|
CHED 96366- IV tx, each additional hour BCE
|
Facility
|
OP
|
$153.00
|
|
|
Service Code
|
CPT 96366
|
| Hospital Charge Code |
8930541
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$0.78 |
| Max. Negotiated Rate |
$99.45 |
| Rate for Payer: Aetna Commercial |
$84.15
|
| Rate for Payer: Aetna Medicare |
$65.16
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$13.77
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$43.44
|
| Rate for Payer: Amerigroup Medicare |
$43.44
|
| Rate for Payer: BCBS of TX Blue Advantage |
$38.25
|
| Rate for Payer: BCBS of TX Blue Essentials |
$45.72
|
| Rate for Payer: BCBS of TX Medicare |
$43.44
|
| Rate for Payer: BCBS of TX PPO |
$50.99
|
| Rate for Payer: Cash Price |
$134.64
|
| Rate for Payer: Cash Price |
$134.64
|
| Rate for Payer: Cash Price |
$134.64
|
| Rate for Payer: Cigna Commercial |
$98.40
|
| Rate for Payer: Cigna Medicare |
$43.44
|
| Rate for Payer: Employer Direct Commercial |
$43.44
|
| Rate for Payer: Humana Medicare/TRICARE |
$43.44
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$43.44
|
| Rate for Payer: Molina Medicare |
$43.44
|
| Rate for Payer: Multiplan Auto |
$99.45
|
| Rate for Payer: Multiplan Commercial |
$99.45
|
| Rate for Payer: Multiplan Workers Comp |
$99.45
|
| Rate for Payer: Scott and White EPO/PPO |
$0.78
|
| Rate for Payer: Scott and White Medicare |
$43.44
|
| Rate for Payer: Superior Health Plan EPO |
$43.44
|
| Rate for Payer: Superior Health Plan Medicare |
$43.44
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$43.44
|
| Rate for Payer: Universal American Medicare |
$43.44
|
| Rate for Payer: Wellcare Medicare |
$43.44
|
| Rate for Payer: Wellmed Medicare |
$43.44
|
|
|
CHED 96366- IV tx, each additional hour BCE
|
Facility
|
IP
|
$153.00
|
|
|
Service Code
|
CPT 96366
|
| Hospital Charge Code |
8930541
|
|
Hospital Revenue Code
|
260
|
| Rate for Payer: Cash Price |
$134.64
|
|
|
CHED 96367- IV tx, sequential infusion BCE
|
Facility
|
IP
|
$175.00
|
|
|
Service Code
|
CPT 96367
|
| Hospital Charge Code |
8928544
|
|
Hospital Revenue Code
|
260
|
| Rate for Payer: Cash Price |
$154.00
|
|
|
CHED 96367- IV tx, sequential infusion BCE
|
Facility
|
OP
|
$175.00
|
|
|
Service Code
|
CPT 96367
|
| Hospital Charge Code |
8928544
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$1.15 |
| Max. Negotiated Rate |
$145.94 |
| Rate for Payer: Aetna Commercial |
$96.25
|
| Rate for Payer: Aetna Medicare |
$96.64
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$15.75
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$64.43
|
| Rate for Payer: Amerigroup Medicare |
$64.43
|
| Rate for Payer: BCBS of TX Blue Advantage |
$55.18
|
| Rate for Payer: BCBS of TX Blue Essentials |
$65.96
|
| Rate for Payer: BCBS of TX Medicare |
$64.43
|
| Rate for Payer: BCBS of TX PPO |
$73.57
|
| Rate for Payer: Cash Price |
$154.00
|
| Rate for Payer: Cash Price |
$154.00
|
| Rate for Payer: Cash Price |
$154.00
|
| Rate for Payer: Cigna Commercial |
$145.94
|
| Rate for Payer: Cigna Medicare |
$64.43
|
| Rate for Payer: Employer Direct Commercial |
$64.43
|
| Rate for Payer: Humana Medicare/TRICARE |
$64.43
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$64.43
|
| Rate for Payer: Molina Medicare |
$64.43
|
| Rate for Payer: Multiplan Auto |
$113.75
|
| Rate for Payer: Multiplan Commercial |
$113.75
|
| Rate for Payer: Multiplan Workers Comp |
$113.75
|
| Rate for Payer: Scott and White EPO/PPO |
$1.15
|
| Rate for Payer: Scott and White Medicare |
$64.43
|
| Rate for Payer: Superior Health Plan EPO |
$64.43
|
| Rate for Payer: Superior Health Plan Medicare |
