|
CHED Laceration Complex - Trunk Each Addl 5 cm BCE
|
Facility
|
OP
|
$3,409.00
|
|
|
Service Code
|
HCPCS 13102
|
| Hospital Charge Code |
8912636
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$86.92 |
| Max. Negotiated Rate |
$3,520.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$306.81
|
| Rate for Payer: BCBS of TX Blue Advantage |
$1,022.70
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,227.24
|
| Rate for Payer: BCBS of TX PPO |
$3,520.00
|
| Rate for Payer: Cash Price |
$2,318.12
|
| Rate for Payer: Cash Price |
$2,318.12
|
| Rate for Payer: Cash Price |
$2,318.12
|
| Rate for Payer: Cigna Medicaid |
$2,454.48
|
| Rate for Payer: Molina CHIP/Medicaid |
$2,454.48
|
| Rate for Payer: Multiplan Auto |
$2,215.85
|
| Rate for Payer: Multiplan Commercial |
$2,215.85
|
| Rate for Payer: Multiplan Workers Comp |
$2,215.85
|
| Rate for Payer: Parkland Medicaid |
$2,454.48
|
| Rate for Payer: Scott and White EPO/PPO |
$86.92
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$2,454.48
|
| Rate for Payer: Superior Health Plan EPO |
$463.62
|
|
|
CHED Laceration Intermediate - Face 20.1 to 30.0 cm BCE
|
Facility
|
IP
|
$2,839.00
|
|
|
Service Code
|
HCPCS 12056
|
| Hospital Charge Code |
8914613
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$1,930.52
|
|
|
CHED Laceration Intermediate - Face 20.1 to 30.0 cm BCE
|
Facility
|
OP
|
$2,839.00
|
|
|
Service Code
|
HCPCS 12056
|
| Hospital Charge Code |
8914613
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$255.51 |
| Max. Negotiated Rate |
$2,044.08 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$255.51
|
| 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 |
$1,930.52
|
| Rate for Payer: Cash Price |
$1,930.52
|
| Rate for Payer: Cash Price |
$1,930.52
|
| Rate for Payer: Cigna Commercial |
$863.21
|
| Rate for Payer: Cigna Medicaid |
$2,044.08
|
| 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 |
$2,044.08
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$408.37
|
| Rate for Payer: Molina Medicare |
$408.37
|
| Rate for Payer: Multiplan Auto |
$1,845.35
|
| Rate for Payer: Multiplan Commercial |
$1,845.35
|
| Rate for Payer: Multiplan Workers Comp |
$1,845.35
|
| Rate for Payer: Parkland Medicaid |
$2,044.08
|
| Rate for Payer: Scott and White EPO/PPO |
$470.48
|
| Rate for Payer: Scott and White Medicare |
$408.37
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$2,044.08
|
| 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 Laceration Intermediate - Face <= 2.5 cm BCE
|
Facility
|
OP
|
$1,065.00
|
|
|
Service Code
|
HCPCS 12051
|
| Hospital Charge Code |
8914611
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$95.85 |
| Max. Negotiated Rate |
$863.21 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$95.85
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$408.37
|
| Rate for Payer: Amerigroup Medicare |
$408.37
|
| Rate for Payer: BCBS of TX Blue Advantage |
$269.62
|
| Rate for Payer: BCBS of TX Blue Essentials |
$322.90
|
| Rate for Payer: BCBS of TX Medicare |
$408.37
|
| Rate for Payer: BCBS of TX PPO |
$406.85
|
| Rate for Payer: Cash Price |
$724.20
|
| Rate for Payer: Cash Price |
$724.20
|
| Rate for Payer: Cash Price |
$724.20
|
| Rate for Payer: Cigna Commercial |
$863.21
|
| Rate for Payer: Cigna Medicaid |
$766.80
|
| 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 |
$766.80
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$408.37
|
| Rate for Payer: Molina Medicare |
$408.37
|
| Rate for Payer: Multiplan Auto |
$692.25
|
| Rate for Payer: Multiplan Commercial |
$692.25
|
| Rate for Payer: Multiplan Workers Comp |
$692.25
|
| Rate for Payer: Parkland Medicaid |
$766.80
|
| Rate for Payer: Scott and White EPO/PPO |
$208.11
|
| Rate for Payer: Scott and White Medicare |
$408.37
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$766.80
|
| 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 Laceration Intermediate - Face <= 2.5 cm BCE
|
Facility
|
IP
|
$1,065.00
|
|
|
Service Code
|
HCPCS 12051
|
| Hospital Charge Code |
8914611
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$724.20
|
|
|
