|
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
|
|
|
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 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 |
$81.63 |
| 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 |
$453.50
|
| 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 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 |
$58.47 |
| 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 |
$1,029.50
|
| 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
|
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 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 |
$461.00
|
| 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 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 |
$222.50
|
| 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 |
$206.50
|
| 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
|
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 |
$681.50
|
| 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 -> 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 -> 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
|
|
|
ED Cardiovascular Procedure -> CPR
|
Facility
|
OP
|
$1,150.00
|
|
|
Service Code
|
HCPCS 92950
|
| Hospital Charge Code |
4000121
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$103.50 |
| Max. Negotiated Rate |
$828.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$103.50
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$216.91
|
| Rate for Payer: Amerigroup Medicare |
$216.91
|
| Rate for Payer: BCBS of TX Blue Advantage |
$422.68
|
| Rate for Payer: BCBS of TX Blue Essentials |
$506.20
|
| Rate for Payer: BCBS of TX Medicare |
$216.91
|
| Rate for Payer: BCBS of TX PPO |
$637.81
|
| Rate for Payer: Cash Price |
$782.00
|
| Rate for Payer: Cash Price |
$782.00
|
| Rate for Payer: Cash Price |
$782.00
|
| Rate for Payer: Cigna Commercial |
$458.51
|
| Rate for Payer: Cigna Medicaid |
$828.00
|
| Rate for Payer: Cigna Medicare |
$216.91
|
| Rate for Payer: Employer Direct Commercial |
$216.91
|
| Rate for Payer: Humana Medicare/TRICARE |
$216.91
|
| Rate for Payer: Molina CHIP/Medicaid |
$828.00
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$216.91
|
| Rate for Payer: Molina Medicare |
$216.91
|
| Rate for Payer: Multiplan Auto |
$747.50
|
| Rate for Payer: Multiplan Commercial |
$747.50
|
| Rate for Payer: Multiplan Workers Comp |
$747.50
|
| Rate for Payer: Parkland Medicaid |
$828.00
|
| Rate for Payer: Scott and White EPO/PPO |
$575.00
|
| Rate for Payer: Scott and White Medicare |
$216.91
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$828.00
|
| Rate for Payer: Superior Health Plan EPO |
$216.91
|
| Rate for Payer: Superior Health Plan Medicare |
$216.91
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$216.91
|
| Rate for Payer: Universal American Medicare |
$216.91
|
| Rate for Payer: Wellcare Medicare |
$216.91
|
| Rate for Payer: Wellmed Medicare |
$216.91
|
|
|
ED Cardiovascular Procedure -> Pacemaker, transcutaneous
|
Facility
|
IP
|
$1,357.00
|
|
|
Service Code
|
HCPCS 92953
|
| Hospital Charge Code |
8912585
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$922.76
|
|
|
ED Cardiovascular Procedure -> Pacemaker, transcutaneous
|
Facility
|
OP
|
$1,357.00
|
|
|
Service Code
|
HCPCS 92953
|
| Hospital Charge Code |
8912585
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$122.13 |
| Max. Negotiated Rate |
$1,403.47 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$122.13
|
| 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 |
$922.76
|
| Rate for Payer: Cash Price |
$922.76
|
| Rate for Payer: Cash Price |
$922.76
|
| Rate for Payer: Cigna Commercial |
$1,403.47
|
| Rate for Payer: Cigna Medicaid |
$977.04
|
| 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 |
$977.04
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$663.96
|
| Rate for Payer: Molina Medicare |
$663.96
|
| Rate for Payer: Multiplan Auto |
$882.05
|
