|
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
|
|
|
ED Line Procedure -> Arterial Catheterization
|
Facility
|
OP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 36620
|
| Hospital Charge Code |
320002
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$90.00 |
| Max. Negotiated Rate |
$720.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$90.00
|
| Rate for Payer: BCBS of TX Blue Advantage |
$300.00
|
| Rate for Payer: BCBS of TX Blue Essentials |
$360.00
|
| Rate for Payer: BCBS of TX PPO |
$400.00
|
| Rate for Payer: Cash Price |
$680.00
|
| Rate for Payer: Cigna Medicaid |
$720.00
|
| Rate for Payer: Molina CHIP/Medicaid |
$720.00
|
| Rate for Payer: Multiplan Auto |
$650.00
|
| Rate for Payer: Multiplan Commercial |
$650.00
|
| Rate for Payer: Multiplan Workers Comp |
$650.00
|
| Rate for Payer: Parkland Medicaid |
$720.00
|
| Rate for Payer: Scott and White EPO/PPO |
$500.00
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$720.00
|
| Rate for Payer: Superior Health Plan EPO |
$136.00
|
|
|
ED Line Procedure -> Arterial Catheterization
|
Facility
|
IP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 36620
|
| Hospital Charge Code |
320002
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$680.00
|
|
|
ED Line Procedure -> Central Line >= 5 y/o
|
Facility
|
OP
|
$4,645.00
|
|
|
Service Code
|
HCPCS 36556
|
| Hospital Charge Code |
2170058
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$418.05 |
| Max. Negotiated Rate |
$6,704.76 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$418.05
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3,171.87
|
| Rate for Payer: Amerigroup Medicare |
$3,171.87
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,723.99
|
| Rate for Payer: BCBS of TX Blue Essentials |
$3,262.26
|
| Rate for Payer: BCBS of TX Medicare |
$3,171.87
|
| Rate for Payer: BCBS of TX PPO |
$4,110.45
|
| Rate for Payer: Cash Price |
$3,158.60
|
| Rate for Payer: Cash Price |
$3,158.60
|
| Rate for Payer: Cash Price |
$3,158.60
|
| Rate for Payer: Cigna Commercial |
$6,704.76
|
| Rate for Payer: Cigna Medicaid |
$3,344.40
|
| Rate for Payer: Cigna Medicare |
$3,171.87
|
| Rate for Payer: Employer Direct Commercial |
$3,171.87
|
| Rate for Payer: Humana Medicare/TRICARE |
$3,171.87
|
| Rate for Payer: Molina CHIP/Medicaid |
$3,344.40
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3,171.87
|
| Rate for Payer: Molina Medicare |
$3,171.87
|
| Rate for Payer: Multiplan Auto |
$3,019.25
|
| Rate for Payer: Multiplan Commercial |
$3,019.25
|
| Rate for Payer: Multiplan Workers Comp |
$3,019.25
|
| Rate for Payer: Parkland Medicaid |
$3,344.40
|
| Rate for Payer: Scott and White EPO/PPO |
$2,322.50
|
| Rate for Payer: Scott and White Medicare |
$3,171.87
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$3,344.40
|
| Rate for Payer: Superior Health Plan EPO |
$3,171.87
|
| Rate for Payer: Superior Health Plan Medicare |
$3,171.87
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3,171.87
|
| Rate for Payer: Universal American Medicare |
$3,171.87
|
| Rate for Payer: Wellcare Medicare |
$3,171.87
|
| Rate for Payer: Wellmed Medicare |
$3,171.87
|
|
|
ED Line Procedure -> Central Line >= 5 y/o
|
Facility
|
IP
|
$4,645.00
|
|
|
Service Code
|
HCPCS 36556
|
| Hospital Charge Code |
2170058
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$3,158.60
|
|
|
ED Line Procedure -> Intraosseous Infusion
|
Facility
|
OP
|
$536.00
|
|
|
Service Code
|
HCPCS 36680
|
| Hospital Charge Code |
5202573
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$48.24 |
| Max. Negotiated Rate |
$948.59 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$48.24
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$448.76
|
| Rate for Payer: Amerigroup Medicare |
$448.76
|
| Rate for Payer: BCBS of TX Blue Advantage |
$607.20
|
| Rate for Payer: BCBS of TX Blue Essentials |
$727.18
|
| Rate for Payer: BCBS of TX Medicare |
$448.76
|
