|
ED ID Body Site -> I&D Abscess/Cyst Simple
|
Facility
|
IP
|
$993.50
|
|
|
Service Code
|
HCPCS 10060
|
| Hospital Charge Code |
7150089
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$675.58
|
|
|
ED ID Body Site -> I&D Abscess/Cyst Simple
|
Facility
|
OP
|
$993.50
|
|
|
Service Code
|
HCPCS 10060
|
| Hospital Charge Code |
7150089
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$89.42 |
| Max. Negotiated Rate |
$715.32 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$89.42
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$201.55
|
| Rate for Payer: Amerigroup Medicare |
$201.55
|
| Rate for Payer: BCBS of TX Blue Advantage |
$125.97
|
| Rate for Payer: BCBS of TX Blue Essentials |
$150.86
|
| Rate for Payer: BCBS of TX Medicare |
$201.55
|
| Rate for Payer: BCBS of TX PPO |
$190.08
|
| Rate for Payer: Cash Price |
$675.58
|
| Rate for Payer: Cash Price |
$675.58
|
| Rate for Payer: Cash Price |
$675.58
|
| Rate for Payer: Cigna Commercial |
$426.04
|
| Rate for Payer: Cigna Medicaid |
$715.32
|
| 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 |
$715.32
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$201.55
|
| Rate for Payer: Molina Medicare |
$201.55
|
| Rate for Payer: Multiplan Auto |
$645.77
|
| Rate for Payer: Multiplan Commercial |
$645.77
|
| Rate for Payer: Multiplan Workers Comp |
$645.77
|
| Rate for Payer: Parkland Medicaid |
$715.32
|
| Rate for Payer: Scott and White EPO/PPO |
$132.22
|
| Rate for Payer: Scott and White Medicare |
$201.55
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$715.32
|
| 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 ID Body Site -> Perianal, superficial
|
Facility
|
IP
|
$1,869.00
|
|
|
Service Code
|
HCPCS 46050
|
| Hospital Charge Code |
5202541
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$1,270.92
|
|
|
ED ID Body Site -> Perianal, superficial
|
Facility
|
OP
|
$1,869.00
|
|
|
Service Code
|
HCPCS 46050
|
| Hospital Charge Code |
5202541
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$125.46 |
| Max. Negotiated Rate |
$1,974.73 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$168.21
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$934.20
|
| Rate for Payer: Amerigroup Medicare |
$934.20
|
| Rate for Payer: BCBS of TX Blue Advantage |
$1,275.68
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,527.76
|
| Rate for Payer: BCBS of TX Medicare |
$934.20
|
| Rate for Payer: BCBS of TX PPO |
$1,924.98
|
| Rate for Payer: Cash Price |
$1,270.92
|
| Rate for Payer: Cash Price |
$1,270.92
|
| Rate for Payer: Cash Price |
$1,270.92
|
| Rate for Payer: Cigna Commercial |
$1,974.73
|
| Rate for Payer: Cigna Medicaid |
$1,345.68
|
| Rate for Payer: Cigna Medicare |
$934.20
|
| Rate for Payer: Employer Direct Commercial |
$934.20
|
| Rate for Payer: Humana Medicare/TRICARE |
$934.20
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,345.68
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$934.20
|
| Rate for Payer: Molina Medicare |
$934.20
|
| Rate for Payer: Multiplan Auto |
$1,214.85
|
| Rate for Payer: Multiplan Commercial |
$1,214.85
|
| Rate for Payer: Multiplan Workers Comp |
$1,214.85
|
| Rate for Payer: Parkland Medicaid |
$1,345.68
|
| Rate for Payer: Scott and White EPO/PPO |
$125.46
|
| Rate for Payer: Scott and White Medicare |
$934.20
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,345.68
|
| Rate for Payer: Superior Health Plan EPO |
$934.20
|
| Rate for Payer: Superior Health Plan Medicare |
$934.20
