|
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 |
$221.51
|
| 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
|
OP
|
$1,357.00
|
|
|
Service Code
|
HCPCS 92953
|
| Hospital Charge Code |
8912585
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.19 |
| 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 |
$1.19
|
| 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 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 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 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 |
$97.83 |
| 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 |
$97.83
|
| 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 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 |
$601.70
|
| 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 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 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 |
$73.09 |
| 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 |
$73.09
|
| 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 |
$668.92
|
| 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
|
|
|
ED CLOSURE LACERATION VESTIBULE MOUTH 2.5 CM/< BCE
|
Facility
|
OP
|
$815.00
|
|
|
Service Code
|
HCPCS 40830
|
| Hospital Charge Code |
8910598
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$73.35 |
| Max. Negotiated Rate |
$586.80 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$73.35
|
| 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 |
$554.20
|
| Rate for Payer: Cash Price |
$554.20
|
| Rate for Payer: Cash Price |
$554.20
|
| Rate for Payer: Cigna Commercial |
$502.95
|
| Rate for Payer: Cigna Medicaid |
$586.80
|
| 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 |
$586.80
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$237.93
|
| Rate for Payer: Molina Medicare |
$237.93
|
| Rate for Payer: Multiplan Auto |
$529.75
|
| Rate for Payer: Multiplan Commercial |
$529.75
|
| Rate for Payer: Multiplan Workers Comp |
$529.75
|
| Rate for Payer: Parkland Medicaid |
$586.80
|
| Rate for Payer: Scott and White EPO/PPO |
$179.30
|
| Rate for Payer: Scott and White Medicare |
$237.93
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$586.80
|
| 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 CLOSURE LACERATION VESTIBULE MOUTH 2.5 CM/< BCE
|
Facility
|
IP
|
$815.00
|
|
|
Service Code
|
HCPCS 40830
|
| Hospital Charge Code |
8910598
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$554.20
|
|
|
ED CLSD TX BIMALLEOLAR ANKLE FX W/MANJ BCE
|
Facility
|
IP
|
$2,770.75
|
|
|
Service Code
|
HCPCS 27810
|
| Hospital Charge Code |
8912582
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$1,884.11
|
|
|
ED CLSD TX BIMALLEOLAR ANKLE FX W/MANJ BCE
|
Facility
|
OP
|
$2,770.75
|
|
|
Service Code
|
HCPCS 27810
|
| Hospital Charge Code |
8912582
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$249.37 |
| Max. Negotiated Rate |
$3,415.58 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$249.37
|
| 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 |
$1,884.11
|
| Rate for Payer: Cash Price |
$1,884.11
|
| Rate for Payer: Cash Price |
$1,884.11
|
| Rate for Payer: Cigna Commercial |
$3,414.49
|
| Rate for Payer: Cigna Medicaid |
$1,994.94
|
| 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 |
$1,994.94
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,615.32
|
| Rate for Payer: Molina Medicare |
$1,615.32
|
| Rate for Payer: Multiplan Auto |
$1,800.99
|
| Rate for Payer: Multiplan Commercial |
$1,800.99
|
| Rate for Payer: Multiplan Workers Comp |
$1,800.99
|
| Rate for Payer: Parkland Medicaid |
$1,994.94
|
| Rate for Payer: Scott and White EPO/PPO |
$541.96
|
| Rate for Payer: Scott and White Medicare |
$1,615.32
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,994.94
|
| 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
|
|
|
ED CLTX CARPO/METACARPAL FX DISLC THUMB W/MANJ BCE
|
Facility
|
OP
|
$2,762.00
|
|
|
Service Code
|
HCPCS 26645
|
| Hospital Charge Code |
8664505
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$248.58 |
| Max. Negotiated Rate |
$3,415.58 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$248.58
|
| 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 |
$1,878.16
|
| Rate for Payer: Cash Price |
$1,878.16
|
| Rate for Payer: Cash Price |
$1,878.16
|
| Rate for Payer: Cigna Commercial |
$3,414.49
|
| Rate for Payer: Cigna Medicaid |
$1,988.64
|
| 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 |
$1,988.64
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,615.32
|
| Rate for Payer: Molina Medicare |
$1,615.32
|
| Rate for Payer: Multiplan Auto |
$1,795.30
|
| Rate for Payer: Multiplan Commercial |
$1,795.30
|
| Rate for Payer: Multiplan Workers Comp |
$1,795.30
|
| Rate for Payer: Parkland Medicaid |
$1,988.64
|
| Rate for Payer: Scott and White EPO/PPO |
$502.25
|
| Rate for Payer: Scott and White Medicare |
$1,615.32
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,988.64
|
| 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
|
|
|
ED CLTX CARPO/METACARPAL FX DISLC THUMB W/MANJ BCE
|
Facility
|
IP
|
$2,762.00
|
|
|
Service Code
|
HCPCS 26645
|
| Hospital Charge Code |
8664505
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$1,878.16
|
|
|
ED CLTX HUMERAL SHFT FX W/MANJ W/WO SKELETAL TRACJ BCE
|
Facility
|
IP
|
$2,762.00
|
|
|
Service Code
|
HCPCS 24505
|