CHED Laceration Intermediate - Face 2.6 to 5.0 cm BCE
|
Facility
|
OP
|
$1,253.00
|
|
|
Service Code
|
HCPCS 12052
|
| Hospital Charge Code |
8912637
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$112.77 |
| Max. Negotiated Rate |
$902.16 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$112.77
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$408.37
|
| Rate for Payer: Amerigroup Medicare |
$408.37
|
| Rate for Payer: BCBS of TX Blue Advantage |
$269.62
|
| Rate for Payer: BCBS of TX Blue Essentials |
$322.90
|
| Rate for Payer: BCBS of TX Medicare |
$408.37
|
| Rate for Payer: BCBS of TX PPO |
$406.85
|
| Rate for Payer: Cash Price |
$852.04
|
| Rate for Payer: Cash Price |
$852.04
|
| Rate for Payer: Cash Price |
$852.04
|
| Rate for Payer: Cigna Commercial |
$863.21
|
| Rate for Payer: Cigna Medicaid |
$902.16
|
| 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 |
$902.16
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$408.37
|
| Rate for Payer: Molina Medicare |
$408.37
|
| Rate for Payer: Multiplan Auto |
$814.45
|
| Rate for Payer: Multiplan Commercial |
$814.45
|
| Rate for Payer: Multiplan Workers Comp |
$814.45
|
| Rate for Payer: Parkland Medicaid |
$902.16
|
| Rate for Payer: Scott and White EPO/PPO |
$244.68
|
| Rate for Payer: Scott and White Medicare |
$408.37
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$902.16
|
| 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 Laceration Intermediate - Face 2.6 to 5.0 cm BCE
|
Facility
|
IP
|
$1,253.00
|
|
|
Service Code
|
HCPCS 12052
|
| Hospital Charge Code |
8912637
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$852.04
|
|
|
CHED Laceration Intermediate - Face > 30.0 cm BCE
|
Facility
|
IP
|
$1,050.00
|
|
|
Service Code
|
HCPCS 12057
|
| Hospital Charge Code |
8914612
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$714.00
|
|
|
CHED Laceration Intermediate - Face > 30.0 cm BCE
|
Facility
|
OP
|
$1,050.00
|
|
|
Service Code
|
HCPCS 12057
|
| Hospital Charge Code |
8914612
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$94.50 |
| Max. Negotiated Rate |
$863.21 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$94.50
|
| 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 |
$714.00
|
| Rate for Payer: Cash Price |
$714.00
|
| Rate for Payer: Cash Price |
$714.00
|
| Rate for Payer: Cigna Commercial |
$863.21
|
| Rate for Payer: Cigna Medicaid |
$756.00
|
| 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 |
$756.00
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$408.37
|
| Rate for Payer: Molina Medicare |
$408.37
|
| Rate for Payer: Multiplan Auto |
$682.50
|
| Rate for Payer: Multiplan Commercial |
$682.50
|
| Rate for Payer: Multiplan Workers Comp |
$682.50
|
| Rate for Payer: Parkland Medicaid |
$756.00
|
| Rate for Payer: Scott and White EPO/PPO |
$513.11
|
| Rate for Payer: Scott and White Medicare |
$408.37
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$756.00
|
| 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 Laceration Intermediate - Neck <= 2.5 cm BCE
|
Facility
|
OP
|
$688.00
|
|
|
Service Code
|
HCPCS 12041
|
| Hospital Charge Code |
8910630
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$61.92 |
| Max. Negotiated Rate |
$863.21 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$61.92
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$408.37
|
| Rate for Payer: Amerigroup Medicare |
$408.37
|
| Rate for Payer: BCBS of TX Blue Advantage |
$269.62
|
| Rate for Payer: BCBS of TX Blue Essentials |
$322.90
|
| Rate for Payer: BCBS of TX Medicare |
$408.37
|
| Rate for Payer: BCBS of TX PPO |
$406.85
|
| Rate for Payer: Cash Price |
$467.84
|
| Rate for Payer: Cash Price |
$467.84
|
| Rate for Payer: Cash Price |
$467.84
|
| Rate for Payer: Cigna Commercial |
$863.21
|
| Rate for Payer: Cigna Medicaid |
$495.36
|
| 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 |
$495.36
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$408.37
|
| Rate for Payer: Molina Medicare |
$408.37
|
| Rate for Payer: Multiplan Auto |
$447.20
|
| Rate for Payer: Multiplan Commercial |
$447.20
|
| Rate for Payer: Multiplan Workers Comp |
$447.20
