|
CHED DRAINAGE EXTERNAL EAR ABSCESS/HEMATOMA SIMPLE BCE
|
Facility
|
IP
|
$1,518.43
|
|
|
Service Code
|
CPT 69000
|
| Hospital Charge Code |
8914577
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$1,336.22
|
|
|
CHED DRAINAGE EXTERNAL EAR ABSCESS/HEMATOMA SIMPLE BCE
|
Facility
|
OP
|
$1,518.43
|
|
|
Service Code
|
CPT 69000
|
| Hospital Charge Code |
8914577
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$11.51 |
| Max. Negotiated Rate |
$1,457.60 |
| Rate for Payer: Aetna Commercial |
$1,400.00
|
| Rate for Payer: Aetna Medicare |
$965.18
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$136.66
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$643.45
|
| Rate for Payer: Amerigroup Medicare |
$643.45
|
| Rate for Payer: BCBS of TX Blue Advantage |
$217.57
|
| Rate for Payer: BCBS of TX Blue Essentials |
$260.56
|
| Rate for Payer: BCBS of TX Medicare |
$643.45
|
| Rate for Payer: BCBS of TX PPO |
$328.31
|
| Rate for Payer: Cash Price |
$1,336.22
|
| Rate for Payer: Cash Price |
$1,336.22
|
| Rate for Payer: Cash Price |
$1,336.22
|
| Rate for Payer: Cigna Commercial |
$1,457.60
|
| Rate for Payer: Cigna Medicaid |
$107.14
|
| Rate for Payer: Cigna Medicare |
$643.45
|
| Rate for Payer: Employer Direct Commercial |
$643.45
|
| Rate for Payer: Humana Medicare/TRICARE |
$643.45
|
| Rate for Payer: Molina CHIP/Medicaid |
$107.14
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$643.45
|
| Rate for Payer: Molina Medicare |
$643.45
|
| Rate for Payer: Multiplan Auto |
$986.98
|
| Rate for Payer: Multiplan Commercial |
$986.98
|
| Rate for Payer: Multiplan Workers Comp |
$986.98
|
| Rate for Payer: Parkland Medicaid |
$107.14
|
| Rate for Payer: Scott and White EPO/PPO |
$11.51
|
| Rate for Payer: Scott and White Medicare |
$643.45
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$107.14
|
| Rate for Payer: Superior Health Plan EPO |
$643.45
|
| Rate for Payer: Superior Health Plan Medicare |
$643.45
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$643.45
|
| Rate for Payer: Universal American Medicare |
$643.45
|
| Rate for Payer: Wellcare Medicare |
$643.45
|
| Rate for Payer: Wellmed Medicare |
$643.45
|
|
|
CHED Drainage of abscess, cyst, hematoma from dentoalveolar
|
Facility
|
OP
|
$823.00
|
|
|
Service Code
|
CPT 41800
|
| Hospital Charge Code |
8910612
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2.09 |
| Max. Negotiated Rate |
$534.95 |
| Rate for Payer: Aetna Commercial |
$452.65
|
| Rate for Payer: Aetna Medicare |
$175.23
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$74.07
|
| 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 |
$724.24
|
| Rate for Payer: Cash Price |
$724.24
|
| Rate for Payer: Cash Price |
$724.24
|
| 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 |
$534.95
|
| Rate for Payer: Multiplan Commercial |
$534.95
|
| Rate for Payer: Multiplan Workers Comp |
$534.95
|
| 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 Drainage of abscess, cyst, hematoma from dentoalveolar
|
Facility
|
IP
|
$823.00
|
|
|
Service Code
|
CPT 41800
|
| Hospital Charge Code |
8910612
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$724.24
|
|
|
CHED DRAINAGE OF FINGER ABSCESS SIMPLE BCE
|
Facility
|
OP
|
$938.00
|
|
|
Service Code
|
CPT 26010
|
| Hospital Charge Code |
8910608
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3.27 |
| Max. Negotiated Rate |
$609.70 |
| Rate for Payer: Aetna Commercial |
$515.90
|
| Rate for Payer: Aetna Medicare |
$274.64
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$84.42
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$183.09
|
| Rate for Payer: Amerigroup Medicare |
$183.09
|
| Rate for Payer: BCBS of TX Blue Advantage |
$147.44
|
| Rate for Payer: BCBS of TX Blue Essentials |
$176.58
|
| Rate for Payer: BCBS of TX Medicare |
$183.09
|
| Rate for Payer: BCBS of TX PPO |
$222.49
|
| Rate for Payer: Cash Price |
