|
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 |
$245.07 |
| 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 |
$245.07
|
| 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 -> 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 -> 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 -> Laryngoscopy, direct
|
Facility
|
OP
|
$5,290.00
|
|
|
Service Code
|
HCPCS 31525
|
| Hospital Charge Code |
3301019
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$195.79 |
| 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 |
$195.79
|
| 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 -> Thoracentesis w/ imaging
|
Facility
|
OP
|
$1,959.00
|
|
|
Service Code
|
HCPCS 32555
|
| Hospital Charge Code |
2180027
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$131.10 |
| 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 |
$131.10
|
| 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
|
OP
|
$1,590.00
|
|
|
Service Code
|
HCPCS 32554
|
| Hospital Charge Code |
8914570
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$106.76 |
| 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 |
$106.76
|
| 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 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 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 FINGER SPLINT DYNAMIC BCE
|
Facility
|
OP
|
$493.00
|
|
|
Service Code
|
HCPCS 29131
|
| Hospital Charge Code |
8478520
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$42.48 |
| 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 |
$42.48
|
| 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 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 |
$60.99
|
| 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
|
|
|
ED APPLICATION SHORT ARM SPLINT DYNAMIC BCE
|
Facility
|
IP
|
$625.00
|
|
|
Service Code
|
HCPCS 29126
|
| Hospital Charge Code |
8912573
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$425.00
|
|
|
ED BLADDER IRRIGATION SIMPLE LAVAGE AND OR INSTILLATION BCE
|
Facility
|
OP
|
$907.00
|
|
|
Service Code
|
HCPCS 51700
|
| Hospital Charge Code |
8912577
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$36.35 |
| Max. Negotiated Rate |
$653.04 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$81.63
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$250.99
|
| Rate for Payer: Amerigroup Medicare |
$250.99
|
| Rate for Payer: BCBS of TX Blue Advantage |
$87.39
|
| Rate for Payer: BCBS of TX Blue Essentials |
$104.66
|
| Rate for Payer: BCBS of TX Medicare |
$250.99
|
| Rate for Payer: BCBS of TX PPO |
$131.87
|
| Rate for Payer: Cash Price |
$616.76
|
| Rate for Payer: Cash Price |
$616.76
|
| Rate for Payer: Cash Price |
$616.76
|
| Rate for Payer: Cigna Commercial |
$530.54
|
| Rate for Payer: Cigna Medicaid |
$653.04
|
| Rate for Payer: Cigna Medicare |
$250.99
|
| Rate for Payer: Employer Direct Commercial |
$250.99
|
| Rate for Payer: Humana Medicare/TRICARE |
$250.99
|
| Rate for Payer: Molina CHIP/Medicaid |
$653.04
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$250.99
|
| Rate for Payer: Molina Medicare |
$250.99
|
| Rate for Payer: Multiplan Auto |
$589.55
|
| Rate for Payer: Multiplan Commercial |
$589.55
|
| Rate for Payer: Multiplan Workers Comp |
$589.55
|
| Rate for Payer: Parkland Medicaid |
$653.04
|
| Rate for Payer: Scott and White EPO/PPO |
$36.35
|
| Rate for Payer: Scott and White Medicare |
$250.99
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$653.04
|
| Rate for Payer: Superior Health Plan EPO |
$250.99
|
| Rate for Payer: Superior Health Plan Medicare |
$250.99
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$250.99
