|
CHED Critical Care Ill/Injured Patient Addl 30 Min 99292 BCE
|
Facility
|
OP
|
$1,680.00
|
|
|
Service Code
|
HCPCS 99292
|
| Hospital Charge Code |
8928548
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$130.21 |
| Max. Negotiated Rate |
$3,520.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$151.20
|
| 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 PPO |
$3,520.00
|
| Rate for Payer: Cash Price |
$1,142.40
|
| Rate for Payer: Cash Price |
$1,142.40
|
| Rate for Payer: Cash Price |
$1,142.40
|
| Rate for Payer: Cigna Medicaid |
$1,209.60
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,209.60
|
| Rate for Payer: Multiplan Auto |
$1,092.00
|
| Rate for Payer: Multiplan Commercial |
$1,092.00
|
| Rate for Payer: Multiplan Workers Comp |
$1,092.00
|
| Rate for Payer: Parkland Medicaid |
$1,209.60
|
| Rate for Payer: Scott and White EPO/PPO |
$130.21
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,209.60
|
| Rate for Payer: Superior Health Plan EPO |
$228.48
|
|
|
CHED Critical Care Ill/Injured Patient Addl 30 Min 99292 BCE
|
Facility
|
IP
|
$1,680.00
|
|
|
Service Code
|
HCPCS 99292
|
| Hospital Charge Code |
8928548
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$1,142.40
|
|
|
CHED Critical Care Ill/Injured Patient Init 30-74 Min 99291 BCE
|
Facility
|
OP
|
$3,605.00
|
|
|
Service Code
|
HCPCS 99291
|
| Hospital Charge Code |
8928547
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$258.57 |
| Max. Negotiated Rate |
$4,117.38 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$324.45
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$829.79
|
| Rate for Payer: Amerigroup Medicare |
$829.79
|
| 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 |
$829.79
|
| Rate for Payer: BCBS of TX PPO |
$3,520.00
|
| Rate for Payer: Cash Price |
$2,451.40
|
| Rate for Payer: Cash Price |
$2,451.40
|
| Rate for Payer: Cash Price |
$2,451.40
|
| Rate for Payer: Cigna Commercial |
$4,117.38
|
| Rate for Payer: Cigna Medicaid |
$2,595.60
|
| Rate for Payer: Cigna Medicare |
$829.79
|
| Rate for Payer: Employer Direct Commercial |
$829.79
|
| Rate for Payer: Humana Medicare/TRICARE |
$829.79
|
| Rate for Payer: Molina CHIP/Medicaid |
$2,595.60
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$829.79
|
| Rate for Payer: Molina Medicare |
$829.79
|
| Rate for Payer: Multiplan Auto |
$2,343.25
|
| Rate for Payer: Multiplan Commercial |
$2,343.25
|
| Rate for Payer: Multiplan Workers Comp |
$2,343.25
|
| Rate for Payer: Parkland Medicaid |
$2,595.60
|
| Rate for Payer: Scott and White EPO/PPO |
$258.57
|
| Rate for Payer: Scott and White Medicare |
$829.79
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$2,595.60
|
| Rate for Payer: Superior Health Plan EPO |
$829.79
|
| Rate for Payer: Superior Health Plan Medicare |
$829.79
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$829.79
|
| Rate for Payer: Universal American Medicare |
$829.79
|
| Rate for Payer: Wellcare Medicare |
$829.79
|
| Rate for Payer: Wellmed Medicare |
$829.79
|
|
|
CHED Critical Care Ill/Injured Patient Init 30-74 Min 99291 BCE
|
Facility
|
IP
|
$3,605.00
|
|
|
Service Code
|
HCPCS 99291
|
| Hospital Charge Code |
8928547
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$2,451.40
|
|
|
CHED CTRL NSL HEMRRG PST NASAL PACKS&/CAUTERY 1ST BCE
|
Facility
|
OP
|
$744.40
|
|
|
Service Code
|
HCPCS 30905
|
| Hospital Charge Code |
8910602
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$67.00 |
| Max. Negotiated Rate |
$535.97 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$67.00
|
