|
CHED Airway/Intubation Procedures Thoracentesis w/o Imaging BCE
|
Facility
|
OP
|
$1,473.63
|
|
|
Service Code
|
HCPCS 32554
|
| Hospital Charge Code |
2180026
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$106.76 |
| Max. Negotiated Rate |
$1,588.89 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$132.63
|
| 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 |
$1,002.07
|
| Rate for Payer: Cash Price |
$1,002.07
|
| Rate for Payer: Cash Price |
$1,002.07
|
| Rate for Payer: Cigna Commercial |
$1,332.05
|
| Rate for Payer: Cigna Medicaid |
$1,061.01
|
| 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 |
$1,061.01
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$630.16
|
| Rate for Payer: Molina Medicare |
$630.16
|
| Rate for Payer: Multiplan Auto |
$957.86
|
| Rate for Payer: Multiplan Commercial |
$957.86
|
| Rate for Payer: Multiplan Workers Comp |
$957.86
|
| Rate for Payer: Parkland Medicaid |
$1,061.01
|
| Rate for Payer: Scott and White EPO/PPO |
$106.76
|
| Rate for Payer: Scott and White Medicare |
$630.16
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,061.01
|
| 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 APPLICATION FINGER SPLINT DYNAMIC BCE
|
Facility
|
IP
|
$492.92
|
|
|
Service Code
|
HCPCS 29131
|
| Hospital Charge Code |
8912574
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$335.19
|
|
|
CHED APPLICATION FINGER SPLINT DYNAMIC BCE
|
Facility
|
OP
|
$492.92
|
|
|
Service Code
|
HCPCS 29131
|
| Hospital Charge Code |
8912574
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$42.48 |
| Max. Negotiated Rate |
$354.90 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$44.36
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$59.26
|
| Rate for Payer: Amerigroup Medicare |
$59.26
|
| Rate for Payer: BCBS of TX Blue Advantage |
$91.87
|
| Rate for Payer: BCBS of TX Blue Essentials |
$110.02
|
| Rate for Payer: BCBS of TX Medicare |
$59.26
|
| Rate for Payer: BCBS of TX PPO |
$138.63
|
| Rate for Payer: Cash Price |
$335.19
|
| Rate for Payer: Cash Price |
$335.19
|
| Rate for Payer: Cash Price |
$335.19
|
| Rate for Payer: Cigna Commercial |
$125.27
|
| Rate for Payer: Cigna Medicaid |
$354.90
|
| Rate for Payer: Cigna Medicare |
$59.26
|
| Rate for Payer: Employer Direct Commercial |
$59.26
|
| Rate for Payer: Humana Medicare/TRICARE |
$59.26
|
| Rate for Payer: Molina CHIP/Medicaid |
$354.90
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$59.26
|
| Rate for Payer: Molina Medicare |
$59.26
|
| Rate for Payer: Multiplan Auto |
$320.40
|
| Rate for Payer: Multiplan Commercial |
$320.40
|
| Rate for Payer: Multiplan Workers Comp |
$320.40
|
| Rate for Payer: Parkland Medicaid |
$354.90
|
| Rate for Payer: Scott and White EPO/PPO |
$42.48
|
| Rate for Payer: Scott and White Medicare |
$59.26
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$354.90
|
| Rate for Payer: Superior Health Plan EPO |
$59.26
|
| Rate for Payer: Superior Health Plan Medicare |
$59.26
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$59.26
|
| Rate for Payer: Universal American Medicare |
$59.26
|
| Rate for Payer: Wellcare Medicare |
$59.26
|
| Rate for Payer: Wellmed Medicare |
$59.26
|
|
|
CHED APPLICATION SHORT ARM SPLINT DYNAMIC BCE
|
Facility
|
IP
|
$575.73
|
|
|
Service Code
|
HCPCS 29126
|
| Hospital Charge Code |
8478471
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$391.50
|
|
|
CHED APPLICATION SHORT ARM SPLINT DYNAMIC BCE
|
Facility
|
OP
|
$575.73
|
|
|
Service Code
|
HCPCS 29126
|
| Hospital Charge Code |
8478471
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$51.82 |
