|
CHED 99284 - Level 4 BCE
|
Facility
|
OP
|
$2,117.00
|
|
|
Service Code
|
HCPCS 99284
|
| Hospital Charge Code |
8932546
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$146.88 |
| Max. Negotiated Rate |
$2,500.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$280.00
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$419.16
|
| Rate for Payer: Amerigroup Medicare |
$419.16
|
| Rate for Payer: BCBS of TX Blue Advantage |
$1,875.00
|
| Rate for Payer: BCBS of TX Blue Essentials |
$2,250.00
|
| Rate for Payer: BCBS of TX Medicare |
$419.16
|
| Rate for Payer: BCBS of TX PPO |
$2,500.00
|
| Rate for Payer: Cash Price |
$1,439.56
|
| Rate for Payer: Cash Price |
$1,439.56
|
| Rate for Payer: Cash Price |
$1,439.56
|
| Rate for Payer: Cigna Commercial |
$1,557.58
|
| Rate for Payer: Cigna Medicaid |
$1,524.24
|
| Rate for Payer: Cigna Medicare |
$419.16
|
| Rate for Payer: Employer Direct Commercial |
$419.16
|
| Rate for Payer: Humana Medicare/TRICARE |
$419.16
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,524.24
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$419.16
|
| Rate for Payer: Molina Medicare |
$419.16
|
| Rate for Payer: Multiplan Auto |
$1,376.05
|
| Rate for Payer: Multiplan Commercial |
$1,376.05
|
| Rate for Payer: Multiplan Workers Comp |
$1,376.05
|
| Rate for Payer: Parkland Medicaid |
$1,524.24
|
| Rate for Payer: Scott and White EPO/PPO |
$146.88
|
| Rate for Payer: Scott and White Medicare |
$419.16
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,524.24
|
| Rate for Payer: Superior Health Plan EPO |
$419.16
|
| Rate for Payer: Superior Health Plan Medicare |
$419.16
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$419.16
|
| Rate for Payer: Universal American Medicare |
$419.16
|
| Rate for Payer: Wellcare Medicare |
$419.16
|
| Rate for Payer: Wellmed Medicare |
$419.16
|
|
|
CHED 99284 - Level 4 BCE
|
Facility
|
IP
|
$2,117.00
|
|
|
Service Code
|
HCPCS 99284
|
| Hospital Charge Code |
8932546
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$1,439.56
|
|
|
CHED 99285 - Level 5 BCE
|
Facility
|
IP
|
$3,040.00
|
|
|
Service Code
|
HCPCS 99285
|
| Hospital Charge Code |
8932547
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$2,067.20
|
|
|
CHED 99285 - Level 5 BCE
|
Facility
|
OP
|
$3,040.00
|
|
|
Service Code
|
HCPCS 99285
|
| Hospital Charge Code |
8932547
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$212.75 |
| Max. Negotiated Rate |
$3,520.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$280.00
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$598.24
|
| Rate for Payer: Amerigroup Medicare |
$598.24
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,640.00
|
| Rate for Payer: BCBS of TX Blue Essentials |
$3,168.00
|
| Rate for Payer: BCBS of TX Medicare |
$598.24
|
| Rate for Payer: BCBS of TX PPO |
$3,520.00
|
| Rate for Payer: Cash Price |
$2,067.20
|
| Rate for Payer: Cash Price |
$2,067.20
|
| Rate for Payer: Cash Price |
$2,067.20
|
| Rate for Payer: Cigna Commercial |
$2,968.44
|
| Rate for Payer: Cigna Medicaid |
$2,188.80
|
| Rate for Payer: Cigna Medicare |
$598.24
|
| Rate for Payer: Employer Direct Commercial |
$598.24
|
| Rate for Payer: Humana Medicare/TRICARE |
$598.24
|
| Rate for Payer: Molina CHIP/Medicaid |
$2,188.80
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$598.24
|
| Rate for Payer: Molina Medicare |
$598.24
|
| Rate for Payer: Multiplan Auto |
$1,976.00
|
| Rate for Payer: Multiplan Commercial |