| 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 |
$506.19
|
| Rate for Payer: Cash Price |
$506.19
|
| Rate for Payer: Cash Price |
$506.19
|
| Rate for Payer: Cigna Commercial |
$282.53
|
| Rate for Payer: Cigna Medicaid |
$535.97
|
| 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 |
$535.97
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$133.65
|
| Rate for Payer: Molina Medicare |
$133.65
|
| Rate for Payer: Multiplan Auto |
$483.86
|
| Rate for Payer: Multiplan Commercial |
$483.86
|
| Rate for Payer: Multiplan Workers Comp |
$483.86
|
| Rate for Payer: Parkland Medicaid |
$535.97
|
| Rate for Payer: Scott and White EPO/PPO |
$128.70
|
| Rate for Payer: Scott and White Medicare |
$133.65
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$535.97
|
| 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 CTRL NSL HEMRRG PST NASAL PACKS&/CAUTERY 1ST BCE
|
Facility
|
IP
|
$744.40
|
|
|
Service Code
|
HCPCS 30905
|
| Hospital Charge Code |
8910602
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$506.19
|
|
|
CHED CYSTO CALIBRATION DILAT URTL STRIX/STENOSIS BCE
|
Facility
|
OP
|
$650.94
|
|
|
Service Code
|
HCPCS 52281
|
| Hospital Charge Code |
8582478
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$58.58 |
| Max. Negotiated Rate |
$4,464.31 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$58.58
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$2,099.91
|
| Rate for Payer: Amerigroup Medicare |
$2,099.91
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,958.49
|
| Rate for Payer: BCBS of TX Blue Essentials |
$3,543.10
|
| Rate for Payer: BCBS of TX Medicare |
$2,099.91
|
| Rate for Payer: BCBS of TX PPO |
$4,464.31
|
| 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 |
$4,438.84
|
| Rate for Payer: Cigna Medicaid |
$468.68
|
| Rate for Payer: Cigna Medicare |
$2,099.91
|
| Rate for Payer: Employer Direct Commercial |
$2,099.91
|
| Rate for Payer: Humana Medicare/TRICARE |
$2,099.91
|
| Rate for Payer: Molina CHIP/Medicaid |
$468.68
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$2,099.91
|
| Rate for Payer: Molina Medicare |
$2,099.91
|
| 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 |
$184.11
|
| Rate for Payer: Scott and White Medicare |
$2,099.91
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$468.68
|
| Rate for Payer: Superior Health Plan EPO |
$2,099.91
|
| Rate for Payer: Superior Health Plan Medicare |
$2,099.91
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$2,099.91
|
| Rate for Payer: Universal American Medicare |
$2,099.91
|
| Rate for Payer: Wellcare Medicare |
$2,099.91
|
| Rate for Payer: Wellmed Medicare |
$2,099.91
|
|
|
CHED CYSTO CALIBRATION DILAT URTL STRIX/STENOSIS BCE
|
Facility
|
OP
|
$650.94
|
|
|
Service Code
|
HCPCS 52281
|
| Hospital Charge Code |
8910603
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$58.58 |
| Max. Negotiated Rate |
$4,464.31 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$58.58
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$2,099.91
|
| Rate for Payer: Amerigroup Medicare |
$2,099.91
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,958.49
|
| Rate for Payer: BCBS of TX Blue Essentials |
$3,543.10
|
| Rate for Payer: BCBS of TX Medicare |
$2,099.91
|
| Rate for Payer: BCBS of TX PPO |
$4,464.31
|
| 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 |
$4,438.84
|
| Rate for Payer: Cigna Medicaid |
$468.68
|
| Rate for Payer: Cigna Medicare |
$2,099.91
|
| Rate for Payer: Employer Direct Commercial |
$2,099.91
|
| Rate for Payer: Humana Medicare/TRICARE |
$2,099.91
|
