|
CHED 96365- IV tx, first hour BCE
|
Facility
|
IP
|
$300.00
|
|
|
Service Code
|
HCPCS 96365
|
| Hospital Charge Code |
8928543
|
|
Hospital Revenue Code
|
260
|
| Rate for Payer: Cash Price |
$204.00
|
|
|
CHED 96366- IV tx, each additional hour BCE
|
Facility
|
IP
|
$153.00
|
|
|
Service Code
|
HCPCS 96366
|
| Hospital Charge Code |
8930541
|
|
Hospital Revenue Code
|
260
|
| Rate for Payer: Cash Price |
$104.04
|
|
|
CHED 96366- IV tx, each additional hour BCE
|
Facility
|
OP
|
$153.00
|
|
|
Service Code
|
HCPCS 96366
|
| Hospital Charge Code |
8930541
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$13.77 |
| Max. Negotiated Rate |
$110.16 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$13.77
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$47.04
|
| Rate for Payer: Amerigroup Medicare |
$47.04
|
| Rate for Payer: BCBS of TX Blue Advantage |
$45.90
|
| Rate for Payer: BCBS of TX Blue Essentials |
$55.08
|
| Rate for Payer: BCBS of TX Medicare |
$47.04
|
| Rate for Payer: BCBS of TX PPO |
$61.20
|
| Rate for Payer: Cash Price |
$104.04
|
| Rate for Payer: Cash Price |
$104.04
|
| Rate for Payer: Cash Price |
$104.04
|
| Rate for Payer: Cigna Commercial |
$99.43
|
| Rate for Payer: Cigna Medicaid |
$110.16
|
| Rate for Payer: Cigna Medicare |
$47.04
|
| Rate for Payer: Employer Direct Commercial |
$47.04
|
| Rate for Payer: Humana Medicare/TRICARE |
$47.04
|
| Rate for Payer: Molina CHIP/Medicaid |
$110.16
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$47.04
|
| Rate for Payer: Molina Medicare |
$47.04
|
| Rate for Payer: Multiplan Auto |
$99.45
|
| Rate for Payer: Multiplan Commercial |
$99.45
|
| Rate for Payer: Multiplan Workers Comp |
$99.45
|
| Rate for Payer: Parkland Medicaid |
$110.16
|
| Rate for Payer: Scott and White EPO/PPO |
$25.11
|
| Rate for Payer: Scott and White Medicare |
$47.04
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$110.16
|
| Rate for Payer: Superior Health Plan EPO |
$47.04
|
| Rate for Payer: Superior Health Plan Medicare |
$47.04
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$47.04
|
| Rate for Payer: Universal American Medicare |
$47.04
|
| Rate for Payer: Wellcare Medicare |
$47.04
|
| Rate for Payer: Wellmed Medicare |
$47.04
|
|
|
CHED 96367- IV tx, sequential infusion BCE
|
Facility
|
IP
|
$175.00
|
|
|
Service Code
|
HCPCS 96367
|
| Hospital Charge Code |
8928544
|
|
Hospital Revenue Code
|
260
|
| Rate for Payer: Cash Price |
$119.00
|
|
|
CHED 96367- IV tx, sequential infusion BCE
|
Facility
|
OP
|
$175.00
|
|
|
Service Code
|
HCPCS 96367
|
| Hospital Charge Code |
8928544
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$15.75 |
| Max. Negotiated Rate |
$152.89 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$15.75
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$72.33
|
| Rate for Payer: Amerigroup Medicare |
$72.33
|
| Rate for Payer: BCBS of TX Blue Advantage |
$52.50
|
| Rate for Payer: BCBS of TX Blue Essentials |
$63.00
|
| Rate for Payer: BCBS of TX Medicare |
$72.33
|
| Rate for Payer: BCBS of TX PPO |
$70.00
|
| Rate for Payer: Cash Price |
$119.00
|
| Rate for Payer: Cash Price |
$119.00
|
| Rate for Payer: Cash Price |
$119.00
|
| Rate for Payer: Cigna Commercial |
$152.89
|