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$934.20
|
| Rate for Payer: Universal American Medicare |
$934.20
|
| Rate for Payer: Wellcare Medicare |
$934.20
|
| Rate for Payer: Wellmed Medicare |
$934.20
|
|
|
ED ID Body Site -> Peritonsillar
|
Facility
|
IP
|
$1,336.00
|
|
|
Service Code
|
HCPCS 42700
|
| Hospital Charge Code |
9250040
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$908.48
|
|
|
ED ID Body Site -> Peritonsillar
|
Facility
|
OP
|
$1,336.00
|
|
|
Service Code
|
HCPCS 42700
|
| Hospital Charge Code |
9250040
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$120.24 |
| Max. Negotiated Rate |
$961.92 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$120.24
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$237.93
|
| Rate for Payer: Amerigroup Medicare |
$237.93
|
| Rate for Payer: BCBS of TX Blue Advantage |
$340.08
|
| Rate for Payer: BCBS of TX Blue Essentials |
$407.28
|
| Rate for Payer: BCBS of TX Medicare |
$237.93
|
| Rate for Payer: BCBS of TX PPO |
$513.17
|
| Rate for Payer: Cash Price |
$908.48
|
| Rate for Payer: Cash Price |
$908.48
|
| Rate for Payer: Cash Price |
$908.48
|
| Rate for Payer: Cigna Commercial |
$502.95
|
| Rate for Payer: Cigna Medicaid |
$961.92
|
| Rate for Payer: Cigna Medicare |
$237.93
|
| Rate for Payer: Employer Direct Commercial |
$237.93
|
| Rate for Payer: Humana Medicare/TRICARE |
$237.93
|
| Rate for Payer: Molina CHIP/Medicaid |
$961.92
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$237.93
|
| Rate for Payer: Molina Medicare |
$237.93
|
| Rate for Payer: Multiplan Auto |
$868.40
|
| Rate for Payer: Multiplan Commercial |
$868.40
|
| Rate for Payer: Multiplan Workers Comp |
$868.40
|
| Rate for Payer: Parkland Medicaid |
$961.92
|
| Rate for Payer: Scott and White EPO/PPO |
$168.75
|
| Rate for Payer: Scott and White Medicare |
$237.93
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$961.92
|
| Rate for Payer: Superior Health Plan EPO |
$237.93
|
| Rate for Payer: Superior Health Plan Medicare |
$237.93
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$237.93
|
| Rate for Payer: Universal American Medicare |
$237.93
|
| Rate for Payer: Wellcare Medicare |
$237.93
|
| Rate for Payer: Wellmed Medicare |
$237.93
|
|
|
ED ID Body Site -> Pilonidal cyst, multiple
|
Facility
|
OP
|
$1,780.00
|
|
|
Service Code
|
HCPCS 10081
|
| Hospital Charge Code |
5202537
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$160.20 |
| Max. Negotiated Rate |
$1,503.68 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$160.20
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$711.36
|
| Rate for Payer: Amerigroup Medicare |
$711.36
|
| Rate for Payer: BCBS of TX Blue Advantage |
$348.36
|
| Rate for Payer: BCBS of TX Blue Essentials |
$417.20
|
| Rate for Payer: BCBS of TX Medicare |
$711.36
|
| Rate for Payer: BCBS of TX PPO |
$525.67
|
| Rate for Payer: Cash Price |
$1,210.40
|
| Rate for Payer: Cash Price |
$1,210.40
|
| Rate for Payer: Cash Price |
$1,210.40
|
| Rate for Payer: Cigna Commercial |
$1,503.68
|
| Rate for Payer: Cigna Medicaid |
$1,281.60
|
| 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 |
$1,281.60
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$711.36
|
| Rate for Payer: Molina Medicare |
$711.36
|
| Rate for Payer: Multiplan Auto |
$1,157.00
|
| Rate for Payer: Multiplan Commercial |
$1,157.00
|
| Rate for Payer: Multiplan Workers Comp |
$1,157.00
|
| Rate for Payer: Parkland Medicaid |
$1,281.60
|
| Rate for Payer: Scott and White EPO/PPO |
