|
ED GI/GU/Rectal Procedure -> Replace G-Tube
|
Facility
|
IP
|
$620.00
|
|
|
Service Code
|
HCPCS 43762
|
| Hospital Charge Code |
8424451
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$421.60
|
|
|
ED I AND D OF BARTHOLINS GLND ABS BCE
|
Facility
|
OP
|
$695.00
|
|
|
Service Code
|
HCPCS 56420
|
| Hospital Charge Code |
8912614
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$62.55 |
| Max. Negotiated Rate |
$500.40 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$62.55
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$203.09
|
| Rate for Payer: Amerigroup Medicare |
$203.09
|
| Rate for Payer: BCBS of TX Blue Advantage |
$140.11
|
| Rate for Payer: BCBS of TX Blue Essentials |
$167.80
|
| Rate for Payer: BCBS of TX Medicare |
$203.09
|
| Rate for Payer: BCBS of TX PPO |
$211.43
|
| Rate for Payer: Cash Price |
$472.60
|
| Rate for Payer: Cash Price |
$472.60
|
| Rate for Payer: Cash Price |
$472.60
|
| Rate for Payer: Cigna Commercial |
$429.31
|
| Rate for Payer: Cigna Medicaid |
$500.40
|
| Rate for Payer: Cigna Medicare |
$203.09
|
| Rate for Payer: Employer Direct Commercial |
$203.09
|
| Rate for Payer: Humana Medicare/TRICARE |
$203.09
|
| Rate for Payer: Molina CHIP/Medicaid |
$500.40
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$203.09
|
| Rate for Payer: Molina Medicare |
$203.09
|
| Rate for Payer: Multiplan Auto |
$451.75
|
| Rate for Payer: Multiplan Commercial |
$451.75
|
| Rate for Payer: Multiplan Workers Comp |
$451.75
|
| Rate for Payer: Parkland Medicaid |
$500.40
|
| Rate for Payer: Scott and White EPO/PPO |
$137.04
|
| Rate for Payer: Scott and White Medicare |
$203.09
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$500.40
|
| Rate for Payer: Superior Health Plan EPO |
$203.09
|
| Rate for Payer: Superior Health Plan Medicare |
$203.09
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$203.09
|
| Rate for Payer: Universal American Medicare |
$203.09
|
| Rate for Payer: Wellcare Medicare |
$203.09
|
| Rate for Payer: Wellmed Medicare |
$203.09
|
|
|
ED I AND D OF BARTHOLINS GLND ABS BCE
|
Facility
|
IP
|
$695.00
|
|
|
Service Code
|
HCPCS 56420
|
| Hospital Charge Code |
8912614
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$472.60
|
|
|
ED ID Aspiration -> Abscess/Cyst/Hematoma
|
Facility
|
IP
|
$895.00
|
|
|
Service Code
|
HCPCS 10160
|
| Hospital Charge Code |
3521001
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$608.60
|
|
|
ED ID Aspiration -> Abscess/Cyst/Hematoma
|
Facility
|
OP
|
$895.00
|
|
|
Service Code
|
HCPCS 10160
|
| Hospital Charge Code |
3521001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$80.55 |
| Max. Negotiated Rate |
$863.21 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$80.55
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$408.37
|
| Rate for Payer: Amerigroup Medicare |
$408.37
|
| Rate for Payer: BCBS of TX Blue Advantage |
$139.23
|
| Rate for Payer: BCBS of TX Blue Essentials |
$166.74
|
| Rate for Payer: BCBS of TX Medicare |
$408.37
|
| Rate for Payer: BCBS of TX PPO |
$210.09
|
| Rate for Payer: Cash Price |
$608.60
|
| Rate for Payer: Cash Price |
$608.60
|
| Rate for Payer: Cash Price |
$608.60
|
| Rate for Payer: Cigna Commercial |
$863.21
|
| Rate for Payer: Cigna Medicaid |
$644.40
|
| 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 |
$644.40
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$408.37
|
| Rate for Payer: Molina Medicare |
$408.37
|
| Rate for Payer: Multiplan Auto |
$581.75
|
| Rate for Payer: Multiplan Commercial |
$581.75
|
| Rate for Payer: Multiplan Workers Comp |
$581.75
|
| Rate for Payer: Parkland Medicaid |
$644.40
|
| Rate for Payer: Scott and White EPO/PPO |
