|
CHED CLSD TX OF ANKLE FX WO MANIP
|
Facility
|
IP
|
$809.00
|
|
|
Service Code
|
HCPCS 28430
|
| Hospital Charge Code |
9076980
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$550.12
|
|
|
CHED CLSD TX SHLDR DISLC W/FX HUM TUBRST W/MAN BCE
|
Facility
|
OP
|
$2,948.50
|
|
|
Service Code
|
HCPCS 23665
|
| Hospital Charge Code |
8430475
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$265.37 |
| Max. Negotiated Rate |
$3,415.58 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$265.37
|
| 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 |
$2,004.98
|
| Rate for Payer: Cash Price |
$2,004.98
|
| Rate for Payer: Cash Price |
$2,004.98
|
| Rate for Payer: Cigna Commercial |
$3,414.49
|
| Rate for Payer: Cigna Medicaid |
$2,122.92
|
| 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 |
$2,122.92
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,615.32
|
| Rate for Payer: Molina Medicare |
$1,615.32
|
| Rate for Payer: Multiplan Auto |
$1,916.53
|
| Rate for Payer: Multiplan Commercial |
$1,916.53
|
| Rate for Payer: Multiplan Workers Comp |
$1,916.53
|
| Rate for Payer: Parkland Medicaid |
$2,122.92
|
| Rate for Payer: Scott and White EPO/PPO |
$509.16
|
| Rate for Payer: Scott and White Medicare |
$1,615.32
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$2,122.92
|
| 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 SHLDR DISLC W/FX HUM TUBRST W/MAN BCE
|
Facility
|
OP
|
$2,948.50
|
|
|
Service Code
|
HCPCS 23665
|
| Hospital Charge Code |
8912581
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$265.37 |
| Max. Negotiated Rate |
$3,415.58 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$265.37
|
| 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 |
$2,004.98
|
| Rate for Payer: Cash Price |
$2,004.98
|
| Rate for Payer: Cash Price |
$2,004.98
|
| Rate for Payer: Cigna Commercial |
$3,414.49
|
| Rate for Payer: Cigna Medicaid |
$2,122.92
|
| 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 |
$2,122.92
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,615.32
|
| Rate for Payer: Molina Medicare |
$1,615.32
|
| Rate for Payer: Multiplan Auto |
$1,916.53
|
| Rate for Payer: Multiplan Commercial |
$1,916.53
|
| Rate for Payer: Multiplan Workers Comp |
$1,916.53
|
| Rate for Payer: Parkland Medicaid |
$2,122.92
|
| Rate for Payer: Scott and White EPO/PPO |
$509.16
|
| Rate for Payer: Scott and White Medicare |
$1,615.32
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$2,122.92
|
| 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 SHLDR DISLC W/FX HUM TUBRST W/MAN BCE
|
Facility
|
IP
|
$2,948.50
|
|
|
Service Code
|
HCPCS 23665
|
| Hospital Charge Code |
8430475
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$2,004.98
|
|
|
CHED CLSD TX SHLDR DISLC W/FX HUM TUBRST W/MAN BCE
|
Facility
|
IP
|
$2,948.50
|
|
|
Service Code
|
HCPCS 23665
|
| Hospital Charge Code |
8912581
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$2,004.98
|
|
|
CHED CLTX CARPO/METACARPAL FX DISLC THUMB W/MANJ BCE
|
Facility
|
OP
|
$2,211.23
|
|
|
Service Code
|
HCPCS 26645
|
| Hospital Charge Code |
8910599
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$199.01 |
| Max. Negotiated Rate |
$3,415.58 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$199.01
|
| 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 |
$1,503.64
|
| Rate for Payer: Cash Price |
$1,503.64
|
| Rate for Payer: Cash Price |
$1,503.64
|
| Rate for Payer: Cigna Commercial |
$3,414.49
|
| Rate for Payer: Cigna Medicaid |
$1,592.09
|
| 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 |
$1,592.09
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,615.32
|
| Rate for Payer: Molina Medicare |
$1,615.32
|
| Rate for Payer: Multiplan Auto |
$1,437.30
|
| Rate for Payer: Multiplan Commercial |
$1,437.30
|
| Rate for Payer: Multiplan Workers Comp |
$1,437.30
|
| Rate for Payer: Parkland Medicaid |
$1,592.09
|
| Rate for Payer: Scott and White EPO/PPO |
$502.25
|
| Rate for Payer: Scott and White Medicare |
$1,615.32
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,592.09
|
| 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 CLTX CARPO/METACARPAL FX DISLC THUMB W/MANJ BCE
|
Facility
|
IP
|
$2,211.23
|
|
|
Service Code
|
HCPCS 26645
|
| Hospital Charge Code |
8910599
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$1,503.64
|
