|
ED Orthopedic Splinting Site -> Posterior Short Leg Splint
|
Facility
|
OP
|
$569.00
|
|
|
Service Code
|
HCPCS 29515
|
| Hospital Charge Code |
9220241
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$51.21 |
| Max. Negotiated Rate |
$409.68 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$51.21
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$163.24
|
| Rate for Payer: Amerigroup Medicare |
$163.24
|
| Rate for Payer: BCBS of TX Blue Advantage |
$70.51
|
| Rate for Payer: BCBS of TX Blue Essentials |
$84.44
|
| Rate for Payer: BCBS of TX Medicare |
$163.24
|
| Rate for Payer: BCBS of TX PPO |
$106.39
|
| Rate for Payer: Cash Price |
$386.92
|
| Rate for Payer: Cash Price |
$386.92
|
| Rate for Payer: Cash Price |
$386.92
|
| Rate for Payer: Cigna Commercial |
$345.06
|
| Rate for Payer: Cigna Medicaid |
$409.68
|
| 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 |
$409.68
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$163.24
|
| Rate for Payer: Molina Medicare |
$163.24
|
| Rate for Payer: Multiplan Auto |
$369.85
|
| Rate for Payer: Multiplan Commercial |
$369.85
|
| Rate for Payer: Multiplan Workers Comp |
$369.85
|
| Rate for Payer: Parkland Medicaid |
$409.68
|
| Rate for Payer: Scott and White EPO/PPO |
$284.50
|
| Rate for Payer: Scott and White Medicare |
$163.24
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$409.68
|
| 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 Strapping Site -> Toes
|
Facility
|
IP
|
$329.00
|
|
|
Service Code
|
HCPCS 29550
|
| Hospital Charge Code |
5202581
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$223.72
|
|
|
ED Orthopedic Strapping Site -> Toes
|
Facility
|
OP
|
$329.00
|
|
|
Service Code
|
HCPCS 29550
|
| Hospital Charge Code |
5202581
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$29.61 |
| Max. Negotiated Rate |
$236.88 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$29.61
|
| 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 |
$223.72
|
| Rate for Payer: Cash Price |
$223.72
|
| Rate for Payer: Cash Price |
$223.72
|
| Rate for Payer: Cigna Commercial |
$125.27
|
| Rate for Payer: Cigna Medicaid |
$236.88
|
| 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 |
$236.88
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$59.26
|
| Rate for Payer: Molina Medicare |
$59.26
|
| Rate for Payer: Multiplan Auto |
$213.85
|
| Rate for Payer: Multiplan Commercial |
$213.85
|
| Rate for Payer: Multiplan Workers Comp |
$213.85
|
| Rate for Payer: Parkland Medicaid |
$236.88
|
| Rate for Payer: Scott and White EPO/PPO |
$164.50
|
| Rate for Payer: Scott and White Medicare |
$59.26
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$236.88
|
| 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 Paracentesis -> with imaging
|
Facility
|
IP
|
$1,947.00
|
|
|
Service Code
|
HCPCS 49083
|
| Hospital Charge Code |
2170756
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$1,323.96
|
|
|
ED Paracentesis -> with imaging
|
Facility
|
OP
|
$1,947.00
|
|
|
Service Code
|
HCPCS 49083
|
| Hospital Charge Code |
2170756
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$175.23 |
| Max. Negotiated Rate |
$1,980.52 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$175.23
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$911.12
|
| Rate for Payer: Amerigroup Medicare |
$911.12
|
| Rate for Payer: BCBS of TX Blue Advantage |
$1,312.49
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,571.84
|
| Rate for Payer: BCBS of TX Medicare |
$911.12
|
| Rate for Payer: BCBS of TX PPO |
$1,980.52
|
| Rate for Payer: Cash Price |
$1,323.96
|
| Rate for Payer: Cash Price |
$1,323.96
|
| Rate for Payer: Cash Price |
$1,323.96
|
| Rate for Payer: Cigna Commercial |
$1,925.93
|
| Rate for Payer: Cigna Medicaid |
$1,401.84
|
| Rate for Payer: Cigna Medicare |
$911.12
|
| Rate for Payer: Employer Direct Commercial |
$911.12
|
| Rate for Payer: Humana Medicare/TRICARE |
$911.12
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,401.84
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$911.12
|
| Rate for Payer: Molina Medicare |
