|
CHED Orthopedic Splinting Site Posterior Short Leg Splint BCE
|
Facility
|
IP
|
$553.30
|
|
|
Service Code
|
HCPCS 29515
|
| Hospital Charge Code |
8910644
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$376.24
|
|
|
CHED Orthopedic Strapping Site Toes BCE
|
Facility
|
OP
|
$329.19
|
|
|
Service Code
|
HCPCS 29550
|
| Hospital Charge Code |
8912647
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$13.54 |
| Max. Negotiated Rate |
$237.02 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$29.63
|
| 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 |
$223.85
|
| Rate for Payer: Cash Price |
$223.85
|
| Rate for Payer: Cash Price |
$223.85
|
| Rate for Payer: Cigna Commercial |
$125.27
|
| Rate for Payer: Cigna Medicaid |
$237.02
|
| 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 |
$237.02
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$59.26
|
| Rate for Payer: Molina Medicare |
$59.26
|
| Rate for Payer: Multiplan Auto |
$213.97
|
| Rate for Payer: Multiplan Commercial |
$213.97
|
| Rate for Payer: Multiplan Workers Comp |
$213.97
|
| Rate for Payer: Parkland Medicaid |
$237.02
|
| Rate for Payer: Scott and White EPO/PPO |
$13.54
|
| Rate for Payer: Scott and White Medicare |
$59.26
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$237.02
|
| 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 Orthopedic Strapping Site Toes BCE
|
Facility
|
IP
|
$329.19
|
|
|
Service Code
|
HCPCS 29550
|
| Hospital Charge Code |
8912647
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$223.85
|
|
|
CHED Orthopedic Strapping Site Unna boot BCE
|
Facility
|
OP
|
$993.50
|
|
|
Service Code
|
HCPCS 29580
|
| Hospital Charge Code |
8914628
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$31.86 |
| Max. Negotiated Rate |
$715.32 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$89.42
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$163.24
|
| Rate for Payer: Amerigroup Medicare |
$163.24
|
| Rate for Payer: BCBS of TX Blue Advantage |
$70.51
|
| Rate for Payer: BCBS of TX Blue Essentials |
$84.44
|
| Rate for Payer: BCBS of TX Medicare |
$163.24
|
| Rate for Payer: BCBS of TX PPO |
$106.39
|
| 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 |
$345.06
|
| Rate for Payer: Cigna Medicaid |
$715.32
|
| Rate for Payer: Cigna Medicare |
$163.24
|
| Rate for Payer: Employer Direct Commercial |
$163.24
|
| Rate for Payer: Humana Medicare/TRICARE |
$163.24
|
| Rate for Payer: Molina CHIP/Medicaid |
$715.32
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$163.24
|
| Rate for Payer: Molina Medicare |
$163.24
|
| 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 |
$31.86
|
| Rate for Payer: Scott and White Medicare |
$163.24
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$715.32
|
| Rate for Payer: Superior Health Plan EPO |
$163.24
|
| Rate for Payer: Superior Health Plan Medicare |
$163.24
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$163.24
|
| Rate for Payer: Universal American Medicare |
$163.24
|
| Rate for Payer: Wellcare Medicare |
$163.24
|
| Rate for Payer: Wellmed Medicare |
$163.24
|
|
|
CHED Orthopedic Strapping Site Unna boot BCE
|
Facility
|
IP
|
$993.50
|
|
|
Service Code
|
HCPCS 29580
|
| Hospital Charge Code |
8914628
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$675.58
|
|
|
CHED Paracentesis with imaging BCE
|
Facility
|
OP
|
$2,613.56
|
|
|
Service Code
|
HCPCS 49083
|
| Hospital Charge Code |
8910646
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$127.86 |
| Max. Negotiated Rate |
$1,980.52 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$235.22
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$911.12
|
| Rate for Payer: Amerigroup Medicare |
$911.12
|
| Rate for Payer: BCBS of TX Blue Advantage |
$1,312.49
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,571.84
|
