|
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, peripheral
|
Facility
|
OP
|
$1,261.00
|
|
|
Service Code
|
HCPCS 64450
|
| Hospital Charge Code |
6110415
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$80.76 |
| 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 |
$630.50
|
| 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, 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 -> 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 |
$267.50
|
| 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 -> Sacroiliac Joint Arthrography
|
Facility
|
OP
|
$2,500.00
|
|
|
Service Code
|
HCPCS 27096
|
| Hospital Charge Code |
5202549
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$143.24 |
| 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 |
$1,250.00
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,800.00
|
| Rate for Payer: Superior Health Plan EPO |
$340.00
|
|
|
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 -> 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 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 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 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 |
$881.91
|
| 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 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 |
$354.87 |
| 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 |
$1,971.50
|
| 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 |
$443.50
|
| 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
|
|
|
ED Laceration Complex - Eye/Ear/Nose/Lip -> 1.1 to 2.5 cm
|
Facility
|
OP
|
$1,558.00
|
|
|
Service Code
|
HCPCS 13151
|
| Hospital Charge Code |
9250776
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$140.22 |
| Max. Negotiated Rate |
$1,569.38 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$140.22
|
| 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 |
$1,059.44
|
| Rate for Payer: Cash Price |
$1,059.44
|
| Rate for Payer: Cash Price |
$1,059.44
|
| Rate for Payer: Cigna Commercial |
$1,569.38
|
| Rate for Payer: Cigna Medicaid |
$1,121.76
|
| 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 |
$1,121.76
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$742.44
|
| Rate for Payer: Molina Medicare |
$742.44
|
| Rate for Payer: Multiplan Auto |
$1,012.70
|
| Rate for Payer: Multiplan Commercial |
$1,012.70
|
| Rate for Payer: Multiplan Workers Comp |
$1,012.70
|
| Rate for Payer: Parkland Medicaid |
$1,121.76
|
| Rate for Payer: Scott and White EPO/PPO |
$779.00
|
| Rate for Payer: Scott and White Medicare |
$742.44
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,121.76
|
| 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 Laceration Complex - Eye/Ear/Nose/Lip -> 1.1 to 2.5 cm
|
Facility
|
IP
|
$1,558.00
|
|
|
Service Code
|
HCPCS 13151
|
| Hospital Charge Code |
9250776
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$1,059.44
|
|
|
ED Laceration Complex - Eye/Ear/Nose/Lip -> 2.6 to 7.5 cm
|
Facility
|
OP
|
$1,597.00
|
|
|
Service Code
|
HCPCS 13152
|
| Hospital Charge Code |
8912632
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$143.73 |
| Max. Negotiated Rate |
$1,569.38 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$143.73
|
| 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 |
$1,085.96
|
| Rate for Payer: Cash Price |
$1,085.96
|
| Rate for Payer: Cash Price |
$1,085.96
|
| Rate for Payer: Cigna Commercial |
$1,569.38
|
| Rate for Payer: Cigna Medicaid |
$1,149.84
|
| 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 |
$1,149.84
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$742.44
|
| Rate for Payer: Molina Medicare |
$742.44
|
| Rate for Payer: Multiplan Auto |
$1,038.05
|
| Rate for Payer: Multiplan Commercial |
$1,038.05
|
| Rate for Payer: Multiplan Workers Comp |
$1,038.05
|
| Rate for Payer: Parkland Medicaid |
$1,149.84
|
| Rate for Payer: Scott and White EPO/PPO |
$798.50
|
| Rate for Payer: Scott and White Medicare |
$742.44
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,149.84
|
| 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 Laceration Complex - Eye/Ear/Nose/Lip -> 2.6 to 7.5 cm
|
Facility
|
OP
|
$1,597.00
|
|
|
Service Code
