|
ED Dislocation Repair Site -> Toe, Interphalangeal w/o Anes
|
Facility
|
IP
|
$328.00
|
|
|
Service Code
|
HCPCS 28660
|
| Hospital Charge Code |
8912593
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$223.04
|
|
|
ED Dislocation Repair Site -> Toe, Interphalangeal w/o Anes
|
Facility
|
OP
|
$328.00
|
|
|
Service Code
|
HCPCS 28660
|
| Hospital Charge Code |
8912593
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$29.52 |
| Max. Negotiated Rate |
$523.79 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$29.52
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$247.79
|
| Rate for Payer: Amerigroup Medicare |
$247.79
|
| Rate for Payer: BCBS of TX Blue Advantage |
$115.11
|
| Rate for Payer: BCBS of TX Blue Essentials |
$137.86
|
| Rate for Payer: BCBS of TX Medicare |
$247.79
|
| Rate for Payer: BCBS of TX PPO |
$173.70
|
| Rate for Payer: Cash Price |
$223.04
|
| Rate for Payer: Cash Price |
$223.04
|
| Rate for Payer: Cash Price |
$223.04
|
| Rate for Payer: Cigna Commercial |
$523.79
|
| Rate for Payer: Cigna Medicaid |
$236.16
|
| 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 |
$236.16
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$247.79
|
| Rate for Payer: Molina Medicare |
$247.79
|
| Rate for Payer: Multiplan Auto |
$213.20
|
| Rate for Payer: Multiplan Commercial |
$213.20
|
| Rate for Payer: Multiplan Workers Comp |
$213.20
|
| Rate for Payer: Parkland Medicaid |
$236.16
|
| Rate for Payer: Scott and White EPO/PPO |
$164.00
|
| Rate for Payer: Scott and White Medicare |
$247.79
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$236.16
|
| 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
|
|
|
ED Dislocation Repair Site -> Toe, Metatarsophalangeal w/o Anesthesia
|
Facility
|
OP
|
$480.00
|
|
|
Service Code
|
HCPCS 28630
|
| Hospital Charge Code |
5202515
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$43.20 |
| Max. Negotiated Rate |
$523.79 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$43.20
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$247.79
|
| Rate for Payer: Amerigroup Medicare |
$247.79
|
| Rate for Payer: BCBS of TX Blue Advantage |
$148.86
|
| Rate for Payer: BCBS of TX Blue Essentials |
$178.28
|
| Rate for Payer: BCBS of TX Medicare |
$247.79
|
| Rate for Payer: BCBS of TX PPO |
$224.63
|
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Cigna Commercial |
$523.79
|
| Rate for Payer: Cigna Medicaid |
$345.60
|
| 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 |
$345.60
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$247.79
|
| Rate for Payer: Molina Medicare |
$247.79
|
| Rate for Payer: Multiplan Auto |
$312.00
|
| Rate for Payer: Multiplan Commercial |
$312.00
|
| Rate for Payer: Multiplan Workers Comp |
$312.00
|
| Rate for Payer: Parkland Medicaid |
$345.60
|
| Rate for Payer: Scott and White EPO/PPO |
$240.00
|
| Rate for Payer: Scott and White Medicare |
$247.79
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$345.60
|
| 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 Dislocation Repair Site -> Toe, Metatarsophalangeal w/o Anesthesia
|
Facility
|
IP
|
$480.00
|
|
|
Service Code
|
HCPCS 28630
|
| Hospital Charge Code |
5202515
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$326.40
|
|
|
ED DRAINAGE EXTERNAL EAR ABSCESS/HEMATOMA SIMPLE BCE
|
Facility
|
IP
|
$1,518.43
|
|
|
Service Code
|
HCPCS 69000
|
| Hospital Charge Code |
8914577
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$1,032.53
|
|
|
ED DRAINAGE EXTERNAL EAR ABSCESS/HEMATOMA SIMPLE BCE
|
Facility
|
OP
|
$1,518.43
|
|
|
Service Code
|
HCPCS 69000
|
| Hospital Charge Code |
8914577
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$136.66 |
| Max. Negotiated Rate |
$1,503.68 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$136.66
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$711.36
|
| Rate for Payer: Amerigroup Medicare |
$711.36
|
| Rate for Payer: BCBS of TX Blue Advantage |
$217.57
|
| Rate for Payer: BCBS of TX Blue Essentials |
