|
CHED ID Aspirate Ganglion Cyst BCE
|
Facility
|
OP
|
$627.50
|
|
|
Service Code
|
HCPCS 20612
|
| Hospital Charge Code |
8910622
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$56.48 |
| Max. Negotiated Rate |
$651.79 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$56.48
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$308.35
|
| Rate for Payer: Amerigroup Medicare |
$308.35
|
| Rate for Payer: BCBS of TX Blue Advantage |
$58.47
|
| Rate for Payer: BCBS of TX Blue Essentials |
$70.02
|
| Rate for Payer: BCBS of TX Medicare |
$308.35
|
| Rate for Payer: BCBS of TX PPO |
$88.23
|
| Rate for Payer: Cash Price |
$426.70
|
| Rate for Payer: Cash Price |
$426.70
|
| Rate for Payer: Cash Price |
$426.70
|
| Rate for Payer: Cigna Commercial |
$651.79
|
| Rate for Payer: Cigna Medicaid |
$451.80
|
| Rate for Payer: Cigna Medicare |
$308.35
|
| Rate for Payer: Employer Direct Commercial |
$308.35
|
| Rate for Payer: Humana Medicare/TRICARE |
$308.35
|
| Rate for Payer: Molina CHIP/Medicaid |
$451.80
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$308.35
|
| Rate for Payer: Molina Medicare |
$308.35
|
| Rate for Payer: Multiplan Auto |
$407.88
|
| Rate for Payer: Multiplan Commercial |
$407.88
|
| Rate for Payer: Multiplan Workers Comp |
$407.88
|
| Rate for Payer: Parkland Medicaid |
$451.80
|
| Rate for Payer: Scott and White EPO/PPO |
$313.75
|
| Rate for Payer: Scott and White Medicare |
$308.35
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$451.80
|
| Rate for Payer: Superior Health Plan EPO |
$308.35
|
| Rate for Payer: Superior Health Plan Medicare |
$308.35
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$308.35
|
| Rate for Payer: Universal American Medicare |
$308.35
|
| Rate for Payer: Wellcare Medicare |
$308.35
|
| Rate for Payer: Wellmed Medicare |
$308.35
|
|
|
CHED ID Aspirate Ganglion Cyst BCE
|
Facility
|
IP
|
$627.50
|
|
|
Service Code
|
HCPCS 20612
|
| Hospital Charge Code |
8910622
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$426.70
|
|
|
CHED ID Body Site I&D Abscess/Cyst Complex BCE
|
Facility
|
OP
|
$2,238.42
|
|
|
Service Code
|
HCPCS 10061
|
| Hospital Charge Code |
8912620
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$192.87 |
| Max. Negotiated Rate |
$1,611.66 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$201.46
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$408.37
|
| Rate for Payer: Amerigroup Medicare |
$408.37
|
| Rate for Payer: BCBS of TX Blue Advantage |
$192.87
|
| Rate for Payer: BCBS of TX Blue Essentials |
$230.98
|
| Rate for Payer: BCBS of TX Medicare |
$408.37
|
| Rate for Payer: BCBS of TX PPO |
$291.03
|
| Rate for Payer: Cash Price |
$1,522.13
|
| Rate for Payer: Cash Price |
$1,522.13
|
| Rate for Payer: Cash Price |
$1,522.13
|
| Rate for Payer: Cigna Commercial |
$863.21
|
| Rate for Payer: Cigna Medicaid |
$1,611.66
|
| 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 |
$1,611.66
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$408.37
|
| Rate for Payer: Molina Medicare |
$408.37
|
| Rate for Payer: Multiplan Auto |
$1,454.97
|
| Rate for Payer: Multiplan Commercial |
$1,454.97
|
| Rate for Payer: Multiplan Workers Comp |
$1,454.97
|
| Rate for Payer: Parkland Medicaid |
$1,611.66
|
| Rate for Payer: Scott and White EPO/PPO |
$1,119.21
|
| Rate for Payer: Scott and White Medicare |
$408.37
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,611.66
|
| 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 ID Body Site I&D Abscess/Cyst Complex BCE
|
Facility
|
IP
|
$2,238.42
|
|
|
Service Code
|
HCPCS 10061
|
| Hospital Charge Code |
8912620