$64.43
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$64.43
|
| Rate for Payer: Universal American Medicare |
$64.43
|
| Rate for Payer: Wellcare Medicare |
$64.43
|
| Rate for Payer: Wellmed Medicare |
$64.43
|
|
|
CHED 96368- IV tx, concurrent infusion BCE
|
Facility
|
IP
|
$149.00
|
|
|
Service Code
|
CPT 96368
|
| Hospital Charge Code |
8930542
|
|
Hospital Revenue Code
|
260
|
| Rate for Payer: Cash Price |
$131.12
|
|
|
CHED 96368- IV tx, concurrent infusion BCE
|
Facility
|
OP
|
$149.00
|
|
|
Service Code
|
CPT 96368
|
| Hospital Charge Code |
8930542
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$13.41 |
| Max. Negotiated Rate |
$96.85 |
| Rate for Payer: Aetna Commercial |
$81.95
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$13.41
|
| Rate for Payer: BCBS of TX Blue Advantage |
$36.99
|
| Rate for Payer: BCBS of TX Blue Essentials |
$44.22
|
| Rate for Payer: BCBS of TX PPO |
$49.32
|
| Rate for Payer: Cash Price |
$131.12
|
| Rate for Payer: Cash Price |
$131.12
|
| Rate for Payer: Multiplan Auto |
$96.85
|
| Rate for Payer: Multiplan Commercial |
$96.85
|
| Rate for Payer: Multiplan Workers Comp |
$96.85
|
| Rate for Payer: Scott and White EPO/PPO |
$74.50
|
| Rate for Payer: Superior Health Plan EPO |
$20.26
|
|
|
CHED 96372- Subq/IM Injection BCE
|
Facility
|
OP
|
$280.00
|
|
|
Service Code
|
CPT 96372
|
| Hospital Charge Code |
8930543
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$1.15 |
| Max. Negotiated Rate |
$182.00 |
| Rate for Payer: Aetna Commercial |
$154.00
|
| Rate for Payer: Aetna Medicare |
$96.64
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$25.20
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$64.43
|
| Rate for Payer: Amerigroup Medicare |
$64.43
|
| Rate for Payer: BCBS of TX Blue Advantage |
$105.22
|
| Rate for Payer: BCBS of TX Blue Essentials |
$125.78
|
| Rate for Payer: BCBS of TX Medicare |
$64.43
|
| Rate for Payer: BCBS of TX PPO |
$140.29
|
| Rate for Payer: Cash Price |
$246.40
|
| Rate for Payer: Cash Price |
$246.40
|
| Rate for Payer: Cash Price |
$246.40
|
| Rate for Payer: Cigna Commercial |
$145.94
|
| Rate for Payer: Cigna Medicaid |
$11.23
|
| Rate for Payer: Cigna Medicare |
$64.43
|
| Rate for Payer: Employer Direct Commercial |
$64.43
|
| Rate for Payer: Humana Medicare/TRICARE |
$64.43
|
| Rate for Payer: Molina CHIP/Medicaid |
$11.23
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$64.43
|
| Rate for Payer: Molina Medicare |
$64.43
|
| Rate for Payer: Multiplan Auto |
$182.00
|
| Rate for Payer: Multiplan Commercial |
$182.00
|
| Rate for Payer: Multiplan Workers Comp |
$182.00
|
| Rate for Payer: Parkland Medicaid |
$11.23
|
| Rate for Payer: Scott and White EPO/PPO |
$1.15
|
| Rate for Payer: Scott and White Medicare |
$64.43
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$11.23
|
| Rate for Payer: Superior Health Plan EPO |
$64.43
|
| Rate for Payer: Superior Health Plan Medicare |
$64.43
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$64.43
|
| Rate for Payer: Universal American Medicare |
$64.43
|
| Rate for Payer: Wellcare Medicare |
$64.43
|
| Rate for Payer: Wellmed Medicare |
$64.43
|
|
|
CHED 96372- Subq/IM Injection BCE
|
Facility
|
IP
|
$280.00
|
|
|
Service Code
|
CPT 96372
|
| Hospital Charge Code |
8930543
|
|
Hospital Revenue Code
|
260
|
| Rate for Payer: Cash Price |
$246.40
|
|
|
CHED 96373- Intra-Arterial Injection BCE
|
Facility
|
IP
|
$360.00
|
|
|
Service Code
|
CPT 96373
|
| Hospital Charge Code |
8930544
|
|
Hospital Revenue Code
|
260
|
| Rate for Payer: Cash Price |
$316.80
|
|
|