$260.56
|
| Rate for Payer: BCBS of TX Medicare |
$711.36
|
| Rate for Payer: BCBS of TX PPO |
$328.31
|
| Rate for Payer: Cash Price |
$1,032.53
|
| Rate for Payer: Cash Price |
$1,032.53
|
| Rate for Payer: Cash Price |
$1,032.53
|
| Rate for Payer: Cigna Commercial |
$1,503.68
|
| Rate for Payer: Cigna Medicaid |
$1,093.27
|
| Rate for Payer: Cigna Medicare |
$711.36
|
| Rate for Payer: Employer Direct Commercial |
$711.36
|
| Rate for Payer: Humana Medicare/TRICARE |
$711.36
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,093.27
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$711.36
|
| Rate for Payer: Molina Medicare |
$711.36
|
| Rate for Payer: Multiplan Auto |
$986.98
|
| Rate for Payer: Multiplan Commercial |
$986.98
|
| Rate for Payer: Multiplan Workers Comp |
$986.98
|
| Rate for Payer: Parkland Medicaid |
$1,093.27
|
| Rate for Payer: Scott and White EPO/PPO |
$759.22
|
| Rate for Payer: Scott and White Medicare |
$711.36
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,093.27
|
| Rate for Payer: Superior Health Plan EPO |
$711.36
|
| Rate for Payer: Superior Health Plan Medicare |
$711.36
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$711.36
|
| Rate for Payer: Universal American Medicare |
$711.36
|
| Rate for Payer: Wellcare Medicare |
$711.36
|
| Rate for Payer: Wellmed Medicare |
$711.36
|
|
|
ED Drainage of abscess, cyst, hematoma from dentoalveolar structures BCE
|
Facility
|
OP
|
$413.00
|
|
|
Service Code
|
HCPCS 41800
|
| Hospital Charge Code |
8640516
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$37.17 |
| Max. Negotiated Rate |
$297.36 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$37.17
|
| 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 |
$280.84
|
| Rate for Payer: Cash Price |
$280.84
|
| Rate for Payer: Cash Price |
$280.84
|
| Rate for Payer: Cigna Commercial |
$282.53
|
| Rate for Payer: Cigna Medicaid |
$297.36
|
| 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 |
$297.36
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$133.65
|
| Rate for Payer: Molina Medicare |
$133.65
|
| 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 |
$133.65
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$297.36
|
| 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 Drainage of abscess, cyst, hematoma from dentoalveolar structures BCE
|
Facility
|
IP
|
$413.00
|
|
|
Service Code
|
HCPCS 41800
|
| Hospital Charge Code |
8640516
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$280.84
|
|
|
ED DRAINAGE OF FINGER ABSCESS SIMPLE BCE
|
Facility
|
IP
|
$533.00
|
|
|
Service Code
|
HCPCS 26010
|
| Hospital Charge Code |
8418454
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$362.44
|
|
|
ED DRAINAGE OF FINGER ABSCESS SIMPLE BCE
|
Facility
|
OP
|
$533.00
|
|
|
Service Code
|
HCPCS 26010
|
| Hospital Charge Code |
8418454
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$47.97 |
| Max. Negotiated Rate |
$426.04 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$47.97
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$201.55
|
| Rate for Payer: Amerigroup Medicare |
$201.55
|
| Rate for Payer: BCBS of TX Blue Advantage |
$147.44
|
| Rate for Payer: BCBS of TX Blue Essentials |
$176.58
|
| Rate for Payer: BCBS of TX Medicare |
$201.55
|
| Rate for Payer: BCBS of TX PPO |
$222.49
|
| Rate for Payer: Cash Price |
$362.44
|
| Rate for Payer: Cash Price |
$362.44
|
| Rate for Payer: Cash Price |
$362.44
|
| Rate for Payer: Cigna Commercial |
$426.04
|
| Rate for Payer: Cigna Medicaid |
$383.76
|
| 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 |
$383.76
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$201.55
|
| Rate for Payer: Molina Medicare |
$201.55
|
| Rate for Payer: Multiplan Auto |
$346.45
|
| Rate for Payer: Multiplan Commercial |
$346.45
|
| Rate for Payer: Multiplan Workers Comp |
$346.45
|
| Rate for Payer: Parkland Medicaid |
$383.76
|
| Rate for Payer: Scott and White EPO/PPO |
$266.50
|
| Rate for Payer: Scott and White Medicare |