| Max. Negotiated Rate |
$414.53 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$51.82
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$133.65
|
| Rate for Payer: Amerigroup Medicare |
$133.65
|
| 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 |
$133.65
|
| Rate for Payer: BCBS of TX PPO |
$274.76
|
| Rate for Payer: Cash Price |
$391.50
|
| Rate for Payer: Cash Price |
$391.50
|
| Rate for Payer: Cash Price |
$391.50
|
| Rate for Payer: Cigna Commercial |
$282.53
|
| Rate for Payer: Cigna Medicaid |
$414.53
|
| Rate for Payer: Cigna Medicare |
$133.65
|
| Rate for Payer: Employer Direct Commercial |
$133.65
|
| Rate for Payer: Humana Medicare/TRICARE |
$133.65
|
| Rate for Payer: Molina CHIP/Medicaid |
$414.53
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$133.65
|
| Rate for Payer: Molina Medicare |
$133.65
|
| Rate for Payer: Multiplan Auto |
$374.22
|
| Rate for Payer: Multiplan Commercial |
$374.22
|
| Rate for Payer: Multiplan Workers Comp |
$374.22
|
| Rate for Payer: Parkland Medicaid |
$414.53
|
| Rate for Payer: Scott and White EPO/PPO |
$60.99
|
| Rate for Payer: Scott and White Medicare |
$133.65
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$414.53
|
| Rate for Payer: Superior Health Plan EPO |
$133.65
|
| Rate for Payer: Superior Health Plan Medicare |
$133.65
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$133.65
|
| Rate for Payer: Universal American Medicare |
$133.65
|
| Rate for Payer: Wellcare Medicare |
$133.65
|
| Rate for Payer: Wellmed Medicare |
$133.65
|
|
|
CHED Arterial Line Activity Blood Drawn BCE
|
Facility
|
OP
|
$102.00
|
|
|
Service Code
|
HCPCS 36600
|
| Hospital Charge Code |
8910593
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$9.18 |
| Max. Negotiated Rate |
$282.53 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$9.18
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$133.65
|
| Rate for Payer: Amerigroup Medicare |
$133.65
|
| 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 |
$133.65
|
| Rate for Payer: BCBS of TX PPO |
$274.76
|
| Rate for Payer: Cash Price |
$69.36
|
| Rate for Payer: Cash Price |
$69.36
|
| Rate for Payer: Cash Price |
$69.36
|
| Rate for Payer: Cigna Commercial |
$282.53
|
| Rate for Payer: Cigna Medicaid |
$73.44
|
| Rate for Payer: Cigna Medicare |
$133.65
|
| Rate for Payer: Employer Direct Commercial |
$133.65
|
| Rate for Payer: Humana Medicare/TRICARE |
$133.65
|
| Rate for Payer: Molina CHIP/Medicaid |
$73.44
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$133.65
|
| Rate for Payer: Molina Medicare |
$133.65
|
| Rate for Payer: Multiplan Auto |
$66.30
|
| Rate for Payer: Multiplan Commercial |
$66.30
|
| Rate for Payer: Multiplan Workers Comp |
$66.30
|
| Rate for Payer: Parkland Medicaid |
$73.44
|
| Rate for Payer: Scott and White EPO/PPO |
$18.09
|
| Rate for Payer: Scott and White Medicare |
$133.65
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$73.44
|
| Rate for Payer: Superior Health Plan EPO |
$133.65
|
| Rate for Payer: Superior Health Plan Medicare |
$133.65
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$133.65
|
| Rate for Payer: Universal American Medicare |
$133.65
|
| Rate for Payer: Wellcare Medicare |
$133.65
|
| Rate for Payer: Wellmed Medicare |
$133.65
|
|
|
CHED Arterial Line Activity Blood Drawn BCE
|
Facility
|
IP
|
$102.00
|
|
|
Service Code
|
HCPCS 36600
|
| Hospital Charge Code |
67874000345
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$69.36
|
|
|
CHED Arterial Line Activity Blood Drawn BCE
|
Facility
|
IP
|
$102.00
|
|
|
Service Code
|
HCPCS 36600
|
