|
CHED LineProcedure Arterial Catheterization BCE
|
Facility
|
OP
|
$1,751.63
|
|
|
Service Code
|
HCPCS 36620
|
| Hospital Charge Code |
8910639
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$53.26 |
| Max. Negotiated Rate |
$3,520.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$157.65
|
| Rate for Payer: BCBS of TX Blue Advantage |
$525.49
|
| Rate for Payer: BCBS of TX Blue Essentials |
$630.59
|
| Rate for Payer: BCBS of TX PPO |
$3,520.00
|
| Rate for Payer: Cash Price |
$1,191.11
|
| Rate for Payer: Cash Price |
$1,191.11
|
| Rate for Payer: Cash Price |
$1,191.11
|
| Rate for Payer: Cigna Medicaid |
$1,261.17
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,261.17
|
| Rate for Payer: Multiplan Auto |
$1,138.56
|
| Rate for Payer: Multiplan Commercial |
$1,138.56
|
| Rate for Payer: Multiplan Workers Comp |
$1,138.56
|
| Rate for Payer: Parkland Medicaid |
$1,261.17
|
| Rate for Payer: Scott and White EPO/PPO |
$53.26
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,261.17
|
| Rate for Payer: Superior Health Plan EPO |
$238.22
|
|
|
CHED LineProcedure Central Line >= 5 y/o BCE
|
Facility
|
IP
|
$3,105.84
|
|
|
Service Code
|
HCPCS 36556
|
| Hospital Charge Code |
8914620
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$2,111.97
|
|
|
CHED LineProcedure Central Line >= 5 y/o BCE
|
Facility
|
OP
|
$3,105.84
|
|
|
Service Code
|
HCPCS 36556
|
| Hospital Charge Code |
8914620
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$101.69 |
| Max. Negotiated Rate |
$6,704.76 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$279.53
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3,171.87
|
| Rate for Payer: Amerigroup Medicare |
$3,171.87
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,723.99
|
| Rate for Payer: BCBS of TX Blue Essentials |
$3,262.26
|
| Rate for Payer: BCBS of TX Medicare |
$3,171.87
|
| Rate for Payer: BCBS of TX PPO |
$4,110.45
|
| Rate for Payer: Cash Price |
$2,111.97
|
| Rate for Payer: Cash Price |
$2,111.97
|
| Rate for Payer: Cash Price |
$2,111.97
|
| Rate for Payer: Cigna Commercial |
$6,704.76
|
| Rate for Payer: Cigna Medicaid |
$2,236.20
|
| Rate for Payer: Cigna Medicare |
$3,171.87
|
| Rate for Payer: Employer Direct Commercial |
$3,171.87
|
| Rate for Payer: Humana Medicare/TRICARE |
$3,171.87
|
| Rate for Payer: Molina CHIP/Medicaid |
$2,236.20
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3,171.87
|
| Rate for Payer: Molina Medicare |
$3,171.87
|
| Rate for Payer: Multiplan Auto |
$2,018.80
|
| Rate for Payer: Multiplan Commercial |
$2,018.80
|
| Rate for Payer: Multiplan Workers Comp |
$2,018.80
|
| Rate for Payer: Parkland Medicaid |
$2,236.20
|
| Rate for Payer: Scott and White EPO/PPO |
$101.69
|
| Rate for Payer: Scott and White Medicare |
$3,171.87
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$2,236.20
|
| Rate for Payer: Superior Health Plan EPO |
$3,171.87
|
| Rate for Payer: Superior Health Plan Medicare |
$3,171.87
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3,171.87
|
| Rate for Payer: Universal American Medicare |
$3,171.87
|
| Rate for Payer: Wellcare Medicare |
$3,171.87
|
| Rate for Payer: Wellmed Medicare |
$3,171.87
|
|
|
CHED LineProcedure Intraosseous Infusion BCE
|
Facility
|
IP
|
$420.53
|
|
|
Service Code
|
HCPCS 36680
|
| Hospital Charge Code |
8914621
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$285.96
|
|
|
CHED LineProcedure Intraosseous Infusion BCE
|
Facility
|
OP
|
$420.53
|
|
|
Service Code
|
HCPCS 36680
|
| Hospital Charge Code |
8914621
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$37.85 |
| Max. Negotiated Rate |
$948.59 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$37.85
|
| 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 |
$285.96
|
| Rate for Payer: Cash Price |
$285.96
|
| Rate for Payer: Cash Price |
$285.96
|
| Rate for Payer: Cigna Commercial |
$948.59
|
| Rate for Payer: Cigna Medicaid |
$302.78
|
| 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 |
$302.78
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$448.76
|
| Rate for Payer: Molina Medicare |
$448.76
|
| Rate for Payer: Multiplan Auto |
$273.34
|
| Rate for Payer: Multiplan Commercial |
$273.34
|
| Rate for Payer: Multiplan Workers Comp |
