|
CHED BLADDER IRRIGATION SIMPLE LAVAGE AND OR INSTILLATION B
|
Facility
|
IP
|
$907.00
|
|
|
Service Code
|
CPT 51700
|
| Hospital Charge Code |
8912577
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$798.16
|
|
|
CHED BLADDER IRRIGATION SIMPLE LAVAGE AND OR INSTILLATION B
|
Facility
|
OP
|
$907.00
|
|
|
Service Code
|
CPT 51700
|
| Hospital Charge Code |
8912577
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$4.04 |
| Max. Negotiated Rate |
$589.55 |
| Rate for Payer: Aetna Commercial |
$498.85
|
| Rate for Payer: Aetna Medicare |
$339.04
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$81.63
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$226.03
|
| Rate for Payer: Amerigroup Medicare |
$226.03
|
| Rate for Payer: BCBS of TX Blue Advantage |
$87.39
|
| Rate for Payer: BCBS of TX Blue Essentials |
$104.66
|
| Rate for Payer: BCBS of TX Medicare |
$226.03
|
| Rate for Payer: BCBS of TX PPO |
$131.87
|
| Rate for Payer: Cash Price |
$798.16
|
| Rate for Payer: Cash Price |
$798.16
|
| Rate for Payer: Cash Price |
$798.16
|
| Rate for Payer: Cigna Commercial |
$512.01
|
| Rate for Payer: Cigna Medicaid |
$44.30
|
| 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 |
$44.30
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$226.03
|
| Rate for Payer: Molina Medicare |
$226.03
|
| Rate for Payer: Multiplan Auto |
$589.55
|
| Rate for Payer: Multiplan Commercial |
$589.55
|
| Rate for Payer: Multiplan Workers Comp |
$589.55
|
| Rate for Payer: Parkland Medicaid |
$44.30
|
| 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 |
$44.30
|
| 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
|
|
|
CHED BLOOD TRANSFUSION BCE
|
Facility
|
IP
|
$1,493.00
|
|
|
Service Code
|
CPT 36430
|
| Hospital Charge Code |
8910594
|
|
Hospital Revenue Code
|
391
|
| Rate for Payer: Cash Price |
$1,313.84
|
|
|
CHED BLOOD TRANSFUSION BCE
|
Facility
|
OP
|
$1,493.00
|
|
|
Service Code
|
CPT 36430
|
| Hospital Charge Code |
8910594
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$7.10 |
| Max. Negotiated Rate |
$970.45 |
| Rate for Payer: Aetna Commercial |
$821.15
|
| Rate for Payer: Aetna Medicare |
$595.52
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$134.37
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$397.01
|
| Rate for Payer: Amerigroup Medicare |
$397.01
|
| Rate for Payer: BCBS of TX Blue Advantage |
$58.47
|
| Rate for Payer: BCBS of TX Blue Essentials |
$70.02
|
| Rate for Payer: BCBS of TX Medicare |
$397.01
|
| Rate for Payer: BCBS of TX PPO |
$88.23
|
| Rate for Payer: Cash Price |
$1,313.84
|
| Rate for Payer: Cash Price |
$1,313.84
|
| Rate for Payer: Cash Price |
$1,313.84
|
| Rate for Payer: Cigna Commercial |
$899.35
|
| Rate for Payer: Cigna Medicaid |
$30.73
|
| Rate for Payer: Cigna Medicare |
$397.01
|
| Rate for Payer: Employer Direct Commercial |
$397.01
|
| Rate for Payer: Humana Medicare/TRICARE |
$397.01
|
| Rate for Payer: Molina CHIP/Medicaid |
$30.73
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$397.01
|
| Rate for Payer: Molina Medicare |
$397.01
|
| Rate for Payer: Multiplan Auto |
$970.45
|
| Rate for Payer: Multiplan Commercial |
$970.45
|
| Rate for Payer: Multiplan Workers Comp |
$970.45
|
| Rate for Payer: Parkland Medicaid |
$30.73
|
| Rate for Payer: Scott and White EPO/PPO |
$7.10
|
| Rate for Payer: Scott and White Medicare |
$397.01
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$30.73
|
| Rate for Payer: Superior Health Plan EPO |
$397.01
|
| Rate for Payer: Superior Health Plan Medicare |
$397.01
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$397.01
|
| Rate for Payer: Universal American Medicare |
$397.01
|
| Rate for Payer: Wellcare Medicare |
$397.01
|
| Rate for Payer: Wellmed Medicare |
$397.01
|
|
|
CHED Burns Dress/Debride Large Burn, >10% BCE
|
Facility
|
IP
|
