|
CHED CHANGE CYSTOSTOMY TUBE COMPLICATED BCE
|
Facility
|
OP
|
$4,406.63
|
|
|
Service Code
|
HCPCS 51710
|
| Hospital Charge Code |
8772541
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$97.83 |
| Max. Negotiated Rate |
$3,172.77 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$396.60
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$700.47
|
| Rate for Payer: Amerigroup Medicare |
$700.47
|
| Rate for Payer: BCBS of TX Blue Advantage |
$929.41
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,113.06
|
| Rate for Payer: BCBS of TX Medicare |
$700.47
|
| Rate for Payer: BCBS of TX PPO |
$1,402.46
|
| Rate for Payer: Cash Price |
$2,996.51
|
| Rate for Payer: Cash Price |
$2,996.51
|
| Rate for Payer: Cash Price |
$2,996.51
|
| Rate for Payer: Cigna Commercial |
$1,480.67
|
| Rate for Payer: Cigna Medicaid |
$3,172.77
|
| Rate for Payer: Cigna Medicare |
$700.47
|
| Rate for Payer: Employer Direct Commercial |
$700.47
|
| Rate for Payer: Humana Medicare/TRICARE |
$700.47
|
| Rate for Payer: Molina CHIP/Medicaid |
$3,172.77
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$700.47
|
| Rate for Payer: Molina Medicare |
$700.47
|
| Rate for Payer: Multiplan Auto |
$2,864.31
|
| Rate for Payer: Multiplan Commercial |
$2,864.31
|
| Rate for Payer: Multiplan Workers Comp |
$2,864.31
|
| Rate for Payer: Parkland Medicaid |
$3,172.77
|
| Rate for Payer: Scott and White EPO/PPO |
$97.83
|
| Rate for Payer: Scott and White Medicare |
$700.47
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$3,172.77
|
| Rate for Payer: Superior Health Plan EPO |
$700.47
|
| Rate for Payer: Superior Health Plan Medicare |
$700.47
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$700.47
|
| Rate for Payer: Universal American Medicare |
$700.47
|
| Rate for Payer: Wellcare Medicare |
$700.47
|
| Rate for Payer: Wellmed Medicare |
$700.47
|
|
|
CHED CHANGE CYSTOSTOMY TUBE COMPLICATED BCE
|
Facility
|
IP
|
$4,406.63
|
|
|
Service Code
|
HCPCS 51710
|
| Hospital Charge Code |
8772541
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$2,996.51
|
|
|
CHED Chemical Cautery Yes BCE
|
Facility
|
IP
|
$993.50
|
|
|
Service Code
|
HCPCS 17250
|
| Hospital Charge Code |
8910606
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$675.58
|
|
|
CHED Chemical Cautery Yes BCE
|
Facility
|
OP
|
$993.50
|
|
|
Service Code
|
HCPCS 17250
|
| Hospital Charge Code |
8910606
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$46.23 |
| Max. Negotiated Rate |
$715.32 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$89.42
|
| 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 |
$675.58
|
| Rate for Payer: Cash Price |
$675.58
|
| Rate for Payer: Cash Price |
$675.58
|
| Rate for Payer: Cigna Commercial |
$426.04
|
| Rate for Payer: Cigna Medicaid |
$715.32
|
| 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 |
$715.32
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$201.55
|
| Rate for Payer: Molina Medicare |
$201.55
|
| Rate for Payer: Multiplan Auto |
$645.77
|
| Rate for Payer: Multiplan Commercial |
$645.77
|
| Rate for Payer: Multiplan Workers Comp |
$645.77
|
| Rate for Payer: Parkland Medicaid |
$715.32
|
| Rate for Payer: Scott and White EPO/PPO |
$46.23
|
| Rate for Payer: Scott and White Medicare |
$201.55
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$715.32
|
| 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 CLOSED TREATMENT OF HIP DISLC TRAUMATIC W/O ANESTHESIA BCE
|
Facility
|
IP
|
$1,276.42
|
|
|
Service Code
|
HCPCS 27250
|
| Hospital Charge Code |
8470468
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$867.97
|
|
|
CHED CLOSED TREATMENT OF HIP DISLC TRAUMATIC W/O ANESTHESIA BCE