|
HCPCS 13152
|
| Hospital Charge Code |
9250777
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$143.73 |
| Max. Negotiated Rate |
$1,569.38 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$143.73
|
| 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 |
$1,085.96
|
| Rate for Payer: Cash Price |
$1,085.96
|
| Rate for Payer: Cash Price |
$1,085.96
|
| Rate for Payer: Cigna Commercial |
$1,569.38
|
| Rate for Payer: Cigna Medicaid |
$1,149.84
|
| 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 |
$1,149.84
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$742.44
|
| Rate for Payer: Molina Medicare |
$742.44
|
| Rate for Payer: Multiplan Auto |
$1,038.05
|
| Rate for Payer: Multiplan Commercial |
$1,038.05
|
| Rate for Payer: Multiplan Workers Comp |
$1,038.05
|
| Rate for Payer: Parkland Medicaid |
$1,149.84
|
| Rate for Payer: Scott and White EPO/PPO |
$798.50
|
| Rate for Payer: Scott and White Medicare |
$742.44
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,149.84
|
| 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 Laceration Complex - Eye/Ear/Nose/Lip -> 2.6 to 7.5 cm
|
Facility
|
IP
|
$1,597.00
|
|
|
Service Code
|
HCPCS 13152
|
| Hospital Charge Code |
8912632
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$1,085.96
|
|
|
ED Laceration Complex - Eye/Ear/Nose/Lip -> 2.6 to 7.5 cm
|
Facility
|
IP
|
$1,597.00
|
|
|
Service Code
|
HCPCS 13152
|
| Hospital Charge Code |
9250777
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$1,085.96
|
|
|
ED Laceration Complex - Eye/Ear/Nose/Lip -> Each Addl 5 cm
|
Facility
|
IP
|
$2,381.00
|
|
|
Service Code
|
HCPCS 13153
|
| Hospital Charge Code |
5202550
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$1,619.08
|
|
|
ED Laceration Complex - Eye/Ear/Nose/Lip -> Each Addl 5 cm
|
Facility
|
OP
|
$2,381.00
|
|
|
Service Code
|
HCPCS 13153
|
| Hospital Charge Code |
5202550
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$214.29 |
| Max. Negotiated Rate |
$1,714.32 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$214.29
|
| Rate for Payer: BCBS of TX Blue Advantage |
$714.30
|
| Rate for Payer: BCBS of TX Blue Essentials |
$857.16
|
| Rate for Payer: BCBS of TX PPO |
$952.40
|
| Rate for Payer: Cash Price |
$1,619.08
|
| Rate for Payer: Cigna Medicaid |
$1,714.32
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,714.32
|
| Rate for Payer: Multiplan Auto |
$1,547.65
|
| Rate for Payer: Multiplan Commercial |
$1,547.65
|
| Rate for Payer: Multiplan Workers Comp |
$1,547.65
|
| Rate for Payer: Parkland Medicaid |
$1,714.32
|
| Rate for Payer: Scott and White EPO/PPO |
$1,190.50
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,714.32
|
| Rate for Payer: Superior Health Plan EPO |
$323.82
|
|
|
ED LACERATION COMPLEX F/C/C/M/N/AX/G/H/F EA ADDL 5 CM/< BCE
|
Facility
|
IP
|
$2,545.00
|
|
|
Service Code
|
HCPCS 13133
|
| Hospital Charge Code |
8810574
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$1,730.60
|
|
|
ED LACERATION COMPLEX F/C/C/M/N/AX/G/H/F EA ADDL 5 CM/< BCE
|
Facility
|
OP
|
$2,545.00
|
|
|
Service Code
|
HCPCS 13133
|
| Hospital Charge Code |
8810574
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$229.05 |
| Max. Negotiated Rate |
$1,832.40 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$229.05
|
| Rate for Payer: BCBS of TX Blue Advantage |
$763.50
|
| Rate for Payer: BCBS of TX Blue Essentials |
$916.20
|
| Rate for Payer: BCBS of TX PPO |
$1,018.00
|
| Rate for Payer: Cash Price |
$1,730.60
|
| Rate for Payer: Cigna Medicaid |
$1,832.40
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,832.40
|
| Rate for Payer: Multiplan Auto |
$1,654.25
|
| Rate for Payer: Multiplan Commercial |
$1,654.25
|
| Rate for Payer: Multiplan Workers Comp |
$1,654.25
|
| Rate for Payer: Parkland Medicaid |
$1,832.40
|
| Rate for Payer: Scott and White EPO/PPO |
$1,272.50
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,832.40
|
| Rate for Payer: Superior Health Plan EPO |
$346.12
|
|
|
ED Laceration Complex - F/N/H/F/G -> 2.6 to 7.5 cm
|
Facility
|
IP
|
$1,041.00
|
|
|
Service Code
|
HCPCS 13132
|
| Hospital Charge Code |
5202551
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$707.88
|
|
