|
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 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 |
$407.50
|
| 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 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 |
$1,385.38
|
| 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 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 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 |
$1,381.00
|
| 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
|
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 |
$1,381.00
|
| 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
|
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 |
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 |
$1,381.00
|
| 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 |
$420.00
|
| 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 |
$1,381.00
|
| 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 CTRL NSL HEMRRG PST NASAL PACKS&/CAUTERY 1ST BCE
|
Facility
|
IP
|
$372.00
|
|
|
Service Code
|
HCPCS 30905
|
| Hospital Charge Code |
8734588
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$252.96
|
|
|
ED CTRL NSL HEMRRG PST NASAL PACKS&/CAUTERY 1ST BCE
|
Facility
|
OP
|
$372.00
|
|
|
Service Code
|
HCPCS 30905
|
| Hospital Charge Code |
8734588
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$33.48 |
| Max. Negotiated Rate |
$282.53 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$33.48
|
| 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 |
$252.96
|
| Rate for Payer: Cash Price |
$252.96
|
| Rate for Payer: Cash Price |
$252.96
|
| Rate for Payer: Cigna Commercial |
$282.53
|
| Rate for Payer: Cigna Medicaid |
$267.84
|
| 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 |
$267.84
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$133.65
|
| Rate for Payer: Molina Medicare |
$133.65
|
| Rate for Payer: Multiplan Auto |
$241.80
|
| Rate for Payer: Multiplan Commercial |
$241.80
|
| Rate for Payer: Multiplan Workers Comp |
$241.80
|
| Rate for Payer: Parkland Medicaid |
$267.84
|
| Rate for Payer: Scott and White EPO/PPO |
$186.00
|
| Rate for Payer: Scott and White Medicare |
$133.65
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$267.84
|
| 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 Debridement -> Addl 10% infected skin
|
Facility
|
OP
|
$72.00
|
|
|
Service Code
|
HCPCS 11001
|
| Hospital Charge Code |
5202503
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$6.48 |
| Max. Negotiated Rate |
$51.84 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$6.48
|
| Rate for Payer: BCBS of TX Blue Advantage |
$21.60
|
| Rate for Payer: BCBS of TX Blue Essentials |
$25.92
|
| Rate for Payer: BCBS of TX PPO |
$28.80
|
| Rate for Payer: Cash Price |
$48.96
|
| Rate for Payer: Cigna Medicaid |
$51.84
|
| Rate for Payer: Molina CHIP/Medicaid |
$51.84
|
| Rate for Payer: Multiplan Auto |
$46.80
|
| Rate for Payer: Multiplan Commercial |
$46.80
|
| Rate for Payer: Multiplan Workers Comp |
$46.80
|
| Rate for Payer: Parkland Medicaid |
$51.84
|
| Rate for Payer: Scott and White EPO/PPO |
$36.00
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$51.84
|
| Rate for Payer: Superior Health Plan EPO |
$9.79
|
|
|
ED Debridement -> Addl 10% infected skin
|
Facility
|
IP
|
$72.00
|
|
|
Service Code
|
HCPCS 11001
|
| Hospital Charge Code |
5202503
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$48.96
|
|
|
ED Debridement -> To devitalized tissue, <= 20 sq cm
|
Facility
|
OP
|
$794.80
|
|
|
Service Code
|
HCPCS 97597
|
| Hospital Charge Code |
7150659
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$71.53 |
| Max. Negotiated Rate |
$572.26 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$71.53
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$201.55
|
| Rate for Payer: Amerigroup Medicare |
$201.55
|
| Rate for Payer: BCBS of TX Blue Advantage |
$238.44
|
| Rate for Payer: BCBS of TX Blue Essentials |
$286.13
|
| Rate for Payer: BCBS of TX Medicare |
$201.55
|
| Rate for Payer: BCBS of TX PPO |
$317.92
|
| Rate for Payer: Cash Price |
$540.46
|
| Rate for Payer: Cash Price |
$540.46
|
| Rate for Payer: Cash Price |
$540.46
|
| Rate for Payer: Cigna Commercial |
$426.04
|
| Rate for Payer: Cigna Medicaid |
$572.26
|
| 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 |
$572.26
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$201.55
|
| Rate for Payer: Molina Medicare |
$201.55
|
| Rate for Payer: Multiplan Auto |
$516.62
|
| Rate for Payer: Multiplan Commercial |
$516.62
|
| Rate for Payer: Multiplan Workers Comp |
$516.62
|
| Rate for Payer: Parkland Medicaid |
$572.26
|
| Rate for Payer: Scott and White EPO/PPO |
$397.40
|
| Rate for Payer: Scott and White Medicare |
$201.55
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$572.26
|