|
Facility
|
IP
|
$1,276.42
|
|
|
Service Code
|
HCPCS 27250
|
| Hospital Charge Code |
8914573
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$867.97
|
|
|
CHED CLOSED TREATMENT OF HIP DISLC TRAUMATIC W/O ANESTHESIA BCE
|
Facility
|
OP
|
$1,276.42
|
|
|
Service Code
|
HCPCS 27250
|
| Hospital Charge Code |
8914573
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$114.88 |
| Max. Negotiated Rate |
$919.02 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$114.88
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$247.79
|
| Rate for Payer: Amerigroup Medicare |
$247.79
|
| Rate for Payer: BCBS of TX Blue Advantage |
$360.12
|
| Rate for Payer: BCBS of TX Blue Essentials |
$431.28
|
| Rate for Payer: BCBS of TX Medicare |
$247.79
|
| Rate for Payer: BCBS of TX PPO |
$543.41
|
| Rate for Payer: Cash Price |
$867.97
|
| Rate for Payer: Cash Price |
$867.97
|
| Rate for Payer: Cash Price |
$867.97
|
| Rate for Payer: Cigna Commercial |
$523.79
|
| Rate for Payer: Cigna Medicaid |
$919.02
|
| Rate for Payer: Cigna Medicare |
$247.79
|
| Rate for Payer: Employer Direct Commercial |
$247.79
|
| Rate for Payer: Humana Medicare/TRICARE |
$247.79
|
| Rate for Payer: Molina CHIP/Medicaid |
$919.02
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$247.79
|
| Rate for Payer: Molina Medicare |
$247.79
|
| Rate for Payer: Multiplan Auto |
$829.67
|
| Rate for Payer: Multiplan Commercial |
$829.67
|
| Rate for Payer: Multiplan Workers Comp |
$829.67
|
| Rate for Payer: Parkland Medicaid |
$919.02
|
| Rate for Payer: Scott and White EPO/PPO |
$217.75
|
| Rate for Payer: Scott and White Medicare |
$247.79
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$919.02
|
| Rate for Payer: Superior Health Plan EPO |
$247.79
|
| Rate for Payer: Superior Health Plan Medicare |
$247.79
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$247.79
|
| Rate for Payer: Universal American Medicare |
$247.79
|
| Rate for Payer: Wellcare Medicare |
$247.79
|
| Rate for Payer: Wellmed Medicare |
$247.79
|
|
|
CHED CLOSED TREATMENT OF HIP DISLC TRAUMATIC W/O ANESTHESIA BCE
|
Facility
|
OP
|
$1,276.42
|
|
|
Service Code
|
HCPCS 27250
|
| Hospital Charge Code |
8470468
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$114.88 |
| Max. Negotiated Rate |
$919.02 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$114.88
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$247.79
|
| Rate for Payer: Amerigroup Medicare |
$247.79
|
| Rate for Payer: BCBS of TX Blue Advantage |
$360.12
|
| Rate for Payer: BCBS of TX Blue Essentials |
$431.28
|
| Rate for Payer: BCBS of TX Medicare |
$247.79
|
| Rate for Payer: BCBS of TX PPO |
$543.41
|
| Rate for Payer: Cash Price |
$867.97
|
| Rate for Payer: Cash Price |
$867.97
|
| Rate for Payer: Cash Price |
$867.97
|
| Rate for Payer: Cigna Commercial |
$523.79
|
| Rate for Payer: Cigna Medicaid |
$919.02
|
| Rate for Payer: Cigna Medicare |
$247.79
|
| Rate for Payer: Employer Direct Commercial |
$247.79
|
| Rate for Payer: Humana Medicare/TRICARE |
$247.79
|
| Rate for Payer: Molina CHIP/Medicaid |
$919.02
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$247.79
|
| Rate for Payer: Molina Medicare |
$247.79
|
| Rate for Payer: Multiplan Auto |
$829.67
|
| Rate for Payer: Multiplan Commercial |
$829.67
|
| Rate for Payer: Multiplan Workers Comp |
$829.67
|
| Rate for Payer: Parkland Medicaid |
$919.02
|
| Rate for Payer: Scott and White EPO/PPO |
$217.75
|
| Rate for Payer: Scott and White Medicare |
$247.79
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$919.02
|
| Rate for Payer: Superior Health Plan EPO |
$247.79
|
