|
Open treatment of trimalleolar ankle fracture, includes internal fixation, when performed, medial an
|
Facility
|
OP
|
$15,074.51
|
|
|
Service Code
|
CPT 27823
|
| Hospital Charge Code |
36027823
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$144.31 |
| Max. Negotiated Rate |
$15,074.51 |
| Rate for Payer: Aetna Commercial |
$7,210.00
|
| Rate for Payer: Aetna Medicare |
$9,814.08
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$3,190.98
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$6,542.72
|
| Rate for Payer: Amerigroup Medicare |
$6,542.72
|
| Rate for Payer: BCBS of TX Blue Advantage |
$9,989.86
|
| Rate for Payer: BCBS of TX Blue Essentials |
$11,963.90
|
| Rate for Payer: BCBS of TX Medicare |
$6,542.72
|
| Rate for Payer: BCBS of TX PPO |
$15,074.51
|
| Rate for Payer: Cigna Commercial |
$14,821.16
|
| Rate for Payer: Cigna Medicaid |
$3,190.98
|
| Rate for Payer: Cigna Medicare |
$6,542.72
|
| Rate for Payer: Employer Direct Commercial |
$6,542.72
|
| Rate for Payer: Humana Medicare/TRICARE |
$6,542.72
|
| Rate for Payer: Molina CHIP/Medicaid |
$3,190.98
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$6,542.72
|
| Rate for Payer: Molina Medicare |
$6,542.72
|
| Rate for Payer: Multiplan Auto |
$10,000.00
|
| Rate for Payer: Multiplan Commercial |
$10,000.00
|
| Rate for Payer: Multiplan Workers Comp |
$10,000.00
|
| Rate for Payer: Parkland Medicaid |
$3,190.98
|
| Rate for Payer: Scott and White EPO/PPO |
$144.31
|
| Rate for Payer: Scott and White Medicare |
$6,542.72
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$3,190.98
|
| Rate for Payer: Superior Health Plan EPO |
$6,542.72
|
| Rate for Payer: Superior Health Plan Medicare |
$6,542.72
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$6,542.72
|
| Rate for Payer: Universal American Medicare |
$6,542.72
|
| Rate for Payer: Wellcare Medicare |
$6,542.72
|
| Rate for Payer: Wellmed Medicare |
$6,542.72
|
|
|
Open treatment of trimalleolar ankle fracture, includes internal fixation, when performed, medial an
|
Facility
|
OP
|
$15,074.51
|
|
|
Service Code
|
CPT 27822
|
| Hospital Charge Code |
36027822
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$144.31 |
| Max. Negotiated Rate |
$15,074.51 |
| Rate for Payer: Aetna Commercial |
$7,210.00
|
| Rate for Payer: Aetna Medicare |
$9,814.08
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$3,224.61
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$6,542.72
|
| Rate for Payer: Amerigroup Medicare |
$6,542.72
|
| Rate for Payer: BCBS of TX Blue Advantage |
$9,989.86
|
| Rate for Payer: BCBS of TX Blue Essentials |
$11,963.90
|
| Rate for Payer: BCBS of TX Medicare |
$6,542.72
|
| Rate for Payer: BCBS of TX PPO |
$15,074.51
|
| Rate for Payer: Cigna Commercial |
$14,821.16
|
| Rate for Payer: Cigna Medicaid |
$3,224.61
|
| Rate for Payer: Cigna Medicare |
$6,542.72
|
| Rate for Payer: Employer Direct Commercial |
$6,542.72
|
| Rate for Payer: Humana Medicare/TRICARE |
$6,542.72
|
| Rate for Payer: Molina CHIP/Medicaid |
$3,224.61
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$6,542.72
|
| Rate for Payer: Molina Medicare |
$6,542.72
|
| Rate for Payer: Multiplan Auto |
$10,000.00
|
| Rate for Payer: Multiplan Commercial |
$10,000.00
|
| Rate for Payer: Multiplan Workers Comp |
$10,000.00
|
| Rate for Payer: Parkland Medicaid |
$3,224.61
|
| Rate for Payer: Scott and White EPO/PPO |
$144.31
|
| Rate for Payer: Scott and White Medicare |
$6,542.72
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$3,224.61
|
| Rate for Payer: Superior Health Plan EPO |
$6,542.72
|
| Rate for Payer: Superior Health Plan Medicare |
$6,542.72
