|
Under Lower Extremity Application of Casts
|
Facility
|
OP
|
$739.14
|
|
|
Service Code
|
HCPCS 29445
|
| Hospital Charge Code |
9900540
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$49.94 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$49.94
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$280.97
|
| Rate for Payer: Amerigroup Medicare |
$280.97
|
| 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 |
$280.97
|
| Rate for Payer: BCBS of TX PPO |
$156.42
|
| Rate for Payer: Cash Price |
$502.62
|
| Rate for Payer: Cash Price |
$502.62
|
| Rate for Payer: Cash Price |
$502.62
|
| Rate for Payer: Cigna Commercial |
$593.92
|
| Rate for Payer: Cigna Medicaid |
$532.18
|
| 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 |
$532.18
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$280.97
|
| Rate for Payer: Molina Medicare |
$280.97
|
| 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 |
$532.18
|
| Rate for Payer: Scott and White EPO/PPO |
$519.79
|
| Rate for Payer: Scott and White Medicare |
$280.97
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$532.18
|
| 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
|
|
|
Under Lower Extremity Application of Casts
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 29445
|
| Hospital Charge Code |
36029445
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$49.94 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$49.94
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$280.97
|
| Rate for Payer: Amerigroup Medicare |
$280.97
|
| 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 |
$280.97
|
| Rate for Payer: BCBS of TX PPO |
$156.42
|
| Rate for Payer: Cigna Commercial |
$593.92
|
| 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 Dual Medicare/Medicaid |
$280.97
|
| Rate for Payer: Molina Medicare |
$280.97
|
| 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: Scott and White EPO/PPO |
$519.79
|
| Rate for Payer: Scott and White Medicare |
$280.97
|
| 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
|
|
|
Under Lower Extremity Application of Casts
|
Facility
|
IP
|
$739.14
|
|
|
Service Code
|
HCPCS 29445
|
| Hospital Charge Code |
9900540
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$502.62
|
|
|
Under Otolaryngologic and Binocular Microscopy Procedures
|
Facility
|
IP
|
$2,771.40
|
|
|
Service Code
|
HCPCS 92502
|
| Hospital Charge Code |
9900906
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$1,884.55
|
|
|
Under Otolaryngologic and Binocular Microscopy Procedures
|
Facility
|
OP
|
$2,771.40
|
|
|
Service Code
|
HCPCS 92502
|
| Hospital Charge Code |
9900906
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$249.43 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$249.43
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$541.79
|
| Rate for Payer: Amerigroup Medicare |
$541.79
|
| Rate for Payer: BCBS of TX Blue Advantage |
$737.67
|
| Rate for Payer: BCBS of TX Blue Essentials |
$883.44
|
| Rate for Payer: BCBS of TX Medicare |
$541.79
|
| Rate for Payer: BCBS of TX PPO |
$1,113.13
|
| Rate for Payer: Cash Price |
$1,884.55
|
| Rate for Payer: Cash Price |
$1,884.55
|
| Rate for Payer: Cash Price |
$1,884.55
|
| Rate for Payer: Cigna Commercial |
$1,145.24
|
| Rate for Payer: Cigna Medicaid |
$1,995.41
|
| Rate for Payer: Cigna Medicare |
$541.79
|
| Rate for Payer: Employer Direct Commercial |
$541.79
|
| Rate for Payer: Humana Medicare/TRICARE |
$541.79
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,995.41
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$541.79
|
| Rate for Payer: Molina Medicare |
$541.79
|
| 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 |
$1,995.41
|
| Rate for Payer: Scott and White EPO/PPO |
$1,385.70
|
| Rate for Payer: Scott and White Medicare |
$541.79
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,995.41
|
| Rate for Payer: Superior Health Plan EPO |
$541.79
|
| Rate for Payer: Superior Health Plan Medicare |
$541.79
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$541.79
|
| Rate for Payer: Universal American Medicare |