CHED 96373- Intra-Arterial Injection BCE
|
Facility
|
OP
|
$360.00
|
|
|
Service Code
|
CPT 96373
|
| Hospital Charge Code |
8930544
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$3.51 |
| Max. Negotiated Rate |
$444.05 |
| Rate for Payer: Aetna Commercial |
$198.00
|
| Rate for Payer: Aetna Medicare |
$294.03
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$32.40
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$196.02
|
| Rate for Payer: Amerigroup Medicare |
$196.02
|
| Rate for Payer: BCBS of TX Blue Advantage |
$33.23
|
| Rate for Payer: BCBS of TX Blue Essentials |
$39.73
|
| Rate for Payer: BCBS of TX Medicare |
$196.02
|
| Rate for Payer: BCBS of TX PPO |
$44.31
|
| Rate for Payer: Cash Price |
$316.80
|
| Rate for Payer: Cash Price |
$316.80
|
| Rate for Payer: Cash Price |
$316.80
|
| Rate for Payer: Cigna Commercial |
$444.05
|
| Rate for Payer: Cigna Medicare |
$196.02
|
| Rate for Payer: Employer Direct Commercial |
$196.02
|
| Rate for Payer: Humana Medicare/TRICARE |
$196.02
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$196.02
|
| Rate for Payer: Molina Medicare |
$196.02
|
| Rate for Payer: Multiplan Auto |
$234.00
|
| Rate for Payer: Multiplan Commercial |
$234.00
|
| Rate for Payer: Multiplan Workers Comp |
$234.00
|
| Rate for Payer: Scott and White EPO/PPO |
$3.51
|
| Rate for Payer: Scott and White Medicare |
$196.02
|
| Rate for Payer: Superior Health Plan EPO |
$196.02
|
| Rate for Payer: Superior Health Plan Medicare |
$196.02
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$196.02
|
| Rate for Payer: Universal American Medicare |
$196.02
|
| Rate for Payer: Wellcare Medicare |
$196.02
|
| Rate for Payer: Wellmed Medicare |
$196.02
|
|
|
CHED 96374- IV Injection, single/initial BCE
|
Facility
|
IP
|
$360.00
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
8928545
|
|
Hospital Revenue Code
|
260
|
| Rate for Payer: Cash Price |
$316.80
|
|
|
CHED 96374- IV Injection, single/initial BCE
|
Facility
|
OP
|
$360.00
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
8928545
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$3.51 |
| Max. Negotiated Rate |
$444.05 |
| Rate for Payer: Aetna Commercial |
$198.00
|
| Rate for Payer: Aetna Medicare |
$294.03
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$32.40
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$196.02
|
| Rate for Payer: Amerigroup Medicare |
$196.02
|
| Rate for Payer: BCBS of TX Blue Advantage |
$68.97
|
| Rate for Payer: BCBS of TX Blue Essentials |
$82.45
|
| Rate for Payer: BCBS of TX Medicare |
$196.02
|
| Rate for Payer: BCBS of TX PPO |
$91.96
|
| Rate for Payer: Cash Price |
$316.80
|
| Rate for Payer: Cash Price |
$316.80
|
| Rate for Payer: Cash Price |
$316.80
|
| Rate for Payer: Cigna Commercial |
$444.05
|
| Rate for Payer: Cigna Medicare |
$196.02
|
| Rate for Payer: Employer Direct Commercial |
$196.02
|
| Rate for Payer: Humana Medicare/TRICARE |
$196.02
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$196.02
|
| Rate for Payer: Molina Medicare |
$196.02
|
| Rate for Payer: Multiplan Auto |
$234.00
|
| Rate for Payer: Multiplan Commercial |
$234.00
|
| Rate for Payer: Multiplan Workers Comp |
$234.00
|
| Rate for Payer: Scott and White EPO/PPO |
$3.51
|
| Rate for Payer: Scott and White Medicare |
$196.02
|
| Rate for Payer: Superior Health Plan EPO |
$196.02
|
| Rate for Payer: Superior Health Plan Medicare |
$196.02
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$196.02
|
| Rate for Payer: Universal American Medicare |
$196.02
|
| Rate for Payer: Wellcare Medicare |
$196.02
|