| 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 Debridement -> To devitalized tissue, <= 20 sq cm
|
Facility
|
IP
|
$794.80
|
|
|
Service Code
|
HCPCS 97597
|
| Hospital Charge Code |
7150659
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$540.46
|
|
|
ED Debridement -> To muscle/fascia, <= 20 sq cm
|
Facility
|
OP
|
$4,383.94
|
|
|
Service Code
|
HCPCS 11043
|
| Hospital Charge Code |
7150170
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$394.55 |
| Max. Negotiated Rate |
$3,156.44 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$394.55
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$742.44
|
| Rate for Payer: Amerigroup Medicare |
$742.44
|
| Rate for Payer: BCBS of TX Blue Advantage |
$830.02
|
| Rate for Payer: BCBS of TX Blue Essentials |
$994.04
|
| Rate for Payer: BCBS of TX Medicare |
$742.44
|
| Rate for Payer: BCBS of TX PPO |
$1,252.49
|
| Rate for Payer: Cash Price |
$2,981.08
|
| Rate for Payer: Cash Price |
$2,981.08
|
| Rate for Payer: Cash Price |
$2,981.08
|
| Rate for Payer: Cigna Commercial |
$1,569.38
|
| Rate for Payer: Cigna Medicaid |
$3,156.44
|
| Rate for Payer: Cigna Medicare |
$742.44
|
| Rate for Payer: Employer Direct Commercial |
$742.44
|
| Rate for Payer: Humana Medicare/TRICARE |
$742.44
|
| Rate for Payer: Molina CHIP/Medicaid |
$3,156.44
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$742.44
|
| Rate for Payer: Molina Medicare |
$742.44
|
| Rate for Payer: Multiplan Auto |
$2,849.56
|
| Rate for Payer: Multiplan Commercial |
$2,849.56
|
| Rate for Payer: Multiplan Workers Comp |
$2,849.56
|
| Rate for Payer: Parkland Medicaid |
$3,156.44
|
| Rate for Payer: Scott and White EPO/PPO |
$2,191.97
|
| Rate for Payer: Scott and White Medicare |
$742.44
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$3,156.44
|
| Rate for Payer: Superior Health Plan EPO |
$742.44
|
| Rate for Payer: Superior Health Plan Medicare |
$742.44
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$742.44
|
| Rate for Payer: Universal American Medicare |
$742.44
|
| Rate for Payer: Wellcare Medicare |
$742.44
|
| Rate for Payer: Wellmed Medicare |
$742.44
|
|
|
ED Debridement -> To muscle/fascia, <= 20 sq cm
|
Facility
|
IP
|
$4,383.94
|
|
|
Service Code
|
HCPCS 11043
|
| Hospital Charge Code |
7150170
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$2,981.08
|
|
|
ED Debridement -> To subcutaneous tissue, <= 20 sq cm
|
Facility
|
OP
|
$1,546.00
|
|
|
Service Code
|
HCPCS 11042
|
| Hospital Charge Code |
7150162
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$139.14 |
| Max. Negotiated Rate |
$1,113.12 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$139.14
|
| 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 |
$1,051.28
|
| Rate for Payer: Cash Price |
$1,051.28
|
| Rate for Payer: Cash Price |
$1,051.28
|
| Rate for Payer: Cigna Commercial |
$863.21
|
| Rate for Payer: Cigna Medicaid |
$1,113.12
|
| 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 |
$1,113.12
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$408.37
|
| Rate for Payer: Molina Medicare |
$408.37
|
| Rate for Payer: Multiplan Auto |
$1,004.90
|
| Rate for Payer: Multiplan Commercial |
$1,004.90
|
| Rate for Payer: Multiplan Workers Comp |
$1,004.90
|
| Rate for Payer: Parkland Medicaid |
$1,113.12
|
| Rate for Payer: Scott and White EPO/PPO |
$773.00
|
| Rate for Payer: Scott and White Medicare |
$408.37
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,113.12
|
| 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 Debridement -> To subcutaneous tissue, <= 20 sq cm
|
Facility
|
IP
|
$1,546.00
|
|
|
Service Code
|
HCPCS 11042
|
| Hospital Charge Code |
7150162
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$1,051.28
|
|
|
ED Dislocation Repair Site -> Ankle w/o Anesthesia
|
Facility
|
OP
|
$978.00
|
|
|
Service Code
|
HCPCS 27840
|
| Hospital Charge Code |
5202514
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$88.02 |
| Max. Negotiated Rate |
$704.16 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$88.02
|
| 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 |
$665.04
|
| Rate for Payer: Cash Price |
$665.04
|
| Rate for Payer: Cash Price |
$665.04
|
| Rate for Payer: Cigna Commercial |
$523.79
|
| Rate for Payer: Cigna Medicaid |
$704.16
|
| 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 |
$704.16
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$247.79
|
| Rate for Payer: Molina Medicare |
$247.79
|
| Rate for Payer: Multiplan Auto |
$635.70
|
| Rate for Payer: Multiplan Commercial |
$635.70
|
| Rate for Payer: Multiplan Workers Comp |
$635.70
|
| Rate for Payer: Parkland Medicaid |
$704.16
|
| Rate for Payer: Scott and White EPO/PPO |
$489.00
|
| Rate for Payer: Scott and White Medicare |
$247.79
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$704.16
|
| 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
|
|
