|
ECHOBRITE 20GX6 NEEDLE
|
Facility
|
IP
|
$692.76
|
|
| Hospital Charge Code |
992616
|
|
Hospital Revenue Code
|
272
|
| Rate for Payer: Cash Price |
$471.08
|
|
|
ECHOBRITE 20GX6 NEEDLE
|
Facility
|
OP
|
$692.76
|
|
| Hospital Charge Code |
992616
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$62.35 |
| Max. Negotiated Rate |
$498.79 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$62.35
|
| Rate for Payer: BCBS of TX Blue Advantage |
$207.83
|
| Rate for Payer: BCBS of TX Blue Essentials |
$249.39
|
| Rate for Payer: BCBS of TX PPO |
$277.10
|
| Rate for Payer: Cash Price |
$471.08
|
| Rate for Payer: Cigna Medicaid |
$498.79
|
| Rate for Payer: Molina CHIP/Medicaid |
$498.79
|
| Rate for Payer: Multiplan Auto |
$450.29
|
| Rate for Payer: Multiplan Commercial |
$450.29
|
| Rate for Payer: Multiplan Workers Comp |
$450.29
|
| Rate for Payer: Parkland Medicaid |
$498.79
|
| Rate for Payer: Scott and White EPO/PPO |
$346.38
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$498.79
|
| Rate for Payer: Superior Health Plan EPO |
$94.22
|
|
|
Echocardiogram Transesophageal (TEE) BCE
|
Facility
|
OP
|
$2,932.00
|
|
|
Service Code
|
HCPCS 93314
|
| Hospital Charge Code |
8614517
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$263.88 |
| Max. Negotiated Rate |
$2,111.04 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$263.88
|
| Rate for Payer: BCBS of TX Blue Advantage |
$879.60
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,055.52
|
| Rate for Payer: BCBS of TX PPO |
$1,172.80
|
| Rate for Payer: Cash Price |
$1,993.76
|
| Rate for Payer: Cigna Medicaid |
$2,111.04
|
| Rate for Payer: Molina CHIP/Medicaid |
$2,111.04
|
| Rate for Payer: Multiplan Auto |
$1,905.80
|
| Rate for Payer: Multiplan Commercial |
$1,905.80
|
| Rate for Payer: Multiplan Workers Comp |
$1,905.80
|
| Rate for Payer: Parkland Medicaid |
$2,111.04
|
| Rate for Payer: Scott and White EPO/PPO |
$1,466.00
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$2,111.04
|
| Rate for Payer: Superior Health Plan EPO |
$398.75
|
|
|
Echocardiogram Transesophageal (TEE) BCE
|
Facility
|
IP
|
$2,932.00
|
|
|
Service Code
|
HCPCS 93314
|
| Hospital Charge Code |
8614517
|
|
Hospital Revenue Code
|
483
|
| Rate for Payer: Cash Price |
$1,993.76
|
|
|
ECMO OR TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITH MAJOR O.R. PROCEDURES
|
Facility
|
IP
|
$403,278.80
|
|
|
Service Code
|
MSDRG 003
|
| Min. Negotiated Rate |
$157,357.64 |
| Max. Negotiated Rate |
$403,278.80 |
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$160,320.12
|
| Rate for Payer: Amerigroup Medicare |
$160,320.12
|
| Rate for Payer: BCBS of TX Medicare |
$160,320.12
|
| Rate for Payer: Cigna Commercial |
$273,380.58
|
| Rate for Payer: Cigna Medicare |
$160,320.12
|
| Rate for Payer: Employer Direct Commercial |
$160,320.12
|
| Rate for Payer: Humana Medicare/TRICARE |
$160,320.12
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$160,320.12
|
| Rate for Payer: Molina Medicare |
$160,320.12
|
| Rate for Payer: Multiplan Auto |
$403,278.80
|
| Rate for Payer: Multiplan Commercial |
$403,278.80
|
| Rate for Payer: Multiplan Workers Comp |
$403,278.80
|
| Rate for Payer: Scott and White EPO/PPO |
$185,720.50
|
| Rate for Payer: Scott and White Medicare |
$160,320.12
|
| Rate for Payer: Superior Health Plan EPO |
$160,320.12
|
| Rate for Payer: Superior Health Plan Medicare |
$160,320.12
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$160,320.12
|
| Rate for Payer: Universal American Medicare |
$160,320.12
|
| Rate for Payer: Wellcare Medicare |
$160,320.12
|
| Rate for Payer: Wellmed Medicare |
$160,320.12
|
|
|
ECMO OR TRACH W MV >96 HRS OR PDX EXC FACE, MOUTH & NECK W MAJ O.R.