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$1,522.13
|
|
|
CHED ID Body Site I&D Abscess/Cyst Simple BCE
|
Facility
|
OP
|
$993.50
|
|
|
Service Code
|
HCPCS 10060
|
| Hospital Charge Code |
8910623
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$89.42 |
| 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 |
$125.97
|
| Rate for Payer: BCBS of TX Blue Essentials |
$150.86
|
| Rate for Payer: BCBS of TX Medicare |
$201.55
|
| Rate for Payer: BCBS of TX PPO |
$190.08
|
| 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 |
$496.75
|
| 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 ID Body Site I&D Abscess/Cyst Simple BCE
|
Facility
|
IP
|
$993.50
|
|
|
Service Code
|
HCPCS 10060
|
| Hospital Charge Code |
8910623
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$675.58
|
|
|
CHED ID Body Site Perianal, superficial BCE
|
Facility
|
IP
|
$3,738.75
|
|
|
Service Code
|
HCPCS 46050
|
| Hospital Charge Code |
8912621
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$2,542.35
|
|
|
CHED ID Body Site Perianal, superficial BCE
|
Facility
|
OP
|
$3,738.75
|
|
|
Service Code
|
HCPCS 46050
|
| Hospital Charge Code |
8912621
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$336.49 |
| Max. Negotiated Rate |
$2,691.90 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$336.49
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$934.20
|
| Rate for Payer: Amerigroup Medicare |
$934.20
|
| Rate for Payer: BCBS of TX Blue Advantage |
$1,275.68
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,527.76
|
| Rate for Payer: BCBS of TX Medicare |
$934.20
|
| Rate for Payer: BCBS of TX PPO |
$1,924.98
|
| Rate for Payer: Cash Price |
$2,542.35
|
| Rate for Payer: Cash Price |
$2,542.35
|
| Rate for Payer: Cash Price |
$2,542.35
|
| Rate for Payer: Cigna Commercial |
$1,974.73
|
| Rate for Payer: Cigna Medicaid |
$2,691.90
|
| Rate for Payer: Cigna Medicare |
$934.20
|
| Rate for Payer: Employer Direct Commercial |
$934.20
|
| Rate for Payer: Humana Medicare/TRICARE |
$934.20
|
| Rate for Payer: Molina CHIP/Medicaid |
$2,691.90
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$934.20
|
| Rate for Payer: Molina Medicare |
$934.20
|
| Rate for Payer: Multiplan Auto |
$2,430.19
|
| Rate for Payer: Multiplan Commercial |
$2,430.19
|
| Rate for Payer: Multiplan Workers Comp |
$2,430.19
|
| Rate for Payer: Parkland Medicaid |
$2,691.90
|
| Rate for Payer: Scott and White EPO/PPO |
$1,869.38
|
| Rate for Payer: Scott and White Medicare |
$934.20
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$2,691.90
|
| Rate for Payer: Superior Health Plan EPO |
$934.20
|
| Rate for Payer: Superior Health Plan Medicare |
$934.20
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$934.20
|
| Rate for Payer: Universal American Medicare |
$934.20
|
| Rate for Payer: Wellcare Medicare |
$934.20
|
| Rate for Payer: Wellmed Medicare |
$934.20
|
|
|
CHED ID Body Site Peritonsillar BCE
|
Facility
|
IP
|
$1,336.00
|
|
|
Service Code
|
HCPCS 42700
|
| Hospital Charge Code |
8914602
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$908.48
|
|
|
CHED ID Body Site Peritonsillar BCE
|
Facility
|
OP
|
$1,336.00
|
|
|
Service Code
|
HCPCS 42700
|
| Hospital Charge Code |
8914602
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$120.24 |
| Max. Negotiated Rate |
$961.92 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$120.24
|
| 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 |
$908.48
|
| Rate for Payer: Cash Price |
$908.48
|
| Rate for Payer: Cash Price |
$908.48
|
| Rate for Payer: Cigna Commercial |
$502.95
|
| Rate for Payer: Cigna Medicaid |
$961.92
|