$1,976.00
|
| Rate for Payer: Multiplan Workers Comp |
$1,976.00
|
| Rate for Payer: Parkland Medicaid |
$2,188.80
|
| Rate for Payer: Scott and White EPO/PPO |
$212.75
|
| Rate for Payer: Scott and White Medicare |
$598.24
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$2,188.80
|
| Rate for Payer: Superior Health Plan EPO |
$598.24
|
| Rate for Payer: Superior Health Plan Medicare |
$598.24
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$598.24
|
| Rate for Payer: Universal American Medicare |
$598.24
|
| Rate for Payer: Wellcare Medicare |
$598.24
|
| Rate for Payer: Wellmed Medicare |
$598.24
|
|
|
CHED Addl Admin Charge 90472 BCE
|
Facility
|
OP
|
$96.00
|
|
|
Service Code
|
HCPCS 90472
|
| Hospital Charge Code |
8910590
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$8.64 |
| Max. Negotiated Rate |
$69.12 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$8.64
|
| Rate for Payer: BCBS of TX Blue Advantage |
$28.80
|
| Rate for Payer: BCBS of TX Blue Essentials |
$34.56
|
| Rate for Payer: BCBS of TX PPO |
$38.40
|
| Rate for Payer: Cash Price |
$65.28
|
| Rate for Payer: Cash Price |
$65.28
|
| Rate for Payer: Cigna Medicaid |
$69.12
|
| Rate for Payer: Molina CHIP/Medicaid |
$69.12
|
| Rate for Payer: Multiplan Auto |
$62.40
|
| Rate for Payer: Multiplan Commercial |
$62.40
|
| Rate for Payer: Multiplan Workers Comp |
$62.40
|
| Rate for Payer: Parkland Medicaid |
$69.12
|
| Rate for Payer: Scott and White EPO/PPO |
$18.11
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$69.12
|
| Rate for Payer: Superior Health Plan EPO |
$13.06
|
|
|
CHED Addl Admin Charge 90472 BCE
|
Facility
|
IP
|
$96.00
|
|
|
Service Code
|
HCPCS 90472
|
| Hospital Charge Code |
8910590
|
|
Hospital Revenue Code
|
771
|
| Rate for Payer: Cash Price |
$65.28
|
|
|
CHED Airway/Intubation Procedures Chest Tube Insertion BCE
|
Facility
|
OP
|
$2,373.75
|
|
|
Service Code
|
HCPCS 32551
|
| Hospital Charge Code |
4613202
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$186.86 |
| Max. Negotiated Rate |
$4,110.45 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$213.64
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,581.33
|
| Rate for Payer: Amerigroup Medicare |
$1,581.33
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,723.99
|
| Rate for Payer: BCBS of TX Blue Essentials |
$3,262.26
|
| Rate for Payer: BCBS of TX Medicare |
$1,581.33
|
| Rate for Payer: BCBS of TX PPO |
$4,110.45
|
| Rate for Payer: Cash Price |
$1,614.15
|
| Rate for Payer: Cash Price |
$1,614.15
|
| Rate for Payer: Cash Price |
$1,614.15
|
| Rate for Payer: Cigna Commercial |
$3,342.63
|
| Rate for Payer: Cigna Medicaid |
$1,709.10
|
| Rate for Payer: Cigna Medicare |
$1,581.33
|
| Rate for Payer: Employer Direct Commercial |
$1,581.33
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,581.33
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,709.10
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,581.33
|
| Rate for Payer: Molina Medicare |
$1,581.33
|
| Rate for Payer: Multiplan Auto |
$1,542.94
|
| Rate for Payer: Multiplan Commercial |
$1,542.94
|
| Rate for Payer: Multiplan Workers Comp |
$1,542.94
|
| Rate for Payer: Parkland Medicaid |
$1,709.10
|
| Rate for Payer: Scott and White EPO/PPO |
$186.86
|
| Rate for Payer: Scott and White Medicare |
$1,581.33
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,709.10
|
| Rate for Payer: Superior Health Plan EPO |
$1,581.33
|
| Rate for Payer: Superior Health Plan Medicare |