$119.30
|
| Rate for Payer: Scott and White Medicare |
$408.37
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$644.40
|
| 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 ID Aspiration -> Arthrocentesis - fingers or toes
|
Facility
|
OP
|
$622.00
|
|
|
Service Code
|
HCPCS 20600
|
| Hospital Charge Code |
2100012
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$41.58 |
| Max. Negotiated Rate |
$651.79 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$55.98
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$308.35
|
| Rate for Payer: Amerigroup Medicare |
$308.35
|
| Rate for Payer: BCBS of TX Blue Advantage |
$41.58
|
| Rate for Payer: BCBS of TX Blue Essentials |
$49.80
|
| Rate for Payer: BCBS of TX Medicare |
$308.35
|
| Rate for Payer: BCBS of TX PPO |
$62.75
|
| Rate for Payer: Cash Price |
$422.96
|
| Rate for Payer: Cash Price |
$422.96
|
| Rate for Payer: Cash Price |
$422.96
|
| Rate for Payer: Cigna Commercial |
$651.79
|
| Rate for Payer: Cigna Medicaid |
$447.84
|
| Rate for Payer: Cigna Medicare |
$308.35
|
| Rate for Payer: Employer Direct Commercial |
$308.35
|
| Rate for Payer: Humana Medicare/TRICARE |
$308.35
|
| Rate for Payer: Molina CHIP/Medicaid |
$447.84
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$308.35
|
| Rate for Payer: Molina Medicare |
$308.35
|
| Rate for Payer: Multiplan Auto |
$404.30
|
| Rate for Payer: Multiplan Commercial |
$404.30
|
| Rate for Payer: Multiplan Workers Comp |
$404.30
|
| Rate for Payer: Parkland Medicaid |
$447.84
|
| Rate for Payer: Scott and White EPO/PPO |
$43.73
|
| Rate for Payer: Scott and White Medicare |
$308.35
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$447.84
|
| Rate for Payer: Superior Health Plan EPO |
$308.35
|
| Rate for Payer: Superior Health Plan Medicare |
$308.35
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$308.35
|
| Rate for Payer: Universal American Medicare |
$308.35
|
| Rate for Payer: Wellcare Medicare |
$308.35
|
| Rate for Payer: Wellmed Medicare |
$308.35
|
|
|
ED ID Aspiration -> Arthrocentesis - fingers or toes
|
Facility
|
IP
|
$622.00
|
|
|
Service Code
|
HCPCS 20600
|
| Hospital Charge Code |
2100012
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$422.96
|
|
|
ED ID Aspiration -> Arthrocentesis - shoulder, hip, knee, or subacromial bursa
|
Facility
|
OP
|
$1,676.00
|
|
|
Service Code
|
HCPCS 20610
|
| Hospital Charge Code |
6110555
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$51.84 |
| Max. Negotiated Rate |
$1,206.72 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$150.84
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$308.35
|
| Rate for Payer: Amerigroup Medicare |
$308.35
|
| Rate for Payer: BCBS of TX Blue Advantage |
$51.84
|
| Rate for Payer: BCBS of TX Blue Essentials |
$62.08
|
| Rate for Payer: BCBS of TX Medicare |
$308.35
|
| Rate for Payer: BCBS of TX PPO |
$78.22
|
| Rate for Payer: Cash Price |
$1,139.68
|
| Rate for Payer: Cash Price |
$1,139.68
|
| Rate for Payer: Cash Price |
$1,139.68
|
| Rate for Payer: Cigna Commercial |
$651.79
|
| Rate for Payer: Cigna Medicaid |
$1,206.72
|
| Rate for Payer: Cigna Medicare |
$308.35
|
| Rate for Payer: Employer Direct Commercial |
$308.35
|
| Rate for Payer: Humana Medicare/TRICARE |
$308.35
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,206.72
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$308.35
|
| Rate for Payer: Molina Medicare |
$308.35
|
| Rate for Payer: Multiplan Auto |
$1,089.40
|
| Rate for Payer: Multiplan Commercial |
$1,089.40
|
| Rate for Payer: Multiplan Workers Comp |
$1,089.40
|
| Rate for Payer: Parkland Medicaid |
$1,206.72
|
| Rate for Payer: Scott and White EPO/PPO |