$825.44
|
| Rate for Payer: Cash Price |
$825.44
|
| Rate for Payer: Cash Price |
$825.44
|
| 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 |
$609.70
|
| Rate for Payer: Multiplan Commercial |
$609.70
|
| Rate for Payer: Multiplan Workers Comp |
$609.70
|
| 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 DRAINAGE OF FINGER ABSCESS SIMPLE BCE
|
Facility
|
IP
|
$938.00
|
|
|
Service Code
|
CPT 26010
|
| Hospital Charge Code |
8910608
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$825.44
|
|
|
CHED Ear Procedures Cerumen Irrigation/Lavage BCE
|
Facility
|
IP
|
$483.69
|
|
|
Service Code
|
CPT 69209
|
| Hospital Charge Code |
8914587
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$425.65
|
|
|
CHED Ear Procedures Cerumen Irrigation/Lavage BCE
|
Facility
|
OP
|
$483.69
|
|
|
Service Code
|
CPT 69209
|
| Hospital Charge Code |
8914587
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$314.40 |
| Rate for Payer: Aetna Commercial |
$266.03
|
| Rate for Payer: Aetna Medicare |
$83.91
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$43.53
|
| 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 |
$425.65
|
| Rate for Payer: Cash Price |
$425.65
|
| Rate for Payer: Cash Price |
$425.65
|
| 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 |
$314.40
|
| Rate for Payer: Multiplan Commercial |
$314.40
|
| Rate for Payer: Multiplan Workers Comp |
$314.40
|
| 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 Ear Procedures Cerumen w/ Instrumentation BCE
|
Facility
|
OP
|
$3,278.95
|
|
|
Service Code
|
CPT 69210
|
| Hospital Charge Code |
8912596
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$2,131.32 |
| Rate for Payer: Aetna Commercial |
$1,803.42
|
| Rate for Payer: Aetna Medicare |
$83.91
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$295.11
|
| 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 |
$2,885.48
|
| Rate for Payer: Cash Price |
$2,885.48
|
| Rate for Payer: Cash Price |
$2,885.48
|
| 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 |
$2,131.32
|
| Rate for Payer: Multiplan Commercial |
$2,131.32
|
| Rate for Payer: Multiplan Workers Comp |
$2,131.32
|
| 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 Ear Procedures Cerumen w/ Instrumentation BCE
|
Facility
|
IP
|
$3,278.95
|
|
|
Service Code
|
CPT 69210
|
| Hospital Charge Code |
8912596
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$2,885.48
|
|
|
CHED EGD PLACE GASTROSTOMY TUBE BCE
|
Facility
|
IP
|
$5,390.12
|
|
|
Service Code
|
CPT 43246
|
| Hospital Charge Code |
8912595
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$4,743.31
|
|
|
CHED EGD PLACE GASTROSTOMY TUBE BCE
|
Facility
|
OP
|
$5,390.12
|
|
|
Service Code
|
CPT 43246
|
| Hospital Charge Code |
8912595
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$31.12 |
| Max. Negotiated Rate |
$3,942.10 |
| Rate for Payer: Aetna Commercial |
$2,200.00
|
| Rate for Payer: Aetna Medicare |
$2,610.33
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$485.11
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,740.22
|
| Rate for Payer: Amerigroup Medicare |
$1,740.22
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,600.86
|
| Rate for Payer: BCBS of TX Blue Essentials |
$3,114.80
|
| Rate for Payer: BCBS of TX Medicare |
$1,740.22
|
| Rate for Payer: BCBS of TX PPO |
$3,924.65
|
| Rate for Payer: Cash Price |
$4,743.31
|
| Rate for Payer: Cash Price |
$4,743.31
|
| Rate for Payer: Cash Price |
$4,743.31
|
| Rate for Payer: Cigna Commercial |
$3,942.10
|
| Rate for Payer: Cigna Medicaid |
$564.97
|
| Rate for Payer: Cigna Medicare |
$1,740.22
|
| Rate for Payer: Employer Direct Commercial |
$1,740.22
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,740.22
|
| Rate for Payer: Molina CHIP/Medicaid |
$564.97
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,740.22
|
| Rate for Payer: Molina Medicare |
$1,740.22
|
