|
ED Laceration Simple - Face -> 20.1 to 30.0 cm
|
Facility
|
IP
|
$1,383.00
|
|
|
Service Code
|
HCPCS 12017
|
| Hospital Charge Code |
5202566
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$940.44
|
|
|
ED Laceration Simple - Face -> 20.1 to 30.0 cm
|
Facility
|
OP
|
$1,383.00
|
|
|
Service Code
|
HCPCS 12017
|
| Hospital Charge Code |
5202566
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$124.47 |
| Max. Negotiated Rate |
$995.76 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$124.47
|
| 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 |
$940.44
|
| Rate for Payer: Cash Price |
$940.44
|
| Rate for Payer: Cash Price |
$940.44
|
| Rate for Payer: Cigna Commercial |
$863.21
|
| Rate for Payer: Cigna Medicaid |
$995.76
|
| 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 |
$995.76
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$408.37
|
| Rate for Payer: Molina Medicare |
$408.37
|
| Rate for Payer: Multiplan Auto |
$898.95
|
| Rate for Payer: Multiplan Commercial |
$898.95
|
| Rate for Payer: Multiplan Workers Comp |
$898.95
|
| Rate for Payer: Parkland Medicaid |
$995.76
|
| Rate for Payer: Scott and White EPO/PPO |
$691.50
|
| Rate for Payer: Scott and White Medicare |
$408.37
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$995.76
|
| 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 Laceration Simple - Face -> <= 2.5 cm
|
Facility
|
IP
|
$641.00
|
|
|
Service Code
|
HCPCS 12011
|
| Hospital Charge Code |
9240524
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$435.88
|
|
|
ED Laceration Simple - Face -> <= 2.5 cm
|
Facility
|
OP
|
$641.00
|
|
|
Service Code
|
HCPCS 12011
|
| Hospital Charge Code |
9240524
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$57.69 |
| Max. Negotiated Rate |
$461.52 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$57.69
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$201.55
|
| Rate for Payer: Amerigroup Medicare |
$201.55
|
| Rate for Payer: BCBS of TX Blue Advantage |
$291.80
|
| Rate for Payer: BCBS of TX Blue Essentials |
$349.46
|
| Rate for Payer: BCBS of TX Medicare |
$201.55
|
| Rate for Payer: BCBS of TX PPO |
$440.32
|
| Rate for Payer: Cash Price |
$435.88
|
| Rate for Payer: Cash Price |
$435.88
|
| Rate for Payer: Cash Price |
$435.88
|
| Rate for Payer: Cigna Commercial |
$426.04
|
| Rate for Payer: Cigna Medicaid |
$461.52
|
| 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 |
$461.52
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$201.55
|
| Rate for Payer: Molina Medicare |
$201.55
|
| Rate for Payer: Multiplan Auto |
$416.65
|
| Rate for Payer: Multiplan Commercial |
$416.65
|
| Rate for Payer: Multiplan Workers Comp |
$416.65
|
| Rate for Payer: Parkland Medicaid |
$461.52
|
| Rate for Payer: Scott and White EPO/PPO |
$320.50
|
| Rate for Payer: Scott and White Medicare |
$201.55
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$461.52
|
| 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 Laceration Simple - Face -> 2.6 to 5.0 cm
|
Facility
|
IP
|
$793.00
|
|
|
Service Code
|
HCPCS 12013
|
| Hospital Charge Code |
5202564
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$539.24
|
|
|
ED Laceration Simple - Face -> 2.6 to 5.0 cm
|
Facility
|
OP
|
$793.00
|
|
|
Service Code
|
HCPCS 12013
|
| Hospital Charge Code |
5202564
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$71.37 |
| Max. Negotiated Rate |
$570.96 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$71.37
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$201.55
|
| Rate for Payer: Amerigroup Medicare |
$201.55
|
| Rate for Payer: BCBS of TX Blue Advantage |
$291.80
|
