|
CHED Dislocation Repair Site Thumb BCE
|
Facility
|
OP
|
$675.00
|
|
|
Service Code
|
HCPCS 26641
|
| Hospital Charge Code |
8912592
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$60.75 |
| Max. Negotiated Rate |
$523.79 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$60.75
|
| 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 |
$459.00
|
| Rate for Payer: Cash Price |
$459.00
|
| Rate for Payer: Cash Price |
$459.00
|
| Rate for Payer: Cigna Commercial |
$523.79
|
| Rate for Payer: Cigna Medicaid |
$486.00
|
| 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 |
$486.00
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$247.79
|
| Rate for Payer: Molina Medicare |
$247.79
|
| Rate for Payer: Multiplan Auto |
$438.75
|
| Rate for Payer: Multiplan Commercial |
$438.75
|
| Rate for Payer: Multiplan Workers Comp |
$438.75
|
| Rate for Payer: Parkland Medicaid |
$486.00
|
| Rate for Payer: Scott and White EPO/PPO |
$487.40
|
| Rate for Payer: Scott and White Medicare |
$247.79
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$486.00
|
| 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 Thumb BCE
|
Facility
|
IP
|
$675.00
|
|
|
Service Code
|
HCPCS 26641
|
| Hospital Charge Code |
8912592
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$459.00
|
|
|
CHED Dislocation Repair Site Toe, Interphalangeal w/o Anes BCE
|
Facility
|
IP
|
$218.35
|
|
|
Service Code
|
HCPCS 28660
|
| Hospital Charge Code |
5202516
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$148.48
|
|
|
CHED Dislocation Repair Site Toe, Interphalangeal w/o Anes BCE
|
Facility
|
OP
|
$218.35
|
|
|
Service Code
|
HCPCS 28660
|
| Hospital Charge Code |
5202516
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$19.65 |
| Max. Negotiated Rate |
$523.79 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$19.65
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$247.79
|
| Rate for Payer: Amerigroup Medicare |
$247.79
|
| Rate for Payer: BCBS of TX Blue Advantage |
$115.11
|
| Rate for Payer: BCBS of TX Blue Essentials |
$137.86
|
| Rate for Payer: BCBS of TX Medicare |
$247.79
|
| Rate for Payer: BCBS of TX PPO |
$173.70
|
| Rate for Payer: Cash Price |
$148.48
|
| Rate for Payer: Cash Price |
$148.48
|
| Rate for Payer: Cash Price |
$148.48
|
| Rate for Payer: Cigna Commercial |
$523.79
|
| Rate for Payer: Cigna Medicaid |
$157.21
|
| 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 |
$157.21
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$247.79
|
| Rate for Payer: Molina Medicare |
$247.79
|
| Rate for Payer: Multiplan Auto |
$141.93
|
| Rate for Payer: Multiplan Commercial |
$141.93
|
| Rate for Payer: Multiplan Workers Comp |
$141.93
|
| Rate for Payer: Parkland Medicaid |
$157.21
|
| Rate for Payer: Scott and White EPO/PPO |
$117.64
|
| Rate for Payer: Scott and White Medicare |
$247.79
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$157.21
|
| 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 Toe, Metatarsophalangeal w/o Anesthesia BCE
|
Facility
|
OP
|
$960.50
|
|
|
Service Code
|
HCPCS 28630
|
| Hospital Charge Code |
8912594
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$86.44 |
| Max. Negotiated Rate |
$691.56 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$86.44
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$247.79
|
| Rate for Payer: Amerigroup Medicare |
$247.79
|
| Rate for Payer: BCBS of TX Blue Advantage |
$148.86
|
| Rate for Payer: BCBS of TX Blue Essentials |
$178.28
|
| Rate for Payer: BCBS of TX Medicare |
$247.79
|
| Rate for Payer: BCBS of TX PPO |
$224.63
|
| Rate for Payer: Cash Price |
$653.14
|
| Rate for Payer: Cash Price |
$653.14
|
| Rate for Payer: Cash Price |
$653.14
|
| Rate for Payer: Cigna Commercial |
$523.79
|
| Rate for Payer: Cigna Medicaid |
$691.56
|
| 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 |
$691.56
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$247.79
|
| Rate for Payer: Molina Medicare |
$247.79
|
| Rate for Payer: Multiplan Auto |
$624.33
|
| Rate for Payer: Multiplan Commercial |
$624.33
|
| Rate for Payer: Multiplan Workers Comp |