|
| Rate for Payer: Universal American Medicare |
$250.99
|
| Rate for Payer: Wellcare Medicare |
$250.99
|
| Rate for Payer: Wellmed Medicare |
$250.99
|
|
|
ED BLADDER IRRIGATION SIMPLE LAVAGE AND OR INSTILLATION BCE
|
Facility
|
IP
|
$907.00
|
|
|
Service Code
|
HCPCS 51700
|
| Hospital Charge Code |
8912577
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$616.76
|
|
|
ED BLOOD TRANSFUSION BCE
|
Facility
|
IP
|
$2,059.00
|
|
|
Service Code
|
HCPCS 36430
|
| Hospital Charge Code |
8398512
|
|
Hospital Revenue Code
|
391
|
| Rate for Payer: Cash Price |
$1,400.12
|
|
|
ED BLOOD TRANSFUSION BCE
|
Facility
|
OP
|
$2,059.00
|
|
|
Service Code
|
HCPCS 36430
|
| Hospital Charge Code |
8398512
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$52.19 |
| Max. Negotiated Rate |
$1,482.48 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$185.31
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$443.18
|
| Rate for Payer: Amerigroup Medicare |
$443.18
|
| Rate for Payer: BCBS of TX Blue Advantage |
$58.47
|
| Rate for Payer: BCBS of TX Blue Essentials |
$70.02
|
| Rate for Payer: BCBS of TX Medicare |
$443.18
|
| Rate for Payer: BCBS of TX PPO |
$88.23
|
| Rate for Payer: Cash Price |
$1,400.12
|
| Rate for Payer: Cash Price |
$1,400.12
|
| Rate for Payer: Cash Price |
$1,400.12
|
| Rate for Payer: Cigna Commercial |
$936.81
|
| Rate for Payer: Cigna Medicaid |
$1,482.48
|
| Rate for Payer: Cigna Medicare |
$443.18
|
| Rate for Payer: Employer Direct Commercial |
$443.18
|
| Rate for Payer: Humana Medicare/TRICARE |
$443.18
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,482.48
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$443.18
|
| Rate for Payer: Molina Medicare |
$443.18
|
| Rate for Payer: Multiplan Auto |
$1,338.35
|
| Rate for Payer: Multiplan Commercial |
$1,338.35
|
| Rate for Payer: Multiplan Workers Comp |
$1,338.35
|
| Rate for Payer: Parkland Medicaid |
$1,482.48
|
| Rate for Payer: Scott and White EPO/PPO |
$52.19
|
| Rate for Payer: Scott and White Medicare |
$443.18
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,482.48
|
| Rate for Payer: Superior Health Plan EPO |
$443.18
|
| Rate for Payer: Superior Health Plan Medicare |
$443.18
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$443.18
|
| Rate for Payer: Universal American Medicare |
$443.18
|
| Rate for Payer: Wellcare Medicare |
$443.18
|
| Rate for Payer: Wellmed Medicare |
$443.18
|
|
|
ED Burns -> Dress/Debride Large Burn, >10%
|
Facility
|
OP
|
$922.00
|
|
|
Service Code
|
HCPCS 16030
|
| Hospital Charge Code |
5202502
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$82.98 |
| Max. Negotiated Rate |
$863.21 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$82.98
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$408.37
|
| Rate for Payer: Amerigroup Medicare |
$408.37
|
| Rate for Payer: BCBS of TX Blue Advantage |
$533.58
|
| Rate for Payer: BCBS of TX Blue Essentials |
$639.02
|
| Rate for Payer: BCBS of TX Medicare |
$408.37
|
| Rate for Payer: BCBS of TX PPO |
$805.17
|
| Rate for Payer: Cash Price |
$626.96
|
| Rate for Payer: Cash Price |
$626.96
|
| Rate for Payer: Cash Price |
$626.96
|
| Rate for Payer: Cigna Commercial |
$863.21
|
| Rate for Payer: Cigna Medicaid |
$663.84
|
| Rate for Payer: Cigna Medicare |
$408.37
|
| Rate for Payer: Employer Direct Commercial |
$408.37
|
| Rate for Payer: Humana Medicare/TRICARE |
$408.37
|
| Rate for Payer: Molina CHIP/Medicaid |
$663.84
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$408.37
|
| Rate for Payer: Molina Medicare |
$408.37
|
| Rate for Payer: Multiplan Auto |