| Rate for Payer: Multiplan Commercial |
$882.05
|
| Rate for Payer: Multiplan Workers Comp |
$882.05
|
| Rate for Payer: Parkland Medicaid |
$977.04
|
| Rate for Payer: Scott and White EPO/PPO |
$678.50
|
| Rate for Payer: Scott and White Medicare |
$663.96
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$977.04
|
| 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 CHANGE CYSTOSTOMY TUBE COMPLICATED BCE
|
Facility
|
OP
|
$4,406.63
|
|
|
Service Code
|
HCPCS 51710
|
| Hospital Charge Code |
8914572
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$396.60 |
| Max. Negotiated Rate |
$3,172.77 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$396.60
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$700.47
|
| Rate for Payer: Amerigroup Medicare |
$700.47
|
| Rate for Payer: BCBS of TX Blue Advantage |
$929.41
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,113.06
|
| Rate for Payer: BCBS of TX Medicare |
$700.47
|
| Rate for Payer: BCBS of TX PPO |
$1,402.46
|
| Rate for Payer: Cash Price |
$2,996.51
|
| Rate for Payer: Cash Price |
$2,996.51
|
| Rate for Payer: Cash Price |
$2,996.51
|
| Rate for Payer: Cigna Commercial |
$1,480.67
|
| Rate for Payer: Cigna Medicaid |
$3,172.77
|
| Rate for Payer: Cigna Medicare |
$700.47
|
| Rate for Payer: Employer Direct Commercial |
$700.47
|
| Rate for Payer: Humana Medicare/TRICARE |
$700.47
|
| Rate for Payer: Molina CHIP/Medicaid |
$3,172.77
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$700.47
|
| Rate for Payer: Molina Medicare |
$700.47
|
| Rate for Payer: Multiplan Auto |
$2,864.31
|
| Rate for Payer: Multiplan Commercial |
$2,864.31
|
| Rate for Payer: Multiplan Workers Comp |
$2,864.31
|
| Rate for Payer: Parkland Medicaid |
$3,172.77
|
| Rate for Payer: Scott and White EPO/PPO |
$2,203.32
|
| Rate for Payer: Scott and White Medicare |
$700.47
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$3,172.77
|
| Rate for Payer: Superior Health Plan EPO |
$700.47
|
| Rate for Payer: Superior Health Plan Medicare |
$700.47
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$700.47
|
| Rate for Payer: Universal American Medicare |
$700.47
|
| Rate for Payer: Wellcare Medicare |
$700.47
|
| Rate for Payer: Wellmed Medicare |
$700.47
|
|
|
ED CHANGE CYSTOSTOMY TUBE COMPLICATED BCE
|
Facility
|
IP
|
$4,406.63
|
|
|
Service Code
|
HCPCS 51710
|
| Hospital Charge Code |
8914572
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$2,996.51
|
|
|
ED CLOSED TX FEMORAL SHAFT FX W/O MANIPULATION BCE
|
Facility
|
IP
|
$1,220.00
|
|
|
Service Code
|
HCPCS 27500
|
| Hospital Charge Code |
8498466
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$829.60
|
|
|
ED CLOSED TX FEMORAL SHAFT FX W/O MANIPULATION BCE
|
Facility
|
OP
|
$1,220.00
|
|
|
Service Code
|
HCPCS 27500
|
| Hospital Charge Code |
8498466
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$109.80 |
| Max. Negotiated Rate |
$878.40 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$109.80
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$247.79
|
| Rate for Payer: Amerigroup Medicare |
$247.79
|
| Rate for Payer: BCBS of TX Blue Advantage |
$360.12
|
| Rate for Payer: BCBS of TX Blue Essentials |
$431.28
|
| Rate for Payer: BCBS of TX Medicare |
$247.79
|
| Rate for Payer: BCBS of TX PPO |
$543.41
|
| Rate for Payer: Cash Price |
$829.60
|
| Rate for Payer: Cash Price |
$829.60
|
| Rate for Payer: Cash Price |
$829.60
|
| Rate for Payer: Cigna Commercial |
$523.79
|
| Rate for Payer: Cigna Medicaid |
$878.40
|
| 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 |
$878.40
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$247.79
|
| Rate for Payer: Molina Medicare |
$247.79
|
| Rate for Payer: Multiplan Auto |
$793.00
|
| Rate for Payer: Multiplan Commercial |
$793.00
|
| Rate for Payer: Multiplan Workers Comp |
$793.00
|
| Rate for Payer: Parkland Medicaid |
$878.40
|
| Rate for Payer: Scott and White EPO/PPO |
$610.00
|
| Rate for Payer: Scott and White Medicare |
