|
CHED CLOSED TX NASAL FRACTURE W/O STABILIZATION BCE
|
Facility
|
OP
|
$5,101.05
|
|
|
Service Code
|
CPT 21315
|
| Hospital Charge Code |
8910597
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$24.94 |
| Max. Negotiated Rate |
$3,400.34 |
| Rate for Payer: Aetna Commercial |
$2,200.00
|
| Rate for Payer: Aetna Medicare |
$2,092.08
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$459.09
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,394.72
|
| Rate for Payer: Amerigroup Medicare |
$1,394.72
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,253.40
|
| Rate for Payer: BCBS of TX Blue Essentials |
$2,698.68
|
| Rate for Payer: BCBS of TX Medicare |
$1,394.72
|
| Rate for Payer: BCBS of TX PPO |
$3,400.34
|
| Rate for Payer: Cash Price |
$4,488.92
|
| Rate for Payer: Cash Price |
$4,488.92
|
| Rate for Payer: Cash Price |
$4,488.92
|
| Rate for Payer: Cigna Commercial |
$3,159.45
|
| Rate for Payer: Cigna Medicaid |
$420.64
|
| Rate for Payer: Cigna Medicare |
$1,394.72
|
| Rate for Payer: Employer Direct Commercial |
$1,394.72
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,394.72
|
| Rate for Payer: Molina CHIP/Medicaid |
$420.64
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,394.72
|
| Rate for Payer: Molina Medicare |
$1,394.72
|
| Rate for Payer: Multiplan Auto |
$3,315.68
|
| Rate for Payer: Multiplan Commercial |
$3,315.68
|
| Rate for Payer: Multiplan Workers Comp |
$3,315.68
|
| Rate for Payer: Parkland Medicaid |
$420.64
|
| Rate for Payer: Scott and White EPO/PPO |
$24.94
|
| Rate for Payer: Scott and White Medicare |
$1,394.72
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$420.64
|
| Rate for Payer: Superior Health Plan EPO |
$1,394.72
|
| Rate for Payer: Superior Health Plan Medicare |
$1,394.72
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,394.72
|
| Rate for Payer: Universal American Medicare |
$1,394.72
|
| Rate for Payer: Wellcare Medicare |
$1,394.72
|
| Rate for Payer: Wellmed Medicare |
$1,394.72
|
|
|
CHED CLOSED TX RADIAL SHAFT FX AND CLOSED TX DISLOCATION DIS
|
Facility
|
OP
|
$3,322.90
|
|
|
Service Code
|
CPT 25520
|
| Hospital Charge Code |
8912580
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$26.29 |
| Max. Negotiated Rate |
$3,415.58 |
| Rate for Payer: Aetna Commercial |
$1,827.60
|
| Rate for Payer: Aetna Medicare |
$2,204.79
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$299.06
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,469.86
|
| Rate for Payer: Amerigroup Medicare |
$1,469.86
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,263.50
|
| Rate for Payer: BCBS of TX Blue Essentials |
$2,710.78
|
| Rate for Payer: BCBS of TX Medicare |
$1,469.86
|
| Rate for Payer: BCBS of TX PPO |
$3,415.58
|
| Rate for Payer: Cash Price |
$2,924.15
|
| Rate for Payer: Cash Price |
$2,924.15
|
| Rate for Payer: Cash Price |
$2,924.15
|
| Rate for Payer: Cigna Commercial |
$3,329.66
|
| Rate for Payer: Cigna Medicaid |
$593.04
|
| Rate for Payer: Cigna Medicare |
$1,469.86
|
| Rate for Payer: Employer Direct Commercial |
$1,469.86
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,469.86
|
| Rate for Payer: Molina CHIP/Medicaid |
$593.04
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,469.86
|
| Rate for Payer: Molina Medicare |
$1,469.86
|
| Rate for Payer: Multiplan Auto |
$2,159.88
|
| Rate for Payer: Multiplan Commercial |
$2,159.88
|
| Rate for Payer: Multiplan Workers Comp |
$2,159.88
|
| Rate for Payer: Parkland Medicaid |
$593.04
|
| Rate for Payer: Scott and White EPO/PPO |
$26.29
|
| Rate for Payer: Scott and White Medicare |
$1,469.86
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$593.04
|
| Rate for Payer: Superior Health Plan EPO |
$1,469.86
|