| Rate for Payer: BCBS of TX Medicare |
$911.12
|
| Rate for Payer: BCBS of TX PPO |
$1,980.52
|
| Rate for Payer: Cash Price |
$1,777.22
|
| Rate for Payer: Cash Price |
$1,777.22
|
| Rate for Payer: Cash Price |
$1,777.22
|
| Rate for Payer: Cigna Commercial |
$1,925.93
|
| Rate for Payer: Cigna Medicaid |
$1,881.76
|
| Rate for Payer: Cigna Medicare |
$911.12
|
| Rate for Payer: Employer Direct Commercial |
$911.12
|
| Rate for Payer: Humana Medicare/TRICARE |
$911.12
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,881.76
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$911.12
|
| Rate for Payer: Molina Medicare |
$911.12
|
| Rate for Payer: Multiplan Auto |
$1,698.81
|
| Rate for Payer: Multiplan Commercial |
$1,698.81
|
| Rate for Payer: Multiplan Workers Comp |
$1,698.81
|
| Rate for Payer: Parkland Medicaid |
$1,881.76
|
| Rate for Payer: Scott and White EPO/PPO |
$127.86
|
| Rate for Payer: Scott and White Medicare |
$911.12
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,881.76
|
| Rate for Payer: Superior Health Plan EPO |
$911.12
|
| Rate for Payer: Superior Health Plan Medicare |
$911.12
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$911.12
|
| Rate for Payer: Universal American Medicare |
$911.12
|
| Rate for Payer: Wellcare Medicare |
$911.12
|
| Rate for Payer: Wellmed Medicare |
$911.12
|
|
|
CHED Paracentesis with imaging BCE
|
Facility
|
IP
|
$2,613.56
|
|
|
Service Code
|
HCPCS 49083
|
| Hospital Charge Code |
8910646
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$1,777.22
|
|
|
CHED Paracentesis without imaging BCE
|
Facility
|
IP
|
$2,308.91
|
|
|
Service Code
|
HCPCS 49082
|
| Hospital Charge Code |
3520069
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$1,570.06
|
|
|
CHED Paracentesis without imaging BCE
|
Facility
|
OP
|
$2,308.91
|
|
|
Service Code
|
HCPCS 49082
|
| Hospital Charge Code |
3520069
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$89.05 |
| Max. Negotiated Rate |
$1,980.52 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$207.80
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$911.12
|
| Rate for Payer: Amerigroup Medicare |
$911.12
|
| Rate for Payer: BCBS of TX Blue Advantage |
$1,312.49
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,571.84
|
| Rate for Payer: BCBS of TX Medicare |
$911.12
|
| Rate for Payer: BCBS of TX PPO |
$1,980.52
|
| Rate for Payer: Cash Price |
$1,570.06
|
| Rate for Payer: Cash Price |
$1,570.06
|
| Rate for Payer: Cash Price |
$1,570.06
|
| Rate for Payer: Cigna Commercial |
$1,925.93
|
| Rate for Payer: Cigna Medicaid |
$1,662.42
|
| Rate for Payer: Cigna Medicare |
$911.12
|
| Rate for Payer: Employer Direct Commercial |
$911.12
|
| Rate for Payer: Humana Medicare/TRICARE |
$911.12
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,662.42
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$911.12
|
| Rate for Payer: Molina Medicare |
$911.12
|
| Rate for Payer: Multiplan Auto |
$1,500.79
|
| Rate for Payer: Multiplan Commercial |
$1,500.79
|
| Rate for Payer: Multiplan Workers Comp |
$1,500.79
|
| Rate for Payer: Parkland Medicaid |
$1,662.42
|
| Rate for Payer: Scott and White EPO/PPO |
$89.05
|
| Rate for Payer: Scott and White Medicare |
$911.12
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,662.42
|
| Rate for Payer: Superior Health Plan EPO |
$911.12
|
| Rate for Payer: Superior Health Plan Medicare |
$911.12
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$911.12
|
| Rate for Payer: Universal American Medicare |
$911.12
|
| Rate for Payer: Wellcare Medicare |
$911.12
|
| Rate for Payer: Wellmed Medicare |
$911.12
|
|
|
CHED PICC Line Insertion >= 5 Years BCE
|
Facility
|
IP
|
$3,367.48
|
|
|
Service Code
|
HCPCS 36569
|
| Hospital Charge Code |
8912650
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$2,289.89
|
|
|