| Rate for Payer: Molina CHIP/Medicaid |
$468.68
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$2,099.91
|
| Rate for Payer: Molina Medicare |
$2,099.91
|
| 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 |
$184.11
|
| Rate for Payer: Scott and White Medicare |
$2,099.91
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$468.68
|
| Rate for Payer: Superior Health Plan EPO |
$2,099.91
|
| Rate for Payer: Superior Health Plan Medicare |
$2,099.91
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$2,099.91
|
| Rate for Payer: Universal American Medicare |
$2,099.91
|
| Rate for Payer: Wellcare Medicare |
$2,099.91
|
| Rate for Payer: Wellmed Medicare |
$2,099.91
|
|
|
CHED CYSTO CALIBRATION DILAT URTL STRIX/STENOSIS BCE
|
Facility
|
IP
|
$650.94
|
|
|
Service Code
|
HCPCS 52281
|
| Hospital Charge Code |
8582478
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$442.64
|
|
|
CHED CYSTO CALIBRATION DILAT URTL STRIX/STENOSIS BCE
|
Facility
|
IP
|
$650.94
|
|
|
Service Code
|
HCPCS 52281
|
| Hospital Charge Code |
8910603
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$442.64
|
|
|
CHED CYSTO W/IRRIG & EVAC MULTPLE OBSTRUCTING CLOTS BCE
|
Facility
|
OP
|
$5,979.00
|
|
|
Service Code
|
HCPCS 52001
|
| Hospital Charge Code |
8910604
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$346.44 |
| Max. Negotiated Rate |
$7,606.72 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$538.11
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3,541.04
|
| Rate for Payer: Amerigroup Medicare |
$3,541.04
|
| Rate for Payer: BCBS of TX Blue Advantage |
$5,040.96
|
| Rate for Payer: BCBS of TX Blue Essentials |
$6,037.08
|
| Rate for Payer: BCBS of TX Medicare |
$3,541.04
|
| Rate for Payer: BCBS of TX PPO |
$7,606.72
|
| Rate for Payer: Cash Price |
$4,065.72
|
| Rate for Payer: Cash Price |
$4,065.72
|
| Rate for Payer: Cash Price |
$4,065.72
|
| Rate for Payer: Cigna Commercial |
$7,485.13
|
| Rate for Payer: Cigna Medicaid |
$4,304.88
|
| Rate for Payer: Cigna Medicare |
$3,541.04
|
| Rate for Payer: Employer Direct Commercial |
$3,541.04
|
| Rate for Payer: Humana Medicare/TRICARE |
$3,541.04
|
| Rate for Payer: Molina CHIP/Medicaid |
$4,304.88
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3,541.04
|
| Rate for Payer: Molina Medicare |
$3,541.04
|
| Rate for Payer: Multiplan Auto |
$3,886.35
|
| Rate for Payer: Multiplan Commercial |
$3,886.35
|
| Rate for Payer: Multiplan Workers Comp |
$3,886.35
|
| Rate for Payer: Parkland Medicaid |
$4,304.88
|
| Rate for Payer: Scott and White EPO/PPO |
$346.44
|
| Rate for Payer: Scott and White Medicare |
$3,541.04
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$4,304.88
|
| Rate for Payer: Superior Health Plan EPO |
$3,541.04
|
| Rate for Payer: Superior Health Plan Medicare |
$3,541.04
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3,541.04
|
| Rate for Payer: Universal American Medicare |
$3,541.04
|
| Rate for Payer: Wellcare Medicare |
$3,541.04
|
| Rate for Payer: Wellmed Medicare |
$3,541.04
|
|
|
CHED CYSTO W/IRRIG & EVAC MULTPLE OBSTRUCTING CLOTS BCE
|
Facility
|
IP
|
$5,979.00
|
|
|
Service Code
|
HCPCS 52001
|
| Hospital Charge Code |
8910604
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$4,065.72
|
|
|
CHED CYSTO W/IRRIG & EVAC MULTPLE OBSTRUCTING CLOTS BCE
|
Facility
|
OP
|
$5,979.00
|
|
|
Service Code
|
HCPCS 52001
|
| Hospital Charge Code |
8862559
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$346.44 |
| Max. Negotiated Rate |
$7,606.72 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$538.11