|
|
CHED CLTX FX PHLX/PHLG OTH/THN GRT TOE W/O MANIP BCE
|
Facility
|
OP
|
$578.91
|
|
|
Service Code
|
HCPCS 28510
|
| Hospital Charge Code |
8910600
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$52.10 |
| Max. Negotiated Rate |
$523.79 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$52.10
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$247.79
|
| Rate for Payer: Amerigroup Medicare |
$247.79
|
| Rate for Payer: BCBS of TX Blue Advantage |
$130.78
|
| Rate for Payer: BCBS of TX Blue Essentials |
$156.62
|
| Rate for Payer: BCBS of TX Medicare |
$247.79
|
| Rate for Payer: BCBS of TX PPO |
$197.34
|
| Rate for Payer: Cash Price |
$393.66
|
| Rate for Payer: Cash Price |
$393.66
|
| Rate for Payer: Cash Price |
$393.66
|
| Rate for Payer: Cigna Commercial |
$523.79
|
| Rate for Payer: Cigna Medicaid |
$416.82
|
| 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 |
$416.82
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$247.79
|
| Rate for Payer: Molina Medicare |
$247.79
|
| Rate for Payer: Multiplan Auto |
$376.29
|
| Rate for Payer: Multiplan Commercial |
$376.29
|
| Rate for Payer: Multiplan Workers Comp |
$376.29
|
| Rate for Payer: Parkland Medicaid |
$416.82
|
| Rate for Payer: Scott and White EPO/PPO |
$154.01
|
| Rate for Payer: Scott and White Medicare |
$247.79
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$416.82
|
| 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 CLTX FX PHLX/PHLG OTH/THN GRT TOE W/O MANIP BCE
|
Facility
|
IP
|
$578.91
|
|
|
Service Code
|
HCPCS 28510
|
| Hospital Charge Code |
8910600
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$393.66
|
|
|
CHED CLTX MEDIAL MALLEOLUS FX W/O MANIP BCE
|
Facility
|
OP
|
$840.00
|
|
|
Service Code
|
HCPCS 27760
|
| Hospital Charge Code |
8914576
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$75.60 |
| Max. Negotiated Rate |
$604.80 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$75.60
|
| 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 |
$571.20
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Cigna Commercial |
$523.79
|
| Rate for Payer: Cigna Medicaid |
$604.80
|
| 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 |
$604.80
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$247.79
|
| Rate for Payer: Molina Medicare |
$247.79
|
| Rate for Payer: Multiplan Auto |
$546.00
|
| Rate for Payer: Multiplan Commercial |
$546.00
|
| Rate for Payer: Multiplan Workers Comp |
$546.00
|
| Rate for Payer: Parkland Medicaid |
$604.80
|
| Rate for Payer: Scott and White EPO/PPO |
$394.00
|
| Rate for Payer: Scott and White Medicare |
$247.79
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$604.80
|
| 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 CLTX MEDIAL MALLEOLUS FX W/O MANIP BCE
|
Facility
|
IP
|
$840.00
|
|
|
Service Code
|
HCPCS 27760
|
| Hospital Charge Code |
8914576
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$571.20
|
|
|
CHED CLTX POST ANKLE FX BCE
|
Facility
|
OP
|
$2,762.00
|
|
|
Service Code
|
HCPCS 27762
|
| Hospital Charge Code |
8966540
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$248.58 |
| Max. Negotiated Rate |
$3,415.58 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$248.58
|
| 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 |
$1,878.16
|
| Rate for Payer: Cash Price |
$1,878.16
|
| Rate for Payer: Cash Price |
$1,878.16
|
| Rate for Payer: Cigna Commercial |
$3,414.49
|
| Rate for Payer: Cigna Medicaid |
$1,988.64
|
| 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 |
$1,988.64
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,615.32
|
| Rate for Payer: Molina Medicare |
$1,615.32
|
| Rate for Payer: Multiplan Auto |
$1,795.30
|
| Rate for Payer: Multiplan Commercial |
$1,795.30
|
| Rate for Payer: Multiplan Workers Comp |
$1,795.30
|
| Rate for Payer: Parkland Medicaid |
$1,988.64
|
| Rate for Payer: Scott and White EPO/PPO |
$557.90
|
| Rate for Payer: Scott and White Medicare |
$1,615.32
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,988.64
|
| 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 CLTX POST ANKLE FX BCE
|
Facility
|
IP
|
$2,762.00
|
|
|
Service Code
|
HCPCS 27762
|
| Hospital Charge Code |
8966540
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$1,878.16
|
|
|
CHED CLTX SHOULDER DISLC W/SURG/ANTMCL NECK FX W/MANJ BCE
|
