|
ED RMVL FB XTRNL EYE CORNEAL W/SLIT LAMP BCE
|
Facility
|
OP
|
$494.00
|
|
|
Service Code
|
CPT 65222
|
| Hospital Charge Code |
8726549
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2.09 |
| Max. Negotiated Rate |
$321.10 |
| Rate for Payer: Aetna Commercial |
$271.70
|
| Rate for Payer: Aetna Medicare |
$175.23
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$44.46
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$116.82
|
| Rate for Payer: Amerigroup Medicare |
$116.82
|
| 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 |
$116.82
|
| Rate for Payer: BCBS of TX PPO |
$274.76
|
| Rate for Payer: Cash Price |
$434.72
|
| Rate for Payer: Cash Price |
$434.72
|
| Rate for Payer: Cash Price |
$434.72
|
| Rate for Payer: Cigna Commercial |
$264.63
|
| Rate for Payer: Cigna Medicare |
$116.82
|
| Rate for Payer: Employer Direct Commercial |
$116.82
|
| Rate for Payer: Humana Medicare/TRICARE |
$116.82
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$116.82
|
| Rate for Payer: Molina Medicare |
$116.82
|
| Rate for Payer: Multiplan Auto |
$321.10
|
| Rate for Payer: Multiplan Commercial |
$321.10
|
| Rate for Payer: Multiplan Workers Comp |
$321.10
|
| Rate for Payer: Scott and White EPO/PPO |
$2.09
|
| Rate for Payer: Scott and White Medicare |
$116.82
|
| Rate for Payer: Superior Health Plan EPO |
$116.82
|
| Rate for Payer: Superior Health Plan Medicare |
$116.82
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$116.82
|
| Rate for Payer: Universal American Medicare |
$116.82
|
| Rate for Payer: Wellcare Medicare |
$116.82
|
| Rate for Payer: Wellmed Medicare |
$116.82
|
|
|
ED RMVL NON-BIODEGRADABLE DRUG DELIV IMPLT BCE
|
Facility
|
OP
|
$5,620.00
|
|
|
Service Code
|
CPT 11982
|
| Hospital Charge Code |
8724546
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$6.52 |
| Max. Negotiated Rate |
$3,653.00 |
| Rate for Payer: Aetna Commercial |
$3,091.00
|
| Rate for Payer: Aetna Medicare |
$546.58
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$505.80
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$364.39
|
| Rate for Payer: Amerigroup Medicare |
$364.39
|
| 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 |
$364.39
|
| Rate for Payer: BCBS of TX PPO |
$916.25
|
| Rate for Payer: Cash Price |
$4,945.60
|
| Rate for Payer: Cash Price |
$4,945.60
|
| Rate for Payer: Cash Price |
$4,945.60
|
| Rate for Payer: Cigna Commercial |
$825.46
|
| Rate for Payer: Cigna Medicaid |
$54.42
|
| Rate for Payer: Cigna Medicare |
$364.39
|
| Rate for Payer: Employer Direct Commercial |
$364.39
|
| Rate for Payer: Humana Medicare/TRICARE |
$364.39
|
| Rate for Payer: Molina CHIP/Medicaid |
$54.42
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$364.39
|
| Rate for Payer: Molina Medicare |
$364.39
|
| Rate for Payer: Multiplan Auto |
$3,653.00
|
| Rate for Payer: Multiplan Commercial |
$3,653.00
|
| Rate for Payer: Multiplan Workers Comp |
$3,653.00
|
| Rate for Payer: Parkland Medicaid |
$54.42
|
| Rate for Payer: Scott and White EPO/PPO |
$6.52
|
| Rate for Payer: Scott and White Medicare |
$364.39
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$54.42
|
| Rate for Payer: Superior Health Plan EPO |
$364.39
|
| Rate for Payer: Superior Health Plan Medicare |
$364.39
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$364.39
|
| Rate for Payer: Universal American Medicare |
$364.39
|
| Rate for Payer: Wellcare Medicare |
$364.39
|
| Rate for Payer: Wellmed Medicare |
$364.39
|
|
|
ED RMVL NON-BIODEGRADABLE DRUG DELIV IMPLT BCE
|
Facility
|
IP
|
$5,620.00
|
|
|
Service Code
|
CPT 11982
|
| Hospital Charge Code |
8724546
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$4,945.60
|
|
|
