|
CHED Critical Care Ill/Injured Patient Addl 30 Min 99292 BCE
|
Facility
|
IP
|
$1,680.00
|
|
|
Service Code
|
CPT 99292
|
| Hospital Charge Code |
8928548
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$1,478.40
|
|
|
CHED Critical Care Ill/Injured Patient Addl 30 Min 99292 BCE
|
Facility
|
OP
|
$1,680.00
|
|
|
Service Code
|
CPT 99292
|
| Hospital Charge Code |
8928548
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$151.20 |
| Max. Negotiated Rate |
$2,900.00 |
| Rate for Payer: Aetna Commercial |
$924.00
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$151.20
|
| Rate for Payer: BCBS of TX Blue Advantage |
$197.52
|
| Rate for Payer: BCBS of TX Blue Essentials |
$236.12
|
| Rate for Payer: BCBS of TX PPO |
$263.37
|
| Rate for Payer: Cash Price |
$1,478.40
|
| Rate for Payer: Cash Price |
$1,478.40
|
| Rate for Payer: Cash Price |
$1,478.40
|
| Rate for Payer: Multiplan Auto |
$1,092.00
|
| Rate for Payer: Multiplan Commercial |
$1,092.00
|
| Rate for Payer: Multiplan Workers Comp |
$1,092.00
|
| Rate for Payer: Scott and White EPO/PPO |
$2,900.00
|
| Rate for Payer: Superior Health Plan EPO |
$228.48
|
|
|
CHED Critical Care Ill/Injured Patient Init 30-74 Min 99291
|
Facility
|
OP
|
$3,605.00
|
|
|
Service Code
|
CPT 99291
|
| Hospital Charge Code |
8928547
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$14.51 |
| Max. Negotiated Rate |
$4,315.36 |
| Rate for Payer: Aetna Commercial |
$1,982.75
|
| Rate for Payer: Aetna Medicare |
$1,217.31
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$324.45
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$811.54
|
| Rate for Payer: Amerigroup Medicare |
$811.54
|
| Rate for Payer: BCBS of TX Blue Advantage |
$1,159.99
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,386.65
|
| Rate for Payer: BCBS of TX Medicare |
$811.54
|
| Rate for Payer: BCBS of TX PPO |
$1,546.65
|
| Rate for Payer: Cash Price |
$3,172.40
|
| Rate for Payer: Cash Price |
$3,172.40
|
| Rate for Payer: Cigna Commercial |
$4,315.36
|
| Rate for Payer: Cigna Medicare |
$811.54
|
| Rate for Payer: Employer Direct Commercial |
$811.54
|
| Rate for Payer: Humana Medicare/TRICARE |
$811.54
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$811.54
|
| Rate for Payer: Molina Medicare |
$811.54
|
| Rate for Payer: Multiplan Auto |
$2,343.25
|
| Rate for Payer: Multiplan Commercial |
$2,343.25
|
| Rate for Payer: Multiplan Workers Comp |
$2,343.25
|
| Rate for Payer: Scott and White EPO/PPO |
$14.51
|
| Rate for Payer: Scott and White Medicare |
$811.54
|
| Rate for Payer: Superior Health Plan EPO |
$811.54
|
| Rate for Payer: Superior Health Plan Medicare |
$811.54
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$811.54
|
| Rate for Payer: Universal American Medicare |
$811.54
|
| Rate for Payer: Wellcare Medicare |
$811.54
|
| Rate for Payer: Wellmed Medicare |
$811.54
|
|
|
CHED Critical Care Ill/Injured Patient Init 30-74 Min 99291
|
Facility
|
IP
|
$3,605.00
|
|
|
Service Code
|
CPT 99291
|
| Hospital Charge Code |
8928547
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$3,172.40
|
|
|
CHED CTRL NSL HEMRRG PST NASAL PACKS&/CAUTERY 1ST BCE
|
Facility
|
IP
|
$744.40
|
|
|
Service Code
|
CPT 30905
|
| Hospital Charge Code |
8910602
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$655.07
|
|
|
CHED CTRL NSL HEMRRG PST NASAL PACKS&/CAUTERY 1ST BCE
|
Facility
|
OP
|
$744.40
|
|
|
Service Code
|
CPT 30905
|
| Hospital Charge Code |
8910602