CHED PICC Line Insertion >= 5 Years BCE
|
Facility
|
OP
|
$3,367.48
|
|
|
Service Code
|
HCPCS 36569
|
| Hospital Charge Code |
8912650
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$113.76 |
| Max. Negotiated Rate |
$4,110.45 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$303.07
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,581.33
|
| Rate for Payer: Amerigroup Medicare |
$1,581.33
|
| 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 |
$1,581.33
|
| Rate for Payer: BCBS of TX PPO |
$4,110.45
|
| Rate for Payer: Cash Price |
$2,289.89
|
| Rate for Payer: Cash Price |
$2,289.89
|
| Rate for Payer: Cash Price |
$2,289.89
|
| Rate for Payer: Cigna Commercial |
$3,342.63
|
| Rate for Payer: Cigna Medicaid |
$2,424.59
|
| Rate for Payer: Cigna Medicare |
$1,581.33
|
| Rate for Payer: Employer Direct Commercial |
$1,581.33
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,581.33
|
| Rate for Payer: Molina CHIP/Medicaid |
$2,424.59
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,581.33
|
| Rate for Payer: Molina Medicare |
$1,581.33
|
| Rate for Payer: Multiplan Auto |
$2,188.86
|
| Rate for Payer: Multiplan Commercial |
$2,188.86
|
| Rate for Payer: Multiplan Workers Comp |
$2,188.86
|
| Rate for Payer: Parkland Medicaid |
$2,424.59
|
| Rate for Payer: Scott and White EPO/PPO |
$113.76
|
| Rate for Payer: Scott and White Medicare |
$1,581.33
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$2,424.59
|
| Rate for Payer: Superior Health Plan EPO |
$1,581.33
|
| Rate for Payer: Superior Health Plan Medicare |
$1,581.33
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,581.33
|
| Rate for Payer: Universal American Medicare |
$1,581.33
|
| Rate for Payer: Wellcare Medicare |
$1,581.33
|
| Rate for Payer: Wellmed Medicare |
$1,581.33
|
|
|
CHED Pneum Initial Admin Charge 90471/G0009 BCE
|
Facility
|
OP
|
$58.00
|
|
|
Service Code
|
HCPCS 90471
|
| Hospital Charge Code |
8914631
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$152.89 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$5.22
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$72.33
|
| Rate for Payer: Amerigroup Medicare |
$72.33
|
| Rate for Payer: BCBS of TX Blue Advantage |
$17.40
|
| Rate for Payer: BCBS of TX Blue Essentials |
$20.88
|
| Rate for Payer: BCBS of TX Medicare |
$72.33
|
| Rate for Payer: BCBS of TX PPO |
$23.20
|
| Rate for Payer: Cash Price |
$39.44
|
| Rate for Payer: Cash Price |
$39.44
|
| Rate for Payer: Cash Price |
$39.44
|
| Rate for Payer: Cigna Commercial |
$152.89
|
| Rate for Payer: Cigna Medicaid |
$41.76
|
| Rate for Payer: Cigna Medicare |
$72.33
|
| Rate for Payer: Employer Direct Commercial |
$72.33
|
| Rate for Payer: Humana Medicare/TRICARE |
$72.33
|
| Rate for Payer: Molina CHIP/Medicaid |
$41.76
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$72.33
|
| Rate for Payer: Molina Medicare |
$72.33
|
| Rate for Payer: Multiplan Auto |
$37.70
|
| Rate for Payer: Multiplan Commercial |
$37.70
|
| Rate for Payer: Multiplan Workers Comp |
$37.70
|
| Rate for Payer: Parkland Medicaid |
$41.76
|
| Rate for Payer: Scott and White EPO/PPO |
$25.52
|
| Rate for Payer: Scott and White Medicare |
$72.33
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$41.76
|
| Rate for Payer: Superior Health Plan EPO |
$72.33
|
| Rate for Payer: Superior Health Plan Medicare |
$72.33
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$72.33
|
| Rate for Payer: Universal American Medicare |
$72.33
|
| Rate for Payer: Wellcare Medicare |
$72.33
|
| Rate for Payer: Wellmed Medicare |
$72.33
|
|
|
CHED Pneum Initial Admin Charge 90471/G0009 BCE
|
Facility
|
OP
|
$58.00
|
|
|
Service Code
|
HCPCS 90471
|
| Hospital Charge Code |
8914588
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$152.89 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$5.22