| Hospital Charge Code |
8910593
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$69.36
|
|
|
CHED Arterial Line Activity Blood Drawn BCE
|
Facility
|
OP
|
$102.00
|
|
|
Service Code
|
HCPCS 36600
|
| Hospital Charge Code |
67874000345
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$9.18 |
| Max. Negotiated Rate |
$282.53 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$9.18
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$133.65
|
| Rate for Payer: Amerigroup Medicare |
$133.65
|
| 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 |
$133.65
|
| Rate for Payer: BCBS of TX PPO |
$274.76
|
| Rate for Payer: Cash Price |
$69.36
|
| Rate for Payer: Cash Price |
$69.36
|
| Rate for Payer: Cash Price |
$69.36
|
| Rate for Payer: Cigna Commercial |
$282.53
|
| Rate for Payer: Cigna Medicaid |
$73.44
|
| Rate for Payer: Cigna Medicare |
$133.65
|
| Rate for Payer: Employer Direct Commercial |
$133.65
|
| Rate for Payer: Humana Medicare/TRICARE |
$133.65
|
| Rate for Payer: Molina CHIP/Medicaid |
$73.44
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$133.65
|
| Rate for Payer: Molina Medicare |
$133.65
|
| Rate for Payer: Multiplan Auto |
$66.30
|
| Rate for Payer: Multiplan Commercial |
$66.30
|
| Rate for Payer: Multiplan Workers Comp |
$66.30
|
| Rate for Payer: Parkland Medicaid |
$73.44
|
| Rate for Payer: Scott and White EPO/PPO |
$18.09
|
| Rate for Payer: Scott and White Medicare |
$133.65
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$73.44
|
| Rate for Payer: Superior Health Plan EPO |
$133.65
|
| Rate for Payer: Superior Health Plan Medicare |
$133.65
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$133.65
|
| Rate for Payer: Universal American Medicare |
$133.65
|
| Rate for Payer: Wellcare Medicare |
$133.65
|
| Rate for Payer: Wellmed Medicare |
$133.65
|
|
|
CHED BLADDER IRRIGATION SIMPLE LAVAGE AND OR INSTILLATION BCE
|
Facility
|
IP
|
$907.00
|
|
|
Service Code
|
HCPCS 51700
|
| Hospital Charge Code |
8438508
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$616.76
|
|
|
CHED BLADDER IRRIGATION SIMPLE LAVAGE AND OR INSTILLATION BCE
|
Facility
|
OP
|
$907.00
|
|
|
Service Code
|
HCPCS 51700
|
| Hospital Charge Code |
8438508
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$36.35 |
| Max. Negotiated Rate |
$653.04 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$81.63
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$250.99
|
| Rate for Payer: Amerigroup Medicare |
$250.99
|
| Rate for Payer: BCBS of TX Blue Advantage |
$87.39
|
| Rate for Payer: BCBS of TX Blue Essentials |
$104.66
|
| Rate for Payer: BCBS of TX Medicare |
$250.99
|
| Rate for Payer: BCBS of TX PPO |
$131.87
|
| Rate for Payer: Cash Price |
$616.76
|
| Rate for Payer: Cash Price |
$616.76
|
| Rate for Payer: Cash Price |
$616.76
|
| Rate for Payer: Cigna Commercial |
$530.54
|
| Rate for Payer: Cigna Medicaid |
$653.04
|
| Rate for Payer: Cigna Medicare |
$250.99
|
| Rate for Payer: Employer Direct Commercial |
$250.99
|
| Rate for Payer: Humana Medicare/TRICARE |
$250.99
|
| Rate for Payer: Molina CHIP/Medicaid |
$653.04
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$250.99
|
| Rate for Payer: Molina Medicare |
$250.99
|
| Rate for Payer: Multiplan Auto |
$589.55
|
| Rate for Payer: Multiplan Commercial |
$589.55
|
| Rate for Payer: Multiplan Workers Comp |
$589.55
|
| Rate for Payer: Parkland Medicaid |
$653.04
|
| Rate for Payer: Scott and White EPO/PPO |
$36.35
|
| Rate for Payer: Scott and White Medicare |
$250.99
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$653.04
|
| Rate for Payer: Superior Health Plan EPO |
