|
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 |
$125.69 |
| 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 |
$125.69
|
| 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 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 |
$134.86
|
| 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
|
OP
|
$993.50
|
|
|
Service Code
|
HCPCS 11730
|
| Hospital Charge Code |
7150776
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$65.64 |
| 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 |
$65.64
|
| 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 -> 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 -> 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 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 |
$9.04 |
| 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 |
$9.04
|
| 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 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 |
$68.83
|
| 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 |
$971.16
|
| 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
|
|
|
ED OB/GYN Procedure -> Removal of Contraceptive Capsule
|
Facility
|
OP
|
$1,718.00
|
|
|
Service Code
|
HCPCS 11976
|
| Hospital Charge Code |
5202577
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$112.86 |
| Max. Negotiated Rate |
$1,503.68 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$154.62
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$711.36
|
| Rate for Payer: Amerigroup Medicare |
$711.36
|
| Rate for Payer: BCBS of TX Blue Advantage |
$125.97
|
| Rate for Payer: BCBS of TX Blue Essentials |
$150.86
|
| Rate for Payer: BCBS of TX Medicare |
$711.36
|
| Rate for Payer: BCBS of TX PPO |
$190.08
|
| Rate for Payer: Cash Price |
$1,168.24
|
| Rate for Payer: Cash Price |
$1,168.24
|
| Rate for Payer: Cash Price |
$1,168.24
|
| Rate for Payer: Cigna Commercial |
$1,503.68
|
| Rate for Payer: Cigna Medicaid |
$1,236.96
|
| Rate for Payer: Cigna Medicare |
$711.36
|
| Rate for Payer: Employer Direct Commercial |
$711.36
|
| Rate for Payer: Humana Medicare/TRICARE |
$711.36
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,236.96
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$711.36
|
| Rate for Payer: Molina Medicare |
$711.36
|
| Rate for Payer: Multiplan Auto |
$1,116.70
|
| Rate for Payer: Multiplan Commercial |
$1,116.70
|
| Rate for Payer: Multiplan Workers Comp |
$1,116.70
|
| Rate for Payer: Parkland Medicaid |
$1,236.96
|
| Rate for Payer: Scott and White EPO/PPO |
$112.86
|
| Rate for Payer: Scott and White Medicare |
$711.36
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,236.96
|
| Rate for Payer: Superior Health Plan EPO |
$711.36
|
| Rate for Payer: Superior Health Plan Medicare |
$711.36
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$711.36
|
| Rate for Payer: Universal American Medicare |
$711.36
|
| Rate for Payer: Wellcare Medicare |
$711.36
|
| Rate for Payer: Wellmed Medicare |
$711.36
|
|
|
ED OB/GYN Procedure -> Removal of Contraceptive Capsule
|
Facility
|
IP
|
$1,718.00
|
|
|
Service Code
|
HCPCS 11976
|
| Hospital Charge Code |
5202577
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$1,168.24
|
|
|
ED OPEN TX PHALANGEAL SHAFT FX PROXIMAL/MIDDLE PHALANX EA W/INT FIX WHEN PERFORMED BCE
|
Facility
|
IP
|
$11,099.00
|
|
|
Service Code
|
HCPCS 26735
|
| Hospital Charge Code |
8470467
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$7,547.32
|
|
|
ED OPEN TX PHALANGEAL SHAFT FX PROXIMAL/MIDDLE PHALANX EA W/INT FIX WHEN PERFORMED BCE
|
Facility
|
OP
|
$11,099.00
|
|
|
Service Code
|
HCPCS 26735
|
| Hospital Charge Code |
8470467
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$744.58 |
| Max. Negotiated Rate |
$7,991.28 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$998.91
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3,286.91
|
| Rate for Payer: Amerigroup Medicare |