| Rate for Payer: Superior Health Plan Medicare |
$247.79
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$247.79
|
| Rate for Payer: Universal American Medicare |
$247.79
|
| Rate for Payer: Wellcare Medicare |
$247.79
|
| Rate for Payer: Wellmed Medicare |
$247.79
|
|
|
CHED CLOSED TX FEMORAL SHAFT FX W/O MANIPULATION BCE
|
Facility
|
IP
|
$1,002.53
|
|
|
Service Code
|
HCPCS 27500
|
| Hospital Charge Code |
8914574
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$681.72
|
|
|
CHED CLOSED TX FEMORAL SHAFT FX W/O MANIPULATION BCE
|
Facility
|
OP
|
$1,002.53
|
|
|
Service Code
|
HCPCS 27500
|
| Hospital Charge Code |
8914574
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$90.23 |
| Max. Negotiated Rate |
$721.82 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$90.23
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$247.79
|
| Rate for Payer: Amerigroup Medicare |
$247.79
|
| Rate for Payer: BCBS of TX Blue Advantage |
$360.12
|
| Rate for Payer: BCBS of TX Blue Essentials |
$431.28
|
| Rate for Payer: BCBS of TX Medicare |
$247.79
|
| Rate for Payer: BCBS of TX PPO |
$543.41
|
| Rate for Payer: Cash Price |
$681.72
|
| Rate for Payer: Cash Price |
$681.72
|
| Rate for Payer: Cash Price |
$681.72
|
| Rate for Payer: Cigna Commercial |
$523.79
|
| Rate for Payer: Cigna Medicaid |
$721.82
|
| Rate for Payer: Cigna Medicare |
$247.79
|
| Rate for Payer: Employer Direct Commercial |
$247.79
|
| Rate for Payer: Humana Medicare/TRICARE |
$247.79
|
| Rate for Payer: Molina CHIP/Medicaid |
$721.82
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$247.79
|
| Rate for Payer: Molina Medicare |
$247.79
|
| Rate for Payer: Multiplan Auto |
$651.64
|
| Rate for Payer: Multiplan Commercial |
$651.64
|
| Rate for Payer: Multiplan Workers Comp |
$651.64
|
| Rate for Payer: Parkland Medicaid |
$721.82
|
| Rate for Payer: Scott and White EPO/PPO |
$601.70
|
| Rate for Payer: Scott and White Medicare |
$247.79
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$721.82
|
| Rate for Payer: Superior Health Plan EPO |
$247.79
|
| Rate for Payer: Superior Health Plan Medicare |
$247.79
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$247.79
|
| Rate for Payer: Universal American Medicare |
$247.79
|
| Rate for Payer: Wellcare Medicare |
$247.79
|
| Rate for Payer: Wellmed Medicare |
$247.79
|
|
|
CHED CLOSED TX NASAL FRACTURE W/O STABILIZATION BCE
|
Facility
|
OP
|
$5,101.05
|
|
|
Service Code
|
HCPCS 21315
|
| Hospital Charge Code |
8474494
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$73.09 |
| Max. Negotiated Rate |
$3,672.76 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$459.09
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,558.65
|
| Rate for Payer: Amerigroup Medicare |
$1,558.65
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,253.40
|
| Rate for Payer: BCBS of TX Blue Essentials |
$2,698.68
|
| Rate for Payer: BCBS of TX Medicare |
$1,558.65
|
| Rate for Payer: BCBS of TX PPO |
$3,400.34
|
| Rate for Payer: Cash Price |
$3,468.71
|
| Rate for Payer: Cash Price |
$3,468.71
|
| Rate for Payer: Cash Price |
$3,468.71
|
| Rate for Payer: Cigna Commercial |
$3,294.71
|
| Rate for Payer: Cigna Medicaid |
$3,672.76
|
| Rate for Payer: Cigna Medicare |
$1,558.65
|
| Rate for Payer: Employer Direct Commercial |
$1,558.65
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,558.65
|
| Rate for Payer: Molina CHIP/Medicaid |
$3,672.76
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,558.65
|
| Rate for Payer: Molina Medicare |
$1,558.65
|
| Rate for Payer: Multiplan Auto |
$3,315.68
|
| Rate for Payer: Multiplan Commercial |
$3,315.68
|