$911.12
|
| Rate for Payer: Multiplan Auto |
$1,265.55
|
| Rate for Payer: Multiplan Commercial |
$1,265.55
|
| Rate for Payer: Multiplan Workers Comp |
$1,265.55
|
| Rate for Payer: Parkland Medicaid |
$1,401.84
|
| Rate for Payer: Scott and White EPO/PPO |
$973.50
|
| Rate for Payer: Scott and White Medicare |
$911.12
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,401.84
|
| Rate for Payer: Superior Health Plan EPO |
$911.12
|
| Rate for Payer: Superior Health Plan Medicare |
$911.12
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$911.12
|
| Rate for Payer: Universal American Medicare |
$911.12
|
| Rate for Payer: Wellcare Medicare |
$911.12
|
| Rate for Payer: Wellmed Medicare |
$911.12
|
|
|
ED Paracentesis -> without imaging
|
Facility
|
IP
|
$1,573.00
|
|
|
Service Code
|
HCPCS 49082
|
| Hospital Charge Code |
8910647
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$1,069.64
|
|
|
ED Paracentesis -> without imaging
|
Facility
|
OP
|
$1,573.00
|
|
|
Service Code
|
HCPCS 49082
|
| Hospital Charge Code |
8910647
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$141.57 |
| Max. Negotiated Rate |
$1,980.52 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$141.57
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$911.12
|
| Rate for Payer: Amerigroup Medicare |
$911.12
|
| Rate for Payer: BCBS of TX Blue Advantage |
$1,312.49
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,571.84
|
| Rate for Payer: BCBS of TX Medicare |
$911.12
|
| Rate for Payer: BCBS of TX PPO |
$1,980.52
|
| Rate for Payer: Cash Price |
$1,069.64
|
| Rate for Payer: Cash Price |
$1,069.64
|
| Rate for Payer: Cash Price |
$1,069.64
|
| Rate for Payer: Cigna Commercial |
$1,925.93
|
| Rate for Payer: Cigna Medicaid |
$1,132.56
|
| Rate for Payer: Cigna Medicare |
$911.12
|
| Rate for Payer: Employer Direct Commercial |
$911.12
|
| Rate for Payer: Humana Medicare/TRICARE |
$911.12
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,132.56
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$911.12
|
| Rate for Payer: Molina Medicare |
$911.12
|
| Rate for Payer: Multiplan Auto |
$1,022.45
|
| Rate for Payer: Multiplan Commercial |
$1,022.45
|
| Rate for Payer: Multiplan Workers Comp |
$1,022.45
|
| Rate for Payer: Parkland Medicaid |
$1,132.56
|
| Rate for Payer: Scott and White EPO/PPO |
$786.50
|
| Rate for Payer: Scott and White Medicare |
$911.12
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,132.56
|
| Rate for Payer: Superior Health Plan EPO |
$911.12
|
| Rate for Payer: Superior Health Plan Medicare |
$911.12
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$911.12
|
| Rate for Payer: Universal American Medicare |
$911.12
|
| Rate for Payer: Wellcare Medicare |
$911.12
|
| Rate for Payer: Wellmed Medicare |
$911.12
|
|
|
ED PRESSD NONPRESSD INHAL TRMENT BCE
|
Facility
|
IP
|
$170.00
|
|
|
Service Code
|
HCPCS 94640
|
| Hospital Charge Code |
8402468
|
|
Hospital Revenue Code
|
410
|
| Rate for Payer: Cash Price |
$115.60
|
|
|
ED PRESSD NONPRESSD INHAL TRMENT BCE
|
Facility
|
OP
|
$170.00
|
|
|
Service Code
|
HCPCS 94640
|
| Hospital Charge Code |
8402468
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$15.30 |
| Max. Negotiated Rate |
$464.99 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$15.30
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$219.97
|
| Rate for Payer: Amerigroup Medicare |
$219.97
|
| Rate for Payer: BCBS of TX Blue Advantage |
$51.00
|
| Rate for Payer: BCBS of TX Blue Essentials |
$61.20
|
| Rate for Payer: BCBS of TX Medicare |
$219.97
|
| Rate for Payer: BCBS of TX PPO |
$68.00
|
| Rate for Payer: Cash Price |
$115.60
|
| Rate for Payer: Cash Price |
$115.60
|
| Rate for Payer: Cash Price |
$115.60
|
| Rate for Payer: Cigna Commercial |
$464.99
|
| Rate for Payer: Cigna Medicaid |
$122.40
|
| Rate for Payer: Cigna Medicare |
$219.97
|
| Rate for Payer: Employer Direct Commercial |
$219.97
|
| Rate for Payer: Humana Medicare/TRICARE |
$219.97
|
| Rate for Payer: Molina CHIP/Medicaid |
$122.40
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$219.97
|