$201.55
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$383.76
|
| 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 Ear Procedure -> Cerumen Irrigation/Lavage
|
Facility
|
OP
|
$484.00
|
|
|
Service Code
|
HCPCS 69209
|
| Hospital Charge Code |
5202517
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$43.56 |
| Max. Negotiated Rate |
$348.48 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$43.56
|
| 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 |
$329.12
|
| Rate for Payer: Cash Price |
$329.12
|
| Rate for Payer: Cash Price |
$329.12
|
| Rate for Payer: Cigna Commercial |
$125.27
|
| Rate for Payer: Cigna Medicaid |
$348.48
|
| 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 |
$348.48
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$59.26
|
| Rate for Payer: Molina Medicare |
$59.26
|
| Rate for Payer: Multiplan Auto |
$314.60
|
| Rate for Payer: Multiplan Commercial |
$314.60
|
| Rate for Payer: Multiplan Workers Comp |
$314.60
|
| Rate for Payer: Parkland Medicaid |
$348.48
|
| Rate for Payer: Scott and White EPO/PPO |
$242.00
|
| Rate for Payer: Scott and White Medicare |
$59.26
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$348.48
|
| 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 Ear Procedure -> Cerumen Irrigation/Lavage
|
Facility
|
IP
|
$484.00
|
|
|
Service Code
|
HCPCS 69209
|
| Hospital Charge Code |
5202517
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$329.12
|
|
|
ED Ear Procedure -> Cerumen w/ Instrumentation
|
Facility
|
IP
|
$1,639.00
|
|
|
Service Code
|
HCPCS 69210
|
| Hospital Charge Code |
7150378
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$1,114.52
|
|
|
ED Ear Procedure -> Cerumen w/ Instrumentation
|
Facility
|
OP
|
$1,639.00
|
|
|
Service Code
|
HCPCS 69210
|
| Hospital Charge Code |
7150378
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$59.26 |
| Max. Negotiated Rate |
$1,180.08 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$147.51
|
| 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 |
$1,114.52
|
| Rate for Payer: Cash Price |
$1,114.52
|
| Rate for Payer: Cash Price |
$1,114.52
|
| Rate for Payer: Cigna Commercial |
$125.27
|
| Rate for Payer: Cigna Medicaid |
$1,180.08
|
| 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 |
$1,180.08
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$59.26
|
| Rate for Payer: Molina Medicare |
$59.26
|
| Rate for Payer: Multiplan Auto |
$1,065.35
|
| Rate for Payer: Multiplan Commercial |
$1,065.35
|
| Rate for Payer: Multiplan Workers Comp |
$1,065.35
|
| Rate for Payer: Parkland Medicaid |
$1,180.08
|
| Rate for Payer: Scott and White EPO/PPO |
$819.50
|
| Rate for Payer: Scott and White Medicare |
$59.26
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,180.08
|
| 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 EGD PLACE GASTROSTOMY TUBE BCE
|
Facility
|
OP
|
$5,390.12
|
|
|
Service Code
|
HCPCS 43246
|
| Hospital Charge Code |
8796540
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$485.11 |
| Max. Negotiated Rate |
$4,074.70 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$485.11
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,927.65
|
| Rate for Payer: Amerigroup Medicare |
$1,927.65
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,600.86
|
| Rate for Payer: BCBS of TX Blue Essentials |
$3,114.80
|
| Rate for Payer: BCBS of TX Medicare |
$1,927.65
|
| Rate for Payer: BCBS of TX PPO |
$3,924.65
|
| Rate for Payer: Cash Price |
$3,665.28
|
| Rate for Payer: Cash Price |
$3,665.28
|
| Rate for Payer: Cash Price |
$3,665.28
|
| Rate for Payer: Cigna Commercial |
$4,074.70
|
| Rate for Payer: Cigna Medicaid |
$3,880.89
|
| Rate for Payer: Cigna Medicare |
$1,927.65
|
| Rate for Payer: Employer Direct Commercial |
$1,927.65
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,927.65
|
| Rate for Payer: Molina CHIP/Medicaid |
$3,880.89
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,927.65
|
| Rate for Payer: Molina Medicare |