ED RPLC GASTRO/CECOSTOMY TUBE PERC W/GUIDE CNTRST IMG BCE
|
Facility
|
IP
|
$1,573.00
|
|
|
Service Code
|
CPT 49450
|
| Hospital Charge Code |
8424452
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$1,384.24
|
|
|
ED RPLC GASTRO/CECOSTOMY TUBE PERC W/GUIDE CNTRST IMG BCE
|
Facility
|
OP
|
$1,573.00
|
|
|
Service Code
|
CPT 49450
|
| Hospital Charge Code |
8424452
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$14.83 |
| Max. Negotiated Rate |
$2,200.00 |
| Rate for Payer: Aetna Commercial |
$2,200.00
|
| Rate for Payer: Aetna Medicare |
$1,243.53
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$141.57
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$829.02
|
| Rate for Payer: Amerigroup Medicare |
$829.02
|
| 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 |
$829.02
|
| Rate for Payer: BCBS of TX PPO |
$1,980.52
|
| Rate for Payer: Cash Price |
$1,384.24
|
| Rate for Payer: Cash Price |
$1,384.24
|
| Rate for Payer: Cash Price |
$1,384.24
|
| Rate for Payer: Cigna Commercial |
$1,877.98
|
| Rate for Payer: Cigna Medicaid |
$334.95
|
| Rate for Payer: Cigna Medicare |
$829.02
|
| Rate for Payer: Employer Direct Commercial |
$829.02
|
| Rate for Payer: Humana Medicare/TRICARE |
$829.02
|
| Rate for Payer: Molina CHIP/Medicaid |
$334.95
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$829.02
|
| Rate for Payer: Molina Medicare |
$829.02
|
| Rate for Payer: Multiplan Auto |
$1,022.45
|
| Rate for Payer: Multiplan Commercial |
$1,022.45
|
| Rate for Payer: Multiplan Workers Comp |
$1,022.45
|
| Rate for Payer: Parkland Medicaid |
$334.95
|
| Rate for Payer: Scott and White EPO/PPO |
$14.83
|
| Rate for Payer: Scott and White Medicare |
$829.02
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$334.95
|
| Rate for Payer: Superior Health Plan EPO |
$829.02
|
| Rate for Payer: Superior Health Plan Medicare |
$829.02
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$829.02
|
| Rate for Payer: Universal American Medicare |
$829.02
|
| Rate for Payer: Wellcare Medicare |
$829.02
|
| Rate for Payer: Wellmed Medicare |
$829.02
|
|
|
ED RPLC GASTRO TUBE PERC WO IMG NO REVSN GASTRO TRCT BCE
|
Facility
|
IP
|
$620.00
|
|
|
Service Code
|
CPT 43762
|
| Hospital Charge Code |
8424451
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$545.60
|
|
|
ED RPLC GASTRO TUBE PERC WO IMG NO REVSN GASTRO TRCT BCE
|
Facility
|
OP
|
$620.00
|
|
|
Service Code
|
CPT 43762
|
| Hospital Charge Code |
8424451
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$4.04 |
| Max. Negotiated Rate |
$591.95 |
| Rate for Payer: Aetna Commercial |
$341.00
|
| Rate for Payer: Aetna Medicare |
$339.04
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$55.80
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$226.03
|
| Rate for Payer: Amerigroup Medicare |
$226.03
|
| Rate for Payer: BCBS of TX Blue Advantage |
$392.28
|
| Rate for Payer: BCBS of TX Blue Essentials |
$469.80
|
| Rate for Payer: BCBS of TX Medicare |
$226.03
|
| Rate for Payer: BCBS of TX PPO |
$591.95
|
| Rate for Payer: Cash Price |
$545.60
|
| Rate for Payer: Cash Price |
$545.60
|
| Rate for Payer: Cash Price |
$545.60
|
| Rate for Payer: Cigna Commercial |
$512.01
|
| Rate for Payer: Cigna Medicaid |
$110.15
|
| Rate for Payer: Cigna Medicare |
$226.03
|
| Rate for Payer: Employer Direct Commercial |
$226.03
|
| Rate for Payer: Humana Medicare/TRICARE |
$226.03
|
| Rate for Payer: Molina CHIP/Medicaid |
$110.15
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$226.03
|
| Rate for Payer: Molina Medicare |
$226.03
|
| Rate for Payer: Multiplan Auto |
$403.00
|
| Rate for Payer: Multiplan Commercial |
$403.00
|
| Rate for Payer: Multiplan Workers Comp |
$403.00
|