| Rate for Payer: Cigna Medicaid |
$126.00
|
| Rate for Payer: Cigna Medicare |
$72.33
|
| Rate for Payer: Employer Direct Commercial |
$72.33
|
| Rate for Payer: Humana Medicare/TRICARE |
$72.33
|
| Rate for Payer: Molina CHIP/Medicaid |
$126.00
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$72.33
|
| Rate for Payer: Molina Medicare |
$72.33
|
| Rate for Payer: Multiplan Auto |
$113.75
|
| Rate for Payer: Multiplan Commercial |
$113.75
|
| Rate for Payer: Multiplan Workers Comp |
$113.75
|
| Rate for Payer: Parkland Medicaid |
$126.00
|
| Rate for Payer: Scott and White EPO/PPO |
$35.01
|
| Rate for Payer: Scott and White Medicare |
$72.33
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$126.00
|
| Rate for Payer: Superior Health Plan EPO |
$72.33
|
| Rate for Payer: Superior Health Plan Medicare |
$72.33
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$72.33
|
| Rate for Payer: Universal American Medicare |
$72.33
|
| Rate for Payer: Wellcare Medicare |
$72.33
|
| Rate for Payer: Wellmed Medicare |
$72.33
|
|
|
CHED 96368- IV tx, concurrent infusion BCE
|
Facility
|
IP
|
$149.00
|
|
|
Service Code
|
HCPCS 96368
|
| Hospital Charge Code |
8930542
|
|
Hospital Revenue Code
|
260
|
| Rate for Payer: Cash Price |
$101.32
|
|
|
CHED 96368- IV tx, concurrent infusion BCE
|
Facility
|
OP
|
$149.00
|
|
|
Service Code
|
HCPCS 96368
|
| Hospital Charge Code |
8930542
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$13.41 |
| Max. Negotiated Rate |
$107.28 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$13.41
|
| Rate for Payer: BCBS of TX Blue Advantage |
$44.70
|
| Rate for Payer: BCBS of TX Blue Essentials |
$53.64
|
| Rate for Payer: BCBS of TX PPO |
$59.60
|
| Rate for Payer: Cash Price |
$101.32
|
| Rate for Payer: Cash Price |
$101.32
|
| Rate for Payer: Cigna Medicaid |
$107.28
|
| Rate for Payer: Molina CHIP/Medicaid |
$107.28
|
| Rate for Payer: Multiplan Auto |
$96.85
|
| Rate for Payer: Multiplan Commercial |
$96.85
|
| Rate for Payer: Multiplan Workers Comp |
$96.85
|
| Rate for Payer: Parkland Medicaid |
$107.28
|
| Rate for Payer: Scott and White EPO/PPO |
$24.29
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$107.28
|
| Rate for Payer: Superior Health Plan EPO |
$20.26
|
|
|
CHED 96372- Subq/IM Injection BCE
|
Facility
|
OP
|
$280.00
|
|
|
Service Code
|
HCPCS 96372
|
| Hospital Charge Code |
8930543
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$17.70 |
| Max. Negotiated Rate |
$201.60 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$25.20
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$72.33
|
| Rate for Payer: Amerigroup Medicare |
$72.33
|
| Rate for Payer: BCBS of TX Blue Advantage |
$84.00
|
| Rate for Payer: BCBS of TX Blue Essentials |
$100.80
|
| Rate for Payer: BCBS of TX Medicare |
$72.33
|
| Rate for Payer: BCBS of TX PPO |
$112.00
|
| Rate for Payer: Cash Price |
$190.40
|
| Rate for Payer: Cash Price |
$190.40
|
| Rate for Payer: Cash Price |
$190.40
|
| Rate for Payer: Cigna Commercial |
$152.89
|
| Rate for Payer: Cigna Medicaid |
$201.60
|
| Rate for Payer: Cigna Medicare |
$72.33
|
| Rate for Payer: Employer Direct Commercial |
$72.33
|
| Rate for Payer: Humana Medicare/TRICARE |
$72.33
|
| Rate for Payer: Molina CHIP/Medicaid |
