|
CHED Rhythm ECG 1-3 leads tracing only BCE
|
Facility
|
OP
|
$220.24
|
|
|
Service Code
|
CPT 93041
|
| Hospital Charge Code |
8914635
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$143.16 |
| Rate for Payer: Aetna Commercial |
$9.55
|
| Rate for Payer: Aetna Medicare |
$83.91
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$19.82
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$55.94
|
| Rate for Payer: Amerigroup Medicare |
$55.94
|
| Rate for Payer: BCBS of TX Blue Advantage |
$95.72
|
| Rate for Payer: BCBS of TX Blue Essentials |
$114.42
|
| Rate for Payer: BCBS of TX Medicare |
$55.94
|
| Rate for Payer: BCBS of TX PPO |
$127.62
|
| Rate for Payer: Cash Price |
$193.81
|
| Rate for Payer: Cash Price |
$193.81
|
| Rate for Payer: Cash Price |
$193.81
|
| Rate for Payer: Cigna Commercial |
$126.71
|
| Rate for Payer: Cigna Medicare |
$55.94
|
| Rate for Payer: Employer Direct Commercial |
$55.94
|
| Rate for Payer: Humana Medicare/TRICARE |
$55.94
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$55.94
|
| Rate for Payer: Molina Medicare |
$55.94
|
| Rate for Payer: Multiplan Auto |
$143.16
|
| Rate for Payer: Multiplan Commercial |
$143.16
|
| Rate for Payer: Multiplan Workers Comp |
$143.16
|
| Rate for Payer: Scott and White EPO/PPO |
$1.00
|
| Rate for Payer: Scott and White Medicare |
$55.94
|
| Rate for Payer: Superior Health Plan EPO |
$55.94
|
| Rate for Payer: Superior Health Plan Medicare |
$55.94
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$55.94
|
| Rate for Payer: Universal American Medicare |
$55.94
|
| Rate for Payer: Wellcare Medicare |
$55.94
|
| Rate for Payer: Wellmed Medicare |
$55.94
|
|
|
CHED Rhythm ECG 1-3 leads tracing only BCE
|
Facility
|
IP
|
$220.24
|
|
|
Service Code
|
CPT 93041
|
| Hospital Charge Code |
8914635
|
|
Hospital Revenue Code
|
730
|
| Rate for Payer: Cash Price |
$193.81
|
|
|
CHED RMVL FB XTRNL EYE CORNEAL W/SLIT LAMP BCE
|
Facility
|
IP
|
$592.25
|
|
|
Service Code
|
CPT 65222
|
| Hospital Charge Code |
8910650
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$521.18
|
|
|
CHED RMVL FB XTRNL EYE CORNEAL W/SLIT LAMP BCE
|
Facility
|
OP
|
$592.25
|
|
|
Service Code
|
CPT 65222
|
| Hospital Charge Code |
8910650
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2.09 |
| Max. Negotiated Rate |
$384.96 |
| Rate for Payer: Aetna Commercial |
$325.74
|
| Rate for Payer: Aetna Medicare |
$175.23
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$53.30
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$116.82
|
| Rate for Payer: Amerigroup Medicare |
$116.82
|
| 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 |
$116.82
|
| Rate for Payer: BCBS of TX PPO |
$274.76
|
| Rate for Payer: Cash Price |
$521.18
|
| Rate for Payer: Cash Price |
$521.18
|
| Rate for Payer: Cash Price |
$521.18
|
| Rate for Payer: Cigna Commercial |
$264.63
|
| Rate for Payer: Cigna Medicare |
$116.82
|
| Rate for Payer: Employer Direct Commercial |
$116.82
|
| Rate for Payer: Humana Medicare/TRICARE |
$116.82
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$116.82
|
| Rate for Payer: Molina Medicare |
$116.82
|
| Rate for Payer: Multiplan Auto |
$384.96
|
| Rate for Payer: Multiplan Commercial |
$384.96
|
| Rate for Payer: Multiplan Workers Comp |
$384.96
|
| Rate for Payer: Scott and White EPO/PPO |
$2.09
|
| Rate for Payer: Scott and White Medicare |
$116.82
|
| Rate for Payer: Superior Health Plan EPO |