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$72.33
|
| Rate for Payer: Amerigroup Medicare |
$72.33
|
| Rate for Payer: BCBS of TX Blue Advantage |
$17.40
|
| Rate for Payer: BCBS of TX Blue Essentials |
$20.88
|
| Rate for Payer: BCBS of TX Medicare |
$72.33
|
| Rate for Payer: BCBS of TX PPO |
$23.20
|
| Rate for Payer: Cash Price |
$39.44
|
| Rate for Payer: Cash Price |
$39.44
|
| Rate for Payer: Cash Price |
$39.44
|
| Rate for Payer: Cigna Commercial |
$152.89
|
| Rate for Payer: Cigna Medicaid |
$41.76
|
| Rate for Payer: Cigna Medicare |
$72.33
|
| Rate for Payer: Employer Direct Commercial |
$72.33
|
| Rate for Payer: Humana Medicare/TRICARE |
$72.33
|
| Rate for Payer: Molina CHIP/Medicaid |
$41.76
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$72.33
|
| Rate for Payer: Molina Medicare |
$72.33
|
| Rate for Payer: Multiplan Auto |
$37.70
|
| Rate for Payer: Multiplan Commercial |
$37.70
|
| Rate for Payer: Multiplan Workers Comp |
$37.70
|
| Rate for Payer: Parkland Medicaid |
$41.76
|
| Rate for Payer: Scott and White EPO/PPO |
$25.52
|
| Rate for Payer: Scott and White Medicare |
$72.33
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$41.76
|
| Rate for Payer: Superior Health Plan EPO |
$72.33
|
| Rate for Payer: Superior Health Plan Medicare |
$72.33
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$72.33
|
| Rate for Payer: Universal American Medicare |
$72.33
|
| Rate for Payer: Wellcare Medicare |
$72.33
|
| Rate for Payer: Wellmed Medicare |
$72.33
|
|
|
CHED Pneum Initial Admin Charge 90471/G0009 BCE
|
Facility
|
IP
|
$58.00
|
|
|
Service Code
|
HCPCS 90471
|
| Hospital Charge Code |
8914631
|
|
Hospital Revenue Code
|
771
|
| Rate for Payer: Cash Price |
$39.44
|
|
|
CHED Pneum Initial Admin Charge 90471/G0009 BCE
|
Facility
|
IP
|
$58.00
|
|
|
Service Code
|
HCPCS 90471
|
| Hospital Charge Code |
8914588
|
|
Hospital Revenue Code
|
771
|
| Rate for Payer: Cash Price |
$39.44
|
|
|
CHED PRESSD NONPRESSD INHAL TRMENT BCE
|
Facility
|
IP
|
$385.53
|
|
|
Service Code
|
HCPCS 94640
|
| Hospital Charge Code |
8910645
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$262.16
|
|
|
CHED PRESSD NONPRESSD INHAL TRMENT BCE
|
Facility
|
OP
|
$385.53
|
|
|
Service Code
|
HCPCS 94640
|
| Hospital Charge Code |
4049136
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$9.84 |
| Max. Negotiated Rate |
$3,520.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$34.70
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$219.97
|
| Rate for Payer: Amerigroup Medicare |
$219.97
|
| Rate for Payer: BCBS of TX Blue Advantage |
$115.66
|
| Rate for Payer: BCBS of TX Blue Essentials |
$138.79
|
| Rate for Payer: BCBS of TX Medicare |
$219.97
|
| Rate for Payer: BCBS of TX PPO |
$3,520.00
|
| Rate for Payer: Cash Price |
$262.16
|
| Rate for Payer: Cash Price |
$262.16
|
| Rate for Payer: Cash Price |
$262.16
|
| Rate for Payer: Cigna Commercial |
$464.99
|
| Rate for Payer: Cigna Medicaid |
$277.58
|
| Rate for Payer: Cigna Medicare |
$219.97
|
| Rate for Payer: Employer Direct Commercial |
$219.97
|
| Rate for Payer: Humana Medicare/TRICARE |
$219.97
|
| Rate for Payer: Molina CHIP/Medicaid |
$277.58
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$219.97
|
| Rate for Payer: Molina Medicare |
$219.97
|
| Rate for Payer: Multiplan Auto |
$250.59
|
| Rate for Payer: Multiplan Commercial |
$250.59
|
| Rate for Payer: Multiplan Workers Comp |
$250.59
|
| Rate for Payer: Parkland Medicaid |
$277.58
|
| Rate for Payer: Scott and White EPO/PPO |
$9.84
|
| Rate for Payer: Scott and White Medicare |
$219.97
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$277.58
|
| Rate for Payer: Superior Health Plan EPO |
$219.97
|
| Rate for Payer: Superior Health Plan Medicare |
$219.97
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$219.97
|
