|
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 |
$541.77
|
| 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 |
$567.19
|
| 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
|
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 |
$381.09
|
| 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 -> 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 -> 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 |
$426.80
|
| 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
|
IP
|
$708.00
|
|
|
Service Code
|
HCPCS 26755
|
| Hospital Charge Code |
9220217
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$481.44
|
|
|
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 |
$350.35
|
| 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, finger or thumb w/ manipulation
|
Facility
|
OP
|
$785.00
|
|
|
Service Code
|
HCPCS 26725
|
| Hospital Charge Code |
9220213
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$70.65 |
| Max. Negotiated Rate |
$565.20 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$70.65
|
| 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 |
$533.80
|
| Rate for Payer: Cash Price |
$533.80
|
| Rate for Payer: Cash Price |
$533.80
|
| Rate for Payer: Cigna Commercial |
$523.79
|
| Rate for Payer: Cigna Medicaid |
$565.20
|
| 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 |
$565.20
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$247.79
|
| Rate for Payer: Molina Medicare |
$247.79
|
| Rate for Payer: Multiplan Auto |
$510.25
|
| Rate for Payer: Multiplan Commercial |
$510.25
|
| Rate for Payer: Multiplan Workers Comp |
$510.25
|
| Rate for Payer: Parkland Medicaid |
$565.20
|
| Rate for Payer: Scott and White EPO/PPO |
$389.70
|
| Rate for Payer: Scott and White Medicare |
$247.79
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$565.20
|
| 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, finger or thumb w/ manipulation
|
Facility
|
IP
|
$785.00
|
|
|
Service Code
|
HCPCS 26725
|
| Hospital Charge Code |
9220213
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$533.80
|
|
|
ED Fracture Site -> Phalangeal, finger or thumb w/o manipulation
|
Facility
|
IP
|
$715.00
|
|
|
Service Code
|
HCPCS 26720
|
| Hospital Charge Code |
8912604
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$486.20
|
|
|
ED Fracture Site -> Phalangeal, finger or thumb w/o manipulation
|
Facility
|
OP
|
$715.00
|
|
|
Service Code
|
HCPCS 26720
|
| Hospital Charge Code |
8912604
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$64.35 |
| Max. Negotiated Rate |
$523.79 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$64.35
|
| 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 |
$486.20
|
| Rate for Payer: Cash Price |
$486.20
|
| Rate for Payer: Cash Price |
$486.20
|
| Rate for Payer: Cigna Commercial |
$523.79
|
| Rate for Payer: Cigna Medicaid |
$514.80
|
| 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 |
$514.80
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$247.79
|
| Rate for Payer: Molina Medicare |
$247.79
|
| Rate for Payer: Multiplan Auto |
$464.75
|
| Rate for Payer: Multiplan Commercial |
$464.75
|
| Rate for Payer: Multiplan Workers Comp |
$464.75
|
| Rate for Payer: Parkland Medicaid |
$514.80
|
| Rate for Payer: Scott and White EPO/PPO |
$244.49
|
| Rate for Payer: Scott and White Medicare |
$247.79
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$514.80
|
| 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 Fracture Site -> Radial Shaft fx / Distal radioulnar joint dislocation
|
Facility
|
OP
|
$3,323.00
|
|
|
Service Code
|
HCPCS 25520
|
| Hospital Charge Code |
8546479
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$299.07 |
| Max. Negotiated Rate |
$3,415.58 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$299.07
|
| 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 |
$2,259.64
|
| Rate for Payer: Cash Price |
$2,259.64
|
| Rate for Payer: Cash Price |
$2,259.64
|
| Rate for Payer: Cigna Commercial |
$3,414.49
|
| Rate for Payer: Cigna Medicaid |
$2,392.56
|
| 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 |
$2,392.56
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,615.32
|
| Rate for Payer: Molina Medicare |
$1,615.32
|
| Rate for Payer: Multiplan Auto |
$2,159.95
|
| Rate for Payer: Multiplan Commercial |
$2,159.95
|
| Rate for Payer: Multiplan Workers Comp |
$2,159.95
|
| Rate for Payer: Parkland Medicaid |
$2,392.56
|
| Rate for Payer: Scott and White EPO/PPO |
$688.02
|
| Rate for Payer: Scott and White Medicare |
$1,615.32
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$2,392.56
|
| 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 -> Radial Shaft fx / Distal radioulnar joint dislocation