|
Facility
|
IP
|
$403,278.80
|
|
|
Service Code
|
MSDRG 003
|
| Min. Negotiated Rate |
$157,357.64 |
| Max. Negotiated Rate |
$403,278.80 |
| Rate for Payer: BCBS of TX Blue Advantage |
$157,357.64
|
| Rate for Payer: BCBS of TX Blue Essentials |
$188,810.87
|
| Rate for Payer: BCBS of TX PPO |
$209,797.99
|
|
|
Economy insufflation tubing with 0.1 micron filter
|
Facility
|
OP
|
$16.50
|
|
| Hospital Charge Code |
992789
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$11.88 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1.49
|
| Rate for Payer: BCBS of TX Blue Advantage |
$4.95
|
| Rate for Payer: BCBS of TX Blue Essentials |
$5.94
|
| Rate for Payer: BCBS of TX PPO |
$6.60
|
| Rate for Payer: Cash Price |
$11.22
|
| Rate for Payer: Cigna Medicaid |
$11.88
|
| Rate for Payer: Molina CHIP/Medicaid |
$11.88
|
| Rate for Payer: Multiplan Auto |
$10.72
|
| Rate for Payer: Multiplan Commercial |
$10.72
|
| Rate for Payer: Multiplan Workers Comp |
$10.72
|
| Rate for Payer: Parkland Medicaid |
$11.88
|
| Rate for Payer: Scott and White EPO/PPO |
$8.25
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$11.88
|
| Rate for Payer: Superior Health Plan EPO |
$2.24
|
|
|
Economy insufflation tubing with 0.1 micron filter
|
Facility
|
IP
|
$16.50
|
|
| Hospital Charge Code |
992789
|
|
Hospital Revenue Code
|
272
|
| Rate for Payer: Cash Price |
$11.22
|
|
|
ED Airway/Intubation Procedure -> Chest Tube Insertion
|
Facility
|
IP
|
$819.00
|
|
|
Service Code
|
HCPCS 32551
|
| Hospital Charge Code |
3851086
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$556.92
|
|
|
ED Airway/Intubation Procedure -> Chest Tube Insertion
|
Facility
|
OP
|
$819.00
|
|
|
Service Code
|
HCPCS 32551
|
| Hospital Charge Code |
3851086
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$73.71 |
| Max. Negotiated Rate |
$4,110.45 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$73.71
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,581.33
|
| Rate for Payer: Amerigroup Medicare |
$1,581.33
|
| 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 |
$1,581.33
|
| Rate for Payer: BCBS of TX PPO |
$4,110.45
|
| Rate for Payer: Cash Price |
$556.92
|
| Rate for Payer: Cash Price |
$556.92
|
| Rate for Payer: Cash Price |
$556.92
|
| Rate for Payer: Cigna Commercial |
$3,342.63
|
| Rate for Payer: Cigna Medicaid |
$589.68
|
| Rate for Payer: Cigna Medicare |
$1,581.33
|
| Rate for Payer: Employer Direct Commercial |
$1,581.33
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,581.33
|
| Rate for Payer: Molina CHIP/Medicaid |
$589.68
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,581.33
|
| Rate for Payer: Molina Medicare |
$1,581.33
|
| Rate for Payer: Multiplan Auto |
$532.35
|
| Rate for Payer: Multiplan Commercial |
$532.35
|
| Rate for Payer: Multiplan Workers Comp |
$532.35
|
| Rate for Payer: Parkland Medicaid |
$589.68
|
| Rate for Payer: Scott and White EPO/PPO |
$409.50
|
| Rate for Payer: Scott and White Medicare |
$1,581.33
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$589.68
|
| Rate for Payer: Superior Health Plan EPO |
$1,581.33
|
| Rate for Payer: Superior Health Plan Medicare |
$1,581.33
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,581.33
|
| Rate for Payer: Universal American Medicare |