| Rate for Payer: BCBS of TX PPO |
$916.25
|
| Rate for Payer: Cash Price |
$364.48
|
| Rate for Payer: Cash Price |
$364.48
|
| Rate for Payer: Cash Price |
$364.48
|
| Rate for Payer: Cigna Commercial |
$948.59
|
| Rate for Payer: Cigna Medicaid |
$385.92
|
| Rate for Payer: Cigna Medicare |
$448.76
|
| Rate for Payer: Employer Direct Commercial |
$448.76
|
| Rate for Payer: Humana Medicare/TRICARE |
$448.76
|
| Rate for Payer: Molina CHIP/Medicaid |
$385.92
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$448.76
|
| Rate for Payer: Molina Medicare |
$448.76
|
| Rate for Payer: Multiplan Auto |
$348.40
|
| Rate for Payer: Multiplan Commercial |
$348.40
|
| Rate for Payer: Multiplan Workers Comp |
$348.40
|
| Rate for Payer: Parkland Medicaid |
$385.92
|
| Rate for Payer: Scott and White EPO/PPO |
$268.00
|
| Rate for Payer: Scott and White Medicare |
$448.76
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$385.92
|
| Rate for Payer: Superior Health Plan EPO |
$448.76
|
| Rate for Payer: Superior Health Plan Medicare |
$448.76
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$448.76
|
| Rate for Payer: Universal American Medicare |
$448.76
|
| Rate for Payer: Wellcare Medicare |
$448.76
|
| Rate for Payer: Wellmed Medicare |
$448.76
|
|
|
ED Line Procedure -> Intraosseous Infusion
|
Facility
|
IP
|
$536.00
|
|
|
Service Code
|
HCPCS 36680
|
| Hospital Charge Code |
5202573
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$364.48
|
|
|
ED Nail Repair Procedure -> Debridement of Nail 1-5
|
Facility
|
OP
|
$993.50
|
|
|
Service Code
|
HCPCS 11720
|
| Hospital Charge Code |
7150246
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$59.26 |
| Max. Negotiated Rate |
$715.32 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$89.42
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$59.26
|
| Rate for Payer: Amerigroup Medicare |
$59.26
|
| Rate for Payer: BCBS of TX Blue Advantage |
$91.87
|
| Rate for Payer: BCBS of TX Blue Essentials |
$110.02
|
| Rate for Payer: BCBS of TX Medicare |
$59.26
|
| Rate for Payer: BCBS of TX PPO |
$138.63
|
| 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 |
$125.27
|
| Rate for Payer: Cigna Medicaid |
$715.32
|
| Rate for Payer: Cigna Medicare |
$59.26
|
| Rate for Payer: Employer Direct Commercial |
$59.26
|
| Rate for Payer: Humana Medicare/TRICARE |
$59.26
|
| Rate for Payer: Molina CHIP/Medicaid |
$715.32
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$59.26
|
| Rate for Payer: Molina Medicare |
$59.26
|
| 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 |
$59.26
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$715.32
|
| Rate for Payer: Superior Health Plan EPO |
$59.26
|
| Rate for Payer: Superior Health Plan Medicare |
$59.26
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$59.26
|
| Rate for Payer: Universal American Medicare |
$59.26
|
| Rate for Payer: Wellcare Medicare |
$59.26
|
| Rate for Payer: Wellmed Medicare |
$59.26
|
|
|
ED Nail Repair Procedure -> Debridement of Nail 1-5
|
Facility
|
IP
|
$993.50
|
|
|
Service Code
|
HCPCS 11720
|
| Hospital Charge Code |
7150246
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$675.58
|
|
|
ED Nail Repair Procedure -> Debridement of Nail 6+
|
Facility
|
IP
|
$993.50
|
|
|
Service Code
|
HCPCS 11721
|
| Hospital Charge Code |
7150253
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$675.58
|
|
|
ED Nail Repair Procedure -> Debridement of Nail 6+
|
Facility
|
OP
|
$993.50
|
|
|
Service Code
|
HCPCS 11721
|
| Hospital Charge Code |
7150253
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$59.26 |
| Max. Negotiated Rate |
$715.32 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$89.42
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$59.26
|
| Rate for Payer: Amerigroup Medicare |
$59.26
|
| Rate for Payer: BCBS of TX Blue Advantage |
$91.87
|
| Rate for Payer: BCBS of TX Blue Essentials |
$110.02
|
| Rate for Payer: BCBS of TX Medicare |