$116.82
|
| Rate for Payer: Superior Health Plan Medicare |
$116.82
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$116.82
|
| Rate for Payer: Universal American Medicare |
$116.82
|
| Rate for Payer: Wellcare Medicare |
$116.82
|
| Rate for Payer: Wellmed Medicare |
$116.82
|
|
|
CHED RMVL NON-BIODEGRADABLE DRUG DELIV IMPLT BCE
|
Facility
|
OP
|
$5,619.66
|
|
|
Service Code
|
CPT 11982
|
| Hospital Charge Code |
8910651
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$6.52 |
| Max. Negotiated Rate |
$3,652.78 |
| Rate for Payer: Aetna Commercial |
$3,090.81
|
| Rate for Payer: Aetna Medicare |
$546.58
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$505.77
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$364.39
|
| Rate for Payer: Amerigroup Medicare |
$364.39
|
| 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 |
$364.39
|
| Rate for Payer: BCBS of TX PPO |
$916.25
|
| Rate for Payer: Cash Price |
$4,945.30
|
| Rate for Payer: Cash Price |
$4,945.30
|
| Rate for Payer: Cash Price |
$4,945.30
|
| Rate for Payer: Cigna Commercial |
$825.46
|
| Rate for Payer: Cigna Medicaid |
$54.42
|
| Rate for Payer: Cigna Medicare |
$364.39
|
| Rate for Payer: Employer Direct Commercial |
$364.39
|
| Rate for Payer: Humana Medicare/TRICARE |
$364.39
|
| Rate for Payer: Molina CHIP/Medicaid |
$54.42
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$364.39
|
| Rate for Payer: Molina Medicare |
$364.39
|
| Rate for Payer: Multiplan Auto |
$3,652.78
|
| Rate for Payer: Multiplan Commercial |
$3,652.78
|
| Rate for Payer: Multiplan Workers Comp |
$3,652.78
|
| Rate for Payer: Parkland Medicaid |
$54.42
|
| Rate for Payer: Scott and White EPO/PPO |
$6.52
|
| Rate for Payer: Scott and White Medicare |
$364.39
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$54.42
|
| Rate for Payer: Superior Health Plan EPO |
$364.39
|
| Rate for Payer: Superior Health Plan Medicare |
$364.39
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$364.39
|
| Rate for Payer: Universal American Medicare |
$364.39
|
| Rate for Payer: Wellcare Medicare |
$364.39
|
| Rate for Payer: Wellmed Medicare |
$364.39
|
|
|
CHED RMVL NON-BIODEGRADABLE DRUG DELIV IMPLT BCE
|
Facility
|
IP
|
$5,619.66
|
|
|
Service Code
|
CPT 11982
|
| Hospital Charge Code |
8910651
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$4,945.30
|
|
|
CHED RMVL SUPFCL SOFT TISS FB SUBLINGUAL MUCOSA BCE
|
Facility
|
OP
|
$2,749.00
|
|
|
Service Code
|
CPT 41599
|
| Hospital Charge Code |
8912655
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$1,786.85 |
| Rate for Payer: Aetna Commercial |
$1,511.95
|
| Rate for Payer: Aetna Medicare |
$335.08
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$247.41
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$223.39
|
| Rate for Payer: Amerigroup Medicare |
$223.39
|
| Rate for Payer: BCBS of TX Blue Advantage |
$340.08
|
| Rate for Payer: BCBS of TX Blue Essentials |
$407.28
|
| Rate for Payer: BCBS of TX Medicare |
$223.39
|
| Rate for Payer: BCBS of TX PPO |
$513.17
|
| Rate for Payer: Cash Price |
$2,419.12
|
| Rate for Payer: Cash Price |
$2,419.12
|
| Rate for Payer: Cash Price |
$2,419.12
|
| Rate for Payer: Cigna Commercial |
$506.05
|
| Rate for Payer: Cigna Medicare |
$223.39
|
| Rate for Payer: Employer Direct Commercial |
$223.39
|
| Rate for Payer: Humana Medicare/TRICARE |
$223.39