$1,581.33
|
| Rate for Payer: Wellcare Medicare |
$1,581.33
|
| Rate for Payer: Wellmed Medicare |
$1,581.33
|
|
|
ED Airway/Intubation Procedure -> Cricothyrotomy
|
Facility
|
OP
|
$1,090.00
|
|
|
Service Code
|
HCPCS 31605
|
| Hospital Charge Code |
8914571
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$98.10 |
| Max. Negotiated Rate |
$784.80 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$98.10
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$237.93
|
| Rate for Payer: Amerigroup Medicare |
$237.93
|
| Rate for Payer: BCBS of TX Blue Advantage |
$340.08
|
| Rate for Payer: BCBS of TX Blue Essentials |
$407.28
|
| Rate for Payer: BCBS of TX Medicare |
$237.93
|
| Rate for Payer: BCBS of TX PPO |
$513.17
|
| Rate for Payer: Cash Price |
$741.20
|
| Rate for Payer: Cash Price |
$741.20
|
| Rate for Payer: Cash Price |
$741.20
|
| Rate for Payer: Cigna Commercial |
$502.95
|
| Rate for Payer: Cigna Medicaid |
$784.80
|
| Rate for Payer: Cigna Medicare |
$237.93
|
| Rate for Payer: Employer Direct Commercial |
$237.93
|
| Rate for Payer: Humana Medicare/TRICARE |
$237.93
|
| Rate for Payer: Molina CHIP/Medicaid |
$784.80
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$237.93
|
| Rate for Payer: Molina Medicare |
$237.93
|
| Rate for Payer: Multiplan Auto |
$708.50
|
| Rate for Payer: Multiplan Commercial |
$708.50
|
| Rate for Payer: Multiplan Workers Comp |
$708.50
|
| Rate for Payer: Parkland Medicaid |
$784.80
|
| Rate for Payer: Scott and White EPO/PPO |
$545.00
|
| Rate for Payer: Scott and White Medicare |
$237.93
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$784.80
|
| Rate for Payer: Superior Health Plan EPO |
$237.93
|
| Rate for Payer: Superior Health Plan Medicare |
$237.93
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$237.93
|
| Rate for Payer: Universal American Medicare |
$237.93
|
| Rate for Payer: Wellcare Medicare |
$237.93
|
| Rate for Payer: Wellmed Medicare |
$237.93
|
|
|
ED Airway/Intubation Procedure -> Cricothyrotomy
|
Facility
|
IP
|
$1,090.00
|
|
|
Service Code
|
HCPCS 31605
|
| Hospital Charge Code |
8914571
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$741.20
|
|
|
ED Airway/Intubation Procedure -> Endotracheal intubation
|
Facility
|
OP
|
$1,049.00
|
|
|
Service Code
|
HCPCS 31500
|
| Hospital Charge Code |
300533
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$94.41 |
| Max. Negotiated Rate |
$755.28 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$94.41
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$237.93
|
| Rate for Payer: Amerigroup Medicare |
$237.93
|
| Rate for Payer: BCBS of TX Blue Advantage |
$340.08
|
| Rate for Payer: BCBS of TX Blue Essentials |
$407.28
|
| Rate for Payer: BCBS of TX Medicare |
$237.93
|
| Rate for Payer: BCBS of TX PPO |
$513.17
|
| Rate for Payer: Cash Price |
$713.32
|
| Rate for Payer: Cash Price |
$713.32
|
| Rate for Payer: Cash Price |
$713.32
|
| Rate for Payer: Cigna Commercial |
$502.95
|
| Rate for Payer: Cigna Medicaid |
$755.28
|
| Rate for Payer: Cigna Medicare |
$237.93
|
| Rate for Payer: Employer Direct Commercial |
$237.93
|
| Rate for Payer: Humana Medicare/TRICARE |
$237.93
|
| Rate for Payer: Molina CHIP/Medicaid |
$755.28
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$237.93