$55.49
|
| Rate for Payer: Scott and White Medicare |
$308.35
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,206.72
|
| Rate for Payer: Superior Health Plan EPO |
$308.35
|
| Rate for Payer: Superior Health Plan Medicare |
$308.35
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$308.35
|
| Rate for Payer: Universal American Medicare |
$308.35
|
| Rate for Payer: Wellcare Medicare |
$308.35
|
| Rate for Payer: Wellmed Medicare |
$308.35
|
|
|
ED ID Aspiration -> Arthrocentesis - shoulder, hip, knee, or subacromial bursa
|
Facility
|
IP
|
$1,676.00
|
|
|
Service Code
|
HCPCS 20610
|
| Hospital Charge Code |
6110555
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$1,139.68
|
|
|
ED ID Aspiration -> Arthrocentesis - temporomandibular, AC, wrist, elbow or ankl
|
Facility
|
OP
|
$719.00
|
|
|
Service Code
|
HCPCS 20605
|
| Hospital Charge Code |
6110548
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$43.39 |
| Max. Negotiated Rate |
$651.79 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$64.71
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$308.35
|
| Rate for Payer: Amerigroup Medicare |
$308.35
|
| Rate for Payer: BCBS of TX Blue Advantage |
$43.39
|
| Rate for Payer: BCBS of TX Blue Essentials |
$51.96
|
| Rate for Payer: BCBS of TX Medicare |
$308.35
|
| Rate for Payer: BCBS of TX PPO |
$65.47
|
| Rate for Payer: Cash Price |
$488.92
|
| Rate for Payer: Cash Price |
$488.92
|
| Rate for Payer: Cash Price |
$488.92
|
| Rate for Payer: Cigna Commercial |
$651.79
|
| Rate for Payer: Cigna Medicaid |
$517.68
|
| Rate for Payer: Cigna Medicare |
$308.35
|
| Rate for Payer: Employer Direct Commercial |
$308.35
|
| Rate for Payer: Humana Medicare/TRICARE |
$308.35
|
| Rate for Payer: Molina CHIP/Medicaid |
$517.68
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$308.35
|
| Rate for Payer: Molina Medicare |
$308.35
|
| Rate for Payer: Multiplan Auto |
$467.35
|
| Rate for Payer: Multiplan Commercial |
$467.35
|
| Rate for Payer: Multiplan Workers Comp |
$467.35
|
| Rate for Payer: Parkland Medicaid |
$517.68
|
| Rate for Payer: Scott and White EPO/PPO |
$44.98
|
| Rate for Payer: Scott and White Medicare |
$308.35
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$517.68
|
| Rate for Payer: Superior Health Plan EPO |
$308.35
|
| Rate for Payer: Superior Health Plan Medicare |
$308.35
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$308.35
|
| Rate for Payer: Universal American Medicare |
$308.35
|
| Rate for Payer: Wellcare Medicare |
$308.35
|
| Rate for Payer: Wellmed Medicare |
$308.35
|
|
|
ED ID Aspiration -> Arthrocentesis - temporomandibular, AC, wrist, elbow or ankl
|
Facility
|
IP
|
$719.00
|
|
|
Service Code
|
HCPCS 20605
|
| Hospital Charge Code |
6110548
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$488.92
|
|
|
ED ID Aspiration -> For biopsy
|
Facility
|
OP
|
$2,667.00
|
|
|
Service Code
|
HCPCS 10021
|
| Hospital Charge Code |
9250076
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$66.61 |
| Max. Negotiated Rate |
$1,920.24 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$240.03
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$408.37
|
| Rate for Payer: Amerigroup Medicare |
$408.37
|
| Rate for Payer: BCBS of TX Blue Advantage |
$98.85
|
| Rate for Payer: BCBS of TX Blue Essentials |
$118.38
|
| Rate for Payer: BCBS of TX Medicare |
$408.37
|
| Rate for Payer: BCBS of TX PPO |
$149.16
|
| Rate for Payer: Cash Price |
$1,813.56
|
| Rate for Payer: Cash Price |
$1,813.56
|
| Rate for Payer: Cash Price |
$1,813.56
|
| Rate for Payer: Cigna Commercial |
$863.21
|
| Rate for Payer: Cigna Medicaid |
$1,920.24
|