$201.60
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$72.33
|
| Rate for Payer: Molina Medicare |
$72.33
|
| Rate for Payer: Multiplan Auto |
$182.00
|
| Rate for Payer: Multiplan Commercial |
$182.00
|
| Rate for Payer: Multiplan Workers Comp |
$182.00
|
| Rate for Payer: Parkland Medicaid |
$201.60
|
| Rate for Payer: Scott and White EPO/PPO |
$17.70
|
| Rate for Payer: Scott and White Medicare |
$72.33
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$201.60
|
| Rate for Payer: Superior Health Plan EPO |
$72.33
|
| Rate for Payer: Superior Health Plan Medicare |
$72.33
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$72.33
|
| Rate for Payer: Universal American Medicare |
$72.33
|
| Rate for Payer: Wellcare Medicare |
$72.33
|
| Rate for Payer: Wellmed Medicare |
$72.33
|
|
|
CHED 96372- Subq/IM Injection BCE
|
Facility
|
IP
|
$280.00
|
|
|
Service Code
|
HCPCS 96372
|
| Hospital Charge Code |
8930543
|
|
Hospital Revenue Code
|
260
|
| Rate for Payer: Cash Price |
$190.40
|
|
|
CHED 96373- Intra-Arterial Injection BCE
|
Facility
|
OP
|
$360.00
|
|
|
Service Code
|
HCPCS 96373
|
| Hospital Charge Code |
8930544
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$23.05 |
| Max. Negotiated Rate |
$451.67 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$32.40
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$213.67
|
| Rate for Payer: Amerigroup Medicare |
$213.67
|
| Rate for Payer: BCBS of TX Blue Advantage |
$108.00
|
| Rate for Payer: BCBS of TX Blue Essentials |
$129.60
|
| Rate for Payer: BCBS of TX Medicare |
$213.67
|
| Rate for Payer: BCBS of TX PPO |
$144.00
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cigna Commercial |
$451.67
|
| Rate for Payer: Cigna Medicaid |
$259.20
|
| Rate for Payer: Cigna Medicare |
$213.67
|
| Rate for Payer: Employer Direct Commercial |
$213.67
|
| Rate for Payer: Humana Medicare/TRICARE |
$213.67
|
| Rate for Payer: Molina CHIP/Medicaid |
$259.20
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$213.67
|
| Rate for Payer: Molina Medicare |
$213.67
|
| Rate for Payer: Multiplan Auto |
$234.00
|
| Rate for Payer: Multiplan Commercial |
$234.00
|
| Rate for Payer: Multiplan Workers Comp |
$234.00
|
| Rate for Payer: Parkland Medicaid |
$259.20
|
| Rate for Payer: Scott and White EPO/PPO |
$23.05
|
| Rate for Payer: Scott and White Medicare |
$213.67
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$259.20
|
| Rate for Payer: Superior Health Plan EPO |
$213.67
|
| Rate for Payer: Superior Health Plan Medicare |
$213.67
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$213.67
|
| Rate for Payer: Universal American Medicare |
$213.67
|
| Rate for Payer: Wellcare Medicare |
$213.67
|
| Rate for Payer: Wellmed Medicare |
$213.67
|
|
|
CHED 96373- Intra-Arterial Injection BCE
|
Facility
|
IP
|
$360.00
|
|
|
Service Code
|
HCPCS 96373
|
| Hospital Charge Code |
8930544
|
|
Hospital Revenue Code
|
260
|
| Rate for Payer: Cash Price |
$244.80
|
|
|
CHED 96374- IV Injection, single/initial BCE
|
Facility
|
OP
|
$360.00
|
|
|
Service Code
|
HCPCS 96374
|
| Hospital Charge Code |
8928545
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$32.40 |
| Max. Negotiated Rate |
$451.67 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$32.40