|
| Rate for Payer: Molina Medicare |
$237.93
|
| Rate for Payer: Multiplan Auto |
$681.85
|
| Rate for Payer: Multiplan Commercial |
$681.85
|
| Rate for Payer: Multiplan Workers Comp |
$681.85
|
| Rate for Payer: Parkland Medicaid |
$755.28
|
| Rate for Payer: Scott and White EPO/PPO |
$524.50
|
| Rate for Payer: Scott and White Medicare |
$237.93
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$755.28
|
| Rate for Payer: Superior Health Plan EPO |
$237.93
|
| Rate for Payer: Superior Health Plan Medicare |
$237.93
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$237.93
|
| Rate for Payer: Universal American Medicare |
$237.93
|
| Rate for Payer: Wellcare Medicare |
$237.93
|
| Rate for Payer: Wellmed Medicare |
$237.93
|
|
|
ED Airway/Intubation Procedure -> Endotracheal intubation
|
Facility
|
IP
|
$1,049.00
|
|
|
Service Code
|
HCPCS 31500
|
| Hospital Charge Code |
300533
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$713.32
|
|
|
ED Airway/Intubation Procedure -> Insert pleural catheter w/ imaging
|
Facility
|
IP
|
$6,427.00
|
|
|
Service Code
|
HCPCS 32550
|
| Hospital Charge Code |
2151249
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$4,370.36
|
|
|
ED Airway/Intubation Procedure -> Insert pleural catheter w/ imaging
|
Facility
|
OP
|
$6,427.00
|
|
|
Service Code
|
HCPCS 32550
|
| Hospital Charge Code |
2151249
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$578.43 |
| Max. Negotiated Rate |
$7,835.54 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$578.43
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3,596.72
|
| Rate for Payer: Amerigroup Medicare |
$3,596.72
|
| Rate for Payer: BCBS of TX Blue Advantage |
$5,192.60
|
| Rate for Payer: BCBS of TX Blue Essentials |
$6,218.68
|
| Rate for Payer: BCBS of TX Medicare |
$3,596.72
|
| Rate for Payer: BCBS of TX PPO |
$7,835.54
|
| Rate for Payer: Cash Price |
$4,370.36
|
| Rate for Payer: Cash Price |
$4,370.36
|
| Rate for Payer: Cash Price |
$4,370.36
|
| Rate for Payer: Cigna Commercial |
$7,602.81
|
| Rate for Payer: Cigna Medicaid |
$4,627.44
|
| Rate for Payer: Cigna Medicare |
$3,596.72
|
| Rate for Payer: Employer Direct Commercial |
$3,596.72
|
| Rate for Payer: Humana Medicare/TRICARE |
$3,596.72
|
| Rate for Payer: Molina CHIP/Medicaid |
$4,627.44
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3,596.72
|
| Rate for Payer: Molina Medicare |
$3,596.72
|
| Rate for Payer: Multiplan Auto |
$4,177.55
|
| Rate for Payer: Multiplan Commercial |
$4,177.55
|
| Rate for Payer: Multiplan Workers Comp |
$4,177.55
|
| Rate for Payer: Parkland Medicaid |
$4,627.44
|
| Rate for Payer: Scott and White EPO/PPO |
$3,213.50
|
| Rate for Payer: Scott and White Medicare |
$3,596.72
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$4,627.44
|
| Rate for Payer: Superior Health Plan EPO |
$3,596.72
|
| Rate for Payer: Superior Health Plan Medicare |
$3,596.72
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3,596.72
|
| Rate for Payer: Universal American Medicare |
$3,596.72
|
| Rate for Payer: Wellcare Medicare |
$3,596.72
|
| Rate for Payer: Wellmed Medicare |
$3,596.72
|
|
|
ED Airway/Intubation Procedure -> Laryngoscopy, direct
|
Facility
|
OP
|
$5,290.00
|
|
|
Service Code
|
HCPCS 31525
|
| Hospital Charge Code |