$624.33
|
| Rate for Payer: Parkland Medicaid |
$691.56
|
| Rate for Payer: Scott and White EPO/PPO |
$137.75
|
| Rate for Payer: Scott and White Medicare |
$247.79
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$691.56
|
| 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 Toe, Metatarsophalangeal w/o Anesthesia BCE
|
Facility
|
IP
|
$960.50
|
|
|
Service Code
|
HCPCS 28630
|
| Hospital Charge Code |
8912594
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$653.14
|
|
|
CHED DRAINAGE EXTERNAL EAR ABSCESS/HEMATOMA SIMPLE BCE
|
Facility
|
OP
|
$1,518.43
|
|
|
Service Code
|
HCPCS 69000
|
| Hospital Charge Code |
8772540
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$136.66 |
| Max. Negotiated Rate |
$1,503.68 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$136.66
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$711.36
|
| Rate for Payer: Amerigroup Medicare |
$711.36
|
| Rate for Payer: BCBS of TX Blue Advantage |
$217.57
|
| Rate for Payer: BCBS of TX Blue Essentials |
$260.56
|
| Rate for Payer: BCBS of TX Medicare |
$711.36
|
| Rate for Payer: BCBS of TX PPO |
$328.31
|
| Rate for Payer: Cash Price |
$1,032.53
|
| Rate for Payer: Cash Price |
$1,032.53
|
| Rate for Payer: Cash Price |
$1,032.53
|
| Rate for Payer: Cigna Commercial |
$1,503.68
|
| Rate for Payer: Cigna Medicaid |
$1,093.27
|
| Rate for Payer: Cigna Medicare |
$711.36
|
| Rate for Payer: Employer Direct Commercial |
$711.36
|
| Rate for Payer: Humana Medicare/TRICARE |
$711.36
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,093.27
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$711.36
|
| Rate for Payer: Molina Medicare |
$711.36
|
| Rate for Payer: Multiplan Auto |
$986.98
|
| Rate for Payer: Multiplan Commercial |
$986.98
|
| Rate for Payer: Multiplan Workers Comp |
$986.98
|
| Rate for Payer: Parkland Medicaid |
$1,093.27
|
| Rate for Payer: Scott and White EPO/PPO |
$155.65
|
| Rate for Payer: Scott and White Medicare |
$711.36
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,093.27
|
| Rate for Payer: Superior Health Plan EPO |
$711.36
|
| Rate for Payer: Superior Health Plan Medicare |
$711.36
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$711.36
|
| Rate for Payer: Universal American Medicare |
$711.36
|
| Rate for Payer: Wellcare Medicare |
$711.36
|
| Rate for Payer: Wellmed Medicare |
$711.36
|
|
|
CHED DRAINAGE EXTERNAL EAR ABSCESS/HEMATOMA SIMPLE BCE
|
Facility
|
IP
|
$1,518.43
|
|
|
Service Code
|
HCPCS 69000
|
| Hospital Charge Code |
8772540
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$1,032.53
|
|
|
CHED Drainage of abscess, cyst, hematoma from dentoalveolar structures BCE
|
Facility
|
IP
|
$823.00
|
|
|
Service Code
|
HCPCS 41800
|
| Hospital Charge Code |
8910612
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$559.64
|
|
|
CHED Drainage of abscess, cyst, hematoma from dentoalveolar structures BCE
|
Facility
|
OP
|
$823.00
|
|
|
Service Code
|
HCPCS 41800
|
| Hospital Charge Code |
8910612
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$74.07 |
| Max. Negotiated Rate |
$592.56 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$74.07
|
| 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 |
$559.64
|
| Rate for Payer: Cash Price |
$559.64
|
| Rate for Payer: Cash Price |
$559.64
|
| Rate for Payer: Cigna Commercial |
$282.53
|
| Rate for Payer: Cigna Medicaid |
$592.56
|
| 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 |
$592.56
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$133.65
|
| Rate for Payer: Molina Medicare |
$133.65
|
| Rate for Payer: Multiplan Auto |
$534.95
|
| Rate for Payer: Multiplan Commercial |
$534.95
|
| Rate for Payer: Multiplan Workers Comp |
$534.95
|
| Rate for Payer: Parkland Medicaid |
$592.56
|
| Rate for Payer: Scott and White EPO/PPO |
$191.11
|
| Rate for Payer: Scott and White Medicare |
$133.65
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$592.56
|
| 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 DRAINAGE OF FINGER ABSCESS SIMPLE BCE
|
Facility
|
OP
|
$938.00
|
|
|
Service Code
|
HCPCS 26010