| Rate for Payer: BCBS of TX Blue Essentials |
$349.46
|
| Rate for Payer: BCBS of TX Medicare |
$201.55
|
| Rate for Payer: BCBS of TX PPO |
$440.32
|
| Rate for Payer: Cash Price |
$539.24
|
| Rate for Payer: Cash Price |
$539.24
|
| Rate for Payer: Cash Price |
$539.24
|
| Rate for Payer: Cigna Commercial |
$426.04
|
| Rate for Payer: Cigna Medicaid |
$570.96
|
| 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 |
$570.96
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$201.55
|
| Rate for Payer: Molina Medicare |
$201.55
|
| Rate for Payer: Multiplan Auto |
$515.45
|
| Rate for Payer: Multiplan Commercial |
$515.45
|
| Rate for Payer: Multiplan Workers Comp |
$515.45
|
| Rate for Payer: Parkland Medicaid |
$570.96
|
| Rate for Payer: Scott and White EPO/PPO |
$396.50
|
| Rate for Payer: Scott and White Medicare |
$201.55
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$570.96
|
| 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 Laceration Simple - Face -> > 30.0 cm
|
Facility
|
IP
|
$1,570.00
|
|
|
Service Code
|
HCPCS 12018
|
| Hospital Charge Code |
5202567
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$1,067.60
|
|
|
ED Laceration Simple - Face -> > 30.0 cm
|
Facility
|
OP
|
$1,570.00
|
|
|
Service Code
|
HCPCS 12018
|
| Hospital Charge Code |
5202567
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$141.30 |
| Max. Negotiated Rate |
$1,130.40 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$141.30
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$201.55
|
| Rate for Payer: Amerigroup Medicare |
$201.55
|
| Rate for Payer: BCBS of TX Blue Advantage |
$291.80
|
| Rate for Payer: BCBS of TX Blue Essentials |
$349.46
|
| Rate for Payer: BCBS of TX Medicare |
$201.55
|
| Rate for Payer: BCBS of TX PPO |
$440.32
|
| Rate for Payer: Cash Price |
$1,067.60
|
| Rate for Payer: Cash Price |
$1,067.60
|
| Rate for Payer: Cash Price |
$1,067.60
|
| Rate for Payer: Cigna Commercial |
$426.04
|
| Rate for Payer: Cigna Medicaid |
$1,130.40
|
| 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 |
$1,130.40
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$201.55
|
| Rate for Payer: Molina Medicare |
$201.55
|
| Rate for Payer: Multiplan Auto |
$1,020.50
|
| Rate for Payer: Multiplan Commercial |
$1,020.50
|
| Rate for Payer: Multiplan Workers Comp |
$1,020.50
|
| Rate for Payer: Parkland Medicaid |
$1,130.40
|
| Rate for Payer: Scott and White EPO/PPO |
$785.00
|
| Rate for Payer: Scott and White Medicare |
$201.55
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,130.40
|
| 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 Laceration Simple - Face -> 5.1 to 7.5 cm
|
Facility
|
IP
|
$881.00
|
|
|
Service Code
|
HCPCS 12014
|
| Hospital Charge Code |
5202565
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$599.08
|
|
|
ED Laceration Simple - Face -> 5.1 to 7.5 cm
|
Facility
|
OP
|
$881.00
|
|
|
Service Code
|
HCPCS 12014
|
| Hospital Charge Code |
5202565
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$79.29 |
| Max. Negotiated Rate |
$634.32 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$79.29
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$201.55
|
| Rate for Payer: Amerigroup Medicare |
$201.55
|
| Rate for Payer: BCBS of TX Blue Advantage |
$291.80
|
| Rate for Payer: BCBS of TX Blue Essentials |
$349.46
|
| Rate for Payer: BCBS of TX Medicare |
$201.55
|
| Rate for Payer: BCBS of TX PPO |
$440.32
|
| Rate for Payer: Cash Price |
$599.08
|
| Rate for Payer: Cash Price |
$599.08
|
| Rate for Payer: Cash Price |
$599.08
|
| Rate for Payer: Cigna Commercial |
$426.04
|
| Rate for Payer: Cigna Medicaid |
$634.32
|
| 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 |