$1,927.65
|
| Rate for Payer: Multiplan Auto |
$3,503.58
|
| Rate for Payer: Multiplan Commercial |
$3,503.58
|
| Rate for Payer: Multiplan Workers Comp |
$3,503.58
|
| Rate for Payer: Parkland Medicaid |
$3,880.89
|
| Rate for Payer: Scott and White EPO/PPO |
$2,695.06
|
| Rate for Payer: Scott and White Medicare |
$1,927.65
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$3,880.89
|
| Rate for Payer: Superior Health Plan EPO |
$1,927.65
|
| Rate for Payer: Superior Health Plan Medicare |
$1,927.65
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,927.65
|
| Rate for Payer: Universal American Medicare |
$1,927.65
|
| Rate for Payer: Wellcare Medicare |
$1,927.65
|
| Rate for Payer: Wellmed Medicare |
$1,927.65
|
|
|
ED EGD PLACE GASTROSTOMY TUBE BCE
|
Facility
|
IP
|
$5,390.12
|
|
|
Service Code
|
HCPCS 43246
|
| Hospital Charge Code |
8796540
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$3,665.28
|
|
|
ED EXC B9 LES MRGN 3.1 TO 4.0CM BCE
|
Facility
|
OP
|
$5,911.00
|
|
|
Service Code
|
HCPCS 11424
|
| Hospital Charge Code |
8402469
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$531.99 |
| Max. Negotiated Rate |
$4,255.92 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$531.99
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,659.12
|
| Rate for Payer: Amerigroup Medicare |
$1,659.12
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,292.24
|
| Rate for Payer: BCBS of TX Blue Essentials |
$2,745.20
|
| Rate for Payer: BCBS of TX Medicare |
$1,659.12
|
| Rate for Payer: BCBS of TX PPO |
$3,458.95
|
| Rate for Payer: Cash Price |
$4,019.48
|
| Rate for Payer: Cash Price |
$4,019.48
|
| Rate for Payer: Cash Price |
$4,019.48
|
| Rate for Payer: Cigna Commercial |
$3,507.10
|
| Rate for Payer: Cigna Medicaid |
$4,255.92
|
| Rate for Payer: Cigna Medicare |
$1,659.12
|
| Rate for Payer: Employer Direct Commercial |
$1,659.12
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,659.12
|
| Rate for Payer: Molina CHIP/Medicaid |
$4,255.92
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,659.12
|
| Rate for Payer: Molina Medicare |
$1,659.12
|
| Rate for Payer: Multiplan Auto |
$3,842.15
|
| Rate for Payer: Multiplan Commercial |
$3,842.15
|
| Rate for Payer: Multiplan Workers Comp |
$3,842.15
|
| Rate for Payer: Parkland Medicaid |
$4,255.92
|
| Rate for Payer: Scott and White EPO/PPO |
$2,955.50
|
| Rate for Payer: Scott and White Medicare |
$1,659.12
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$4,255.92
|
| Rate for Payer: Superior Health Plan EPO |
$1,659.12
|
| Rate for Payer: Superior Health Plan Medicare |
$1,659.12
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,659.12
|
| Rate for Payer: Universal American Medicare |
$1,659.12
|
| Rate for Payer: Wellcare Medicare |
$1,659.12
|
| Rate for Payer: Wellmed Medicare |
$1,659.12
|
|
|
ED EXC B9 LES MRGN 3.1 TO 4.0CM BCE
|
Facility
|
IP
|
$5,911.00
|
|
|
Service Code
|
HCPCS 11424
|
| Hospital Charge Code |
8402469
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$4,019.48
|
|
|
ED Eye Procedure -> Corneal w/o Slit Lamp
|
Facility
|
OP
|
$923.00
|
|
|
Service Code
|
HCPCS 65220
|
| Hospital Charge Code |
5202518
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$83.07 |
| Max. Negotiated Rate |
$948.59 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$83.07
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$448.76
|
| Rate for Payer: Amerigroup Medicare |
$448.76
|
| Rate for Payer: BCBS of TX Blue Advantage |
$607.20
|
| Rate for Payer: BCBS of TX Blue Essentials |
$727.18
|
| Rate for Payer: BCBS of TX Medicare |
$448.76
|
| Rate for Payer: BCBS of TX PPO |
$916.25
|
| Rate for Payer: Cash Price |
$627.64
|
| Rate for Payer: Cash Price |
$627.64
|
| Rate for Payer: Cash Price |
$627.64
|
| Rate for Payer: Cigna Commercial |
$948.59
|
| Rate for Payer: Cigna Medicaid |
$664.56
|
| Rate for Payer: Cigna Medicare |
$448.76
|
| Rate for Payer: Employer Direct Commercial |
$448.76
|
| Rate for Payer: Humana Medicare/TRICARE |