3301019
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$476.10 |
| Max. Negotiated Rate |
$3,808.80 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$476.10
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,788.01
|
| Rate for Payer: Amerigroup Medicare |
$1,788.01
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,389.12
|
| Rate for Payer: BCBS of TX Blue Essentials |
$2,861.22
|
| Rate for Payer: BCBS of TX Medicare |
$1,788.01
|
| Rate for Payer: BCBS of TX PPO |
$3,605.14
|
| Rate for Payer: Cash Price |
$3,597.20
|
| Rate for Payer: Cash Price |
$3,597.20
|
| Rate for Payer: Cash Price |
$3,597.20
|
| Rate for Payer: Cigna Commercial |
$3,779.52
|
| Rate for Payer: Cigna Medicaid |
$3,808.80
|
| Rate for Payer: Cigna Medicare |
$1,788.01
|
| Rate for Payer: Employer Direct Commercial |
$1,788.01
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,788.01
|
| Rate for Payer: Molina CHIP/Medicaid |
$3,808.80
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,788.01
|
| Rate for Payer: Molina Medicare |
$1,788.01
|
| Rate for Payer: Multiplan Auto |
$3,438.50
|
| Rate for Payer: Multiplan Commercial |
$3,438.50
|
| Rate for Payer: Multiplan Workers Comp |
$3,438.50
|
| Rate for Payer: Parkland Medicaid |
$3,808.80
|
| Rate for Payer: Scott and White EPO/PPO |
$2,645.00
|
| Rate for Payer: Scott and White Medicare |
$1,788.01
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$3,808.80
|
| Rate for Payer: Superior Health Plan EPO |
$1,788.01
|
| Rate for Payer: Superior Health Plan Medicare |
$1,788.01
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,788.01
|
| Rate for Payer: Universal American Medicare |
$1,788.01
|
| Rate for Payer: Wellcare Medicare |
$1,788.01
|
| Rate for Payer: Wellmed Medicare |
$1,788.01
|
|
|
ED Airway/Intubation Procedure -> Laryngoscopy, direct
|
Facility
|
IP
|
$5,290.00
|
|
|
Service Code
|
HCPCS 31525
|
| Hospital Charge Code |
3301019
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$3,597.20
|
|
|
ED Airway/Intubation Procedure -> Thoracentesis w/ imaging
|
Facility
|
OP
|
$1,959.00
|
|
|
Service Code
|
HCPCS 32555
|
| Hospital Charge Code |
2180027
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$176.31 |
| Max. Negotiated Rate |
$1,588.89 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$176.31
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$630.16
|
| Rate for Payer: Amerigroup Medicare |
$630.16
|
| Rate for Payer: BCBS of TX Blue Advantage |
$1,052.95
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,261.02
|
| Rate for Payer: BCBS of TX Medicare |
$630.16
|
| Rate for Payer: BCBS of TX PPO |
$1,588.89
|
| Rate for Payer: Cash Price |
$1,332.12
|
| Rate for Payer: Cash Price |
$1,332.12
|
| Rate for Payer: Cash Price |
$1,332.12
|
| Rate for Payer: Cigna Commercial |
$1,332.05
|
| Rate for Payer: Cigna Medicaid |
$1,410.48
|
| Rate for Payer: Cigna Medicare |
$630.16
|
| Rate for Payer: Employer Direct Commercial |
$630.16
|
| Rate for Payer: Humana Medicare/TRICARE |
$630.16
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,410.48
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$630.16
|
| Rate for Payer: Molina Medicare |
$630.16
|
| Rate for Payer: Multiplan Auto |
$1,273.35
|
| Rate for Payer: Multiplan Commercial |
