|
CHED Trauma 1 (full) BCE
|
Facility
|
IP
|
$7,088.00
|
|
|
Service Code
|
HCPCS G0390
|
| Hospital Charge Code |
8930546
|
|
Hospital Revenue Code
|
681
|
| Rate for Payer: Cash Price |
$4,819.84
|
|
|
CHED Trauma 1 (full) BCE
|
Facility
|
OP
|
$7,088.00
|
|
|
Service Code
|
HCPCS G0390
|
| Hospital Charge Code |
8930546
|
|
Hospital Revenue Code
|
681
|
| Min. Negotiated Rate |
$637.92 |
| Max. Negotiated Rate |
$5,103.36 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$637.92
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,338.98
|
| Rate for Payer: Amerigroup Medicare |
$1,338.98
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,126.40
|
| Rate for Payer: BCBS of TX Blue Essentials |
$2,551.68
|
| Rate for Payer: BCBS of TX Medicare |
$1,338.98
|
| Rate for Payer: BCBS of TX PPO |
$2,835.20
|
| Rate for Payer: Cash Price |
$4,819.84
|
| Rate for Payer: Cash Price |
$4,819.84
|
| Rate for Payer: Cash Price |
$4,819.84
|
| Rate for Payer: Cigna Commercial |
$2,830.37
|
| Rate for Payer: Cigna Medicaid |
$5,103.36
|
| Rate for Payer: Cigna Medicare |
$1,338.98
|
| Rate for Payer: Employer Direct Commercial |
$1,338.98
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,338.98
|
| Rate for Payer: Molina CHIP/Medicaid |
$5,103.36
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,338.98
|
| Rate for Payer: Molina Medicare |
$1,338.98
|
| Rate for Payer: Multiplan Auto |
$4,607.20
|
| Rate for Payer: Multiplan Commercial |
$4,607.20
|
| Rate for Payer: Multiplan Workers Comp |
$4,607.20
|
| Rate for Payer: Parkland Medicaid |
$5,103.36
|
| Rate for Payer: Scott and White EPO/PPO |
$3,544.00
|
| Rate for Payer: Scott and White Medicare |
$1,338.98
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$5,103.36
|
| Rate for Payer: Superior Health Plan EPO |
$1,338.98
|
| Rate for Payer: Superior Health Plan Medicare |
$1,338.98
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,338.98
|
| Rate for Payer: Universal American Medicare |
$1,338.98
|
| Rate for Payer: Wellcare Medicare |
$1,338.98
|
| Rate for Payer: Wellmed Medicare |
$1,338.98
|
|
|
CHED Trauma Response - Level II Trauma BCE
|
Facility
|
OP
|
$5,316.00
|
|
|
Service Code
|
HCPCS G0390
|
| Hospital Charge Code |
8932548
|
|
Hospital Revenue Code
|
682
|
| Min. Negotiated Rate |
$478.44 |
| Max. Negotiated Rate |
$3,827.52 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$478.44
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,338.98
|
| Rate for Payer: Amerigroup Medicare |
$1,338.98
|
| Rate for Payer: BCBS of TX Blue Advantage |
$1,594.80
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,913.76
|
| Rate for Payer: BCBS of TX Medicare |
$1,338.98
|
| Rate for Payer: BCBS of TX PPO |
$2,126.40
|
| Rate for Payer: Cash Price |
$3,614.88
|
| Rate for Payer: Cash Price |
$3,614.88
|
| Rate for Payer: Cash Price |
$3,614.88
|
| Rate for Payer: Cigna Commercial |
$2,830.37
|
| Rate for Payer: Cigna Medicaid |
$3,827.52
|
| Rate for Payer: Cigna Medicare |
$1,338.98
|
| Rate for Payer: Employer Direct Commercial |
$1,338.98
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,338.98
|
| Rate for Payer: Molina CHIP/Medicaid |
$3,827.52
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,338.98
|
| Rate for Payer: Molina Medicare |
$1,338.98
|
| Rate for Payer: Multiplan Auto |
$3,455.40
|
| Rate for Payer: Multiplan Commercial |
$3,455.40
|
| Rate for Payer: Multiplan Workers Comp |
$3,455.40
|
| Rate for Payer: Parkland Medicaid |
$3,827.52
|
| Rate for Payer: Scott and White EPO/PPO |
$2,658.00
|
| Rate for Payer: Scott and White Medicare |
$1,338.98
