|
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
|
|
|
CHED Addl Admin Charge 90472 BCE
|
Facility
|
IP
|
$96.00
|
|
|
Service Code
|
CPT 90472
|
| Hospital Charge Code |
8910590
|
|
Hospital Revenue Code
|
771
|
| Rate for Payer: Cash Price |
$84.48
|
|
|
CHED Addl Admin Charge 90472 BCE
|
Facility
|
OP
|
$96.00
|
|
|
Service Code
|
CPT 90472
|
| Hospital Charge Code |
8910590
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$8.64 |
| Max. Negotiated Rate |
$62.40 |
| Rate for Payer: Aetna Commercial |
$52.80
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$8.64
|
| Rate for Payer: BCBS of TX Blue Advantage |
$22.57
|
| Rate for Payer: BCBS of TX Blue Essentials |
$26.98
|
| Rate for Payer: BCBS of TX PPO |
$30.09
|
| Rate for Payer: Cash Price |
$84.48
|
| Rate for Payer: Cash Price |
$84.48
|
| Rate for Payer: Multiplan Auto |
$62.40
|
| Rate for Payer: Multiplan Commercial |
$62.40
|
| Rate for Payer: Multiplan Workers Comp |
$62.40
|
| Rate for Payer: Scott and White EPO/PPO |
$48.00
|
| Rate for Payer: Superior Health Plan EPO |
$13.06
|
|
|
CHED Airway/Intubation Procedures Chest Tube Insertion BCE
|
Facility
|
OP
|
$2,373.75
|
|
|
Service Code
|
CPT 32551
|
| Hospital Charge Code |
8914567
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$26.19 |
| Max. Negotiated Rate |
$4,110.45 |
| Rate for Payer: Aetna Commercial |
$1,400.00
|
| Rate for Payer: Aetna Medicare |
$2,197.02
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$213.64
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,464.68
|
| Rate for Payer: Amerigroup Medicare |
$1,464.68
|
| 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 |
$1,464.68
|
| Rate for Payer: BCBS of TX PPO |
$4,110.45
|
| Rate for Payer: Cash Price |
$2,088.90
|
| Rate for Payer: Cash Price |
$2,088.90
|
| Rate for Payer: Cash Price |
$2,088.90
|
| Rate for Payer: Cigna Commercial |
$3,317.93
|
| Rate for Payer: Cigna Medicare |
$1,464.68
|
| Rate for Payer: Employer Direct Commercial |
$1,464.68
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,464.68
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,464.68
|
| Rate for Payer: Molina Medicare |
$1,464.68
|
| Rate for Payer: Multiplan Auto |
$1,542.94
|
| Rate for Payer: Multiplan Commercial |
$1,542.94
|
| Rate for Payer: Multiplan Workers Comp |
$1,542.94
|
| Rate for Payer: Scott and White EPO/PPO |
$26.19
|
| Rate for Payer: Scott and White Medicare |
$1,464.68
|
| Rate for Payer: Superior Health Plan EPO |
$1,464.68
|
| Rate for Payer: Superior Health Plan Medicare |
$1,464.68
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,464.68
|
| Rate for Payer: Universal American Medicare |
$1,464.68
|
| Rate for Payer: Wellcare Medicare |
$1,464.68
|
| Rate for Payer: Wellmed Medicare |
$1,464.68
|
|
|
CHED Airway/Intubation Procedures Chest Tube Insertion BCE
|
Facility
|
IP
|
$2,373.75
|
|
|
Service Code
|
CPT 32551
|
| Hospital Charge Code |
8914567
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$2,088.90
|
|
|
CHED Airway/Intubation Procedures Cricothyrotomy BCE
|
Facility
|
OP
|
$2,180.05
|
|
|
Service Code
|
CPT 31605
|
| Hospital Charge Code |
8914571
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$1,417.03 |
| Rate for Payer: Aetna Commercial |
$1,199.03
|
| Rate for Payer: Aetna Medicare |
$335.08
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$196.20
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$223.39
|
| Rate for Payer: Amerigroup Medicare |
$223.39
|
| Rate for Payer: BCBS of TX Blue Advantage |
$340.08
|
| Rate for Payer: BCBS of TX Blue Essentials |
$407.28
|
| Rate for Payer: BCBS of TX Medicare |
$223.39
|
| Rate for Payer: BCBS of TX PPO |