|
Facility
|
IP
|
$3,323.00
|
|
|
Service Code
|
HCPCS 25520
|
| Hospital Charge Code |
8546479
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$2,259.64
|
|
|
ED Fracture Site -> Radius/Ulna fx, distal, w/ manipulation
|
Facility
|
OP
|
$2,762.00
|
|
|
Service Code
|
HCPCS 25605
|
| Hospital Charge Code |
9220208
|
|
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 |
$646.26
|
| 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 -> Radius/Ulna fx, distal, w/ manipulation
|
Facility
|
IP
|
$2,762.00
|
|
|
Service Code
|
HCPCS 25605
|
| Hospital Charge Code |
9220208
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$1,878.16
|
|
|
ED Fracture Site -> Radius/Ulna fx, distal, w/o manipulation
|
Facility
|
IP
|
$913.00
|
|
|
Service Code
|
HCPCS 25600
|
| Hospital Charge Code |
9220207
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$620.84
|
|
|
ED Fracture Site -> Radius/Ulna fx, distal, w/o manipulation
|
Facility
|
OP
|
$913.00
|
|
|
Service Code
|
HCPCS 25600
|
| Hospital Charge Code |
9220207
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$82.17 |
| Max. Negotiated Rate |
$657.36 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$82.17
|
| 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 |
$620.84
|
| Rate for Payer: Cash Price |
$620.84
|
| Rate for Payer: Cash Price |
$620.84
|
| Rate for Payer: Cigna Commercial |
$523.79
|
| Rate for Payer: Cigna Medicaid |
$657.36
|
| 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 |
$657.36
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$247.79
|
| Rate for Payer: Molina Medicare |
$247.79
|
| Rate for Payer: Multiplan Auto |
$593.45
|
| Rate for Payer: Multiplan Commercial |
$593.45
|
| Rate for Payer: Multiplan Workers Comp |
$593.45
|
| Rate for Payer: Parkland Medicaid |
$657.36
|
| Rate for Payer: Scott and White EPO/PPO |
$417.16
|
| Rate for Payer: Scott and White Medicare |
$247.79
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$657.36
|
| 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 -> Radius/Ulna fx, shaft, w/o manipulation
|
Facility
|
OP
|
$791.00
|
|
|
Service Code
|
HCPCS 25560
|
| Hospital Charge Code |
8914596
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$71.19 |
| Max. Negotiated Rate |
$569.52 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$71.19
|
| 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 |
$537.88
|
| Rate for Payer: Cash Price |
$537.88
|
| Rate for Payer: Cash Price |
$537.88
|
| Rate for Payer: Cigna Commercial |
$523.79
|
| Rate for Payer: Cigna Medicaid |
$569.52
|
| 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 |
$569.52
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$247.79
|
| Rate for Payer: Molina Medicare |
$247.79
|
| Rate for Payer: Multiplan Auto |
$514.15
|
| Rate for Payer: Multiplan Commercial |
$514.15
|
| Rate for Payer: Multiplan Workers Comp |
$514.15
|
| Rate for Payer: Parkland Medicaid |
$569.52
|
| Rate for Payer: Scott and White EPO/PPO |
$333.62
|
| Rate for Payer: Scott and White Medicare |
$247.79
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$569.52
|
| 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 -> Radius/Ulna fx, shaft, w/o manipulation
|
Facility
|
IP
|
$791.00
|
|
|
Service Code
|
HCPCS 25560
|
| Hospital Charge Code |
8914596
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$537.88
|
|
|
ED Fracture Site -> Radius w/o manipulation
|
Facility
|
OP
|
$699.00
|
|
|
Service Code
|
HCPCS 25500
|
| Hospital Charge Code |
9220204
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$62.91 |
| Max. Negotiated Rate |
$523.79 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$62.91
|
| 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 |
$475.32
|
| Rate for Payer: Cash Price |
$475.32
|
| Rate for Payer: Cash Price |
$475.32
|
| Rate for Payer: Cigna Commercial |
$523.79
|
| Rate for Payer: Cigna Medicaid |
$503.28
|
| 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 |
$503.28
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$247.79
|
| Rate for Payer: Molina Medicare |
$247.79
|
| Rate for Payer: Multiplan Auto |
$454.35
|
| Rate for Payer: Multiplan Commercial |
$454.35
|
| Rate for Payer: Multiplan Workers Comp |
$454.35
|
| Rate for Payer: Parkland Medicaid |
$503.28
|
| Rate for Payer: Scott and White EPO/PPO |
$332.04
|
| Rate for Payer: Scott and White Medicare |
$247.79
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$503.28
|
| 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 -> Radius w/o manipulation
|
Facility
|
IP
|
$699.00
|
|
|
Service Code
|
HCPCS 25500
|
| Hospital Charge Code |
9220204
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$475.32
|
|
