|
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
|
|
|
ED INCISION THROMBOSED HEMORRHOID EXTERNAL BCE
|
Facility
|
OP
|
$818.00
|
|
|
Service Code
|
HCPCS 46083
|
| Hospital Charge Code |
8712540
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$73.62 |
| Max. Negotiated Rate |
$588.96 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$73.62
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$250.99
|
| Rate for Payer: Amerigroup Medicare |
$250.99
|
| Rate for Payer: BCBS of TX Blue Advantage |
$198.21
|
| Rate for Payer: BCBS of TX Blue Essentials |
$237.38
|
| Rate for Payer: BCBS of TX Medicare |
$250.99
|
| Rate for Payer: BCBS of TX PPO |
$299.10
|
| Rate for Payer: Cash Price |
$556.24
|
| Rate for Payer: Cash Price |
$556.24
|
| Rate for Payer: Cash Price |
$556.24
|
| Rate for Payer: Cigna Commercial |
$530.54
|
| Rate for Payer: Cigna Medicaid |
$588.96
|
| Rate for Payer: Cigna Medicare |
$250.99
|
| Rate for Payer: Employer Direct Commercial |
$250.99
|
| Rate for Payer: Humana Medicare/TRICARE |
$250.99
|
| Rate for Payer: Molina CHIP/Medicaid |
$588.96
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$250.99
|
| Rate for Payer: Molina Medicare |
$250.99
|
| Rate for Payer: Multiplan Auto |
$531.70
|
| Rate for Payer: Multiplan Commercial |
$531.70
|
| Rate for Payer: Multiplan Workers Comp |
$531.70
|
| Rate for Payer: Parkland Medicaid |
$588.96
|
| Rate for Payer: Scott and White EPO/PPO |
$136.05
|
| Rate for Payer: Scott and White Medicare |
$250.99
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$588.96
|
| Rate for Payer: Superior Health Plan EPO |
$250.99
|
| Rate for Payer: Superior Health Plan Medicare |
$250.99
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$250.99
|
| Rate for Payer: Universal American Medicare |
$250.99
|
| Rate for Payer: Wellcare Medicare |
$250.99
|
| Rate for Payer: Wellmed Medicare |
$250.99
|
|
|
ED INCISION THROMBOSED HEMORRHOID EXTERNAL BCE
|
Facility
|
IP
|
$818.00
|
|
|
Service Code
|
HCPCS 46083
|
| Hospital Charge Code |
8712540
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$556.24
|
|
|
ED Injections/Nerve Block -> Blood patch
|
Facility
|
IP
|
$1,339.00
|
|
|
Service Code
|
HCPCS 62273
|
| Hospital Charge Code |
610025
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$910.52
|
|
|
ED Injections/Nerve Block -> Blood patch
|
Facility
|
OP
|
$1,339.00
|
|
|
Service Code
|
HCPCS 62273
|
| Hospital Charge Code |
610025
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$120.51 |
| Max. Negotiated Rate |
$1,575.13 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$120.51
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$709.10
|
| Rate for Payer: Amerigroup Medicare |
$709.10
|
| Rate for Payer: BCBS of TX Blue Advantage |
$1,043.83
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,250.10
|
| Rate for Payer: BCBS of TX Medicare |
$709.10
|
| Rate for Payer: BCBS of TX PPO |
$1,575.13
|
| Rate for Payer: Cash Price |
$910.52
|
| Rate for Payer: Cash Price |
$910.52
|
| Rate for Payer: Cash Price |
$910.52
|
| Rate for Payer: Cigna Commercial |
$1,498.91
|
| Rate for Payer: Cigna Medicaid |
$964.08
|
| Rate for Payer: Cigna Medicare |
$709.10
|
| Rate for Payer: Employer Direct Commercial |
$709.10
|
| Rate for Payer: Humana Medicare/TRICARE |
$709.10
|
| Rate for Payer: Molina CHIP/Medicaid |
$964.08
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$709.10
|
| Rate for Payer: Molina Medicare |
$709.10
|
| Rate for Payer: Multiplan Auto |
$870.35
|
| Rate for Payer: Multiplan Commercial |
$870.35
|
| Rate for Payer: Multiplan Workers Comp |
$870.35
|
| Rate for Payer: Parkland Medicaid |
$964.08
|
| Rate for Payer: Scott and White EPO/PPO |
$138.09
|
| Rate for Payer: Scott and White Medicare |
$709.10