$1,273.35
|
| Rate for Payer: Multiplan Workers Comp |
$1,273.35
|
| Rate for Payer: Parkland Medicaid |
$1,410.48
|
| Rate for Payer: Scott and White EPO/PPO |
$979.50
|
| Rate for Payer: Scott and White Medicare |
$630.16
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,410.48
|
| Rate for Payer: Superior Health Plan EPO |
$630.16
|
| Rate for Payer: Superior Health Plan Medicare |
$630.16
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$630.16
|
| Rate for Payer: Universal American Medicare |
$630.16
|
| Rate for Payer: Wellcare Medicare |
$630.16
|
| Rate for Payer: Wellmed Medicare |
$630.16
|
|
|
ED Airway/Intubation Procedure -> Thoracentesis w/ imaging
|
Facility
|
IP
|
$1,959.00
|
|
|
Service Code
|
HCPCS 32555
|
| Hospital Charge Code |
2180027
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$1,332.12
|
|
|
ED Airway/Intubation Procedure -> Thoracentesis w/o imaging
|
Facility
|
IP
|
$1,590.00
|
|
|
Service Code
|
HCPCS 32554
|
| Hospital Charge Code |
8914570
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$1,081.20
|
|
|
ED Airway/Intubation Procedure -> Thoracentesis w/o imaging
|
Facility
|
OP
|
$1,590.00
|
|
|
Service Code
|
HCPCS 32554
|
| Hospital Charge Code |
8914570
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$143.10 |
| Max. Negotiated Rate |
$1,588.89 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$143.10
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$630.16
|
| Rate for Payer: Amerigroup Medicare |
$630.16
|
| Rate for Payer: BCBS of TX Blue Advantage |
$1,052.95
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,261.02
|
| Rate for Payer: BCBS of TX Medicare |
$630.16
|
| Rate for Payer: BCBS of TX PPO |
$1,588.89
|
| Rate for Payer: Cash Price |
$1,081.20
|
| Rate for Payer: Cash Price |
$1,081.20
|
| Rate for Payer: Cash Price |
$1,081.20
|
| Rate for Payer: Cigna Commercial |
$1,332.05
|
| Rate for Payer: Cigna Medicaid |
$1,144.80
|
| Rate for Payer: Cigna Medicare |
$630.16
|
| Rate for Payer: Employer Direct Commercial |
$630.16
|
| Rate for Payer: Humana Medicare/TRICARE |
$630.16
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,144.80
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$630.16
|
| Rate for Payer: Molina Medicare |
$630.16
|
| Rate for Payer: Multiplan Auto |
$1,033.50
|
| Rate for Payer: Multiplan Commercial |
$1,033.50
|
| Rate for Payer: Multiplan Workers Comp |
$1,033.50
|
| Rate for Payer: Parkland Medicaid |
$1,144.80
|
| Rate for Payer: Scott and White EPO/PPO |
$795.00
|
| Rate for Payer: Scott and White Medicare |
$630.16
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,144.80
|
| Rate for Payer: Superior Health Plan EPO |
$630.16
|
| Rate for Payer: Superior Health Plan Medicare |
$630.16
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$630.16
|
| Rate for Payer: Universal American Medicare |
$630.16
|
| Rate for Payer: Wellcare Medicare |
$630.16
|
| Rate for Payer: Wellmed Medicare |
$630.16
|
|
|
ED APPLICATION FINGER SPLINT DYNAMIC BCE
|
Facility
|
OP
|
$493.00
|
|
|
Service Code
|
HCPCS 29131
|
| Hospital Charge Code |
8478520
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$44.37 |
| Max. Negotiated Rate |
$354.96 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$44.37