$59.26
|
| Rate for Payer: BCBS of TX PPO |
$138.63
|
| 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 |
$125.27
|
| Rate for Payer: Cigna Medicaid |
$715.32
|
| Rate for Payer: Cigna Medicare |
$59.26
|
| Rate for Payer: Employer Direct Commercial |
$59.26
|
| Rate for Payer: Humana Medicare/TRICARE |
$59.26
|
| Rate for Payer: Molina CHIP/Medicaid |
$715.32
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$59.26
|
| Rate for Payer: Molina Medicare |
$59.26
|
| 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 |
$59.26
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$715.32
|
| Rate for Payer: Superior Health Plan EPO |
$59.26
|
| Rate for Payer: Superior Health Plan Medicare |
$59.26
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$59.26
|
| Rate for Payer: Universal American Medicare |
$59.26
|
| Rate for Payer: Wellcare Medicare |
$59.26
|
| Rate for Payer: Wellmed Medicare |
$59.26
|
|
|
ED Nail Repair Procedure -> Evacuation of subungual hematoma
|
Facility
|
OP
|
$993.50
|
|
|
Service Code
|
HCPCS 11740
|
| Hospital Charge Code |
5202574
|
|
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 |
$133.65
|
| Rate for Payer: Amerigroup Medicare |
$133.65
|
| Rate for Payer: BCBS of TX Blue Advantage |
$182.08
|
| Rate for Payer: BCBS of TX Blue Essentials |
$218.06
|
| Rate for Payer: BCBS of TX Medicare |
$133.65
|
| Rate for Payer: BCBS of TX PPO |
$274.76
|
| 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 |
$282.53
|
| Rate for Payer: Cigna Medicaid |
$715.32
|
| Rate for Payer: Cigna Medicare |
$133.65
|
| Rate for Payer: Employer Direct Commercial |
$133.65
|
| Rate for Payer: Humana Medicare/TRICARE |
$133.65
|
| Rate for Payer: Molina CHIP/Medicaid |
$715.32
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$133.65
|
| Rate for Payer: Molina Medicare |
$133.65
|
| 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 |
$133.65
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$715.32
|
| Rate for Payer: Superior Health Plan EPO |
$133.65
|
| Rate for Payer: Superior Health Plan Medicare |
$133.65
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$133.65
|
| Rate for Payer: Universal American Medicare |
$133.65
|
| Rate for Payer: Wellcare Medicare |
$133.65
|
| Rate for Payer: Wellmed Medicare |
$133.65
|
|
|
ED Nail Repair Procedure -> Evacuation of subungual hematoma
|
Facility
|
IP
|
$993.50
|
|
|
Service Code
|
HCPCS 11740
|
| Hospital Charge Code |
5202574
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$675.58
|
|
|
ED Nail Repair Procedure -> Nail and Nail Matrix, Excision
|
Facility
|
OP
|
$8,017.06
|
|
|
Service Code
|
HCPCS 11750
|
| Hospital Charge Code |
7150818
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$165.75 |
| Max. Negotiated Rate |
$5,772.28 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$721.54
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$408.37
|
| Rate for Payer: Amerigroup Medicare |
$408.37
|
| Rate for Payer: BCBS of TX Blue Advantage |
$165.75
|
| Rate for Payer: BCBS of TX Blue Essentials |
$198.50
|
| Rate for Payer: BCBS of TX Medicare |
$408.37
|
| Rate for Payer: BCBS of TX PPO |
$250.11
|
| Rate for Payer: Cash Price |
$5,451.60
|
| Rate for Payer: Cash Price |
$5,451.60
|
| Rate for Payer: Cash Price |
$5,451.60
|
| Rate for Payer: Cigna Commercial |
$863.21
|
| Rate for Payer: Cigna Medicaid |
$5,772.28
|
| 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 |
$5,772.28
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$408.37
|
| Rate for Payer: Molina Medicare |
$408.37
|
| Rate for Payer: Multiplan Auto |
$5,211.09
|
| Rate for Payer: Multiplan Commercial |
$5,211.09
|
| Rate for Payer: Multiplan Workers Comp |
$5,211.09
|
| Rate for Payer: Parkland Medicaid |
$5,772.28
|
| Rate for Payer: Scott and White EPO/PPO |
$4,008.53
|
| Rate for Payer: Scott and White Medicare |
$408.37
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$5,772.28
|