| Rate for Payer: Multiplan Workers Comp |
$3,315.68
|
| Rate for Payer: Parkland Medicaid |
$3,672.76
|
| Rate for Payer: Scott and White EPO/PPO |
$73.09
|
| Rate for Payer: Scott and White Medicare |
$1,558.65
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$3,672.76
|
| Rate for Payer: Superior Health Plan EPO |
$1,558.65
|
| Rate for Payer: Superior Health Plan Medicare |
$1,558.65
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,558.65
|
| Rate for Payer: Universal American Medicare |
$1,558.65
|
| Rate for Payer: Wellcare Medicare |
$1,558.65
|
| Rate for Payer: Wellmed Medicare |
$1,558.65
|
|
|
CHED CLOSED TX NASAL FRACTURE W/O STABILIZATION BCE
|
Facility
|
IP
|
$5,101.05
|
|
|
Service Code
|
HCPCS 21315
|
| Hospital Charge Code |
8474494
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$3,468.71
|
|
|
CHED CLOSED TX RADIAL SHAFT FX AND CLOSED TX DISLOCATION DISTAL RADIOULNAR JNT BCE
|
Facility
|
OP
|
$3,322.90
|
|
|
Service Code
|
HCPCS 25520
|
| Hospital Charge Code |
8912580
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$299.06 |
| Max. Negotiated Rate |
$3,415.58 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$299.06
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,615.32
|
| Rate for Payer: Amerigroup Medicare |
$1,615.32
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,263.50
|
| Rate for Payer: BCBS of TX Blue Essentials |
$2,710.78
|
| Rate for Payer: BCBS of TX Medicare |
$1,615.32
|
| Rate for Payer: BCBS of TX PPO |
$3,415.58
|
| Rate for Payer: Cash Price |
$2,259.57
|
| Rate for Payer: Cash Price |
$2,259.57
|
| Rate for Payer: Cash Price |
$2,259.57
|
| Rate for Payer: Cigna Commercial |
$3,414.49
|
| Rate for Payer: Cigna Medicaid |
$2,392.49
|
| Rate for Payer: Cigna Medicare |
$1,615.32
|
| Rate for Payer: Employer Direct Commercial |
$1,615.32
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,615.32
|
| Rate for Payer: Molina CHIP/Medicaid |
$2,392.49
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,615.32
|
| Rate for Payer: Molina Medicare |
$1,615.32
|
| Rate for Payer: Multiplan Auto |
$2,159.89
|
| Rate for Payer: Multiplan Commercial |
$2,159.89
|
| Rate for Payer: Multiplan Workers Comp |
$2,159.89
|
| Rate for Payer: Parkland Medicaid |
$2,392.49
|
| Rate for Payer: Scott and White EPO/PPO |
$688.02
|
| Rate for Payer: Scott and White Medicare |
$1,615.32
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$2,392.49
|
| Rate for Payer: Superior Health Plan EPO |
$1,615.32
|
| Rate for Payer: Superior Health Plan Medicare |
$1,615.32
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,615.32
|
| Rate for Payer: Universal American Medicare |
$1,615.32
|
| Rate for Payer: Wellcare Medicare |
$1,615.32
|
| Rate for Payer: Wellmed Medicare |
$1,615.32
|
|
|
CHED CLOSED TX RADIAL SHAFT FX AND CLOSED TX DISLOCATION DISTAL RADIOULNAR JNT BCE
|
Facility
|
IP
|
$3,322.90
|
|
|
Service Code
|
HCPCS 25520
|
| Hospital Charge Code |
8912580
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$2,259.57
|
|
|
CHED CLOSED TX TRANS-SCAPHOPERILUNAR TYPE FX DISLC W/MANIPULATION BCE
|
Facility
|
OP
|
$1,080.22
|
|
|
Service Code
|
HCPCS 25680
|
| Hospital Charge Code |
8910596
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$97.22 |
| Max. Negotiated Rate |
$777.76 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$97.22
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$247.79
|
| Rate for Payer: Amerigroup Medicare |
$247.79
|
| Rate for Payer: BCBS of TX Blue Advantage |
$360.12
|
| Rate for Payer: BCBS of TX Blue Essentials |
$431.28
|
| Rate for Payer: BCBS of TX Medicare |
$247.79
|
| Rate for Payer: BCBS of TX PPO |
