|
ED Foreign Body Removal Site -> Scrotum
|
Facility
|
OP
|
$8,880.00
|
|
|
Service Code
|
HCPCS 55120
|
| Hospital Charge Code |
8912598
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$799.20 |
| Max. Negotiated Rate |
$6,393.60 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$799.20
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$2,099.91
|
| Rate for Payer: Amerigroup Medicare |
$2,099.91
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,958.49
|
| Rate for Payer: BCBS of TX Blue Essentials |
$3,543.10
|
| Rate for Payer: BCBS of TX Medicare |
$2,099.91
|
| Rate for Payer: BCBS of TX PPO |
$4,464.31
|
| Rate for Payer: Cash Price |
$6,038.40
|
| Rate for Payer: Cash Price |
$6,038.40
|
| Rate for Payer: Cash Price |
$6,038.40
|
| Rate for Payer: Cigna Commercial |
$4,438.84
|
| Rate for Payer: Cigna Medicaid |
$6,393.60
|
| Rate for Payer: Cigna Medicare |
$2,099.91
|
| Rate for Payer: Employer Direct Commercial |
$2,099.91
|
| Rate for Payer: Humana Medicare/TRICARE |
$2,099.91
|
| Rate for Payer: Molina CHIP/Medicaid |
$6,393.60
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$2,099.91
|
| Rate for Payer: Molina Medicare |
$2,099.91
|
| Rate for Payer: Multiplan Auto |
$5,772.00
|
| Rate for Payer: Multiplan Commercial |
$5,772.00
|
| Rate for Payer: Multiplan Workers Comp |
$5,772.00
|
| Rate for Payer: Parkland Medicaid |
$6,393.60
|
| Rate for Payer: Scott and White EPO/PPO |
$4,440.00
|
| Rate for Payer: Scott and White Medicare |
$2,099.91
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$6,393.60
|
| Rate for Payer: Superior Health Plan EPO |
$2,099.91
|
| Rate for Payer: Superior Health Plan Medicare |
$2,099.91
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$2,099.91
|
| Rate for Payer: Universal American Medicare |
$2,099.91
|
| Rate for Payer: Wellcare Medicare |
$2,099.91
|
| Rate for Payer: Wellmed Medicare |
$2,099.91
|
|
|
ED Foreign Body Removal Site -> Skin, Subcutaneous Simple FB
|
Facility
|
OP
|
$2,057.12
|
|
|
Service Code
|
HCPCS 10120
|
| Hospital Charge Code |
7150139
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$178.41 |
| Max. Negotiated Rate |
$1,481.13 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$185.14
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$408.37
|
| Rate for Payer: Amerigroup Medicare |
$408.37
|
| Rate for Payer: BCBS of TX Blue Advantage |
$178.41
|
| Rate for Payer: BCBS of TX Blue Essentials |
$213.66
|
| Rate for Payer: BCBS of TX Medicare |
$408.37
|
| Rate for Payer: BCBS of TX PPO |
$269.21
|
| Rate for Payer: Cash Price |
$1,398.84
|
| Rate for Payer: Cash Price |
$1,398.84
|
| Rate for Payer: Cash Price |
$1,398.84
|
| Rate for Payer: Cigna Commercial |
$863.21
|
| Rate for Payer: Cigna Medicaid |
$1,481.13
|
| 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 |
$1,481.13
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$408.37
|
| Rate for Payer: Molina Medicare |
$408.37
|
| Rate for Payer: Multiplan Auto |
$1,337.13
|
| Rate for Payer: Multiplan Commercial |
$1,337.13
|
| Rate for Payer: Multiplan Workers Comp |
$1,337.13
|
| Rate for Payer: Parkland Medicaid |
$1,481.13
|
| Rate for Payer: Scott and White EPO/PPO |
$1,028.56
|
| Rate for Payer: Scott and White Medicare |
$408.37
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,481.13
|
| 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 Foreign Body Removal Site -> Skin, Subcutaneous Simple FB
|
Facility
|
IP
|
$2,057.12
|
|
|
Service Code
|
HCPCS 10120
|
| Hospital Charge Code |
7150139
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$1,398.84
|
|
|
ED Foreign Body Removal Site -> Upper Arm/Elbow
|
Facility
|
OP
|
$2,714.00
|
|
|
Service Code
|
HCPCS 24200
|
| Hospital Charge Code |
5202520
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$244.26 |
| Max. Negotiated Rate |
$3,507.10 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$244.26
|
| 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 |
$245.91
|
| Rate for Payer: BCBS of TX Blue Essentials |
$294.50
|
| Rate for Payer: BCBS of TX Medicare |
$1,659.12
|
| Rate for Payer: BCBS of TX PPO |
$371.07
|
| Rate for Payer: Cash Price |
$1,845.52
|
| Rate for Payer: Cash Price |
$1,845.52
|
| Rate for Payer: Cash Price |
$1,845.52
|