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$964.08
|
| Rate for Payer: Superior Health Plan EPO |
$709.10
|
| Rate for Payer: Superior Health Plan Medicare |
$709.10
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$709.10
|
| Rate for Payer: Universal American Medicare |
$709.10
|
| Rate for Payer: Wellcare Medicare |
$709.10
|
| Rate for Payer: Wellmed Medicare |
$709.10
|
|
|
ED Injections/Nerve Block -> Injection corpora cavernosa
|
Facility
|
OP
|
$799.00
|
|
|
Service Code
|
HCPCS 54235
|
| Hospital Charge Code |
5202547
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$71.91 |
| Max. Negotiated Rate |
$575.28 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$71.91
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$250.99
|
| Rate for Payer: Amerigroup Medicare |
$250.99
|
| Rate for Payer: BCBS of TX Blue Advantage |
$72.93
|
| Rate for Payer: BCBS of TX Blue Essentials |
$87.34
|
| Rate for Payer: BCBS of TX Medicare |
$250.99
|
| Rate for Payer: BCBS of TX PPO |
$110.05
|
| Rate for Payer: Cash Price |
$543.32
|
| Rate for Payer: Cash Price |
$543.32
|
| Rate for Payer: Cash Price |
$543.32
|
| Rate for Payer: Cigna Commercial |
$530.54
|
| Rate for Payer: Cigna Medicaid |
$575.28
|
| Rate for Payer: Cigna Medicare |
$250.99
|
| Rate for Payer: Employer Direct Commercial |
$250.99
|
| Rate for Payer: Humana Medicare/TRICARE |
$250.99
|
| Rate for Payer: Molina CHIP/Medicaid |
$575.28
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$250.99
|
| Rate for Payer: Molina Medicare |
$250.99
|
| Rate for Payer: Multiplan Auto |
$519.35
|
| Rate for Payer: Multiplan Commercial |
$519.35
|
| Rate for Payer: Multiplan Workers Comp |
$519.35
|
| Rate for Payer: Parkland Medicaid |
$575.28
|
| Rate for Payer: Scott and White EPO/PPO |
$90.49
|
| Rate for Payer: Scott and White Medicare |
$250.99
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$575.28
|
| Rate for Payer: Superior Health Plan EPO |
$250.99
|
| Rate for Payer: Superior Health Plan Medicare |
$250.99
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$250.99
|
| Rate for Payer: Universal American Medicare |
$250.99
|
| Rate for Payer: Wellcare Medicare |
$250.99
|
| Rate for Payer: Wellmed Medicare |
$250.99
|
|
|
ED Injections/Nerve Block -> Injection corpora cavernosa
|
Facility
|
IP
|
$799.00
|
|
|
Service Code
|
HCPCS 54235
|
| Hospital Charge Code |
5202547
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$543.32
|
|
|
ED Injections/Nerve Block -> Injection trigger point
|
Facility
|
OP
|
$744.00
|
|
|
Service Code
|
HCPCS 20552
|
| Hospital Charge Code |
6100192
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$45.02 |
| Max. Negotiated Rate |
$651.79 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$66.96
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$308.35
|
| Rate for Payer: Amerigroup Medicare |
$308.35
|
| Rate for Payer: BCBS of TX Blue Advantage |
$50.63
|
| Rate for Payer: BCBS of TX Blue Essentials |
$60.64
|
| Rate for Payer: BCBS of TX Medicare |
$308.35
|
| Rate for Payer: BCBS of TX PPO |
$76.41
|
| Rate for Payer: Cash Price |
$505.92
|
| Rate for Payer: Cash Price |
$505.92
|
| Rate for Payer: Cash Price |
$505.92
|
| Rate for Payer: Cigna Commercial |
$651.79
|
| Rate for Payer: Cigna Medicaid |
$535.68
|
| 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 |
$535.68
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$308.35
|
| Rate for Payer: Molina Medicare |
$308.35
|
| Rate for Payer: Multiplan Auto |
$483.60
|
| Rate for Payer: Multiplan Commercial |
$483.60
|
| Rate for Payer: Multiplan Workers Comp |
$483.60
|
| Rate for Payer: Parkland Medicaid |
$535.68
|
| Rate for Payer: Scott and White EPO/PPO |
$45.02
|
| Rate for Payer: Scott and White Medicare |
$308.35
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$535.68