$634.32
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$201.55
|
| Rate for Payer: Molina Medicare |
$201.55
|
| Rate for Payer: Multiplan Auto |
$572.65
|
| Rate for Payer: Multiplan Commercial |
$572.65
|
| Rate for Payer: Multiplan Workers Comp |
$572.65
|
| Rate for Payer: Parkland Medicaid |
$634.32
|
| Rate for Payer: Scott and White EPO/PPO |
$440.50
|
| Rate for Payer: Scott and White Medicare |
$201.55
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$634.32
|
| 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 Laceration Simple - Face -> 7.6 to 12.5 cm
|
Facility
|
OP
|
$998.50
|
|
|
Service Code
|
HCPCS 12015
|
| Hospital Charge Code |
8776544
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$89.86 |
| Max. Negotiated Rate |
$718.92 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$89.86
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$201.55
|
| Rate for Payer: Amerigroup Medicare |
$201.55
|
| Rate for Payer: BCBS of TX Blue Advantage |
$291.80
|
| Rate for Payer: BCBS of TX Blue Essentials |
$349.46
|
| Rate for Payer: BCBS of TX Medicare |
$201.55
|
| Rate for Payer: BCBS of TX PPO |
$440.32
|
| Rate for Payer: Cash Price |
$678.98
|
| Rate for Payer: Cash Price |
$678.98
|
| Rate for Payer: Cash Price |
$678.98
|
| Rate for Payer: Cigna Commercial |
$426.04
|
| Rate for Payer: Cigna Medicaid |
$718.92
|
| 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 |
$718.92
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$201.55
|
| Rate for Payer: Molina Medicare |
$201.55
|
| Rate for Payer: Multiplan Auto |
$649.02
|
| Rate for Payer: Multiplan Commercial |
$649.02
|
| Rate for Payer: Multiplan Workers Comp |
$649.02
|
| Rate for Payer: Parkland Medicaid |
$718.92
|
| Rate for Payer: Scott and White EPO/PPO |
$499.25
|
| Rate for Payer: Scott and White Medicare |
$201.55
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$718.92
|
| 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 Laceration Simple - Face -> 7.6 to 12.5 cm
|
Facility
|
IP
|
$998.50
|
|
|
Service Code
|
HCPCS 12015
|
| Hospital Charge Code |
8776544
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$678.98
|
|
|
ED Laceration Simple - Scalp -> 12.6 to 20.0 cm
|
Facility
|
OP
|
$1,134.67
|
|
|
Service Code
|
HCPCS 12005
|
| Hospital Charge Code |
8538504
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$102.12 |
| Max. Negotiated Rate |
$863.21 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$102.12
|
| 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 |
$771.58
|
| Rate for Payer: Cash Price |
$771.58
|
| Rate for Payer: Cash Price |
$771.58
|
| Rate for Payer: Cigna Commercial |
$863.21
|
| Rate for Payer: Cigna Medicaid |
$816.96
|
| 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 |
$816.96
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$408.37
|
| Rate for Payer: Molina Medicare |
$408.37
|
| Rate for Payer: Multiplan Auto |
$737.54
|
| Rate for Payer: Multiplan Commercial |
$737.54
|
| Rate for Payer: Multiplan Workers Comp |
$737.54
|
| Rate for Payer: Parkland Medicaid |
$816.96
|
| Rate for Payer: Scott and White EPO/PPO |
$567.34
|
| Rate for Payer: Scott and White Medicare |
$408.37
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$816.96
|
| 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 Laceration Simple - Scalp -> 12.6 to 20.0 cm
|
Facility
|
IP
|
$1,134.67
|
|
|
Service Code
|
HCPCS 12005
|
| Hospital Charge Code |
8538504
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$771.58
|
|
|
ED Laceration Simple - Scalp -> 20.1 to 30.0 cm
|
Facility
|
IP
|
$1,189.29
|
|
|
Service Code
|
HCPCS 12006
|
