scott and White Medicare |
$37.27
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$273.60
|
| Rate for Payer: Superior Health Plan EPO |
$37.27
|
| Rate for Payer: Superior Health Plan Medicare |
$37.27
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$37.27
|
| Rate for Payer: Universal American Medicare |
$37.27
|
| Rate for Payer: Wellcare Medicare |
$37.27
|
| Rate for Payer: Wellmed Medicare |
$37.27
|
|
|
Clostridium difficile Toxin A
|
Facility
|
IP
|
$358.00
|
|
|
Service Code
|
HCPCS 87449
|
| Hospital Charge Code |
4107449
|
|
Hospital Revenue Code
|
306
|
| Rate for Payer: Cash Price |
$243.44
|
|
|
Clostridium difficile Toxin A
|
Facility
|
OP
|
$358.00
|
|
|
Service Code
|
HCPCS 87449
|
| Hospital Charge Code |
4107449
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.67 |
| Max. Negotiated Rate |
$257.76 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$4.67
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$11.98
|
| Rate for Payer: Amerigroup Medicare |
$11.98
|
| Rate for Payer: BCBS of TX Blue Advantage |
$107.40
|
| Rate for Payer: BCBS of TX Blue Essentials |
$128.88
|
| Rate for Payer: BCBS of TX Medicare |
$11.98
|
| Rate for Payer: BCBS of TX PPO |
$143.20
|
| Rate for Payer: Cash Price |
$243.44
|
| Rate for Payer: Cash Price |
$243.44
|
| Rate for Payer: Cigna Medicaid |
$257.76
|
| Rate for Payer: Cigna Medicare |
$11.98
|
| Rate for Payer: Employer Direct Commercial |
$11.98
|
| Rate for Payer: Humana Medicare/TRICARE |
$11.98
|
| Rate for Payer: Molina CHIP/Medicaid |
$257.76
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$11.98
|
| Rate for Payer: Molina Medicare |
$11.98
|
| Rate for Payer: Multiplan Auto |
$232.70
|
| Rate for Payer: Multiplan Commercial |
$232.70
|
| Rate for Payer: Multiplan Workers Comp |
$232.70
|
| Rate for Payer: Parkland Medicaid |
$257.76
|
| Rate for Payer: Scott and White EPO/PPO |
$14.97
|
| Rate for Payer: Scott and White Medicare |
$11.98
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$257.76
|
| Rate for Payer: Superior Health Plan EPO |
$11.98
|
| Rate for Payer: Superior Health Plan Medicare |
$11.98
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$11.98
|
| Rate for Payer: Universal American Medicare |
$11.98
|
| Rate for Payer: Wellcare Medicare |
$11.98
|
| Rate for Payer: Wellmed Medicare |
$11.98
|
|
|
Clostridium difficile Toxin A
|
Facility
|
OP
|
$358.00
|
|
|
Service Code
|
HCPCS 87449
|
| Hospital Charge Code |
4107912
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.67 |
| Max. Negotiated Rate |
$257.76 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$4.67
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$11.98
|
| Rate for Payer: Amerigroup Medicare |
$11.98
|
| Rate for Payer: BCBS of TX Blue Advantage |
$107.40
|
| Rate for Payer: BCBS of TX Blue Essentials |
$128.88
|
| Rate for Payer: BCBS of TX Medicare |
$11.98
|
| Rate for Payer: BCBS of TX PPO |
$143.20
|
| Rate for Payer: Cash Price |
$243.44
|
| Rate for Payer: Cash Price |
$243.44
|
| Rate for Payer: Cigna Medicaid |
$257.76
|
| Rate for Payer: Cigna Medicare |
$11.98
|
| Rate for Payer: Employer Direct Commercial |
$11.98
|
| Rate for Payer: Humana Medicare/TRICARE |
$11.98
|
| Rate for Payer: Molina CHIP/Medicaid |
$257.76
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$11.98
|
| Rate for Payer: Molina Medicare |
$11.98
|
| Rate for Payer: Multiplan Auto |
$232.70
|
| Rate for Payer: Multiplan Commercial |
$232.70
|
| Rate for Payer: Multiplan Workers Comp |
$232.70
|
| Rate for Payer: Parkland Medicaid |
$257.76
|
| Rate for Payer: Scott and White EPO/PPO |
$14.97
|
| Rate for Payer: Scott and White Medicare |
$11.98
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$257.76
|
| Rate for Payer: Superior Health Plan EPO |
$11.98
|
| Rate for Payer: Superior Health Plan Medicare |
$11.98
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$11.98
|
| Rate for Payer: Universal American Medicare |
$11.98
|
| Rate for Payer: Wellcare Medicare |
$11.98
|
| Rate for Payer: Wellmed Medicare |
$11.98
|
|
|
Clostridium difficile Toxin A
|
Facility
|
IP
|
$358.00
|
|
|
Service Code
|
HCPCS 87449
|
| Hospital Charge Code |
4107912
|
|
Hospital Revenue Code
|
306
|
| Rate for Payer: Cash Price |
$243.44
|
|
|
Clostridium difficile Toxin B
|
Facility
|
OP
|
$479.00
|
|
|
Service Code
|
HCPCS 87324
|
| Hospital Charge Code |
4105006
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.67 |
| Max. Negotiated Rate |
$344.88 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$4.67
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$11.98
|
| Rate for Payer: Amerigroup Medicare |
$11.98
|
| Rate for Payer: BCBS of TX Blue Advantage |
$143.70
|