| Rate for Payer: Cigna Commercial |
$3,507.10
|
| Rate for Payer: Cigna Medicaid |
$1,954.08
|
| 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 |
$1,954.08
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,659.12
|
| Rate for Payer: Molina Medicare |
$1,659.12
|
| Rate for Payer: Multiplan Auto |
$1,764.10
|
| Rate for Payer: Multiplan Commercial |
$1,764.10
|
| Rate for Payer: Multiplan Workers Comp |
$1,764.10
|
| Rate for Payer: Parkland Medicaid |
$1,954.08
|
| Rate for Payer: Scott and White EPO/PPO |
$1,357.00
|
| Rate for Payer: Scott and White Medicare |
$1,659.12
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,954.08
|
| 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 Foreign Body Removal Site -> Upper Arm/Elbow
|
Facility
|
IP
|
$2,714.00
|
|
|
Service Code
|
HCPCS 24200
|
| Hospital Charge Code |
5202520
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$1,845.52
|
|
|
ED Fracture Site -> Bimalleolar Fx, w/o Manipulation
|
Facility
|
IP
|
$1,059.00
|
|
|
Service Code
|
HCPCS 27808
|
| Hospital Charge Code |
9220225
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$720.12
|
|
|
ED Fracture Site -> Bimalleolar Fx, w/o Manipulation
|
Facility
|
OP
|
$1,059.00
|
|
|
Service Code
|
HCPCS 27808
|
| Hospital Charge Code |
9220225
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$95.31 |
| Max. Negotiated Rate |
$762.48 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$95.31
|
| 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 |
$720.12
|
| Rate for Payer: Cash Price |
$720.12
|
| Rate for Payer: Cash Price |
$720.12
|
| Rate for Payer: Cigna Commercial |
$523.79
|
| Rate for Payer: Cigna Medicaid |
$762.48
|
| 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 |
$762.48
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$247.79
|
| Rate for Payer: Molina Medicare |
$247.79
|
| Rate for Payer: Multiplan Auto |
$688.35
|
| Rate for Payer: Multiplan Commercial |
$688.35
|
| Rate for Payer: Multiplan Workers Comp |
$688.35
|
| Rate for Payer: Parkland Medicaid |
$762.48
|
| Rate for Payer: Scott and White EPO/PPO |
$529.50
|
| Rate for Payer: Scott and White Medicare |
$247.79
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$762.48
|
| 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 Fracture Site -> Elbow/ Monteggia w/ manipulation
|
Facility
|
OP
|
$3,361.00
|
|
|
Service Code
|
HCPCS 24620
|
| Hospital Charge Code |
9220202
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$302.49 |
| Max. Negotiated Rate |
$3,415.58 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$302.49
|
| 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 |
$2,285.48
|
| Rate for Payer: Cash Price |
$2,285.48
|
| Rate for Payer: Cash Price |
$2,285.48
|
| Rate for Payer: Cigna Commercial |
$3,414.49
|
| Rate for Payer: Cigna Medicaid |
$2,419.92
|
| 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 |
$2,419.92
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,615.32
|
| Rate for Payer: Molina Medicare |
$1,615.32
|
| Rate for Payer: Multiplan Auto |
$2,184.65
|
| Rate for Payer: Multiplan Commercial |
$2,184.65
|
| Rate for Payer: Multiplan Workers Comp |
$2,184.65
|
| Rate for Payer: Parkland Medicaid |
$2,419.92
|
| Rate for Payer: Scott and White EPO/PPO |
$1,680.50
|
| Rate for Payer: Scott and White Medicare |
$1,615.32
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$2,419.92
|
| 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 Fracture Site -> Elbow/ Monteggia w/ manipulation
|
Facility
|
IP
|
$3,361.00
|
|
|
Service Code
|
HCPCS 24620
|
| Hospital Charge Code |
9220202
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$2,285.48
|
|
|
ED Fracture Site -> Fibula Fx, Distal, w/ manipulation
|
Facility
|
IP
|
$323.00
|
|
|
Service Code
|
HCPCS 27788
|
| Hospital Charge Code |
5202527
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$219.64
|
|
|
ED Fracture Site -> Fibula Fx, Distal, w/ manipulation
|
Facility
|
OP
|
$323.00
|
|
|
Service Code
|
HCPCS 27788
|
| Hospital Charge Code |
5202527
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$29.07 |
| Max. Negotiated Rate |
$543.41 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$29.07
|
| 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 |
$219.64