$513.17
|
| Rate for Payer: Cash Price |
$1,918.44
|
| Rate for Payer: Cash Price |
$1,918.44
|
| Rate for Payer: Cash Price |
$1,918.44
|
| Rate for Payer: Cigna Commercial |
$506.05
|
| Rate for Payer: Cigna Medicaid |
$87.58
|
| Rate for Payer: Cigna Medicare |
$223.39
|
| Rate for Payer: Employer Direct Commercial |
$223.39
|
| Rate for Payer: Humana Medicare/TRICARE |
$223.39
|
| Rate for Payer: Molina CHIP/Medicaid |
$87.58
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$223.39
|
| Rate for Payer: Molina Medicare |
$223.39
|
| Rate for Payer: Multiplan Auto |
$1,417.03
|
| Rate for Payer: Multiplan Commercial |
$1,417.03
|
| Rate for Payer: Multiplan Workers Comp |
$1,417.03
|
| Rate for Payer: Parkland Medicaid |
$87.58
|
| Rate for Payer: Scott and White EPO/PPO |
$4.00
|
| Rate for Payer: Scott and White Medicare |
$223.39
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$87.58
|
| Rate for Payer: Superior Health Plan EPO |
$223.39
|
| Rate for Payer: Superior Health Plan Medicare |
$223.39
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$223.39
|
| Rate for Payer: Universal American Medicare |
$223.39
|
| Rate for Payer: Wellcare Medicare |
$223.39
|
| Rate for Payer: Wellmed Medicare |
$223.39
|
|
|
CHED Airway/Intubation Procedures Cricothyrotomy BCE
|
Facility
|
IP
|
$2,180.05
|
|
|
Service Code
|
CPT 31605
|
| Hospital Charge Code |
8914571
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$1,918.44
|
|
|
CHED Airway/Intubation Procedures Endotracheal Intubation BC
|
Facility
|
OP
|
$1,155.39
|
|
|
Service Code
|
CPT 31500
|
| Hospital Charge Code |
8916577
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$751.00 |
| Rate for Payer: Aetna Commercial |
$635.46
|
| Rate for Payer: Aetna Medicare |
$335.08
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$103.99
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$223.39
|
| Rate for Payer: Amerigroup Medicare |
$223.39
|
| Rate for Payer: BCBS of TX Blue Advantage |
$340.08
|
| Rate for Payer: BCBS of TX Blue Essentials |
$407.28
|
| Rate for Payer: BCBS of TX Medicare |
$223.39
|
| Rate for Payer: BCBS of TX PPO |
$513.17
|
| Rate for Payer: Cash Price |
$1,016.74
|
| Rate for Payer: Cash Price |
$1,016.74
|
| Rate for Payer: Cash Price |
$1,016.74
|
| Rate for Payer: Cigna Commercial |
$506.05
|
| Rate for Payer: Cigna Medicaid |
$87.58
|
| Rate for Payer: Cigna Medicare |
$223.39
|
| Rate for Payer: Employer Direct Commercial |
$223.39
|
| Rate for Payer: Humana Medicare/TRICARE |
$223.39
|
| Rate for Payer: Molina CHIP/Medicaid |
$87.58
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$223.39
|
| Rate for Payer: Molina Medicare |
$223.39
|
| Rate for Payer: Multiplan Auto |
$751.00
|
| Rate for Payer: Multiplan Commercial |
$751.00
|
| Rate for Payer: Multiplan Workers Comp |
$751.00
|
| Rate for Payer: Parkland Medicaid |
$87.58
|
| Rate for Payer: Scott and White EPO/PPO |
$4.00
|
| Rate for Payer: Scott and White Medicare |
$223.39
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$87.58
|
| Rate for Payer: Superior Health Plan EPO |
$223.39
|
| Rate for Payer: Superior Health Plan Medicare |
$223.39
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$223.39
|
| Rate for Payer: Universal American Medicare |
$223.39
|
| Rate for Payer: Wellcare Medicare |
$223.39
|
| Rate for Payer: Wellmed Medicare |
$223.39
|
|
|
CHED Airway/Intubation Procedures Endotracheal Intubation BC
|
Facility
|
IP
|
$1,155.39
|
|
|
Service Code
|
CPT 31500
|
| Hospital Charge Code |
8916577
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$1,016.74
|
|
|
CHED Airway/Intubation Procedures Insert pleural catheter w/