|
| 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 Injections/Nerve Block -> Injection trigger point
|
Facility
|
IP
|
$744.00
|
|
|
Service Code
|
HCPCS 20552
|
| Hospital Charge Code |
6100192
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$505.92
|
|
|
ED Injections/Nerve Block -> Lumbar puncture - Diagnostic
|
Facility
|
IP
|
$1,261.00
|
|
|
Service Code
|
HCPCS 62270
|
| Hospital Charge Code |
315358
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$857.48
|
|
|
ED Injections/Nerve Block -> Lumbar puncture - Diagnostic
|
Facility
|
OP
|
$1,261.00
|
|
|
Service Code
|
HCPCS 62270
|
| Hospital Charge Code |
315358
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$77.08 |
| Max. Negotiated Rate |
$1,575.13 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$113.49
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$709.10
|
| Rate for Payer: Amerigroup Medicare |
$709.10
|
| Rate for Payer: BCBS of TX Blue Advantage |
$1,043.83
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,250.10
|
| Rate for Payer: BCBS of TX Medicare |
$709.10
|
| Rate for Payer: BCBS of TX PPO |
$1,575.13
|
| Rate for Payer: Cash Price |
$857.48
|
| Rate for Payer: Cash Price |
$857.48
|
| Rate for Payer: Cash Price |
$857.48
|
| Rate for Payer: Cigna Commercial |
$1,498.91
|
| Rate for Payer: Cigna Medicaid |
$907.92
|
| Rate for Payer: Cigna Medicare |
$709.10
|
| Rate for Payer: Employer Direct Commercial |
$709.10
|
| Rate for Payer: Humana Medicare/TRICARE |
$709.10
|
| Rate for Payer: Molina CHIP/Medicaid |
$907.92
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$709.10
|
| Rate for Payer: Molina Medicare |
$709.10
|
| Rate for Payer: Multiplan Auto |
$819.65
|
| Rate for Payer: Multiplan Commercial |
$819.65
|
| Rate for Payer: Multiplan Workers Comp |
$819.65
|
| Rate for Payer: Parkland Medicaid |
$907.92
|
| Rate for Payer: Scott and White EPO/PPO |
$77.08
|
| Rate for Payer: Scott and White Medicare |
$709.10
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$907.92
|
| Rate for Payer: Superior Health Plan EPO |
$709.10
|
| Rate for Payer: Superior Health Plan Medicare |
$709.10
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$709.10
|
| Rate for Payer: Universal American Medicare |
$709.10
|
| Rate for Payer: Wellcare Medicare |
$709.10
|
| Rate for Payer: Wellmed Medicare |
$709.10
|
|
|
ED Injections/Nerve Block -> Nerve block, peripheral
|
Facility
|
OP
|
$1,261.00
|
|
|
Service Code
|
HCPCS 64450
|
| Hospital Charge Code |
6110415
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$51.16 |
| Max. Negotiated Rate |
$1,498.91 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$113.49
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$709.10
|
| Rate for Payer: Amerigroup Medicare |
$709.10
|
| Rate for Payer: BCBS of TX Blue Advantage |
$80.76
|
| Rate for Payer: BCBS of TX Blue Essentials |
$96.72
|
| Rate for Payer: BCBS of TX Medicare |
$709.10
|
| Rate for Payer: BCBS of TX PPO |
$121.87
|
| Rate for Payer: Cash Price |
$857.48
|
| Rate for Payer: Cash Price |
$857.48
|
| Rate for Payer: Cash Price |
$857.48
|
| Rate for Payer: Cigna Commercial |
$1,498.91
|
| Rate for Payer: Cigna Medicaid |
$907.92
|
| Rate for Payer: Cigna Medicare |
$709.10
|
| Rate for Payer: Employer Direct Commercial |
$709.10
|
| Rate for Payer: Humana Medicare/TRICARE |
$709.10
|
| Rate for Payer: Molina CHIP/Medicaid |
$907.92
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$709.10
|
| Rate for Payer: Molina Medicare |
$709.10
|
| Rate for Payer: Multiplan Auto |
$819.65
|
| Rate for Payer: Multiplan Commercial |
$819.65
|
| Rate for Payer: Multiplan Workers Comp |
$819.65
|
| Rate for Payer: Parkland Medicaid |
$907.92
|
| Rate for Payer: Scott and White EPO/PPO |
$51.16
|
| Rate for Payer: Scott and White Medicare |