|
| Hospital Charge Code |
8910608
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$84.42 |
| Max. Negotiated Rate |
$675.36 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$84.42
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$201.55
|
| Rate for Payer: Amerigroup Medicare |
$201.55
|
| Rate for Payer: BCBS of TX Blue Advantage |
$147.44
|
| Rate for Payer: BCBS of TX Blue Essentials |
$176.58
|
| Rate for Payer: BCBS of TX Medicare |
$201.55
|
| Rate for Payer: BCBS of TX PPO |
$222.49
|
| Rate for Payer: Cash Price |
$637.84
|
| Rate for Payer: Cash Price |
$637.84
|
| Rate for Payer: Cash Price |
$637.84
|
| Rate for Payer: Cigna Commercial |
$426.04
|
| Rate for Payer: Cigna Medicaid |
$675.36
|
| 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 |
$675.36
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$201.55
|
| Rate for Payer: Molina Medicare |
$201.55
|
| Rate for Payer: Multiplan Auto |
$609.70
|
| Rate for Payer: Multiplan Commercial |
$609.70
|
| Rate for Payer: Multiplan Workers Comp |
$609.70
|
| Rate for Payer: Parkland Medicaid |
$675.36
|
| Rate for Payer: Scott and White EPO/PPO |
$176.05
|
| Rate for Payer: Scott and White Medicare |
$201.55
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$675.36
|
| 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 DRAINAGE OF FINGER ABSCESS SIMPLE BCE
|
Facility
|
IP
|
$938.00
|
|
|
Service Code
|
HCPCS 26010
|
| Hospital Charge Code |
8910608
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$637.84
|
|
|
CHED Ear Procedures Cerumen Irrigation/Lavage BCE
|
Facility
|
OP
|
$483.69
|
|
|
Service Code
|
HCPCS 69209
|
| Hospital Charge Code |
8914587
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$19.73 |
| Max. Negotiated Rate |
$348.26 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$43.53
|
| 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 |
$328.91
|
| Rate for Payer: Cash Price |
$328.91
|
| Rate for Payer: Cash Price |
$328.91
|
| Rate for Payer: Cigna Commercial |
$125.27
|
| Rate for Payer: Cigna Medicaid |
$348.26
|
| 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 |
$348.26
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$59.26
|
| Rate for Payer: Molina Medicare |
$59.26
|
| Rate for Payer: Multiplan Auto |
$314.40
|
| Rate for Payer: Multiplan Commercial |
$314.40
|
| Rate for Payer: Multiplan Workers Comp |
$314.40
|
| Rate for Payer: Parkland Medicaid |
$348.26
|
| Rate for Payer: Scott and White EPO/PPO |
$19.73
|
| Rate for Payer: Scott and White Medicare |
$59.26
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$348.26
|
| 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 Ear Procedures Cerumen Irrigation/Lavage BCE
|
Facility
|
IP
|
$483.69
|
|
|
Service Code
|
HCPCS 69209
|
| Hospital Charge Code |
8914587
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$328.91
|
|
|
CHED Ear Procedures Cerumen w/ Instrumentation BCE
|
Facility
|
IP
|
$3,278.95
|
|
|
Service Code
|
HCPCS 69210
|
| Hospital Charge Code |
8912596
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$2,229.69
|
|
|
CHED Ear Procedures Cerumen w/ Instrumentation BCE
|
Facility
|
OP
|
$3,278.95
|
|
|
Service Code
|
HCPCS 69210
|
| Hospital Charge Code |
8912596
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$39.65 |
| Max. Negotiated Rate |
$2,360.84 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$295.11
|
| 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 |
$2,229.69
|
| Rate for Payer: Cash Price |
$2,229.69
|
| Rate for Payer: Cash Price |
$2,229.69
|
| Rate for Payer: Cigna Commercial |
$125.27
|
| Rate for Payer: Cigna Medicaid |
$2,360.84
|
| 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 |
$2,360.84
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$59.26
|
| Rate for Payer: Molina Medicare |
$59.26
|
| Rate for Payer: Multiplan Auto |
$2,131.32
|
| Rate for Payer: Multiplan Commercial |
$2,131.32
|
| Rate for Payer: Multiplan Workers Comp |
$2,131.32
|
| Rate for Payer: Parkland Medicaid |
$2,360.84
|
| Rate for Payer: Scott and White EPO/PPO |
$39.65
|
| Rate for Payer: Scott and White Medicare |