$922.00
|
|
|
Service Code
|
CPT 16030
|
| Hospital Charge Code |
8912578
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$811.36
|
|
|
CHED Burns Dress/Debride Large Burn, >10% BCE
|
Facility
|
OP
|
$922.00
|
|
|
Service Code
|
CPT 16030
|
| Hospital Charge Code |
8912578
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$6.52 |
| Max. Negotiated Rate |
$826.08 |
| Rate for Payer: Aetna Commercial |
$507.10
|
| Rate for Payer: Aetna Medicare |
$547.00
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$82.98
|
| 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 |
$811.36
|
| Rate for Payer: Cash Price |
$811.36
|
| Rate for Payer: Cash Price |
$811.36
|
| 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 |
$599.30
|
| Rate for Payer: Multiplan Commercial |
$599.30
|
| Rate for Payer: Multiplan Workers Comp |
$599.30
|
| 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
|
|
|
CHED Burns Dress/Debride Medium Burn, 5-10% BCE
|
Facility
|
OP
|
$772.87
|
|
|
Service Code
|
CPT 16025
|
| Hospital Charge Code |
8910595
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3.27 |
| Max. Negotiated Rate |
$502.37 |
| Rate for Payer: Aetna Commercial |
$425.08
|
| Rate for Payer: Aetna Medicare |
$274.64
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$69.56
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$183.09
|
| Rate for Payer: Amerigroup Medicare |
$183.09
|
| 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 |
$183.09
|
| Rate for Payer: BCBS of TX PPO |
$440.32
|
| Rate for Payer: Cash Price |
$680.13
|
| Rate for Payer: Cash Price |
$680.13
|
| Rate for Payer: Cash Price |
$680.13
|
| Rate for Payer: Cigna Commercial |
$414.75
|
| Rate for Payer: Cigna Medicaid |
$74.34
|
| Rate for Payer: Cigna Medicare |
$183.09
|
| Rate for Payer: Employer Direct Commercial |
$183.09
|
| Rate for Payer: Humana Medicare/TRICARE |
$183.09
|
| Rate for Payer: Molina CHIP/Medicaid |
$74.34
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$183.09
|
| Rate for Payer: Molina Medicare |
$183.09
|
| Rate for Payer: Multiplan Auto |
$502.37
|
| Rate for Payer: Multiplan Commercial |
$502.37
|
| Rate for Payer: Multiplan Workers Comp |
$502.37
|
| Rate for Payer: Parkland Medicaid |
$74.34
|
| Rate for Payer: Scott and White EPO/PPO |
$3.27
|
| Rate for Payer: Scott and White Medicare |
$183.09
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$74.34
|
| Rate for Payer: Superior Health Plan EPO |
$183.09
|
| Rate for Payer: Superior Health Plan Medicare |
$183.09
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$183.09
|
| Rate for Payer: Universal American Medicare |
$183.09
|
| Rate for Payer: Wellcare Medicare |
$183.09
|
| Rate for Payer: Wellmed Medicare |
$183.09
|
|
|
CHED Burns Dress/Debride Medium Burn, 5-10% BCE
|
Facility
|
IP
|
$772.87
|
|
|
Service Code
|
CPT 16025
|
| Hospital Charge Code |
8910595
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$680.13
|
|
|
CHED Burns Dress/Debride Small Burn, <5% BCE
|
Facility
|
OP
|
$716.77
|
|
|
Service Code
|
CPT 16020
|
| Hospital Charge Code |
8912579
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3.27 |
| Max. Negotiated Rate |
$465.90 |
| Rate for Payer: Aetna Commercial |
$394.22
|
| Rate for Payer: Aetna Medicare |
$274.64
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$64.51
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$183.09
|
| Rate for Payer: Amerigroup Medicare |
$183.09
|
| 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 |
$183.09
|
| Rate for Payer: BCBS of TX PPO |
$440.32
|
| Rate for Payer: Cash Price |
$630.76
|
| Rate for Payer: Cash Price |
$630.76
|
| Rate for Payer: Cash Price |
$630.76
|
| Rate for Payer: Cigna Commercial |
$414.75
|
| Rate for Payer: Cigna Medicaid |
$44.31
|
| Rate for Payer: Cigna Medicare |
$183.09
|