$448.76
|
| Rate for Payer: Molina CHIP/Medicaid |
$664.56
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$448.76
|
| Rate for Payer: Molina Medicare |
$448.76
|
| Rate for Payer: Multiplan Auto |
$599.95
|
| Rate for Payer: Multiplan Commercial |
$599.95
|
| Rate for Payer: Multiplan Workers Comp |
$599.95
|
| Rate for Payer: Parkland Medicaid |
$664.56
|
| Rate for Payer: Scott and White EPO/PPO |
$461.50
|
| Rate for Payer: Scott and White Medicare |
$448.76
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$664.56
|
| Rate for Payer: Superior Health Plan EPO |
$448.76
|
| Rate for Payer: Superior Health Plan Medicare |
$448.76
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$448.76
|
| Rate for Payer: Universal American Medicare |
$448.76
|
| Rate for Payer: Wellcare Medicare |
$448.76
|
| Rate for Payer: Wellmed Medicare |
$448.76
|
|
|
ED Eye Procedure -> Corneal w/o Slit Lamp
|
Facility
|
IP
|
$923.00
|
|
|
Service Code
|
HCPCS 65220
|
| Hospital Charge Code |
5202518
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$627.64
|
|
|
ED Foreign Body Removal Site -> Auditory canal, external w/o anesthesia
|
Facility
|
IP
|
$476.00
|
|
|
Service Code
|
HCPCS 69200
|
| Hospital Charge Code |
9250012
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$323.68
|
|
|
ED Foreign Body Removal Site -> Auditory canal, external w/o anesthesia
|
Facility
|
OP
|
$476.00
|
|
|
Service Code
|
HCPCS 69200
|
| Hospital Charge Code |
9250012
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$42.84 |
| Max. Negotiated Rate |
$342.72 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$42.84
|
| 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 |
$323.68
|
| Rate for Payer: Cash Price |
$323.68
|
| Rate for Payer: Cash Price |
$323.68
|
| Rate for Payer: Cigna Commercial |
$282.53
|
| Rate for Payer: Cigna Medicaid |
$342.72
|
| 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 |
$342.72
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$133.65
|
| Rate for Payer: Molina Medicare |
$133.65
|
| Rate for Payer: Multiplan Auto |
$309.40
|
| Rate for Payer: Multiplan Commercial |
$309.40
|
| Rate for Payer: Multiplan Workers Comp |
$309.40
|
| Rate for Payer: Parkland Medicaid |
$342.72
|
| Rate for Payer: Scott and White EPO/PPO |
$238.00
|
| Rate for Payer: Scott and White Medicare |
$133.65
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$342.72
|
| 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 Foreign Body Removal Site -> Intranasal
|
Facility
|
OP
|
$323.00
|
|
|
Service Code
|
HCPCS 30300
|
| Hospital Charge Code |
5202521
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$29.07 |
| Max. Negotiated Rate |
$282.53 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$29.07
|
| 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 |
$219.64
|
| Rate for Payer: Cash Price |
$219.64
|
| Rate for Payer: Cash Price |
$219.64
|
| Rate for Payer: Cigna Commercial |
$282.53
|
| Rate for Payer: Cigna Medicaid |
$232.56
|
| 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 |
$232.56
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$133.65
|
| Rate for Payer: Molina Medicare |
$133.65
|
| Rate for Payer: Multiplan Auto |
$209.95
|
| Rate for Payer: Multiplan Commercial |
$209.95
|
| Rate for Payer: Multiplan Workers Comp |
$209.95
|
| Rate for Payer: Parkland Medicaid |
$232.56
|
| Rate for Payer: Scott and White EPO/PPO |
$161.50
|
| Rate for Payer: Scott and White Medicare |
$133.65
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$232.56
|
| 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 Foreign Body Removal Site -> Intranasal
|
Facility
|
IP
|
$323.00
|
|
|
Service Code
|
HCPCS 30300
|
| Hospital Charge Code |
5202521
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$219.64
|
|
|
ED Foreign Body Removal Site -> Scrotum
|
Facility
|
IP
|
$8,880.00
|
|
|
Service Code
|
HCPCS 55120
|
| Hospital Charge Code |
8912598
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$6,038.40
|
|