| 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 Nail Repair Procedure -> Nail and Nail Matrix, Excision
|
Facility
|
IP
|
$8,017.06
|
|
|
Service Code
|
HCPCS 11750
|
| Hospital Charge Code |
7150818
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$5,451.60
|
|
|
ED Nail Repair Procedure -> Nail Bed Repair
|
Facility
|
OP
|
$1,062.00
|
|
|
Service Code
|
HCPCS 11760
|
| Hospital Charge Code |
5202575
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$95.58 |
| Max. Negotiated Rate |
$1,569.38 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$95.58
|
| 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 |
$722.16
|
| Rate for Payer: Cash Price |
$722.16
|
| Rate for Payer: Cash Price |
$722.16
|
| Rate for Payer: Cigna Commercial |
$1,569.38
|
| Rate for Payer: Cigna Medicaid |
$764.64
|
| 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 |
$764.64
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$742.44
|
| Rate for Payer: Molina Medicare |
$742.44
|
| Rate for Payer: Multiplan Auto |
$690.30
|
| Rate for Payer: Multiplan Commercial |
$690.30
|
| Rate for Payer: Multiplan Workers Comp |
$690.30
|
| Rate for Payer: Parkland Medicaid |
$764.64
|
| Rate for Payer: Scott and White EPO/PPO |
$531.00
|
| Rate for Payer: Scott and White Medicare |
$742.44
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$764.64
|
| 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 Nail Repair Procedure -> Nail Bed Repair
|
Facility
|
IP
|
$1,062.00
|
|
|
Service Code
|
HCPCS 11760
|
| Hospital Charge Code |
5202575
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$722.16
|
|
|
ED Nail Repair Procedure -> Nail plate avulsion, single
|
Facility
|
IP
|
$993.50
|
|
|
Service Code
|
HCPCS 11730
|
| Hospital Charge Code |
7150776
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$675.58
|
|
|
ED Nail Repair Procedure -> Nail plate avulsion, single
|
Facility
|
OP
|
$993.50
|
|
|
Service Code
|
HCPCS 11730
|
| Hospital Charge Code |
7150776
|
|
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 Nail Repair Procedure -> Trim Nondystrophic Nails
|
Facility
|
OP
|
$993.50
|
|
|
Service Code
|
HCPCS 11719
|
| Hospital Charge Code |
7150238
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$59.26 |
| Max. Negotiated Rate |
$715.32 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$89.42
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$59.26
|
| Rate for Payer: Amerigroup Medicare |
$59.26
|
| Rate for Payer: BCBS of TX Blue Advantage |
$91.87
|
| Rate for Payer: BCBS of TX Blue Essentials |
$110.02
|
| Rate for Payer: BCBS of TX Medicare |
$59.26
|
| Rate for Payer: BCBS of TX PPO |
$138.63
|
| 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 |
$125.27
|
| Rate for Payer: Cigna Medicaid |
$715.32
|
| Rate for Payer: Cigna Medicare |
$59.26
|
| Rate for Payer: Employer Direct Commercial |
$59.26
|
| Rate for Payer: Humana Medicare/TRICARE |
$59.26
|
| Rate for Payer: Molina CHIP/Medicaid |
$715.32
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$59.26
|
| Rate for Payer: Molina Medicare |
$59.26
|
| 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 |
$59.26
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$715.32
|
| Rate for Payer: Superior Health Plan EPO |
$59.26
|
| Rate for Payer: Superior Health Plan Medicare |
$59.26
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$59.26
|
| Rate for Payer: Universal American Medicare |
$59.26
|
| Rate for Payer: Wellcare Medicare |
$59.26
|
| Rate for Payer: Wellmed Medicare |
$59.26
|
|
|
ED Nail Repair Procedure -> Trim Nondystrophic Nails
|
Facility
|
IP
|
$993.50
|
|
|
Service Code
|
HCPCS 11719
|
| Hospital Charge Code |
7150238
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$675.58
|
|
|
ED Nosebleed Complexity -> Anterior, Simple
|
Facility
|
OP
|
$732.00
|
|
|
Service Code
|
HCPCS 30901
|
| Hospital Charge Code |
5202576
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$65.88 |