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$6,542.72
|
| Rate for Payer: Universal American Medicare |
$6,542.72
|
| Rate for Payer: Wellcare Medicare |
$6,542.72
|
| Rate for Payer: Wellmed Medicare |
$6,542.72
|
|
|
Open treatment of ulnar fracture, proximal end (eg, olecranon or coronoid process[es]), includes int
|
Facility
|
OP
|
$15,074.51
|
|
|
Service Code
|
CPT 24685
|
| Hospital Charge Code |
36024685
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$144.31 |
| Max. Negotiated Rate |
$15,074.51 |
| Rate for Payer: Aetna Commercial |
$7,210.00
|
| Rate for Payer: Aetna Medicare |
$9,814.08
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$3,173.46
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$6,542.72
|
| Rate for Payer: Amerigroup Medicare |
$6,542.72
|
| Rate for Payer: BCBS of TX Blue Advantage |
$9,989.86
|
| Rate for Payer: BCBS of TX Blue Essentials |
$11,963.90
|
| Rate for Payer: BCBS of TX Medicare |
$6,542.72
|
| Rate for Payer: BCBS of TX PPO |
$15,074.51
|
| Rate for Payer: Cigna Commercial |
$14,821.16
|
| Rate for Payer: Cigna Medicaid |
$3,173.46
|
| Rate for Payer: Cigna Medicare |
$6,542.72
|
| Rate for Payer: Employer Direct Commercial |
$6,542.72
|
| Rate for Payer: Humana Medicare/TRICARE |
$6,542.72
|
| Rate for Payer: Molina CHIP/Medicaid |
$3,173.46
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$6,542.72
|
| Rate for Payer: Molina Medicare |
$6,542.72
|
| Rate for Payer: Multiplan Auto |
$10,000.00
|
| Rate for Payer: Multiplan Commercial |
$10,000.00
|
| Rate for Payer: Multiplan Workers Comp |
$10,000.00
|
| Rate for Payer: Parkland Medicaid |
$3,173.46
|
| Rate for Payer: Scott and White EPO/PPO |
$144.31
|
| Rate for Payer: Scott and White Medicare |
$6,542.72
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$3,173.46
|
| Rate for Payer: Superior Health Plan EPO |
$6,542.72
|
| Rate for Payer: Superior Health Plan Medicare |
$6,542.72
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$6,542.72
|
| Rate for Payer: Universal American Medicare |
$6,542.72
|
| Rate for Payer: Wellcare Medicare |
$6,542.72
|
| Rate for Payer: Wellmed Medicare |
$6,542.72
|
|
|
Open treatment of ulnar shaft fracture
|
Facility
|
OP
|
$15,074.51
|
|
|
Service Code
|
CPT 25545
|
| Hospital Charge Code |
36025545
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$144.31 |
| Max. Negotiated Rate |
$15,074.51 |
| Rate for Payer: Aetna Commercial |
$7,210.00
|
| Rate for Payer: Aetna Medicare |
$9,814.08
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$3,160.14
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$6,542.72
|
| Rate for Payer: Amerigroup Medicare |
$6,542.72
|
| Rate for Payer: BCBS of TX Blue Advantage |
$9,989.86
|
| Rate for Payer: BCBS of TX Blue Essentials |
$11,963.90
|
| Rate for Payer: BCBS of TX Medicare |
$6,542.72
|
| Rate for Payer: BCBS of TX PPO |
$15,074.51
|
| Rate for Payer: Cigna Commercial |
$14,821.16
|
| Rate for Payer: Cigna Medicaid |
$3,160.14
|
| Rate for Payer: Cigna Medicare |
$6,542.72
|
| Rate for Payer: Employer Direct Commercial |
$6,542.72
|
| Rate for Payer: Humana Medicare/TRICARE |
$6,542.72
|
| Rate for Payer: Molina CHIP/Medicaid |
$3,160.14
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$6,542.72
|
| Rate for Payer: Molina Medicare |
$6,542.72
|
| Rate for Payer: Multiplan Auto |
$10,000.00
|
| Rate for Payer: Multiplan Commercial |
$10,000.00
|
| Rate for Payer: Multiplan Workers Comp |
$10,000.00
|
| Rate for Payer: Parkland Medicaid |
$3,160.14
|
| Rate for Payer: Scott and White EPO/PPO |
$144.31
|
| Rate for Payer: Scott and White Medicare |
$6,542.72
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$3,160.14
|