$273.34
|
| Rate for Payer: Parkland Medicaid |
$302.78
|
| Rate for Payer: Scott and White EPO/PPO |
$71.97
|
| Rate for Payer: Scott and White Medicare |
$448.76
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$302.78
|
| 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 Nail RepairProcedure Debridement of Nail 1-5 BCE
|
Facility
|
OP
|
$993.50
|
|
|
Service Code
|
HCPCS 11720
|
| Hospital Charge Code |
8910640
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$17.20 |
| Max. Negotiated Rate |
$715.32 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$89.42
|
| 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 |
$675.58
|
| Rate for Payer: Cash Price |
$675.58
|
| Rate for Payer: Cash Price |
$675.58
|
| Rate for Payer: Cigna Commercial |
$125.27
|
| Rate for Payer: Cigna Medicaid |
$715.32
|
| 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 |
$715.32
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$59.26
|
| Rate for Payer: Molina Medicare |
$59.26
|
| 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 |
$17.20
|
| Rate for Payer: Scott and White Medicare |
$59.26
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$715.32
|
| 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 Nail RepairProcedure Debridement of Nail 1-5 BCE
|
Facility
|
IP
|
$993.50
|
|
|
Service Code
|
HCPCS 11720
|
| Hospital Charge Code |
8910640
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$675.58
|
|
|
CHED Nail RepairProcedure Debridement of Nail 6+ BCE
|
Facility
|
IP
|
$993.50
|
|
|
Service Code
|
HCPCS 11721
|
| Hospital Charge Code |
8912641
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$675.58
|
|
|
CHED Nail RepairProcedure Debridement of Nail 6+ BCE
|
Facility
|
OP
|
$993.50
|
|
|
Service Code
|
HCPCS 11721
|
| Hospital Charge Code |
8912641
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$28.73 |
| Max. Negotiated Rate |
$715.32 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$89.42
|
| 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 |
$675.58
|
| Rate for Payer: Cash Price |
$675.58
|
| Rate for Payer: Cash Price |
$675.58
|
| Rate for Payer: Cigna Commercial |
$125.27
|
| Rate for Payer: Cigna Medicaid |
$715.32
|
| 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 |
$715.32
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$59.26
|
| Rate for Payer: Molina Medicare |
$59.26
|
| 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 |
$28.73
|
| Rate for Payer: Scott and White Medicare |
$59.26
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$715.32
|
| 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 Nail RepairProcedure Evacuation of subungual hematoma BCE
|
Facility
|
OP
|
$993.50
|
|
|
Service Code
|
HCPCS 11740
|
| Hospital Charge Code |
8914622
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$39.88 |
| Max. Negotiated Rate |
$715.32 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$89.42
|
| 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 |
$675.58
|
| Rate for Payer: Cash Price |
$675.58
|
| Rate for Payer: Cash Price |
$675.58
|
| Rate for Payer: Cigna Commercial |
$282.53
|
| Rate for Payer: Cigna Medicaid |
$715.32
|
| 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 |
$715.32
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$133.65
|
| Rate for Payer: Molina Medicare |
$133.65
|
| 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 |
$39.88
|
| Rate for Payer: Scott and White Medicare |
$133.65
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$715.32
|
| 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 Nail RepairProcedure Evacuation of subungual hematoma BCE
|
Facility
|
IP
|
$993.50
|
|
|
Service Code
|
HCPCS 11740
|
| Hospital Charge Code |
8914622
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$675.58
|
|
|
CHED Nail RepairProcedure Nail and Nail Matrix, Excision BCE
|
Facility
|
IP
|
$8,017.06
|
|
|
Service Code
|
HCPCS 11750
|
| Hospital Charge Code |
8910641
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$5,451.60
|
|
|
CHED Nail RepairProcedure Nail and Nail Matrix, Excision BCE
|
Facility
|
OP
|
$8,017.06
|
|
|
Service Code
|
HCPCS 11750
|
| Hospital Charge Code |
8910641
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$125.69 |
| Max. Negotiated Rate |