|
Facility
|
OP
|
$6,539.91
|
|
|
Service Code
|
CPT 32550
|
| Hospital Charge Code |
8912575
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$56.58 |
| Max. Negotiated Rate |
$7,835.54 |
| Rate for Payer: Aetna Commercial |
$4,635.00
|
| Rate for Payer: Aetna Medicare |
$4,746.03
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$588.59
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3,164.02
|
| Rate for Payer: Amerigroup Medicare |
$3,164.02
|
| Rate for Payer: BCBS of TX Blue Advantage |
$5,192.60
|
| Rate for Payer: BCBS of TX Blue Essentials |
$6,218.68
|
| Rate for Payer: BCBS of TX Medicare |
$3,164.02
|
| Rate for Payer: BCBS of TX PPO |
$7,835.54
|
| Rate for Payer: Cash Price |
$5,755.12
|
| Rate for Payer: Cash Price |
$5,755.12
|
| Rate for Payer: Cash Price |
$5,755.12
|
| Rate for Payer: Cigna Commercial |
$7,167.43
|
| Rate for Payer: Cigna Medicaid |
$1,551.50
|
| Rate for Payer: Cigna Medicare |
$3,164.02
|
| Rate for Payer: Employer Direct Commercial |
$3,164.02
|
| Rate for Payer: Humana Medicare/TRICARE |
$3,164.02
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,551.50
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3,164.02
|
| Rate for Payer: Molina Medicare |
$3,164.02
|
| Rate for Payer: Multiplan Auto |
$4,250.94
|
| Rate for Payer: Multiplan Commercial |
$4,250.94
|
| Rate for Payer: Multiplan Workers Comp |
$4,250.94
|
| Rate for Payer: Parkland Medicaid |
$1,551.50
|
| Rate for Payer: Scott and White EPO/PPO |
$56.58
|
| Rate for Payer: Scott and White Medicare |
$3,164.02
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,551.50
|
| Rate for Payer: Superior Health Plan EPO |
$3,164.02
|
| Rate for Payer: Superior Health Plan Medicare |
$3,164.02
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3,164.02
|
| Rate for Payer: Universal American Medicare |
$3,164.02
|
| Rate for Payer: Wellcare Medicare |
$3,164.02
|
| Rate for Payer: Wellmed Medicare |
$3,164.02
|
|
|
CHED Airway/Intubation Procedures Insert pleural catheter w/
|
Facility
|
IP
|
$6,539.91
|
|
|
Service Code
|
CPT 32550
|
| Hospital Charge Code |
8912575
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$5,755.12
|
|
|
CHED Airway/Intubation Procedures Laryngoscopy, direct BCE
|
Facility
|
IP
|
$5,289.70
|
|
|
Service Code
|
CPT 31525
|
| Hospital Charge Code |
8914568
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$4,654.94
|
|
|
CHED Airway/Intubation Procedures Laryngoscopy, direct BCE
|
Facility
|
OP
|
$5,289.70
|
|
|
Service Code
|
CPT 31525
|
| Hospital Charge Code |
8914568
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$27.76 |
| Max. Negotiated Rate |
$3,605.14 |
| Rate for Payer: Aetna Commercial |
$2,200.00
|
| Rate for Payer: Aetna Medicare |
$2,328.34
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$476.07
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,552.23
|
| Rate for Payer: Amerigroup Medicare |
$1,552.23
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,389.12
|
| Rate for Payer: BCBS of TX Blue Essentials |
$2,861.22
|
| Rate for Payer: BCBS of TX Medicare |
$1,552.23
|
| Rate for Payer: BCBS of TX PPO |
$3,605.14
|
| Rate for Payer: Cash Price |
$4,654.94
|
| Rate for Payer: Cash Price |
$4,654.94
|
| Rate for Payer: Cash Price |
$4,654.94
|
| Rate for Payer: Cigna Commercial |
$3,516.25
|
| Rate for Payer: Cigna Medicaid |
$525.71
|
| Rate for Payer: Cigna Medicare |
$1,552.23
|
| Rate for Payer: Employer Direct Commercial |
$1,552.23
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,552.23
|
| Rate for Payer: Molina CHIP/Medicaid |
$525.71
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,552.23
|
| Rate for Payer: Molina Medicare |