| Rate for Payer: Multiplan Auto |
$3,503.58
|
| Rate for Payer: Multiplan Commercial |
$3,503.58
|
| Rate for Payer: Multiplan Workers Comp |
$3,503.58
|
| Rate for Payer: Parkland Medicaid |
$564.97
|
| Rate for Payer: Scott and White EPO/PPO |
$31.12
|
| Rate for Payer: Scott and White Medicare |
$1,740.22
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$564.97
|
| Rate for Payer: Superior Health Plan EPO |
$1,740.22
|
| Rate for Payer: Superior Health Plan Medicare |
$1,740.22
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,740.22
|
| Rate for Payer: Universal American Medicare |
$1,740.22
|
| Rate for Payer: Wellcare Medicare |
$1,740.22
|
| Rate for Payer: Wellmed Medicare |
$1,740.22
|
|
|
CHED EXC B9 LES MRGN 3.1 TO 4.0CM BCE
|
Facility
|
IP
|
$5,911.44
|
|
|
Service Code
|
CPT 11424
|
| Hospital Charge Code |
8910613
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$5,202.07
|
|
|
CHED EXC B9 LES MRGN 3.1 TO 4.0CM BCE
|
Facility
|
OP
|
$5,911.44
|
|
|
Service Code
|
CPT 11424
|
| Hospital Charge Code |
8910613
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$26.52 |
| Max. Negotiated Rate |
$3,842.44 |
| Rate for Payer: Aetna Commercial |
$2,200.00
|
| Rate for Payer: Aetna Medicare |
$2,224.11
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$532.03
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,482.74
|
| Rate for Payer: Amerigroup Medicare |
$1,482.74
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,292.24
|
| Rate for Payer: BCBS of TX Blue Essentials |
$2,745.20
|
| Rate for Payer: BCBS of TX Medicare |
$1,482.74
|
| Rate for Payer: BCBS of TX PPO |
$3,458.95
|
| Rate for Payer: Cash Price |
$5,202.07
|
| Rate for Payer: Cash Price |
$5,202.07
|
| Rate for Payer: Cash Price |
$5,202.07
|
| Rate for Payer: Cigna Commercial |
$3,358.84
|
| Rate for Payer: Cigna Medicaid |
$486.45
|
| Rate for Payer: Cigna Medicare |
$1,482.74
|
| Rate for Payer: Employer Direct Commercial |
$1,482.74
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,482.74
|
| Rate for Payer: Molina CHIP/Medicaid |
$486.45
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,482.74
|
| Rate for Payer: Molina Medicare |
$1,482.74
|
| Rate for Payer: Multiplan Auto |
$3,842.44
|
| Rate for Payer: Multiplan Commercial |
$3,842.44
|
| Rate for Payer: Multiplan Workers Comp |
$3,842.44
|
| Rate for Payer: Parkland Medicaid |
$486.45
|
| Rate for Payer: Scott and White EPO/PPO |
$26.52
|
| Rate for Payer: Scott and White Medicare |
$1,482.74
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$486.45
|
| Rate for Payer: Superior Health Plan EPO |
$1,482.74
|
| Rate for Payer: Superior Health Plan Medicare |
$1,482.74
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,482.74
|
| Rate for Payer: Universal American Medicare |
$1,482.74
|
| Rate for Payer: Wellcare Medicare |
$1,482.74
|
| Rate for Payer: Wellmed Medicare |
$1,482.74
|
|
|
CHED Eye Procedures Corneal w/o Slit Lamp BCE
|
Facility
|
IP
|
$848.06
|
|
|
Service Code
|
CPT 65220
|
| Hospital Charge Code |
8910614
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$746.29
|
|
|
CHED Eye Procedures Corneal w/o Slit Lamp BCE
|
Facility
|
OP
|
$848.06
|
|
|
Service Code
|
CPT 65220
|
| Hospital Charge Code |
8910614
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$6.52 |
| Max. Negotiated Rate |
$916.25 |
| Rate for Payer: Aetna Commercial |
$466.43
|
| Rate for Payer: Aetna Medicare |
$546.58
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$76.33
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$364.39
|
| Rate for Payer: Amerigroup Medicare |
$364.39
|
| Rate for Payer: BCBS of TX Blue Advantage |
$607.20
|
| Rate for Payer: BCBS of TX Blue Essentials |
$727.18
|
| Rate for Payer: BCBS of TX Medicare |
$364.39
|
| Rate for Payer: BCBS of TX PPO |
$916.25
|
| Rate for Payer: Cash Price |
$746.29
|
| Rate for Payer: Cash Price |
$746.29