| Rate for Payer: Superior Health Plan EPO |
$6,542.72
|
| Rate for Payer: Superior Health Plan Medicare |
$6,542.72
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$6,542.72
|
| Rate for Payer: Universal American Medicare |
$6,542.72
|
| Rate for Payer: Wellcare Medicare |
$6,542.72
|
| Rate for Payer: Wellmed Medicare |
$6,542.72
|
|
|
Open treatment of ulnar styloid fracture
|
Facility
|
OP
|
$15,074.51
|
|
|
Service Code
|
CPT 25652
|
| Hospital Charge Code |
36025652
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$144.31 |
| Max. Negotiated Rate |
$15,074.51 |
| Rate for Payer: Aetna Commercial |
$7,210.00
|
| Rate for Payer: Aetna Medicare |
$9,814.08
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$3,121.14
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$6,542.72
|
| Rate for Payer: Amerigroup Medicare |
$6,542.72
|
| Rate for Payer: BCBS of TX Blue Advantage |
$9,989.86
|
| Rate for Payer: BCBS of TX Blue Essentials |
$11,963.90
|
| Rate for Payer: BCBS of TX Medicare |
$6,542.72
|
| Rate for Payer: BCBS of TX PPO |
$15,074.51
|
| Rate for Payer: Cigna Commercial |
$14,821.16
|
| Rate for Payer: Cigna Medicaid |
$3,121.14
|
| Rate for Payer: Cigna Medicare |
$6,542.72
|
| Rate for Payer: Employer Direct Commercial |
$6,542.72
|
| Rate for Payer: Humana Medicare/TRICARE |
$6,542.72
|
| Rate for Payer: Molina CHIP/Medicaid |
$3,121.14
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$6,542.72
|
| Rate for Payer: Molina Medicare |
$6,542.72
|
| Rate for Payer: Multiplan Auto |
$10,000.00
|
| Rate for Payer: Multiplan Commercial |
$10,000.00
|
| Rate for Payer: Multiplan Workers Comp |
$10,000.00
|
| Rate for Payer: Parkland Medicaid |
$3,121.14
|
| Rate for Payer: Scott and White EPO/PPO |
$144.31
|
| Rate for Payer: Scott and White Medicare |
$6,542.72
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$3,121.14
|
| Rate for Payer: Superior Health Plan EPO |
$6,542.72
|
| Rate for Payer: Superior Health Plan Medicare |
$6,542.72
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$6,542.72
|
| Rate for Payer: Universal American Medicare |
$6,542.72
|
| Rate for Payer: Wellcare Medicare |
$6,542.72
|
| Rate for Payer: Wellmed Medicare |
$6,542.72
|
|
|
OP Hemodialysis Treatment Complete
|
Facility
|
OP
|
$2,811.00
|
|
|
Service Code
|
CPT 90935
|
| Hospital Charge Code |
800029
|
|
Hospital Revenue Code
|
829
|
| Min. Negotiated Rate |
$11.43 |
| Max. Negotiated Rate |
$1,827.15 |
| Rate for Payer: Aetna Commercial |
$94.88
|
| Rate for Payer: Aetna Medicare |
$958.62
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$252.99
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$639.08
|
| Rate for Payer: Amerigroup Medicare |
$639.08
|
| Rate for Payer: BCBS of TX Blue Advantage |
$843.30
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,011.96
|
| Rate for Payer: BCBS of TX Medicare |
$639.08
|
| Rate for Payer: BCBS of TX PPO |
$1,124.40
|
| Rate for Payer: Cash Price |
$2,473.68
|
| Rate for Payer: Cash Price |
$2,473.68
|
| Rate for Payer: Cash Price |
$2,473.68
|
| Rate for Payer: Cigna Commercial |
$1,447.70
|
| Rate for Payer: Cigna Medicare |
$639.08
|
| Rate for Payer: Employer Direct Commercial |
$639.08
|
| Rate for Payer: Humana Medicare/TRICARE |
$639.08
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$639.08
|
| Rate for Payer: Molina Medicare |
$639.08
|
| Rate for Payer: Multiplan Auto |
$1,827.15
|
| Rate for Payer: Multiplan Commercial |
$1,827.15
|
| Rate for Payer: Multiplan Workers Comp |
$1,827.15
|
| Rate for Payer: Scott and White EPO/PPO |
$11.43
|
| Rate for Payer: Scott and White Medicare |
$639.08
|
| Rate for Payer: Superior Health Plan EPO |