| Rate for Payer: Superior Health Plan Medicare |
$1,469.86
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,469.86
|
| Rate for Payer: Universal American Medicare |
$1,469.86
|
| Rate for Payer: Wellcare Medicare |
$1,469.86
|
| Rate for Payer: Wellmed Medicare |
$1,469.86
|
|
|
CHED CLOSED TX RADIAL SHAFT FX AND CLOSED TX DISLOCATION DIS
|
Facility
|
IP
|
$3,322.90
|
|
|
Service Code
|
CPT 25520
|
| Hospital Charge Code |
8912580
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$2,924.15
|
|
|
CHED CLOSED TX TRANS-SCAPHOPERILUNAR TYPE FX DISLC W/MANIPUL
|
Facility
|
IP
|
$1,080.22
|
|
|
Service Code
|
CPT 25680
|
| Hospital Charge Code |
8910596
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$950.59
|
|
|
CHED CLOSED TX TRANS-SCAPHOPERILUNAR TYPE FX DISLC W/MANIPUL
|
Facility
|
OP
|
$1,080.22
|
|
|
Service Code
|
CPT 25680
|
| Hospital Charge Code |
8910596
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3.86 |
| Max. Negotiated Rate |
$702.14 |
| Rate for Payer: Aetna Commercial |
$594.12
|
| Rate for Payer: Aetna Medicare |
$323.50
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$97.22
|
| 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 |
$950.59
|
| Rate for Payer: Cash Price |
$950.59
|
| Rate for Payer: Cash Price |
$950.59
|
| 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 |
$702.14
|
| Rate for Payer: Multiplan Commercial |
$702.14
|
| Rate for Payer: Multiplan Workers Comp |
$702.14
|
| 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 CLOSURE LACERATION VESTIBULE MOUTH 2.5 CM/< BCE
|
Facility
|
OP
|
$815.16
|
|
|
Service Code
|
CPT 40830
|
| Hospital Charge Code |
8910598
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$529.85 |
| Rate for Payer: Aetna Commercial |
$448.34
|
| Rate for Payer: Aetna Medicare |
$335.08
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$73.36
|
| 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 |
$717.34
|
| Rate for Payer: Cash Price |
$717.34
|
| Rate for Payer: Cash Price |
$717.34
|
| 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 |
$529.85
|
| Rate for Payer: Multiplan Commercial |
$529.85
|
| Rate for Payer: Multiplan Workers Comp |
$529.85
|
| 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 CLOSURE LACERATION VESTIBULE MOUTH 2.5 CM/< BCE
|
Facility
|
IP
|
$815.16
|
|
|
Service Code
|
CPT 40830
|
| Hospital Charge Code |
8910598
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$717.34
|
|
|
CHED CLSD TX BIMALLEOLAR ANKLE FX W/MANJ BCE
|
Facility
|
IP
|
$2,770.75
|
|
|
Service Code
|
CPT 27810
|
| Hospital Charge Code |
8912582
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$2,438.26
|
|
|
CHED CLSD TX BIMALLEOLAR ANKLE FX W/MANJ BCE
|
Facility
|
OP
|
$2,770.75
|
|
|
Service Code
|
CPT 27810
|
| Hospital Charge Code |
8912582
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$26.29 |
| Max. Negotiated Rate |
$3,415.58 |
| Rate for Payer: Aetna Commercial |
$1,400.00
|
| Rate for Payer: Aetna Medicare |
$2,204.79
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$249.37
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,469.86
|
| Rate for Payer: Amerigroup Medicare |
$1,469.86
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,263.50
|
| Rate for Payer: BCBS of TX Blue Essentials |
$2,710.78
|
| Rate for Payer: BCBS of TX Medicare |
$1,469.86
|
| Rate for Payer: BCBS of TX PPO |
$3,415.58
|
| Rate for Payer: Cash Price |
$2,438.26
|
| Rate for Payer: Cash Price |
$2,438.26
|
| Rate for Payer: Cash Price |
$2,438.26
|
| Rate for Payer: Cigna Commercial |
$3,329.66
|
| Rate for Payer: Cigna Medicaid |
$593.04
|
| Rate for Payer: Cigna Medicare |
$1,469.86
|
| Rate for Payer: Employer Direct Commercial |
$1,469.86
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,469.86