| Rate for Payer: Parkland Medicaid |
$110.15
|
| Rate for Payer: Scott and White EPO/PPO |
$4.04
|
| Rate for Payer: Scott and White Medicare |
$226.03
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$110.15
|
| Rate for Payer: Superior Health Plan EPO |
$226.03
|
| Rate for Payer: Superior Health Plan Medicare |
$226.03
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$226.03
|
| Rate for Payer: Universal American Medicare |
$226.03
|
| Rate for Payer: Wellcare Medicare |
$226.03
|
| Rate for Payer: Wellmed Medicare |
$226.03
|
|
|
ED RPR S N A GEN TRK 12.6 TO 20.0CM BCE
|
Facility
|
IP
|
$1,019.00
|
|
|
Service Code
|
CPT 12005
|
| Hospital Charge Code |
8400484
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$896.72
|
|
|
ED RPR S N A GEN TRK 12.6 TO 20.0CM BCE
|
Facility
|
OP
|
$1,019.00
|
|
|
Service Code
|
CPT 12005
|
| Hospital Charge Code |
8400484
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$6.52 |
| Max. Negotiated Rate |
$826.08 |
| Rate for Payer: Aetna Commercial |
$560.45
|
| Rate for Payer: Aetna Medicare |
$547.00
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$91.71
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$364.67
|
| Rate for Payer: Amerigroup Medicare |
$364.67
|
| 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 |
$364.67
|
| Rate for Payer: BCBS of TX PPO |
$805.17
|
| Rate for Payer: Cash Price |
$896.72
|
| Rate for Payer: Cash Price |
$896.72
|
| Rate for Payer: Cash Price |
$896.72
|
| Rate for Payer: Cigna Commercial |
$826.08
|
| Rate for Payer: Cigna Medicaid |
$143.08
|
| Rate for Payer: Cigna Medicare |
$364.67
|
| Rate for Payer: Employer Direct Commercial |
$364.67
|
| Rate for Payer: Humana Medicare/TRICARE |
$364.67
|
| Rate for Payer: Molina CHIP/Medicaid |
$143.08
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$364.67
|
| Rate for Payer: Molina Medicare |
$364.67
|
| Rate for Payer: Multiplan Auto |
$662.35
|
| Rate for Payer: Multiplan Commercial |
$662.35
|
| Rate for Payer: Multiplan Workers Comp |
$662.35
|
| Rate for Payer: Parkland Medicaid |
$143.08
|
| Rate for Payer: Scott and White EPO/PPO |
$6.52
|
| Rate for Payer: Scott and White Medicare |
$364.67
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$143.08
|
| Rate for Payer: Superior Health Plan EPO |
$364.67
|
| Rate for Payer: Superior Health Plan Medicare |
$364.67
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$364.67
|
| Rate for Payer: Universal American Medicare |
$364.67
|
| Rate for Payer: Wellcare Medicare |
$364.67
|
| Rate for Payer: Wellmed Medicare |
$364.67
|
|
|
ED Sedation - Different Physician: Each Addl 15 mins
|
Facility
|
IP
|
$342.00
|
|
|
Service Code
|
CPT 99157
|
| Hospital Charge Code |
2161303
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$300.96
|
|
|
ED Sedation - Different Physician: Each Addl 15 mins
|
Facility
|
OP
|
$342.00
|
|
|
Service Code
|
CPT 99157
|
| Hospital Charge Code |
2161303
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$30.78 |
| Max. Negotiated Rate |
$222.30 |
| Rate for Payer: Aetna Commercial |
$188.10
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$30.78
|
| Rate for Payer: BCBS of TX Blue Advantage |
$114.13
|
| Rate for Payer: BCBS of TX Blue Essentials |
$136.43
|
| Rate for Payer: BCBS of TX PPO |
$152.17
|
| Rate for Payer: Cash Price |
$300.96
|
| Rate for Payer: Cash Price |
$300.96
|
| Rate for Payer: Multiplan Auto |
$222.30
|
| Rate for Payer: Multiplan Commercial |
$222.30
|
| Rate for Payer: Multiplan Workers Comp |
$222.30
|
| Rate for Payer: Scott and White EPO/PPO |
$171.00
|
| Rate for Payer: Superior Health Plan EPO |
$46.51
|
|
|
ED Sedation - Different Physician Each Addl 15 mins BCE
|
Facility
|
IP