|
| Rate for Payer: Cash Price |
$219.64
|
| Rate for Payer: Cash Price |
$219.64
|
| Rate for Payer: Cigna Commercial |
$523.79
|
| Rate for Payer: Cigna Medicaid |
$232.56
|
| 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 |
$232.56
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$247.79
|
| Rate for Payer: Molina Medicare |
$247.79
|
| 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 |
$247.79
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$232.56
|
| 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 Fracture Site -> Fibula Fx, Distal, w/o manipulation
|
Facility
|
OP
|
$243.00
|
|
|
Service Code
|
HCPCS 27786
|
| Hospital Charge Code |
9220224
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$21.87 |
| Max. Negotiated Rate |
$543.41 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$21.87
|
| 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 |
$165.24
|
| Rate for Payer: Cash Price |
$165.24
|
| Rate for Payer: Cash Price |
$165.24
|
| Rate for Payer: Cigna Commercial |
$523.79
|
| Rate for Payer: Cigna Medicaid |
$174.96
|
| 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 |
$174.96
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$247.79
|
| Rate for Payer: Molina Medicare |
$247.79
|
| Rate for Payer: Multiplan Auto |
$157.95
|
| Rate for Payer: Multiplan Commercial |
$157.95
|
| Rate for Payer: Multiplan Workers Comp |
$157.95
|
| Rate for Payer: Parkland Medicaid |
$174.96
|
| Rate for Payer: Scott and White EPO/PPO |
$121.50
|
| Rate for Payer: Scott and White Medicare |
$247.79
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$174.96
|
| 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 Fracture Site -> Fibula Fx, Distal, w/o manipulation
|
Facility
|
IP
|
$243.00
|
|
|
Service Code
|
HCPCS 27786
|
| Hospital Charge Code |
9220224
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$165.24
|
|
|
ED Fracture Site -> Great Toe w/ manipulation
|
Facility
|
OP
|
$1,117.00
|
|
|
Service Code
|
HCPCS 28495
|
| Hospital Charge Code |
9220229
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$100.53 |
| Max. Negotiated Rate |
$804.24 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$100.53
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$247.79
|
| Rate for Payer: Amerigroup Medicare |
$247.79
|
| Rate for Payer: BCBS of TX Blue Advantage |
$181.96
|
| Rate for Payer: BCBS of TX Blue Essentials |
$217.92
|
| Rate for Payer: BCBS of TX Medicare |
$247.79
|
| Rate for Payer: BCBS of TX PPO |
$274.58
|
| Rate for Payer: Cash Price |
$759.56
|
| Rate for Payer: Cash Price |
$759.56
|
| Rate for Payer: Cash Price |
$759.56
|
| Rate for Payer: Cigna Commercial |
$523.79
|
| Rate for Payer: Cigna Medicaid |
$804.24
|
| 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 |
$804.24
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$247.79
|
| Rate for Payer: Molina Medicare |
$247.79
|
| Rate for Payer: Multiplan Auto |
$726.05
|
| Rate for Payer: Multiplan Commercial |
$726.05
|
| Rate for Payer: Multiplan Workers Comp |
$726.05
|
| Rate for Payer: Parkland Medicaid |
$804.24
|
| Rate for Payer: Scott and White EPO/PPO |
$558.50
|
| Rate for Payer: Scott and White Medicare |
$247.79
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$804.24
|
| 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 Fracture Site -> Great Toe w/ manipulation
|
Facility
|
IP
|
$1,117.00
|
|
|
Service Code
|
HCPCS 28495
|
| Hospital Charge Code |
9220229
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$759.56
|
|
|
ED Fracture Site -> Humerus, proximal, w/ manipulation
|
Facility
|
IP
|
$2,762.00
|
|
|
Service Code
|
HCPCS 23605
|
| Hospital Charge Code |
5202523
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$1,878.16
|
|
|
ED Fracture Site -> Humerus, proximal, w/ manipulation
|
Facility
|
OP
|
$2,762.00
|
|
|
Service Code
|
HCPCS 23605
|
| Hospital Charge Code |
5202523
|
|
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 Fracture Site -> Malleolus, Posterior, w/ manipulation
|
Facility
|
IP
|
$4,421.00
|
|
|
Service Code
|
HCPCS 27768
|
| Hospital Charge Code |
5202526
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$3,006.28
|
|
|
ED Fracture Site -> Malleolus, Posterior, w/ manipulation
|
Facility
|
OP
|