| 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 |
$1,920.24
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$408.37
|
| Rate for Payer: Molina Medicare |
$408.37
|
| Rate for Payer: Multiplan Auto |
$1,733.55
|
| Rate for Payer: Multiplan Commercial |
$1,733.55
|
| Rate for Payer: Multiplan Workers Comp |
$1,733.55
|
| Rate for Payer: Parkland Medicaid |
$1,920.24
|
| Rate for Payer: Scott and White EPO/PPO |
$66.61
|
| Rate for Payer: Scott and White Medicare |
$408.37
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,920.24
|
| 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 ID Aspiration -> For biopsy
|
Facility
|
IP
|
$2,667.00
|
|
|
Service Code
|
HCPCS 10021
|
| Hospital Charge Code |
9250076
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$1,813.56
|
|
|
ED ID Aspiration -> Ganglion Cyst
|
Facility
|
IP
|
$628.00
|
|
|
Service Code
|
HCPCS 20612
|
| Hospital Charge Code |
5202535
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$427.04
|
|
|
ED ID Aspiration -> Ganglion Cyst
|
Facility
|
OP
|
$628.00
|
|
|
Service Code
|
HCPCS 20612
|
| Hospital Charge Code |
5202535
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$50.27 |
| Max. Negotiated Rate |
$651.79 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$56.52
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$308.35
|
| Rate for Payer: Amerigroup Medicare |
$308.35
|
| Rate for Payer: BCBS of TX Blue Advantage |
$58.47
|
| Rate for Payer: BCBS of TX Blue Essentials |
$70.02
|
| Rate for Payer: BCBS of TX Medicare |
$308.35
|
| Rate for Payer: BCBS of TX PPO |
$88.23
|
| Rate for Payer: Cash Price |
$427.04
|
| Rate for Payer: Cash Price |
$427.04
|
| Rate for Payer: Cash Price |
$427.04
|
| Rate for Payer: Cigna Commercial |
$651.79
|
| Rate for Payer: Cigna Medicaid |
$452.16
|
| Rate for Payer: Cigna Medicare |
$308.35
|
| Rate for Payer: Employer Direct Commercial |
$308.35
|
| Rate for Payer: Humana Medicare/TRICARE |
$308.35
|
| Rate for Payer: Molina CHIP/Medicaid |
$452.16
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$308.35
|
| Rate for Payer: Molina Medicare |
$308.35
|
| Rate for Payer: Multiplan Auto |
$408.20
|
| Rate for Payer: Multiplan Commercial |
$408.20
|
| Rate for Payer: Multiplan Workers Comp |
$408.20
|
| Rate for Payer: Parkland Medicaid |
$452.16
|
| Rate for Payer: Scott and White EPO/PPO |
$50.27
|
| Rate for Payer: Scott and White Medicare |
$308.35
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$452.16
|
| Rate for Payer: Superior Health Plan EPO |
$308.35
|
| Rate for Payer: Superior Health Plan Medicare |
$308.35
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$308.35
|
| Rate for Payer: Universal American Medicare |
$308.35
|
| Rate for Payer: Wellcare Medicare |
$308.35
|
| Rate for Payer: Wellmed Medicare |
$308.35
|
|
|
ED ID Body Site -> Bartholin's Gland
|
Facility
|
IP
|
$695.00
|
|
|
Service Code
|
HCPCS 56420
|
| Hospital Charge Code |
8398503
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$472.60
|
|
|
ED ID Body Site -> Bartholin's Gland
|
Facility
|
OP
|
$695.00
|
|
|
Service Code
|
HCPCS 56420
|
| Hospital Charge Code |
8398503
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$62.55 |
| Max. Negotiated Rate |
$500.40 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$62.55
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$203.09
|
| Rate for Payer: Amerigroup Medicare |
$203.09
|
| Rate for Payer: BCBS of TX Blue Advantage |
$140.11
|
| Rate for Payer: BCBS of TX Blue Essentials |
$167.80
|
| Rate for Payer: BCBS of TX Medicare |
$203.09
|
| Rate for Payer: BCBS of TX PPO |
$211.43
|
| Rate for Payer: Cash Price |
$472.60
|
| Rate for Payer: Cash Price |