$210.18
|
| Rate for Payer: Scott and White Medicare |
$711.36
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,281.60
|
| 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 ID Body Site -> Pilonidal cyst, multiple
|
Facility
|
IP
|
$1,780.00
|
|
|
Service Code
|
HCPCS 10081
|
| Hospital Charge Code |
5202537
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$1,210.40
|
|
|
ED ID Body Site -> Pilonidal cyst, single
|
Facility
|
OP
|
$266.00
|
|
|
Service Code
|
HCPCS 10080
|
| Hospital Charge Code |
5202536
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$23.94 |
| Max. Negotiated Rate |
$1,503.68 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$23.94
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$711.36
|
| Rate for Payer: Amerigroup Medicare |
$711.36
|
| Rate for Payer: BCBS of TX Blue Advantage |
$276.03
|
| Rate for Payer: BCBS of TX Blue Essentials |
$330.58
|
| Rate for Payer: BCBS of TX Medicare |
$711.36
|
| Rate for Payer: BCBS of TX PPO |
$416.53
|
| Rate for Payer: Cash Price |
$180.88
|
| Rate for Payer: Cash Price |
$180.88
|
| Rate for Payer: Cash Price |
$180.88
|
| Rate for Payer: Cigna Commercial |
$1,503.68
|
| Rate for Payer: Cigna Medicaid |
$191.52
|
| 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 |
$191.52
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$711.36
|
| Rate for Payer: Molina Medicare |
$711.36
|
| Rate for Payer: Multiplan Auto |
$172.90
|
| Rate for Payer: Multiplan Commercial |
$172.90
|
| Rate for Payer: Multiplan Workers Comp |
$172.90
|
| Rate for Payer: Parkland Medicaid |
$191.52
|
| Rate for Payer: Scott and White EPO/PPO |
$130.20
|
| Rate for Payer: Scott and White Medicare |
$711.36
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$191.52
|
| 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 ID Body Site -> Pilonidal cyst, single
|
Facility
|
IP
|
$266.00
|
|
|
Service Code
|
HCPCS 10080
|
| Hospital Charge Code |
5202536
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$180.88
|
|
|
ED ID Body Site -> Scrotal Space
|
Facility
|
OP
|
$7,660.00
|
|
|
Service Code
|
HCPCS 54700
|
| Hospital Charge Code |
5202542
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$262.26 |
| Max. Negotiated Rate |
$5,515.20 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$689.40
|
| 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 |
$5,208.80
|
| Rate for Payer: Cash Price |
$5,208.80
|
| Rate for Payer: Cash Price |
$5,208.80
|
| Rate for Payer: Cigna Commercial |
$4,438.84
|
| Rate for Payer: Cigna Medicaid |
$5,515.20
|
| 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 |
$5,515.20
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$2,099.91
|
| Rate for Payer: Molina Medicare |
$2,099.91
|
| Rate for Payer: Multiplan Auto |
$4,979.00
|
| Rate for Payer: Multiplan Commercial |
$4,979.00
|
| Rate for Payer: Multiplan Workers Comp |
$4,979.00
|
| Rate for Payer: Parkland Medicaid |
$5,515.20
|
| Rate for Payer: Scott and White EPO/PPO |
$262.26
|
| Rate for Payer: Scott and White Medicare |
$2,099.91
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$5,515.20
|
| 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 ID Body Site -> Scrotal Space
|
Facility
|
IP
|
$7,660.00
|
|
|
Service Code
|
HCPCS 54700
|
| Hospital Charge Code |
5202542
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$5,208.80
|
|
|
ED ID Body Site -> Vestibule of Mouth, Simple
|
Facility
|
IP
|
$1,175.00
|
|
|
Service Code
|
HCPCS 40800
|
| Hospital Charge Code |