$541.79
|
| Rate for Payer: Wellcare Medicare |
$541.79
|
| Rate for Payer: Wellmed Medicare |
$541.79
|
|
|
Under Otolaryngologic and Binocular Microscopy Procedures
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 92502
|
| Hospital Charge Code |
36092502
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$541.79 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$541.79
|
| Rate for Payer: Amerigroup Medicare |
$541.79
|
| Rate for Payer: BCBS of TX Blue Advantage |
$737.67
|
| Rate for Payer: BCBS of TX Blue Essentials |
$883.44
|
| Rate for Payer: BCBS of TX Medicare |
$541.79
|
| Rate for Payer: BCBS of TX PPO |
$1,113.13
|
| Rate for Payer: Cigna Commercial |
$1,145.24
|
| Rate for Payer: Cigna Medicare |
$541.79
|
| Rate for Payer: Employer Direct Commercial |
$541.79
|
| Rate for Payer: Humana Medicare/TRICARE |
$541.79
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$541.79
|
| Rate for Payer: Molina Medicare |
$541.79
|
| 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: Scott and White Medicare |
$541.79
|
| Rate for Payer: Superior Health Plan EPO |
$541.79
|
| Rate for Payer: Superior Health Plan Medicare |
$541.79
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$541.79
|
| Rate for Payer: Universal American Medicare |
$541.79
|
| Rate for Payer: Wellcare Medicare |
$541.79
|
| Rate for Payer: Wellmed Medicare |
$541.79
|
|
|
UNDERPAD SUPER ABSORBENT 30 X 36 5/PK
|
Facility
|
IP
|
$4.49
|
|
| Hospital Charge Code |
993902
|
|
Hospital Revenue Code
|
271
|
| Rate for Payer: Cash Price |
$3.05
|
|
|
UNDERPAD SUPER ABSORBENT 30 X 36 5/PK
|
Facility
|
OP
|
$4.49
|
|
| Hospital Charge Code |
993902
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$3.23 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$0.40
|
| Rate for Payer: BCBS of TX Blue Advantage |
$1.35
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1.62
|
| Rate for Payer: BCBS of TX PPO |
$1.80
|
| Rate for Payer: Cash Price |
$3.05
|
| Rate for Payer: Cigna Medicaid |
$3.23
|
| Rate for Payer: Molina CHIP/Medicaid |
$3.23
|
| Rate for Payer: Multiplan Auto |
$2.92
|
| Rate for Payer: Multiplan Commercial |
$2.92
|
| Rate for Payer: Multiplan Workers Comp |
$2.92
|
| Rate for Payer: Parkland Medicaid |
$3.23
|
| Rate for Payer: Scott and White EPO/PPO |
$2.25
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$3.23
|
| Rate for Payer: Superior Health Plan EPO |
$0.61
|
|
|
UNDERPAD ULTRASORB,ADVANCED,30X36,300LB
|
Facility
|
OP
|
$26.94
|
|
| Hospital Charge Code |
993850
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.42 |
| Max. Negotiated Rate |
$19.40 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2.42
|
| Rate for Payer: BCBS of TX Blue Advantage |
$8.08
|
| Rate for Payer: BCBS of TX Blue Essentials |
$9.70
|
| Rate for Payer: BCBS of TX PPO |
$10.78
|
| Rate for Payer: Cash Price |
$18.32
|
| Rate for Payer: Cigna Medicaid |
$19.40
|
| Rate for Payer: Molina CHIP/Medicaid |
$19.40
|
| Rate for Payer: Multiplan Auto |
$17.51
|
| Rate for Payer: Multiplan Commercial |
$17.51
|
| Rate for Payer: Multiplan Workers Comp |
$17.51
|
| Rate for Payer: Parkland Medicaid |
$19.40
|
| Rate for Payer: Scott and White EPO/PPO |
$13.47
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$19.40
|
| Rate for Payer: Superior Health Plan EPO |
$3.66
|
|
|
UNDERPAD ULTRASORB,ADVANCED,30X36,300LB
|
Facility
|
IP
|
$26.94
|
|
| Hospital Charge Code |
993850
|
|
Hospital Revenue Code
|
272
|
| Rate for Payer: Cash Price |
$18.32
|
|
|
Under Repair (Brow Ptosis, Blepharoptosis, Lid Retraction, Ectropion, Entropion) Procedures on the E
|
Facility
|
OP
|
$12,014.10
|
|
|
Service Code
|
HCPCS 67900
|
| Hospital Charge Code |
9900875
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$698.30 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$698.30
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$2,388.32
|
| Rate for Payer: Amerigroup Medicare |
$2,388.32
|
| Rate for Payer: BCBS of TX Blue Advantage |
$3,231.78
|
| Rate for Payer: BCBS of TX Blue Essentials |
$3,870.40
|
| Rate for Payer: BCBS of TX Medicare |