$472.60
|
| Rate for Payer: Cash Price |
$472.60
|
| Rate for Payer: Cigna Commercial |
$429.31
|
| Rate for Payer: Cigna Medicaid |
$500.40
|
| Rate for Payer: Cigna Medicare |
$203.09
|
| Rate for Payer: Employer Direct Commercial |
$203.09
|
| Rate for Payer: Humana Medicare/TRICARE |
$203.09
|
| Rate for Payer: Molina CHIP/Medicaid |
$500.40
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$203.09
|
| Rate for Payer: Molina Medicare |
$203.09
|
| Rate for Payer: Multiplan Auto |
$451.75
|
| Rate for Payer: Multiplan Commercial |
$451.75
|
| Rate for Payer: Multiplan Workers Comp |
$451.75
|
| Rate for Payer: Parkland Medicaid |
$500.40
|
| Rate for Payer: Scott and White EPO/PPO |
$137.04
|
| Rate for Payer: Scott and White Medicare |
$203.09
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$500.40
|
| Rate for Payer: Superior Health Plan EPO |
$203.09
|
| Rate for Payer: Superior Health Plan Medicare |
$203.09
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$203.09
|
| Rate for Payer: Universal American Medicare |
$203.09
|
| Rate for Payer: Wellcare Medicare |
$203.09
|
| Rate for Payer: Wellmed Medicare |
$203.09
|
|
|
ED ID Body Site -> Finger, Complex
|
Facility
|
OP
|
$2,073.00
|
|
|
Service Code
|
HCPCS 26011
|
| Hospital Charge Code |
5202538
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$186.57 |
| Max. Negotiated Rate |
$3,507.10 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$186.57
|
| 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 |
$1,409.64
|
| Rate for Payer: Cash Price |
$1,409.64
|
| Rate for Payer: Cash Price |
$1,409.64
|
| Rate for Payer: Cigna Commercial |
$3,507.10
|
| Rate for Payer: Cigna Medicaid |
$1,492.56
|
| 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 |
$1,492.56
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,659.12
|
| Rate for Payer: Molina Medicare |
$1,659.12
|
| Rate for Payer: Multiplan Auto |
$1,347.45
|
| Rate for Payer: Multiplan Commercial |
$1,347.45
|
| Rate for Payer: Multiplan Workers Comp |
$1,347.45
|
| Rate for Payer: Parkland Medicaid |
$1,492.56
|
| Rate for Payer: Scott and White EPO/PPO |
$230.24
|
| Rate for Payer: Scott and White Medicare |
$1,659.12
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,492.56
|
| 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 ID Body Site -> Finger, Complex
|
Facility
|
IP
|
$2,073.00
|
|
|
Service Code
|
HCPCS 26011
|
| Hospital Charge Code |
5202538
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$1,409.64
|
|
|
ED ID Body Site -> Hematoma, Seroma, Fluid collection
|
Facility
|
OP
|
$6,773.30
|
|
|
Service Code
|
HCPCS 10140
|
| Hospital Charge Code |
9900076
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$146.29 |
| Max. Negotiated Rate |
$4,876.78 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$609.60
|
| 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 |
$183.82
|
| Rate for Payer: BCBS of TX Blue Essentials |
$220.14
|
| Rate for Payer: BCBS of TX Medicare |
$1,659.12
|
| Rate for Payer: BCBS of TX PPO |
$277.38
|
| Rate for Payer: Cash Price |
$4,605.84
|
| Rate for Payer: Cash Price |
$4,605.84
|
| Rate for Payer: Cash Price |
$4,605.84
|
| Rate for Payer: Cigna Commercial |
$3,507.10
|
| Rate for Payer: Cigna Medicaid |
$4,876.78
|
| 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 |
$4,876.78
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,659.12
|
| Rate for Payer: Molina Medicare |
$1,659.12
|
| Rate for Payer: Multiplan Auto |
$4,402.65
|
| Rate for Payer: Multiplan Commercial |
$4,402.65
|
| Rate for Payer: Multiplan Workers Comp |
$4,402.65
|
| Rate for Payer: Parkland Medicaid |
$4,876.78
|