| Rate for Payer: Employer Direct Commercial |
$183.09
|
| Rate for Payer: Humana Medicare/TRICARE |
$183.09
|
| Rate for Payer: Molina CHIP/Medicaid |
$44.31
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$183.09
|
| Rate for Payer: Molina Medicare |
$183.09
|
| Rate for Payer: Multiplan Auto |
$465.90
|
| Rate for Payer: Multiplan Commercial |
$465.90
|
| Rate for Payer: Multiplan Workers Comp |
$465.90
|
| Rate for Payer: Parkland Medicaid |
$44.31
|
| Rate for Payer: Scott and White EPO/PPO |
$3.27
|
| Rate for Payer: Scott and White Medicare |
$183.09
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$44.31
|
| Rate for Payer: Superior Health Plan EPO |
$183.09
|
| Rate for Payer: Superior Health Plan Medicare |
$183.09
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$183.09
|
| Rate for Payer: Universal American Medicare |
$183.09
|
| Rate for Payer: Wellcare Medicare |
$183.09
|
| Rate for Payer: Wellmed Medicare |
$183.09
|
|
|
CHED Burns Dress/Debride Small Burn, <5% BCE
|
Facility
|
IP
|
$716.77
|
|
|
Service Code
|
CPT 16020
|
| Hospital Charge Code |
8912579
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$630.76
|
|
|
CHED Cardiovascular Procedure Cardioversion BCE
|
Facility
|
OP
|
$1,304.00
|
|
|
Service Code
|
CPT 92960
|
| Hospital Charge Code |
8912584
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$10.64 |
| Max. Negotiated Rate |
$1,400.00 |
| Rate for Payer: Aetna Commercial |
$1,400.00
|
| Rate for Payer: Aetna Medicare |
$892.82
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$117.36
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$595.21
|
| Rate for Payer: Amerigroup Medicare |
$595.21
|
| Rate for Payer: BCBS of TX Blue Advantage |
$895.89
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,072.92
|
| Rate for Payer: BCBS of TX Medicare |
$595.21
|
| Rate for Payer: BCBS of TX PPO |
$1,351.88
|
| Rate for Payer: Cash Price |
$1,147.52
|
| Rate for Payer: Cash Price |
$1,147.52
|
| Rate for Payer: Cash Price |
$1,147.52
|
| Rate for Payer: Cigna Commercial |
$1,348.32
|
| Rate for Payer: Cigna Medicare |
$595.21
|
| Rate for Payer: Employer Direct Commercial |
$595.21
|
| Rate for Payer: Humana Medicare/TRICARE |
$595.21
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$595.21
|
| Rate for Payer: Molina Medicare |
$595.21
|
| Rate for Payer: Multiplan Auto |
$847.60
|
| Rate for Payer: Multiplan Commercial |
$847.60
|
| Rate for Payer: Multiplan Workers Comp |
$847.60
|
| Rate for Payer: Scott and White EPO/PPO |
$10.64
|
| Rate for Payer: Scott and White Medicare |
$595.21
|
| Rate for Payer: Superior Health Plan EPO |
$595.21
|
| Rate for Payer: Superior Health Plan Medicare |
$595.21
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$595.21
|
| Rate for Payer: Universal American Medicare |
$595.21
|
| Rate for Payer: Wellcare Medicare |
$595.21
|
| Rate for Payer: Wellmed Medicare |
$595.21
|
|
|
CHED Cardiovascular Procedure Cardioversion BCE
|
Facility
|
IP
|
$1,304.00
|
|
|
Service Code
|
CPT 92960
|
| Hospital Charge Code |
8912584
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$1,147.52
|
|
|
CHED Cardiovascular Procedure CPR BCE
|
Facility
|
OP
|
$1,150.00
|
|
|
Service Code
|
CPT 92950
|
| Hospital Charge Code |
8910605
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$5.13 |
| Max. Negotiated Rate |
$747.50 |
| Rate for Payer: Aetna Commercial |
$632.50
|
| Rate for Payer: Aetna Medicare |
$430.59
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$103.50
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$287.06
|
| Rate for Payer: Amerigroup Medicare |
$287.06
|
| Rate for Payer: BCBS of TX Blue Advantage |
$422.68
|
| Rate for Payer: BCBS of TX Blue Essentials |
$506.20
|
| Rate for Payer: BCBS of TX Medicare |
$287.06
|
| Rate for Payer: BCBS of TX PPO |
$637.81
|
| Rate for Payer: Cash Price |