$2,388.32
|
| Rate for Payer: BCBS of TX PPO |
$4,876.70
|
| Rate for Payer: Cash Price |
$8,169.59
|
| Rate for Payer: Cash Price |
$8,169.59
|
| Rate for Payer: Cash Price |
$8,169.59
|
| Rate for Payer: Cigna Commercial |
$5,048.47
|
| Rate for Payer: Cigna Medicaid |
$8,650.15
|
| Rate for Payer: Cigna Medicare |
$2,388.32
|
| Rate for Payer: Employer Direct Commercial |
$2,388.32
|
| Rate for Payer: Humana Medicare/TRICARE |
$2,388.32
|
| Rate for Payer: Molina CHIP/Medicaid |
$8,650.15
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$2,388.32
|
| Rate for Payer: Molina Medicare |
$2,388.32
|
| 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 |
$8,650.15
|
| Rate for Payer: Scott and White EPO/PPO |
$4,418.39
|
| Rate for Payer: Scott and White Medicare |
$2,388.32
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$8,650.15
|
| Rate for Payer: Superior Health Plan EPO |
$2,388.32
|
| Rate for Payer: Superior Health Plan Medicare |
$2,388.32
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$2,388.32
|
| Rate for Payer: Universal American Medicare |
$2,388.32
|
| Rate for Payer: Wellcare Medicare |
$2,388.32
|
| Rate for Payer: Wellmed Medicare |
$2,388.32
|
|
|
Under Repair (Brow Ptosis, Blepharoptosis, Lid Retraction, Ectropion, Entropion) Procedures on the E
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 67900
|
| Hospital Charge Code |
36067900
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$698.30 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$698.30
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$2,388.32
|
| Rate for Payer: Amerigroup Medicare |
$2,388.32
|
| Rate for Payer: BCBS of TX Blue Advantage |
$3,231.78
|
| Rate for Payer: BCBS of TX Blue Essentials |
$3,870.40
|
| Rate for Payer: BCBS of TX Medicare |
$2,388.32
|
| Rate for Payer: BCBS of TX PPO |
$4,876.70
|
| Rate for Payer: Cigna Commercial |
$5,048.47
|
| Rate for Payer: Cigna Medicare |
$2,388.32
|
| Rate for Payer: Employer Direct Commercial |
$2,388.32
|
| Rate for Payer: Humana Medicare/TRICARE |
$2,388.32
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$2,388.32
|
| Rate for Payer: Molina Medicare |
$2,388.32
|
| 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: Scott and White EPO/PPO |
$4,418.39
|
| Rate for Payer: Scott and White Medicare |
$2,388.32
|
| Rate for Payer: Superior Health Plan EPO |
$2,388.32
|
| Rate for Payer: Superior Health Plan Medicare |
$2,388.32
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$2,388.32
|
| Rate for Payer: Universal American Medicare |
$2,388.32
|
| Rate for Payer: Wellcare Medicare |
$2,388.32
|
| Rate for Payer: Wellmed Medicare |
$2,388.32
|
|
|
Under Repair (Brow Ptosis, Blepharoptosis, Lid Retraction, Ectropion, Entropion) Procedures on the E
|
Facility
|
IP
|
$12,014.10
|
|
|
Service Code
|
HCPCS 67900
|
| Hospital Charge Code |
9900875
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$8,169.59
|
|
|
Under Repair, Revision, and/or Reconstruction Procedures on the Foot and Toes
|
Facility
|
OP
|
$15,408.22
|
|
|
Service Code
|
CPT 28238
|
| Hospital Charge Code |
36028238
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,398.52 |
| Max. Negotiated Rate |
$15,408.22 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2,398.52
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$7,289.28
|
| Rate for Payer: Amerigroup Medicare |
$7,289.28
|
| 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 |
$7,289.28
|
| Rate for Payer: BCBS of TX PPO |
$15,074.51
|
| Rate for Payer: Cigna Commercial |
$15,408.22
|
| Rate for Payer: Cigna Medicare |
$7,289.28
|
| Rate for Payer: Employer Direct Commercial |
$7,289.28
|
| Rate for Payer: Humana Medicare/TRICARE |
$7,289.28
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$7,289.28
|
| Rate for Payer: Molina Medicare |
$7,289.28
|
| 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: Scott and White EPO/PPO |
$13,485.17
|
| Rate for Payer: Scott and White Medicare |
$7,289.28
|
| Rate for Payer: Superior Health Plan EPO |
$7,289.28
|
| Rate for Payer: Superior Health Plan Medicare |
$7,289.28