| Rate for Payer: Scott and White EPO/PPO |
$146.29
|
| Rate for Payer: Scott and White Medicare |
$1,659.12
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$4,876.78
|
| 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 ID Body Site -> Hematoma, Seroma, Fluid collection
|
Facility
|
IP
|
$6,773.30
|
|
|
Service Code
|
HCPCS 10140
|
| Hospital Charge Code |
5050140
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$4,605.84
|
|
|
ED ID Body Site -> Hematoma, Seroma, Fluid collection
|
Facility
|
IP
|
$6,773.30
|
|
|
Service Code
|
HCPCS 10140
|
| Hospital Charge Code |
9900076
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$4,605.84
|
|
|
ED ID Body Site -> Hematoma, Seroma, Fluid collection
|
Facility
|
OP
|
$6,773.30
|
|
|
Service Code
|
HCPCS 10140
|
| Hospital Charge Code |
5050140
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$146.29 |
| Max. Negotiated Rate |
$4,876.78 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$609.60
|
| 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 |
$183.82
|
| Rate for Payer: BCBS of TX Blue Essentials |
$220.14
|
| Rate for Payer: BCBS of TX Medicare |
$1,659.12
|
| Rate for Payer: BCBS of TX PPO |
$277.38
|
| Rate for Payer: Cash Price |
$4,605.84
|
| Rate for Payer: Cash Price |
$4,605.84
|
| Rate for Payer: Cash Price |
$4,605.84
|
| Rate for Payer: Cigna Commercial |
$3,507.10
|
| Rate for Payer: Cigna Medicaid |
$4,876.78
|
| 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 |
$4,876.78
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,659.12
|
| Rate for Payer: Molina Medicare |
$1,659.12
|
| Rate for Payer: Multiplan Auto |
$4,402.65
|
| Rate for Payer: Multiplan Commercial |
$4,402.65
|
| Rate for Payer: Multiplan Workers Comp |
$4,402.65
|
| Rate for Payer: Parkland Medicaid |
$4,876.78
|
| Rate for Payer: Scott and White EPO/PPO |
$146.29
|
| Rate for Payer: Scott and White Medicare |
$1,659.12
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$4,876.78
|
| 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 ID Body Site -> I&D Abscess/Cyst Complex
|
Facility
|
OP
|
$2,238.42
|
|
|
Service Code
|
HCPCS 10061
|
| Hospital Charge Code |
7150097
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$192.87 |
| Max. Negotiated Rate |
$1,611.66 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$201.46
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$408.37
|
| Rate for Payer: Amerigroup Medicare |
$408.37
|
| Rate for Payer: BCBS of TX Blue Advantage |
$192.87
|
| Rate for Payer: BCBS of TX Blue Essentials |
$230.98
|
| Rate for Payer: BCBS of TX Medicare |
$408.37
|
| Rate for Payer: BCBS of TX PPO |
$291.03
|
| Rate for Payer: Cash Price |
$1,522.13
|
| Rate for Payer: Cash Price |
$1,522.13
|
| Rate for Payer: Cash Price |
$1,522.13
|
| Rate for Payer: Cigna Commercial |
$863.21
|
| Rate for Payer: Cigna Medicaid |
$1,611.66
|
| 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 |
$1,611.66
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$408.37
|
| Rate for Payer: Molina Medicare |
$408.37
|
| Rate for Payer: Multiplan Auto |
$1,454.97
|
| Rate for Payer: Multiplan Commercial |
$1,454.97
|
| Rate for Payer: Multiplan Workers Comp |
$1,454.97
|
| Rate for Payer: Parkland Medicaid |
$1,611.66
|
| Rate for Payer: Scott and White EPO/PPO |
$227.86
|
| Rate for Payer: Scott and White Medicare |
$408.37
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,611.66
|
| 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 ID Body Site -> I&D Abscess/Cyst Complex
|
Facility
|
IP
|
$2,238.42
|
|
|
Service Code
|
HCPCS 10061
|
| Hospital Charge Code |
7150097
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$1,522.13
|
|