$639.08
|
| Rate for Payer: Superior Health Plan Medicare |
$639.08
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$639.08
|
| Rate for Payer: Universal American Medicare |
$639.08
|
| Rate for Payer: Wellcare Medicare |
$639.08
|
| Rate for Payer: Wellmed Medicare |
$639.08
|
|
|
Ophth irrigation, extraocular Ophth Soln 120 mL
|
Facility
|
IP
|
$8.00
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
77737205
|
|
Hospital Revenue Code
|
250
|
| Rate for Payer: Cash Price |
$5.44
|
|
|
Ophth irrigation, extraocular Ophth Soln 120 mL
|
Facility
|
OP
|
$8.00
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
77737205
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.72 |
| Max. Negotiated Rate |
$5.20 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$0.72
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2.40
|
| Rate for Payer: BCBS of TX Blue Essentials |
$2.88
|
| Rate for Payer: BCBS of TX PPO |
$3.20
|
| Rate for Payer: Cash Price |
$5.44
|
| Rate for Payer: Multiplan Auto |
$5.20
|
| Rate for Payer: Multiplan Commercial |
$5.20
|
| Rate for Payer: Multiplan Workers Comp |
$5.20
|
| Rate for Payer: Scott and White EPO/PPO |
$4.00
|
| Rate for Payer: Superior Health Plan EPO |
$1.09
|
|
|
Opiate Screen Urine
|
Facility
|
IP
|
$317.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
1640113
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$278.96
|
|
|
Opiate Screen Urine
|
Facility
|
OP
|
$317.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
1640113
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.23 |
| Max. Negotiated Rate |
$206.05 |
| Rate for Payer: Aetna Commercial |
$65.24
|
| Rate for Payer: Aetna Medicare |
$93.21
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$24.23
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$62.14
|
| Rate for Payer: Amerigroup Medicare |
$62.14
|
| Rate for Payer: BCBS of TX Blue Advantage |
$102.53
|
| Rate for Payer: BCBS of TX Blue Essentials |
$123.04
|
| Rate for Payer: BCBS of TX Medicare |
$62.14
|
| Rate for Payer: BCBS of TX PPO |
$137.33
|
| Rate for Payer: Cash Price |
$278.96
|
| Rate for Payer: Cash Price |
$278.96
|
| Rate for Payer: Cigna Medicaid |
$62.14
|
| Rate for Payer: Cigna Medicare |
$62.14
|
| Rate for Payer: Employer Direct Commercial |
$62.14
|
| Rate for Payer: Humana Medicare/TRICARE |
$62.14
|
| Rate for Payer: Molina CHIP/Medicaid |
$62.14
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$62.14
|
| Rate for Payer: Molina Medicare |
$62.14
|
| Rate for Payer: Multiplan Auto |
$206.05
|
| Rate for Payer: Multiplan Commercial |
$206.05
|
| Rate for Payer: Multiplan Workers Comp |
$206.05
|
| Rate for Payer: Parkland Medicaid |
$62.14
|
| Rate for Payer: Scott and White EPO/PPO |
$77.68
|
| Rate for Payer: Scott and White Medicare |
$62.14
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$62.14
|
| Rate for Payer: Superior Health Plan EPO |
$62.14
|
| Rate for Payer: Superior Health Plan Medicare |
$62.14
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$62.14
|
| Rate for Payer: Universal American Medicare |
$62.14
|
| Rate for Payer: Wellcare Medicare |
$62.14
|
| Rate for Payer: Wellmed Medicare |
$62.14
|
|
|
OP Peritoneal Dialysis Treatment Complete
|
Facility
|
OP
|
$2,495.91
|
|
|
Service Code
|
CPT 90945
|
| Hospital Charge Code |
8856543
|
|
Hospital Revenue Code
|
830
|
| Min. Negotiated Rate |
$7.24 |
| Max. Negotiated Rate |
$1,622.34 |
| Rate for Payer: Aetna Commercial |
$1,372.75
|
| Rate for Payer: Aetna Medicare |
$607.59
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$224.63
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$405.06
|
| Rate for Payer: Amerigroup Medicare |