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$7,289.28
|
| Rate for Payer: Universal American Medicare |
$7,289.28
|
| Rate for Payer: Wellcare Medicare |
$7,289.28
|
| Rate for Payer: Wellmed Medicare |
$7,289.28
|
|
|
Under Repair, Revision, and/or Reconstruction Procedures on the Foot and Toes
|
Facility
|
IP
|
$20,865.37
|
|
|
Service Code
|
HCPCS 28202
|
| Hospital Charge Code |
9900489
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$14,188.45
|
|
|
Under Repair, Revision, and/or Reconstruction Procedures on the Foot and Toes
|
Facility
|
OP
|
$20,865.37
|
|
|
Service Code
|
HCPCS 28202
|
| Hospital Charge Code |
9900489
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,105.96 |
| Max. Negotiated Rate |
$15,408.22 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$3,105.96
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$7,289.28
|
| Rate for Payer: Amerigroup Medicare |
$7,289.28
|
| 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 |
$7,289.28
|
| Rate for Payer: BCBS of TX PPO |
$15,074.51
|
| Rate for Payer: Cash Price |
$14,188.45
|
| Rate for Payer: Cash Price |
$14,188.45
|
| Rate for Payer: Cash Price |
$14,188.45
|
| Rate for Payer: Cigna Commercial |
$15,408.22
|
| Rate for Payer: Cigna Medicaid |
$15,023.07
|
| Rate for Payer: Cigna Medicare |
$7,289.28
|
| Rate for Payer: Employer Direct Commercial |
$7,289.28
|
| Rate for Payer: Humana Medicare/TRICARE |
$7,289.28
|
| Rate for Payer: Molina CHIP/Medicaid |
$15,023.07
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$7,289.28
|
| Rate for Payer: Molina Medicare |
$7,289.28
|
| 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 |
$15,023.07
|
| Rate for Payer: Scott and White EPO/PPO |
$13,485.17
|
| Rate for Payer: Scott and White Medicare |
$7,289.28
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$15,023.07
|
| Rate for Payer: Superior Health Plan EPO |
$7,289.28
|
| Rate for Payer: Superior Health Plan Medicare |
$7,289.28
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$7,289.28
|
| Rate for Payer: Universal American Medicare |
$7,289.28
|
| Rate for Payer: Wellcare Medicare |
$7,289.28
|
| Rate for Payer: Wellmed Medicare |
$7,289.28
|
|
|
Under Repair, Revision, and/or Reconstruction Procedures on the Foot and Toes
|
Facility
|
OP
|
$20,504.00
|
|
|
Service Code
|
HCPCS 28238
|
| Hospital Charge Code |
9900494
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,398.52 |
| Max. Negotiated Rate |
$15,408.22 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2,398.52
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$7,289.28
|
| Rate for Payer: Amerigroup Medicare |
$7,289.28
|
| 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 |
$7,289.28
|
| Rate for Payer: BCBS of TX PPO |
$15,074.51
|
| Rate for Payer: Cash Price |
$13,942.72
|
| Rate for Payer: Cash Price |
$13,942.72
|
| Rate for Payer: Cash Price |
$13,942.72
|
| Rate for Payer: Cigna Commercial |
$15,408.22
|
| Rate for Payer: Cigna Medicaid |
$14,762.88
|
| Rate for Payer: Cigna Medicare |
$7,289.28
|
| Rate for Payer: Employer Direct Commercial |
$7,289.28
|
| Rate for Payer: Humana Medicare/TRICARE |
$7,289.28
|
| Rate for Payer: Molina CHIP/Medicaid |
$14,762.88
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$7,289.28
|
| Rate for Payer: Molina Medicare |
$7,289.28
|
| 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 |
$14,762.88
|
| Rate for Payer: Scott and White EPO/PPO |
$13,485.17
|
| Rate for Payer: Scott and White Medicare |
$7,289.28
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$14,762.88
|
| Rate for Payer: Superior Health Plan EPO |
$7,289.28
|
| Rate for Payer: Superior Health Plan Medicare |
$7,289.28
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$7,289.28
|
| Rate for Payer: Universal American Medicare |
$7,289.28
|
| Rate for Payer: Wellcare Medicare |
$7,289.28
|
| Rate for Payer: Wellmed Medicare |
$7,289.28
|
|
|
Under Repair, Revision, and/or Reconstruction Procedures on the Foot and Toes
|
Facility
|
IP
|
$20,504.00
|
|
|
Service Code
|
HCPCS 28238
|
| Hospital Charge Code |
9900494