$543.41
|
| Rate for Payer: Cash Price |
$734.55
|
| Rate for Payer: Cash Price |
$734.55
|
| Rate for Payer: Cash Price |
$734.55
|
| Rate for Payer: Cigna Commercial |
$523.79
|
| Rate for Payer: Cigna Medicaid |
$777.76
|
| Rate for Payer: Cigna Medicare |
$247.79
|
| Rate for Payer: Employer Direct Commercial |
$247.79
|
| Rate for Payer: Humana Medicare/TRICARE |
$247.79
|
| Rate for Payer: Molina CHIP/Medicaid |
$777.76
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$247.79
|
| Rate for Payer: Molina Medicare |
$247.79
|
| Rate for Payer: Multiplan Auto |
$702.14
|
| Rate for Payer: Multiplan Commercial |
$702.14
|
| Rate for Payer: Multiplan Workers Comp |
$702.14
|
| Rate for Payer: Parkland Medicaid |
$777.76
|
| Rate for Payer: Scott and White EPO/PPO |
$668.92
|
| Rate for Payer: Scott and White Medicare |
$247.79
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$777.76
|
| Rate for Payer: Superior Health Plan EPO |
$247.79
|
| Rate for Payer: Superior Health Plan Medicare |
$247.79
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$247.79
|
| Rate for Payer: Universal American Medicare |
$247.79
|
| Rate for Payer: Wellcare Medicare |
$247.79
|
| Rate for Payer: Wellmed Medicare |
$247.79
|
|
|
CHED CLOSED TX TRANS-SCAPHOPERILUNAR TYPE FX DISLC W/MANIPULATION BCE
|
Facility
|
IP
|
$1,080.22
|
|
|
Service Code
|
HCPCS 25680
|
| Hospital Charge Code |
8910596
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$734.55
|
|
|
CHED CLOSURE LACERATION VESTIBULE MOUTH 2.5 CM/< BCE
|
Facility
|
OP
|
$815.16
|
|
|
Service Code
|
HCPCS 40830
|
| Hospital Charge Code |
8704536
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$73.36 |
| Max. Negotiated Rate |
$586.92 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$73.36
|
| 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 |
$554.31
|
| Rate for Payer: Cash Price |
$554.31
|
| Rate for Payer: Cash Price |
$554.31
|
| Rate for Payer: Cigna Commercial |
$502.95
|
| Rate for Payer: Cigna Medicaid |
$586.92
|
| 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 |
$586.92
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$237.93
|
| Rate for Payer: Molina Medicare |
$237.93
|
| Rate for Payer: Multiplan Auto |
$529.85
|
| Rate for Payer: Multiplan Commercial |
$529.85
|
| Rate for Payer: Multiplan Workers Comp |
$529.85
|
| Rate for Payer: Parkland Medicaid |
$586.92
|
| Rate for Payer: Scott and White EPO/PPO |
$179.30
|
| Rate for Payer: Scott and White Medicare |
$237.93
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$586.92
|
| 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 CLOSURE LACERATION VESTIBULE MOUTH 2.5 CM/< BCE
|
Facility
|
IP
|
$815.16
|
|
|
Service Code
|
HCPCS 40830
|
| Hospital Charge Code |
8704536
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$554.31
|
|
|
CHED CLSD TX BIMALLEOLAR ANKLE FX W/MANJ BCE
|
Facility
|
OP
|
$2,770.75
|
|
|
Service Code
|
HCPCS 27810
|
| Hospital Charge Code |
8840544
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$249.37 |
| Max. Negotiated Rate |
$3,415.58 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$249.37
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,615.32
|
| Rate for Payer: Amerigroup Medicare |
$1,615.32
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,263.50
|
| Rate for Payer: BCBS of TX Blue Essentials |
$2,710.78
|
| Rate for Payer: BCBS of TX Medicare |
$1,615.32
|
| Rate for Payer: BCBS of TX PPO |
$3,415.58
|
| Rate for Payer: Cash Price |
$1,884.11
|
| Rate for Payer: Cash Price |
$1,884.11
|
| Rate for Payer: Cash Price |
$1,884.11
|
| Rate for Payer: Cigna Commercial |
$3,414.49
|