|
| Rate for Payer: Parkland Medicaid |
$495.36
|
| Rate for Payer: Scott and White EPO/PPO |
$178.25
|
| Rate for Payer: Scott and White Medicare |
$408.37
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$495.36
|
| 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 Laceration Intermediate - Neck <= 2.5 cm BCE
|
Facility
|
IP
|
$688.00
|
|
|
Service Code
|
HCPCS 12041
|
| Hospital Charge Code |
8910630
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$467.84
|
|
|
CHED Laceration Intermediate - Neck > 30.0 cm BCE
|
Facility
|
IP
|
$6,641.00
|
|
|
Service Code
|
HCPCS 12047
|
| Hospital Charge Code |
8914614
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$4,515.88
|
|
|
CHED Laceration Intermediate - Neck > 30.0 cm BCE
|
Facility
|
OP
|
$6,641.00
|
|
|
Service Code
|
HCPCS 12047
|
| Hospital Charge Code |
8914614
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$431.77 |
| Max. Negotiated Rate |
$4,781.52 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$597.69
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$2,072.68
|
| Rate for Payer: Amerigroup Medicare |
$2,072.68
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,709.98
|
| Rate for Payer: BCBS of TX Blue Essentials |
$3,245.48
|
| Rate for Payer: BCBS of TX Medicare |
$2,072.68
|
| Rate for Payer: BCBS of TX PPO |
$4,089.30
|
| Rate for Payer: Cash Price |
$4,515.88
|
| Rate for Payer: Cash Price |
$4,515.88
|
| Rate for Payer: Cash Price |
$4,515.88
|
| Rate for Payer: Cigna Commercial |
$4,381.27
|
| Rate for Payer: Cigna Medicaid |
$4,781.52
|
| Rate for Payer: Cigna Medicare |
$2,072.68
|
| Rate for Payer: Employer Direct Commercial |
$2,072.68
|
| Rate for Payer: Humana Medicare/TRICARE |
$2,072.68
|
| Rate for Payer: Molina CHIP/Medicaid |
$4,781.52
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$2,072.68
|
| Rate for Payer: Molina Medicare |
$2,072.68
|
| Rate for Payer: Multiplan Auto |
$4,316.65
|
| Rate for Payer: Multiplan Commercial |
$4,316.65
|
| Rate for Payer: Multiplan Workers Comp |
$4,316.65
|
| Rate for Payer: Parkland Medicaid |
$4,781.52
|
| Rate for Payer: Scott and White EPO/PPO |
$431.77
|
| Rate for Payer: Scott and White Medicare |
$2,072.68
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$4,781.52
|
| Rate for Payer: Superior Health Plan EPO |
$2,072.68
|
| Rate for Payer: Superior Health Plan Medicare |
$2,072.68
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$2,072.68
|
| Rate for Payer: Universal American Medicare |
$2,072.68
|
| Rate for Payer: Wellcare Medicare |
$2,072.68
|
| Rate for Payer: Wellmed Medicare |
$2,072.68
|
|
|
CHED Laceration Intermediate - Scalp 20.1 to 30.0 cm BCE
|
Facility
|
OP
|
$1,472.00
|
|
|
Service Code
|
HCPCS 12036
|
| Hospital Charge Code |
8914617
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$132.48 |
| Max. Negotiated Rate |
$1,569.38 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$132.48
|
| 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 |
$1,000.96
|
| Rate for Payer: Cash Price |
$1,000.96
|
| Rate for Payer: Cash Price |
$1,000.96
|
| Rate for Payer: Cigna Commercial |
$1,569.38
|
| Rate for Payer: Cigna Medicaid |
$1,059.84
|
| 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 |
$1,059.84
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$742.44
|
| Rate for Payer: Molina Medicare |
$742.44
|
| Rate for Payer: Multiplan Auto |
$956.80
|
| Rate for Payer: Multiplan Commercial |
$956.80
|
| Rate for Payer: Multiplan Workers Comp |
$956.80
|
| Rate for Payer: Parkland Medicaid |
$1,059.84
|
| Rate for Payer: Scott and White EPO/PPO |
$345.11
|
| Rate for Payer: Scott and White Medicare |
$742.44
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,059.84
|
| 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 Laceration Intermediate - Scalp 20.1 to 30.0 cm BCE
|
Facility
|
IP
|
$1,472.00
|
|
|
Service Code
|
HCPCS 12036
|
| Hospital Charge Code |
8914617
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$1,000.96
|
|
|
CHED Laceration Intermediate - Scalp <= 2.5 cm BCE
|
Facility
|
OP
|
$710.00
|
|
|
Service Code
|
HCPCS 12031
|
| Hospital Charge Code |