$1,581.33
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,581.33
|
| Rate for Payer: Universal American Medicare |
$1,581.33
|
| Rate for Payer: Wellcare Medicare |
$1,581.33
|
| Rate for Payer: Wellmed Medicare |
$1,581.33
|
|
|
CHED Airway/Intubation Procedures Chest Tube Insertion BCE
|
Facility
|
IP
|
$2,373.75
|
|
|
Service Code
|
HCPCS 32551
|
| Hospital Charge Code |
8914567
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$1,614.15
|
|
|
CHED Airway/Intubation Procedures Chest Tube Insertion BCE
|
Facility
|
IP
|
$2,373.75
|
|
|
Service Code
|
HCPCS 32551
|
| Hospital Charge Code |
4613202
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$1,614.15
|
|
|
CHED Airway/Intubation Procedures Chest Tube Insertion BCE
|
Facility
|
OP
|
$2,373.75
|
|
|
Service Code
|
HCPCS 32551
|
| Hospital Charge Code |
8914567
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$186.86 |
| Max. Negotiated Rate |
$4,110.45 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$213.64
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,581.33
|
| Rate for Payer: Amerigroup Medicare |
$1,581.33
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,723.99
|
| Rate for Payer: BCBS of TX Blue Essentials |
$3,262.26
|
| Rate for Payer: BCBS of TX Medicare |
$1,581.33
|
| Rate for Payer: BCBS of TX PPO |
$4,110.45
|
| Rate for Payer: Cash Price |
$1,614.15
|
| Rate for Payer: Cash Price |
$1,614.15
|
| Rate for Payer: Cash Price |
$1,614.15
|
| Rate for Payer: Cigna Commercial |
$3,342.63
|
| Rate for Payer: Cigna Medicaid |
$1,709.10
|
| Rate for Payer: Cigna Medicare |
$1,581.33
|
| Rate for Payer: Employer Direct Commercial |
$1,581.33
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,581.33
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,709.10
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,581.33
|
| Rate for Payer: Molina Medicare |
$1,581.33
|
| Rate for Payer: Multiplan Auto |
$1,542.94
|
| Rate for Payer: Multiplan Commercial |
$1,542.94
|
| Rate for Payer: Multiplan Workers Comp |
$1,542.94
|
| Rate for Payer: Parkland Medicaid |
$1,709.10
|
| Rate for Payer: Scott and White EPO/PPO |
$186.86
|
| Rate for Payer: Scott and White Medicare |
$1,581.33
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,709.10
|
| Rate for Payer: Superior Health Plan EPO |
$1,581.33
|
| Rate for Payer: Superior Health Plan Medicare |
$1,581.33
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,581.33
|
| Rate for Payer: Universal American Medicare |
$1,581.33
|
| Rate for Payer: Wellcare Medicare |
$1,581.33
|
| Rate for Payer: Wellmed Medicare |
$1,581.33
|
|
|
CHED Airway/Intubation Procedures Cricothyrotomy BCE
|
Facility
|
IP
|
$2,180.05
|
|
|
Service Code
|
HCPCS 31605
|
| Hospital Charge Code |
5202589
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$1,482.43
|
|
|
CHED Airway/Intubation Procedures Cricothyrotomy BCE
|
Facility
|
OP
|
$2,180.05
|
|
|
Service Code
|
HCPCS 31605
|
| Hospital Charge Code |
5202589
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$196.20 |
| Max. Negotiated Rate |
$1,569.64 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$196.20
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$237.93
|
| Rate for Payer: Amerigroup Medicare |
$237.93
|
| 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 |
$237.93
|
| Rate for Payer: BCBS of TX PPO |
$513.17
|
| Rate for Payer: Cash Price |
$1,482.43
|
| Rate for Payer: Cash Price |
$1,482.43
|