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2.09 |
| Max. Negotiated Rate |
$483.86 |
| Rate for Payer: Aetna Commercial |
$409.42
|
| Rate for Payer: Aetna Medicare |
$175.23
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$67.00
|
| 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 |
$655.07
|
| Rate for Payer: Cash Price |
$655.07
|
| Rate for Payer: Cash Price |
$655.07
|
| 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 |
$483.86
|
| Rate for Payer: Multiplan Commercial |
$483.86
|
| Rate for Payer: Multiplan Workers Comp |
$483.86
|
| 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
|
|
|
CHED CYSTO CALIBRATION DILAT URTL STRIX/STENOSIS BCE
|
Facility
|
IP
|
$650.94
|
|
|
Service Code
|
CPT 52281
|
| Hospital Charge Code |
8910603
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$572.83
|
|
|
CHED CYSTO CALIBRATION DILAT URTL STRIX/STENOSIS BCE
|
Facility
|
OP
|
$650.94
|
|
|
Service Code
|
CPT 52281
|
| Hospital Charge Code |
8910603
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$33.31 |
| Max. Negotiated Rate |
$4,464.31 |
| Rate for Payer: Aetna Commercial |
$2,200.00
|
| Rate for Payer: Aetna Medicare |
$2,794.14
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$58.58
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,862.76
|
| Rate for Payer: Amerigroup Medicare |
$1,862.76
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,958.49
|
| Rate for Payer: BCBS of TX Blue Essentials |
$3,543.10
|
| Rate for Payer: BCBS of TX Medicare |
$1,862.76
|
| Rate for Payer: BCBS of TX PPO |
$4,464.31
|
| 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 |
$4,219.69
|
| Rate for Payer: Cigna Medicaid |
$652.80
|
| Rate for Payer: Cigna Medicare |
$1,862.76
|
| Rate for Payer: Employer Direct Commercial |
$1,862.76
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,862.76
|
| Rate for Payer: Molina CHIP/Medicaid |
$652.80
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,862.76
|
| Rate for Payer: Molina Medicare |
$1,862.76
|
| 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 |
$652.80
|
| Rate for Payer: Scott and White EPO/PPO |
$33.31
|
| Rate for Payer: Scott and White Medicare |
$1,862.76
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$652.80
|
| Rate for Payer: Superior Health Plan EPO |
$1,862.76
|
| Rate for Payer: Superior Health Plan Medicare |
$1,862.76
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,862.76
|
| Rate for Payer: Universal American Medicare |
$1,862.76
|
| Rate for Payer: Wellcare Medicare |
$1,862.76
|
| Rate for Payer: Wellmed Medicare |
$1,862.76
|
|
|
CHED CYSTO W/IRRIG & EVAC MULTPLE OBSTRUCTING CLOTS BCE
|
Facility
|
IP
|
$5,979.00
|
|
|
Service Code
|
CPT 52001
|
| Hospital Charge Code |
8910604
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$5,261.52
|
|
|
CHED CYSTO W/IRRIG & EVAC MULTPLE OBSTRUCTING CLOTS BCE
|
Facility
|
OP
|
$5,979.00
|
|
|
Service Code
|
CPT 52001
|
| Hospital Charge Code |
8910604
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$57.02 |
| Max. Negotiated Rate |
$7,606.72 |
| Rate for Payer: Aetna Commercial |
$2,200.00
|
| Rate for Payer: Aetna Medicare |
$4,782.38
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$538.11
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3,188.25
|
| Rate for Payer: Amerigroup Medicare |
$3,188.25
|
| Rate for Payer: BCBS of TX Blue Advantage |
$5,040.96
|
| Rate for Payer: BCBS of TX Blue Essentials |
$6,037.08
|