| 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 |
$961.92
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$237.93
|
| Rate for Payer: Molina Medicare |
$237.93
|
| Rate for Payer: Multiplan Auto |
$868.40
|
| Rate for Payer: Multiplan Commercial |
$868.40
|
| Rate for Payer: Multiplan Workers Comp |
$868.40
|
| Rate for Payer: Parkland Medicaid |
$961.92
|
| Rate for Payer: Scott and White EPO/PPO |
$668.00
|
| Rate for Payer: Scott and White Medicare |
$237.93
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$961.92
|
| 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 ID Body Site Pilonidal cyst, multiple BCE
|
Facility
|
IP
|
$3,559.73
|
|
|
Service Code
|
HCPCS 10081
|
| Hospital Charge Code |
8910624
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$2,420.62
|
|
|
CHED ID Body Site Pilonidal cyst, multiple BCE
|
Facility
|
OP
|
$3,559.73
|
|
|
Service Code
|
HCPCS 10081
|
| Hospital Charge Code |
8910624
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$320.38 |
| Max. Negotiated Rate |
$2,563.01 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$320.38
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$711.36
|
| Rate for Payer: Amerigroup Medicare |
$711.36
|
| Rate for Payer: BCBS of TX Blue Advantage |
$348.36
|
| Rate for Payer: BCBS of TX Blue Essentials |
$417.20
|
| Rate for Payer: BCBS of TX Medicare |
$711.36
|
| Rate for Payer: BCBS of TX PPO |
$525.67
|
| Rate for Payer: Cash Price |
$2,420.62
|
| Rate for Payer: Cash Price |
$2,420.62
|
| Rate for Payer: Cash Price |
$2,420.62
|
| Rate for Payer: Cigna Commercial |
$1,503.68
|
| Rate for Payer: Cigna Medicaid |
$2,563.01
|
| 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 |
$2,563.01
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$711.36
|
| Rate for Payer: Molina Medicare |
$711.36
|
| Rate for Payer: Multiplan Auto |
$2,313.82
|
| Rate for Payer: Multiplan Commercial |
$2,313.82
|
| Rate for Payer: Multiplan Workers Comp |
$2,313.82
|
| Rate for Payer: Parkland Medicaid |
$2,563.01
|
| Rate for Payer: Scott and White EPO/PPO |
$1,779.87
|
| Rate for Payer: Scott and White Medicare |
$711.36
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$2,563.01
|
| 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 ID Body Site Pilonidal cyst, single BCE
|
Facility
|
OP
|
$177.00
|
|
|
Service Code
|
HCPCS 10080
|
| Hospital Charge Code |
8910625
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$15.93 |
| Max. Negotiated Rate |
$1,503.68 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$15.93
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$711.36
|
| Rate for Payer: Amerigroup Medicare |
$711.36
|
| Rate for Payer: BCBS of TX Blue Advantage |
$276.03
|
| Rate for Payer: BCBS of TX Blue Essentials |
$330.58
|
| Rate for Payer: BCBS of TX Medicare |
$711.36
|
| Rate for Payer: BCBS of TX PPO |
$416.53
|
| Rate for Payer: Cash Price |
$120.36
|
| Rate for Payer: Cash Price |
$120.36
|
| Rate for Payer: Cash Price |
$120.36
|
| Rate for Payer: Cigna Commercial |
$1,503.68
|
| Rate for Payer: Cigna Medicaid |
$127.44
|
| 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 |
$127.44
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$711.36
|
| Rate for Payer: Molina Medicare |
$711.36
|
| Rate for Payer: Multiplan Auto |
$115.05
|
| Rate for Payer: Multiplan Commercial |
$115.05
|
| Rate for Payer: Multiplan Workers Comp |
$115.05
|
| Rate for Payer: Parkland Medicaid |
$127.44
|
| Rate for Payer: Scott and White EPO/PPO |
$88.50
|
| Rate for Payer: Scott and White Medicare |
$711.36
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$127.44
|