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$3,827.52
|
| Rate for Payer: Superior Health Plan EPO |
$1,338.98
|
| Rate for Payer: Superior Health Plan Medicare |
$1,338.98
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,338.98
|
| Rate for Payer: Universal American Medicare |
$1,338.98
|
| Rate for Payer: Wellcare Medicare |
$1,338.98
|
| Rate for Payer: Wellmed Medicare |
$1,338.98
|
|
|
CHED Trauma Response - Level II Trauma BCE
|
Facility
|
IP
|
$5,316.00
|
|
|
Service Code
|
HCPCS G0390
|
| Hospital Charge Code |
8932548
|
|
Hospital Revenue Code
|
682
|
| Rate for Payer: Cash Price |
$3,614.88
|
|
|
CHED TX FX METACARPAL W/O MAN CLSD BCE
|
Facility
|
OP
|
$682.00
|
|
|
Service Code
|
HCPCS 26600
|
| Hospital Charge Code |
8912663
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$61.38 |
| Max. Negotiated Rate |
$523.79 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$61.38
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$247.79
|
| Rate for Payer: Amerigroup Medicare |
$247.79
|
| Rate for Payer: BCBS of TX Blue Advantage |
$181.96
|
| Rate for Payer: BCBS of TX Blue Essentials |
$217.92
|
| Rate for Payer: BCBS of TX Medicare |
$247.79
|
| Rate for Payer: BCBS of TX PPO |
$274.58
|
| Rate for Payer: Cash Price |
$463.76
|
| Rate for Payer: Cash Price |
$463.76
|
| Rate for Payer: Cash Price |
$463.76
|
| Rate for Payer: Cigna Commercial |
$523.79
|
| Rate for Payer: Cigna Medicaid |
$491.04
|
| Rate for Payer: Cigna Medicare |
$247.79
|
| Rate for Payer: Employer Direct Commercial |
$247.79
|
| Rate for Payer: Humana Medicare/TRICARE |
$247.79
|
| Rate for Payer: Molina CHIP/Medicaid |
$491.04
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$247.79
|
| Rate for Payer: Molina Medicare |
$247.79
|
| Rate for Payer: Multiplan Auto |
$443.30
|
| Rate for Payer: Multiplan Commercial |
$443.30
|
| Rate for Payer: Multiplan Workers Comp |
$443.30
|
| Rate for Payer: Parkland Medicaid |
$491.04
|
| Rate for Payer: Scott and White EPO/PPO |
$341.00
|
| Rate for Payer: Scott and White Medicare |
$247.79
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$491.04
|
| Rate for Payer: Superior Health Plan EPO |
$247.79
|
| Rate for Payer: Superior Health Plan Medicare |
$247.79
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$247.79
|
| Rate for Payer: Universal American Medicare |
$247.79
|
| Rate for Payer: Wellcare Medicare |
$247.79
|
| Rate for Payer: Wellmed Medicare |
$247.79
|
|
|
CHED TX FX METACARPAL W/O MAN CLSD BCE
|
Facility
|
IP
|
$682.00
|
|
|
Service Code
|
HCPCS 26600
|
| Hospital Charge Code |
8912663
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$463.76
|
|
|
CHED TX FX TIBIAL SHAFT W/O MAN CLSD BCE
|
Facility
|
IP
|
$775.26
|
|
|
Service Code
|
HCPCS 27750
|
| Hospital Charge Code |
8910654
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$527.18
|
|
|
CHED TX FX TIBIAL SHAFT W/O MAN CLSD BCE
|
Facility
|
OP
|
$775.26
|
|
|
Service Code
|
HCPCS 27750
|
| Hospital Charge Code |
8910654
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$69.77 |
| Max. Negotiated Rate |
$558.19 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$69.77
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$247.79
|
| Rate for Payer: Amerigroup Medicare |
$247.79
|
| Rate for Payer: BCBS of TX Blue Advantage |
$360.12
|
| Rate for Payer: BCBS of TX Blue Essentials |
$431.28
|
| Rate for Payer: BCBS of TX Medicare |
$247.79
|
| Rate for Payer: BCBS of TX PPO |
$543.41
|
| Rate for Payer: Cash Price |
$527.18
|
| Rate for Payer: Cash Price |
$527.18
|
| Rate for Payer: Cash Price |
$527.18
|
| Rate for Payer: Cigna Commercial |
$523.79
|