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$213.67
|
| Rate for Payer: Amerigroup Medicare |
$213.67
|
| Rate for Payer: BCBS of TX Blue Advantage |
$108.00
|
| Rate for Payer: BCBS of TX Blue Essentials |
$129.60
|
| Rate for Payer: BCBS of TX Medicare |
$213.67
|
| Rate for Payer: BCBS of TX PPO |
$144.00
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cigna Commercial |
$451.67
|
| Rate for Payer: Cigna Medicaid |
$259.20
|
| Rate for Payer: Cigna Medicare |
$213.67
|
| Rate for Payer: Employer Direct Commercial |
$213.67
|
| Rate for Payer: Humana Medicare/TRICARE |
$213.67
|
| Rate for Payer: Molina CHIP/Medicaid |
$259.20
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$213.67
|
| Rate for Payer: Molina Medicare |
$213.67
|
| Rate for Payer: Multiplan Auto |
$234.00
|
| Rate for Payer: Multiplan Commercial |
$234.00
|
| Rate for Payer: Multiplan Workers Comp |
$234.00
|
| Rate for Payer: Parkland Medicaid |
$259.20
|
| Rate for Payer: Scott and White EPO/PPO |
$45.26
|
| Rate for Payer: Scott and White Medicare |
$213.67
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$259.20
|
| Rate for Payer: Superior Health Plan EPO |
$213.67
|
| Rate for Payer: Superior Health Plan Medicare |
$213.67
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$213.67
|
| Rate for Payer: Universal American Medicare |
$213.67
|
| Rate for Payer: Wellcare Medicare |
$213.67
|
| Rate for Payer: Wellmed Medicare |
$213.67
|
|
|
CHED 96374- IV Injection, single/initial BCE
|
Facility
|
IP
|
$360.00
|
|
|
Service Code
|
HCPCS 96374
|
| Hospital Charge Code |
8928545
|
|
Hospital Revenue Code
|
260
|
| Rate for Payer: Cash Price |
$244.80
|
|
|
CHED 96375- IV Injection, add new drug BCE
|
Facility
|
IP
|
$330.00
|
|
|
Service Code
|
HCPCS 96375
|
| Hospital Charge Code |
5202445
|
|
Hospital Revenue Code
|
260
|
| Rate for Payer: Cash Price |
$224.40
|
|
|
CHED 96375- IV Injection, add new drug BCE
|
Facility
|
OP
|
$330.00
|
|
|
Service Code
|
HCPCS 96375
|
| Hospital Charge Code |
5202445
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$18.93 |
| Max. Negotiated Rate |
$237.60 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$29.70
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$47.04
|
| Rate for Payer: Amerigroup Medicare |
$47.04
|
| Rate for Payer: BCBS of TX Blue Advantage |
$99.00
|
| Rate for Payer: BCBS of TX Blue Essentials |
$118.80
|
| Rate for Payer: BCBS of TX Medicare |
$47.04
|
| Rate for Payer: BCBS of TX PPO |
$132.00
|
| Rate for Payer: Cash Price |
$224.40
|
| Rate for Payer: Cash Price |
$224.40
|
| Rate for Payer: Cash Price |
$224.40
|
| Rate for Payer: Cigna Commercial |
$99.43
|
| Rate for Payer: Cigna Medicaid |
$237.60
|
| Rate for Payer: Cigna Medicare |
$47.04
|
| Rate for Payer: Employer Direct Commercial |
$47.04
|
| Rate for Payer: Humana Medicare/TRICARE |
$47.04
|
| Rate for Payer: Molina CHIP/Medicaid |
$237.60
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$47.04
|
| Rate for Payer: Molina Medicare |
$47.04
|
| Rate for Payer: Multiplan Auto |
$214.50
|
| Rate for Payer: Multiplan Commercial |
$214.50
|
| Rate for Payer: Multiplan Workers Comp |
$214.50
|
| Rate for Payer: Parkland Medicaid |
$237.60
|