| Rate for Payer: BCBS of TX Medicare |
$3,188.25
|
| Rate for Payer: BCBS of TX PPO |
$7,606.72
|
| Rate for Payer: Cash Price |
$5,261.52
|
| Rate for Payer: Cash Price |
$5,261.52
|
| Rate for Payer: Cash Price |
$5,261.52
|
| Rate for Payer: Cigna Commercial |
$7,222.32
|
| Rate for Payer: Cigna Medicaid |
$1,142.90
|
| Rate for Payer: Cigna Medicare |
$3,188.25
|
| Rate for Payer: Employer Direct Commercial |
$3,188.25
|
| Rate for Payer: Humana Medicare/TRICARE |
$3,188.25
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,142.90
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3,188.25
|
| Rate for Payer: Molina Medicare |
$3,188.25
|
| Rate for Payer: Multiplan Auto |
$3,886.35
|
| Rate for Payer: Multiplan Commercial |
$3,886.35
|
| Rate for Payer: Multiplan Workers Comp |
$3,886.35
|
| Rate for Payer: Parkland Medicaid |
$1,142.90
|
| Rate for Payer: Scott and White EPO/PPO |
$57.02
|
| Rate for Payer: Scott and White Medicare |
$3,188.25
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,142.90
|
| Rate for Payer: Superior Health Plan EPO |
$3,188.25
|
| Rate for Payer: Superior Health Plan Medicare |
$3,188.25
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3,188.25
|
| Rate for Payer: Universal American Medicare |
$3,188.25
|
| Rate for Payer: Wellcare Medicare |
$3,188.25
|
| Rate for Payer: Wellmed Medicare |
$3,188.25
|
|
|
CHED Debridement Addl 10% Infected skin BCE
|
Facility
|
IP
|
$71.54
|
|
|
Service Code
|
CPT 11001
|
| Hospital Charge Code |
8910609
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$62.96
|
|
|
CHED Debridement Addl 10% Infected skin BCE
|
Facility
|
OP
|
$71.54
|
|
|
Service Code
|
CPT 11001
|
| Hospital Charge Code |
8910609
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$6.44 |
| Max. Negotiated Rate |
$46.50 |
| Rate for Payer: Aetna Commercial |
$39.35
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$6.44
|
| Rate for Payer: Cash Price |
$62.96
|
| Rate for Payer: Multiplan Auto |
$46.50
|
| Rate for Payer: Multiplan Commercial |
$46.50
|
| Rate for Payer: Multiplan Workers Comp |
$46.50
|
| Rate for Payer: Scott and White EPO/PPO |
$35.77
|
| Rate for Payer: Superior Health Plan EPO |
$9.73
|
|
|
CHED Debridement To devitalized tissue, <= 20 sq cm BCE
|
Facility
|
IP
|
$363.00
|
|
|
Service Code
|
CPT 97597
|
| Hospital Charge Code |
8910610
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$319.44
|
|
|
CHED Debridement To devitalized tissue, <= 20 sq cm BCE
|
Facility
|
OP
|
$363.00
|
|
|
Service Code
|
CPT 97597
|
| Hospital Charge Code |
8910610
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3.27 |
| Max. Negotiated Rate |
$414.75 |
| Rate for Payer: Aetna Commercial |
$199.65
|
| Rate for Payer: Aetna Medicare |
$274.64
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$32.67
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$183.09
|
| Rate for Payer: Amerigroup Medicare |
$183.09
|
| Rate for Payer: BCBS of TX Blue Advantage |
$42.65
|
| Rate for Payer: BCBS of TX Blue Essentials |
$50.98
|
| Rate for Payer: BCBS of TX Medicare |
$183.09
|
| Rate for Payer: BCBS of TX PPO |
$56.86
|
| Rate for Payer: Cash Price |
$319.44
|
| Rate for Payer: Cash Price |
$319.44
|
| Rate for Payer: Cash Price |
$319.44
|
| 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 |
$235.95
|
| Rate for Payer: Multiplan Commercial |
$235.95
|
| Rate for Payer: Multiplan Workers Comp |
$235.95
|
| 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 Debridement To muscle/fascia, <= 20 sq cm BCE