| Rate for Payer: Cigna Medicaid |
$558.19
|
| Rate for Payer: Cigna Medicare |
$247.79
|
| Rate for Payer: Employer Direct Commercial |
$247.79
|
| Rate for Payer: Humana Medicare/TRICARE |
$247.79
|
| Rate for Payer: Molina CHIP/Medicaid |
$558.19
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$247.79
|
| Rate for Payer: Molina Medicare |
$247.79
|
| Rate for Payer: Multiplan Auto |
$503.92
|
| Rate for Payer: Multiplan Commercial |
$503.92
|
| Rate for Payer: Multiplan Workers Comp |
$503.92
|
| Rate for Payer: Parkland Medicaid |
$558.19
|
| Rate for Payer: Scott and White EPO/PPO |
$387.63
|
| Rate for Payer: Scott and White Medicare |
$247.79
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$558.19
|
| Rate for Payer: Superior Health Plan EPO |
$247.79
|
| Rate for Payer: Superior Health Plan Medicare |
$247.79
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$247.79
|
| Rate for Payer: Universal American Medicare |
$247.79
|
| Rate for Payer: Wellcare Medicare |
$247.79
|
| Rate for Payer: Wellmed Medicare |
$247.79
|
|
|
CHED TX SPONTAN HIP DISLC ABDCT SPLNT/TRCJ W/O ANES BCE
|
Facility
|
IP
|
$1,066.75
|
|
|
Service Code
|
HCPCS 27256
|
| Hospital Charge Code |
8622505
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$725.39
|
|
|
CHED TX SPONTAN HIP DISLC ABDCT SPLNT/TRCJ W/O ANES BCE
|
Facility
|
OP
|
$1,066.75
|
|
|
Service Code
|
HCPCS 27256
|
| Hospital Charge Code |
8622505
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$96.01 |
| Max. Negotiated Rate |
$768.06 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$96.01
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$247.79
|
| Rate for Payer: Amerigroup Medicare |
$247.79
|
| Rate for Payer: BCBS of TX Blue Advantage |
$360.12
|
| Rate for Payer: BCBS of TX Blue Essentials |
$431.28
|
| Rate for Payer: BCBS of TX Medicare |
$247.79
|
| Rate for Payer: BCBS of TX PPO |
$543.41
|
| Rate for Payer: Cash Price |
$725.39
|
| Rate for Payer: Cash Price |
$725.39
|
| Rate for Payer: Cash Price |
$725.39
|
| Rate for Payer: Cigna Commercial |
$523.79
|
| Rate for Payer: Cigna Medicaid |
$768.06
|
| Rate for Payer: Cigna Medicare |
$247.79
|
| Rate for Payer: Employer Direct Commercial |
$247.79
|
| Rate for Payer: Humana Medicare/TRICARE |
$247.79
|
| Rate for Payer: Molina CHIP/Medicaid |
$768.06
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$247.79
|
| Rate for Payer: Molina Medicare |
$247.79
|
| Rate for Payer: Multiplan Auto |
$693.39
|
| Rate for Payer: Multiplan Commercial |
$693.39
|
| Rate for Payer: Multiplan Workers Comp |
$693.39
|
| Rate for Payer: Parkland Medicaid |
$768.06
|
| Rate for Payer: Scott and White EPO/PPO |
$533.38
|
| Rate for Payer: Scott and White Medicare |
$247.79
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$768.06
|
| Rate for Payer: Superior Health Plan EPO |
$247.79
|
| Rate for Payer: Superior Health Plan Medicare |
$247.79
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$247.79
|
| Rate for Payer: Universal American Medicare |
$247.79
|
| Rate for Payer: Wellcare Medicare |
$247.79
|
| Rate for Payer: Wellmed Medicare |
$247.79
|
|
|
CHED WEDGE EXCISION SKIN NAIL FOLD (EG, TOENAIL) BCE
|
Facility
|
OP
|
$828.01
|
|
|
Service Code
|
HCPCS 11765
|
| Hospital Charge Code |
8578508
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$74.52 |
| Max. Negotiated Rate |
$863.21 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$74.52
|
| 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 |
$563.05
|
| Rate for Payer: Cash Price |
$563.05
|
| Rate for Payer: Cash Price |
$563.05
|
| Rate for Payer: Cigna Commercial |
$863.21
|