$4,421.00
|
|
|
Service Code
|
HCPCS 27768
|
| Hospital Charge Code |
5202526
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$397.89 |
| Max. Negotiated Rate |
$3,415.58 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$397.89
|
| 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 |
$3,006.28
|
| Rate for Payer: Cash Price |
$3,006.28
|
| Rate for Payer: Cash Price |
$3,006.28
|
| Rate for Payer: Cigna Commercial |
$3,414.49
|
| Rate for Payer: Cigna Medicaid |
$3,183.12
|
| 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 |
$3,183.12
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,615.32
|
| Rate for Payer: Molina Medicare |
$1,615.32
|
| Rate for Payer: Multiplan Auto |
$2,873.65
|
| Rate for Payer: Multiplan Commercial |
$2,873.65
|
| Rate for Payer: Multiplan Workers Comp |
$2,873.65
|
| Rate for Payer: Parkland Medicaid |
$3,183.12
|
| Rate for Payer: Scott and White EPO/PPO |
$2,210.50
|
| Rate for Payer: Scott and White Medicare |
$1,615.32
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$3,183.12
|
| 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 Fracture Site -> Metacarpal fx, w/ manipulation
|
Facility
|
IP
|
$1,318.00
|
|
|
Service Code
|
HCPCS 26605
|
| Hospital Charge Code |
8912603
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$896.24
|
|
|
ED Fracture Site -> Metacarpal fx, w/ manipulation
|
Facility
|
OP
|
$1,318.00
|
|
|
Service Code
|
HCPCS 26605
|
| Hospital Charge Code |
8912603
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$118.62 |
| Max. Negotiated Rate |
$948.96 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$118.62
|
| 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 |
$896.24
|
| Rate for Payer: Cash Price |
$896.24
|
| Rate for Payer: Cash Price |
$896.24
|
| Rate for Payer: Cigna Commercial |
$523.79
|
| Rate for Payer: Cigna Medicaid |
$948.96
|
| 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 |
$948.96
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$247.79
|
| Rate for Payer: Molina Medicare |
$247.79
|
| Rate for Payer: Multiplan Auto |
$856.70
|
| Rate for Payer: Multiplan Commercial |
$856.70
|
| Rate for Payer: Multiplan Workers Comp |
$856.70
|
| Rate for Payer: Parkland Medicaid |
$948.96
|
| Rate for Payer: Scott and White EPO/PPO |
$659.00
|
| Rate for Payer: Scott and White Medicare |
$247.79
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$948.96
|
| 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 Fracture Site -> MP/Interphalangeal Joint, w/ manipulation
|
Facility
|
IP
|
$2,762.00
|
|
|
Service Code
|
HCPCS 26742
|
| Hospital Charge Code |
9220215
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$1,878.16
|
|
|
ED Fracture Site -> MP/Interphalangeal Joint, w/ manipulation
|
Facility
|
OP
|
$2,762.00
|
|
|
Service Code
|
HCPCS 26742
|
| Hospital Charge Code |
9220215
|
|
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 Fracture Site -> Phalangeal, Distal w/ manipulation
|
Facility
|
OP
|
$708.00
|
|
|
Service Code
|
HCPCS 26755
|
| Hospital Charge Code |
9220217
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$63.72 |
| Max. Negotiated Rate |
$543.41 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$63.72
|
| 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 |
$481.44
|
| Rate for Payer: Cash Price |
$481.44
|
| Rate for Payer: Cash Price |
$481.44
|
| Rate for Payer: Cigna Commercial |
$523.79
|
| Rate for Payer: Cigna Medicaid |
$509.76
|
| 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 |
$509.76
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$247.79
|
| Rate for Payer: Molina Medicare |
$247.79
|
| Rate for Payer: Multiplan Auto |
$460.20
|
| Rate for Payer: Multiplan Commercial |
$460.20
|
| Rate for Payer: Multiplan Workers Comp |
$460.20
|
| Rate for Payer: Parkland Medicaid |
$509.76
|
| Rate for Payer: Scott and White EPO/PPO |
$354.00
|
| Rate for Payer: Scott and White Medicare |
$247.79
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$509.76
|
| 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 Fracture Site -> Phalangeal, Distal w/ manipulation
|
Facility
|
IP
|
$708.00
|
|
|
Service Code
|
HCPCS 26755
|
| Hospital Charge Code |
9220217
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$481.44
|
|