|
| Rate for Payer: Molina CHIP/Medicaid |
$593.04
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,469.86
|
| Rate for Payer: Molina Medicare |
$1,469.86
|
| Rate for Payer: Multiplan Auto |
$1,800.99
|
| Rate for Payer: Multiplan Commercial |
$1,800.99
|
| Rate for Payer: Multiplan Workers Comp |
$1,800.99
|
| Rate for Payer: Parkland Medicaid |
$593.04
|
| Rate for Payer: Scott and White EPO/PPO |
$26.29
|
| Rate for Payer: Scott and White Medicare |
$1,469.86
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$593.04
|
| Rate for Payer: Superior Health Plan EPO |
$1,469.86
|
| Rate for Payer: Superior Health Plan Medicare |
$1,469.86
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,469.86
|
| Rate for Payer: Universal American Medicare |
$1,469.86
|
| Rate for Payer: Wellcare Medicare |
$1,469.86
|
| Rate for Payer: Wellmed Medicare |
$1,469.86
|
|
|
CHED CLSD TX SHLDR DISLC W/FX HUM TUBRST W/MAN BCE
|
Facility
|
OP
|
$2,948.50
|
|
|
Service Code
|
CPT 23665
|
| Hospital Charge Code |
8912581
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$26.29 |
| Max. Negotiated Rate |
$3,415.58 |
| Rate for Payer: Aetna Commercial |
$1,400.00
|
| Rate for Payer: Aetna Medicare |
$2,204.79
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$265.36
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,469.86
|
| Rate for Payer: Amerigroup Medicare |
$1,469.86
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,263.50
|
| Rate for Payer: BCBS of TX Blue Essentials |
$2,710.78
|
| Rate for Payer: BCBS of TX Medicare |
$1,469.86
|
| Rate for Payer: BCBS of TX PPO |
$3,415.58
|
| Rate for Payer: Cash Price |
$2,594.68
|
| Rate for Payer: Cash Price |
$2,594.68
|
| Rate for Payer: Cash Price |
$2,594.68
|
| Rate for Payer: Cigna Commercial |
$3,329.66
|
| Rate for Payer: Cigna Medicaid |
$593.04
|
| Rate for Payer: Cigna Medicare |
$1,469.86
|
| Rate for Payer: Employer Direct Commercial |
$1,469.86
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,469.86
|
| Rate for Payer: Molina CHIP/Medicaid |
$593.04
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,469.86
|
| Rate for Payer: Molina Medicare |
$1,469.86
|
| Rate for Payer: Multiplan Auto |
$1,916.52
|
| Rate for Payer: Multiplan Commercial |
$1,916.52
|
| Rate for Payer: Multiplan Workers Comp |
$1,916.52
|
| Rate for Payer: Parkland Medicaid |
$593.04
|
| Rate for Payer: Scott and White EPO/PPO |
$26.29
|
| Rate for Payer: Scott and White Medicare |
$1,469.86
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$593.04
|
| Rate for Payer: Superior Health Plan EPO |
$1,469.86
|
| Rate for Payer: Superior Health Plan Medicare |
$1,469.86
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,469.86
|
| Rate for Payer: Universal American Medicare |
$1,469.86
|
| Rate for Payer: Wellcare Medicare |
$1,469.86
|
| Rate for Payer: Wellmed Medicare |
$1,469.86
|
|
|
CHED CLSD TX SHLDR DISLC W/FX HUM TUBRST W/MAN BCE
|
Facility
|
IP
|
$2,948.50
|
|
|
Service Code
|
CPT 23665
|
| Hospital Charge Code |
8912581
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$2,594.68
|
|
|
CHED CLTX CARPO/METACARPAL FX DISLC THUMB W/MANJ BCE
|
Facility
|
IP
|
$2,211.23
|
|
|
Service Code
|
CPT 26645
|
| Hospital Charge Code |
8910599
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$1,945.88
|
|
|
CHED CLTX CARPO/METACARPAL FX DISLC THUMB W/MANJ BCE
|
Facility
|
OP
|
$2,211.23
|
|
|
Service Code
|
CPT 26645
|
| Hospital Charge Code |
8910599
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$26.29 |
| Max. Negotiated Rate |
$3,415.58 |
| Rate for Payer: Aetna Commercial |
$1,216.18
|
| Rate for Payer: Aetna Medicare |
$2,204.79
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$199.01