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$59.26
|
| Rate for Payer: Amerigroup Medicare |
$59.26
|
| 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 |
$59.26
|
| Rate for Payer: BCBS of TX PPO |
$138.63
|
| Rate for Payer: Cash Price |
$335.24
|
| Rate for Payer: Cash Price |
$335.24
|
| Rate for Payer: Cash Price |
$335.24
|
| Rate for Payer: Cigna Commercial |
$125.27
|
| Rate for Payer: Cigna Medicaid |
$354.96
|
| Rate for Payer: Cigna Medicare |
$59.26
|
| Rate for Payer: Employer Direct Commercial |
$59.26
|
| Rate for Payer: Humana Medicare/TRICARE |
$59.26
|
| Rate for Payer: Molina CHIP/Medicaid |
$354.96
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$59.26
|
| Rate for Payer: Molina Medicare |
$59.26
|
| Rate for Payer: Multiplan Auto |
$320.45
|
| Rate for Payer: Multiplan Commercial |
$320.45
|
| Rate for Payer: Multiplan Workers Comp |
$320.45
|
| Rate for Payer: Parkland Medicaid |
$354.96
|
| Rate for Payer: Scott and White EPO/PPO |
$246.50
|
| Rate for Payer: Scott and White Medicare |
$59.26
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$354.96
|
| Rate for Payer: Superior Health Plan EPO |
$59.26
|
| Rate for Payer: Superior Health Plan Medicare |
$59.26
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$59.26
|
| Rate for Payer: Universal American Medicare |
$59.26
|
| Rate for Payer: Wellcare Medicare |
$59.26
|
| Rate for Payer: Wellmed Medicare |
$59.26
|
|
|
ED APPLICATION FINGER SPLINT DYNAMIC BCE
|
Facility
|
IP
|
$493.00
|
|
|
Service Code
|
HCPCS 29131
|
| Hospital Charge Code |
8478520
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$335.24
|
|
|
ED APPLICATION SHORT ARM SPLINT DYNAMIC BCE
|
Facility
|
OP
|
$625.00
|
|
|
Service Code
|
HCPCS 29126
|
| Hospital Charge Code |
8912573
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$56.25 |
| Max. Negotiated Rate |
$450.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$56.25
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$133.65
|
| Rate for Payer: Amerigroup Medicare |
$133.65
|
| 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 |
$133.65
|
| Rate for Payer: BCBS of TX PPO |
$274.76
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cigna Commercial |
$282.53
|
| Rate for Payer: Cigna Medicaid |
$450.00
|
| Rate for Payer: Cigna Medicare |
$133.65
|
| Rate for Payer: Employer Direct Commercial |
$133.65
|
| Rate for Payer: Humana Medicare/TRICARE |
$133.65
|
| Rate for Payer: Molina CHIP/Medicaid |
$450.00
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$133.65
|
| Rate for Payer: Molina Medicare |
$133.65
|
| Rate for Payer: Multiplan Auto |
$406.25
|
| Rate for Payer: Multiplan Commercial |
$406.25
|
| Rate for Payer: Multiplan Workers Comp |
$406.25
|
| Rate for Payer: Parkland Medicaid |
$450.00
|
| Rate for Payer: Scott and White EPO/PPO |
$312.50
|
| Rate for Payer: Scott and White Medicare |
$133.65
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$450.00
|
| Rate for Payer: Superior Health Plan EPO |
$133.65
|
| Rate for Payer: Superior Health Plan Medicare |
$133.65
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$133.65
|
| Rate for Payer: Universal American Medicare |
$133.65
|
| Rate for Payer: Wellcare Medicare |
$133.65
|
| Rate for Payer: Wellmed Medicare |
$133.65
|
|