|
Facility
|
IP
|
$4,383.94
|
|
|
Service Code
|
CPT 11043
|
| Hospital Charge Code |
8912587
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$3,857.87
|
|
|
CHED Debridement To muscle/fascia, <= 20 sq cm BCE
|
Facility
|
OP
|
$4,383.94
|
|
|
Service Code
|
CPT 11043
|
| Hospital Charge Code |
8912587
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$10.27 |
| Max. Negotiated Rate |
$2,849.56 |
| Rate for Payer: Aetna Commercial |
$2,411.17
|
| Rate for Payer: Aetna Medicare |
$861.57
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$394.55
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$574.38
|
| Rate for Payer: Amerigroup Medicare |
$574.38
|
| Rate for Payer: BCBS of TX Blue Advantage |
$830.02
|
| Rate for Payer: BCBS of TX Blue Essentials |
$994.04
|
| Rate for Payer: BCBS of TX Medicare |
$574.38
|
| Rate for Payer: BCBS of TX PPO |
$1,252.49
|
| Rate for Payer: Cash Price |
$3,857.87
|
| Rate for Payer: Cash Price |
$3,857.87
|
| Rate for Payer: Cash Price |
$3,857.87
|
| Rate for Payer: Cigna Commercial |
$1,301.14
|
| Rate for Payer: Cigna Medicaid |
$216.80
|
| Rate for Payer: Cigna Medicare |
$574.38
|
| Rate for Payer: Employer Direct Commercial |
$574.38
|
| Rate for Payer: Humana Medicare/TRICARE |
$574.38
|
| Rate for Payer: Molina CHIP/Medicaid |
$216.80
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$574.38
|
| Rate for Payer: Molina Medicare |
$574.38
|
| Rate for Payer: Multiplan Auto |
$2,849.56
|
| Rate for Payer: Multiplan Commercial |
$2,849.56
|
| Rate for Payer: Multiplan Workers Comp |
$2,849.56
|
| Rate for Payer: Parkland Medicaid |
$216.80
|
| Rate for Payer: Scott and White EPO/PPO |
$10.27
|
| Rate for Payer: Scott and White Medicare |
$574.38
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$216.80
|
| Rate for Payer: Superior Health Plan EPO |
$574.38
|
| Rate for Payer: Superior Health Plan Medicare |
$574.38
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$574.38
|
| Rate for Payer: Universal American Medicare |
$574.38
|
| Rate for Payer: Wellcare Medicare |
$574.38
|
| Rate for Payer: Wellmed Medicare |
$574.38
|
|
|
CHED Debridement To subcutaneous tissue, <= 20 sq cm BCE
|
Facility
|
OP
|
$2,409.97
|
|
|
Service Code
|
CPT 11042
|
| Hospital Charge Code |
8914579
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$6.52 |
| Max. Negotiated Rate |
$1,566.48 |
| Rate for Payer: Aetna Commercial |
$1,325.48
|
| Rate for Payer: Aetna Medicare |
$547.00
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$216.90
|
| 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 |
$2,120.77
|
| Rate for Payer: Cash Price |
$2,120.77
|
| Rate for Payer: Cash Price |
$2,120.77
|
| 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 |
$1,566.48
|
| Rate for Payer: Multiplan Commercial |
$1,566.48
|
| Rate for Payer: Multiplan Workers Comp |
$1,566.48
|
| 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 Debridement To subcutaneous tissue, <= 20 sq cm BCE
|
Facility
|
IP
|
$2,409.97
|
|
|
Service Code
|
CPT 11042
|
| Hospital Charge Code |
8914579
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$2,120.77
|
|
|
CHED Dislocation Repair Site Ankle w/o Anesthesia BCE
|
Facility
|
OP
|
$1,082.00
|
|
|
Service Code
|
CPT 27840
|
| Hospital Charge Code |
8914580
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3.86 |
| Max. Negotiated Rate |
$703.30 |
| Rate for Payer: Aetna Commercial |
$595.10