8914615
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$63.90 |
| Max. Negotiated Rate |
$863.21 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$63.90
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$408.37
|
| Rate for Payer: Amerigroup Medicare |
$408.37
|
| Rate for Payer: BCBS of TX Blue Advantage |
$269.62
|
| Rate for Payer: BCBS of TX Blue Essentials |
$322.90
|
| Rate for Payer: BCBS of TX Medicare |
$408.37
|
| Rate for Payer: BCBS of TX PPO |
$406.85
|
| Rate for Payer: Cash Price |
$482.80
|
| Rate for Payer: Cash Price |
$482.80
|
| Rate for Payer: Cash Price |
$482.80
|
| Rate for Payer: Cigna Commercial |
$863.21
|
| Rate for Payer: Cigna Medicaid |
$511.20
|
| 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 |
$511.20
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$408.37
|
| Rate for Payer: Molina Medicare |
$408.37
|
| Rate for Payer: Multiplan Auto |
$461.50
|
| Rate for Payer: Multiplan Commercial |
$461.50
|
| Rate for Payer: Multiplan Workers Comp |
$461.50
|
| Rate for Payer: Parkland Medicaid |
$511.20
|
| Rate for Payer: Scott and White EPO/PPO |
$186.12
|
| Rate for Payer: Scott and White Medicare |
$408.37
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$511.20
|
| 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 Laceration Intermediate - Scalp <= 2.5 cm BCE
|
Facility
|
IP
|
$710.00
|
|
|
Service Code
|
HCPCS 12031
|
| Hospital Charge Code |
8914615
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$482.80
|
|
|
CHED Laceration Intermediate - Scalp 2.6 to 7.5 cm BCE
|
Facility
|
OP
|
$868.00
|
|
|
Service Code
|
HCPCS 12032
|
| Hospital Charge Code |
8910631
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$78.12 |
| Max. Negotiated Rate |
$863.21 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$78.12
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$408.37
|
| Rate for Payer: Amerigroup Medicare |
$408.37
|
| Rate for Payer: BCBS of TX Blue Advantage |
$269.62
|
| Rate for Payer: BCBS of TX Blue Essentials |
$322.90
|
| Rate for Payer: BCBS of TX Medicare |
$408.37
|
| Rate for Payer: BCBS of TX PPO |
$406.85
|
| Rate for Payer: Cash Price |
$590.24
|
| Rate for Payer: Cash Price |
$590.24
|
| Rate for Payer: Cash Price |
$590.24
|
| Rate for Payer: Cigna Commercial |
$863.21
|
| Rate for Payer: Cigna Medicaid |
$624.96
|
| 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 |
$624.96
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$408.37
|
| Rate for Payer: Molina Medicare |
$408.37
|
| Rate for Payer: Multiplan Auto |
$564.20
|
| Rate for Payer: Multiplan Commercial |
$564.20
|
| Rate for Payer: Multiplan Workers Comp |
$564.20
|
| Rate for Payer: Parkland Medicaid |
$624.96
|
| Rate for Payer: Scott and White EPO/PPO |
$233.80
|
| Rate for Payer: Scott and White Medicare |
$408.37
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$624.96
|
| 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 Laceration Intermediate - Scalp 2.6 to 7.5 cm BCE
|
Facility
|
IP
|
$868.00
|
|
|
Service Code
|
HCPCS 12032
|
| Hospital Charge Code |
8910631
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$590.24
|
|
|
CHED Laceration Intermediate - Scalp > 30.0 cm BCE
|
Facility
|
IP
|
$3,398.00
|
|
|
Service Code
|
HCPCS 12037
|
| Hospital Charge Code |
8914616
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$2,310.64
|
|
|
CHED Laceration Intermediate - Scalp > 30.0 cm BCE
|
Facility
|
OP
|
$3,398.00
|
|
|
Service Code
|
HCPCS 12037
|
| Hospital Charge Code |
8914616
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$305.82 |
| Max. Negotiated Rate |
$4,381.27 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$305.82
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$2,072.68
|
| Rate for Payer: Amerigroup Medicare |
$2,072.68
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,709.98
|
| Rate for Payer: BCBS of TX Blue Essentials |
$3,245.48
|
| Rate for Payer: BCBS of TX Medicare |
$2,072.68
|
| Rate for Payer: BCBS of TX PPO |
$4,089.30
|
| Rate for Payer: Cash Price |
$2,310.64
|
| Rate for Payer: Cash Price |
$2,310.64
|
| Rate for Payer: Cash Price |
$2,310.64