| Hospital Charge Code |
8914575
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$1,878.16
|
|
|
ED CLTX HUMERAL SHFT FX W/MANJ W/WO SKELETAL TRACJ BCE
|
Facility
|
OP
|
$2,762.00
|
|
|
Service Code
|
HCPCS 24505
|
| Hospital Charge Code |
8662520
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$248.58 |
| Max. Negotiated Rate |
$3,415.58 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$248.58
|
| 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 |
$1,878.16
|
| Rate for Payer: Cash Price |
$1,878.16
|
| Rate for Payer: Cash Price |
$1,878.16
|
| Rate for Payer: Cigna Commercial |
$3,414.49
|
| Rate for Payer: Cigna Medicaid |
$1,988.64
|
| 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 |
$1,988.64
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,615.32
|
| Rate for Payer: Molina Medicare |
$1,615.32
|
| Rate for Payer: Multiplan Auto |
$1,795.30
|
| Rate for Payer: Multiplan Commercial |
$1,795.30
|
| Rate for Payer: Multiplan Workers Comp |
$1,795.30
|
| Rate for Payer: Parkland Medicaid |
$1,988.64
|
| Rate for Payer: Scott and White EPO/PPO |
$573.14
|
| Rate for Payer: Scott and White Medicare |
$1,615.32
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,988.64
|
| 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
|
|
|
ED CLTX HUMERAL SHFT FX W/MANJ W/WO SKELETAL TRACJ BCE
|
Facility
|
IP
|
$2,762.00
|
|
|
Service Code
|
HCPCS 24505
|
| Hospital Charge Code |
8662520
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$1,878.16
|
|
|
ED CLTX HUMERAL SHFT FX W/MANJ W/WO SKELETAL TRACJ BCE
|
Facility
|
OP
|
$2,762.00
|
|
|
Service Code
|
HCPCS 24505
|
| Hospital Charge Code |
8914575
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$248.58 |
| Max. Negotiated Rate |
$3,415.58 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$248.58
|
| 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 |
$1,878.16
|
| Rate for Payer: Cash Price |
$1,878.16
|
| Rate for Payer: Cash Price |
$1,878.16
|
| Rate for Payer: Cigna Commercial |
$3,414.49
|
| Rate for Payer: Cigna Medicaid |
$1,988.64
|
| 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 |
$1,988.64
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,615.32
|
| Rate for Payer: Molina Medicare |
$1,615.32
|
| Rate for Payer: Multiplan Auto |
$1,795.30
|
| Rate for Payer: Multiplan Commercial |
$1,795.30
|
| Rate for Payer: Multiplan Workers Comp |
$1,795.30
|
| Rate for Payer: Parkland Medicaid |
$1,988.64
|
| Rate for Payer: Scott and White EPO/PPO |
$573.14
|
| Rate for Payer: Scott and White Medicare |
$1,615.32
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,988.64
|
| 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
|
|
|
ED CLTX MEDIAL MALLEOLUS FX W/O MANIP BCE
|
Facility
|
IP
|
$840.00
|
|
|
Service Code
|
HCPCS 27760
|
| Hospital Charge Code |
8726548
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$571.20
|
|
|
ED CLTX MEDIAL MALLEOLUS FX W/O MANIP BCE
|
Facility
|
OP
|
$840.00
|
|
|
Service Code
|
HCPCS 27760
|
| Hospital Charge Code |
8726548
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$75.60 |
| Max. Negotiated Rate |
$604.80 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$75.60
|
| 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 |
$571.20
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Cigna Commercial |
$523.79
|
| Rate for Payer: Cigna Medicaid |
$604.80
|
| 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 |
$604.80
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$247.79
|
| Rate for Payer: Molina Medicare |
$247.79
|
| Rate for Payer: Multiplan Auto |
$546.00
|
| Rate for Payer: Multiplan Commercial |
$546.00
|
| Rate for Payer: Multiplan Workers Comp |
$546.00
|
| Rate for Payer: Parkland Medicaid |
$604.80
|
| Rate for Payer: Scott and White EPO/PPO |
$394.00
|
| Rate for Payer: Scott and White Medicare |
$247.79
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$604.80
|
| 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 CLTX SHOULDER DISLC W/SURG/ANTMCL NECK FX W/MANJ BCE
|
Facility
|
IP
|
$2,762.00
|
|
|
Service Code
|
HCPCS 23675
|
| Hospital Charge Code |
8652508
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$1,878.16
|
|
|
ED CLTX SHOULDER DISLC W/SURG/ANTMCL NECK FX W/MANJ BCE
|
Facility
|
OP
|
$2,762.00
|
|
|
Service Code
|
HCPCS 23675
|
| Hospital Charge Code |
8652508
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$248.58 |
| Max. Negotiated Rate |
$3,415.58 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$248.58
|
| 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 |
$1,878.16
|
| Rate for Payer: Cash Price |
$1,878.16
|
| Rate for Payer: Cash Price |
$1,878.16
|
| Rate for Payer: Cigna Commercial |
$3,414.49
|
| Rate for Payer: Cigna Medicaid |
$1,988.64
|
| 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 |
$1,988.64
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,615.32
|
| Rate for Payer: Molina Medicare |
$1,615.32
|
| Rate for Payer: Multiplan Auto |
$1,795.30
|
| Rate for Payer: Multiplan Commercial |
$1,795.30
|
| Rate for Payer: Multiplan Workers Comp |
$1,795.30
|
| Rate for Payer: Parkland Medicaid |
$1,988.64
|
| Rate for Payer: Scott and White EPO/PPO |
$633.90
|
| Rate for Payer: Scott and White Medicare |
$1,615.32
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,988.64
|
| 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
|
|