$405.06
|
| Rate for Payer: BCBS of TX Blue Advantage |
$748.77
|
| Rate for Payer: BCBS of TX Blue Essentials |
$898.53
|
| Rate for Payer: BCBS of TX Medicare |
$405.06
|
| Rate for Payer: BCBS of TX PPO |
$998.36
|
| Rate for Payer: Cash Price |
$2,196.40
|
| Rate for Payer: Cash Price |
$2,196.40
|
| Rate for Payer: Cash Price |
$2,196.40
|
| Rate for Payer: Cigna Commercial |
$917.59
|
| Rate for Payer: Cigna Medicare |
$405.06
|
| Rate for Payer: Employer Direct Commercial |
$405.06
|
| Rate for Payer: Humana Medicare/TRICARE |
$405.06
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$405.06
|
| Rate for Payer: Molina Medicare |
$405.06
|
| Rate for Payer: Multiplan Auto |
$1,622.34
|
| Rate for Payer: Multiplan Commercial |
$1,622.34
|
| Rate for Payer: Multiplan Workers Comp |
$1,622.34
|
| Rate for Payer: Scott and White EPO/PPO |
$7.24
|
| Rate for Payer: Scott and White Medicare |
$405.06
|
| Rate for Payer: Superior Health Plan EPO |
$405.06
|
| Rate for Payer: Superior Health Plan Medicare |
$405.06
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$405.06
|
| Rate for Payer: Universal American Medicare |
$405.06
|
| Rate for Payer: Wellcare Medicare |
$405.06
|
| Rate for Payer: Wellmed Medicare |
$405.06
|
|
|
OP Peritoneal Dialysis Treatment Complete
|
Facility
|
IP
|
$2,495.91
|
|
|
Service Code
|
CPT 90945
|
| Hospital Charge Code |
8856543
|
|
Hospital Revenue Code
|
830
|
| Rate for Payer: Cash Price |
$2,196.40
|
|
|
OPTISEAL EXTENSION 6FR 13CM
|
Facility
|
OP
|
$263.32
|
|
| Hospital Charge Code |
145518
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$23.70 |
| Max. Negotiated Rate |
$171.16 |
| Rate for Payer: Aetna Commercial |
$144.83
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$23.70
|
| Rate for Payer: BCBS of TX Blue Advantage |
$79.00
|
| Rate for Payer: BCBS of TX Blue Essentials |
$94.80
|
| Rate for Payer: BCBS of TX PPO |
$105.33
|
| Rate for Payer: Cash Price |
$231.72
|
| Rate for Payer: Multiplan Auto |
$171.16
|
| Rate for Payer: Multiplan Commercial |
$171.16
|
| Rate for Payer: Multiplan Workers Comp |
$171.16
|
| Rate for Payer: Scott and White EPO/PPO |
$131.66
|
| Rate for Payer: Superior Health Plan EPO |
$35.81
|
|
|
OPTISEAL EXTENSION 6FR 13CM
|
Facility
|
IP
|
$263.32
|
|
| Hospital Charge Code |
145518
|
|
Hospital Revenue Code
|
272
|
| Rate for Payer: Cash Price |
$231.72
|
|
|
OPWC Apply Rigid Leg Cast Lt BCE
|
Facility
|
OP
|
$874.00
|
|
|
Service Code
|
CPT 29445 LT
|
| Hospital Charge Code |
8910540
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$4.39 |
| Max. Negotiated Rate |
$568.10 |
| Rate for Payer: Aetna Commercial |
$480.70
|
| Rate for Payer: Aetna Medicare |
$368.42
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$78.66
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$245.61
|
| Rate for Payer: Amerigroup Medicare |
$245.61
|
| Rate for Payer: BCBS of TX Blue Advantage |
$103.66
|
| Rate for Payer: BCBS of TX Blue Essentials |
$124.14
|
| Rate for Payer: BCBS of TX Medicare |
$245.61
|
| Rate for Payer: BCBS of TX PPO |
$156.42
|
| Rate for Payer: Cash Price |
$769.12
|
| Rate for Payer: Cash Price |
$769.12
|
| Rate for Payer: Cash Price |
$769.12
|
| Rate for Payer: Cigna Commercial |
$556.38
|
| Rate for Payer: Cigna Medicaid |
$49.56
|
| Rate for Payer: Cigna Medicare |
$245.61
|
| Rate for Payer: Employer Direct Commercial |
$245.61
|
| Rate for Payer: Humana Medicare/TRICARE |
$245.61
|
| Rate for Payer: Molina CHIP/Medicaid |
$49.56
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$245.61
|
| Rate for Payer: Molina Medicare |
$245.61
|
| Rate for Payer: Multiplan Auto |
$568.10
|