| Rate for Payer: Cash Price |
$1,482.43
|
| Rate for Payer: Cigna Commercial |
$502.95
|
| Rate for Payer: Cigna Medicaid |
$1,569.64
|
| Rate for Payer: Cigna Medicare |
$237.93
|
| Rate for Payer: Employer Direct Commercial |
$237.93
|
| Rate for Payer: Humana Medicare/TRICARE |
$237.93
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,569.64
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$237.93
|
| Rate for Payer: Molina Medicare |
$237.93
|
| Rate for Payer: Multiplan Auto |
$1,417.03
|
| Rate for Payer: Multiplan Commercial |
$1,417.03
|
| Rate for Payer: Multiplan Workers Comp |
$1,417.03
|
| Rate for Payer: Parkland Medicaid |
$1,569.64
|
| Rate for Payer: Scott and White EPO/PPO |
$397.86
|
| Rate for Payer: Scott and White Medicare |
$237.93
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,569.64
|
| Rate for Payer: Superior Health Plan EPO |
$237.93
|
| Rate for Payer: Superior Health Plan Medicare |
$237.93
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$237.93
|
| Rate for Payer: Universal American Medicare |
$237.93
|
| Rate for Payer: Wellcare Medicare |
$237.93
|
| Rate for Payer: Wellmed Medicare |
$237.93
|
|
|
CHED Airway/Intubation Procedures Endotracheal Intubation BCE
|
Facility
|
OP
|
$1,155.39
|
|
|
Service Code
|
HCPCS 31500
|
| Hospital Charge Code |
4000220
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$103.99 |
| Max. Negotiated Rate |
$831.88 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$103.99
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$237.93
|
| Rate for Payer: Amerigroup Medicare |
$237.93
|
| 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 |
$237.93
|
| Rate for Payer: BCBS of TX PPO |
$513.17
|
| Rate for Payer: Cash Price |
$785.67
|
| Rate for Payer: Cash Price |
$785.67
|
| Rate for Payer: Cash Price |
$785.67
|
| Rate for Payer: Cigna Commercial |
$502.95
|
| Rate for Payer: Cigna Medicaid |
$831.88
|
| Rate for Payer: Cigna Medicare |
$237.93
|
| Rate for Payer: Employer Direct Commercial |
$237.93
|
| Rate for Payer: Humana Medicare/TRICARE |
$237.93
|
| Rate for Payer: Molina CHIP/Medicaid |
$831.88
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$237.93
|
| Rate for Payer: Molina Medicare |
$237.93
|
| Rate for Payer: Multiplan Auto |
$751.00
|
| Rate for Payer: Multiplan Commercial |
$751.00
|
| Rate for Payer: Multiplan Workers Comp |
$751.00
|
| Rate for Payer: Parkland Medicaid |
$831.88
|
| Rate for Payer: Scott and White EPO/PPO |
$170.07
|
| Rate for Payer: Scott and White Medicare |
$237.93
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$831.88
|
| Rate for Payer: Superior Health Plan EPO |
$237.93
|
| Rate for Payer: Superior Health Plan Medicare |
$237.93
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$237.93
|
| Rate for Payer: Universal American Medicare |
$237.93
|
| Rate for Payer: Wellcare Medicare |
$237.93
|
| Rate for Payer: Wellmed Medicare |
$237.93
|
|
|
CHED Airway/Intubation Procedures Endotracheal Intubation BCE
|
Facility
|
IP
|
$1,155.39
|
|
|
Service Code
|
HCPCS 31500
|
| Hospital Charge Code |
4000220
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$785.67
|
|
|
CHED Airway/Intubation Procedures Endotracheal Intubation BCE
|
Facility
|
IP
|
$1,155.39
|
|
|
Service Code
|
HCPCS 31500
|
| Hospital Charge Code |
8916577
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$785.67
|
|
|
CHED Airway/Intubation Procedures Endotracheal Intubation BCE
|
Facility
|
OP
|
$1,155.39
|
|
|