$250.99
|
| Rate for Payer: Superior Health Plan Medicare |
$250.99
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$250.99
|
| Rate for Payer: Universal American Medicare |
$250.99
|
| Rate for Payer: Wellcare Medicare |
$250.99
|
| Rate for Payer: Wellmed Medicare |
$250.99
|
|
|
CHED BLOOD TRANSFUSION BCE
|
Facility
|
OP
|
$1,493.00
|
|
|
Service Code
|
HCPCS 36430
|
| Hospital Charge Code |
8910594
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$52.19 |
| Max. Negotiated Rate |
$1,074.96 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$134.37
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$443.18
|
| Rate for Payer: Amerigroup Medicare |
$443.18
|
| Rate for Payer: BCBS of TX Blue Advantage |
$58.47
|
| Rate for Payer: BCBS of TX Blue Essentials |
$70.02
|
| Rate for Payer: BCBS of TX Medicare |
$443.18
|
| Rate for Payer: BCBS of TX PPO |
$88.23
|
| Rate for Payer: Cash Price |
$1,015.24
|
| Rate for Payer: Cash Price |
$1,015.24
|
| Rate for Payer: Cash Price |
$1,015.24
|
| Rate for Payer: Cigna Commercial |
$936.81
|
| Rate for Payer: Cigna Medicaid |
$1,074.96
|
| Rate for Payer: Cigna Medicare |
$443.18
|
| Rate for Payer: Employer Direct Commercial |
$443.18
|
| Rate for Payer: Humana Medicare/TRICARE |
$443.18
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,074.96
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$443.18
|
| Rate for Payer: Molina Medicare |
$443.18
|
| Rate for Payer: Multiplan Auto |
$970.45
|
| Rate for Payer: Multiplan Commercial |
$970.45
|
| Rate for Payer: Multiplan Workers Comp |
$970.45
|
| Rate for Payer: Parkland Medicaid |
$1,074.96
|
| Rate for Payer: Scott and White EPO/PPO |
$52.19
|
| Rate for Payer: Scott and White Medicare |
$443.18
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,074.96
|
| Rate for Payer: Superior Health Plan EPO |
$443.18
|
| Rate for Payer: Superior Health Plan Medicare |
$443.18
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$443.18
|
| Rate for Payer: Universal American Medicare |
$443.18
|
| Rate for Payer: Wellcare Medicare |
$443.18
|
| Rate for Payer: Wellmed Medicare |
$443.18
|
|
|
CHED BLOOD TRANSFUSION BCE
|
Facility
|
IP
|
$1,493.00
|
|
|
Service Code
|
HCPCS 36430
|
| Hospital Charge Code |
8910594
|
|
Hospital Revenue Code
|
391
|
| Rate for Payer: Cash Price |
$1,015.24
|
|
|
CHED Burns Dress/Debride Large Burn, >10% BCE
|
Facility
|
IP
|
$922.00
|
|
|
Service Code
|
HCPCS 16030
|
| Hospital Charge Code |
8912578
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$626.96
|
|
|
CHED Burns Dress/Debride Large Burn, >10% BCE
|
Facility
|
OP
|
$922.00
|
|
|
Service Code
|
HCPCS 16030
|
| Hospital Charge Code |
8912578
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$82.98 |
| Max. Negotiated Rate |
$863.21 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$82.98
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$408.37
|
| Rate for Payer: Amerigroup Medicare |
$408.37
|
| 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 |
$408.37
|
| Rate for Payer: BCBS of TX PPO |
$805.17
|
| Rate for Payer: Cash Price |
$626.96
|
| Rate for Payer: Cash Price |
$626.96
|
| Rate for Payer: Cash Price |
$626.96
|
| Rate for Payer: Cigna Commercial |
$863.21
|
| Rate for Payer: Cigna Medicaid |
$663.84
|
| Rate for Payer: Cigna Medicare |
$408.37
|
| Rate for Payer: Employer Direct Commercial |
$408.37
|
| Rate for Payer: Humana Medicare/TRICARE |
$408.37
|
| Rate for Payer: Molina CHIP/Medicaid |
$663.84
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$408.37
|
| Rate for Payer: Molina Medicare |