| 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 ID Body Site Pilonidal cyst, single BCE
|
Facility
|
IP
|
$177.00
|
|
|
Service Code
|
HCPCS 10080
|
| Hospital Charge Code |
8910625
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$120.36
|
|
|
CHED ID Body Site Scrotal Space BCE
|
Facility
|
OP
|
$7,660.00
|
|
|
Service Code
|
HCPCS 54700
|
| Hospital Charge Code |
8910626
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$689.40 |
| Max. Negotiated Rate |
$5,515.20 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$689.40
|
| 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 |
$5,208.80
|
| Rate for Payer: Cash Price |
$5,208.80
|
| Rate for Payer: Cash Price |
$5,208.80
|
| Rate for Payer: Cigna Commercial |
$4,438.84
|
| Rate for Payer: Cigna Medicaid |
$5,515.20
|
| 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 |
$5,515.20
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$2,099.91
|
| Rate for Payer: Molina Medicare |
$2,099.91
|
| Rate for Payer: Multiplan Auto |
$4,979.00
|
| Rate for Payer: Multiplan Commercial |
$4,979.00
|
| Rate for Payer: Multiplan Workers Comp |
$4,979.00
|
| Rate for Payer: Parkland Medicaid |
$5,515.20
|
| Rate for Payer: Scott and White EPO/PPO |
$3,830.00
|
| Rate for Payer: Scott and White Medicare |
$2,099.91
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$5,515.20
|
| 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 ID Body Site Scrotal Space BCE
|
Facility
|
IP
|
$7,660.00
|
|
|
Service Code
|
HCPCS 54700
|
| Hospital Charge Code |
8910626
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$5,208.80
|
|
|
CHED ID Body Site Vestibule of Mouth, Complex BCE
|
Facility
|
OP
|
$4,220.72
|
|
|
Service Code
|
HCPCS 40801
|
| Hospital Charge Code |
8914603
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$379.86 |
| Max. Negotiated Rate |
$3,038.92 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$379.86
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$541.79
|
| Rate for Payer: Amerigroup Medicare |
$541.79
|
| Rate for Payer: BCBS of TX Blue Advantage |
$737.67
|
| Rate for Payer: BCBS of TX Blue Essentials |
$883.44
|
| Rate for Payer: BCBS of TX Medicare |
$541.79
|
| Rate for Payer: BCBS of TX PPO |
$1,113.13
|
| Rate for Payer: Cash Price |
$2,870.09
|
| Rate for Payer: Cash Price |
$2,870.09
|
| Rate for Payer: Cash Price |
$2,870.09
|
| Rate for Payer: Cigna Commercial |
$1,145.24
|
| Rate for Payer: Cigna Medicaid |
$3,038.92
|
| Rate for Payer: Cigna Medicare |
$541.79
|
| Rate for Payer: Employer Direct Commercial |
$541.79
|
| Rate for Payer: Humana Medicare/TRICARE |
$541.79
|
| Rate for Payer: Molina CHIP/Medicaid |
$3,038.92
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$541.79
|
| Rate for Payer: Molina Medicare |
$541.79
|
| Rate for Payer: Multiplan Auto |
$2,743.47
|
| Rate for Payer: Multiplan Commercial |
$2,743.47
|
| Rate for Payer: Multiplan Workers Comp |
$2,743.47
|
| Rate for Payer: Parkland Medicaid |
$3,038.92
|
| Rate for Payer: Scott and White EPO/PPO |
$2,110.36
|
| Rate for Payer: Scott and White Medicare |
$541.79
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$3,038.92
|
| Rate for Payer: Superior Health Plan EPO |
$541.79
|
| Rate for Payer: Superior Health Plan Medicare |
$541.79
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$541.79
|
| Rate for Payer: Universal American Medicare |
$541.79
|
| Rate for Payer: Wellcare Medicare |
$541.79
|
| Rate for Payer: Wellmed Medicare |
$541.79
|
|
|
CHED ID Body Site Vestibule of Mouth, Complex BCE
|
Facility
|
OP
|
$4,220.72
|
|
|
Service Code
|
HCPCS 40801
|
| Hospital Charge Code |
5202540