|
| Rate for Payer: Cash Price |
$746.29
|
| Rate for Payer: Cigna Commercial |
$825.46
|
| Rate for Payer: Cigna Medicare |
$364.39
|
| Rate for Payer: Employer Direct Commercial |
$364.39
|
| Rate for Payer: Humana Medicare/TRICARE |
$364.39
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$364.39
|
| Rate for Payer: Molina Medicare |
$364.39
|
| Rate for Payer: Multiplan Auto |
$551.24
|
| Rate for Payer: Multiplan Commercial |
$551.24
|
| Rate for Payer: Multiplan Workers Comp |
$551.24
|
| Rate for Payer: Scott and White EPO/PPO |
$6.52
|
| Rate for Payer: Scott and White Medicare |
$364.39
|
| Rate for Payer: Superior Health Plan EPO |
$364.39
|
| Rate for Payer: Superior Health Plan Medicare |
$364.39
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$364.39
|
| Rate for Payer: Universal American Medicare |
$364.39
|
| Rate for Payer: Wellcare Medicare |
$364.39
|
| Rate for Payer: Wellmed Medicare |
$364.39
|
|
|
CHED Flu Initial Admin Charge 90471 BCE
|
Facility
|
IP
|
$59.00
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
8914588
|
|
Hospital Revenue Code
|
771
|
| Rate for Payer: Cash Price |
$51.92
|
|
|
CHED Flu Initial Admin Charge 90471 BCE
|
Facility
|
OP
|
$59.00
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
8914588
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$1.15 |
| Max. Negotiated Rate |
$145.94 |
| Rate for Payer: Aetna Commercial |
$32.45
|
| Rate for Payer: Aetna Medicare |
$96.64
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$5.31
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$64.43
|
| Rate for Payer: Amerigroup Medicare |
$64.43
|
| Rate for Payer: BCBS of TX Blue Advantage |
$105.22
|
| Rate for Payer: BCBS of TX Blue Essentials |
$125.78
|
| Rate for Payer: BCBS of TX Medicare |
$64.43
|
| Rate for Payer: BCBS of TX PPO |
$140.29
|
| Rate for Payer: Cash Price |
$51.92
|
| Rate for Payer: Cash Price |
$51.92
|
| Rate for Payer: Cash Price |
$51.92
|
| Rate for Payer: Cigna Commercial |
$145.94
|
| Rate for Payer: Cigna Medicare |
$64.43
|
| Rate for Payer: Employer Direct Commercial |
$64.43
|
| Rate for Payer: Humana Medicare/TRICARE |
$64.43
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$64.43
|
| Rate for Payer: Molina Medicare |
$64.43
|
| Rate for Payer: Multiplan Auto |
$38.35
|
| Rate for Payer: Multiplan Commercial |
$38.35
|
| Rate for Payer: Multiplan Workers Comp |
$38.35
|
| Rate for Payer: Scott and White EPO/PPO |
$1.15
|
| Rate for Payer: Scott and White Medicare |
$64.43
|
| Rate for Payer: Superior Health Plan EPO |
$64.43
|
| Rate for Payer: Superior Health Plan Medicare |
$64.43
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$64.43
|
| Rate for Payer: Universal American Medicare |
$64.43
|
| Rate for Payer: Wellcare Medicare |
$64.43
|
| Rate for Payer: Wellmed Medicare |
$64.43
|
|
|
CHED Foreign Body Removal Site Auditory canal, external w/o
|
Facility
|
OP
|
$317.06
|
|
|
Service Code
|
CPT 69200
|
| Hospital Charge Code |
8914589
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2.09 |
| Max. Negotiated Rate |
$274.76 |
| Rate for Payer: Aetna Commercial |
$174.38
|
| Rate for Payer: Aetna Medicare |
$175.23
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$28.54
|
| 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 |
$279.01
|
| Rate for Payer: Cash Price |
$279.01
|
| Rate for Payer: Cash Price |
$279.01
|
| 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 |
$206.09
|
| Rate for Payer: Multiplan Commercial |
$206.09
|
| Rate for Payer: Multiplan Workers Comp |
$206.09
|
| 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 Foreign Body Removal Site Auditory canal, external w/o
|
Facility
|
IP
|
$317.06
|
|
|
Service Code
|
CPT 69200
|
| Hospital Charge Code |
8914589
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$279.01
|
|
|
CHED Foreign Body Removal Site Intranasal BCE
|
Facility
|
IP