Facility
|
OP
|
$3,090.80
|
|
|
Service Code
|
HCPCS 23675
|
| Hospital Charge Code |
8912583
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$278.17 |
| Max. Negotiated Rate |
$3,415.58 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$278.17
|
| 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 |
$2,101.74
|
| Rate for Payer: Cash Price |
$2,101.74
|
| Rate for Payer: Cash Price |
$2,101.74
|
| Rate for Payer: Cigna Commercial |
$3,414.49
|
| Rate for Payer: Cigna Medicaid |
$2,225.38
|
| 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 |
$2,225.38
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,615.32
|
| Rate for Payer: Molina Medicare |
$1,615.32
|
| Rate for Payer: Multiplan Auto |
$2,009.02
|
| Rate for Payer: Multiplan Commercial |
$2,009.02
|
| Rate for Payer: Multiplan Workers Comp |
$2,009.02
|
| Rate for Payer: Parkland Medicaid |
$2,225.38
|
| Rate for Payer: Scott and White EPO/PPO |
$633.90
|
| Rate for Payer: Scott and White Medicare |
$1,615.32
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$2,225.38
|
| 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 CLTX SHOULDER DISLC W/SURG/ANTMCL NECK FX W/MANJ BCE
|
Facility
|
IP
|
$3,090.80
|
|
|
Service Code
|
HCPCS 23675
|
| Hospital Charge Code |
8912583
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$2,101.74
|
|
|
CHED CLTX TIBIAL SHAFT FX W/MANJ W/WO SKEL TRACJ BCE
|
Facility
|
IP
|
$3,682.70
|
|
|
Service Code
|
HCPCS 27752
|
| Hospital Charge Code |
8846848
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$2,504.24
|
|
|
CHED CLTX TIBIAL SHAFT FX W/MANJ W/WO SKEL TRACJ BCE
|
Facility
|
OP
|
$3,682.70
|
|
|
Service Code
|
HCPCS 27752
|
| Hospital Charge Code |
8846848
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$331.44 |
| Max. Negotiated Rate |
$3,415.58 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$331.44
|
| 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 |
$2,504.24
|
| Rate for Payer: Cash Price |
$2,504.24
|
| Rate for Payer: Cash Price |
$2,504.24
|
| Rate for Payer: Cigna Commercial |
$3,414.49
|
| Rate for Payer: Cigna Medicaid |
$2,651.54
|
| 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 |
$2,651.54
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,615.32
|
| Rate for Payer: Molina Medicare |
$1,615.32
|
| Rate for Payer: Multiplan Auto |
$2,393.76
|
| Rate for Payer: Multiplan Commercial |
$2,393.76
|
| Rate for Payer: Multiplan Workers Comp |
$2,393.76
|
| Rate for Payer: Parkland Medicaid |
$2,651.54
|
| Rate for Payer: Scott and White EPO/PPO |
$616.54
|
| Rate for Payer: Scott and White Medicare |
$1,615.32
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$2,651.54
|
| 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 Collect Blood Port/Access Device BCE
|
Facility
|
IP
|
$424.50
|
|
|
Service Code
|
HCPCS 36591
|
| Hospital Charge Code |
8910607
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$288.66
|
|
|
CHED Collect Blood Port/Access Device BCE
|
Facility
|
OP
|
$424.50
|
|
|
Service Code
|
HCPCS 36591
|
| Hospital Charge Code |
7003494
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$34.16 |
| Max. Negotiated Rate |
$3,520.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$38.20
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$133.65
|
| Rate for Payer: Amerigroup Medicare |
$133.65
|
| Rate for Payer: BCBS of TX Blue Advantage |
$127.35
|
| Rate for Payer: BCBS of TX Blue Essentials |
$152.82
|
| Rate for Payer: BCBS of TX Medicare |
$133.65
|
| Rate for Payer: BCBS of TX PPO |
$3,520.00
|
| Rate for Payer: Cash Price |
$288.66
|
| Rate for Payer: Cash Price |
$288.66
|
| Rate for Payer: Cash Price |
$288.66
|
| Rate for Payer: Cigna Commercial |
$282.53
|
| Rate for Payer: Cigna Medicaid |
$305.64
|
| 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 |
$305.64
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$133.65
|
| Rate for Payer: Molina Medicare |
$133.65
|
| Rate for Payer: Multiplan Auto |
$275.93
|
| Rate for Payer: Multiplan Commercial |
$275.93
|
| Rate for Payer: Multiplan Workers Comp |
$275.93
|
| Rate for Payer: Parkland Medicaid |
$305.64
|
| Rate for Payer: Scott and White EPO/PPO |
$34.16
|
| Rate for Payer: Scott and White Medicare |
$133.65
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$305.64
|