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$379.86 |
| Max. Negotiated Rate |
$3,038.92 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$379.86
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$541.79
|
| Rate for Payer: Amerigroup Medicare |
$541.79
|
| Rate for Payer: BCBS of TX Blue Advantage |
$737.67
|
| Rate for Payer: BCBS of TX Blue Essentials |
$883.44
|
| Rate for Payer: BCBS of TX Medicare |
$541.79
|
| Rate for Payer: BCBS of TX PPO |
$1,113.13
|
| Rate for Payer: Cash Price |
$2,870.09
|
| Rate for Payer: Cash Price |
$2,870.09
|
| Rate for Payer: Cash Price |
$2,870.09
|
| Rate for Payer: Cigna Commercial |
$1,145.24
|
| Rate for Payer: Cigna Medicaid |
$3,038.92
|
| Rate for Payer: Cigna Medicare |
$541.79
|
| Rate for Payer: Employer Direct Commercial |
$541.79
|
| Rate for Payer: Humana Medicare/TRICARE |
$541.79
|
| Rate for Payer: Molina CHIP/Medicaid |
$3,038.92
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$541.79
|
| Rate for Payer: Molina Medicare |
$541.79
|
| Rate for Payer: Multiplan Auto |
$2,743.47
|
| Rate for Payer: Multiplan Commercial |
$2,743.47
|
| Rate for Payer: Multiplan Workers Comp |
$2,743.47
|
| Rate for Payer: Parkland Medicaid |
$3,038.92
|
| Rate for Payer: Scott and White EPO/PPO |
$2,110.36
|
| Rate for Payer: Scott and White Medicare |
$541.79
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$3,038.92
|
| Rate for Payer: Superior Health Plan EPO |
$541.79
|
| Rate for Payer: Superior Health Plan Medicare |
$541.79
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$541.79
|
| Rate for Payer: Universal American Medicare |
$541.79
|
| Rate for Payer: Wellcare Medicare |
$541.79
|
| Rate for Payer: Wellmed Medicare |
$541.79
|
|
|
CHED ID Body Site Vestibule of Mouth, Complex BCE
|
Facility
|
IP
|
$4,220.72
|
|
|
Service Code
|
HCPCS 40801
|
| Hospital Charge Code |
8914603
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$2,870.09
|
|
|
CHED ID Body Site Vestibule of Mouth, Complex BCE
|
Facility
|
IP
|
$4,220.72
|
|
|
Service Code
|
HCPCS 40801
|
| Hospital Charge Code |
5202540
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$2,870.09
|
|
|
CHED ID Body Site Vestibule of Mouth, Simple BCE
|
Facility
|
OP
|
$1,289.70
|
|
|
Service Code
|
HCPCS 40800
|
| Hospital Charge Code |
5202539
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$116.07 |
| Max. Negotiated Rate |
$1,503.68 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$116.07
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$711.36
|
| Rate for Payer: Amerigroup Medicare |
$711.36
|
| Rate for Payer: BCBS of TX Blue Advantage |
$277.84
|
| Rate for Payer: BCBS of TX Blue Essentials |
$332.74
|
| Rate for Payer: BCBS of TX Medicare |
$711.36
|
| Rate for Payer: BCBS of TX PPO |
$419.25
|
| Rate for Payer: Cash Price |
$877.00
|
| Rate for Payer: Cash Price |
$877.00
|
| Rate for Payer: Cash Price |
$877.00
|
| Rate for Payer: Cigna Commercial |
$1,503.68
|
| Rate for Payer: Cigna Medicaid |
$928.58
|
| 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 |
$928.58
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$711.36
|
| Rate for Payer: Molina Medicare |
$711.36
|
| Rate for Payer: Multiplan Auto |
$838.30
|
| Rate for Payer: Multiplan Commercial |
$838.30
|
| Rate for Payer: Multiplan Workers Comp |
$838.30
|
| Rate for Payer: Parkland Medicaid |
$928.58
|
| Rate for Payer: Scott and White EPO/PPO |
$644.85
|
| Rate for Payer: Scott and White Medicare |
$711.36
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$928.58
|
| 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 ID Body Site Vestibule of Mouth, Simple BCE
|
Facility
|
IP