| Rate for Payer: Cigna Medicaid |
$596.17
|
| 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 |
$596.17
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$408.37
|
| Rate for Payer: Molina Medicare |
$408.37
|
| Rate for Payer: Multiplan Auto |
$538.21
|
| Rate for Payer: Multiplan Commercial |
$538.21
|
| Rate for Payer: Multiplan Workers Comp |
$538.21
|
| Rate for Payer: Parkland Medicaid |
$596.17
|
| Rate for Payer: Scott and White EPO/PPO |
$414.00
|
| Rate for Payer: Scott and White Medicare |
$408.37
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$596.17
|
| 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 WEDGE EXCISION SKIN NAIL FOLD (EG, TOENAIL) BCE
|
Facility
|
IP
|
$828.01
|
|
|
Service Code
|
HCPCS 11765
|
| Hospital Charge Code |
8578508
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$563.05
|
|
|
CHED Wound Dehiscence Superficial BCE
|
Facility
|
IP
|
$3,282.13
|
|
|
Service Code
|
HCPCS 12020
|
| Hospital Charge Code |
8912666
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$2,231.85
|
|
|
CHED Wound Dehiscence Superficial BCE
|
Facility
|
OP
|
$3,282.13
|
|
|
Service Code
|
HCPCS 12020
|
| Hospital Charge Code |
8912666
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$295.39 |
| Max. Negotiated Rate |
$2,363.13 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$295.39
|
| 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 |
$2,231.85
|
| Rate for Payer: Cash Price |
$2,231.85
|
| Rate for Payer: Cash Price |
$2,231.85
|
| Rate for Payer: Cigna Commercial |
$1,569.38
|
| Rate for Payer: Cigna Medicaid |
$2,363.13
|
| 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 |
$2,363.13
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$742.44
|
| Rate for Payer: Molina Medicare |
$742.44
|
| Rate for Payer: Multiplan Auto |
$2,133.38
|
| Rate for Payer: Multiplan Commercial |
$2,133.38
|
| Rate for Payer: Multiplan Workers Comp |
$2,133.38
|
| Rate for Payer: Parkland Medicaid |
$2,363.13
|
| Rate for Payer: Scott and White EPO/PPO |
$1,641.07
|
| Rate for Payer: Scott and White Medicare |
$742.44
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$2,363.13
|
| 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
|
|
|
*Chemical Cauterization of Wound
|
Facility
|
IP
|
$993.50
|
|
|
Service Code
|
HCPCS 17250
|
| Hospital Charge Code |
7150345
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$675.58
|
|
|
*Chemical Cauterization of Wound
|
Facility
|
OP
|
$993.50
|
|
|
Service Code
|
HCPCS 17250
|
| Hospital Charge Code |
7150345
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$89.42 |
| Max. Negotiated Rate |
$10,000.00 |
| 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 |
$10,000.00
|
| Rate for Payer: Multiplan Commercial |
$10,000.00
|
| Rate for Payer: Multiplan Workers Comp |
$10,000.00
|
| Rate for Payer: Parkland Medicaid |
$715.32
|
| Rate for Payer: Scott and White EPO/PPO |
$372.87
|
| 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
|
|
|
CHEM INDICATOR STRIP CS
|
Facility
|
OP
|
$4.16
|
|
| Hospital Charge Code |
992579
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.37 |
| Max. Negotiated Rate |
$3.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$0.37
|
| Rate for Payer: BCBS of TX Blue Advantage |
$1.25
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1.50
|
| Rate for Payer: BCBS of TX PPO |
$1.66
|
| Rate for Payer: Cash Price |
$2.83
|
| Rate for Payer: Cigna Medicaid |
$3.00
|
| Rate for Payer: Molina CHIP/Medicaid |
$3.00
|
| Rate for Payer: Multiplan Auto |
$2.70
|
| Rate for Payer: Multiplan Commercial |
$2.70
|
| Rate for Payer: Multiplan Workers Comp |
$2.70
|