$5,772.28 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$721.54
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$408.37
|
| Rate for Payer: Amerigroup Medicare |
$408.37
|
| Rate for Payer: BCBS of TX Blue Advantage |
$165.75
|
| Rate for Payer: BCBS of TX Blue Essentials |
$198.50
|
| Rate for Payer: BCBS of TX Medicare |
$408.37
|
| Rate for Payer: BCBS of TX PPO |
$250.11
|
| Rate for Payer: Cash Price |
$5,451.60
|
| Rate for Payer: Cash Price |
$5,451.60
|
| Rate for Payer: Cash Price |
$5,451.60
|
| Rate for Payer: Cigna Commercial |
$863.21
|
| Rate for Payer: Cigna Medicaid |
$5,772.28
|
| 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 |
$5,772.28
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$408.37
|
| Rate for Payer: Molina Medicare |
$408.37
|
| Rate for Payer: Multiplan Auto |
$5,211.09
|
| Rate for Payer: Multiplan Commercial |
$5,211.09
|
| Rate for Payer: Multiplan Workers Comp |
$5,211.09
|
| Rate for Payer: Parkland Medicaid |
$5,772.28
|
| Rate for Payer: Scott and White EPO/PPO |
$125.69
|
| Rate for Payer: Scott and White Medicare |
$408.37
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$5,772.28
|
| 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 Nail RepairProcedure Nail Bed Repair BCE
|
Facility
|
OP
|
$2,124.70
|
|
|
Service Code
|
HCPCS 11760
|
| Hospital Charge Code |
8914623
|
|
Hospital Revenue Code
|
451
|
| Min. Negotiated Rate |
$134.86 |
| Max. Negotiated Rate |
$1,569.38 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$191.22
|
| 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 |
$1,444.80
|
| Rate for Payer: Cash Price |
$1,444.80
|
| Rate for Payer: Cash Price |
$1,444.80
|
| Rate for Payer: Cigna Commercial |
$1,569.38
|
| Rate for Payer: Cigna Medicaid |
$1,529.78
|
| 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 |
$1,529.78
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$742.44
|
| Rate for Payer: Molina Medicare |
$742.44
|
| Rate for Payer: Multiplan Auto |
$1,381.06
|
| Rate for Payer: Multiplan Commercial |
$1,381.06
|
| Rate for Payer: Multiplan Workers Comp |
$1,381.06
|
| Rate for Payer: Parkland Medicaid |
$1,529.78
|
| Rate for Payer: Scott and White EPO/PPO |
$134.86
|
| Rate for Payer: Scott and White Medicare |
$742.44
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,529.78
|
| 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 Nail RepairProcedure Nail Bed Repair BCE
|
Facility
|
IP
|
$2,124.70
|
|
|
Service Code
|
HCPCS 11760
|
| Hospital Charge Code |
8914623
|
|
Hospital Revenue Code
|
451
|
| Rate for Payer: Cash Price |
$1,444.80
|
|
|
CHED Nail RepairProcedure Nail plate avulsion, single BCE
|
Facility
|
OP
|
$993.50
|
|
|
Service Code
|
HCPCS 11730
|
| Hospital Charge Code |
8914624
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$65.64 |
| 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 |
$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 |
$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 |
$65.64
|
| 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 Nail RepairProcedure Nail plate avulsion, single BCE
|
Facility
|
IP
|
$993.50
|
|
|
Service Code
|
HCPCS 11730
|
| Hospital Charge Code |
8914624
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$675.58
|
|
|
CHED Nail RepairProcedure Trim Nondystrophic Nails BCE
|
Facility
|
IP
|
$993.50
|
|
|
Service Code
|
HCPCS 11719
|
| Hospital Charge Code |
8912642
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$675.58
|
|
|
CHED Nail RepairProcedure Trim Nondystrophic Nails BCE
|
Facility
|
OP
|
$993.50
|
|
|
Service Code
|
HCPCS 11719
|
| Hospital Charge Code |
8912642
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$9.04 |
| Max. Negotiated Rate |
$715.32 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$89.42
|
| 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 |
$675.58
|
| Rate for Payer: Cash Price |
$675.58
|
| Rate for Payer: Cash Price |
$675.58
|
| Rate for Payer: Cigna Commercial |
$125.27
|
| Rate for Payer: Cigna Medicaid |
$715.32
|
| 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 |
$715.32
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$59.26
|
| Rate for Payer: Molina Medicare |
$59.26
|
| 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 |