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,469.86
|
| Rate for Payer: Amerigroup Medicare |
$1,469.86
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,263.50
|
| Rate for Payer: BCBS of TX Blue Essentials |
$2,710.78
|
| Rate for Payer: BCBS of TX Medicare |
$1,469.86
|
| Rate for Payer: BCBS of TX PPO |
$3,415.58
|
| Rate for Payer: Cash Price |
$1,945.88
|
| Rate for Payer: Cash Price |
$1,945.88
|
| Rate for Payer: Cash Price |
$1,945.88
|
| Rate for Payer: Cigna Commercial |
$3,329.66
|
| Rate for Payer: Cigna Medicaid |
$593.04
|
| Rate for Payer: Cigna Medicare |
$1,469.86
|
| Rate for Payer: Employer Direct Commercial |
$1,469.86
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,469.86
|
| Rate for Payer: Molina CHIP/Medicaid |
$593.04
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,469.86
|
| Rate for Payer: Molina Medicare |
$1,469.86
|
| Rate for Payer: Multiplan Auto |
$1,437.30
|
| Rate for Payer: Multiplan Commercial |
$1,437.30
|
| Rate for Payer: Multiplan Workers Comp |
$1,437.30
|
| Rate for Payer: Parkland Medicaid |
$593.04
|
| Rate for Payer: Scott and White EPO/PPO |
$26.29
|
| Rate for Payer: Scott and White Medicare |
$1,469.86
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$593.04
|
| Rate for Payer: Superior Health Plan EPO |
$1,469.86
|
| Rate for Payer: Superior Health Plan Medicare |
$1,469.86
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,469.86
|
| Rate for Payer: Universal American Medicare |
$1,469.86
|
| Rate for Payer: Wellcare Medicare |
$1,469.86
|
| Rate for Payer: Wellmed Medicare |
$1,469.86
|
|
|
CHED CLTX FX PHLX/PHLG OTH/THN GRT TOE W/O MANIP BCE
|
Facility
|
IP
|
$578.91
|
|
|
Service Code
|
CPT 28510
|
| Hospital Charge Code |
8910600
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$509.44
|
|
|
CHED CLTX FX PHLX/PHLG OTH/THN GRT TOE W/O MANIP BCE
|
Facility
|
OP
|
$578.91
|
|
|
Service Code
|
CPT 28510
|
| Hospital Charge Code |
8910600
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3.86 |
| Max. Negotiated Rate |
$488.55 |
| Rate for Payer: Aetna Commercial |
$318.40
|
| Rate for Payer: Aetna Medicare |
$323.50
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$52.10
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$215.67
|
| Rate for Payer: Amerigroup Medicare |
$215.67
|
| Rate for Payer: BCBS of TX Blue Advantage |
$130.78
|
| Rate for Payer: BCBS of TX Blue Essentials |
$156.62
|
| Rate for Payer: BCBS of TX Medicare |
$215.67
|
| Rate for Payer: BCBS of TX PPO |
$197.34
|
| Rate for Payer: Cash Price |
$509.44
|
| Rate for Payer: Cash Price |
$509.44
|
| Rate for Payer: Cash Price |
$509.44
|
| Rate for Payer: Cigna Commercial |
$488.55
|
| Rate for Payer: Cigna Medicaid |
$62.85
|
| 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 |
$62.85
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$215.67
|
| Rate for Payer: Molina Medicare |
$215.67
|
| Rate for Payer: Multiplan Auto |
$376.29
|
| Rate for Payer: Multiplan Commercial |
$376.29
|
| Rate for Payer: Multiplan Workers Comp |
$376.29
|
| Rate for Payer: Parkland Medicaid |
$62.85
|
| 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 |
$62.85
|
| 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 CLTX HUMERAL SHFT FX W/MANJ W/WO SKELETAL TRACJ BCE
|
Facility
|
OP
|
$2,467.60
|
|
|
Service Code
|
CPT 24505
|
| Hospital Charge Code |
8914575
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$26.29 |
| Max. Negotiated Rate |
$3,415.58 |
| Rate for Payer: Aetna Commercial |
$1,357.18
|
| Rate for Payer: Aetna Medicare |
$2,204.79
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$222.08
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,469.86
|
| Rate for Payer: Amerigroup Medicare |
$1,469.86