| Rate for Payer: Parkland Medicaid |
$3.00
|
| Rate for Payer: Scott and White EPO/PPO |
$2.08
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$3.00
|
| Rate for Payer: Superior Health Plan EPO |
$0.57
|
|
|
CHEM INDICATOR STRIP CS
|
Facility
|
IP
|
$4.16
|
|
| Hospital Charge Code |
992579
|
|
Hospital Revenue Code
|
272
|
| Rate for Payer: Cash Price |
$2.83
|
|
|
Chemodenervation of muscle(s) muscle(s) innervated by facial, trigeminal, cervical spinal and acces
|
Facility
|
IP
|
$1,567.02
|
|
|
Service Code
|
HCPCS 64615
|
| Hospital Charge Code |
9900821
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$1,065.57
|
|
|
Chemodenervation of muscle(s) muscle(s) innervated by facial, trigeminal, cervical spinal and acces
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 64615
|
| Hospital Charge Code |
36064615
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$59.25 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$59.25
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$308.35
|
| Rate for Payer: Amerigroup Medicare |
$308.35
|
| Rate for Payer: BCBS of TX Blue Advantage |
$113.91
|
| Rate for Payer: BCBS of TX Blue Essentials |
$136.42
|
| Rate for Payer: BCBS of TX Medicare |
$308.35
|
| Rate for Payer: BCBS of TX PPO |
$171.89
|
| Rate for Payer: Cigna Commercial |
$651.79
|
| 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 Dual Medicare/Medicaid |
$308.35
|
| Rate for Payer: Molina Medicare |
$308.35
|
| Rate for Payer: Multiplan Auto |
$10,000.00
|
| Rate for Payer: Multiplan Commercial |
$10,000.00
|
| Rate for Payer: Multiplan Workers Comp |
$10,000.00
|
| Rate for Payer: Scott and White EPO/PPO |
$570.45
|
| Rate for Payer: Scott and White Medicare |
$308.35
|
| 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
|
|
|
Chemodenervation of muscle(s) muscle(s) innervated by facial, trigeminal, cervical spinal and acces
|
Facility
|
OP
|
$1,567.02
|
|
|
Service Code
|
HCPCS 64615
|
| Hospital Charge Code |
9900821
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$59.25 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$59.25
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$308.35
|
| Rate for Payer: Amerigroup Medicare |
$308.35
|
| Rate for Payer: BCBS of TX Blue Advantage |
$113.91
|
| Rate for Payer: BCBS of TX Blue Essentials |
$136.42
|
| Rate for Payer: BCBS of TX Medicare |
$308.35
|
| Rate for Payer: BCBS of TX PPO |
$171.89
|
| Rate for Payer: Cash Price |
$1,065.57
|
| Rate for Payer: Cash Price |
$1,065.57
|
| Rate for Payer: Cash Price |
$1,065.57
|
| Rate for Payer: Cigna Commercial |
$651.79
|
| Rate for Payer: Cigna Medicaid |
$1,128.25
|
| 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 |
$1,128.25
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$308.35
|
| Rate for Payer: Molina Medicare |
$308.35
|
| Rate for Payer: Multiplan Auto |
$10,000.00
|
| Rate for Payer: Multiplan Commercial |
$10,000.00
|
| Rate for Payer: Multiplan Workers Comp |
$10,000.00
|
| Rate for Payer: Parkland Medicaid |
$1,128.25
|
| Rate for Payer: Scott and White EPO/PPO |
$570.45
|
| Rate for Payer: Scott and White Medicare |
$308.35
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,128.25
|
| 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
|
|
|
Chemodenervation of one extremity 5 or more muscles
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 64644
|
| Hospital Charge Code |
36064644
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$85.54 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$85.54
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$709.10
|
| Rate for Payer: Amerigroup Medicare |
$709.10