$599.30
|
| Rate for Payer: Multiplan Commercial |
$599.30
|
| Rate for Payer: Multiplan Workers Comp |
$599.30
|
| Rate for Payer: Parkland Medicaid |
$663.84
|
| Rate for Payer: Scott and White EPO/PPO |
$160.91
|
| Rate for Payer: Scott and White Medicare |
$408.37
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$663.84
|
| Rate for Payer: Superior Health Plan EPO |
$408.37
|
| Rate for Payer: Superior Health Plan Medicare |
$408.37
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$408.37
|
| Rate for Payer: Universal American Medicare |
$408.37
|
| Rate for Payer: Wellcare Medicare |
$408.37
|
| Rate for Payer: Wellmed Medicare |
$408.37
|
|
|
ED Burns -> Dress/Debride Large Burn, >10%
|
Facility
|
IP
|
$922.00
|
|
|
Service Code
|
HCPCS 16030
|
| Hospital Charge Code |
5202502
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$626.96
|
|
|
ED Burns -> Dress/Debride Medium Burn, 5-10%
|
Facility
|
IP
|
$445.00
|
|
|
Service Code
|
HCPCS 16025
|
| Hospital Charge Code |
5200040
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$302.60
|
|
|
ED Burns -> Dress/Debride Medium Burn, 5-10%
|
Facility
|
OP
|
$445.00
|
|
|
Service Code
|
HCPCS 16025
|
| Hospital Charge Code |
5200040
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$40.05 |
| Max. Negotiated Rate |
$440.32 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$40.05
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$201.55
|
| Rate for Payer: Amerigroup Medicare |
$201.55
|
| Rate for Payer: BCBS of TX Blue Advantage |
$291.80
|
| Rate for Payer: BCBS of TX Blue Essentials |
$349.46
|
| Rate for Payer: BCBS of TX Medicare |
$201.55
|
| Rate for Payer: BCBS of TX PPO |
$440.32
|
| Rate for Payer: Cash Price |
$302.60
|
| Rate for Payer: Cash Price |
$302.60
|
| Rate for Payer: Cash Price |
$302.60
|
| Rate for Payer: Cigna Commercial |
$426.04
|
| Rate for Payer: Cigna Medicaid |
$320.40
|
| Rate for Payer: Cigna Medicare |
$201.55
|
| Rate for Payer: Employer Direct Commercial |
$201.55
|
| Rate for Payer: Humana Medicare/TRICARE |
$201.55
|
| Rate for Payer: Molina CHIP/Medicaid |
$320.40
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$201.55
|
| Rate for Payer: Molina Medicare |
$201.55
|
| Rate for Payer: Multiplan Auto |
$289.25
|
| Rate for Payer: Multiplan Commercial |
$289.25
|
| Rate for Payer: Multiplan Workers Comp |
$289.25
|
| Rate for Payer: Parkland Medicaid |
$320.40
|
| Rate for Payer: Scott and White EPO/PPO |
$136.40
|
| Rate for Payer: Scott and White Medicare |
$201.55
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$320.40
|
| Rate for Payer: Superior Health Plan EPO |
$201.55
|
| Rate for Payer: Superior Health Plan Medicare |
$201.55
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$201.55
|
| Rate for Payer: Universal American Medicare |
$201.55
|
| Rate for Payer: Wellcare Medicare |
$201.55
|
| Rate for Payer: Wellmed Medicare |
$201.55
|
|
|
ED Burns -> Dress/Debride Small Burn, <5%
|
Facility
|
OP
|
$413.00
|
|
|
Service Code
|
HCPCS 16020
|
| Hospital Charge Code |
7150819
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$37.17 |
| Max. Negotiated Rate |
$440.32 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$37.17
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$201.55
|
| Rate for Payer: Amerigroup Medicare |
$201.55
|
| Rate for Payer: BCBS of TX Blue Advantage |
$291.80
|
| Rate for Payer: BCBS of TX Blue Essentials |
$349.46
|
| Rate for Payer: BCBS of TX Medicare |
$201.55
|
| Rate for Payer: BCBS of TX PPO |
$440.32
|
| Rate for Payer: Cash Price |
$280.84
|
| Rate for Payer: Cash Price |