| Hospital Charge Code |
8414458
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$808.72
|
|
|
ED Laceration Simple - Scalp -> 20.1 to 30.0 cm
|
Facility
|
OP
|
$1,189.29
|
|
|
Service Code
|
HCPCS 12006
|
| Hospital Charge Code |
8414458
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$107.04 |
| Max. Negotiated Rate |
$863.21 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$107.04
|
| 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 |
$808.72
|
| Rate for Payer: Cash Price |
$808.72
|
| Rate for Payer: Cash Price |
$808.72
|
| Rate for Payer: Cigna Commercial |
$863.21
|
| Rate for Payer: Cigna Medicaid |
$856.29
|
| 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 |
$856.29
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$408.37
|
| Rate for Payer: Molina Medicare |
$408.37
|
| Rate for Payer: Multiplan Auto |
$773.04
|
| Rate for Payer: Multiplan Commercial |
$773.04
|
| Rate for Payer: Multiplan Workers Comp |
$773.04
|
| Rate for Payer: Parkland Medicaid |
$856.29
|
| Rate for Payer: Scott and White EPO/PPO |
$594.64
|
| Rate for Payer: Scott and White Medicare |
$408.37
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$856.29
|
| 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 Laceration Simple - Scalp -> <= 2.5 cm
|
Facility
|
OP
|
$993.50
|
|
|
Service Code
|
HCPCS 12001
|
| Hospital Charge Code |
8914618
|
|
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 |
$291.80
|
| Rate for Payer: BCBS of TX Blue Essentials |
$349.46
|
| Rate for Payer: BCBS of TX Medicare |
$201.55
|
| Rate for Payer: BCBS of TX PPO |
$440.32
|
| 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 |
$496.75
|
| 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 Laceration Simple - Scalp -> <= 2.5 cm
|
Facility
|
IP
|
$993.50
|
|
|
Service Code
|
HCPCS 12001
|
| Hospital Charge Code |
8914618
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$675.58
|
|
|
ED Laceration Simple - Scalp -> 2.6 to 7.5 cm
|
Facility
|
OP
|
$737.00
|
|
|
Service Code
|
HCPCS 12002
|
| Hospital Charge Code |
5202569
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$66.33 |
| Max. Negotiated Rate |
$530.64 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$66.33
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$201.55
|
| Rate for Payer: Amerigroup Medicare |
$201.55
|
| Rate for Payer: BCBS of TX Blue Advantage |
$291.80
|
| Rate for Payer: BCBS of TX Blue Essentials |
$349.46
|
| Rate for Payer: BCBS of TX Medicare |
$201.55
|
| Rate for Payer: BCBS of TX PPO |
$440.32
|
| Rate for Payer: Cash Price |
$501.16
|
| Rate for Payer: Cash Price |
$501.16
|
| Rate for Payer: Cash Price |
$501.16
|
| Rate for Payer: Cigna Commercial |
$426.04
|
| Rate for Payer: Cigna Medicaid |
$530.64
|
| 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 |
$530.64
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$201.55
|
| Rate for Payer: Molina Medicare |
$201.55
|
| Rate for Payer: Multiplan Auto |
$479.05
|
| Rate for Payer: Multiplan Commercial |
$479.05
|
| Rate for Payer: Multiplan Workers Comp |
$479.05
|
| Rate for Payer: Parkland Medicaid |
$530.64
|
| Rate for Payer: Scott and White EPO/PPO |
$368.50
|
| Rate for Payer: Scott and White Medicare |
$201.55
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$530.64
|
| 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 Laceration Simple - Scalp -> 2.6 to 7.5 cm
|
Facility
|
IP
|
$737.00
|
|
|
Service Code
|
HCPCS 12002
|
| Hospital Charge Code |
5202569
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$501.16
|
|
|
ED Laceration Simple - Scalp -> 7.6 to 12.5 cm
|
Facility
|
OP
|
$751.00
|
|
|
Service Code
|
HCPCS 12004
|
| Hospital Charge Code |