8914604
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$799.00
|
|
|
ED ID Body Site -> Vestibule of Mouth, Simple
|
Facility
|
OP
|
$1,175.00
|
|
|
Service Code
|
HCPCS 40800
|
| Hospital Charge Code |
8914604
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$105.75 |
| Max. Negotiated Rate |
$1,503.68 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$105.75
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$711.36
|
| Rate for Payer: Amerigroup Medicare |
$711.36
|
| Rate for Payer: BCBS of TX Blue Advantage |
$277.84
|
| Rate for Payer: BCBS of TX Blue Essentials |
$332.74
|
| Rate for Payer: BCBS of TX Medicare |
$711.36
|
| Rate for Payer: BCBS of TX PPO |
$419.25
|
| Rate for Payer: Cash Price |
$799.00
|
| Rate for Payer: Cash Price |
$799.00
|
| Rate for Payer: Cash Price |
$799.00
|
| Rate for Payer: Cigna Commercial |
$1,503.68
|
| Rate for Payer: Cigna Medicaid |
$846.00
|
| 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 |
$846.00
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$711.36
|
| Rate for Payer: Molina Medicare |
$711.36
|
| Rate for Payer: Multiplan Auto |
$763.75
|
| Rate for Payer: Multiplan Commercial |
$763.75
|
| Rate for Payer: Multiplan Workers Comp |
$763.75
|
| Rate for Payer: Parkland Medicaid |
$846.00
|
| Rate for Payer: Scott and White EPO/PPO |
$147.06
|
| Rate for Payer: Scott and White Medicare |
$711.36
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$846.00
|
| 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 ID Body Site -> Vulva/Perineum
|
Facility
|
OP
|
$1,052.00
|
|
|
Service Code
|
HCPCS 56405
|
| Hospital Charge Code |
8682618
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$94.68 |
| Max. Negotiated Rate |
$757.44 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$94.68
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$306.12
|
| Rate for Payer: Amerigroup Medicare |
$306.12
|
| Rate for Payer: BCBS of TX Blue Advantage |
$116.92
|
| Rate for Payer: BCBS of TX Blue Essentials |
$140.02
|
| Rate for Payer: BCBS of TX Medicare |
$306.12
|
| Rate for Payer: BCBS of TX PPO |
$176.43
|
| Rate for Payer: Cash Price |
$715.36
|
| Rate for Payer: Cash Price |
$715.36
|
| Rate for Payer: Cash Price |
$715.36
|
| Rate for Payer: Cigna Commercial |
$647.08
|
| Rate for Payer: Cigna Medicaid |
$757.44
|
| Rate for Payer: Cigna Medicare |
$306.12
|
| Rate for Payer: Employer Direct Commercial |
$306.12
|
| Rate for Payer: Humana Medicare/TRICARE |
$306.12
|
| Rate for Payer: Molina CHIP/Medicaid |
$757.44
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$306.12
|
| Rate for Payer: Molina Medicare |
$306.12
|
| Rate for Payer: Multiplan Auto |
$683.80
|
| Rate for Payer: Multiplan Commercial |
$683.80
|
| Rate for Payer: Multiplan Workers Comp |
$683.80
|
| Rate for Payer: Parkland Medicaid |
$757.44
|
| Rate for Payer: Scott and White EPO/PPO |
$157.60
|
| Rate for Payer: Scott and White Medicare |
$306.12
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$757.44
|
| Rate for Payer: Superior Health Plan EPO |
$306.12
|
| Rate for Payer: Superior Health Plan Medicare |
$306.12
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$306.12
|
| Rate for Payer: Universal American Medicare |
$306.12
|
| Rate for Payer: Wellcare Medicare |
$306.12
|
| Rate for Payer: Wellmed Medicare |
$306.12
|
|
|
ED ID Body Site -> Vulva/Perineum
|
Facility
|
IP
|
$1,052.00
|
|
|
Service Code
|
HCPCS 56405
|
| Hospital Charge Code |
8682618