| Rate for Payer: Molina Medicare |
$219.97
|
| Rate for Payer: Multiplan Auto |
$110.50
|
| Rate for Payer: Multiplan Commercial |
$110.50
|
| Rate for Payer: Multiplan Workers Comp |
$110.50
|
| Rate for Payer: Parkland Medicaid |
$122.40
|
| Rate for Payer: Scott and White EPO/PPO |
$180.00
|
| Rate for Payer: Scott and White Medicare |
$219.97
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$122.40
|
| Rate for Payer: Superior Health Plan EPO |
$219.97
|
| Rate for Payer: Superior Health Plan Medicare |
$219.97
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$219.97
|
| Rate for Payer: Universal American Medicare |
$219.97
|
| Rate for Payer: Wellcare Medicare |
$219.97
|
| Rate for Payer: Wellmed Medicare |
$219.97
|
|
|
ED REPAIR COMPLEX SCALP/ARM/LEG 2.6-7.5 CM BCE
|
Facility
|
IP
|
$1,514.00
|
|
|
Service Code
|
HCPCS 13121
|
| Hospital Charge Code |
8568926
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$1,029.52
|
|
|
ED REPAIR COMPLEX SCALP/ARM/LEG 2.6-7.5 CM BCE
|
Facility
|
OP
|
$1,514.00
|
|
|
Service Code
|
HCPCS 13121
|
| Hospital Charge Code |
8568926
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$136.26 |
| Max. Negotiated Rate |
$1,252.49 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$136.26
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$408.37
|
| Rate for Payer: Amerigroup Medicare |
$408.37
|
| 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 |
$408.37
|
| Rate for Payer: BCBS of TX PPO |
$1,252.49
|
| Rate for Payer: Cash Price |
$1,029.52
|
| Rate for Payer: Cash Price |
$1,029.52
|
| Rate for Payer: Cash Price |
$1,029.52
|
| Rate for Payer: Cigna Commercial |
$863.21
|
| Rate for Payer: Cigna Medicaid |
$1,090.08
|
| 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 |
$1,090.08
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$408.37
|
| Rate for Payer: Molina Medicare |
$408.37
|
| Rate for Payer: Multiplan Auto |
$984.10
|
| Rate for Payer: Multiplan Commercial |
$984.10
|
| Rate for Payer: Multiplan Workers Comp |
$984.10
|
| Rate for Payer: Parkland Medicaid |
$1,090.08
|
| Rate for Payer: Scott and White EPO/PPO |
$757.00
|
| Rate for Payer: Scott and White Medicare |
$408.37
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,090.08
|
| 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 REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.6-7.5 CM BCE
|
Facility
|
IP
|
$1,545.00
|
|
|
Service Code
|
HCPCS 12042
|
| Hospital Charge Code |
8568927
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$1,050.60
|
|
|
ED REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.6-7.5 CM BCE
|
Facility
|
OP
|
$1,545.00
|
|
|
Service Code
|
HCPCS 12042
|
| Hospital Charge Code |
8568927
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$139.05 |
| Max. Negotiated Rate |
$1,112.40 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$139.05
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$408.37
|
| Rate for Payer: Amerigroup Medicare |
$408.37
|
| Rate for Payer: BCBS of TX Blue Advantage |
$269.62
|
| Rate for Payer: BCBS of TX Blue Essentials |
$322.90
|
| Rate for Payer: BCBS of TX Medicare |
$408.37
|
| Rate for Payer: BCBS of TX PPO |
$406.85
|
| Rate for Payer: Cash Price |
$1,050.60
|
| Rate for Payer: Cash Price |
$1,050.60
|
| Rate for Payer: Cash Price |
$1,050.60
|
| Rate for Payer: Cigna Commercial |
$863.21
|
| Rate for Payer: Cigna Medicaid |
$1,112.40
|
| 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 |
$1,112.40
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$408.37
|
| Rate for Payer: Molina Medicare |
$408.37
|
| Rate for Payer: Multiplan Auto |
$1,004.25
|
| Rate for Payer: Multiplan Commercial |
$1,004.25
|
| Rate for Payer: Multiplan Workers Comp |
$1,004.25
|
| Rate for Payer: Parkland Medicaid |
$1,112.40
|
| Rate for Payer: Scott and White EPO/PPO |
$772.50
|
| Rate for Payer: Scott and White Medicare |
$408.37
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,112.40
|
| 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 REPAIR INTERMEDIATE S A T E 12.6-20.0CM BCE
|
Facility
|
IP
|
$1,248.00
|
|