$1,012.00
|
| Rate for Payer: Cash Price |
$1,012.00
|
| Rate for Payer: Cash Price |
$1,012.00
|
| Rate for Payer: Cigna Commercial |
$650.28
|
| Rate for Payer: Cigna Medicare |
$287.06
|
| Rate for Payer: Employer Direct Commercial |
$287.06
|
| Rate for Payer: Humana Medicare/TRICARE |
$287.06
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$287.06
|
| Rate for Payer: Molina Medicare |
$287.06
|
| Rate for Payer: Multiplan Auto |
$747.50
|
| Rate for Payer: Multiplan Commercial |
$747.50
|
| Rate for Payer: Multiplan Workers Comp |
$747.50
|
| Rate for Payer: Scott and White EPO/PPO |
$5.13
|
| Rate for Payer: Scott and White Medicare |
$287.06
|
| Rate for Payer: Superior Health Plan EPO |
$287.06
|
| Rate for Payer: Superior Health Plan Medicare |
$287.06
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$287.06
|
| Rate for Payer: Universal American Medicare |
$287.06
|
| Rate for Payer: Wellcare Medicare |
$287.06
|
| Rate for Payer: Wellmed Medicare |
$287.06
|
|
|
CHED Cardiovascular Procedure CPR BCE
|
Facility
|
IP
|
$1,150.00
|
|
|
Service Code
|
CPT 92950
|
| Hospital Charge Code |
8910605
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$1,012.00
|
|
|
CHED Cardiovascular Procedure Pacemaker, transcutaneous BCE
|
Facility
|
OP
|
$1,356.75
|
|
|
Service Code
|
CPT 92953
|
| Hospital Charge Code |
8912585
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$10.64 |
| Max. Negotiated Rate |
$1,400.00 |
| Rate for Payer: Aetna Commercial |
$1,400.00
|
| Rate for Payer: Aetna Medicare |
$892.82
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$122.11
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$595.21
|
| Rate for Payer: Amerigroup Medicare |
$595.21
|
| Rate for Payer: BCBS of TX Blue Advantage |
$895.89
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,072.92
|
| Rate for Payer: BCBS of TX Medicare |
$595.21
|
| Rate for Payer: BCBS of TX PPO |
$1,351.88
|
| Rate for Payer: Cash Price |
$1,193.94
|
| Rate for Payer: Cash Price |
$1,193.94
|
| Rate for Payer: Cash Price |
$1,193.94
|
| Rate for Payer: Cigna Commercial |
$1,348.32
|
| Rate for Payer: Cigna Medicare |
$595.21
|
| Rate for Payer: Employer Direct Commercial |
$595.21
|
| Rate for Payer: Humana Medicare/TRICARE |
$595.21
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$595.21
|
| Rate for Payer: Molina Medicare |
$595.21
|
| Rate for Payer: Multiplan Auto |
$881.89
|
| Rate for Payer: Multiplan Commercial |
$881.89
|
| Rate for Payer: Multiplan Workers Comp |
$881.89
|
| Rate for Payer: Scott and White EPO/PPO |
$10.64
|
| Rate for Payer: Scott and White Medicare |
$595.21
|
| Rate for Payer: Superior Health Plan EPO |
$595.21
|
| Rate for Payer: Superior Health Plan Medicare |
$595.21
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$595.21
|
| Rate for Payer: Universal American Medicare |
$595.21
|
| Rate for Payer: Wellcare Medicare |
$595.21
|
| Rate for Payer: Wellmed Medicare |
$595.21
|
|
|
CHED Cardiovascular Procedure Pacemaker, transcutaneous BCE
|
Facility
|
IP
|
$1,356.75
|
|
|
Service Code
|
CPT 92953
|
| Hospital Charge Code |
8912585
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$1,193.94
|
|
|
CHED CHANGE CYSTOSTOMY TUBE COMPLICATED BCE
|
Facility
|
IP
|
$4,406.63
|
|
|
Service Code
|
CPT 51710
|
| Hospital Charge Code |
8914572
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$3,877.83
|
|
|
CHED CHANGE CYSTOSTOMY TUBE COMPLICATED BCE
|
Facility
|
OP
|
$4,406.63
|
|
|
Service Code
|
CPT 51710
|
| Hospital Charge Code |
8914572
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$11.17 |
| Max. Negotiated Rate |
$2,864.31 |
| Rate for Payer: Aetna Commercial |
$1,400.00
|
| Rate for Payer: Aetna Medicare |
$937.10
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$396.60
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$624.73