|
| Rate for Payer: Aetna Medicare |
$323.50
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$97.38
|
| 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 |
$952.16
|
| Rate for Payer: Cash Price |
$952.16
|
| Rate for Payer: Cash Price |
$952.16
|
| 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 |
$703.30
|
| Rate for Payer: Multiplan Commercial |
$703.30
|
| Rate for Payer: Multiplan Workers Comp |
$703.30
|
| 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 Dislocation Repair Site Ankle w/o Anesthesia BCE
|
Facility
|
IP
|
$1,082.00
|
|
|
Service Code
|
CPT 27840
|
| Hospital Charge Code |
8914580
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$952.16
|
|
|
CHED Dislocation Repair Site Elbow w/ Anesthesia BCE
|
Facility
|
OP
|
$4,398.68
|
|
|
Service Code
|
CPT 24605
|
| Hospital Charge Code |
8910611
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$26.29 |
| Max. Negotiated Rate |
$3,415.58 |
| Rate for Payer: Aetna Commercial |
$2,200.00
|
| Rate for Payer: Aetna Medicare |
$2,204.79
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$395.88
|
| 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 |
$3,870.84
|
| Rate for Payer: Cash Price |
$3,870.84
|
| Rate for Payer: Cash Price |
$3,870.84
|
| 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 |
$2,859.14
|
| Rate for Payer: Multiplan Commercial |
$2,859.14
|
| Rate for Payer: Multiplan Workers Comp |
$2,859.14
|
| 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 Dislocation Repair Site Elbow w/ Anesthesia BCE
|
Facility
|
IP
|
$4,398.68
|
|
|
Service Code
|
CPT 24605
|
| Hospital Charge Code |
8910611
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$3,870.84
|
|
|
CHED Dislocation Repair Site Elbow w/o Anesthesia BCE
|
Facility
|
OP
|
$1,398.90
|
|
|
Service Code
|
CPT 24600
|
| Hospital Charge Code |
8914581
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3.86 |
| Max. Negotiated Rate |
$909.28 |
| Rate for Payer: Aetna Commercial |
$769.40
|
| Rate for Payer: Aetna Medicare |
$323.50
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$125.90
|
| 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 |
$1,231.03
|
| Rate for Payer: Cash Price |
$1,231.03
|
| Rate for Payer: Cash Price |
$1,231.03
|
| 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 |
$909.28
|
| Rate for Payer: Multiplan Commercial |
$909.28
|
| Rate for Payer: Multiplan Workers Comp |
$909.28
|
| 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 Dislocation Repair Site Elbow w/o Anesthesia BCE
|
Facility
|
IP
|
$1,398.90
|
|
|
Service Code
|
CPT 24600
|
| Hospital Charge Code |
8914581
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$1,231.03
|
|
|
CHED Dislocation Repair Site Finger w/o Anesthesia BCE
|
Facility
|
OP
|
$395.94
|
|
|
Service Code
|
CPT 26770
|
| Hospital Charge Code |
8914582
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3.86 |
| Max. Negotiated Rate |
$543.41 |
| Rate for Payer: Aetna Commercial |
$217.77
|
| Rate for Payer: Aetna Medicare |
$323.50
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$35.63
|
| 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 |
$348.43
|
| Rate for Payer: Cash Price |
$348.43
|
| Rate for Payer: Cash Price |
$348.43
|
| 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 |
$257.36
|
| Rate for Payer: Multiplan Commercial |
$257.36
|
| Rate for Payer: Multiplan Workers Comp |
$257.36
|
| 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
|
|