$59.26
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$2,360.84
|
| 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 EGD PLACE GASTROSTOMY TUBE BCE
|
Facility
|
OP
|
$5,390.12
|
|
|
Service Code
|
HCPCS 43246
|
| Hospital Charge Code |
8912595
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$241.66 |
| Max. Negotiated Rate |
$4,074.70 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$485.11
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,927.65
|
| Rate for Payer: Amerigroup Medicare |
$1,927.65
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,600.86
|
| Rate for Payer: BCBS of TX Blue Essentials |
$3,114.80
|
| Rate for Payer: BCBS of TX Medicare |
$1,927.65
|
| Rate for Payer: BCBS of TX PPO |
$3,924.65
|
| Rate for Payer: Cash Price |
$3,665.28
|
| Rate for Payer: Cash Price |
$3,665.28
|
| Rate for Payer: Cash Price |
$3,665.28
|
| Rate for Payer: Cigna Commercial |
$4,074.70
|
| Rate for Payer: Cigna Medicaid |
$3,880.89
|
| Rate for Payer: Cigna Medicare |
$1,927.65
|
| Rate for Payer: Employer Direct Commercial |
$1,927.65
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,927.65
|
| Rate for Payer: Molina CHIP/Medicaid |
$3,880.89
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,927.65
|
| Rate for Payer: Molina Medicare |
$1,927.65
|
| Rate for Payer: Multiplan Auto |
$3,503.58
|
| Rate for Payer: Multiplan Commercial |
$3,503.58
|
| Rate for Payer: Multiplan Workers Comp |
$3,503.58
|
| Rate for Payer: Parkland Medicaid |
$3,880.89
|
| Rate for Payer: Scott and White EPO/PPO |
$241.66
|
| Rate for Payer: Scott and White Medicare |
$1,927.65
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$3,880.89
|
| Rate for Payer: Superior Health Plan EPO |
$1,927.65
|
| Rate for Payer: Superior Health Plan Medicare |
$1,927.65
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,927.65
|
| Rate for Payer: Universal American Medicare |
$1,927.65
|
| Rate for Payer: Wellcare Medicare |
$1,927.65
|
| Rate for Payer: Wellmed Medicare |
$1,927.65
|
|
|
CHED EGD PLACE GASTROSTOMY TUBE BCE
|
Facility
|
IP
|
$5,390.12
|
|
|
Service Code
|
HCPCS 43246
|
| Hospital Charge Code |
8912595
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$3,665.28
|
|
|
CHED Eye Procedures Corneal w/o Slit Lamp BCE
|
Facility
|
OP
|
$848.06
|
|
|
Service Code
|
HCPCS 65220
|
| Hospital Charge Code |
8910614
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$50.34 |
| Max. Negotiated Rate |
$948.59 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$76.33
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$448.76
|
| Rate for Payer: Amerigroup Medicare |
$448.76
|
| Rate for Payer: BCBS of TX Blue Advantage |
$607.20
|
| Rate for Payer: BCBS of TX Blue Essentials |
$727.18
|
| Rate for Payer: BCBS of TX Medicare |
$448.76
|
| Rate for Payer: BCBS of TX PPO |
$916.25
|
| Rate for Payer: Cash Price |
$576.68
|
| Rate for Payer: Cash Price |
$576.68
|
| Rate for Payer: Cash Price |
$576.68
|
| Rate for Payer: Cigna Commercial |
$948.59
|
| Rate for Payer: Cigna Medicaid |
$610.60
|
| Rate for Payer: Cigna Medicare |
$448.76
|
| Rate for Payer: Employer Direct Commercial |
$448.76
|
| Rate for Payer: Humana Medicare/TRICARE |
$448.76
|
| Rate for Payer: Molina CHIP/Medicaid |
$610.60
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$448.76
|
| Rate for Payer: Molina Medicare |
$448.76
|
| Rate for Payer: Multiplan Auto |
$551.24
|
| Rate for Payer: Multiplan Commercial |
$551.24
|
| Rate for Payer: Multiplan Workers Comp |
$551.24
|
| Rate for Payer: Parkland Medicaid |
$610.60
|
| Rate for Payer: Scott and White EPO/PPO |
$50.34
|
| Rate for Payer: Scott and White Medicare |
$448.76
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$610.60
|
| Rate for Payer: Superior Health Plan EPO |
$448.76
|
| Rate for Payer: Superior Health Plan Medicare |
$448.76
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$448.76
|
| Rate for Payer: Universal American Medicare |
$448.76
|
| Rate for Payer: Wellcare Medicare |
$448.76
|
| Rate for Payer: Wellmed Medicare |
$448.76
|
|
|