|
Service Code
|
HCPCS 12035
|
| Hospital Charge Code |
8404451
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$848.64
|
|
|
ED REPAIR INTERMEDIATE S A T E 12.6-20.0CM BCE
|
Facility
|
OP
|
$1,248.00
|
|
|
Service Code
|
HCPCS 12035
|
| Hospital Charge Code |
8404451
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$112.32 |
| Max. Negotiated Rate |
$898.56 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$112.32
|
| 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 |
$848.64
|
| Rate for Payer: Cash Price |
$848.64
|
| Rate for Payer: Cash Price |
$848.64
|
| Rate for Payer: Cigna Commercial |
$863.21
|
| Rate for Payer: Cigna Medicaid |
$898.56
|
| 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 |
$898.56
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$408.37
|
| Rate for Payer: Molina Medicare |
$408.37
|
| Rate for Payer: Multiplan Auto |
$811.20
|
| Rate for Payer: Multiplan Commercial |
$811.20
|
| Rate for Payer: Multiplan Workers Comp |
$811.20
|
| Rate for Payer: Parkland Medicaid |
$898.56
|
| Rate for Payer: Scott and White EPO/PPO |
$624.00
|
| Rate for Payer: Scott and White Medicare |
$408.37
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$898.56
|
| 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 REPAIR INTERMEDIATE WOUNDS S/A/T/E EXCL HAND/FEET 7.6 CM TO 12.5 CM BCE
|
Facility
|
IP
|
$1,082.00
|
|
|
Service Code
|
HCPCS 12034
|
| Hospital Charge Code |
8470466
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$735.76
|
|
|
ED REPAIR INTERMEDIATE WOUNDS S/A/T/E EXCL HAND/FEET 7.6 CM TO 12.5 CM BCE
|
Facility
|
OP
|
$1,082.00
|
|
|
Service Code
|
HCPCS 12034
|
| Hospital Charge Code |
8470466
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$97.38 |
| Max. Negotiated Rate |
$863.21 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$97.38
|
| 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 |
$735.76
|
| Rate for Payer: Cash Price |
$735.76
|
| Rate for Payer: Cash Price |
$735.76
|
| Rate for Payer: Cigna Commercial |
$863.21
|
| Rate for Payer: Cigna Medicaid |
$779.04
|
| 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 |
$779.04
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$408.37
|
| Rate for Payer: Molina Medicare |
$408.37
|
| Rate for Payer: Multiplan Auto |
$703.30
|
| Rate for Payer: Multiplan Commercial |
$703.30
|
| Rate for Payer: Multiplan Workers Comp |
$703.30
|
| Rate for Payer: Parkland Medicaid |
$779.04
|
| Rate for Payer: Scott and White EPO/PPO |
$541.00
|
| Rate for Payer: Scott and White Medicare |
$408.37
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$779.04
|
| 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 REPAIR LAC 2.5 CM OR LESS FLOOR OF MOUTH AND/OR ANT TWO-THIRDS OF TONGUE BCE
|
Facility
|
OP
|
$536.00
|
|
|
Service Code
|
HCPCS 41250
|
| Hospital Charge Code |
8472467
|
|
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 |
$182.08
|
| Rate for Payer: BCBS of TX Blue Essentials |
$218.06
|
| Rate for Payer: BCBS of TX Medicare |
$448.76
|
| Rate for Payer: BCBS of TX PPO |
$274.76
|
| 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 REPAIR LAC 2.5 CM OR LESS FLOOR OF MOUTH AND/OR ANT TWO-THIRDS OF TONGUE BCE
|
Facility
|
IP
|
$536.00
|
|
|
Service Code
|
HCPCS 41250
|
| Hospital Charge Code |
8472467
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$364.48
|
|
|
ED RMVL FB XTRNL EYE CORNEAL W/SLIT LAMP BCE
|
Facility
|
OP
|
$494.00
|
|
|
Service Code
|
HCPCS 65222
|
| Hospital Charge Code |
8726549
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$44.46 |
| Max. Negotiated Rate |
$355.68 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$44.46
|
| 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 |
$335.92
|
| Rate for Payer: Cash Price |
$335.92
|
| Rate for Payer: Cash Price |
$335.92
|
| Rate for Payer: Cigna Commercial |
$282.53
|
| Rate for Payer: Cigna Medicaid |
$355.68
|
| 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 |
$355.68
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$133.65
|
| Rate for Payer: Molina Medicare |
$133.65
|
| Rate for Payer: Multiplan Auto |