| Rate for Payer: Cigna Medicaid |
$1,994.94
|
| Rate for Payer: Cigna Medicare |
$1,615.32
|
| Rate for Payer: Employer Direct Commercial |
$1,615.32
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,615.32
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,994.94
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,615.32
|
| Rate for Payer: Molina Medicare |
$1,615.32
|
| Rate for Payer: Multiplan Auto |
$1,800.99
|
| Rate for Payer: Multiplan Commercial |
$1,800.99
|
| Rate for Payer: Multiplan Workers Comp |
$1,800.99
|
| Rate for Payer: Parkland Medicaid |
$1,994.94
|
| Rate for Payer: Scott and White EPO/PPO |
$541.96
|
| Rate for Payer: Scott and White Medicare |
$1,615.32
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,994.94
|
| Rate for Payer: Superior Health Plan EPO |
$1,615.32
|
| Rate for Payer: Superior Health Plan Medicare |
$1,615.32
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,615.32
|
| Rate for Payer: Universal American Medicare |
$1,615.32
|
| Rate for Payer: Wellcare Medicare |
$1,615.32
|
| Rate for Payer: Wellmed Medicare |
$1,615.32
|
|
|
CHED CLSD TX BIMALLEOLAR ANKLE FX W/MANJ BCE
|
Facility
|
IP
|
$2,770.75
|
|
|
Service Code
|
HCPCS 27810
|
| Hospital Charge Code |
8840544
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$1,884.11
|
|
|
CHED CLSD TX KNEE DISLOCATION W/O ANESTH BCE
|
Facility
|
IP
|
$1,417.00
|
|
|
Service Code
|
HCPCS 27550
|
| Hospital Charge Code |
9054973
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$963.56
|
|
|
CHED CLSD TX KNEE DISLOCATION W/O ANESTH BCE
|
Facility
|
OP
|
$1,417.00
|
|
|
Service Code
|
HCPCS 27550
|
| Hospital Charge Code |
9054973
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$127.53 |
| Max. Negotiated Rate |
$1,020.24 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$127.53
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$247.79
|
| Rate for Payer: Amerigroup Medicare |
$247.79
|
| Rate for Payer: BCBS of TX Blue Advantage |
$360.12
|
| Rate for Payer: BCBS of TX Blue Essentials |
$431.28
|
| Rate for Payer: BCBS of TX Medicare |
$247.79
|
| Rate for Payer: BCBS of TX PPO |
$543.41
|
| Rate for Payer: Cash Price |
$963.56
|
| Rate for Payer: Cash Price |
$963.56
|
| Rate for Payer: Cash Price |
$963.56
|
| Rate for Payer: Cigna Commercial |
$523.79
|
| Rate for Payer: Cigna Medicaid |
$1,020.24
|
| Rate for Payer: Cigna Medicare |
$247.79
|
| Rate for Payer: Employer Direct Commercial |
$247.79
|
| Rate for Payer: Humana Medicare/TRICARE |
$247.79
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,020.24
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$247.79
|
| Rate for Payer: Molina Medicare |
$247.79
|
| Rate for Payer: Multiplan Auto |
$921.05
|
| Rate for Payer: Multiplan Commercial |
$921.05
|
| Rate for Payer: Multiplan Workers Comp |
$921.05
|
| Rate for Payer: Parkland Medicaid |
$1,020.24
|
| Rate for Payer: Scott and White EPO/PPO |
$592.49
|
| Rate for Payer: Scott and White Medicare |
$247.79
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,020.24
|
| Rate for Payer: Superior Health Plan EPO |
$247.79
|
| Rate for Payer: Superior Health Plan Medicare |
$247.79
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$247.79
|
| Rate for Payer: Universal American Medicare |
$247.79
|
| Rate for Payer: Wellcare Medicare |
$247.79
|
| Rate for Payer: Wellmed Medicare |
$247.79
|
|
|
CHED CLSD TX OF ANKLE FX W MANIP
|
Facility
|
OP
|
$2,774.75
|
|
|
Service Code
|
HCPCS 28435
|
| Hospital Charge Code |
9073040
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$249.73 |
| Max. Negotiated Rate |
$3,415.58 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$249.73