CHED Eye Procedures Corneal w/o Slit Lamp BCE
|
Facility
|
IP
|
$848.06
|
|
|
Service Code
|
HCPCS 65220
|
| Hospital Charge Code |
8910614
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$576.68
|
|
|
CHED Foreign Body Removal Site Auditory canal, external w/o anesthesia BCE
|
Facility
|
IP
|
$317.06
|
|
|
Service Code
|
HCPCS 69200
|
| Hospital Charge Code |
8914589
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$215.60
|
|
|
CHED Foreign Body Removal Site Auditory canal, external w/o anesthesia BCE
|
Facility
|
OP
|
$317.06
|
|
|
Service Code
|
HCPCS 69200
|
| Hospital Charge Code |
8914589
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$28.54 |
| Max. Negotiated Rate |
$282.53 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$28.54
|
| 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 |
$215.60
|
| Rate for Payer: Cash Price |
$215.60
|
| Rate for Payer: Cash Price |
$215.60
|
| Rate for Payer: Cigna Commercial |
$282.53
|
| Rate for Payer: Cigna Medicaid |
$228.28
|
| 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 |
$228.28
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$133.65
|
| Rate for Payer: Molina Medicare |
$133.65
|
| Rate for Payer: Multiplan Auto |
$206.09
|
| Rate for Payer: Multiplan Commercial |
$206.09
|
| Rate for Payer: Multiplan Workers Comp |
$206.09
|
| Rate for Payer: Parkland Medicaid |
$228.28
|
| Rate for Payer: Scott and White EPO/PPO |
$58.06
|
| Rate for Payer: Scott and White Medicare |
$133.65
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$228.28
|
| 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 Foreign Body Removal Site Intranasal BCE
|
Facility
|
IP
|
$533.00
|
|
|
Service Code
|
HCPCS 30300
|
| Hospital Charge Code |
8912597
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$362.44
|
|
|
CHED Foreign Body Removal Site Intranasal BCE
|
Facility
|
OP
|
$533.00
|
|
|
Service Code
|
HCPCS 30300
|
| Hospital Charge Code |
8912597
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$47.97 |
| Max. Negotiated Rate |
$383.76 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$47.97
|
| 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 |
$362.44
|
| Rate for Payer: Cash Price |
$362.44
|
| Rate for Payer: Cash Price |
$362.44
|
| Rate for Payer: Cigna Commercial |
$282.53
|
| Rate for Payer: Cigna Medicaid |
$383.76
|
| 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 |
$383.76
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$133.65
|
| Rate for Payer: Molina Medicare |
$133.65
|
| Rate for Payer: Multiplan Auto |
$346.45
|
| Rate for Payer: Multiplan Commercial |
$346.45
|
| Rate for Payer: Multiplan Workers Comp |
$346.45
|
| Rate for Payer: Parkland Medicaid |
$383.76
|
| Rate for Payer: Scott and White EPO/PPO |
$152.65
|
| Rate for Payer: Scott and White Medicare |
$133.65
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$383.76
|
| 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 Foreign Body Removal Site Scrotum BCE
|
Facility
|
OP
|
$8,880.13
|
|
|
Service Code
|
HCPCS 55120
|
| Hospital Charge Code |
5202522
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$439.05 |
| Max. Negotiated Rate |
$6,393.69 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$799.21
|
| 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 |
$6,038.49
|
| Rate for Payer: Cash Price |
$6,038.49
|
| Rate for Payer: Cash Price |
$6,038.49
|
| Rate for Payer: Cigna Commercial |
$4,438.84
|
| Rate for Payer: Cigna Medicaid |
$6,393.69
|
| 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 |
$6,393.69
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$2,099.91
|
| Rate for Payer: Molina Medicare |
$2,099.91
|
| Rate for Payer: Multiplan Auto |
$5,772.08
|
| Rate for Payer: Multiplan Commercial |
$5,772.08
|
| Rate for Payer: Multiplan Workers Comp |
$5,772.08
|
| Rate for Payer: Parkland Medicaid |
$6,393.69
|
| Rate for Payer: Scott and White EPO/PPO |
$439.05
|
| Rate for Payer: Scott and White Medicare |
$2,099.91
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$6,393.69
|
| 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
|
|