$3,286.91
|
| Rate for Payer: BCBS of TX Blue Advantage |
$4,571.54
|
| Rate for Payer: BCBS of TX Blue Essentials |
$5,474.90
|
| Rate for Payer: BCBS of TX Medicare |
$3,286.91
|
| Rate for Payer: BCBS of TX PPO |
$6,898.37
|
| Rate for Payer: Cash Price |
$7,547.32
|
| Rate for Payer: Cash Price |
$7,547.32
|
| Rate for Payer: Cash Price |
$7,547.32
|
| Rate for Payer: Cigna Commercial |
$6,947.94
|
| Rate for Payer: Cigna Medicaid |
$7,991.28
|
| Rate for Payer: Cigna Medicare |
$3,286.91
|
| Rate for Payer: Employer Direct Commercial |
$3,286.91
|
| Rate for Payer: Humana Medicare/TRICARE |
$3,286.91
|
| Rate for Payer: Molina CHIP/Medicaid |
$7,991.28
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3,286.91
|
| Rate for Payer: Molina Medicare |
$3,286.91
|
| Rate for Payer: Multiplan Auto |
$7,214.35
|
| Rate for Payer: Multiplan Commercial |
$7,214.35
|
| Rate for Payer: Multiplan Workers Comp |
$7,214.35
|
| Rate for Payer: Parkland Medicaid |
$7,991.28
|
| Rate for Payer: Scott and White EPO/PPO |
$744.58
|
| Rate for Payer: Scott and White Medicare |
$3,286.91
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$7,991.28
|
| Rate for Payer: Superior Health Plan EPO |
$3,286.91
|
| Rate for Payer: Superior Health Plan Medicare |
$3,286.91
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3,286.91
|
| Rate for Payer: Universal American Medicare |
$3,286.91
|
| Rate for Payer: Wellcare Medicare |
$3,286.91
|
| Rate for Payer: Wellmed Medicare |
$3,286.91
|
|
|
ED Orthopedic Cast Application -> Foot/Ankle
|
Facility
|
OP
|
$580.00
|
|
|
Service Code
|
HCPCS 29405
|
| Hospital Charge Code |
8914630
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$52.20 |
| Max. Negotiated Rate |
$593.92 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$52.20
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$280.97
|
| Rate for Payer: Amerigroup Medicare |
$280.97
|
| 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 |
$280.97
|
| Rate for Payer: BCBS of TX PPO |
$121.87
|
| Rate for Payer: Cash Price |
$394.40
|
| Rate for Payer: Cash Price |
$394.40
|
| Rate for Payer: Cash Price |
$394.40
|
| Rate for Payer: Cigna Commercial |
$593.92
|
| Rate for Payer: Cigna Medicaid |
$417.60
|
| Rate for Payer: Cigna Medicare |
$280.97
|
| Rate for Payer: Employer Direct Commercial |
$280.97
|
| Rate for Payer: Humana Medicare/TRICARE |
$280.97
|
| Rate for Payer: Molina CHIP/Medicaid |
$417.60
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$280.97
|
| Rate for Payer: Molina Medicare |
$280.97
|
| Rate for Payer: Multiplan Auto |
$377.00
|
| Rate for Payer: Multiplan Commercial |
$377.00
|
| Rate for Payer: Multiplan Workers Comp |
$377.00
|
| Rate for Payer: Parkland Medicaid |
$417.60
|
| Rate for Payer: Scott and White EPO/PPO |
$72.39
|
| Rate for Payer: Scott and White Medicare |
$280.97
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$417.60
|
| Rate for Payer: Superior Health Plan EPO |
$280.97
|
| Rate for Payer: Superior Health Plan Medicare |
$280.97
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$280.97
|
| Rate for Payer: Universal American Medicare |
$280.97
|
| Rate for Payer: Wellcare Medicare |
$280.97
|
| Rate for Payer: Wellmed Medicare |
$280.97
|
|
|
ED Orthopedic Cast Application -> Foot/Ankle
|
Facility
|
IP
|
$580.00
|
|
|
Service Code
|
HCPCS 29405
|
| Hospital Charge Code |
8914630
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$394.40
|
|
|
ED Orthopedic Cast Application -> Forearm
|
Facility
|
OP
|
$520.00
|
|
|
Service Code
|
HCPCS 29075
|
| Hospital Charge Code |
9220231
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$46.80 |
| Max. Negotiated Rate |
$593.92 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$46.80
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$280.97
|
| Rate for Payer: Amerigroup Medicare |
$280.97
|
| Rate for Payer: BCBS of TX Blue Advantage |