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,263.50
|
| Rate for Payer: BCBS of TX Blue Essentials |
$2,710.78
|
| Rate for Payer: BCBS of TX Medicare |
$1,469.86
|
| Rate for Payer: BCBS of TX PPO |
$3,415.58
|
| Rate for Payer: Cash Price |
$2,171.49
|
| Rate for Payer: Cash Price |
$2,171.49
|
| Rate for Payer: Cash Price |
$2,171.49
|
| Rate for Payer: Cigna Commercial |
$3,329.66
|
| Rate for Payer: Cigna Medicaid |
$593.04
|
| Rate for Payer: Cigna Medicare |
$1,469.86
|
| Rate for Payer: Employer Direct Commercial |
$1,469.86
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,469.86
|
| Rate for Payer: Molina CHIP/Medicaid |
$593.04
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,469.86
|
| Rate for Payer: Molina Medicare |
$1,469.86
|
| Rate for Payer: Multiplan Auto |
$1,603.94
|
| Rate for Payer: Multiplan Commercial |
$1,603.94
|
| Rate for Payer: Multiplan Workers Comp |
$1,603.94
|
| Rate for Payer: Parkland Medicaid |
$593.04
|
| Rate for Payer: Scott and White EPO/PPO |
$26.29
|
| Rate for Payer: Scott and White Medicare |
$1,469.86
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$593.04
|
| Rate for Payer: Superior Health Plan EPO |
$1,469.86
|
| Rate for Payer: Superior Health Plan Medicare |
$1,469.86
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,469.86
|
| Rate for Payer: Universal American Medicare |
$1,469.86
|
| Rate for Payer: Wellcare Medicare |
$1,469.86
|
| Rate for Payer: Wellmed Medicare |
$1,469.86
|
|
|
CHED CLTX HUMERAL SHFT FX W/MANJ W/WO SKELETAL TRACJ BCE
|
Facility
|
IP
|
$2,467.60
|
|
|
Service Code
|
CPT 24505
|
| Hospital Charge Code |
8914575
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$2,171.49
|
|
|
CHED CLTX MEDIAL MALLEOLUS FX W/O MANIP BCE
|
Facility
|
IP
|
$840.00
|
|
|
Service Code
|
CPT 27760
|
| Hospital Charge Code |
8914576
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$739.20
|
|
|
CHED CLTX MEDIAL MALLEOLUS FX W/O MANIP BCE
|
Facility
|
OP
|
$840.00
|
|
|
Service Code
|
CPT 27760
|
| Hospital Charge Code |
8914576
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3.86 |
| Max. Negotiated Rate |
$546.00 |
| Rate for Payer: Aetna Commercial |
$462.00
|
| Rate for Payer: Aetna Medicare |
$323.50
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$75.60
|
| 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 |
$739.20
|
| Rate for Payer: Cash Price |
$739.20
|
| Rate for Payer: Cash Price |
$739.20
|
| 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 |
$546.00
|
| Rate for Payer: Multiplan Commercial |
$546.00
|
| Rate for Payer: Multiplan Workers Comp |
$546.00
|
| 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 CLTX SHOULDER DISLC W/SURG/ANTMCL NECK FX W/MANJ BCE
|
Facility
|
IP
|
$3,090.80
|
|
|
Service Code
|
CPT 23675
|
| Hospital Charge Code |
8912583
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$2,719.90
|
|
|
CHED CLTX SHOULDER DISLC W/SURG/ANTMCL NECK FX W/MANJ BCE
|
Facility
|
OP
|
$3,090.80
|
|
|
Service Code
|
CPT 23675
|
| Hospital Charge Code |
8912583
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$26.29 |
| Max. Negotiated Rate |
$3,415.58 |
| Rate for Payer: Aetna Commercial |
$1,699.94
|
| Rate for Payer: Aetna Medicare |
$2,204.79
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$278.17
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,469.86
|
| Rate for Payer: Amerigroup Medicare |
$1,469.86
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,263.50
|
| Rate for Payer: BCBS of TX Blue Essentials |
$2,710.78
|
| Rate for Payer: BCBS of TX Medicare |
$1,469.86
|
| Rate for Payer: BCBS of TX PPO |
$3,415.58
|
| Rate for Payer: Cash Price |
$2,719.90
|
| Rate for Payer: Cash Price |
$2,719.90
|
| Rate for Payer: Cash Price |
$2,719.90
|