| Rate for Payer: BCBS of TX Blue Essentials |
$172.44
|
| Rate for Payer: BCBS of TX Medicare |
$11.98
|
| Rate for Payer: BCBS of TX PPO |
$191.60
|
| Rate for Payer: Cash Price |
$325.72
|
| Rate for Payer: Cash Price |
$325.72
|
| Rate for Payer: Cigna Medicaid |
$344.88
|
| Rate for Payer: Cigna Medicare |
$11.98
|
| Rate for Payer: Employer Direct Commercial |
$11.98
|
| Rate for Payer: Humana Medicare/TRICARE |
$11.98
|
| Rate for Payer: Molina CHIP/Medicaid |
$344.88
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$11.98
|
| Rate for Payer: Molina Medicare |
$11.98
|
| Rate for Payer: Multiplan Auto |
$311.35
|
| Rate for Payer: Multiplan Commercial |
$311.35
|
| Rate for Payer: Multiplan Workers Comp |
$311.35
|
| Rate for Payer: Parkland Medicaid |
$344.88
|
| Rate for Payer: Scott and White EPO/PPO |
$14.97
|
| Rate for Payer: Scott and White Medicare |
$11.98
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$344.88
|
| Rate for Payer: Superior Health Plan EPO |
$11.98
|
| Rate for Payer: Superior Health Plan Medicare |
$11.98
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$11.98
|
| Rate for Payer: Universal American Medicare |
$11.98
|
| Rate for Payer: Wellcare Medicare |
$11.98
|
| Rate for Payer: Wellmed Medicare |
$11.98
|
|
|
Clostridium difficile Toxin B
|
Facility
|
IP
|
$479.00
|
|
|
Service Code
|
HCPCS 87324
|
| Hospital Charge Code |
4105006
|
|
Hospital Revenue Code
|
306
|
| Rate for Payer: Cash Price |
$325.72
|
|
|
CLOSURE, SKIN, PRINEO, DERMA BOND 22CM
|
Facility
|
OP
|
$672.15
|
|
| Hospital Charge Code |
993767
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$60.49 |
| Max. Negotiated Rate |
$483.95 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$60.49
|
| Rate for Payer: BCBS of TX Blue Advantage |
$201.65
|
| Rate for Payer: BCBS of TX Blue Essentials |
$241.97
|
| Rate for Payer: BCBS of TX PPO |
$268.86
|
| Rate for Payer: Cash Price |
$457.06
|
| Rate for Payer: Cigna Medicaid |
$483.95
|
| Rate for Payer: Molina CHIP/Medicaid |
$483.95
|
| Rate for Payer: Multiplan Auto |
$436.90
|
| Rate for Payer: Multiplan Commercial |
$436.90
|
| Rate for Payer: Multiplan Workers Comp |
$436.90
|
| Rate for Payer: Parkland Medicaid |
$483.95
|
| Rate for Payer: Scott and White EPO/PPO |
$336.07
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$483.95
|
| Rate for Payer: Superior Health Plan EPO |
$91.41
|
|
|
CLOSURE, SKIN, PRINEO, DERMA BOND 22CM
|
Facility
|
IP
|
$672.15
|
|
| Hospital Charge Code |
993767
|
|
Hospital Revenue Code
|
272
|
| Rate for Payer: Cash Price |
$457.06
|
|
|
CLOTH, 2% CHLORHEXIDINE GLUCONATE
|
Facility
|
OP
|
$11.81
|
|
| Hospital Charge Code |
993964
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.06 |
| Max. Negotiated Rate |
$8.50 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1.06
|
| Rate for Payer: BCBS of TX Blue Advantage |
$3.54
|
| Rate for Payer: BCBS of TX Blue Essentials |
$4.25
|
| Rate for Payer: BCBS of TX PPO |
$4.72
|
| Rate for Payer: Cash Price |
$8.03
|
| Rate for Payer: Cigna Medicaid |
$8.50
|
| Rate for Payer: Molina CHIP/Medicaid |
$8.50
|
| Rate for Payer: Multiplan Auto |
$7.68
|
| Rate for Payer: Multiplan Commercial |
$7.68
|
| Rate for Payer: Multiplan Workers Comp |
$7.68
|
| Rate for Payer: Parkland Medicaid |
$8.50
|
| Rate for Payer: Scott and White EPO/PPO |
$5.91
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$8.50
|
| Rate for Payer: Superior Health Plan EPO |
$1.61
|
|
|
CLOTH, 2% CHLORHEXIDINE GLUCONATE
|
Facility
|
IP
|
$11.81
|
|
| Hospital Charge Code |
993964
|
|
Hospital Revenue Code
|
271
|
| Rate for Payer: Cash Price |
$8.03
|
|
|
clotrimazole 1% Cream 30 g
|
Facility
|
IP
|
$23.99
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
77476727
|
|
Hospital Revenue Code
|
250
|
| Rate for Payer: Cash Price |
$16.31
|
|
|
clotrimazole 1% Cream 30 g
|
Facility
|
OP
|
$23.99
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
77476727
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.16 |
| Max. Negotiated Rate |
$17.27 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2.16
|
| Rate for Payer: BCBS of TX Blue Advantage |
$7.20
|
| Rate for Payer: BCBS of TX Blue Essentials |
$8.64
|
| Rate for Payer: BCBS of TX PPO |
$9.60
|
| Rate for Payer: Cash Price |
$16.31
|
| Rate for Payer: Cigna Medicaid |
$17.27
|
| Rate for Payer: Molina CHIP/Medicaid |
$17.27
|
| Rate for Payer: Multiplan Auto |
$15.59
|
| Rate for Payer: Multiplan Commercial |
$15.59
|
| Rate for Payer: Multiplan Workers Comp |
$15.59
|
| Rate for Payer: Parkland Medicaid |
$17.27
|
| Rate for Payer: Scott and White EPO/PPO |
$11.99
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$17.27
|
| Rate for Payer: Superior Health Plan EPO |
$3.26
|
|