|
| Rate for Payer: Amerigroup Medicare |
$624.73
|
| Rate for Payer: BCBS of TX Blue Advantage |
$929.41
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,113.06
|
| Rate for Payer: BCBS of TX Medicare |
$624.73
|
| Rate for Payer: BCBS of TX PPO |
$1,402.46
|
| Rate for Payer: Cash Price |
$3,877.83
|
| Rate for Payer: Cash Price |
$3,877.83
|
| Rate for Payer: Cash Price |
$3,877.83
|
| Rate for Payer: Cigna Commercial |
$1,415.20
|
| Rate for Payer: Cigna Medicaid |
$238.15
|
| Rate for Payer: Cigna Medicare |
$624.73
|
| Rate for Payer: Employer Direct Commercial |
$624.73
|
| Rate for Payer: Humana Medicare/TRICARE |
$624.73
|
| Rate for Payer: Molina CHIP/Medicaid |
$238.15
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$624.73
|
| Rate for Payer: Molina Medicare |
$624.73
|
| Rate for Payer: Multiplan Auto |
$2,864.31
|
| Rate for Payer: Multiplan Commercial |
$2,864.31
|
| Rate for Payer: Multiplan Workers Comp |
$2,864.31
|
| Rate for Payer: Parkland Medicaid |
$238.15
|
| Rate for Payer: Scott and White EPO/PPO |
$11.17
|
| Rate for Payer: Scott and White Medicare |
$624.73
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$238.15
|
| Rate for Payer: Superior Health Plan EPO |
$624.73
|
| Rate for Payer: Superior Health Plan Medicare |
$624.73
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$624.73
|
| Rate for Payer: Universal American Medicare |
$624.73
|
| Rate for Payer: Wellcare Medicare |
$624.73
|
| Rate for Payer: Wellmed Medicare |
$624.73
|
|
|
CHED Chemical Cautery Yes BCE
|
Facility
|
OP
|
$614.73
|
|
|
Service Code
|
CPT 17250
|
| Hospital Charge Code |
8910606
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3.27 |
| Max. Negotiated Rate |
$440.32 |
| Rate for Payer: Aetna Commercial |
$338.10
|
| Rate for Payer: Aetna Medicare |
$274.64
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$55.33
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$183.09
|
| Rate for Payer: Amerigroup Medicare |
$183.09
|
| 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 |
$183.09
|
| Rate for Payer: BCBS of TX PPO |
$440.32
|
| Rate for Payer: Cash Price |
$540.96
|
| Rate for Payer: Cash Price |
$540.96
|
| Rate for Payer: Cash Price |
$540.96
|
| Rate for Payer: Cigna Commercial |
$414.75
|
| Rate for Payer: Cigna Medicare |
$183.09
|
| Rate for Payer: Employer Direct Commercial |
$183.09
|
| Rate for Payer: Humana Medicare/TRICARE |
$183.09
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$183.09
|
| Rate for Payer: Molina Medicare |
$183.09
|
| Rate for Payer: Multiplan Auto |
$399.57
|
| Rate for Payer: Multiplan Commercial |
$399.57
|
| Rate for Payer: Multiplan Workers Comp |
$399.57
|
| Rate for Payer: Scott and White EPO/PPO |
$3.27
|
| Rate for Payer: Scott and White Medicare |
$183.09
|
| Rate for Payer: Superior Health Plan EPO |
$183.09
|
| Rate for Payer: Superior Health Plan Medicare |
$183.09
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$183.09
|
| Rate for Payer: Universal American Medicare |
$183.09
|
| Rate for Payer: Wellcare Medicare |
$183.09
|
| Rate for Payer: Wellmed Medicare |
$183.09
|
|
|
CHED Chemical Cautery Yes BCE
|
Facility
|
IP
|
$614.73
|
|
|
Service Code
|
CPT 17250
|
| Hospital Charge Code |
8910606
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$540.96
|
|
|
CHED CLOSED TREATMENT OF HIP DISLC TRAUMATIC W/O ANESTHESIA
|
Facility
|
OP
|
$1,276.42
|
|
|
Service Code
|
CPT 27250
|
| Hospital Charge Code |
8914573
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3.86 |
| Max. Negotiated Rate |
$829.67 |
| Rate for Payer: Aetna Commercial |
$702.03
|
| Rate for Payer: Aetna Medicare |
$323.50
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$114.88
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$215.67
|
| Rate for Payer: Amerigroup Medicare |
$215.67