Service Code
|
HCPCS 31500
|
| Hospital Charge Code |
8916577
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$103.99 |
| Max. Negotiated Rate |
$831.88 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$103.99
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$237.93
|
| Rate for Payer: Amerigroup Medicare |
$237.93
|
| 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 |
$237.93
|
| Rate for Payer: BCBS of TX PPO |
$513.17
|
| Rate for Payer: Cash Price |
$785.67
|
| Rate for Payer: Cash Price |
$785.67
|
| Rate for Payer: Cash Price |
$785.67
|
| Rate for Payer: Cigna Commercial |
$502.95
|
| Rate for Payer: Cigna Medicaid |
$831.88
|
| Rate for Payer: Cigna Medicare |
$237.93
|
| Rate for Payer: Employer Direct Commercial |
$237.93
|
| Rate for Payer: Humana Medicare/TRICARE |
$237.93
|
| Rate for Payer: Molina CHIP/Medicaid |
$831.88
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$237.93
|
| Rate for Payer: Molina Medicare |
$237.93
|
| Rate for Payer: Multiplan Auto |
$751.00
|
| Rate for Payer: Multiplan Commercial |
$751.00
|
| Rate for Payer: Multiplan Workers Comp |
$751.00
|
| Rate for Payer: Parkland Medicaid |
$831.88
|
| Rate for Payer: Scott and White EPO/PPO |
$170.07
|
| Rate for Payer: Scott and White Medicare |
$237.93
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$831.88
|
| Rate for Payer: Superior Health Plan EPO |
$237.93
|
| Rate for Payer: Superior Health Plan Medicare |
$237.93
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$237.93
|
| Rate for Payer: Universal American Medicare |
$237.93
|
| Rate for Payer: Wellcare Medicare |
$237.93
|
| Rate for Payer: Wellmed Medicare |
$237.93
|
|
|
CHED Airway/Intubation Procedures Insert pleural catheter w/ imaging BCE
|
Facility
|
IP
|
$6,539.91
|
|
|
Service Code
|
HCPCS 32550
|
| Hospital Charge Code |
8912575
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$4,447.14
|
|
|
CHED Airway/Intubation Procedures Insert pleural catheter w/ imaging BCE
|
Facility
|
OP
|
$6,539.91
|
|
|
Service Code
|
HCPCS 32550
|
| Hospital Charge Code |
8912575
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$245.07 |
| Max. Negotiated Rate |
$7,835.54 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$588.59
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3,596.72
|
| Rate for Payer: Amerigroup Medicare |
$3,596.72
|
| Rate for Payer: BCBS of TX Blue Advantage |
$5,192.60
|
| Rate for Payer: BCBS of TX Blue Essentials |
$6,218.68
|
| Rate for Payer: BCBS of TX Medicare |
$3,596.72
|
| Rate for Payer: BCBS of TX PPO |
$7,835.54
|
| Rate for Payer: Cash Price |
$4,447.14
|
| Rate for Payer: Cash Price |
$4,447.14
|
| Rate for Payer: Cash Price |
$4,447.14
|
| Rate for Payer: Cigna Commercial |
$7,602.81
|
| Rate for Payer: Cigna Medicaid |
$4,708.74
|
| Rate for Payer: Cigna Medicare |
$3,596.72
|
| Rate for Payer: Employer Direct Commercial |
$3,596.72
|
| Rate for Payer: Humana Medicare/TRICARE |
$3,596.72
|
| Rate for Payer: Molina CHIP/Medicaid |
$4,708.74
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3,596.72
|
| Rate for Payer: Molina Medicare |
$3,596.72
|
| Rate for Payer: Multiplan Auto |
$4,250.94
|
| Rate for Payer: Multiplan Commercial |
$4,250.94
|
| Rate for Payer: Multiplan Workers Comp |
$4,250.94
|
| Rate for Payer: Parkland Medicaid |
$4,708.74
|
| Rate for Payer: Scott and White EPO/PPO |
$245.07
|
| Rate for Payer: Scott and White Medicare |
$3,596.72
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$4,708.74