|
$297.00
|
|
|
Service Code
|
CPT 99157
|
| Hospital Charge Code |
2161303
|
|
Hospital Revenue Code
|
370
|
| Rate for Payer: Cash Price |
$261.36
|
|
|
ED Sedation - Different Physician Each Addl 15 mins BCE
|
Facility
|
OP
|
$297.00
|
|
|
Service Code
|
CPT 99157
|
| Hospital Charge Code |
2161303
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$26.73 |
| Max. Negotiated Rate |
$193.05 |
| Rate for Payer: Aetna Commercial |
$163.35
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$26.73
|
| Rate for Payer: BCBS of TX Blue Advantage |
$114.13
|
| Rate for Payer: BCBS of TX Blue Essentials |
$136.43
|
| Rate for Payer: BCBS of TX PPO |
$152.17
|
| Rate for Payer: Cash Price |
$261.36
|
| Rate for Payer: Cash Price |
$261.36
|
| Rate for Payer: Multiplan Auto |
$193.05
|
| Rate for Payer: Multiplan Commercial |
$193.05
|
| Rate for Payer: Multiplan Workers Comp |
$193.05
|
| Rate for Payer: Scott and White EPO/PPO |
$148.50
|
| Rate for Payer: Superior Health Plan EPO |
$40.39
|
|
|
ED Sedation - Different Physician: First 15 mins >= 5 years
|
Facility
|
OP
|
$479.00
|
|
|
Service Code
|
CPT 99156
|
| Hospital Charge Code |
2161302
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$43.11 |
| Max. Negotiated Rate |
$311.35 |
| Rate for Payer: Aetna Commercial |
$263.45
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$43.11
|
| Rate for Payer: BCBS of TX Blue Advantage |
$140.47
|
| Rate for Payer: BCBS of TX Blue Essentials |
$167.92
|
| Rate for Payer: BCBS of TX PPO |
$187.29
|
| Rate for Payer: Cash Price |
$421.52
|
| Rate for Payer: Cash Price |
$421.52
|
| Rate for Payer: Multiplan Auto |
$311.35
|
| Rate for Payer: Multiplan Commercial |
$311.35
|
| Rate for Payer: Multiplan Workers Comp |
$311.35
|
| Rate for Payer: Scott and White EPO/PPO |
$239.50
|
| Rate for Payer: Superior Health Plan EPO |
$65.14
|
|
|
ED Sedation - Different Physician: First 15 mins >= 5 years
|
Facility
|
IP
|
$479.00
|
|
|
Service Code
|
CPT 99156
|
| Hospital Charge Code |
2161302
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$421.52
|
|
|
ED Sedation - Different Physician First 15 mins >= 5 years BCE
|
Facility
|
IP
|
$479.00
|
|
|
Service Code
|
CPT 99156
|
| Hospital Charge Code |
2161302
|
|
Hospital Revenue Code
|
370
|
| Rate for Payer: Cash Price |
$421.52
|
|
|
ED Sedation - Different Physician First 15 mins >= 5 years BCE
|
Facility
|
OP
|
$479.00
|
|
|
Service Code
|
CPT 99156
|
| Hospital Charge Code |
2161302
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$43.11 |
| Max. Negotiated Rate |
$311.35 |
| Rate for Payer: Aetna Commercial |
$263.45
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$43.11
|
| Rate for Payer: BCBS of TX Blue Advantage |
$140.47
|
| Rate for Payer: BCBS of TX Blue Essentials |
$167.92
|
| Rate for Payer: BCBS of TX PPO |
$187.29
|
| Rate for Payer: Cash Price |
$421.52
|
| Rate for Payer: Cash Price |
$421.52
|
| Rate for Payer: Multiplan Auto |
$311.35
|
| Rate for Payer: Multiplan Commercial |
$311.35
|
| Rate for Payer: Multiplan Workers Comp |
$311.35
|
| Rate for Payer: Scott and White EPO/PPO |
$239.50
|
| Rate for Payer: Superior Health Plan EPO |
$65.14
|
|
|
ED Sedation - Same Physician: Each Addl 15 mins
|
Facility
|
OP
|
$154.00
|
|
|
Service Code
|
CPT 99153
|
| Hospital Charge Code |
6100408
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$13.86 |
| Max. Negotiated Rate |
$100.10 |
| Rate for Payer: Aetna Commercial |
$84.70
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$13.86
|
| Rate for Payer: BCBS of TX Blue Advantage |
$18.81
|
| Rate for Payer: BCBS of TX Blue Essentials |
$22.48
|
| Rate for Payer: BCBS of TX PPO |
$25.08
|
| Rate for Payer: Cash Price |