$709.10
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$907.92
|
| Rate for Payer: Superior Health Plan EPO |
$709.10
|
| Rate for Payer: Superior Health Plan Medicare |
$709.10
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$709.10
|
| Rate for Payer: Universal American Medicare |
$709.10
|
| Rate for Payer: Wellcare Medicare |
$709.10
|
| Rate for Payer: Wellmed Medicare |
$709.10
|
|
|
ED Injections/Nerve Block -> Nerve block, peripheral
|
Facility
|
IP
|
$1,261.00
|
|
|
Service Code
|
HCPCS 64450
|
| Hospital Charge Code |
6110415
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$857.48
|
|
|
ED Injections/Nerve Block -> Nerve block, trigeminal
|
Facility
|
OP
|
$535.00
|
|
|
Service Code
|
HCPCS 64400
|
| Hospital Charge Code |
5202548
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$48.15 |
| Max. Negotiated Rate |
$651.79 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$48.15
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$308.35
|
| Rate for Payer: Amerigroup Medicare |
$308.35
|
| Rate for Payer: BCBS of TX Blue Advantage |
$127.77
|
| Rate for Payer: BCBS of TX Blue Essentials |
$153.02
|
| Rate for Payer: BCBS of TX Medicare |
$308.35
|
| Rate for Payer: BCBS of TX PPO |
$192.81
|
| Rate for Payer: Cash Price |
$363.80
|
| Rate for Payer: Cash Price |
$363.80
|
| Rate for Payer: Cash Price |
$363.80
|
| Rate for Payer: Cigna Commercial |
$651.79
|
| Rate for Payer: Cigna Medicaid |
$385.20
|
| 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 |
$385.20
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$308.35
|
| Rate for Payer: Molina Medicare |
$308.35
|
| Rate for Payer: Multiplan Auto |
$347.75
|
| Rate for Payer: Multiplan Commercial |
$347.75
|
| Rate for Payer: Multiplan Workers Comp |
$347.75
|
| Rate for Payer: Parkland Medicaid |
$385.20
|
| Rate for Payer: Scott and White EPO/PPO |
$62.89
|
| Rate for Payer: Scott and White Medicare |
$308.35
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$385.20
|
| 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 Injections/Nerve Block -> Nerve block, trigeminal
|
Facility
|
IP
|
$535.00
|
|
|
Service Code
|
HCPCS 64400
|
| Hospital Charge Code |
5202548
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$363.80
|
|
|
ED Injections/Nerve Block -> Sacroiliac Joint Arthrography
|
Facility
|
IP
|
$2,500.00
|
|
|
Service Code
|
HCPCS 27096
|
| Hospital Charge Code |
5202549
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$1,700.00
|
|
|
ED Injections/Nerve Block -> Sacroiliac Joint Arthrography
|
Facility
|
OP
|
$2,500.00
|
|
|
Service Code
|
HCPCS 27096
|
| Hospital Charge Code |
5202549
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$101.30 |
| Max. Negotiated Rate |
$1,800.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$225.00
|
| Rate for Payer: BCBS of TX Blue Advantage |
$143.24
|
| Rate for Payer: BCBS of TX Blue Essentials |
$171.54
|
| Rate for Payer: BCBS of TX PPO |
$216.14
|
| Rate for Payer: Cash Price |
$1,700.00
|
| Rate for Payer: Cash Price |
$1,700.00
|
| Rate for Payer: Cigna Medicaid |
$1,800.00
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,800.00
|
| Rate for Payer: Multiplan Auto |
$1,625.00
|
| Rate for Payer: Multiplan Commercial |
$1,625.00
|
| Rate for Payer: Multiplan Workers Comp |
$1,625.00
|
| Rate for Payer: Parkland Medicaid |
$1,800.00
|
| Rate for Payer: Scott and White EPO/PPO |
$101.30
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,800.00
|
| Rate for Payer: Superior Health Plan EPO |
$340.00
|
|
|
ED Injections/Nerve Block -> Thrombolytic Administration
|
Facility
|
IP
|
$2,917.00
|
|
|
Service Code
|
HCPCS 37195
|
| Hospital Charge Code |
5202590
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$1,983.56
|
|
|
ED Injections/Nerve Block -> Thrombolytic Administration