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$223.39
|
| Rate for Payer: Molina Medicare |
$223.39
|
| Rate for Payer: Multiplan Auto |
$1,786.85
|
| Rate for Payer: Multiplan Commercial |
$1,786.85
|
| Rate for Payer: Multiplan Workers Comp |
$1,786.85
|
| Rate for Payer: Scott and White EPO/PPO |
$4.00
|
| Rate for Payer: Scott and White Medicare |
$223.39
|
| Rate for Payer: Superior Health Plan EPO |
$223.39
|
| Rate for Payer: Superior Health Plan Medicare |
$223.39
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$223.39
|
| Rate for Payer: Universal American Medicare |
$223.39
|
| Rate for Payer: Wellcare Medicare |
$223.39
|
| Rate for Payer: Wellmed Medicare |
$223.39
|
|
|
CHED RMVL SUPFCL SOFT TISS FB SUBLINGUAL MUCOSA BCE
|
Facility
|
IP
|
$2,749.00
|
|
|
Service Code
|
CPT 41599
|
| Hospital Charge Code |
8912655
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$2,419.12
|
|
|
CHED RPLC GASTRO/CECOSTOMY TUBE PERC W/GUIDE CNTRST IMG BCE
|
Facility
|
IP
|
$2,430.57
|
|
|
Service Code
|
CPT 49450
|
| Hospital Charge Code |
8912656
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$2,138.90
|
|
|
CHED RPLC GASTRO/CECOSTOMY TUBE PERC W/GUIDE CNTRST IMG BCE
|
Facility
|
OP
|
$2,430.57
|
|
|
Service Code
|
CPT 49450
|
| Hospital Charge Code |
8912656
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$14.83 |
| Max. Negotiated Rate |
$2,200.00 |
| Rate for Payer: Aetna Commercial |
$2,200.00
|
| Rate for Payer: Aetna Medicare |
$1,243.53
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$218.75
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$829.02
|
| Rate for Payer: Amerigroup Medicare |
$829.02
|
| 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 |
$829.02
|
| Rate for Payer: BCBS of TX PPO |
$1,980.52
|
| Rate for Payer: Cash Price |
$2,138.90
|
| Rate for Payer: Cash Price |
$2,138.90
|
| Rate for Payer: Cash Price |
$2,138.90
|
| Rate for Payer: Cigna Commercial |
$1,877.98
|
| Rate for Payer: Cigna Medicaid |
$334.95
|
| Rate for Payer: Cigna Medicare |
$829.02
|
| Rate for Payer: Employer Direct Commercial |
$829.02
|
| Rate for Payer: Humana Medicare/TRICARE |
$829.02
|
| Rate for Payer: Molina CHIP/Medicaid |
$334.95
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$829.02
|
| Rate for Payer: Molina Medicare |
$829.02
|
| Rate for Payer: Multiplan Auto |
$1,579.87
|
| Rate for Payer: Multiplan Commercial |
$1,579.87
|
| Rate for Payer: Multiplan Workers Comp |
$1,579.87
|
| Rate for Payer: Parkland Medicaid |
$334.95
|
| Rate for Payer: Scott and White EPO/PPO |
$14.83
|
| Rate for Payer: Scott and White Medicare |
$829.02
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$334.95
|
| Rate for Payer: Superior Health Plan EPO |
$829.02
|
| Rate for Payer: Superior Health Plan Medicare |
$829.02
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$829.02
|
| Rate for Payer: Universal American Medicare |
$829.02
|
| Rate for Payer: Wellcare Medicare |
$829.02
|
| Rate for Payer: Wellmed Medicare |
$829.02
|
|
|
CHED RPLC GASTRO TUBE PERC WO IMG NO REVSN GASTRO TRCT BCE
|
Facility
|
OP
|
$1,239.24
|
|
|
Service Code
|
CPT 43762
|
| Hospital Charge Code |
8910652
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$4.04 |
| Max. Negotiated Rate |
$805.51 |
| Rate for Payer: Aetna Commercial |
$681.58
|
| Rate for Payer: Aetna Medicare |
$339.04
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$111.53