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3,541.04
|
| Rate for Payer: Amerigroup Medicare |
$3,541.04
|
| Rate for Payer: BCBS of TX Blue Advantage |
$5,040.96
|
| Rate for Payer: BCBS of TX Blue Essentials |
$6,037.08
|
| Rate for Payer: BCBS of TX Medicare |
$3,541.04
|
| Rate for Payer: BCBS of TX PPO |
$7,606.72
|
| Rate for Payer: Cash Price |
$4,065.72
|
| Rate for Payer: Cash Price |
$4,065.72
|
| Rate for Payer: Cash Price |
$4,065.72
|
| Rate for Payer: Cigna Commercial |
$7,485.13
|
| Rate for Payer: Cigna Medicaid |
$4,304.88
|
| Rate for Payer: Cigna Medicare |
$3,541.04
|
| Rate for Payer: Employer Direct Commercial |
$3,541.04
|
| Rate for Payer: Humana Medicare/TRICARE |
$3,541.04
|
| Rate for Payer: Molina CHIP/Medicaid |
$4,304.88
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3,541.04
|
| Rate for Payer: Molina Medicare |
$3,541.04
|
| Rate for Payer: Multiplan Auto |
$3,886.35
|
| Rate for Payer: Multiplan Commercial |
$3,886.35
|
| Rate for Payer: Multiplan Workers Comp |
$3,886.35
|
| Rate for Payer: Parkland Medicaid |
$4,304.88
|
| Rate for Payer: Scott and White EPO/PPO |
$346.44
|
| Rate for Payer: Scott and White Medicare |
$3,541.04
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$4,304.88
|
| Rate for Payer: Superior Health Plan EPO |
$3,541.04
|
| Rate for Payer: Superior Health Plan Medicare |
$3,541.04
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3,541.04
|
| Rate for Payer: Universal American Medicare |
$3,541.04
|
| Rate for Payer: Wellcare Medicare |
$3,541.04
|
| Rate for Payer: Wellmed Medicare |
$3,541.04
|
|
|
CHED CYSTO W/IRRIG & EVAC MULTPLE OBSTRUCTING CLOTS BCE
|
Facility
|
IP
|
$5,979.00
|
|
|
Service Code
|
HCPCS 52001
|
| Hospital Charge Code |
8862559
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$4,065.72
|
|
|
CHED Debridement Addl 10% Infected skin BCE
|
Facility
|
OP
|
$71.54
|
|
|
Service Code
|
HCPCS 11001
|
| Hospital Charge Code |
8910609
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$6.44 |
| Max. Negotiated Rate |
$3,520.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$6.44
|
| Rate for Payer: BCBS of TX Blue Advantage |
$21.46
|
| Rate for Payer: BCBS of TX Blue Essentials |
$25.75
|
| Rate for Payer: BCBS of TX PPO |
$3,520.00
|
| Rate for Payer: Cash Price |
$48.65
|
| Rate for Payer: Cash Price |
$48.65
|
| Rate for Payer: Cash Price |
$48.65
|
| Rate for Payer: Cigna Medicaid |
$51.51
|
| Rate for Payer: Molina CHIP/Medicaid |
$51.51
|
| Rate for Payer: Multiplan Auto |
$46.50
|
| Rate for Payer: Multiplan Commercial |
$46.50
|
| Rate for Payer: Multiplan Workers Comp |
$46.50
|
| Rate for Payer: Parkland Medicaid |
$51.51
|
| Rate for Payer: Scott and White EPO/PPO |
$18.02
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$51.51
|
| Rate for Payer: Superior Health Plan EPO |
$9.73
|
|
|
CHED Debridement Addl 10% Infected skin BCE
|
Facility
|
IP
|
$71.54
|
|
|
Service Code
|
HCPCS 11001
|
| Hospital Charge Code |
8910609
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$48.65
|
|
|
CHED Debridement To devitalized tissue, <= 20 sq cm BCE
|
Facility
|
IP
|
$794.80
|
|
|
Service Code
|
HCPCS 97597
|
| Hospital Charge Code |
8910610
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$540.46
|
|
|
CHED Debridement To devitalized tissue, <= 20 sq cm BCE
|
Facility
|
OP
|
$794.80
|
|
|
Service Code
|
HCPCS 97597
|
| Hospital Charge Code |
8910610
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$43.09 |
| Max. Negotiated Rate |
$3,520.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$71.53