5202570
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$67.59 |
| Max. Negotiated Rate |
$540.72 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$67.59
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$201.55
|
| Rate for Payer: Amerigroup Medicare |
$201.55
|
| Rate for Payer: BCBS of TX Blue Advantage |
$291.80
|
| Rate for Payer: BCBS of TX Blue Essentials |
$349.46
|
| Rate for Payer: BCBS of TX Medicare |
$201.55
|
| Rate for Payer: BCBS of TX PPO |
$440.32
|
| Rate for Payer: Cash Price |
$510.68
|
| Rate for Payer: Cash Price |
$510.68
|
| Rate for Payer: Cash Price |
$510.68
|
| Rate for Payer: Cigna Commercial |
$426.04
|
| Rate for Payer: Cigna Medicaid |
$540.72
|
| 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 |
$540.72
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$201.55
|
| Rate for Payer: Molina Medicare |
$201.55
|
| Rate for Payer: Multiplan Auto |
$488.15
|
| Rate for Payer: Multiplan Commercial |
$488.15
|
| Rate for Payer: Multiplan Workers Comp |
$488.15
|
| Rate for Payer: Parkland Medicaid |
$540.72
|
| Rate for Payer: Scott and White EPO/PPO |
$375.50
|
| Rate for Payer: Scott and White Medicare |
$201.55
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$540.72
|
| 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 Laceration Simple - Scalp -> 7.6 to 12.5 cm
|
Facility
|
IP
|
$751.00
|
|
|
Service Code
|
HCPCS 12004
|
| Hospital Charge Code |
5202570
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$510.68
|
|
|
ED Lesion Procedure -> Removal of Skin Tags
|
Facility
|
OP
|
$2,477.00
|
|
|
Service Code
|
HCPCS 11200
|
| Hospital Charge Code |
7150212
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$201.55 |
| Max. Negotiated Rate |
$1,783.44 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$222.93
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$201.55
|
| Rate for Payer: Amerigroup Medicare |
$201.55
|
| Rate for Payer: BCBS of TX Blue Advantage |
$291.80
|
| Rate for Payer: BCBS of TX Blue Essentials |
$349.46
|
| Rate for Payer: BCBS of TX Medicare |
$201.55
|
| Rate for Payer: BCBS of TX PPO |
$440.32
|
| Rate for Payer: Cash Price |
$1,684.36
|
| Rate for Payer: Cash Price |
$1,684.36
|
| Rate for Payer: Cash Price |
$1,684.36
|
| Rate for Payer: Cigna Commercial |
$426.04
|
| Rate for Payer: Cigna Medicaid |
$1,783.44
|
| 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 |
$1,783.44
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$201.55
|
| Rate for Payer: Molina Medicare |
$201.55
|
| Rate for Payer: Multiplan Auto |
$1,610.05
|
| Rate for Payer: Multiplan Commercial |
$1,610.05
|
| Rate for Payer: Multiplan Workers Comp |
$1,610.05
|
| Rate for Payer: Parkland Medicaid |
$1,783.44
|
| Rate for Payer: Scott and White EPO/PPO |
$1,238.50
|
| Rate for Payer: Scott and White Medicare |
$201.55
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,783.44
|
| 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 Lesion Procedure -> Removal of Skin Tags
|
Facility
|
IP
|
$2,477.00
|
|
|
Service Code
|
HCPCS 11200
|
| Hospital Charge Code |
7150212
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$1,684.36
|
|
|
ED Lesion Procedure -> Shaving, corn or callus
|
Facility
|
OP
|
$993.50
|
|
|
Service Code
|
HCPCS 11055
|
| Hospital Charge Code |
7150778
|
|
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 |
$291.80
|
| Rate for Payer: BCBS of TX Blue Essentials |
$349.46
|
| Rate for Payer: BCBS of TX Medicare |
$201.55
|
| Rate for Payer: BCBS of TX PPO |
$440.32
|
| 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 |
$496.75
|
| 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
|
|