| Rate for Payer: Wellmed Medicare |
$196.02
|
|
|
CHED 96375- IV Injection, add new drug BCE
|
Facility
|
OP
|
$330.00
|
|
|
Service Code
|
CPT 96375
|
| Hospital Charge Code |
8932543
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$0.78 |
| Max. Negotiated Rate |
$214.50 |
| Rate for Payer: Aetna Commercial |
$181.50
|
| Rate for Payer: Aetna Medicare |
$65.16
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$29.70
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$43.44
|
| Rate for Payer: Amerigroup Medicare |
$43.44
|
| Rate for Payer: BCBS of TX Blue Advantage |
$29.48
|
| Rate for Payer: BCBS of TX Blue Essentials |
$35.24
|
| Rate for Payer: BCBS of TX Medicare |
$43.44
|
| Rate for Payer: BCBS of TX PPO |
$39.30
|
| Rate for Payer: Cash Price |
$290.40
|
| Rate for Payer: Cash Price |
$290.40
|
| Rate for Payer: Cash Price |
$290.40
|
| Rate for Payer: Cigna Commercial |
$98.40
|
| Rate for Payer: Cigna Medicare |
$43.44
|
| Rate for Payer: Employer Direct Commercial |
$43.44
|
| Rate for Payer: Humana Medicare/TRICARE |
$43.44
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$43.44
|
| Rate for Payer: Molina Medicare |
$43.44
|
| Rate for Payer: Multiplan Auto |
$214.50
|
| Rate for Payer: Multiplan Commercial |
$214.50
|
| Rate for Payer: Multiplan Workers Comp |
$214.50
|
| Rate for Payer: Scott and White EPO/PPO |
$0.78
|
| Rate for Payer: Scott and White Medicare |
$43.44
|
| Rate for Payer: Superior Health Plan EPO |
$43.44
|
| Rate for Payer: Superior Health Plan Medicare |
$43.44
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$43.44
|
| Rate for Payer: Universal American Medicare |
$43.44
|
| Rate for Payer: Wellcare Medicare |
$43.44
|
| Rate for Payer: Wellmed Medicare |
$43.44
|
|
|
CHED 96375- IV Injection, add new drug BCE
|
Facility
|
IP
|
$330.00
|
|
|
Service Code
|
CPT 96375
|
| Hospital Charge Code |
8932543
|
|
Hospital Revenue Code
|
260
|
| Rate for Payer: Cash Price |
$290.40
|
|
|
CHED 96376- IV Injection, add same drug BCE
|
Facility
|
IP
|
$330.00
|
|
|
Service Code
|
CPT 96376
|
| Hospital Charge Code |
8932544
|
|
Hospital Revenue Code
|
260
|
| Rate for Payer: Cash Price |
$290.40
|
|
|
CHED 96376- IV Injection, add same drug BCE
|
Facility
|
OP
|
$330.00
|
|
|
Service Code
|
CPT 96376
|
| Hospital Charge Code |
8932544
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$29.70 |
| Max. Negotiated Rate |
$214.50 |
| Rate for Payer: Aetna Commercial |
$181.50
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$29.70
|
| Rate for Payer: BCBS of TX Blue Advantage |
$41.39
|
| Rate for Payer: BCBS of TX Blue Essentials |
$49.48
|
| Rate for Payer: BCBS of TX PPO |
$55.19
|
| Rate for Payer: Cash Price |
$290.40
|
| Rate for Payer: Cash Price |
$290.40
|
| Rate for Payer: Multiplan Auto |
$214.50
|
| Rate for Payer: Multiplan Commercial |
$214.50
|
| Rate for Payer: Multiplan Workers Comp |
$214.50
|
| Rate for Payer: Scott and White EPO/PPO |
$165.00
|
| Rate for Payer: Superior Health Plan EPO |
$44.88
|
|
|
CHED 99281 - Level 1 BCE
|
Facility
|
IP
|
$375.00
|
|
|
Service Code
|
CPT 99281
|
| Hospital Charge Code |
8930545
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$330.00
|
|
|
CHED 99281 - Level 1 BCE
|
Facility
|
OP
|
$375.00
|
|
|
Service Code
|
CPT 99281
|
| Hospital Charge Code |
8930545
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.45 |
| Max. Negotiated Rate |
$750.00 |
| Rate for Payer: Aetna Commercial |
$750.00
|
| Rate for Payer: Aetna Medicare |
$121.78
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$280.00
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$81.19