| Rate for Payer: Universal American Medicare |
$219.97
|
| Rate for Payer: Wellcare Medicare |
$219.97
|
| Rate for Payer: Wellmed Medicare |
$219.97
|
|
|
CHED PRESSD NONPRESSD INHAL TRMENT BCE
|
Facility
|
OP
|
$385.53
|
|
|
Service Code
|
HCPCS 94640
|
| Hospital Charge Code |
8910645
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$9.84 |
| Max. Negotiated Rate |
$3,520.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$34.70
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$219.97
|
| Rate for Payer: Amerigroup Medicare |
$219.97
|
| Rate for Payer: BCBS of TX Blue Advantage |
$115.66
|
| Rate for Payer: BCBS of TX Blue Essentials |
$138.79
|
| Rate for Payer: BCBS of TX Medicare |
$219.97
|
| Rate for Payer: BCBS of TX PPO |
$3,520.00
|
| Rate for Payer: Cash Price |
$262.16
|
| Rate for Payer: Cash Price |
$262.16
|
| Rate for Payer: Cash Price |
$262.16
|
| Rate for Payer: Cigna Commercial |
$464.99
|
| Rate for Payer: Cigna Medicaid |
$277.58
|
| Rate for Payer: Cigna Medicare |
$219.97
|
| Rate for Payer: Employer Direct Commercial |
$219.97
|
| Rate for Payer: Humana Medicare/TRICARE |
$219.97
|
| Rate for Payer: Molina CHIP/Medicaid |
$277.58
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$219.97
|
| Rate for Payer: Molina Medicare |
$219.97
|
| Rate for Payer: Multiplan Auto |
$250.59
|
| Rate for Payer: Multiplan Commercial |
$250.59
|
| Rate for Payer: Multiplan Workers Comp |
$250.59
|
| Rate for Payer: Parkland Medicaid |
$277.58
|
| Rate for Payer: Scott and White EPO/PPO |
$9.84
|
| Rate for Payer: Scott and White Medicare |
$219.97
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$277.58
|
| Rate for Payer: Superior Health Plan EPO |
$219.97
|
| Rate for Payer: Superior Health Plan Medicare |
$219.97
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$219.97
|
| Rate for Payer: Universal American Medicare |
$219.97
|
| Rate for Payer: Wellcare Medicare |
$219.97
|
| Rate for Payer: Wellmed Medicare |
$219.97
|
|
|
CHED PRESSD NONPRESSD INHAL TRMENT BCE
|
Facility
|
IP
|
$385.53
|
|
|
Service Code
|
HCPCS 94640
|
| Hospital Charge Code |
4049136
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$262.16
|
|
|
CHED PUNCTURE ASPIRATION CYST BREAST BCE
|
Facility
|
OP
|
$647.00
|
|
|
Service Code
|
HCPCS 19000
|
| Hospital Charge Code |
8926640
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$51.08 |
| Max. Negotiated Rate |
$1,503.68 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$58.23
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$711.36
|
| Rate for Payer: Amerigroup Medicare |
$711.36
|
| Rate for Payer: BCBS of TX Blue Advantage |
$130.18
|
| Rate for Payer: BCBS of TX Blue Essentials |
$155.90
|
| Rate for Payer: BCBS of TX Medicare |
$711.36
|
| Rate for Payer: BCBS of TX PPO |
$196.43
|
| Rate for Payer: Cash Price |
$439.96
|
| Rate for Payer: Cash Price |
$439.96
|
| Rate for Payer: Cash Price |
$439.96
|
| Rate for Payer: Cigna Commercial |
$1,503.68
|
| Rate for Payer: Cigna Medicaid |
$465.84
|
| 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 |
$465.84
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$711.36
|
| Rate for Payer: Molina Medicare |
$711.36
|
| Rate for Payer: Multiplan Auto |
$420.55
|
| Rate for Payer: Multiplan Commercial |
$420.55
|
| Rate for Payer: Multiplan Workers Comp |
$420.55
|
| Rate for Payer: Parkland Medicaid |
$465.84
|
| Rate for Payer: Scott and White EPO/PPO |
$51.08
|
| Rate for Payer: Scott and White Medicare |
$711.36
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$465.84
|
| 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 PUNCTURE ASPIRATION CYST BREAST BCE
|
Facility
|
OP
|
$647.00
|
|
|
Service Code
|
HCPCS 19000
|
| Hospital Charge Code |
8922672
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$51.08 |
| Max. Negotiated Rate |