$135.52
|
| Rate for Payer: Cash Price |
$135.52
|
| Rate for Payer: Multiplan Auto |
$100.10
|
| Rate for Payer: Multiplan Commercial |
$100.10
|
| Rate for Payer: Multiplan Workers Comp |
$100.10
|
| Rate for Payer: Scott and White EPO/PPO |
$77.00
|
| Rate for Payer: Superior Health Plan EPO |
$20.94
|
|
|
ED Sedation - Same Physician: Each Addl 15 mins
|
Facility
|
IP
|
$154.00
|
|
|
Service Code
|
CPT 99153
|
| Hospital Charge Code |
6100408
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$135.52
|
|
|
ED Sedation - Same Physician Each Addl 15 mins BCE
|
Facility
|
IP
|
$291.00
|
|
|
Service Code
|
CPT 99153
|
| Hospital Charge Code |
6100408
|
|
Hospital Revenue Code
|
370
|
| Rate for Payer: Cash Price |
$256.08
|
|
|
ED Sedation - Same Physician Each Addl 15 mins BCE
|
Facility
|
OP
|
$291.00
|
|
|
Service Code
|
CPT 99153
|
| Hospital Charge Code |
6100408
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$18.81 |
| Max. Negotiated Rate |
$189.15 |
| Rate for Payer: Aetna Commercial |
$160.05
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$26.19
|
| Rate for Payer: BCBS of TX Blue Advantage |
$18.81
|
| Rate for Payer: BCBS of TX Blue Essentials |
$22.48
|
| Rate for Payer: BCBS of TX PPO |
$25.08
|
| Rate for Payer: Cash Price |
$256.08
|
| Rate for Payer: Cash Price |
$256.08
|
| Rate for Payer: Multiplan Auto |
$189.15
|
| Rate for Payer: Multiplan Commercial |
$189.15
|
| Rate for Payer: Multiplan Workers Comp |
$189.15
|
| Rate for Payer: Scott and White EPO/PPO |
$145.50
|
| Rate for Payer: Superior Health Plan EPO |
$39.58
|
|
|
ED Sedation - Same Physician: First 15 mins < 5 years
|
Facility
|
OP
|
$427.00
|
|
|
Service Code
|
CPT 99151
|
| Hospital Charge Code |
5210309
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$38.43 |
| Max. Negotiated Rate |
$277.55 |
| Rate for Payer: Aetna Commercial |
$234.85
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$38.43
|
| Rate for Payer: BCBS of TX Blue Advantage |
$45.15
|
| Rate for Payer: BCBS of TX Blue Essentials |
$53.98
|
| Rate for Payer: BCBS of TX PPO |
$60.20
|
| Rate for Payer: Cash Price |
$375.76
|
| Rate for Payer: Cash Price |
$375.76
|
| Rate for Payer: Multiplan Auto |
$277.55
|
| Rate for Payer: Multiplan Commercial |
$277.55
|
| Rate for Payer: Multiplan Workers Comp |
$277.55
|
| Rate for Payer: Scott and White EPO/PPO |
$213.50
|
| Rate for Payer: Superior Health Plan EPO |
$58.07
|
|
|
ED Sedation - Same Physician: First 15 mins < 5 years
|
Facility
|
IP
|
$427.00
|
|
|
Service Code
|
CPT 99151
|
| Hospital Charge Code |
5210309
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$375.76
|
|
|
ED Sedation - Same Physician: First 15 mins >= 5 years
|
Facility
|
OP
|
$247.00
|
|
|
Service Code
|
CPT 99152
|
| Hospital Charge Code |
6100390
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$21.94 |
| Max. Negotiated Rate |
$160.55 |
| Rate for Payer: Aetna Commercial |
$135.85
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$22.23
|
| Rate for Payer: BCBS of TX Blue Advantage |
$21.94
|
| Rate for Payer: BCBS of TX Blue Essentials |
$26.23
|
| Rate for Payer: BCBS of TX PPO |
$29.26
|
| Rate for Payer: Cash Price |
$217.36
|
| Rate for Payer: Cash Price |
$217.36
|
| Rate for Payer: Multiplan Auto |
$160.55
|
| Rate for Payer: Multiplan Commercial |
$160.55
|
| Rate for Payer: Multiplan Workers Comp |
$160.55
|
| Rate for Payer: Scott and White EPO/PPO |
$123.50
|
| Rate for Payer: Superior Health Plan EPO |
$33.59
|
|
|
ED Sedation - Same Physician: First 15 mins >= 5 years
|
Facility
|
IP
|
$247.00
|
|
|
Service Code
|
CPT 99152
|
| Hospital Charge Code |
6100390
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$217.36
|
|