$1,552.23
|
| Rate for Payer: Multiplan Auto |
$3,438.30
|
| Rate for Payer: Multiplan Commercial |
$3,438.30
|
| Rate for Payer: Multiplan Workers Comp |
$3,438.30
|
| Rate for Payer: Parkland Medicaid |
$525.71
|
| Rate for Payer: Scott and White EPO/PPO |
$27.76
|
| Rate for Payer: Scott and White Medicare |
$1,552.23
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$525.71
|
| Rate for Payer: Superior Health Plan EPO |
$1,552.23
|
| Rate for Payer: Superior Health Plan Medicare |
$1,552.23
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,552.23
|
| Rate for Payer: Universal American Medicare |
$1,552.23
|
| Rate for Payer: Wellcare Medicare |
$1,552.23
|
| Rate for Payer: Wellmed Medicare |
$1,552.23
|
|
|
CHED Airway/Intubation Procedures Laryngoscopy, flexible BCE
|
Facility
|
IP
|
$937.59
|
|
|
Service Code
|
CPT 31575
|
| Hospital Charge Code |
8912576
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$825.08
|
|
|
CHED Airway/Intubation Procedures Laryngoscopy, flexible BCE
|
Facility
|
OP
|
$937.59
|
|
|
Service Code
|
CPT 31575
|
| Hospital Charge Code |
8912576
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3.24 |
| Max. Negotiated Rate |
$609.43 |
| Rate for Payer: Aetna Commercial |
$515.67
|
| Rate for Payer: Aetna Medicare |
$271.72
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$84.38
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$181.15
|
| Rate for Payer: Amerigroup Medicare |
$181.15
|
| Rate for Payer: BCBS of TX Blue Advantage |
$132.10
|
| Rate for Payer: BCBS of TX Blue Essentials |
$158.20
|
| Rate for Payer: BCBS of TX Medicare |
$181.15
|
| Rate for Payer: BCBS of TX PPO |
$199.33
|
| Rate for Payer: Cash Price |
$825.08
|
| Rate for Payer: Cash Price |
$825.08
|
| Rate for Payer: Cash Price |
$825.08
|
| Rate for Payer: Cigna Commercial |
$410.36
|
| Rate for Payer: Cigna Medicaid |
$68.14
|
| Rate for Payer: Cigna Medicare |
$181.15
|
| Rate for Payer: Employer Direct Commercial |
$181.15
|
| Rate for Payer: Humana Medicare/TRICARE |
$181.15
|
| Rate for Payer: Molina CHIP/Medicaid |
$68.14
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$181.15
|
| Rate for Payer: Molina Medicare |
$181.15
|
| Rate for Payer: Multiplan Auto |
$609.43
|
| Rate for Payer: Multiplan Commercial |
$609.43
|
| Rate for Payer: Multiplan Workers Comp |
$609.43
|
| Rate for Payer: Parkland Medicaid |
$68.14
|
| Rate for Payer: Scott and White EPO/PPO |
$3.24
|
| Rate for Payer: Scott and White Medicare |
$181.15
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$68.14
|
| Rate for Payer: Superior Health Plan EPO |
$181.15
|
| Rate for Payer: Superior Health Plan Medicare |
$181.15
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$181.15
|
| Rate for Payer: Universal American Medicare |
$181.15
|
| Rate for Payer: Wellcare Medicare |
$181.15
|
| Rate for Payer: Wellmed Medicare |
$181.15
|
|
|
CHED Airway/Intubation Procedures Thoracentesis w/ Imaging B
|
Facility
|
IP
|
$2,603.58
|
|
|
Service Code
|
CPT 32555
|
| Hospital Charge Code |
8914569
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$2,291.15
|
|
|
CHED Airway/Intubation Procedures Thoracentesis w/ Imaging B
|
Facility
|
OP
|
$2,603.58
|
|
|
Service Code
|
CPT 32555
|
| Hospital Charge Code |
8914569
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$10.27 |
| Max. Negotiated Rate |
$1,692.33 |
| Rate for Payer: Aetna Commercial |
$1,400.00
|
| Rate for Payer: Aetna Medicare |
$861.78
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$234.32
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$574.52
|
| Rate for Payer: Amerigroup Medicare |
$574.52
|
| Rate for Payer: BCBS of TX Blue Advantage |