|
$533.00
|
|
|
Service Code
|
CPT 30300
|
| Hospital Charge Code |
8912597
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$469.04
|
|
|
CHED Foreign Body Removal Site Intranasal BCE
|
Facility
|
OP
|
$533.00
|
|
|
Service Code
|
CPT 30300
|
| Hospital Charge Code |
8912597
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2.09 |
| Max. Negotiated Rate |
$346.45 |
| Rate for Payer: Aetna Commercial |
$293.15
|
| Rate for Payer: Aetna Medicare |
$175.23
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$47.97
|
| 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 |
$469.04
|
| Rate for Payer: Cash Price |
$469.04
|
| Rate for Payer: Cash Price |
$469.04
|
| 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 |
$346.45
|
| Rate for Payer: Multiplan Commercial |
$346.45
|
| Rate for Payer: Multiplan Workers Comp |
$346.45
|
| 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 Foreign Body Removal Site Scrotum BCE
|
Facility
|
OP
|
$8,880.13
|
|
|
Service Code
|
CPT 55120
|
| Hospital Charge Code |
8912598
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$33.31 |
| Max. Negotiated Rate |
$5,772.08 |
| Rate for Payer: Aetna Commercial |
$3,090.00
|
| Rate for Payer: Aetna Medicare |
$2,794.14
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$799.21
|
| 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 |
$7,814.51
|
| Rate for Payer: Cash Price |
$7,814.51
|
| Rate for Payer: Cash Price |
$7,814.51
|
| 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 |
$5,772.08
|
| Rate for Payer: Multiplan Commercial |
$5,772.08
|
| Rate for Payer: Multiplan Workers Comp |
$5,772.08
|
| 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 Foreign Body Removal Site Scrotum BCE
|
Facility
|
IP
|
$8,880.13
|
|
|
Service Code
|
CPT 55120
|
| Hospital Charge Code |
8912598
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$7,814.51
|
|
|
CHED Foreign Body Removal Site Skin, Subcutaneous Complex FB
|
Facility
|
OP
|
$3,692.25
|
|
|
Service Code
|
CPT 10121
|
| Hospital Charge Code |
8914590
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$26.52 |
| Max. Negotiated Rate |
$3,458.95 |
| Rate for Payer: Aetna Commercial |
$2,200.00
|
| Rate for Payer: Aetna Medicare |
$2,224.11
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$332.30
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,482.74
|
| Rate for Payer: Amerigroup Medicare |
$1,482.74
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,292.24
|
| Rate for Payer: BCBS of TX Blue Essentials |
$2,745.20
|
| Rate for Payer: BCBS of TX Medicare |
$1,482.74
|
| Rate for Payer: BCBS of TX PPO |
$3,458.95
|
| Rate for Payer: Cash Price |
$3,249.18
|
| Rate for Payer: Cash Price |
$3,249.18
|
| Rate for Payer: Cash Price |
$3,249.18
|
| Rate for Payer: Cigna Commercial |
$3,358.84
|
| Rate for Payer: Cigna Medicaid |
$486.45
|
| Rate for Payer: Cigna Medicare |
$1,482.74
|
| Rate for Payer: Employer Direct Commercial |
$1,482.74
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,482.74
|
| Rate for Payer: Molina CHIP/Medicaid |
$486.45
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,482.74
|
| Rate for Payer: Molina Medicare |
$1,482.74
|
| Rate for Payer: Multiplan Auto |
$2,399.96
|
| Rate for Payer: Multiplan Commercial |
$2,399.96
|
| Rate for Payer: Multiplan Workers Comp |
$2,399.96
|
| Rate for Payer: Parkland Medicaid |
$486.45
|
| Rate for Payer: Scott and White EPO/PPO |
$26.52
|
| Rate for Payer: Scott and White Medicare |
$1,482.74
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$486.45
|
| Rate for Payer: Superior Health Plan EPO |
$1,482.74
|
| Rate for Payer: Superior Health Plan Medicare |
$1,482.74
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,482.74
|
| Rate for Payer: Universal American Medicare |
$1,482.74
|
| Rate for Payer: Wellcare Medicare |
$1,482.74
|
| Rate for Payer: Wellmed Medicare |
$1,482.74
|
|