$280.84
|
| Rate for Payer: Cash Price |
$280.84
|
| Rate for Payer: Cigna Commercial |
$426.04
|
| Rate for Payer: Cigna Medicaid |
$297.36
|
| Rate for Payer: Cigna Medicare |
$201.55
|
| Rate for Payer: Employer Direct Commercial |
$201.55
|
| Rate for Payer: Humana Medicare/TRICARE |
$201.55
|
| Rate for Payer: Molina CHIP/Medicaid |
$297.36
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$201.55
|
| Rate for Payer: Molina Medicare |
$201.55
|
| Rate for Payer: Multiplan Auto |
$268.45
|
| Rate for Payer: Multiplan Commercial |
$268.45
|
| Rate for Payer: Multiplan Workers Comp |
$268.45
|
| Rate for Payer: Parkland Medicaid |
$297.36
|
| Rate for Payer: Scott and White EPO/PPO |
$68.72
|
| Rate for Payer: Scott and White Medicare |
$201.55
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$297.36
|
| Rate for Payer: Superior Health Plan EPO |
$201.55
|
| Rate for Payer: Superior Health Plan Medicare |
$201.55
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$201.55
|
| Rate for Payer: Universal American Medicare |
$201.55
|
| Rate for Payer: Wellcare Medicare |
$201.55
|
| Rate for Payer: Wellmed Medicare |
$201.55
|
|
|
ED Burns -> Dress/Debride Small Burn, <5%
|
Facility
|
IP
|
$413.00
|
|
|
Service Code
|
HCPCS 16020
|
| Hospital Charge Code |
7150819
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$280.84
|
|
|
ED Cardiovascular Procedure -> Cardioversion
|
Facility
|
IP
|
$1,363.00
|
|
|
Service Code
|
HCPCS 92960
|
| Hospital Charge Code |
2300077
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$926.84
|
|
|
ED Cardiovascular Procedure -> Cardioversion
|
Facility
|
OP
|
$1,363.00
|
|
|
Service Code
|
HCPCS 92960
|
| Hospital Charge Code |
2300077
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$122.67 |
| Max. Negotiated Rate |
$1,403.47 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$122.67
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$663.96
|
| Rate for Payer: Amerigroup Medicare |
$663.96
|
| Rate for Payer: BCBS of TX Blue Advantage |
$895.89
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,072.92
|
| Rate for Payer: BCBS of TX Medicare |
$663.96
|
| Rate for Payer: BCBS of TX PPO |
$1,351.88
|
| Rate for Payer: Cash Price |
$926.84
|
| Rate for Payer: Cash Price |
$926.84
|
| Rate for Payer: Cash Price |
$926.84
|
| Rate for Payer: Cigna Commercial |
$1,403.47
|
| Rate for Payer: Cigna Medicaid |
$981.36
|
| Rate for Payer: Cigna Medicare |
$663.96
|
| Rate for Payer: Employer Direct Commercial |
$663.96
|
| Rate for Payer: Humana Medicare/TRICARE |
$663.96
|
| Rate for Payer: Molina CHIP/Medicaid |
$981.36
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$663.96
|
| Rate for Payer: Molina Medicare |
$663.96
|
| Rate for Payer: Multiplan Auto |
$885.95
|
| Rate for Payer: Multiplan Commercial |
$885.95
|
| Rate for Payer: Multiplan Workers Comp |
$885.95
|
| Rate for Payer: Parkland Medicaid |
$981.36
|
| Rate for Payer: Scott and White EPO/PPO |
$130.60
|
| Rate for Payer: Scott and White Medicare |
$663.96
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$981.36
|
| Rate for Payer: Superior Health Plan EPO |
$663.96
|
| Rate for Payer: Superior Health Plan Medicare |
$663.96
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$663.96
|
| Rate for Payer: Universal American Medicare |
$663.96
|
| Rate for Payer: Wellcare Medicare |
$663.96
|
| Rate for Payer: Wellmed Medicare |
$663.96
|
|
|
ED Cardiovascular Procedure -> CPR
|
Facility
|
IP
|
$1,150.00
|
|
|
Service Code
|
HCPCS 92950
|
| Hospital Charge Code |
4000121
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$782.00
|
|