|
Facility
|
OP
|
$2,917.00
|
|
|
Service Code
|
HCPCS 37195
|
| Hospital Charge Code |
5202590
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$262.53 |
| Max. Negotiated Rate |
$2,100.24 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$262.53
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$331.81
|
| Rate for Payer: Amerigroup Medicare |
$331.81
|
| Rate for Payer: BCBS of TX Blue Advantage |
$517.03
|
| Rate for Payer: BCBS of TX Blue Essentials |
$619.20
|
| Rate for Payer: BCBS of TX Medicare |
$331.81
|
| Rate for Payer: BCBS of TX PPO |
$780.19
|
| Rate for Payer: Cash Price |
$1,983.56
|
| Rate for Payer: Cash Price |
$1,983.56
|
| Rate for Payer: Cash Price |
$1,983.56
|
| Rate for Payer: Cigna Commercial |
$701.38
|
| Rate for Payer: Cigna Medicaid |
$2,100.24
|
| Rate for Payer: Cigna Medicare |
$331.81
|
| Rate for Payer: Employer Direct Commercial |
$331.81
|
| Rate for Payer: Humana Medicare/TRICARE |
$331.81
|
| Rate for Payer: Molina CHIP/Medicaid |
$2,100.24
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$331.81
|
| Rate for Payer: Molina Medicare |
$331.81
|
| Rate for Payer: Multiplan Auto |
$1,896.05
|
| Rate for Payer: Multiplan Commercial |
$1,896.05
|
| Rate for Payer: Multiplan Workers Comp |
$1,896.05
|
| Rate for Payer: Parkland Medicaid |
$2,100.24
|
| Rate for Payer: Scott and White EPO/PPO |
$1,458.50
|
| Rate for Payer: Scott and White Medicare |
$331.81
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$2,100.24
|
| Rate for Payer: Superior Health Plan EPO |
$331.81
|
| Rate for Payer: Superior Health Plan Medicare |
$331.81
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$331.81
|
| Rate for Payer: Universal American Medicare |
$331.81
|
| Rate for Payer: Wellcare Medicare |
$331.81
|
| Rate for Payer: Wellmed Medicare |
$331.81
|
|
|
ED INTMD RPR FACE/MM 7.6-12.5CM BCE
|
Facility
|
OP
|
$1,763.83
|
|
|
Service Code
|
HCPCS 12054
|
| Hospital Charge Code |
8846543
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$158.74 |
| Max. Negotiated Rate |
$1,269.96 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$158.74
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$408.37
|
| Rate for Payer: Amerigroup Medicare |
$408.37
|
| Rate for Payer: BCBS of TX Blue Advantage |
$533.58
|
| Rate for Payer: BCBS of TX Blue Essentials |
$639.02
|
| Rate for Payer: BCBS of TX Medicare |
$408.37
|
| Rate for Payer: BCBS of TX PPO |
$805.17
|
| Rate for Payer: Cash Price |
$1,199.40
|
| Rate for Payer: Cash Price |
$1,199.40
|
| Rate for Payer: Cash Price |
$1,199.40
|
| Rate for Payer: Cigna Commercial |
$863.21
|
| Rate for Payer: Cigna Medicaid |
$1,269.96
|
| 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 |
$1,269.96
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$408.37
|
| Rate for Payer: Molina Medicare |
$408.37
|
| Rate for Payer: Multiplan Auto |
$1,146.49
|
| Rate for Payer: Multiplan Commercial |
$1,146.49
|
| Rate for Payer: Multiplan Workers Comp |
$1,146.49
|
| Rate for Payer: Parkland Medicaid |
$1,269.96
|
| Rate for Payer: Scott and White EPO/PPO |
$269.43
|
| Rate for Payer: Scott and White Medicare |
$408.37
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,269.96
|
| 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 INTMD RPR FACE/MM 7.6-12.5CM BCE
|
Facility
|
IP
|
$1,763.83
|
|
|
Service Code
|
HCPCS 12054
|
| Hospital Charge Code |
8846543
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$1,199.40
|
|
|
ED INTMD RPR N-HF/GENIT7.6-12.5 BCE
|
Facility
|
IP
|
$3,943.00
|
|
|
Service Code
|
HCPCS 12044
|
| Hospital Charge Code |
8926659
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$2,681.24
|
|
|
ED INTMD RPR N-HF/GENIT7.6-12.5 BCE
|
Facility
|
OP
|
$3,943.00
|
|
|
Service Code
|
HCPCS 12044
|