$321.10
|
| Rate for Payer: Multiplan Commercial |
$321.10
|
| Rate for Payer: Multiplan Workers Comp |
$321.10
|
| Rate for Payer: Parkland Medicaid |
$355.68
|
| Rate for Payer: Scott and White EPO/PPO |
$247.00
|
| Rate for Payer: Scott and White Medicare |
$133.65
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$355.68
|
| 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 RMVL FB XTRNL EYE CORNEAL W/SLIT LAMP BCE
|
Facility
|
IP
|
$494.00
|
|
|
Service Code
|
HCPCS 65222
|
| Hospital Charge Code |
8726549
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$335.92
|
|
|
ED RMVL NON-BIODEGRADABLE DRUG DELIV IMPLT BCE
|
Facility
|
OP
|
$5,620.00
|
|
|
Service Code
|
HCPCS 11982
|
| Hospital Charge Code |
8724546
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$448.76 |
| Max. Negotiated Rate |
$4,046.40 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$505.80
|
| 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 |
$3,821.60
|
| Rate for Payer: Cash Price |
$3,821.60
|
| Rate for Payer: Cash Price |
$3,821.60
|
| Rate for Payer: Cigna Commercial |
$948.59
|
| Rate for Payer: Cigna Medicaid |
$4,046.40
|
| 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 |
$4,046.40
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$448.76
|
| Rate for Payer: Molina Medicare |
$448.76
|
| Rate for Payer: Multiplan Auto |
$3,653.00
|
| Rate for Payer: Multiplan Commercial |
$3,653.00
|
| Rate for Payer: Multiplan Workers Comp |
$3,653.00
|
| Rate for Payer: Parkland Medicaid |
$4,046.40
|
| Rate for Payer: Scott and White EPO/PPO |
$2,810.00
|
| Rate for Payer: Scott and White Medicare |
$448.76
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$4,046.40
|
| 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 RMVL NON-BIODEGRADABLE DRUG DELIV IMPLT BCE
|
Facility
|
IP
|
$5,620.00
|
|
|
Service Code
|
HCPCS 11982
|
| Hospital Charge Code |
8724546
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$3,821.60
|
|
|
ED RPLC GASTRO/CECOSTOMY TUBE PERC W/GUIDE CNTRST IMG BCE
|
Facility
|
IP
|
$1,573.00
|
|
|
Service Code
|
HCPCS 49450
|
| Hospital Charge Code |
8424452
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$1,069.64
|
|
|
ED RPLC GASTRO/CECOSTOMY TUBE PERC W/GUIDE CNTRST IMG BCE
|
Facility
|
OP
|
$1,573.00
|
|
|
Service Code
|
HCPCS 49450
|
| Hospital Charge Code |
8424452
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$141.57 |
| Max. Negotiated Rate |
$1,980.52 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$141.57
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$911.12
|
| Rate for Payer: Amerigroup Medicare |
$911.12
|
| Rate for Payer: BCBS of TX Blue Advantage |
$1,312.49
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,571.84
|
| Rate for Payer: BCBS of TX Medicare |
$911.12
|
| Rate for Payer: BCBS of TX PPO |
$1,980.52
|
| Rate for Payer: Cash Price |
$1,069.64
|
| Rate for Payer: Cash Price |
$1,069.64
|
| Rate for Payer: Cash Price |
$1,069.64
|
| Rate for Payer: Cigna Commercial |
$1,925.93
|
| Rate for Payer: Cigna Medicaid |
$1,132.56
|
| Rate for Payer: Cigna Medicare |
$911.12
|
| Rate for Payer: Employer Direct Commercial |
$911.12
|
| Rate for Payer: Humana Medicare/TRICARE |
$911.12
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,132.56
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$911.12
|
| Rate for Payer: Molina Medicare |
$911.12
|
| Rate for Payer: Multiplan Auto |
$1,022.45
|
| Rate for Payer: Multiplan Commercial |
$1,022.45
|
| Rate for Payer: Multiplan Workers Comp |
$1,022.45
|
| Rate for Payer: Parkland Medicaid |
$1,132.56
|
| Rate for Payer: Scott and White EPO/PPO |
$786.50
|
| Rate for Payer: Scott and White Medicare |
$911.12
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,132.56
|
| Rate for Payer: Superior Health Plan EPO |
$911.12
|
| Rate for Payer: Superior Health Plan Medicare |
$911.12
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$911.12
|
| Rate for Payer: Universal American Medicare |
$911.12
|
| Rate for Payer: Wellcare Medicare |
$911.12
|
| Rate for Payer: Wellmed Medicare |
$911.12
|
|