$408.37
|
| Rate for Payer: Multiplan Auto |
$599.30
|
| Rate for Payer: Multiplan Commercial |
$599.30
|
| Rate for Payer: Multiplan Workers Comp |
$599.30
|
| Rate for Payer: Parkland Medicaid |
$663.84
|
| Rate for Payer: Scott and White EPO/PPO |
$160.91
|
| Rate for Payer: Scott and White Medicare |
$408.37
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$663.84
|
| Rate for Payer: Superior Health Plan EPO |
$408.37
|
| Rate for Payer: Superior Health Plan Medicare |
$408.37
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$408.37
|
| Rate for Payer: Universal American Medicare |
$408.37
|
| Rate for Payer: Wellcare Medicare |
$408.37
|
| Rate for Payer: Wellmed Medicare |
$408.37
|
|
|
CHED Burns Dress/Debride Medium Burn, 5-10% BCE
|
Facility
|
OP
|
$772.87
|
|
|
Service Code
|
HCPCS 16025
|
| Hospital Charge Code |
8910595
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$69.56 |
| Max. Negotiated Rate |
$556.47 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$69.56
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$201.55
|
| Rate for Payer: Amerigroup Medicare |
$201.55
|
| 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 |
$201.55
|
| Rate for Payer: BCBS of TX PPO |
$440.32
|
| Rate for Payer: Cash Price |
$525.55
|
| Rate for Payer: Cash Price |
$525.55
|
| Rate for Payer: Cash Price |
$525.55
|
| Rate for Payer: Cigna Commercial |
$426.04
|
| Rate for Payer: Cigna Medicaid |
$556.47
|
| Rate for Payer: Cigna Medicare |
$201.55
|
| Rate for Payer: Employer Direct Commercial |
$201.55
|
| Rate for Payer: Humana Medicare/TRICARE |
$201.55
|
| Rate for Payer: Molina CHIP/Medicaid |
$556.47
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$201.55
|
| Rate for Payer: Molina Medicare |
$201.55
|
| Rate for Payer: Multiplan Auto |
$502.37
|
| Rate for Payer: Multiplan Commercial |
$502.37
|
| Rate for Payer: Multiplan Workers Comp |
$502.37
|
| Rate for Payer: Parkland Medicaid |
$556.47
|
| Rate for Payer: Scott and White EPO/PPO |
$136.40
|
| Rate for Payer: Scott and White Medicare |
$201.55
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$556.47
|
| Rate for Payer: Superior Health Plan EPO |
$201.55
|
| Rate for Payer: Superior Health Plan Medicare |
$201.55
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$201.55
|
| Rate for Payer: Universal American Medicare |
$201.55
|
| Rate for Payer: Wellcare Medicare |
$201.55
|
| Rate for Payer: Wellmed Medicare |
$201.55
|
|
|
CHED Burns Dress/Debride Medium Burn, 5-10% BCE
|
Facility
|
IP
|
$772.87
|
|
|
Service Code
|
HCPCS 16025
|
| Hospital Charge Code |
8910595
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$525.55
|
|
|
CHED Burns Dress/Debride Small Burn, <5% BCE
|
Facility
|
OP
|
$716.77
|
|
|
Service Code
|
HCPCS 16020
|
| Hospital Charge Code |
8912579
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$64.51 |
| Max. Negotiated Rate |
$516.07 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$64.51
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$201.55
|
| Rate for Payer: Amerigroup Medicare |
$201.55
|
| 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 |
$201.55
|
| Rate for Payer: BCBS of TX PPO |
$440.32
|
| Rate for Payer: Cash Price |
$487.40
|
| Rate for Payer: Cash Price |
$487.40
|
| Rate for Payer: Cash Price |
$487.40
|
| Rate for Payer: Cigna Commercial |
$426.04
|
| Rate for Payer: Cigna Medicaid |
$516.07
|
| Rate for Payer: Cigna Medicare |
$201.55
|
| Rate for Payer: Employer Direct Commercial |
$201.55
|
| Rate for Payer: Humana Medicare/TRICARE |
$201.55
|
| Rate for Payer: Molina CHIP/Medicaid |
$516.07