| Rate for Payer: Multiplan Commercial |
$568.10
|
| Rate for Payer: Multiplan Workers Comp |
$568.10
|
| Rate for Payer: Parkland Medicaid |
$49.56
|
| Rate for Payer: Scott and White EPO/PPO |
$4.39
|
| Rate for Payer: Scott and White Medicare |
$245.61
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$49.56
|
| Rate for Payer: Superior Health Plan EPO |
$245.61
|
| Rate for Payer: Superior Health Plan Medicare |
$245.61
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$245.61
|
| Rate for Payer: Universal American Medicare |
$245.61
|
| Rate for Payer: Wellcare Medicare |
$245.61
|
| Rate for Payer: Wellmed Medicare |
$245.61
|
|
|
OPWC Apply Rigid Leg Cast Lt BCE
|
Facility
|
IP
|
$874.00
|
|
|
Service Code
|
CPT 29445 LT
|
| Hospital Charge Code |
8910540
|
|
Hospital Revenue Code
|
761
|
| Rate for Payer: Cash Price |
$769.12
|
|
|
OPWC Apply Rigid Leg Cast Rt BCE
|
Facility
|
OP
|
$874.00
|
|
|
Service Code
|
CPT 29445 RT
|
| Hospital Charge Code |
8910541
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$4.39 |
| Max. Negotiated Rate |
$568.10 |
| Rate for Payer: Aetna Commercial |
$480.70
|
| Rate for Payer: Aetna Medicare |
$368.42
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$78.66
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$245.61
|
| Rate for Payer: Amerigroup Medicare |
$245.61
|
| Rate for Payer: BCBS of TX Blue Advantage |
$103.66
|
| Rate for Payer: BCBS of TX Blue Essentials |
$124.14
|
| Rate for Payer: BCBS of TX Medicare |
$245.61
|
| Rate for Payer: BCBS of TX PPO |
$156.42
|
| Rate for Payer: Cash Price |
$769.12
|
| Rate for Payer: Cash Price |
$769.12
|
| Rate for Payer: Cash Price |
$769.12
|
| Rate for Payer: Cigna Commercial |
$556.38
|
| Rate for Payer: Cigna Medicaid |
$49.56
|
| Rate for Payer: Cigna Medicare |
$245.61
|
| Rate for Payer: Employer Direct Commercial |
$245.61
|
| Rate for Payer: Humana Medicare/TRICARE |
$245.61
|
| Rate for Payer: Molina CHIP/Medicaid |
$49.56
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$245.61
|
| Rate for Payer: Molina Medicare |
$245.61
|
| Rate for Payer: Multiplan Auto |
$568.10
|
| Rate for Payer: Multiplan Commercial |
$568.10
|
| Rate for Payer: Multiplan Workers Comp |
$568.10
|
| Rate for Payer: Parkland Medicaid |
$49.56
|
| Rate for Payer: Scott and White EPO/PPO |
$4.39
|
| Rate for Payer: Scott and White Medicare |
$245.61
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$49.56
|
| Rate for Payer: Superior Health Plan EPO |
$245.61
|
| Rate for Payer: Superior Health Plan Medicare |
$245.61
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$245.61
|
| Rate for Payer: Universal American Medicare |
$245.61
|
| Rate for Payer: Wellcare Medicare |
$245.61
|
| Rate for Payer: Wellmed Medicare |
$245.61
|
|
|
OPWC Apply Rigid Leg Cast Rt BCE
|
Facility
|
IP
|
$874.00
|
|
|
Service Code
|
CPT 29445 RT
|
| Hospital Charge Code |
8910541
|
|
Hospital Revenue Code
|
761
|
| Rate for Payer: Cash Price |
$769.12
|
|
|
OPWC Avlsn Plte, Smpl, Sngl BCE
|
Facility
|
OP
|
$476.00
|
|
|
Service Code
|
CPT 11730
|
| Hospital Charge Code |
8912540
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3.27 |
| Max. Negotiated Rate |
$440.32 |
| Rate for Payer: Aetna Commercial |
$261.80
|
| Rate for Payer: Aetna Medicare |
$274.64
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$42.84
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$183.09
|
| Rate for Payer: Amerigroup Medicare |
$183.09
|
| 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 |
$183.09
|
| Rate for Payer: BCBS of TX PPO |
$440.32
|
| Rate for Payer: Cash Price |
$418.88
|
| Rate for Payer: Cash Price |
$418.88
|
| Rate for Payer: Cash Price |