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$226.03
|
| Rate for Payer: Amerigroup Medicare |
$226.03
|
| Rate for Payer: BCBS of TX Blue Advantage |
$392.28
|
| Rate for Payer: BCBS of TX Blue Essentials |
$469.80
|
| Rate for Payer: BCBS of TX Medicare |
$226.03
|
| Rate for Payer: BCBS of TX PPO |
$591.95
|
| Rate for Payer: Cash Price |
$1,090.53
|
| Rate for Payer: Cash Price |
$1,090.53
|
| Rate for Payer: Cash Price |
$1,090.53
|
| Rate for Payer: Cigna Commercial |
$512.01
|
| Rate for Payer: Cigna Medicaid |
$110.15
|
| Rate for Payer: Cigna Medicare |
$226.03
|
| Rate for Payer: Employer Direct Commercial |
$226.03
|
| Rate for Payer: Humana Medicare/TRICARE |
$226.03
|
| Rate for Payer: Molina CHIP/Medicaid |
$110.15
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$226.03
|
| Rate for Payer: Molina Medicare |
$226.03
|
| Rate for Payer: Multiplan Auto |
$805.51
|
| Rate for Payer: Multiplan Commercial |
$805.51
|
| Rate for Payer: Multiplan Workers Comp |
$805.51
|
| Rate for Payer: Parkland Medicaid |
$110.15
|
| Rate for Payer: Scott and White EPO/PPO |
$4.04
|
| Rate for Payer: Scott and White Medicare |
$226.03
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$110.15
|
| Rate for Payer: Superior Health Plan EPO |
$226.03
|
| Rate for Payer: Superior Health Plan Medicare |
$226.03
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$226.03
|
| Rate for Payer: Universal American Medicare |
$226.03
|
| Rate for Payer: Wellcare Medicare |
$226.03
|
| Rate for Payer: Wellmed Medicare |
$226.03
|
|
|
CHED RPLC GASTRO TUBE PERC WO IMG NO REVSN GASTRO TRCT BCE
|
Facility
|
IP
|
$1,239.24
|
|
|
Service Code
|
CPT 43762
|
| Hospital Charge Code |
8910652
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$1,090.53
|
|
|
CHED RPR S N A GEN TRK 12.6 TO 20.0CM BCE
|
Facility
|
OP
|
$993.50
|
|
|
Service Code
|
CPT 12005
|
| Hospital Charge Code |
8914634
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$6.52 |
| Max. Negotiated Rate |
$826.08 |
| Rate for Payer: Aetna Commercial |
$546.42
|
| Rate for Payer: Aetna Medicare |
$547.00
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$89.42
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$364.67
|
| Rate for Payer: Amerigroup Medicare |
$364.67
|
| 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 |
$364.67
|
| Rate for Payer: BCBS of TX PPO |
$805.17
|
| Rate for Payer: Cash Price |
$874.28
|
| Rate for Payer: Cash Price |
$874.28
|
| Rate for Payer: Cash Price |
$874.28
|
| Rate for Payer: Cigna Commercial |
$826.08
|
| Rate for Payer: Cigna Medicaid |
$143.08
|
| Rate for Payer: Cigna Medicare |
$364.67
|
| Rate for Payer: Employer Direct Commercial |
$364.67
|
| Rate for Payer: Humana Medicare/TRICARE |
$364.67
|
| Rate for Payer: Molina CHIP/Medicaid |
$143.08
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$364.67
|
| Rate for Payer: Molina Medicare |
$364.67
|
| Rate for Payer: Multiplan Auto |
$645.78
|
| Rate for Payer: Multiplan Commercial |
$645.78
|
| Rate for Payer: Multiplan Workers Comp |
$645.78
|
| Rate for Payer: Parkland Medicaid |
$143.08
|
| Rate for Payer: Scott and White EPO/PPO |
$6.52
|
| Rate for Payer: Scott and White Medicare |
$364.67
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$143.08
|
| Rate for Payer: Superior Health Plan EPO |
$364.67
|
| Rate for Payer: Superior Health Plan Medicare |
$364.67
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$364.67