|
| 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 |
$215.67
|
| Rate for Payer: BCBS of TX PPO |
$543.41
|
| Rate for Payer: Cash Price |
$1,123.25
|
| Rate for Payer: Cash Price |
$1,123.25
|
| Rate for Payer: Cash Price |
$1,123.25
|
| Rate for Payer: Cigna Commercial |
$488.55
|
| Rate for Payer: Cigna Medicaid |
$85.32
|
| Rate for Payer: Cigna Medicare |
$215.67
|
| Rate for Payer: Employer Direct Commercial |
$215.67
|
| Rate for Payer: Humana Medicare/TRICARE |
$215.67
|
| Rate for Payer: Molina CHIP/Medicaid |
$85.32
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$215.67
|
| Rate for Payer: Molina Medicare |
$215.67
|
| Rate for Payer: Multiplan Auto |
$829.67
|
| Rate for Payer: Multiplan Commercial |
$829.67
|
| Rate for Payer: Multiplan Workers Comp |
$829.67
|
| Rate for Payer: Parkland Medicaid |
$85.32
|
| Rate for Payer: Scott and White EPO/PPO |
$3.86
|
| Rate for Payer: Scott and White Medicare |
$215.67
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$85.32
|
| Rate for Payer: Superior Health Plan EPO |
$215.67
|
| Rate for Payer: Superior Health Plan Medicare |
$215.67
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$215.67
|
| Rate for Payer: Universal American Medicare |
$215.67
|
| Rate for Payer: Wellcare Medicare |
$215.67
|
| Rate for Payer: Wellmed Medicare |
$215.67
|
|
|
CHED CLOSED TREATMENT OF HIP DISLC TRAUMATIC W/O ANESTHESIA
|
Facility
|
IP
|
$1,276.42
|
|
|
Service Code
|
CPT 27250
|
| Hospital Charge Code |
8914573
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$1,123.25
|
|
|
CHED CLOSED TX FEMORAL SHAFT FX W/O MANIPULATION BCE
|
Facility
|
IP
|
$1,002.53
|
|
|
Service Code
|
CPT 27500
|
| Hospital Charge Code |
8914574
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$882.23
|
|
|
CHED CLOSED TX FEMORAL SHAFT FX W/O MANIPULATION BCE
|
Facility
|
OP
|
$1,002.53
|
|
|
Service Code
|
CPT 27500
|
| Hospital Charge Code |
8914574
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3.86 |
| Max. Negotiated Rate |
$651.64 |
| Rate for Payer: Aetna Commercial |
$551.39
|
| Rate for Payer: Aetna Medicare |
$323.50
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$90.23
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$215.67
|
| Rate for Payer: Amerigroup Medicare |
$215.67
|
| 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 |
$215.67
|
| Rate for Payer: BCBS of TX PPO |
$543.41
|
| Rate for Payer: Cash Price |
$882.23
|
| Rate for Payer: Cash Price |
$882.23
|
| Rate for Payer: Cash Price |
$882.23
|
| Rate for Payer: Cigna Commercial |
$488.55
|
| Rate for Payer: Cigna Medicaid |
$85.32
|
| Rate for Payer: Cigna Medicare |
$215.67
|
| Rate for Payer: Employer Direct Commercial |
$215.67
|
| Rate for Payer: Humana Medicare/TRICARE |
$215.67
|
| Rate for Payer: Molina CHIP/Medicaid |
$85.32
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$215.67
|
| Rate for Payer: Molina Medicare |
$215.67
|
| Rate for Payer: Multiplan Auto |
$651.64
|
| Rate for Payer: Multiplan Commercial |
$651.64
|
| Rate for Payer: Multiplan Workers Comp |
$651.64
|
| Rate for Payer: Parkland Medicaid |
$85.32
|
| Rate for Payer: Scott and White EPO/PPO |
$3.86
|
| Rate for Payer: Scott and White Medicare |
$215.67
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$85.32
|
| Rate for Payer: Superior Health Plan EPO |
$215.67
|
| Rate for Payer: Superior Health Plan Medicare |
$215.67
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$215.67
|
| Rate for Payer: Universal American Medicare |
$215.67
|
| Rate for Payer: Wellcare Medicare |
$215.67
|
| Rate for Payer: Wellmed Medicare |
$215.67
|
|
|
CHED CLOSED TX NASAL FRACTURE W/O STABILIZATION BCE
|
Facility
|
IP
|
$5,101.05
|
|
|
Service Code
|
CPT 21315
|
| Hospital Charge Code |
8910597
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$4,488.92
|
|