|
$1,289.70
|
|
|
Service Code
|
HCPCS 40800
|
| Hospital Charge Code |
5202539
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$877.00
|
|
|
CHED ID Drainage Eyelid BCE
|
Facility
|
OP
|
$4,865.88
|
|
|
Service Code
|
HCPCS 67700
|
| Hospital Charge Code |
8914605
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$228.26 |
| Max. Negotiated Rate |
$3,503.43 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$437.93
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$318.85
|
| Rate for Payer: Amerigroup Medicare |
$318.85
|
| Rate for Payer: BCBS of TX Blue Advantage |
$228.26
|
| Rate for Payer: BCBS of TX Blue Essentials |
$273.36
|
| Rate for Payer: BCBS of TX Medicare |
$318.85
|
| Rate for Payer: BCBS of TX PPO |
$344.43
|
| Rate for Payer: Cash Price |
$3,308.80
|
| Rate for Payer: Cash Price |
$3,308.80
|
| Rate for Payer: Cash Price |
$3,308.80
|
| Rate for Payer: Cigna Commercial |
$673.99
|
| Rate for Payer: Cigna Medicaid |
$3,503.43
|
| Rate for Payer: Cigna Medicare |
$318.85
|
| Rate for Payer: Employer Direct Commercial |
$318.85
|
| Rate for Payer: Humana Medicare/TRICARE |
$318.85
|
| Rate for Payer: Molina CHIP/Medicaid |
$3,503.43
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$318.85
|
| Rate for Payer: Molina Medicare |
$318.85
|
| Rate for Payer: Multiplan Auto |
$3,162.82
|
| Rate for Payer: Multiplan Commercial |
$3,162.82
|
| Rate for Payer: Multiplan Workers Comp |
$3,162.82
|
| Rate for Payer: Parkland Medicaid |
$3,503.43
|
| Rate for Payer: Scott and White EPO/PPO |
$2,432.94
|
| Rate for Payer: Scott and White Medicare |
$318.85
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$3,503.43
|
| Rate for Payer: Superior Health Plan EPO |
$318.85
|
| Rate for Payer: Superior Health Plan Medicare |
$318.85
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$318.85
|
| Rate for Payer: Universal American Medicare |
$318.85
|
| Rate for Payer: Wellcare Medicare |
$318.85
|
| Rate for Payer: Wellmed Medicare |
$318.85
|
|
|
CHED ID Drainage Eyelid BCE
|
Facility
|
IP
|
$4,865.88
|
|
|
Service Code
|
HCPCS 67700
|
| Hospital Charge Code |
8914605
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$3,308.80
|
|
|
CHED ID Drainage Nose, Internal BCE
|
Facility
|
OP
|
$1,990.00
|
|
|
Service Code
|
HCPCS 30000
|
| Hospital Charge Code |
8912622
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$171.83 |
| Max. Negotiated Rate |
$1,432.80 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$179.10
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$237.93
|
| Rate for Payer: Amerigroup Medicare |
$237.93
|
| Rate for Payer: BCBS of TX Blue Advantage |
$171.83
|
| Rate for Payer: BCBS of TX Blue Essentials |
$205.78
|
| Rate for Payer: BCBS of TX Medicare |
$237.93
|
| Rate for Payer: BCBS of TX PPO |
$259.28
|
| Rate for Payer: Cash Price |
$1,353.20
|
| Rate for Payer: Cash Price |
$1,353.20
|
| Rate for Payer: Cash Price |
$1,353.20
|
| Rate for Payer: Cigna Commercial |
$502.95
|
| Rate for Payer: Cigna Medicaid |
$1,432.80
|
| 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 |
$1,432.80
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$237.93
|
| Rate for Payer: Molina Medicare |
$237.93
|
| Rate for Payer: Multiplan Auto |
$1,293.50
|
| Rate for Payer: Multiplan Commercial |
$1,293.50
|
| Rate for Payer: Multiplan Workers Comp |
$1,293.50
|
| Rate for Payer: Parkland Medicaid |
$1,432.80
|
| Rate for Payer: Scott and White EPO/PPO |
$995.00
|
| Rate for Payer: Scott and White Medicare |
$237.93
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,432.80
|
| 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
|
|