| Rate for Payer: Cigna Commercial |
$3,329.66
|
| Rate for Payer: Cigna Medicaid |
$593.04
|
| Rate for Payer: Cigna Medicare |
$1,469.86
|
| Rate for Payer: Employer Direct Commercial |
$1,469.86
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,469.86
|
| Rate for Payer: Molina CHIP/Medicaid |
$593.04
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,469.86
|
| Rate for Payer: Molina Medicare |
$1,469.86
|
| Rate for Payer: Multiplan Auto |
$2,009.02
|
| Rate for Payer: Multiplan Commercial |
$2,009.02
|
| Rate for Payer: Multiplan Workers Comp |
$2,009.02
|
| Rate for Payer: Parkland Medicaid |
$593.04
|
| Rate for Payer: Scott and White EPO/PPO |
$26.29
|
| Rate for Payer: Scott and White Medicare |
$1,469.86
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$593.04
|
| Rate for Payer: Superior Health Plan EPO |
$1,469.86
|
| Rate for Payer: Superior Health Plan Medicare |
$1,469.86
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,469.86
|
| Rate for Payer: Universal American Medicare |
$1,469.86
|
| Rate for Payer: Wellcare Medicare |
$1,469.86
|
| Rate for Payer: Wellmed Medicare |
$1,469.86
|
|
|
CHED Collect Blood Port/Access Device BCE
|
Facility
|
OP
|
$424.50
|
|
|
Service Code
|
CPT 36591
|
| Hospital Charge Code |
8910607
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2.09 |
| Max. Negotiated Rate |
$275.92 |
| Rate for Payer: Aetna Commercial |
$233.48
|
| Rate for Payer: Aetna Medicare |
$175.23
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$38.20
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$116.82
|
| Rate for Payer: Amerigroup Medicare |
$116.82
|
| Rate for Payer: BCBS of TX Blue Advantage |
$179.90
|
| Rate for Payer: BCBS of TX Blue Essentials |
$215.88
|
| Rate for Payer: BCBS of TX Medicare |
$116.82
|
| Rate for Payer: BCBS of TX PPO |
$240.96
|
| Rate for Payer: Cash Price |
$373.56
|
| Rate for Payer: Cash Price |
$373.56
|
| Rate for Payer: Cash Price |
$373.56
|
| 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 |
$275.92
|
| Rate for Payer: Multiplan Commercial |
$275.92
|
| Rate for Payer: Multiplan Workers Comp |
$275.92
|
| 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 Collect Blood Port/Access Device BCE
|
Facility
|
IP
|
$424.50
|
|
|
Service Code
|
CPT 36591
|
| Hospital Charge Code |
8910607
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$373.56
|
|
|
CHED CONTROL NASAL HEMORRHAGE ANTERIOR CMPLX BCE
|
Facility
|
IP
|
$650.94
|
|
|
Service Code
|
CPT 30903
|
| Hospital Charge Code |
8910601
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$572.83
|
|
|
CHED CONTROL NASAL HEMORRHAGE ANTERIOR CMPLX BCE
|
Facility
|
OP
|
$650.94
|
|
|
Service Code
|
CPT 30903
|
| Hospital Charge Code |
8910601
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2.09 |
| Max. Negotiated Rate |
$423.11 |
| Rate for Payer: Aetna Commercial |
$358.02
|
| Rate for Payer: Aetna Medicare |
$175.23
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$58.58
|
| 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 |
$572.83
|
| Rate for Payer: Cash Price |
$572.83
|
| Rate for Payer: Cash Price |
$572.83
|
| Rate for Payer: Cigna Commercial |
$264.63
|
| Rate for Payer: Cigna Medicaid |
$46.68
|
| 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 CHIP/Medicaid |
$46.68
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$116.82
|
| Rate for Payer: Molina Medicare |
$116.82
|
| Rate for Payer: Multiplan Auto |
$423.11
|
| Rate for Payer: Multiplan Commercial |
$423.11
|
| Rate for Payer: Multiplan Workers Comp |
$423.11
|
| Rate for Payer: Parkland Medicaid |
$46.68
|
| 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 CHIP/Medicaid |
$46.68
|
| 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
|
|