|
| Rate for Payer: Superior Health Plan EPO |
$3,596.72
|
| Rate for Payer: Superior Health Plan Medicare |
$3,596.72
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3,596.72
|
| Rate for Payer: Universal American Medicare |
$3,596.72
|
| Rate for Payer: Wellcare Medicare |
$3,596.72
|
| Rate for Payer: Wellmed Medicare |
$3,596.72
|
|
|
CHED Airway/Intubation Procedures Laryngoscopy, direct BCE
|
Facility
|
OP
|
$5,289.70
|
|
|
Service Code
|
HCPCS 31525
|
| Hospital Charge Code |
8914568
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$195.79 |
| Max. Negotiated Rate |
$3,808.58 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$476.07
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,788.01
|
| Rate for Payer: Amerigroup Medicare |
$1,788.01
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,389.12
|
| Rate for Payer: BCBS of TX Blue Essentials |
$2,861.22
|
| Rate for Payer: BCBS of TX Medicare |
$1,788.01
|
| Rate for Payer: BCBS of TX PPO |
$3,605.14
|
| Rate for Payer: Cash Price |
$3,597.00
|
| Rate for Payer: Cash Price |
$3,597.00
|
| Rate for Payer: Cash Price |
$3,597.00
|
| Rate for Payer: Cigna Commercial |
$3,779.52
|
| Rate for Payer: Cigna Medicaid |
$3,808.58
|
| Rate for Payer: Cigna Medicare |
$1,788.01
|
| Rate for Payer: Employer Direct Commercial |
$1,788.01
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,788.01
|
| Rate for Payer: Molina CHIP/Medicaid |
$3,808.58
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,788.01
|
| Rate for Payer: Molina Medicare |
$1,788.01
|
| Rate for Payer: Multiplan Auto |
$3,438.30
|
| Rate for Payer: Multiplan Commercial |
$3,438.30
|
| Rate for Payer: Multiplan Workers Comp |
$3,438.30
|
| Rate for Payer: Parkland Medicaid |
$3,808.58
|
| Rate for Payer: Scott and White EPO/PPO |
$195.79
|
| Rate for Payer: Scott and White Medicare |
$1,788.01
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$3,808.58
|
| Rate for Payer: Superior Health Plan EPO |
$1,788.01
|
| Rate for Payer: Superior Health Plan Medicare |
$1,788.01
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,788.01
|
| Rate for Payer: Universal American Medicare |
$1,788.01
|
| Rate for Payer: Wellcare Medicare |
$1,788.01
|
| Rate for Payer: Wellmed Medicare |
$1,788.01
|
|
|
CHED Airway/Intubation Procedures Laryngoscopy, direct BCE
|
Facility
|
IP
|
$5,289.70
|
|
|
Service Code
|
HCPCS 31525
|
| Hospital Charge Code |
8914568
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$3,597.00
|
|
|
CHED Airway/Intubation Procedures Laryngoscopy, flexible BCE
|
Facility
|
OP
|
$937.59
|
|
|
Service Code
|
HCPCS 31575
|
| Hospital Charge Code |
8912576
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$84.31 |
| Max. Negotiated Rate |
$675.06 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$84.38
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$200.52
|
| Rate for Payer: Amerigroup Medicare |
$200.52
|
| Rate for Payer: BCBS of TX Blue Advantage |
$132.10
|
| Rate for Payer: BCBS of TX Blue Essentials |
$158.20
|
| Rate for Payer: BCBS of TX Medicare |
$200.52
|
| Rate for Payer: BCBS of TX PPO |
$199.33
|
| Rate for Payer: Cash Price |
$637.56
|
| Rate for Payer: Cash Price |
$637.56
|
| Rate for Payer: Cash Price |
$637.56
|
| Rate for Payer: Cigna Commercial |
$423.85
|
| Rate for Payer: Cigna Medicaid |
$675.06
|
| Rate for Payer: Cigna Medicare |
$200.52
|
| Rate for Payer: Employer Direct Commercial |
$200.52
|