| Max. Negotiated Rate |
$527.04 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$65.88
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$133.65
|
| Rate for Payer: Amerigroup Medicare |
$133.65
|
| Rate for Payer: BCBS of TX Blue Advantage |
$182.08
|
| Rate for Payer: BCBS of TX Blue Essentials |
$218.06
|
| Rate for Payer: BCBS of TX Medicare |
$133.65
|
| Rate for Payer: BCBS of TX PPO |
$274.76
|
| Rate for Payer: Cash Price |
$497.76
|
| Rate for Payer: Cash Price |
$497.76
|
| Rate for Payer: Cash Price |
$497.76
|
| Rate for Payer: Cigna Commercial |
$282.53
|
| Rate for Payer: Cigna Medicaid |
$527.04
|
| Rate for Payer: Cigna Medicare |
$133.65
|
| Rate for Payer: Employer Direct Commercial |
$133.65
|
| Rate for Payer: Humana Medicare/TRICARE |
$133.65
|
| Rate for Payer: Molina CHIP/Medicaid |
$527.04
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$133.65
|
| Rate for Payer: Molina Medicare |
$133.65
|
| Rate for Payer: Multiplan Auto |
$475.80
|
| Rate for Payer: Multiplan Commercial |
$475.80
|
| Rate for Payer: Multiplan Workers Comp |
$475.80
|
| Rate for Payer: Parkland Medicaid |
$527.04
|
| Rate for Payer: Scott and White EPO/PPO |
$366.00
|
| Rate for Payer: Scott and White Medicare |
$133.65
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$527.04
|
| Rate for Payer: Superior Health Plan EPO |
$133.65
|
| Rate for Payer: Superior Health Plan Medicare |
$133.65
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$133.65
|
| Rate for Payer: Universal American Medicare |
$133.65
|
| Rate for Payer: Wellcare Medicare |
$133.65
|
| Rate for Payer: Wellmed Medicare |
$133.65
|
|
|
ED Nosebleed Complexity -> Anterior, Simple
|
Facility
|
IP
|
$732.00
|
|
|
Service Code
|
HCPCS 30901
|
| Hospital Charge Code |
5202576
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$497.76
|
|
|
ED OB/GYN Procedure -> Delivery, vaginal
|
Facility
|
OP
|
$6,737.00
|
|
|
Service Code
|
HCPCS 59409
|
| Hospital Charge Code |
5202578
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$606.33 |
| Max. Negotiated Rate |
$6,873.88 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$606.33
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3,251.88
|
| Rate for Payer: Amerigroup Medicare |
$3,251.88
|
| Rate for Payer: BCBS of TX Blue Advantage |
$4,171.83
|
| Rate for Payer: BCBS of TX Blue Essentials |
$4,996.20
|
| Rate for Payer: BCBS of TX Medicare |
$3,251.88
|
| Rate for Payer: BCBS of TX PPO |
$6,295.21
|
| Rate for Payer: Cash Price |
$4,581.16
|
| Rate for Payer: Cash Price |
$4,581.16
|
| Rate for Payer: Cash Price |
$4,581.16
|
| Rate for Payer: Cigna Commercial |
$6,873.88
|
| Rate for Payer: Cigna Medicaid |
$4,850.64
|
| Rate for Payer: Cigna Medicare |
$3,251.88
|
| Rate for Payer: Employer Direct Commercial |
$3,251.88
|
| Rate for Payer: Humana Medicare/TRICARE |
$3,251.88
|
| Rate for Payer: Molina CHIP/Medicaid |
$4,850.64
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3,251.88
|
| Rate for Payer: Molina Medicare |
$3,251.88
|
| Rate for Payer: Multiplan Auto |
$4,379.05
|
| Rate for Payer: Multiplan Commercial |
$4,379.05
|
| Rate for Payer: Multiplan Workers Comp |
$4,379.05
|
| Rate for Payer: Parkland Medicaid |
$4,850.64
|
| Rate for Payer: Scott and White EPO/PPO |
$3,368.50
|
| Rate for Payer: Scott and White Medicare |
$3,251.88
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$4,850.64
|
| Rate for Payer: Superior Health Plan EPO |
$3,251.88
|
| Rate for Payer: Superior Health Plan Medicare |
$3,251.88
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3,251.88
|
| Rate for Payer: Universal American Medicare |
$3,251.88
|
| Rate for Payer: Wellcare Medicare |
$3,251.88
|
| Rate for Payer: Wellmed Medicare |
$3,251.88
|
|
|
ED OB/GYN Procedure -> Delivery, vaginal
|
Facility
|
IP
|
$6,737.00
|
|
|
Service Code
|
HCPCS 59409
|
| Hospital Charge Code |
5202578
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$4,581.16
|
|