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$201.55
|
| Rate for Payer: Amerigroup Medicare |
$201.55
|
| Rate for Payer: BCBS of TX Blue Advantage |
$238.44
|
| Rate for Payer: BCBS of TX Blue Essentials |
$286.13
|
| Rate for Payer: BCBS of TX Medicare |
$201.55
|
| Rate for Payer: BCBS of TX PPO |
$3,520.00
|
| Rate for Payer: Cash Price |
$540.46
|
| Rate for Payer: Cash Price |
$540.46
|
| Rate for Payer: Cash Price |
$540.46
|
| Rate for Payer: Cigna Commercial |
$426.04
|
| Rate for Payer: Cigna Medicaid |
$572.26
|
| 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 |
$572.26
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$201.55
|
| Rate for Payer: Molina Medicare |
$201.55
|
| Rate for Payer: Multiplan Auto |
$516.62
|
| Rate for Payer: Multiplan Commercial |
$516.62
|
| Rate for Payer: Multiplan Workers Comp |
$516.62
|
| Rate for Payer: Parkland Medicaid |
$572.26
|
| Rate for Payer: Scott and White EPO/PPO |
$43.09
|
| Rate for Payer: Scott and White Medicare |
$201.55
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$572.26
|
| 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 Debridement To muscle/fascia, <= 20 sq cm BCE
|
Facility
|
OP
|
$4,383.94
|
|
|
Service Code
|
HCPCS 11043
|
| Hospital Charge Code |
8912587
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$187.09 |
| Max. Negotiated Rate |
$3,156.44 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$394.55
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$742.44
|
| Rate for Payer: Amerigroup Medicare |
$742.44
|
| Rate for Payer: BCBS of TX Blue Advantage |
$830.02
|
| Rate for Payer: BCBS of TX Blue Essentials |
$994.04
|
| Rate for Payer: BCBS of TX Medicare |
$742.44
|
| Rate for Payer: BCBS of TX PPO |
$1,252.49
|
| Rate for Payer: Cash Price |
$2,981.08
|
| Rate for Payer: Cash Price |
$2,981.08
|
| Rate for Payer: Cash Price |
$2,981.08
|
| Rate for Payer: Cigna Commercial |
$1,569.38
|
| Rate for Payer: Cigna Medicaid |
$3,156.44
|
| Rate for Payer: Cigna Medicare |
$742.44
|
| Rate for Payer: Employer Direct Commercial |
$742.44
|
| Rate for Payer: Humana Medicare/TRICARE |
$742.44
|
| Rate for Payer: Molina CHIP/Medicaid |
$3,156.44
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$742.44
|
| Rate for Payer: Molina Medicare |
$742.44
|
| Rate for Payer: Multiplan Auto |
$2,849.56
|
| Rate for Payer: Multiplan Commercial |
$2,849.56
|
| Rate for Payer: Multiplan Workers Comp |
$2,849.56
|
| Rate for Payer: Parkland Medicaid |
$3,156.44
|
| Rate for Payer: Scott and White EPO/PPO |
$187.09
|
| Rate for Payer: Scott and White Medicare |
$742.44
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$3,156.44
|
| Rate for Payer: Superior Health Plan EPO |
$742.44
|
| Rate for Payer: Superior Health Plan Medicare |
$742.44
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$742.44
|
| Rate for Payer: Universal American Medicare |
$742.44
|
| Rate for Payer: Wellcare Medicare |
$742.44
|
| Rate for Payer: Wellmed Medicare |
$742.44
|
|
|
CHED Debridement To muscle/fascia, <= 20 sq cm BCE
|
Facility
|
IP
|
$4,383.94
|
|
|
Service Code
|
HCPCS 11043
|
| Hospital Charge Code |
8912587
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$2,981.08
|
|
|
CHED Debridement To subcutaneous tissue, <= 20 sq cm BCE
|
Facility
|
IP
|
$1,546.00
|
|
|
Service Code
|
HCPCS 11042
|
| Hospital Charge Code |
8914579
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$1,051.28
|
|
|
CHED Debridement To subcutaneous tissue, <= 20 sq cm BCE
|
Facility
|
OP
|
$1,546.00
|
|
|
Service Code
|
HCPCS 11042
|