|
| Rate for Payer: Cigna Commercial |
$4,381.27
|
| Rate for Payer: Cigna Medicaid |
$2,446.56
|
| Rate for Payer: Cigna Medicare |
$2,072.68
|
| Rate for Payer: Employer Direct Commercial |
$2,072.68
|
| Rate for Payer: Humana Medicare/TRICARE |
$2,072.68
|
| Rate for Payer: Molina CHIP/Medicaid |
$2,446.56
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$2,072.68
|
| Rate for Payer: Molina Medicare |
$2,072.68
|
| Rate for Payer: Multiplan Auto |
$2,208.70
|
| Rate for Payer: Multiplan Commercial |
$2,208.70
|
| Rate for Payer: Multiplan Workers Comp |
$2,208.70
|
| Rate for Payer: Parkland Medicaid |
$2,446.56
|
| Rate for Payer: Scott and White EPO/PPO |
$400.75
|
| Rate for Payer: Scott and White Medicare |
$2,072.68
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$2,446.56
|
| Rate for Payer: Superior Health Plan EPO |
$2,072.68
|
| Rate for Payer: Superior Health Plan Medicare |
$2,072.68
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$2,072.68
|
| Rate for Payer: Universal American Medicare |
$2,072.68
|
| Rate for Payer: Wellcare Medicare |
$2,072.68
|
| Rate for Payer: Wellmed Medicare |
$2,072.68
|
|
|
CHED Laceration Simple - Face 20.1 to 30.0 cm BCE
|
Facility
|
IP
|
$1,383.00
|
|
|
Service Code
|
HCPCS 12017
|
| Hospital Charge Code |
8910635
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$940.44
|
|
|
CHED Laceration Simple - Face 20.1 to 30.0 cm BCE
|
Facility
|
OP
|
$1,383.00
|
|
|
Service Code
|
HCPCS 12017
|
| Hospital Charge Code |
8910635
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$124.47 |
| Max. Negotiated Rate |
$995.76 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$124.47
|
| 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 |
$940.44
|
| Rate for Payer: Cash Price |
$940.44
|
| Rate for Payer: Cash Price |
$940.44
|
| Rate for Payer: Cigna Commercial |
$863.21
|
| Rate for Payer: Cigna Medicaid |
$995.76
|
| 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 |
$995.76
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$408.37
|
| Rate for Payer: Molina Medicare |
$408.37
|
| Rate for Payer: Multiplan Auto |
$898.95
|
| Rate for Payer: Multiplan Commercial |
$898.95
|
| Rate for Payer: Multiplan Workers Comp |
$898.95
|
| Rate for Payer: Parkland Medicaid |
$995.76
|
| Rate for Payer: Scott and White EPO/PPO |
$186.45
|
| Rate for Payer: Scott and White Medicare |
$408.37
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$995.76
|
| 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 Laceration Simple - Face <= 2.5 cm BCE
|
Facility
|
IP
|
$641.00
|
|
|
Service Code
|
HCPCS 12011
|
| Hospital Charge Code |
8910632
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$435.88
|
|
|
CHED Laceration Simple - Face <= 2.5 cm BCE
|
Facility
|
OP
|
$641.00
|
|
|
Service Code
|
HCPCS 12011
|
| Hospital Charge Code |
8910632
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$57.69 |
| Max. Negotiated Rate |
$461.52 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$57.69
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$201.55
|
| Rate for Payer: Amerigroup Medicare |
$201.55
|
| Rate for Payer: BCBS of TX Blue Advantage |
$291.80
|
| Rate for Payer: BCBS of TX Blue Essentials |
$349.46
|
| Rate for Payer: BCBS of TX Medicare |
$201.55
|
| Rate for Payer: BCBS of TX PPO |
$440.32
|
| Rate for Payer: Cash Price |
$435.88
|
| Rate for Payer: Cash Price |
$435.88
|
| Rate for Payer: Cash Price |
$435.88
|
| Rate for Payer: Cigna Commercial |
$426.04
|
| Rate for Payer: Cigna Medicaid |
$461.52
|
| 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 |
$461.52
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$201.55
|
| Rate for Payer: Molina Medicare |
$201.55
|
| Rate for Payer: Multiplan Auto |
$416.65
|
| Rate for Payer: Multiplan Commercial |
$416.65
|
| Rate for Payer: Multiplan Workers Comp |
$416.65
|
| Rate for Payer: Parkland Medicaid |
$461.52
|
| Rate for Payer: Scott and White EPO/PPO |
$67.47
|
| Rate for Payer: Scott and White Medicare |
$201.55
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$461.52
|
| 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
|
|