| Rate for Payer: Scott and White EPO/PPO |
$18.93
|
| Rate for Payer: Scott and White Medicare |
$47.04
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$237.60
|
| Rate for Payer: Superior Health Plan EPO |
$47.04
|
| Rate for Payer: Superior Health Plan Medicare |
$47.04
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$47.04
|
| Rate for Payer: Universal American Medicare |
$47.04
|
| Rate for Payer: Wellcare Medicare |
$47.04
|
| Rate for Payer: Wellmed Medicare |
$47.04
|
|
|
CHED 96376- IV Injection, add same drug BCE
|
Facility
|
OP
|
$330.00
|
|
|
Service Code
|
HCPCS 96376
|
| Hospital Charge Code |
1500404
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$29.70 |
| Max. Negotiated Rate |
$237.60 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$29.70
|
| Rate for Payer: BCBS of TX Blue Advantage |
$99.00
|
| Rate for Payer: BCBS of TX Blue Essentials |
$118.80
|
| Rate for Payer: BCBS of TX PPO |
$132.00
|
| Rate for Payer: Cash Price |
$224.40
|
| Rate for Payer: Cigna Medicaid |
$237.60
|
| Rate for Payer: Molina CHIP/Medicaid |
$237.60
|
| Rate for Payer: Multiplan Auto |
$214.50
|
| Rate for Payer: Multiplan Commercial |
$214.50
|
| Rate for Payer: Multiplan Workers Comp |
$214.50
|
| Rate for Payer: Parkland Medicaid |
$237.60
|
| Rate for Payer: Scott and White EPO/PPO |
$165.00
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$237.60
|
| Rate for Payer: Superior Health Plan EPO |
$44.88
|
|
|
CHED 96376- IV Injection, add same drug BCE
|
Facility
|
IP
|
$330.00
|
|
|
Service Code
|
HCPCS 96376
|
| Hospital Charge Code |
1500404
|
|
Hospital Revenue Code
|
260
|
| Rate for Payer: Cash Price |
$224.40
|
|
|
CHED 99281 - Level 1 BCE
|
Facility
|
IP
|
$375.00
|
|
|
Service Code
|
HCPCS 99281
|
| Hospital Charge Code |
5201777
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$255.00
|
|
|
CHED 99281 - Level 1 BCE
|
Facility
|
OP
|
$375.00
|
|
|
Service Code
|
HCPCS 99281
|
| Hospital Charge Code |
5201777
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$13.90 |
| Max. Negotiated Rate |
$550.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$280.00
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$84.71
|
| Rate for Payer: Amerigroup Medicare |
$84.71
|
| Rate for Payer: BCBS of TX Blue Advantage |
$413.00
|
| Rate for Payer: BCBS of TX Blue Essentials |
$495.00
|
| Rate for Payer: BCBS of TX Medicare |
$84.71
|
| Rate for Payer: BCBS of TX PPO |
$550.00
|
| Rate for Payer: Cash Price |
$255.00
|
| Rate for Payer: Cash Price |
$255.00
|
| Rate for Payer: Cash Price |
$255.00
|
| Rate for Payer: Cigna Commercial |
$314.76
|
| Rate for Payer: Cigna Medicaid |
$270.00
|
| Rate for Payer: Cigna Medicare |
$84.71
|
| Rate for Payer: Employer Direct Commercial |
$84.71
|
| Rate for Payer: Humana Medicare/TRICARE |
$84.71
|
| Rate for Payer: Molina CHIP/Medicaid |
$270.00
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$84.71
|
| Rate for Payer: Molina Medicare |
$84.71
|
| Rate for Payer: Multiplan Auto |
$243.75
|
| Rate for Payer: Multiplan Commercial |
$243.75
|
| Rate for Payer: Multiplan Workers Comp |
$243.75
|
| Rate for Payer: Parkland Medicaid |
$270.00
|
| Rate for Payer: Scott and White EPO/PPO |
$13.90
|
| Rate for Payer: Scott and White Medicare |