$418.88
|
| Rate for Payer: Cigna Commercial |
$414.75
|
| Rate for Payer: Cigna Medicare |
$183.09
|
| Rate for Payer: Employer Direct Commercial |
$183.09
|
| Rate for Payer: Humana Medicare/TRICARE |
$183.09
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$183.09
|
| Rate for Payer: Molina Medicare |
$183.09
|
| Rate for Payer: Multiplan Auto |
$309.40
|
| Rate for Payer: Multiplan Commercial |
$309.40
|
| Rate for Payer: Multiplan Workers Comp |
$309.40
|
| Rate for Payer: Scott and White EPO/PPO |
$3.27
|
| Rate for Payer: Scott and White Medicare |
$183.09
|
| Rate for Payer: Superior Health Plan EPO |
$183.09
|
| Rate for Payer: Superior Health Plan Medicare |
$183.09
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$183.09
|
| Rate for Payer: Universal American Medicare |
$183.09
|
| Rate for Payer: Wellcare Medicare |
$183.09
|
| Rate for Payer: Wellmed Medicare |
$183.09
|
|
|
OPWC Avlsn Plte, Smpl, Sngl BCE
|
Facility
|
IP
|
$476.00
|
|
|
Service Code
|
CPT 11730
|
| Hospital Charge Code |
8912540
|
|
Hospital Revenue Code
|
761
|
| Rate for Payer: Cash Price |
$418.88
|
|
|
OPWC Biopsy Bone Open BCE
|
Facility
|
OP
|
$4,752.00
|
|
|
Service Code
|
CPT 20240
|
| Hospital Charge Code |
8910542
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$57.32 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$3,090.00
|
| Rate for Payer: Aetna Medicare |
$3,898.02
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$815.20
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$2,598.68
|
| Rate for Payer: Amerigroup Medicare |
$2,598.68
|
| Rate for Payer: BCBS of TX Blue Advantage |
$3,872.55
|
| Rate for Payer: BCBS of TX Blue Essentials |
$4,637.78
|
| Rate for Payer: BCBS of TX Medicare |
$2,598.68
|
| Rate for Payer: BCBS of TX PPO |
$5,843.60
|
| Rate for Payer: Cash Price |
$4,181.76
|
| Rate for Payer: Cash Price |
$4,181.76
|
| Rate for Payer: Cigna Commercial |
$5,886.75
|
| Rate for Payer: Cigna Medicaid |
$815.20
|
| Rate for Payer: Cigna Medicare |
$2,598.68
|
| Rate for Payer: Employer Direct Commercial |
$2,598.68
|
| Rate for Payer: Humana Medicare/TRICARE |
$2,598.68
|
| Rate for Payer: Molina CHIP/Medicaid |
$815.20
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$2,598.68
|
| Rate for Payer: Molina Medicare |
$2,598.68
|
| Rate for Payer: Multiplan Auto |
$10,000.00
|
| Rate for Payer: Multiplan Commercial |
$10,000.00
|
| Rate for Payer: Multiplan Workers Comp |
$10,000.00
|
| Rate for Payer: Parkland Medicaid |
$815.20
|
| Rate for Payer: Scott and White EPO/PPO |
$57.32
|
| Rate for Payer: Scott and White Medicare |
$2,598.68
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$815.20
|
| Rate for Payer: Superior Health Plan EPO |
$2,598.68
|
| Rate for Payer: Superior Health Plan Medicare |
$2,598.68
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$2,598.68
|
| Rate for Payer: Universal American Medicare |
$2,598.68
|
| Rate for Payer: Wellcare Medicare |
$2,598.68
|
| Rate for Payer: Wellmed Medicare |
$2,598.68
|
|
|
OPWC Biopsy Bone Open BCE
|
Facility
|
IP
|
$4,752.00
|
|
|
Service Code
|
CPT 20240
|
| Hospital Charge Code |
8910542
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$4,181.76
|
|
|
OPWC BONE BIOPSY NEEDLE/TROCAR DEEP BCE
|
Facility
|
IP
|
$2,948.00
|
|
|
Service Code
|
CPT 20225
|
| Hospital Charge Code |
8912541
|
|
Hospital Revenue Code
|
761
|
| Rate for Payer: Cash Price |
$2,594.24
|
|
|
OPWC BONE BIOPSY NEEDLE/TROCAR DEEP BCE
|
Facility
|
OP
|
$2,948.00
|
|
|
Service Code
|
CPT 20225
|
| Hospital Charge Code |
8912541
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$26.52 |
| Max. Negotiated Rate |
$3,458.95 |