$1,052.95
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,261.02
|
| Rate for Payer: BCBS of TX Medicare |
$574.52
|
| Rate for Payer: BCBS of TX PPO |
$1,588.89
|
| Rate for Payer: Cash Price |
$2,291.15
|
| Rate for Payer: Cash Price |
$2,291.15
|
| Rate for Payer: Cash Price |
$2,291.15
|
| Rate for Payer: Cigna Commercial |
$1,301.46
|
| Rate for Payer: Cigna Medicaid |
$223.75
|
| Rate for Payer: Cigna Medicare |
$574.52
|
| Rate for Payer: Employer Direct Commercial |
$574.52
|
| Rate for Payer: Humana Medicare/TRICARE |
$574.52
|
| Rate for Payer: Molina CHIP/Medicaid |
$223.75
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$574.52
|
| Rate for Payer: Molina Medicare |
$574.52
|
| Rate for Payer: Multiplan Auto |
$1,692.33
|
| Rate for Payer: Multiplan Commercial |
$1,692.33
|
| Rate for Payer: Multiplan Workers Comp |
$1,692.33
|
| Rate for Payer: Parkland Medicaid |
$223.75
|
| Rate for Payer: Scott and White EPO/PPO |
$10.27
|
| Rate for Payer: Scott and White Medicare |
$574.52
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$223.75
|
| Rate for Payer: Superior Health Plan EPO |
$574.52
|
| Rate for Payer: Superior Health Plan Medicare |
$574.52
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$574.52
|
| Rate for Payer: Universal American Medicare |
$574.52
|
| Rate for Payer: Wellcare Medicare |
$574.52
|
| Rate for Payer: Wellmed Medicare |
$574.52
|
|
|
CHED Airway/Intubation Procedures Thoracentesis w/o Imaging
|
Facility
|
IP
|
$1,473.63
|
|
|
Service Code
|
CPT 32554
|
| Hospital Charge Code |
8914570
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$1,296.79
|
|
|
CHED Airway/Intubation Procedures Thoracentesis w/o Imaging
|
Facility
|
OP
|
$1,473.63
|
|
|
Service Code
|
CPT 32554
|
| Hospital Charge Code |
8914570
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$10.27 |
| Max. Negotiated Rate |
$1,588.89 |
| Rate for Payer: Aetna Commercial |
$1,400.00
|
| Rate for Payer: Aetna Medicare |
$861.78
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$132.63
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$574.52
|
| Rate for Payer: Amerigroup Medicare |
$574.52
|
| Rate for Payer: BCBS of TX Blue Advantage |
$1,052.95
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,261.02
|
| Rate for Payer: BCBS of TX Medicare |
$574.52
|
| Rate for Payer: BCBS of TX PPO |
$1,588.89
|
| Rate for Payer: Cash Price |
$1,296.79
|
| Rate for Payer: Cash Price |
$1,296.79
|
| Rate for Payer: Cash Price |
$1,296.79
|
| Rate for Payer: Cigna Commercial |
$1,301.46
|
| Rate for Payer: Cigna Medicaid |
$223.75
|
| Rate for Payer: Cigna Medicare |
$574.52
|
| Rate for Payer: Employer Direct Commercial |
$574.52
|
| Rate for Payer: Humana Medicare/TRICARE |
$574.52
|
| Rate for Payer: Molina CHIP/Medicaid |
$223.75
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$574.52
|
| Rate for Payer: Molina Medicare |
$574.52
|
| Rate for Payer: Multiplan Auto |
$957.86
|
| Rate for Payer: Multiplan Commercial |
$957.86
|
| Rate for Payer: Multiplan Workers Comp |
$957.86
|
| Rate for Payer: Parkland Medicaid |
$223.75
|
| Rate for Payer: Scott and White EPO/PPO |
$10.27
|
| Rate for Payer: Scott and White Medicare |
$574.52
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$223.75
|
| Rate for Payer: Superior Health Plan EPO |
$574.52
|
| Rate for Payer: Superior Health Plan Medicare |
$574.52
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$574.52
|
| Rate for Payer: Universal American Medicare |
$574.52
|
| Rate for Payer: Wellcare Medicare |
$574.52
|
| Rate for Payer: Wellmed Medicare |
$574.52
|
|
|
CHED APPLICATION FINGER SPLINT DYNAMIC BCE