| Hospital Charge Code |
8914579
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$74.08 |
| Max. Negotiated Rate |
$1,113.12 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$139.14
|
| 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 |
$1,051.28
|
| Rate for Payer: Cash Price |
$1,051.28
|
| Rate for Payer: Cash Price |
$1,051.28
|
| Rate for Payer: Cigna Commercial |
$863.21
|
| Rate for Payer: Cigna Medicaid |
$1,113.12
|
| 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 |
$1,113.12
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$408.37
|
| Rate for Payer: Molina Medicare |
$408.37
|
| Rate for Payer: Multiplan Auto |
$1,004.90
|
| Rate for Payer: Multiplan Commercial |
$1,004.90
|
| Rate for Payer: Multiplan Workers Comp |
$1,004.90
|
| Rate for Payer: Parkland Medicaid |
$1,113.12
|
| Rate for Payer: Scott and White EPO/PPO |
$74.08
|
| Rate for Payer: Scott and White Medicare |
$408.37
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,113.12
|
| 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 Dislocation Repair Site Ankle w/o Anesthesia BCE
|
Facility
|
IP
|
$1,082.00
|
|
|
Service Code
|
HCPCS 27840
|
| Hospital Charge Code |
8914580
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$735.76
|
|
|
CHED Dislocation Repair Site Ankle w/o Anesthesia BCE
|
Facility
|
OP
|
$1,082.00
|
|
|
Service Code
|
HCPCS 27840
|
| Hospital Charge Code |
8914580
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$97.38 |
| Max. Negotiated Rate |
$779.04 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$97.38
|
| 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 |
$735.76
|
| Rate for Payer: Cash Price |
$735.76
|
| Rate for Payer: Cash Price |
$735.76
|
| Rate for Payer: Cigna Commercial |
$523.79
|
| Rate for Payer: Cigna Medicaid |
$779.04
|
| 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 |
$779.04
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$247.79
|
| Rate for Payer: Molina Medicare |
$247.79
|
| Rate for Payer: Multiplan Auto |
$703.30
|
| Rate for Payer: Multiplan Commercial |
$703.30
|
| Rate for Payer: Multiplan Workers Comp |
$703.30
|
| Rate for Payer: Parkland Medicaid |
$779.04
|
| Rate for Payer: Scott and White EPO/PPO |
$490.23
|
| Rate for Payer: Scott and White Medicare |
$247.79
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$779.04
|
| 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 Dislocation Repair Site Elbow w/ Anesthesia BCE
|
Facility
|
OP
|
$4,398.68
|
|
|
Service Code
|
HCPCS 24605
|
| Hospital Charge Code |
8910611
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$395.88 |
| Max. Negotiated Rate |
$3,415.58 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$395.88
|
| 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 |
$2,991.10
|
| Rate for Payer: Cash Price |
$2,991.10
|
| Rate for Payer: Cash Price |
$2,991.10
|
| Rate for Payer: Cigna Commercial |
$3,414.49
|
| Rate for Payer: Cigna Medicaid |
$3,167.05
|
| 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 |
$3,167.05
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,615.32
|
| Rate for Payer: Molina Medicare |
$1,615.32
|
| Rate for Payer: Multiplan Auto |
$2,859.14
|
| Rate for Payer: Multiplan Commercial |
$2,859.14
|
| Rate for Payer: Multiplan Workers Comp |
$2,859.14
|
| Rate for Payer: Parkland Medicaid |
$3,167.05
|
| Rate for Payer: Scott and White EPO/PPO |
$602.29
|
| Rate for Payer: Scott and White Medicare |
$1,615.32
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$3,167.05
|
| 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
|
|