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$201.55
|
| Rate for Payer: Molina Medicare |
$201.55
|
| Rate for Payer: Multiplan Auto |
$465.90
|
| Rate for Payer: Multiplan Commercial |
$465.90
|
| Rate for Payer: Multiplan Workers Comp |
$465.90
|
| Rate for Payer: Parkland Medicaid |
$516.07
|
| Rate for Payer: Scott and White EPO/PPO |
$68.72
|
| Rate for Payer: Scott and White Medicare |
$201.55
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$516.07
|
| Rate for Payer: Superior Health Plan EPO |
$201.55
|
| Rate for Payer: Superior Health Plan Medicare |
$201.55
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$201.55
|
| Rate for Payer: Universal American Medicare |
$201.55
|
| Rate for Payer: Wellcare Medicare |
$201.55
|
| Rate for Payer: Wellmed Medicare |
$201.55
|
|
|
CHED Burns Dress/Debride Small Burn, <5% BCE
|
Facility
|
IP
|
$716.77
|
|
|
Service Code
|
HCPCS 16020
|
| Hospital Charge Code |
8912579
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$487.40
|
|
|
CHED Cardiovascular Procedure Cardioversion BCE
|
Facility
|
IP
|
$1,304.00
|
|
|
Service Code
|
HCPCS 92960
|
| Hospital Charge Code |
8912584
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$886.72
|
|
|
CHED Cardiovascular Procedure Cardioversion BCE
|
Facility
|
OP
|
$1,304.00
|
|
|
Service Code
|
HCPCS 92960
|
| Hospital Charge Code |
8912584
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$117.36 |
| Max. Negotiated Rate |
$1,403.47 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$117.36
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$663.96
|
| Rate for Payer: Amerigroup Medicare |
$663.96
|
| Rate for Payer: BCBS of TX Blue Advantage |
$895.89
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,072.92
|
| Rate for Payer: BCBS of TX Medicare |
$663.96
|
| Rate for Payer: BCBS of TX PPO |
$1,351.88
|
| Rate for Payer: Cash Price |
$886.72
|
| Rate for Payer: Cash Price |
$886.72
|
| Rate for Payer: Cash Price |
$886.72
|
| Rate for Payer: Cigna Commercial |
$1,403.47
|
| Rate for Payer: Cigna Medicaid |
$938.88
|
| Rate for Payer: Cigna Medicare |
$663.96
|
| Rate for Payer: Employer Direct Commercial |
$663.96
|
| Rate for Payer: Humana Medicare/TRICARE |
$663.96
|
| Rate for Payer: Molina CHIP/Medicaid |
$938.88
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$663.96
|
| Rate for Payer: Molina Medicare |
$663.96
|
| Rate for Payer: Multiplan Auto |
$847.60
|
| Rate for Payer: Multiplan Commercial |
$847.60
|
| Rate for Payer: Multiplan Workers Comp |
$847.60
|
| Rate for Payer: Parkland Medicaid |
$938.88
|
| Rate for Payer: Scott and White EPO/PPO |
$130.60
|
| Rate for Payer: Scott and White Medicare |
$663.96
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$938.88
|
| Rate for Payer: Superior Health Plan EPO |
$663.96
|
| Rate for Payer: Superior Health Plan Medicare |
$663.96
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$663.96
|
| Rate for Payer: Universal American Medicare |
$663.96
|
| Rate for Payer: Wellcare Medicare |
$663.96
|
| Rate for Payer: Wellmed Medicare |
$663.96
|
|
|
CHED Cardiovascular Procedure CPR BCE
|
Facility
|
IP
|
$1,150.00
|
|
|
Service Code
|
HCPCS 92950
|
| Hospital Charge Code |
8910605
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$782.00
|
|
|
CHED Cardiovascular Procedure CPR BCE
|
Facility
|
OP
|
$1,150.00
|
|
|
Service Code
|
HCPCS 92950
|
| Hospital Charge Code |
8910605
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$103.50 |
| Max. Negotiated Rate |
$828.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$103.50
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$216.91