|
| Rate for Payer: Amerigroup Medicare |
$81.19
|
| Rate for Payer: BCBS of TX Blue Advantage |
$121.14
|
| Rate for Payer: BCBS of TX Blue Essentials |
$144.81
|
| Rate for Payer: BCBS of TX Medicare |
$81.19
|
| Rate for Payer: BCBS of TX PPO |
$161.52
|
| Rate for Payer: Cash Price |
$330.00
|
| Rate for Payer: Cash Price |
$330.00
|
| Rate for Payer: Cash Price |
$330.00
|
| Rate for Payer: Cigna Commercial |
$323.31
|
| Rate for Payer: Cigna Medicare |
$81.19
|
| Rate for Payer: Employer Direct Commercial |
$81.19
|
| Rate for Payer: Humana Medicare/TRICARE |
$81.19
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$81.19
|
| Rate for Payer: Molina Medicare |
$81.19
|
| Rate for Payer: Multiplan Auto |
$243.75
|
| Rate for Payer: Multiplan Commercial |
$243.75
|
| Rate for Payer: Multiplan Workers Comp |
$243.75
|
| Rate for Payer: Scott and White EPO/PPO |
$1.45
|
| Rate for Payer: Scott and White Medicare |
$81.19
|
| Rate for Payer: Superior Health Plan EPO |
$81.19
|
| Rate for Payer: Superior Health Plan Medicare |
$81.19
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$81.19
|
| Rate for Payer: Universal American Medicare |
$81.19
|
| Rate for Payer: Wellcare Medicare |
$81.19
|
| Rate for Payer: Wellmed Medicare |
$81.19
|
|
|
CHED 99282 - Level 2 BCE
|
Facility
|
OP
|
$762.00
|
|
|
Service Code
|
CPT 99282
|
| Hospital Charge Code |
8932545
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2.67 |
| Max. Negotiated Rate |
$1,500.00 |
| Rate for Payer: Aetna Commercial |
$1,500.00
|
| Rate for Payer: Aetna Medicare |
$224.36
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$280.00
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$149.57
|
| Rate for Payer: Amerigroup Medicare |
$149.57
|
| Rate for Payer: BCBS of TX Blue Advantage |
$222.65
|
| Rate for Payer: BCBS of TX Blue Essentials |
$266.16
|
| Rate for Payer: BCBS of TX Medicare |
$149.57
|
| Rate for Payer: BCBS of TX PPO |
$296.87
|
| Rate for Payer: Cash Price |
$670.56
|
| Rate for Payer: Cash Price |
$670.56
|
| Rate for Payer: Cash Price |
$670.56
|
| Rate for Payer: Cigna Commercial |
$595.62
|
| Rate for Payer: Cigna Medicare |
$149.57
|
| Rate for Payer: Employer Direct Commercial |
$149.57
|
| Rate for Payer: Humana Medicare/TRICARE |
$149.57
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$149.57
|
| Rate for Payer: Molina Medicare |
$149.57
|
| Rate for Payer: Multiplan Auto |
$495.30
|
| Rate for Payer: Multiplan Commercial |
$495.30
|
| Rate for Payer: Multiplan Workers Comp |
$495.30
|
| Rate for Payer: Scott and White EPO/PPO |
$2.67
|
| Rate for Payer: Scott and White Medicare |
$149.57
|
| Rate for Payer: Superior Health Plan EPO |
$149.57
|
| Rate for Payer: Superior Health Plan Medicare |
$149.57
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$149.57
|
| Rate for Payer: Universal American Medicare |
$149.57
|
| Rate for Payer: Wellcare Medicare |
$149.57
|
| Rate for Payer: Wellmed Medicare |
$149.57
|
|
|
CHED 99282 - Level 2 BCE
|
Facility
|
IP
|
$762.00
|
|
|
Service Code
|
CPT 99282
|
| Hospital Charge Code |
8932545
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$670.56
|
|
|
CHED 99283 - Level 3 BCE
|
Facility
|
OP
|
$1,554.00
|
|
|
Service Code
|
CPT 99283
|
| Hospital Charge Code |
8928546
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$4.67 |
| Max. Negotiated Rate |
$2,050.00 |
| Rate for Payer: Aetna Commercial |
$2,050.00
|
| Rate for Payer: Aetna Medicare |
$391.41
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$280.00
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$260.94