| Hospital Charge Code |
8926659
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$262.74 |
| Max. Negotiated Rate |
$2,838.96 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$354.87
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$742.44
|
| Rate for Payer: Amerigroup Medicare |
$742.44
|
| Rate for Payer: BCBS of TX Blue Advantage |
$830.02
|
| Rate for Payer: BCBS of TX Blue Essentials |
$994.04
|
| Rate for Payer: BCBS of TX Medicare |
$742.44
|
| Rate for Payer: BCBS of TX PPO |
$1,252.49
|
| Rate for Payer: Cash Price |
$2,681.24
|
| Rate for Payer: Cash Price |
$2,681.24
|
| Rate for Payer: Cash Price |
$2,681.24
|
| Rate for Payer: Cigna Commercial |
$1,569.38
|
| Rate for Payer: Cigna Medicaid |
$2,838.96
|
| Rate for Payer: Cigna Medicare |
$742.44
|
| Rate for Payer: Employer Direct Commercial |
$742.44
|
| Rate for Payer: Humana Medicare/TRICARE |
$742.44
|
| Rate for Payer: Molina CHIP/Medicaid |
$2,838.96
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$742.44
|
| Rate for Payer: Molina Medicare |
$742.44
|
| Rate for Payer: Multiplan Auto |
$2,562.95
|
| Rate for Payer: Multiplan Commercial |
$2,562.95
|
| Rate for Payer: Multiplan Workers Comp |
$2,562.95
|
| Rate for Payer: Parkland Medicaid |
$2,838.96
|
| Rate for Payer: Scott and White EPO/PPO |
$262.74
|
| Rate for Payer: Scott and White Medicare |
$742.44
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$2,838.96
|
| Rate for Payer: Superior Health Plan EPO |
$742.44
|
| Rate for Payer: Superior Health Plan Medicare |
$742.44
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$742.44
|
| Rate for Payer: Universal American Medicare |
$742.44
|
| Rate for Payer: Wellcare Medicare |
$742.44
|
| Rate for Payer: Wellmed Medicare |
$742.44
|
|
|
ED IRRIGATION CORPORA CAVERNOSA PRIAPISM BCE
|
Facility
|
OP
|
$887.00
|
|
|
Service Code
|
HCPCS 54220
|
| Hospital Charge Code |
8576625
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$79.83 |
| Max. Negotiated Rate |
$638.64 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$79.83
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$250.99
|
| Rate for Payer: Amerigroup Medicare |
$250.99
|
| Rate for Payer: BCBS of TX Blue Advantage |
$392.28
|
| Rate for Payer: BCBS of TX Blue Essentials |
$469.80
|
| Rate for Payer: BCBS of TX Medicare |
$250.99
|
| Rate for Payer: BCBS of TX PPO |
$591.95
|
| Rate for Payer: Cash Price |
$603.16
|
| Rate for Payer: Cash Price |
$603.16
|
| Rate for Payer: Cash Price |
$603.16
|
| Rate for Payer: Cigna Commercial |
$530.54
|
| Rate for Payer: Cigna Medicaid |
$638.64
|
| Rate for Payer: Cigna Medicare |
$250.99
|
| Rate for Payer: Employer Direct Commercial |
$250.99
|
| Rate for Payer: Humana Medicare/TRICARE |
$250.99
|
| Rate for Payer: Molina CHIP/Medicaid |
$638.64
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$250.99
|
| Rate for Payer: Molina Medicare |
$250.99
|
| Rate for Payer: Multiplan Auto |
$576.55
|
| Rate for Payer: Multiplan Commercial |
$576.55
|
| Rate for Payer: Multiplan Workers Comp |
$576.55
|
| Rate for Payer: Parkland Medicaid |
$638.64
|
| Rate for Payer: Scott and White EPO/PPO |
$163.96
|
| Rate for Payer: Scott and White Medicare |
$250.99
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$638.64
|
| Rate for Payer: Superior Health Plan EPO |
$250.99
|
| Rate for Payer: Superior Health Plan Medicare |
$250.99
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$250.99
|
| Rate for Payer: Universal American Medicare |
$250.99
|
| Rate for Payer: Wellcare Medicare |
$250.99
|
| Rate for Payer: Wellmed Medicare |
$250.99
|
|
|
ED IRRIGATION CORPORA CAVERNOSA PRIAPISM BCE
|
Facility
|
IP
|
$887.00
|
|
|
Service Code
|
HCPCS 54220
|
| Hospital Charge Code |
8576625
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$603.16
|
|