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$13,942.72
|
|
|
Under Repair, Revision, and/or Reconstruction Procedures on the Foot and Toes
|
Facility
|
OP
|
$15,408.22
|
|
|
Service Code
|
CPT 28202
|
| Hospital Charge Code |
36028202
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,105.96 |
| Max. Negotiated Rate |
$15,408.22 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$3,105.96
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$7,289.28
|
| Rate for Payer: Amerigroup Medicare |
$7,289.28
|
| 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 |
$7,289.28
|
| Rate for Payer: BCBS of TX PPO |
$15,074.51
|
| Rate for Payer: Cigna Commercial |
$15,408.22
|
| Rate for Payer: Cigna Medicare |
$7,289.28
|
| Rate for Payer: Employer Direct Commercial |
$7,289.28
|
| Rate for Payer: Humana Medicare/TRICARE |
$7,289.28
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$7,289.28
|
| Rate for Payer: Molina Medicare |
$7,289.28
|
| 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: Scott and White EPO/PPO |
$13,485.17
|
| Rate for Payer: Scott and White Medicare |
$7,289.28
|
| Rate for Payer: Superior Health Plan EPO |
$7,289.28
|
| Rate for Payer: Superior Health Plan Medicare |
$7,289.28
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$7,289.28
|
| Rate for Payer: Universal American Medicare |
$7,289.28
|
| Rate for Payer: Wellcare Medicare |
$7,289.28
|
| Rate for Payer: Wellmed Medicare |
$7,289.28
|
|
|
Under Repair, Revision, and/or Reconstruction Procedures on the Forearm and Wrist
|
Facility
|
IP
|
$25,588.20
|
|
|
Service Code
|
HCPCS 25400
|
| Hospital Charge Code |
9900293
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$17,399.98
|
|
|
Under Repair, Revision, and/or Reconstruction Procedures on the Forearm and Wrist
|
Facility
|
OP
|
$25,588.20
|
|
|
Service Code
|
HCPCS 25400
|
| Hospital Charge Code |
9900293
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,362.17 |
| Max. Negotiated Rate |
$18,423.50 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$3,362.17
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$7,289.28
|
| Rate for Payer: Amerigroup Medicare |
$7,289.28
|
| 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 |
$7,289.28
|
| Rate for Payer: BCBS of TX PPO |
$15,074.51
|
| Rate for Payer: Cash Price |
$17,399.98
|
| Rate for Payer: Cash Price |
$17,399.98
|
| Rate for Payer: Cash Price |
$17,399.98
|
| Rate for Payer: Cigna Commercial |
$15,408.22
|
| Rate for Payer: Cigna Medicaid |
$18,423.50
|
| Rate for Payer: Cigna Medicare |
$7,289.28
|
| Rate for Payer: Employer Direct Commercial |
$7,289.28
|
| Rate for Payer: Humana Medicare/TRICARE |
$7,289.28
|
| Rate for Payer: Molina CHIP/Medicaid |
$18,423.50
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$7,289.28
|
| Rate for Payer: Molina Medicare |
$7,289.28
|
| 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 |
$18,423.50
|
| Rate for Payer: Scott and White EPO/PPO |
$13,485.17
|
| Rate for Payer: Scott and White Medicare |
$7,289.28
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$18,423.50
|
| Rate for Payer: Superior Health Plan EPO |
$7,289.28
|
| Rate for Payer: Superior Health Plan Medicare |
$7,289.28
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$7,289.28
|
| Rate for Payer: Universal American Medicare |
$7,289.28
|
| Rate for Payer: Wellcare Medicare |
$7,289.28
|
| Rate for Payer: Wellmed Medicare |
$7,289.28
|
|
|
Under Repair, Revision, and/or Reconstruction Procedures on the Forearm and Wrist
|
Facility
|
OP
|
$39,687.78
|
|
|
Service Code
|
HCPCS 25390
|
| Hospital Charge Code |
9900292
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,305.66 |
| Max. Negotiated Rate |
$28,575.20 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$3,305.66
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$7,289.28
|
| Rate for Payer: Amerigroup Medicare |
$7,289.28
|
| 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 |
$7,289.28
|
| Rate for Payer: BCBS of TX PPO |
$15,074.51
|
| Rate for Payer: Cash Price |
$26,987.69
|
| Rate for Payer: Cash Price |
$26,987.69
|