$9.04
|
| Rate for Payer: Scott and White Medicare |
$59.26
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$715.32
|
| 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 NASO/ORO-GASTRIC TUBE PLMT REQ PHYS&FLUOR GDNCE BCE
|
Facility
|
OP
|
$1,019.75
|
|
|
Service Code
|
HCPCS 43752
|
| Hospital Charge Code |
8964548
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$48.24 |
| Max. Negotiated Rate |
$948.59 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$91.78
|
| 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 |
$693.43
|
| Rate for Payer: Cash Price |
$693.43
|
| Rate for Payer: Cash Price |
$693.43
|
| Rate for Payer: Cigna Commercial |
$948.59
|
| Rate for Payer: Cigna Medicaid |
$734.22
|
| 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 |
$734.22
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$448.76
|
| Rate for Payer: Molina Medicare |
$448.76
|
| Rate for Payer: Multiplan Auto |
$662.84
|
| Rate for Payer: Multiplan Commercial |
$662.84
|
| Rate for Payer: Multiplan Workers Comp |
$662.84
|
| Rate for Payer: Parkland Medicaid |
$734.22
|
| Rate for Payer: Scott and White EPO/PPO |
$48.24
|
| Rate for Payer: Scott and White Medicare |
$448.76
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$734.22
|
| 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 NASO/ORO-GASTRIC TUBE PLMT REQ PHYS&FLUOR GDNCE BCE
|
Facility
|
IP
|
$1,019.75
|
|
|
Service Code
|
HCPCS 43752
|
| Hospital Charge Code |
4613752
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$693.43
|
|
|
CHED NASO/ORO-GASTRIC TUBE PLMT REQ PHYS&FLUOR GDNCE BCE
|
Facility
|
IP
|
$1,019.75
|
|
|
Service Code
|
HCPCS 43752
|
| Hospital Charge Code |
8964548
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$693.43
|
|
|
CHED NASO/ORO-GASTRIC TUBE PLMT REQ PHYS&FLUOR GDNCE BCE
|
Facility
|
OP
|
$1,019.75
|
|
|
Service Code
|
HCPCS 43752
|
| Hospital Charge Code |
4613752
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$48.24 |
| Max. Negotiated Rate |
$948.59 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$91.78
|
| 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 |
$693.43
|
| Rate for Payer: Cash Price |
$693.43
|
| Rate for Payer: Cash Price |
$693.43
|
| Rate for Payer: Cigna Commercial |
$948.59
|
| Rate for Payer: Cigna Medicaid |
$734.22
|
| 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 |
$734.22
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$448.76
|
| Rate for Payer: Molina Medicare |
$448.76
|
| Rate for Payer: Multiplan Auto |
$662.84
|
| Rate for Payer: Multiplan Commercial |
$662.84
|
| Rate for Payer: Multiplan Workers Comp |
$662.84
|
| Rate for Payer: Parkland Medicaid |
$734.22
|
| Rate for Payer: Scott and White EPO/PPO |
$48.24
|
| Rate for Payer: Scott and White Medicare |
$448.76
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$734.22
|
| 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 Nosebleed Complexity Anterior, Simple BCE
|
Facility
|
OP
|
$488.04
|
|
|
Service Code
|
HCPCS 30901
|
| Hospital Charge Code |
8914625
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$43.92 |
| Max. Negotiated Rate |
$351.39 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$43.92
|
| 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 |
$331.87
|
| Rate for Payer: Cash Price |
$331.87
|
| Rate for Payer: Cash Price |
$331.87
|
| Rate for Payer: Cigna Commercial |
$282.53
|
| Rate for Payer: Cigna Medicaid |
$351.39
|
| 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 |
$351.39
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$133.65
|
| Rate for Payer: Molina Medicare |
$133.65
|
| Rate for Payer: Multiplan Auto |
$317.23
|
| Rate for Payer: Multiplan Commercial |
$317.23
|
| Rate for Payer: Multiplan Workers Comp |
$317.23
|
| Rate for Payer: Parkland Medicaid |
$351.39
|
| Rate for Payer: Scott and White EPO/PPO |
$68.83
|
| Rate for Payer: Scott and White Medicare |
$133.65
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$351.39
|
| 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 Nosebleed Complexity Anterior, Simple BCE
|
Facility
|
IP
|
$488.04
|
|
|
Service Code
|
HCPCS 30901
|
| Hospital Charge Code |
8914625
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$331.87
|
|