|
| Rate for Payer: Amerigroup Medicare |
$260.94
|
| Rate for Payer: BCBS of TX Blue Advantage |
$388.61
|
| Rate for Payer: BCBS of TX Blue Essentials |
$464.55
|
| Rate for Payer: BCBS of TX Medicare |
$260.94
|
| Rate for Payer: BCBS of TX PPO |
$518.15
|
| Rate for Payer: Cash Price |
$1,367.52
|
| Rate for Payer: Cash Price |
$1,367.52
|
| Rate for Payer: Cash Price |
$1,367.52
|
| Rate for Payer: Cigna Commercial |
$1,039.11
|
| Rate for Payer: Cigna Medicare |
$260.94
|
| Rate for Payer: Employer Direct Commercial |
$260.94
|
| Rate for Payer: Humana Medicare/TRICARE |
$260.94
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$260.94
|
| Rate for Payer: Molina Medicare |
$260.94
|
| Rate for Payer: Multiplan Auto |
$1,010.10
|
| Rate for Payer: Multiplan Commercial |
$1,010.10
|
| Rate for Payer: Multiplan Workers Comp |
$1,010.10
|
| Rate for Payer: Scott and White EPO/PPO |
$4.67
|
| Rate for Payer: Scott and White Medicare |
$260.94
|
| Rate for Payer: Superior Health Plan EPO |
$260.94
|
| Rate for Payer: Superior Health Plan Medicare |
$260.94
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$260.94
|
| Rate for Payer: Universal American Medicare |
$260.94
|
| Rate for Payer: Wellcare Medicare |
$260.94
|
| Rate for Payer: Wellmed Medicare |
$260.94
|
|
|
CHED 99283 - Level 3 BCE
|
Facility
|
IP
|
$1,554.00
|
|
|
Service Code
|
CPT 99283
|
| Hospital Charge Code |
8928546
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$1,367.52
|
|
|
CHED 99284 - Level 4 BCE
|
Facility
|
IP
|
$2,117.00
|
|
|
Service Code
|
CPT 99284
|
| Hospital Charge Code |
8932546
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$1,862.96
|
|
|
CHED 99284 - Level 4 BCE
|
Facility
|
OP
|
$2,117.00
|
|
|
Service Code
|
CPT 99284
|
| Hospital Charge Code |
8932546
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$7.24 |
| Max. Negotiated Rate |
$2,350.00 |
| Rate for Payer: Aetna Commercial |
$2,350.00
|
| Rate for Payer: Aetna Medicare |
$607.59
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$280.00
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$405.06
|
| Rate for Payer: Amerigroup Medicare |
$405.06
|
| Rate for Payer: BCBS of TX Blue Advantage |
$612.11
|
| Rate for Payer: BCBS of TX Blue Essentials |
$731.72
|
| Rate for Payer: BCBS of TX Medicare |
$405.06
|
| Rate for Payer: BCBS of TX PPO |
$816.15
|
| Rate for Payer: Cash Price |
$1,862.96
|
| Rate for Payer: Cash Price |
$1,862.96
|
| Rate for Payer: Cash Price |
$1,862.96
|
| Rate for Payer: Cigna Commercial |
$1,613.02
|
| Rate for Payer: Cigna Medicare |
$405.06
|
| Rate for Payer: Employer Direct Commercial |
$405.06
|
| Rate for Payer: Humana Medicare/TRICARE |
$405.06
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$405.06
|
| Rate for Payer: Molina Medicare |
$405.06
|
| Rate for Payer: Multiplan Auto |
$1,376.05
|
| Rate for Payer: Multiplan Commercial |
$1,376.05
|
| Rate for Payer: Multiplan Workers Comp |
$1,376.05
|
| Rate for Payer: Scott and White EPO/PPO |
$7.24
|
| Rate for Payer: Scott and White Medicare |
$405.06
|
| Rate for Payer: Superior Health Plan EPO |
$405.06
|
| Rate for Payer: Superior Health Plan Medicare |
$405.06
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$405.06
|
| Rate for Payer: Universal American Medicare |
$405.06
|
| Rate for Payer: Wellcare Medicare |
$405.06
|
| Rate for Payer: Wellmed Medicare |
$405.06
|
|
|
CHED 99285 - Level 5 BCE
|
Facility
|
IP
|
$3,040.00
|
|
|
Service Code
|
CPT 99285
|
| Hospital Charge Code |
8932547
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$2,675.20
|
|