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$715.36
|
|
|
ED ID Drainage -> Eyelid
|
Facility
|
IP
|
$4,866.00
|
|
|
Service Code
|
HCPCS 67700
|
| Hospital Charge Code |
5202546
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$3,308.88
|
|
|
ED ID Drainage -> Eyelid
|
Facility
|
OP
|
$4,866.00
|
|
|
Service Code
|
HCPCS 67700
|
| Hospital Charge Code |
5202546
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$142.66 |
| Max. Negotiated Rate |
$3,503.52 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$437.94
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$318.85
|
| Rate for Payer: Amerigroup Medicare |
$318.85
|
| Rate for Payer: BCBS of TX Blue Advantage |
$228.26
|
| Rate for Payer: BCBS of TX Blue Essentials |
$273.36
|
| Rate for Payer: BCBS of TX Medicare |
$318.85
|
| Rate for Payer: BCBS of TX PPO |
$344.43
|
| Rate for Payer: Cash Price |
$3,308.88
|
| Rate for Payer: Cash Price |
$3,308.88
|
| Rate for Payer: Cash Price |
$3,308.88
|
| Rate for Payer: Cigna Commercial |
$673.99
|
| Rate for Payer: Cigna Medicaid |
$3,503.52
|
| Rate for Payer: Cigna Medicare |
$318.85
|
| Rate for Payer: Employer Direct Commercial |
$318.85
|
| Rate for Payer: Humana Medicare/TRICARE |
$318.85
|
| Rate for Payer: Molina CHIP/Medicaid |
$3,503.52
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$318.85
|
| Rate for Payer: Molina Medicare |
$318.85
|
| Rate for Payer: Multiplan Auto |
$3,162.90
|
| Rate for Payer: Multiplan Commercial |
$3,162.90
|
| Rate for Payer: Multiplan Workers Comp |
$3,162.90
|
| Rate for Payer: Parkland Medicaid |
$3,503.52
|
| Rate for Payer: Scott and White EPO/PPO |
$142.66
|
| Rate for Payer: Scott and White Medicare |
$318.85
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$3,503.52
|
| Rate for Payer: Superior Health Plan EPO |
$318.85
|
| Rate for Payer: Superior Health Plan Medicare |
$318.85
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$318.85
|
| Rate for Payer: Universal American Medicare |
$318.85
|
| Rate for Payer: Wellcare Medicare |
$318.85
|
| Rate for Payer: Wellmed Medicare |
$318.85
|
|
|
ED ID Drainage -> Nose, Internal
|
Facility
|
OP
|
$1,990.00
|
|
|
Service Code
|
HCPCS 30000
|
| Hospital Charge Code |
5202543
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$150.34 |
| Max. Negotiated Rate |
$1,432.80 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$179.10
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$237.93
|
| Rate for Payer: Amerigroup Medicare |
$237.93
|
| Rate for Payer: BCBS of TX Blue Advantage |
$171.83
|
| Rate for Payer: BCBS of TX Blue Essentials |
$205.78
|
| Rate for Payer: BCBS of TX Medicare |
$237.93
|
| Rate for Payer: BCBS of TX PPO |
$259.28
|
| Rate for Payer: Cash Price |
$1,353.20
|
| Rate for Payer: Cash Price |
$1,353.20
|
| Rate for Payer: Cash Price |
$1,353.20
|
| Rate for Payer: Cigna Commercial |
$502.95
|
| Rate for Payer: Cigna Medicaid |
$1,432.80
|
| Rate for Payer: Cigna Medicare |
$237.93
|
| Rate for Payer: Employer Direct Commercial |
$237.93
|
| Rate for Payer: Humana Medicare/TRICARE |
$237.93
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,432.80
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$237.93
|
| Rate for Payer: Molina Medicare |
$237.93
|
| Rate for Payer: Multiplan Auto |
$1,293.50
|
| Rate for Payer: Multiplan Commercial |
$1,293.50
|
| Rate for Payer: Multiplan Workers Comp |
$1,293.50
|
| Rate for Payer: Parkland Medicaid |
$1,432.80
|
| Rate for Payer: Scott and White EPO/PPO |
$150.34
|