|
| Rate for Payer: Amerigroup Medicare |
$216.91
|
| Rate for Payer: BCBS of TX Blue Advantage |
$422.68
|
| Rate for Payer: BCBS of TX Blue Essentials |
$506.20
|
| Rate for Payer: BCBS of TX Medicare |
$216.91
|
| Rate for Payer: BCBS of TX PPO |
$637.81
|
| Rate for Payer: Cash Price |
$782.00
|
| Rate for Payer: Cash Price |
$782.00
|
| Rate for Payer: Cash Price |
$782.00
|
| Rate for Payer: Cigna Commercial |
$458.51
|
| Rate for Payer: Cigna Medicaid |
$828.00
|
| Rate for Payer: Cigna Medicare |
$216.91
|
| Rate for Payer: Employer Direct Commercial |
$216.91
|
| Rate for Payer: Humana Medicare/TRICARE |
$216.91
|
| Rate for Payer: Molina CHIP/Medicaid |
$828.00
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$216.91
|
| Rate for Payer: Molina Medicare |
$216.91
|
| Rate for Payer: Multiplan Auto |
$747.50
|
| Rate for Payer: Multiplan Commercial |
$747.50
|
| Rate for Payer: Multiplan Workers Comp |
$747.50
|
| Rate for Payer: Parkland Medicaid |
$828.00
|
| Rate for Payer: Scott and White EPO/PPO |
$221.51
|
| Rate for Payer: Scott and White Medicare |
$216.91
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$828.00
|
| Rate for Payer: Superior Health Plan EPO |
$216.91
|
| Rate for Payer: Superior Health Plan Medicare |
$216.91
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$216.91
|
| Rate for Payer: Universal American Medicare |
$216.91
|
| Rate for Payer: Wellcare Medicare |
$216.91
|
| Rate for Payer: Wellmed Medicare |
$216.91
|
|
|
CHED Cardiovascular Procedure Pacemaker, transcutaneous BCE
|
Facility
|
IP
|
$1,356.75
|
|
|
Service Code
|
HCPCS 92953
|
| Hospital Charge Code |
5201553
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$922.59
|
|
|
CHED Cardiovascular Procedure Pacemaker, transcutaneous BCE
|
Facility
|
OP
|
$1,356.75
|
|
|
Service Code
|
HCPCS 92953
|
| Hospital Charge Code |
5201553
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.19 |
| Max. Negotiated Rate |
$1,403.47 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$122.11
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$663.96
|
| Rate for Payer: Amerigroup Medicare |
$663.96
|
| Rate for Payer: BCBS of TX Blue Advantage |
$895.89
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,072.92
|
| Rate for Payer: BCBS of TX Medicare |
$663.96
|
| Rate for Payer: BCBS of TX PPO |
$1,351.88
|
| Rate for Payer: Cash Price |
$922.59
|
| Rate for Payer: Cash Price |
$922.59
|
| Rate for Payer: Cash Price |
$922.59
|
| Rate for Payer: Cigna Commercial |
$1,403.47
|
| Rate for Payer: Cigna Medicaid |
$976.86
|
| Rate for Payer: Cigna Medicare |
$663.96
|
| Rate for Payer: Employer Direct Commercial |
$663.96
|
| Rate for Payer: Humana Medicare/TRICARE |
$663.96
|
| Rate for Payer: Molina CHIP/Medicaid |
$976.86
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$663.96
|
| Rate for Payer: Molina Medicare |
$663.96
|
| Rate for Payer: Multiplan Auto |
$881.89
|
| Rate for Payer: Multiplan Commercial |
$881.89
|
| Rate for Payer: Multiplan Workers Comp |
$881.89
|
| Rate for Payer: Parkland Medicaid |
$976.86
|
| Rate for Payer: Scott and White EPO/PPO |
$1.19
|
| Rate for Payer: Scott and White Medicare |
$663.96
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$976.86
|
| Rate for Payer: Superior Health Plan EPO |
$663.96
|
| Rate for Payer: Superior Health Plan Medicare |
$663.96
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$663.96
|
| Rate for Payer: Universal American Medicare |
$663.96
|
| Rate for Payer: Wellcare Medicare |
$663.96
|
| Rate for Payer: Wellmed Medicare |
$663.96
|
|