| Rate for Payer: Aetna Commercial |
$2,200.00
|
| Rate for Payer: Aetna Medicare |
$2,224.11
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$265.32
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,482.74
|
| Rate for Payer: Amerigroup Medicare |
$1,482.74
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,292.24
|
| Rate for Payer: BCBS of TX Blue Essentials |
$2,745.20
|
| Rate for Payer: BCBS of TX Medicare |
$1,482.74
|
| Rate for Payer: BCBS of TX PPO |
$3,458.95
|
| Rate for Payer: Cash Price |
$2,594.24
|
| Rate for Payer: Cash Price |
$2,594.24
|
| Rate for Payer: Cash Price |
$2,594.24
|
| Rate for Payer: Cigna Commercial |
$3,358.84
|
| Rate for Payer: Cigna Medicaid |
$486.45
|
| Rate for Payer: Cigna Medicare |
$1,482.74
|
| Rate for Payer: Employer Direct Commercial |
$1,482.74
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,482.74
|
| Rate for Payer: Molina CHIP/Medicaid |
$486.45
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,482.74
|
| Rate for Payer: Molina Medicare |
$1,482.74
|
| Rate for Payer: Multiplan Auto |
$1,916.20
|
| Rate for Payer: Multiplan Commercial |
$1,916.20
|
| Rate for Payer: Multiplan Workers Comp |
$1,916.20
|
| Rate for Payer: Parkland Medicaid |
$486.45
|
| Rate for Payer: Scott and White EPO/PPO |
$26.52
|
| Rate for Payer: Scott and White Medicare |
$1,482.74
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$486.45
|
| Rate for Payer: Superior Health Plan EPO |
$1,482.74
|
| Rate for Payer: Superior Health Plan Medicare |
$1,482.74
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,482.74
|
| Rate for Payer: Universal American Medicare |
$1,482.74
|
| Rate for Payer: Wellcare Medicare |
$1,482.74
|
| Rate for Payer: Wellmed Medicare |
$1,482.74
|
|
|
OPWC Bone Biopsy Needle/Trocar, Superficial BCE
|
Facility
|
OP
|
$2,714.00
|
|
|
Service Code
|
CPT 20220
|
| Hospital Charge Code |
8912542
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$32.70 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$1,400.00
|
| Rate for Payer: Aetna Medicare |
$2,224.11
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$486.45
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,482.74
|
| Rate for Payer: Amerigroup Medicare |
$1,482.74
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,292.24
|
| Rate for Payer: BCBS of TX Blue Essentials |
$2,745.20
|
| Rate for Payer: BCBS of TX Medicare |
$1,482.74
|
| Rate for Payer: BCBS of TX PPO |
$3,458.95
|
| Rate for Payer: Cash Price |
$2,388.32
|
| Rate for Payer: Cash Price |
$2,388.32
|
| Rate for Payer: Cigna Commercial |
$3,358.84
|
| Rate for Payer: Cigna Medicaid |
$486.45
|
| Rate for Payer: Cigna Medicare |
$1,482.74
|
| Rate for Payer: Employer Direct Commercial |
$1,482.74
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,482.74
|
| Rate for Payer: Molina CHIP/Medicaid |
$486.45
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,482.74
|
| Rate for Payer: Molina Medicare |
$1,482.74
|
| Rate for Payer: Multiplan Auto |
$10,000.00
|
| Rate for Payer: Multiplan Commercial |
$10,000.00
|
| Rate for Payer: Multiplan Workers Comp |
$10,000.00
|
| Rate for Payer: Parkland Medicaid |
$486.45
|
| Rate for Payer: Scott and White EPO/PPO |
$32.70
|
| Rate for Payer: Scott and White Medicare |
$1,482.74
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$486.45
|
| Rate for Payer: Superior Health Plan EPO |
$1,482.74
|
| Rate for Payer: Superior Health Plan Medicare |
$1,482.74
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,482.74
|
| Rate for Payer: Universal American Medicare |
$1,482.74
|
| Rate for Payer: Wellcare Medicare |
$1,482.74
|
| Rate for Payer: Wellmed Medicare |
$1,482.74
|
|