$92.22
|
| Rate for Payer: BCBS of TX Blue Essentials |
$110.44
|
| Rate for Payer: BCBS of TX Medicare |
$280.97
|
| Rate for Payer: BCBS of TX PPO |
$139.15
|
| Rate for Payer: Cash Price |
$353.60
|
| Rate for Payer: Cash Price |
$353.60
|
| Rate for Payer: Cash Price |
$353.60
|
| Rate for Payer: Cigna Commercial |
$593.92
|
| Rate for Payer: Cigna Medicaid |
$374.40
|
| Rate for Payer: Cigna Medicare |
$280.97
|
| Rate for Payer: Employer Direct Commercial |
$280.97
|
| Rate for Payer: Humana Medicare/TRICARE |
$280.97
|
| Rate for Payer: Molina CHIP/Medicaid |
$374.40
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$280.97
|
| Rate for Payer: Molina Medicare |
$280.97
|
| Rate for Payer: Multiplan Auto |
$338.00
|
| Rate for Payer: Multiplan Commercial |
$338.00
|
| Rate for Payer: Multiplan Workers Comp |
$338.00
|
| Rate for Payer: Parkland Medicaid |
$374.40
|
| Rate for Payer: Scott and White EPO/PPO |
$77.22
|
| Rate for Payer: Scott and White Medicare |
$280.97
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$374.40
|
| Rate for Payer: Superior Health Plan EPO |
$280.97
|
| Rate for Payer: Superior Health Plan Medicare |
$280.97
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$280.97
|
| Rate for Payer: Universal American Medicare |
$280.97
|
| Rate for Payer: Wellcare Medicare |
$280.97
|
| Rate for Payer: Wellmed Medicare |
$280.97
|
|
|
ED Orthopedic Cast Application -> Forearm
|
Facility
|
IP
|
$520.00
|
|
|
Service Code
|
HCPCS 29075
|
| Hospital Charge Code |
9220231
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$353.60
|
|
|
ED Orthopedic Cast Application -> Hand
|
Facility
|
IP
|
$745.00
|
|
|
Service Code
|
HCPCS 26600
|
| Hospital Charge Code |
9220210
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$506.60
|
|
|
ED Orthopedic Cast Application -> Hand
|
Facility
|
OP
|
$745.00
|
|
|
Service Code
|
HCPCS 26600
|
| Hospital Charge Code |
9220210
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$67.05 |
| Max. Negotiated Rate |
$536.40 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$67.05
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$247.79
|
| Rate for Payer: Amerigroup Medicare |
$247.79
|
| Rate for Payer: BCBS of TX Blue Advantage |
$181.96
|
| Rate for Payer: BCBS of TX Blue Essentials |
$217.92
|
| Rate for Payer: BCBS of TX Medicare |
$247.79
|
| Rate for Payer: BCBS of TX PPO |
$274.58
|
| Rate for Payer: Cash Price |
$506.60
|
| Rate for Payer: Cash Price |
$506.60
|
| Rate for Payer: Cash Price |
$506.60
|
| Rate for Payer: Cigna Commercial |
$523.79
|
| Rate for Payer: Cigna Medicaid |
$536.40
|
| Rate for Payer: Cigna Medicare |
$247.79
|
| Rate for Payer: Employer Direct Commercial |
$247.79
|
| Rate for Payer: Humana Medicare/TRICARE |
$247.79
|
| Rate for Payer: Molina CHIP/Medicaid |
$536.40
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$247.79
|
| Rate for Payer: Molina Medicare |
$247.79
|
| Rate for Payer: Multiplan Auto |
$484.25
|
| Rate for Payer: Multiplan Commercial |
$484.25
|
| Rate for Payer: Multiplan Workers Comp |
$484.25
|
| Rate for Payer: Parkland Medicaid |
$536.40
|
| Rate for Payer: Scott and White EPO/PPO |
$369.54
|
| Rate for Payer: Scott and White Medicare |
$247.79
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$536.40
|
| Rate for Payer: Superior Health Plan EPO |
$247.79
|
| Rate for Payer: Superior Health Plan Medicare |
$247.79
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$247.79
|
| Rate for Payer: Universal American Medicare |
$247.79
|
| Rate for Payer: Wellcare Medicare |
$247.79
|
| Rate for Payer: Wellmed Medicare |
$247.79
|
|
|
ED Orthopedic Cast Application -> Lower extremity
|
Facility
|
IP
|
$741.00
|
|
|
Service Code
|
HCPCS 29345
|
| Hospital Charge Code |
9220235
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$503.88
|
|
|