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,615.32
|
| Rate for Payer: Amerigroup Medicare |
$1,615.32
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,263.50
|
| Rate for Payer: BCBS of TX Blue Essentials |
$2,710.78
|
| Rate for Payer: BCBS of TX Medicare |
$1,615.32
|
| Rate for Payer: BCBS of TX PPO |
$3,415.58
|
| Rate for Payer: Cash Price |
$1,886.83
|
| Rate for Payer: Cash Price |
$1,886.83
|
| Rate for Payer: Cash Price |
$1,886.83
|
| Rate for Payer: Cigna Commercial |
$3,414.49
|
| Rate for Payer: Cigna Medicaid |
$1,997.82
|
| Rate for Payer: Cigna Medicare |
$1,615.32
|
| Rate for Payer: Employer Direct Commercial |
$1,615.32
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,615.32
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,997.82
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,615.32
|
| Rate for Payer: Molina Medicare |
$1,615.32
|
| Rate for Payer: Multiplan Auto |
$1,803.59
|
| Rate for Payer: Multiplan Commercial |
$1,803.59
|
| Rate for Payer: Multiplan Workers Comp |
$1,803.59
|
| Rate for Payer: Parkland Medicaid |
$1,997.82
|
| Rate for Payer: Scott and White EPO/PPO |
$417.11
|
| Rate for Payer: Scott and White Medicare |
$1,615.32
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,997.82
|
| Rate for Payer: Superior Health Plan EPO |
$1,615.32
|
| Rate for Payer: Superior Health Plan Medicare |
$1,615.32
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,615.32
|
| Rate for Payer: Universal American Medicare |
$1,615.32
|
| Rate for Payer: Wellcare Medicare |
$1,615.32
|
| Rate for Payer: Wellmed Medicare |
$1,615.32
|
|
|
CHED CLSD TX OF ANKLE FX W MANIP
|
Facility
|
IP
|
$2,774.75
|
|
|
Service Code
|
HCPCS 28435
|
| Hospital Charge Code |
9073040
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$1,886.83
|
|
|
CHED CLSD TX OF ANKLE FX WO MANIP
|
Facility
|
OP
|
$809.00
|
|
|
Service Code
|
HCPCS 28430
|
| Hospital Charge Code |
9076980
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$72.81 |
| Max. Negotiated Rate |
$582.48 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$72.81
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$247.79
|
| Rate for Payer: Amerigroup Medicare |
$247.79
|
| Rate for Payer: BCBS of TX Blue Advantage |
$181.96
|
| Rate for Payer: BCBS of TX Blue Essentials |
$217.92
|
| Rate for Payer: BCBS of TX Medicare |
$247.79
|
| Rate for Payer: BCBS of TX PPO |
$274.58
|
| Rate for Payer: Cash Price |
$550.12
|
| Rate for Payer: Cash Price |
$550.12
|
| Rate for Payer: Cash Price |
$550.12
|
| Rate for Payer: Cigna Commercial |
$523.79
|
| Rate for Payer: Cigna Medicaid |
$582.48
|
| Rate for Payer: Cigna Medicare |
$247.79
|
| Rate for Payer: Employer Direct Commercial |
$247.79
|
| Rate for Payer: Humana Medicare/TRICARE |
$247.79
|
| Rate for Payer: Molina CHIP/Medicaid |
$582.48
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$247.79
|
| Rate for Payer: Molina Medicare |
$247.79
|
| Rate for Payer: Multiplan Auto |
$525.85
|
| Rate for Payer: Multiplan Commercial |
$525.85
|
| Rate for Payer: Multiplan Workers Comp |
$525.85
|
| Rate for Payer: Parkland Medicaid |
$582.48
|
| Rate for Payer: Scott and White EPO/PPO |
$268.41
|
| Rate for Payer: Scott and White Medicare |
$247.79
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$582.48
|
| Rate for Payer: Superior Health Plan EPO |
$247.79
|
| Rate for Payer: Superior Health Plan Medicare |
$247.79
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$247.79
|
| Rate for Payer: Universal American Medicare |
$247.79
|
| Rate for Payer: Wellcare Medicare |
$247.79
|
| Rate for Payer: Wellmed Medicare |
$247.79
|
|