| Rate for Payer: Humana Medicare/TRICARE |
$200.52
|
| Rate for Payer: Molina CHIP/Medicaid |
$675.06
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$200.52
|
| Rate for Payer: Molina Medicare |
$200.52
|
| Rate for Payer: Multiplan Auto |
$609.43
|
| Rate for Payer: Multiplan Commercial |
$609.43
|
| Rate for Payer: Multiplan Workers Comp |
$609.43
|
| Rate for Payer: Parkland Medicaid |
$675.06
|
| Rate for Payer: Scott and White EPO/PPO |
$84.31
|
| Rate for Payer: Scott and White Medicare |
$200.52
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$675.06
|
| Rate for Payer: Superior Health Plan EPO |
$200.52
|
| Rate for Payer: Superior Health Plan Medicare |
$200.52
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$200.52
|
| Rate for Payer: Universal American Medicare |
$200.52
|
| Rate for Payer: Wellcare Medicare |
$200.52
|
| Rate for Payer: Wellmed Medicare |
$200.52
|
|
|
CHED Airway/Intubation Procedures Laryngoscopy, flexible BCE
|
Facility
|
IP
|
$937.59
|
|
|
Service Code
|
HCPCS 31575
|
| Hospital Charge Code |
8912576
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$637.56
|
|
|
CHED Airway/Intubation Procedures Thoracentesis w/ Imaging BCE
|
Facility
|
OP
|
$2,603.58
|
|
|
Service Code
|
HCPCS 32555
|
| Hospital Charge Code |
8914569
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$131.10 |
| Max. Negotiated Rate |
$1,874.58 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$234.32
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$630.16
|
| Rate for Payer: Amerigroup Medicare |
$630.16
|
| Rate for Payer: BCBS of TX Blue Advantage |
$1,052.95
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,261.02
|
| Rate for Payer: BCBS of TX Medicare |
$630.16
|
| Rate for Payer: BCBS of TX PPO |
$1,588.89
|
| Rate for Payer: Cash Price |
$1,770.43
|
| Rate for Payer: Cash Price |
$1,770.43
|
| Rate for Payer: Cash Price |
$1,770.43
|
| Rate for Payer: Cigna Commercial |
$1,332.05
|
| Rate for Payer: Cigna Medicaid |
$1,874.58
|
| Rate for Payer: Cigna Medicare |
$630.16
|
| Rate for Payer: Employer Direct Commercial |
$630.16
|
| Rate for Payer: Humana Medicare/TRICARE |
$630.16
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,874.58
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$630.16
|
| Rate for Payer: Molina Medicare |
$630.16
|
| Rate for Payer: Multiplan Auto |
$1,692.33
|
| Rate for Payer: Multiplan Commercial |
$1,692.33
|
| Rate for Payer: Multiplan Workers Comp |
$1,692.33
|
| Rate for Payer: Parkland Medicaid |
$1,874.58
|
| Rate for Payer: Scott and White EPO/PPO |
$131.10
|
| Rate for Payer: Scott and White Medicare |
$630.16
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,874.58
|
| Rate for Payer: Superior Health Plan EPO |
$630.16
|
| Rate for Payer: Superior Health Plan Medicare |
$630.16
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$630.16
|
| Rate for Payer: Universal American Medicare |
$630.16
|
| Rate for Payer: Wellcare Medicare |
$630.16
|
| Rate for Payer: Wellmed Medicare |
$630.16
|
|
|
CHED Airway/Intubation Procedures Thoracentesis w/ Imaging BCE
|
Facility
|
IP
|
$2,603.58
|
|
|
Service Code
|
HCPCS 32555
|
| Hospital Charge Code |
8914569
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$1,770.43
|
|
|
CHED Airway/Intubation Procedures Thoracentesis w/o Imaging BCE
|
Facility
|
IP
|
$1,473.63
|
|
|
Service Code
|
HCPCS 32554
|
| Hospital Charge Code |
2180026
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$1,002.07
|
|