|
| Rate for Payer: BCBS of TX Blue Advantage |
$162.72
|
| Rate for Payer: BCBS of TX Blue Essentials |
$194.88
|
| Rate for Payer: BCBS of TX Medicare |
$709.10
|
| Rate for Payer: BCBS of TX PPO |
$245.55
|
| Rate for Payer: Cigna Commercial |
$1,498.91
|
| Rate for Payer: Cigna Medicare |
$709.10
|
| Rate for Payer: Employer Direct Commercial |
$709.10
|
| Rate for Payer: Humana Medicare/TRICARE |
$709.10
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$709.10
|
| Rate for Payer: Molina Medicare |
$709.10
|
| Rate for Payer: Multiplan Auto |
$10,000.00
|
| Rate for Payer: Multiplan Commercial |
$10,000.00
|
| Rate for Payer: Multiplan Workers Comp |
$10,000.00
|
| Rate for Payer: Scott and White EPO/PPO |
$1,311.84
|
| Rate for Payer: Scott and White Medicare |
$709.10
|
| Rate for Payer: Superior Health Plan EPO |
$709.10
|
| Rate for Payer: Superior Health Plan Medicare |
$709.10
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$709.10
|
| Rate for Payer: Universal American Medicare |
$709.10
|
| Rate for Payer: Wellcare Medicare |
$709.10
|
| Rate for Payer: Wellmed Medicare |
$709.10
|
|
|
Chemodenervation of one extremity 5 or more muscles
|
Facility
|
OP
|
$10,882.70
|
|
|
Service Code
|
HCPCS 64644
|
| Hospital Charge Code |
9900834
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$85.54 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$85.54
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$709.10
|
| Rate for Payer: Amerigroup Medicare |
$709.10
|
| Rate for Payer: BCBS of TX Blue Advantage |
$162.72
|
| Rate for Payer: BCBS of TX Blue Essentials |
$194.88
|
| Rate for Payer: BCBS of TX Medicare |
$709.10
|
| Rate for Payer: BCBS of TX PPO |
$245.55
|
| Rate for Payer: Cash Price |
$7,400.24
|
| Rate for Payer: Cash Price |
$7,400.24
|
| Rate for Payer: Cash Price |
$7,400.24
|
| Rate for Payer: Cigna Commercial |
$1,498.91
|
| Rate for Payer: Cigna Medicaid |
$7,835.54
|
| Rate for Payer: Cigna Medicare |
$709.10
|
| Rate for Payer: Employer Direct Commercial |
$709.10
|
| Rate for Payer: Humana Medicare/TRICARE |
$709.10
|
| Rate for Payer: Molina CHIP/Medicaid |
$7,835.54
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$709.10
|
| Rate for Payer: Molina Medicare |
$709.10
|
| Rate for Payer: Multiplan Auto |
$10,000.00
|
| Rate for Payer: Multiplan Commercial |
$10,000.00
|
| Rate for Payer: Multiplan Workers Comp |
$10,000.00
|
| Rate for Payer: Parkland Medicaid |
$7,835.54
|
| Rate for Payer: Scott and White EPO/PPO |
$1,311.84
|
| Rate for Payer: Scott and White Medicare |
$709.10
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$7,835.54
|
| Rate for Payer: Superior Health Plan EPO |
$709.10
|
| Rate for Payer: Superior Health Plan Medicare |
$709.10
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$709.10
|
| Rate for Payer: Universal American Medicare |
$709.10
|
| Rate for Payer: Wellcare Medicare |
$709.10
|
| Rate for Payer: Wellmed Medicare |
$709.10
|
|
|
Chemodenervation of one extremity 5 or more muscles
|
Facility
|
IP
|
$10,882.70
|
|
|
Service Code
|
HCPCS 64644
|
| Hospital Charge Code |
9900834
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$7,400.24
|
|
|
CHEMOTHERAPY FOR ACUTE LEUKEMIA
|
Facility
|
IP
|
$4,034.04
|
|
|
Service Code
|
APR-DRG 6951
|
| Min. Negotiated Rate |
$3,803.43 |
| Max. Negotiated Rate |
$4,034.04 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$3,803.43
|
| Rate for Payer: Cigna Medicaid |
$3,803.43
|
| Rate for Payer: Molina CHIP/Medicaid |
$3,803.43
|
| Rate for Payer: Parkland Medicaid |
$3,803.43
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$4,034.04
|
|