|
| Rate for Payer: Universal American Medicare |
$364.67
|
| Rate for Payer: Wellcare Medicare |
$364.67
|
| Rate for Payer: Wellmed Medicare |
$364.67
|
|
|
CHED RPR S N A GEN TRK 12.6 TO 20.0CM BCE
|
Facility
|
IP
|
$993.50
|
|
|
Service Code
|
CPT 12005
|
| Hospital Charge Code |
8914634
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$874.28
|
|
|
CHED Sedation - Different Physician Each Addl 15 mins BCE
|
Facility
|
IP
|
$296.50
|
|
|
Service Code
|
CPT 99157
|
| Hospital Charge Code |
8914636
|
|
Hospital Revenue Code
|
370
|
| Rate for Payer: Cash Price |
$260.92
|
|
|
CHED Sedation - Different Physician Each Addl 15 mins BCE
|
Facility
|
OP
|
$296.50
|
|
|
Service Code
|
CPT 99157
|
| Hospital Charge Code |
8914636
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$26.68 |
| Max. Negotiated Rate |
$192.72 |
| Rate for Payer: Aetna Commercial |
$163.08
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$26.68
|
| Rate for Payer: BCBS of TX Blue Advantage |
$114.13
|
| Rate for Payer: BCBS of TX Blue Essentials |
$136.43
|
| Rate for Payer: BCBS of TX PPO |
$152.17
|
| Rate for Payer: Cash Price |
$260.92
|
| Rate for Payer: Cash Price |
$260.92
|
| Rate for Payer: Multiplan Auto |
$192.72
|
| Rate for Payer: Multiplan Commercial |
$192.72
|
| Rate for Payer: Multiplan Workers Comp |
$192.72
|
| Rate for Payer: Scott and White EPO/PPO |
$148.25
|
| Rate for Payer: Superior Health Plan EPO |
$40.32
|
|
|
CHED Sedation - Different Physician First 15 mins >= 5 years
|
Facility
|
OP
|
$478.89
|
|
|
Service Code
|
CPT 99156
|
| Hospital Charge Code |
8912659
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$43.10 |
| Max. Negotiated Rate |
$311.28 |
| Rate for Payer: Aetna Commercial |
$263.39
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$43.10
|
| Rate for Payer: BCBS of TX Blue Advantage |
$140.47
|
| Rate for Payer: BCBS of TX Blue Essentials |
$167.92
|
| Rate for Payer: BCBS of TX PPO |
$187.29
|
| Rate for Payer: Cash Price |
$421.42
|
| Rate for Payer: Cash Price |
$421.42
|
| Rate for Payer: Multiplan Auto |
$311.28
|
| Rate for Payer: Multiplan Commercial |
$311.28
|
| Rate for Payer: Multiplan Workers Comp |
$311.28
|
| Rate for Payer: Scott and White EPO/PPO |
$239.44
|
| Rate for Payer: Superior Health Plan EPO |
$65.13
|
|
|
CHED Sedation - Different Physician First 15 mins >= 5 years
|
Facility
|
IP
|
$478.89
|
|
|
Service Code
|
CPT 99156
|
| Hospital Charge Code |
8912659
|
|
Hospital Revenue Code
|
370
|
| Rate for Payer: Cash Price |
$421.42
|
|
|
CHED Sedation - Same Physician Each Addl 15 mins BCE
|
Facility
|
IP
|
$291.20
|
|
|
Service Code
|
CPT 99153
|
| Hospital Charge Code |
8912660
|
|
Hospital Revenue Code
|
370
|
| Rate for Payer: Cash Price |
$256.26
|
|
|
CHED Sedation - Same Physician Each Addl 15 mins BCE
|
Facility
|
OP
|
$291.20
|
|
|
Service Code
|
CPT 99153
|
| Hospital Charge Code |
8912660
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$18.81 |
| Max. Negotiated Rate |
$189.28 |
| Rate for Payer: Aetna Commercial |
$160.16
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$26.21
|
| Rate for Payer: BCBS of TX Blue Advantage |
$18.81
|
| Rate for Payer: BCBS of TX Blue Essentials |
$22.48
|
| Rate for Payer: BCBS of TX PPO |
$25.08
|
| Rate for Payer: Cash Price |
$256.26
|
| Rate for Payer: Cash Price |
$256.26
|
| Rate for Payer: Multiplan Auto |
$189.28
|
| Rate for Payer: Multiplan Commercial |