$84.71
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$270.00
|
| Rate for Payer: Superior Health Plan EPO |
$84.71
|
| Rate for Payer: Superior Health Plan Medicare |
$84.71
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$84.71
|
| Rate for Payer: Universal American Medicare |
$84.71
|
| Rate for Payer: Wellcare Medicare |
$84.71
|
| Rate for Payer: Wellmed Medicare |
$84.71
|
|
|
CHED 99282 - Level 2 BCE
|
Facility
|
OP
|
$762.00
|
|
|
Service Code
|
HCPCS 99282
|
| Hospital Charge Code |
5201785
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$50.73 |
| Max. Negotiated Rate |
$900.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$280.00
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$154.24
|
| Rate for Payer: Amerigroup Medicare |
$154.24
|
| Rate for Payer: BCBS of TX Blue Advantage |
$375.00
|
| Rate for Payer: BCBS of TX Blue Essentials |
$810.00
|
| Rate for Payer: BCBS of TX Medicare |
$154.24
|
| Rate for Payer: BCBS of TX PPO |
$900.00
|
| Rate for Payer: Cash Price |
$518.16
|
| Rate for Payer: Cash Price |
$518.16
|
| Rate for Payer: Cash Price |
$518.16
|
| Rate for Payer: Cigna Commercial |
$573.14
|
| Rate for Payer: Cigna Medicaid |
$548.64
|
| Rate for Payer: Cigna Medicare |
$154.24
|
| Rate for Payer: Employer Direct Commercial |
$154.24
|
| Rate for Payer: Humana Medicare/TRICARE |
$154.24
|
| Rate for Payer: Molina CHIP/Medicaid |
$548.64
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$154.24
|
| Rate for Payer: Molina Medicare |
$154.24
|
| Rate for Payer: Multiplan Auto |
$495.30
|
| Rate for Payer: Multiplan Commercial |
$495.30
|
| Rate for Payer: Multiplan Workers Comp |
$495.30
|
| Rate for Payer: Parkland Medicaid |
$548.64
|
| Rate for Payer: Scott and White EPO/PPO |
$50.73
|
| Rate for Payer: Scott and White Medicare |
$154.24
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$548.64
|
| Rate for Payer: Superior Health Plan EPO |
$154.24
|
| Rate for Payer: Superior Health Plan Medicare |
$154.24
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$154.24
|
| Rate for Payer: Universal American Medicare |
$154.24
|
| Rate for Payer: Wellcare Medicare |
$154.24
|
| Rate for Payer: Wellmed Medicare |
$154.24
|
|
|
CHED 99282 - Level 2 BCE
|
Facility
|
IP
|
$762.00
|
|
|
Service Code
|
HCPCS 99282
|
| Hospital Charge Code |
5201785
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$518.16
|
|
|
CHED 99283 - Level 3 BCE
|
Facility
|
IP
|
$1,554.00
|
|
|
Service Code
|
HCPCS 99283
|
| Hospital Charge Code |
8928546
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$1,056.72
|
|
|
CHED 99283 - Level 3 BCE
|
Facility
|
OP
|
$1,554.00
|
|
|
Service Code
|
HCPCS 99283
|
| Hospital Charge Code |
8928546
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$86.33 |
| Max. Negotiated Rate |
$1,302.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$280.00
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$274.22
|
| Rate for Payer: Amerigroup Medicare |
$274.22
|
| Rate for Payer: BCBS of TX Blue Advantage |
$977.00
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,172.00
|
| Rate for Payer: BCBS of TX Medicare |
$274.22
|
| Rate for Payer: BCBS of TX PPO |
$1,302.00
|
| Rate for Payer: Cash Price |
$1,056.72
|