| Rate for Payer: Cash Price |
$26,987.69
|
| Rate for Payer: Cigna Commercial |
$15,408.22
|
| Rate for Payer: Cigna Medicaid |
$28,575.20
|
| Rate for Payer: Cigna Medicare |
$7,289.28
|
| Rate for Payer: Employer Direct Commercial |
$7,289.28
|
| Rate for Payer: Humana Medicare/TRICARE |
$7,289.28
|
| Rate for Payer: Molina CHIP/Medicaid |
$28,575.20
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$7,289.28
|
| Rate for Payer: Molina Medicare |
$7,289.28
|
| 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 |
$28,575.20
|
| Rate for Payer: Scott and White EPO/PPO |
$13,485.17
|
| Rate for Payer: Scott and White Medicare |
$7,289.28
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$28,575.20
|
| Rate for Payer: Superior Health Plan EPO |
$7,289.28
|
| Rate for Payer: Superior Health Plan Medicare |
$7,289.28
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$7,289.28
|
| Rate for Payer: Universal American Medicare |
$7,289.28
|
| Rate for Payer: Wellcare Medicare |
$7,289.28
|
| Rate for Payer: Wellmed Medicare |
$7,289.28
|
|
|
Under Repair, Revision, and/or Reconstruction Procedures on the Forearm and Wrist
|
Facility
|
OP
|
$15,408.22
|
|
|
Service Code
|
CPT 25390
|
| Hospital Charge Code |
36025390
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,305.66 |
| Max. Negotiated Rate |
$15,408.22 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$3,305.66
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$7,289.28
|
| Rate for Payer: Amerigroup Medicare |
$7,289.28
|
| 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 |
$7,289.28
|
| Rate for Payer: BCBS of TX PPO |
$15,074.51
|
| Rate for Payer: Cigna Commercial |
$15,408.22
|
| Rate for Payer: Cigna Medicare |
$7,289.28
|
| Rate for Payer: Employer Direct Commercial |
$7,289.28
|
| Rate for Payer: Humana Medicare/TRICARE |
$7,289.28
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$7,289.28
|
| Rate for Payer: Molina Medicare |
$7,289.28
|
| 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: Scott and White EPO/PPO |
$13,485.17
|
| Rate for Payer: Scott and White Medicare |
$7,289.28
|
| Rate for Payer: Superior Health Plan EPO |
$7,289.28
|
| Rate for Payer: Superior Health Plan Medicare |
$7,289.28
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$7,289.28
|
| Rate for Payer: Universal American Medicare |
$7,289.28
|
| Rate for Payer: Wellcare Medicare |
$7,289.28
|
| Rate for Payer: Wellmed Medicare |
$7,289.28
|
|
|
Under Repair, Revision, and/or Reconstruction Procedures on the Forearm and Wrist
|
Facility
|
IP
|
$39,687.78
|
|
|
Service Code
|
HCPCS 25390
|
| Hospital Charge Code |
9900292
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$26,987.69
|
|
|
Under Repair, Revision, and/or Reconstruction Procedures on the Forearm and Wrist
|
Facility
|
OP
|
$15,408.22
|
|
|
Service Code
|
CPT 25400
|
| Hospital Charge Code |
36025400
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,362.17 |
| Max. Negotiated Rate |
$15,408.22 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$3,362.17
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$7,289.28
|
| Rate for Payer: Amerigroup Medicare |
$7,289.28
|
| 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 |
$7,289.28
|
| Rate for Payer: BCBS of TX PPO |
$15,074.51
|
| Rate for Payer: Cigna Commercial |
$15,408.22
|
| Rate for Payer: Cigna Medicare |
$7,289.28
|
| Rate for Payer: Employer Direct Commercial |
$7,289.28
|
| Rate for Payer: Humana Medicare/TRICARE |
$7,289.28
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$7,289.28
|
| Rate for Payer: Molina Medicare |
$7,289.28
|
| 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: Scott and White EPO/PPO |
$13,485.17
|
| Rate for Payer: Scott and White Medicare |
$7,289.28
|
| Rate for Payer: Superior Health Plan EPO |
$7,289.28
|
| Rate for Payer: Superior Health Plan Medicare |
$7,289.28
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$7,289.28
|
| Rate for Payer: Universal American Medicare |
$7,289.28
|
| Rate for Payer: Wellcare Medicare |
$7,289.28
|
| Rate for Payer: Wellmed Medicare |
$7,289.28
|
|