$247.79
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$878.40
|
| 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
|
|
|
ED CLOSED TX NASAL FRACTURE W/O STABILIZATION BCE
|
Facility
|
OP
|
$5,101.00
|
|
|
Service Code
|
HCPCS 21315
|
| Hospital Charge Code |
8910597
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$459.09 |
| Max. Negotiated Rate |
$3,672.72 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$459.09
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,558.65
|
| Rate for Payer: Amerigroup Medicare |
$1,558.65
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,253.40
|
| Rate for Payer: BCBS of TX Blue Essentials |
$2,698.68
|
| Rate for Payer: BCBS of TX Medicare |
$1,558.65
|
| Rate for Payer: BCBS of TX PPO |
$3,400.34
|
| Rate for Payer: Cash Price |
$3,468.68
|
| Rate for Payer: Cash Price |
$3,468.68
|
| Rate for Payer: Cash Price |
$3,468.68
|
| Rate for Payer: Cigna Commercial |
$3,294.71
|
| Rate for Payer: Cigna Medicaid |
$3,672.72
|
| Rate for Payer: Cigna Medicare |
$1,558.65
|
| Rate for Payer: Employer Direct Commercial |
$1,558.65
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,558.65
|
| Rate for Payer: Molina CHIP/Medicaid |
$3,672.72
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,558.65
|
| Rate for Payer: Molina Medicare |
$1,558.65
|
| Rate for Payer: Multiplan Auto |
$3,315.65
|
| Rate for Payer: Multiplan Commercial |
$3,315.65
|
| Rate for Payer: Multiplan Workers Comp |
$3,315.65
|
| Rate for Payer: Parkland Medicaid |
$3,672.72
|
| Rate for Payer: Scott and White EPO/PPO |
$2,550.50
|
| Rate for Payer: Scott and White Medicare |
$1,558.65
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$3,672.72
|
| Rate for Payer: Superior Health Plan EPO |
$1,558.65
|
| Rate for Payer: Superior Health Plan Medicare |
$1,558.65
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,558.65
|
| Rate for Payer: Universal American Medicare |
$1,558.65
|
| Rate for Payer: Wellcare Medicare |
$1,558.65
|
| Rate for Payer: Wellmed Medicare |
$1,558.65
|
|
|
ED CLOSED TX NASAL FRACTURE W/O STABILIZATION BCE
|
Facility
|
IP
|
$5,101.00
|
|
|
Service Code
|
HCPCS 21315
|
| Hospital Charge Code |
8910597
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$3,468.68
|
|
|
ED CLOSED TX TRANS-SCAPHOPERILUNAR TYPE FX DISLC W/MANIPULATION BCE
|
Facility
|
IP
|
$1,356.00
|
|
|
Service Code
|
HCPCS 25680
|
| Hospital Charge Code |
8472466
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$922.08
|
|
|
ED CLOSED TX TRANS-SCAPHOPERILUNAR TYPE FX DISLC W/MANIPULATION BCE
|
Facility
|
OP
|
$1,356.00
|
|
|
Service Code
|
HCPCS 25680
|
| Hospital Charge Code |
8472466
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$122.04 |
| Max. Negotiated Rate |
$976.32 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$122.04
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$247.79
|
| Rate for Payer: Amerigroup Medicare |
$247.79
|
| Rate for Payer: BCBS of TX Blue Advantage |
$360.12
|
| Rate for Payer: BCBS of TX Blue Essentials |
$431.28
|
| Rate for Payer: BCBS of TX Medicare |
$247.79
|
| Rate for Payer: BCBS of TX PPO |
$543.41
|
| Rate for Payer: Cash Price |
$922.08
|
| Rate for Payer: Cash Price |
$922.08
|
| Rate for Payer: Cash Price |
$922.08
|
| Rate for Payer: Cigna Commercial |
$523.79
|
| Rate for Payer: Cigna Medicaid |
$976.32
|
| 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 |
$976.32
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$247.79
|
| Rate for Payer: Molina Medicare |
$247.79
|
| Rate for Payer: Multiplan Auto |
$881.40
|
| Rate for Payer: Multiplan Commercial |
$881.40
|
| Rate for Payer: Multiplan Workers Comp |
$881.40
|
| Rate for Payer: Parkland Medicaid |
$976.32
|
| Rate for Payer: Scott and White EPO/PPO |
$678.00
|
| Rate for Payer: Scott and White Medicare |
$247.79
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$976.32
|
| 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
|
|