| Rate for Payer: Cash Price |
$1,056.72
|
| Rate for Payer: Cash Price |
$1,056.72
|
| Rate for Payer: Cigna Commercial |
$1,018.97
|
| Rate for Payer: Cigna Medicaid |
$1,118.88
|
| Rate for Payer: Cigna Medicare |
$274.22
|
| Rate for Payer: Employer Direct Commercial |
$274.22
|
| Rate for Payer: Humana Medicare/TRICARE |
$274.22
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,118.88
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$274.22
|
| Rate for Payer: Molina Medicare |
$274.22
|
| Rate for Payer: Multiplan Auto |
$1,010.10
|
| Rate for Payer: Multiplan Commercial |
$1,010.10
|
| Rate for Payer: Multiplan Workers Comp |
$1,010.10
|
| Rate for Payer: Parkland Medicaid |
$1,118.88
|
| Rate for Payer: Scott and White EPO/PPO |
$86.33
|
| Rate for Payer: Scott and White Medicare |
$274.22
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,118.88
|
| Rate for Payer: Superior Health Plan EPO |
$274.22
|
| Rate for Payer: Superior Health Plan Medicare |
$274.22
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$274.22
|
| Rate for Payer: Universal American Medicare |
$274.22
|
| Rate for Payer: Wellcare Medicare |
$274.22
|
| Rate for Payer: Wellmed Medicare |
$274.22
|
|
|
CHED 99283 - Level 3 BCE
|
Facility
|
OP
|
$1,554.00
|
|
|
Service Code
|
HCPCS 99283
|
| Hospital Charge Code |
5201793
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$86.33 |
| Max. Negotiated Rate |
$1,302.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$280.00
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$274.22
|
| Rate for Payer: Amerigroup Medicare |
$274.22
|
| Rate for Payer: BCBS of TX Blue Advantage |
$977.00
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,172.00
|
| Rate for Payer: BCBS of TX Medicare |
$274.22
|
| Rate for Payer: BCBS of TX PPO |
$1,302.00
|
| Rate for Payer: Cash Price |
$1,056.72
|
| Rate for Payer: Cash Price |
$1,056.72
|
| Rate for Payer: Cash Price |
$1,056.72
|
| Rate for Payer: Cigna Commercial |
$1,018.97
|
| Rate for Payer: Cigna Medicaid |
$1,118.88
|
| Rate for Payer: Cigna Medicare |
$274.22
|
| Rate for Payer: Employer Direct Commercial |
$274.22
|
| Rate for Payer: Humana Medicare/TRICARE |
$274.22
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,118.88
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$274.22
|
| Rate for Payer: Molina Medicare |
$274.22
|
| Rate for Payer: Multiplan Auto |
$1,010.10
|
| Rate for Payer: Multiplan Commercial |
$1,010.10
|
| Rate for Payer: Multiplan Workers Comp |
$1,010.10
|
| Rate for Payer: Parkland Medicaid |
$1,118.88
|
| Rate for Payer: Scott and White EPO/PPO |
$86.33
|
| Rate for Payer: Scott and White Medicare |
$274.22
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,118.88
|
| Rate for Payer: Superior Health Plan EPO |
$274.22
|
| Rate for Payer: Superior Health Plan Medicare |
$274.22
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$274.22
|
| Rate for Payer: Universal American Medicare |
$274.22
|
| Rate for Payer: Wellcare Medicare |
$274.22
|
| Rate for Payer: Wellmed Medicare |
$274.22
|
|
|
CHED 99283 - Level 3 BCE
|
Facility
|
IP
|
$1,554.00
|
|
|
Service Code
|
HCPCS 99283
|
| Hospital Charge Code |
5201793
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$1,056.72
|
|