ED Orthopedic Cast Application -> Lower extremity
|
Facility
|
OP
|
$741.00
|
|
|
Service Code
|
HCPCS 29345
|
| Hospital Charge Code |
9220235
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$66.69 |
| Max. Negotiated Rate |
$593.92 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$66.69
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$280.97
|
| Rate for Payer: Amerigroup Medicare |
$280.97
|
| Rate for Payer: BCBS of TX Blue Advantage |
$131.40
|
| Rate for Payer: BCBS of TX Blue Essentials |
$157.36
|
| Rate for Payer: BCBS of TX Medicare |
$280.97
|
| Rate for Payer: BCBS of TX PPO |
$198.27
|
| Rate for Payer: Cash Price |
$503.88
|
| Rate for Payer: Cash Price |
$503.88
|
| Rate for Payer: Cash Price |
$503.88
|
| Rate for Payer: Cigna Commercial |
$593.92
|
| Rate for Payer: Cigna Medicaid |
$533.52
|
| Rate for Payer: Cigna Medicare |
$280.97
|
| Rate for Payer: Employer Direct Commercial |
$280.97
|
| Rate for Payer: Humana Medicare/TRICARE |
$280.97
|
| Rate for Payer: Molina CHIP/Medicaid |
$533.52
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$280.97
|
| Rate for Payer: Molina Medicare |
$280.97
|
| Rate for Payer: Multiplan Auto |
$481.65
|
| Rate for Payer: Multiplan Commercial |
$481.65
|
| Rate for Payer: Multiplan Workers Comp |
$481.65
|
| Rate for Payer: Parkland Medicaid |
$533.52
|
| Rate for Payer: Scott and White EPO/PPO |
$121.67
|
| Rate for Payer: Scott and White Medicare |
$280.97
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$533.52
|
| Rate for Payer: Superior Health Plan EPO |
$280.97
|
| Rate for Payer: Superior Health Plan Medicare |
$280.97
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$280.97
|
| Rate for Payer: Universal American Medicare |
$280.97
|
| Rate for Payer: Wellcare Medicare |
$280.97
|
| Rate for Payer: Wellmed Medicare |
$280.97
|
|
|
ED Orthopedic Cast Application -> Upper Arm/Elbow
|
Facility
|
OP
|
$682.00
|
|
|
Service Code
|
HCPCS 29085
|
| Hospital Charge Code |
8912648
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$61.38 |
| Max. Negotiated Rate |
$491.04 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$61.38
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$163.24
|
| Rate for Payer: Amerigroup Medicare |
$163.24
|
| Rate for Payer: BCBS of TX Blue Advantage |
$100.05
|
| Rate for Payer: BCBS of TX Blue Essentials |
$119.82
|
| Rate for Payer: BCBS of TX Medicare |
$163.24
|
| Rate for Payer: BCBS of TX PPO |
$150.97
|
| Rate for Payer: Cash Price |
$463.76
|
| Rate for Payer: Cash Price |
$463.76
|
| Rate for Payer: Cash Price |
$463.76
|
| Rate for Payer: Cigna Commercial |
$345.06
|
| Rate for Payer: Cigna Medicaid |
$491.04
|
| Rate for Payer: Cigna Medicare |
$163.24
|
| Rate for Payer: Employer Direct Commercial |
$163.24
|
| Rate for Payer: Humana Medicare/TRICARE |
$163.24
|
| Rate for Payer: Molina CHIP/Medicaid |
$491.04
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$163.24
|
| Rate for Payer: Molina Medicare |
$163.24
|
| Rate for Payer: Multiplan Auto |
$443.30
|
| Rate for Payer: Multiplan Commercial |
$443.30
|
| Rate for Payer: Multiplan Workers Comp |
$443.30
|
| Rate for Payer: Parkland Medicaid |
$491.04
|
| Rate for Payer: Scott and White EPO/PPO |
$83.38
|
| Rate for Payer: Scott and White Medicare |
$163.24
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$491.04
|
| Rate for Payer: Superior Health Plan EPO |
$163.24
|
| Rate for Payer: Superior Health Plan Medicare |
$163.24
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$163.24
|
| Rate for Payer: Universal American Medicare |
$163.24
|
| Rate for Payer: Wellcare Medicare |
$163.24
|
| Rate for Payer: Wellmed Medicare |
$163.24
|
|
|
ED Orthopedic Cast Application -> Upper Arm/Elbow
|
Facility
|
IP
|
$682.00
|
|
|
Service Code
|
HCPCS 29085
|
| Hospital Charge Code |
8912648
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$463.76
|
|