$189.28
|
| Rate for Payer: Multiplan Workers Comp |
$189.28
|
| Rate for Payer: Scott and White EPO/PPO |
$145.60
|
| Rate for Payer: Superior Health Plan EPO |
$39.60
|
|
|
CHED Sedation - Same Physician First 15 mins < 5 years BCE
|
Facility
|
OP
|
$488.00
|
|
|
Service Code
|
CPT 99151
|
| Hospital Charge Code |
8914637
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$43.92 |
| Max. Negotiated Rate |
$317.20 |
| Rate for Payer: Aetna Commercial |
$268.40
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$43.92
|
| Rate for Payer: BCBS of TX Blue Advantage |
$45.15
|
| Rate for Payer: BCBS of TX Blue Essentials |
$53.98
|
| Rate for Payer: BCBS of TX PPO |
$60.20
|
| Rate for Payer: Cash Price |
$429.44
|
| Rate for Payer: Cash Price |
$429.44
|
| Rate for Payer: Multiplan Auto |
$317.20
|
| Rate for Payer: Multiplan Commercial |
$317.20
|
| Rate for Payer: Multiplan Workers Comp |
$317.20
|
| Rate for Payer: Scott and White EPO/PPO |
$244.00
|
| Rate for Payer: Superior Health Plan EPO |
$66.37
|
|
|
CHED Sedation - Same Physician First 15 mins < 5 years BCE
|
Facility
|
IP
|
$488.00
|
|
|
Service Code
|
CPT 99151
|
| Hospital Charge Code |
8914637
|
|
Hospital Revenue Code
|
370
|
| Rate for Payer: Cash Price |
$429.44
|
|
|
CHED Sedation - Same Physician First 15 mins >= 5 years BCE
|
Facility
|
IP
|
$494.00
|
|
|
Service Code
|
CPT 99152
|
| Hospital Charge Code |
8912661
|
|
Hospital Revenue Code
|
370
|
| Rate for Payer: Cash Price |
$434.72
|
|
|
CHED Sedation - Same Physician First 15 mins >= 5 years BCE
|
Facility
|
OP
|
$494.00
|
|
|
Service Code
|
CPT 99152
|
| Hospital Charge Code |
8912661
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$21.94 |
| Max. Negotiated Rate |
$321.10 |
| Rate for Payer: Aetna Commercial |
$271.70
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$44.46
|
| Rate for Payer: BCBS of TX Blue Advantage |
$21.94
|
| Rate for Payer: BCBS of TX Blue Essentials |
$26.23
|
| Rate for Payer: BCBS of TX PPO |
$29.26
|
| Rate for Payer: Cash Price |
$434.72
|
| Rate for Payer: Cash Price |
$434.72
|
| 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: Scott and White EPO/PPO |
$247.00
|
| Rate for Payer: Superior Health Plan EPO |
$67.18
|
|
|
CHED SMPL RPR WND FACE/EAR/EYELID/NOSE/LIP 7.6 TO 12.5 CM BC
|
Facility
|
OP
|
$918.00
|
|
|
Service Code
|
CPT 12015
|
| Hospital Charge Code |
8912658
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3.27 |
| Max. Negotiated Rate |
$596.70 |
| Rate for Payer: Aetna Commercial |
$504.90
|
| Rate for Payer: Aetna Medicare |
$274.64
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$82.62
|
| 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 |
$807.84
|
| Rate for Payer: Cash Price |
$807.84
|
| Rate for Payer: Cash Price |
$807.84
|
| Rate for Payer: Cigna Commercial |
$414.75
|
| Rate for Payer: Cigna Medicaid |
$74.34
|
| 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 CHIP/Medicaid |
$74.34
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$183.09
|
| Rate for Payer: Molina Medicare |
$183.09
|
| Rate for Payer: Multiplan Auto |
$596.70
|
| Rate for Payer: Multiplan Commercial |
$596.70
|
| Rate for Payer: Multiplan Workers Comp |
$596.70
|
| Rate for Payer: Parkland Medicaid |
$74.34
|
| 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 CHIP/Medicaid |
$74.34
|
| 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
|
|