|
Facility
|
IP
|
$492.92
|
|
|
Service Code
|
CPT 29131
|
| Hospital Charge Code |
8912574
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$433.77
|
|
|
CHED APPLICATION FINGER SPLINT DYNAMIC BCE
|
Facility
|
OP
|
$492.92
|
|
|
Service Code
|
CPT 29131
|
| Hospital Charge Code |
8912574
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$320.40 |
| Rate for Payer: Aetna Commercial |
$271.11
|
| Rate for Payer: Aetna Medicare |
$83.91
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$44.36
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$55.94
|
| Rate for Payer: Amerigroup Medicare |
$55.94
|
| 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 |
$55.94
|
| Rate for Payer: BCBS of TX PPO |
$138.63
|
| Rate for Payer: Cash Price |
$433.77
|
| Rate for Payer: Cash Price |
$433.77
|
| Rate for Payer: Cash Price |
$433.77
|
| Rate for Payer: Cigna Commercial |
$126.71
|
| Rate for Payer: Cigna Medicare |
$55.94
|
| Rate for Payer: Employer Direct Commercial |
$55.94
|
| Rate for Payer: Humana Medicare/TRICARE |
$55.94
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$55.94
|
| Rate for Payer: Molina Medicare |
$55.94
|
| Rate for Payer: Multiplan Auto |
$320.40
|
| Rate for Payer: Multiplan Commercial |
$320.40
|
| Rate for Payer: Multiplan Workers Comp |
$320.40
|
| Rate for Payer: Scott and White EPO/PPO |
$1.00
|
| Rate for Payer: Scott and White Medicare |
$55.94
|
| Rate for Payer: Superior Health Plan EPO |
$55.94
|
| Rate for Payer: Superior Health Plan Medicare |
$55.94
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$55.94
|
| Rate for Payer: Universal American Medicare |
$55.94
|
| Rate for Payer: Wellcare Medicare |
$55.94
|
| Rate for Payer: Wellmed Medicare |
$55.94
|
|
|
CHED APPLICATION SHORT ARM SPLINT DYNAMIC BCE
|
Facility
|
OP
|
$575.73
|
|
|
Service Code
|
CPT 29126
|
| Hospital Charge Code |
8912573
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2.09 |
| Max. Negotiated Rate |
$374.22 |
| Rate for Payer: Aetna Commercial |
$316.65
|
| Rate for Payer: Aetna Medicare |
$175.23
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$51.82
|
| 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 |
$506.64
|
| Rate for Payer: Cash Price |
$506.64
|
| Rate for Payer: Cash Price |
$506.64
|
| 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 |
$374.22
|
| Rate for Payer: Multiplan Commercial |
$374.22
|
| Rate for Payer: Multiplan Workers Comp |
$374.22
|
| 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
|
|
|
CHED APPLICATION SHORT ARM SPLINT DYNAMIC BCE
|
Facility
|
IP
|
$575.73
|
|
|
Service Code
|
CPT 29126
|
| Hospital Charge Code |
8912573
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$506.64
|
|
|
CHED Arterial Line Activity Blood Drawn BCE
|
Facility
|
IP
|
$102.00
|
|
|
Service Code
|
CPT 36600
|
| Hospital Charge Code |
8910593
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$89.76
|
|
|
CHED Arterial Line Activity Blood Drawn BCE
|
Facility
|
OP
|
$102.00
|
|
|
Service Code
|
CPT 36600
|
| Hospital Charge Code |
8910593
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2.09 |
| Max. Negotiated Rate |
$274.76 |
| Rate for Payer: Aetna Commercial |
$56.10
|
| Rate for Payer: Aetna Medicare |
$175.23
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$9.18
|
| 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 |
$89.76
|
| Rate for Payer: Cash Price |
$89.76
|
| Rate for Payer: Cash Price |
$89.76
|
| 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 |
$66.30
|
| Rate for Payer: Multiplan Commercial |
$66.30
|
| Rate for Payer: Multiplan Workers Comp |
$66.30
|
| 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
|
|