| 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 Collect Blood Port/Access Device BCE
|
Facility
|
OP
|
$424.50
|
|
|
Service Code
|
HCPCS 36591
|
| Hospital Charge Code |
8910607
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$34.16 |
| Max. Negotiated Rate |
$3,520.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$38.20
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$133.65
|
| Rate for Payer: Amerigroup Medicare |
$133.65
|
| Rate for Payer: BCBS of TX Blue Advantage |
$127.35
|
| Rate for Payer: BCBS of TX Blue Essentials |
$152.82
|
| Rate for Payer: BCBS of TX Medicare |
$133.65
|
| Rate for Payer: BCBS of TX PPO |
$3,520.00
|
| Rate for Payer: Cash Price |
$288.66
|
| Rate for Payer: Cash Price |
$288.66
|
| Rate for Payer: Cash Price |
$288.66
|
| Rate for Payer: Cigna Commercial |
$282.53
|
| Rate for Payer: Cigna Medicaid |
$305.64
|
| 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 |
$305.64
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$133.65
|
| Rate for Payer: Molina Medicare |
$133.65
|
| Rate for Payer: Multiplan Auto |
$275.93
|
| Rate for Payer: Multiplan Commercial |
$275.93
|
| Rate for Payer: Multiplan Workers Comp |
$275.93
|
| Rate for Payer: Parkland Medicaid |
$305.64
|
| Rate for Payer: Scott and White EPO/PPO |
$34.16
|
| Rate for Payer: Scott and White Medicare |
$133.65
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$305.64
|
| 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 Collect Blood Port/Access Device BCE
|
Facility
|
IP
|
$424.50
|
|
|
Service Code
|
HCPCS 36591
|
| Hospital Charge Code |
7003494
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$288.66
|
|
|
CHED CONTROL NASAL HEMORRHAGE ANTERIOR CMPLX BCE
|
Facility
|
IP
|
$650.94
|
|
|
Service Code
|
HCPCS 30903
|
| Hospital Charge Code |
8910601
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$442.64
|
|
|
CHED CONTROL NASAL HEMORRHAGE ANTERIOR CMPLX BCE
|
Facility
|
IP
|
$650.94
|
|
|
Service Code
|
HCPCS 30903
|
| Hospital Charge Code |
8734587
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$442.64
|
|
|
CHED CONTROL NASAL HEMORRHAGE ANTERIOR CMPLX BCE
|
Facility
|
OP
|
$650.94
|
|
|
Service Code
|
HCPCS 30903
|
| Hospital Charge Code |
8734587
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$58.58 |
| Max. Negotiated Rate |
$468.68 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$58.58
|
| 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 |
$442.64
|
| Rate for Payer: Cash Price |
$442.64
|
| Rate for Payer: Cash Price |
$442.64
|
| Rate for Payer: Cigna Commercial |
$282.53
|
| Rate for Payer: Cigna Medicaid |
$468.68
|
| 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 |
$468.68
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$133.65
|
| Rate for Payer: Molina Medicare |
$133.65
|
| Rate for Payer: Multiplan Auto |
$423.11
|
| Rate for Payer: Multiplan Commercial |
$423.11
|
| Rate for Payer: Multiplan Workers Comp |
$423.11
|
| Rate for Payer: Parkland Medicaid |
$468.68
|
| Rate for Payer: Scott and White EPO/PPO |
$93.66
|
| Rate for Payer: Scott and White Medicare |
$133.65
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$468.68
|
| 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 CONTROL NASAL HEMORRHAGE ANTERIOR CMPLX BCE
|
Facility
|
OP
|
$650.94
|
|
|
Service Code
|
HCPCS 30903
|
| Hospital Charge Code |
8910601
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$58.58 |
| Max. Negotiated Rate |
$468.68 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$58.58
|
| 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 |
$442.64
|
| Rate for Payer: Cash Price |
$442.64
|
| Rate for Payer: Cash Price |
$442.64
|
| Rate for Payer: Cigna Commercial |
$282.53
|
| Rate for Payer: Cigna Medicaid |
$468.68
|
| 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 |
$468.68
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$133.65
|
| Rate for Payer: Molina Medicare |
$133.65
|
| Rate for Payer: Multiplan Auto |
$423.11
|
| Rate for Payer: Multiplan Commercial |
$423.11
|
| Rate for Payer: Multiplan Workers Comp |
$423.11
|
| Rate for Payer: Parkland Medicaid |
$468.68
|
| Rate for Payer: Scott and White EPO/PPO |
$93.66
|
| Rate for Payer: Scott and White Medicare |
$133.65
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$468.68
|
| 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
|
|