$1,503.68 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$58.23
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$711.36
|
| Rate for Payer: Amerigroup Medicare |
$711.36
|
| Rate for Payer: BCBS of TX Blue Advantage |
$130.18
|
| Rate for Payer: BCBS of TX Blue Essentials |
$155.90
|
| Rate for Payer: BCBS of TX Medicare |
$711.36
|
| Rate for Payer: BCBS of TX PPO |
$196.43
|
| Rate for Payer: Cash Price |
$439.96
|
| Rate for Payer: Cash Price |
$439.96
|
| Rate for Payer: Cash Price |
$439.96
|
| Rate for Payer: Cigna Commercial |
$1,503.68
|
| Rate for Payer: Cigna Medicaid |
$465.84
|
| 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 |
$465.84
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$711.36
|
| Rate for Payer: Molina Medicare |
$711.36
|
| Rate for Payer: Multiplan Auto |
$420.55
|
| Rate for Payer: Multiplan Commercial |
$420.55
|
| Rate for Payer: Multiplan Workers Comp |
$420.55
|
| Rate for Payer: Parkland Medicaid |
$465.84
|
| Rate for Payer: Scott and White EPO/PPO |
$51.08
|
| Rate for Payer: Scott and White Medicare |
$711.36
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$465.84
|
| 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 PUNCTURE ASPIRATION CYST BREAST BCE
|
Facility
|
IP
|
$647.00
|
|
|
Service Code
|
HCPCS 19000
|
| Hospital Charge Code |
8922672
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$439.96
|
|
|
CHED PUNCTURE ASPIRATION CYST BREAST BCE
|
Facility
|
IP
|
$647.00
|
|
|
Service Code
|
HCPCS 19000
|
| Hospital Charge Code |
8926640
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$439.96
|
|
|
CHED REM FB EYE CONJUNCTIVAL SUPERFICIAL BCE
|
Facility
|
OP
|
$619.27
|
|
|
Service Code
|
HCPCS 65205
|
| Hospital Charge Code |
8984540
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$35.36 |
| Max. Negotiated Rate |
$445.87 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$55.73
|
| 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 |
$421.10
|
| Rate for Payer: Cash Price |
$421.10
|
| Rate for Payer: Cash Price |
$421.10
|
| Rate for Payer: Cigna Commercial |
$282.53
|
| Rate for Payer: Cigna Medicaid |
$445.87
|
| 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 |
$445.87
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$133.65
|
| Rate for Payer: Molina Medicare |
$133.65
|
| Rate for Payer: Multiplan Auto |
$402.53
|
| Rate for Payer: Multiplan Commercial |
$402.53
|
| Rate for Payer: Multiplan Workers Comp |
$402.53
|
| Rate for Payer: Parkland Medicaid |
$445.87
|
| Rate for Payer: Scott and White EPO/PPO |
$35.36
|
| Rate for Payer: Scott and White Medicare |
$133.65
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$445.87
|
| 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 REM FB EYE CONJUNCTIVAL SUPERFICIAL BCE
|
Facility
|
OP
|
$619.27
|
|
|
Service Code
|
HCPCS 65205
|
| Hospital Charge Code |
9028991
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$35.36 |
| Max. Negotiated Rate |
$445.87 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$55.73
|
| 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 |
$421.10
|
| Rate for Payer: Cash Price |
$421.10
|
| Rate for Payer: Cash Price |
$421.10
|
| Rate for Payer: Cigna Commercial |
$282.53
|
| Rate for Payer: Cigna Medicaid |
$445.87
|
| 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 |
$445.87
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$133.65
|
| Rate for Payer: Molina Medicare |
$133.65
|
| Rate for Payer: Multiplan Auto |
$402.53
|
| Rate for Payer: Multiplan Commercial |
$402.53
|
| Rate for Payer: Multiplan Workers Comp |
$402.53
|
| Rate for Payer: Parkland Medicaid |
$445.87
|
| Rate for Payer: Scott and White EPO/PPO |
$35.36
|
| Rate for Payer: Scott and White Medicare |
$133.65
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$445.87
|
| 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
|
|