| Rate for Payer: Scott and White Medicare |
$237.93
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,432.80
|
| Rate for Payer: Superior Health Plan EPO |
$237.93
|
| Rate for Payer: Superior Health Plan Medicare |
$237.93
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$237.93
|
| Rate for Payer: Universal American Medicare |
$237.93
|
| Rate for Payer: Wellcare Medicare |
$237.93
|
| Rate for Payer: Wellmed Medicare |
$237.93
|
|
|
ED ID Drainage -> Nose, Internal
|
Facility
|
IP
|
$1,990.00
|
|
|
Service Code
|
HCPCS 30000
|
| Hospital Charge Code |
5202543
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$1,353.20
|
|
|
ED ID Drainage -> Roof of Mouth
|
Facility
|
OP
|
$838.00
|
|
|
Service Code
|
HCPCS 42000
|
| Hospital Charge Code |
5202544
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$75.42 |
| Max. Negotiated Rate |
$603.36 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$75.42
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$237.93
|
| Rate for Payer: Amerigroup Medicare |
$237.93
|
| Rate for Payer: BCBS of TX Blue Advantage |
$340.08
|
| Rate for Payer: BCBS of TX Blue Essentials |
$407.28
|
| Rate for Payer: BCBS of TX Medicare |
$237.93
|
| Rate for Payer: BCBS of TX PPO |
$513.17
|
| Rate for Payer: Cash Price |
$569.84
|
| Rate for Payer: Cash Price |
$569.84
|
| Rate for Payer: Cash Price |
$569.84
|
| Rate for Payer: Cigna Commercial |
$502.95
|
| Rate for Payer: Cigna Medicaid |
$603.36
|
| Rate for Payer: Cigna Medicare |
$237.93
|
| Rate for Payer: Employer Direct Commercial |
$237.93
|
| Rate for Payer: Humana Medicare/TRICARE |
$237.93
|
| Rate for Payer: Molina CHIP/Medicaid |
$603.36
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$237.93
|
| Rate for Payer: Molina Medicare |
$237.93
|
| Rate for Payer: Multiplan Auto |
$544.70
|
| Rate for Payer: Multiplan Commercial |
$544.70
|
| Rate for Payer: Multiplan Workers Comp |
$544.70
|
| Rate for Payer: Parkland Medicaid |
$603.36
|
| Rate for Payer: Scott and White EPO/PPO |
$135.62
|
| Rate for Payer: Scott and White Medicare |
$237.93
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$603.36
|
| Rate for Payer: Superior Health Plan EPO |
$237.93
|
| Rate for Payer: Superior Health Plan Medicare |
$237.93
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$237.93
|
| Rate for Payer: Universal American Medicare |
$237.93
|
| Rate for Payer: Wellcare Medicare |
$237.93
|
| Rate for Payer: Wellmed Medicare |
$237.93
|
|
|
ED ID Drainage -> Roof of Mouth
|
Facility
|
IP
|
$838.00
|
|
|
Service Code
|
HCPCS 42000
|
| Hospital Charge Code |
5202544
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$569.84
|
|
|
ED ID Drainage -> Scrotal Wall
|
Facility
|
OP
|
$2,714.00
|
|
|
Service Code
|
HCPCS 55100
|
| Hospital Charge Code |
5202545
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$207.45 |
| 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 |
$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 |
$1,845.52
|
| 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 |
$207.45
|
| 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 ID Drainage -> Scrotal Wall
|
Facility
|
IP
|
$2,714.00
|
|
|
Service Code
|
HCPCS 55100
|
| Hospital Charge Code |
5202545
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$1,845.52
|
|
|
ED I & D OF VULVA/PERINEUM ABSCESS BCE
|
Facility
|
IP
|
$1,052.00
|
|
|
Service Code
|
HCPCS 56405
|
| Hospital Charge Code |
8414459
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$715.36
|
|
