|
CHED ID Drainage Nose, Internal BCE
|
Facility
|
IP
|
$1,990.00
|
|
|
Service Code
|
CPT 30000
|
| Hospital Charge Code |
8912622
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$1,751.20
|
|
|
CHED ID Drainage Roof of Mouth BCE
|
Facility
|
IP
|
$837.55
|
|
|
Service Code
|
CPT 42000
|
| Hospital Charge Code |
8914606
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$737.04
|
|
|
CHED ID Drainage Roof of Mouth BCE
|
Facility
|
OP
|
$837.55
|
|
|
Service Code
|
CPT 42000
|
| Hospital Charge Code |
8914606
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$544.41 |
| Rate for Payer: Aetna Commercial |
$460.65
|
| Rate for Payer: Aetna Medicare |
$335.08
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$75.38
|
| 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 |
$737.04
|
| Rate for Payer: Cash Price |
$737.04
|
| Rate for Payer: Cash Price |
$737.04
|
| 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 |
$544.41
|
| Rate for Payer: Multiplan Commercial |
$544.41
|
| Rate for Payer: Multiplan Workers Comp |
$544.41
|
| 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 ID Drainage Scrotal Wall BCE
|
Facility
|
OP
|
$2,714.00
|
|
|
Service Code
|
CPT 55100
|
| Hospital Charge Code |
8912623
|
|
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 |
$244.26
|
| 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 |
$2,388.32
|
| Rate for Payer: Cash Price |
$2,388.32
|
| Rate for Payer: Cash Price |
$2,388.32
|
| 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 |
$1,764.10
|
| Rate for Payer: Multiplan Commercial |
$1,764.10
|
| Rate for Payer: Multiplan Workers Comp |
$1,764.10
|
| 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 ID Drainage Scrotal Wall BCE
|
Facility
|
IP
|
$2,714.00
|
|
|
Service Code
|
CPT 55100
|
| Hospital Charge Code |
8912623
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$2,388.32
|
|
|
CHED I & D OF VULVA/PERINEUM ABSCESS BCE
|
Facility
|
OP
|
$1,364.25
|
|
|
Service Code
|
CPT 56405
|
| Hospital Charge Code |
8914599
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$5.25 |
| Max. Negotiated Rate |
$886.76 |
| Rate for Payer: Aetna Commercial |
$750.34
|
| Rate for Payer: Aetna Medicare |
$440.08
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$122.78
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$293.39
|
| Rate for Payer: Amerigroup Medicare |
$293.39
|
| Rate for Payer: BCBS of TX Blue Advantage |
$116.92
|
| Rate for Payer: BCBS of TX Blue Essentials |
$140.02
|
| Rate for Payer: BCBS of TX Medicare |
$293.39
|
| Rate for Payer: BCBS of TX PPO |
$176.43
|
| Rate for Payer: Cash Price |
$1,200.54
|
| Rate for Payer: Cash Price |
$1,200.54
|
| Rate for Payer: Cash Price |
$1,200.54
|
| Rate for Payer: Cigna Commercial |
$664.62
|
| Rate for Payer: Cigna Medicaid |
$75.58
|
| Rate for Payer: Cigna Medicare |
$293.39
|
| Rate for Payer: Employer Direct Commercial |
$293.39
|
| Rate for Payer: Humana Medicare/TRICARE |
$293.39
|
| Rate for Payer: Molina CHIP/Medicaid |
$75.58
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$293.39
|
| Rate for Payer: Molina Medicare |
$293.39
|
| Rate for Payer: Multiplan Auto |
$886.76
|
| Rate for Payer: Multiplan Commercial |
$886.76
|
| Rate for Payer: Multiplan Workers Comp |
$886.76
|
| Rate for Payer: Parkland Medicaid |
$75.58
|
| Rate for Payer: Scott and White EPO/PPO |
$5.25
|
| Rate for Payer: Scott and White Medicare |
$293.39
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$75.58
|
| Rate for Payer: Superior Health Plan EPO |
$293.39
|
| Rate for Payer: Superior Health Plan Medicare |
$293.39
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$293.39
|
| Rate for Payer: Universal American Medicare |
$293.39
|
| Rate for Payer: Wellcare Medicare |
$293.39
|
| Rate for Payer: Wellmed Medicare |
$293.39
|
|
|
CHED I & D OF VULVA/PERINEUM ABSCESS BCE
|
Facility
|
IP
|
$1,364.25
|
|
|
Service Code
|
CPT 56405
|
| Hospital Charge Code |
8914599
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$1,200.54
|
|
|
CHED INCISION THROMBOSED HEMORRHOID EXTERNAL BCE
|
Facility
|
IP
|
$818.00
|
|
|
Service Code
|
CPT 46083
|
| Hospital Charge Code |
8912624
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$719.84
|
|
|
CHED INCISION THROMBOSED HEMORRHOID EXTERNAL BCE
|
Facility
|
OP
|
$818.00
|
|
|
Service Code
|
CPT 46083
|
| Hospital Charge Code |
8912624
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$4.04 |
| Max. Negotiated Rate |
$531.70 |
| Rate for Payer: Aetna Commercial |
$449.90
|
| Rate for Payer: Aetna Medicare |
$339.04
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$73.62
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$226.03
|
| Rate for Payer: Amerigroup Medicare |
$226.03
|
| Rate for Payer: BCBS of TX Blue Advantage |
$198.21
|
| Rate for Payer: BCBS of TX Blue Essentials |
$237.38
|
| Rate for Payer: BCBS of TX Medicare |
$226.03
|
| Rate for Payer: BCBS of TX PPO |
$299.10
|
| Rate for Payer: Cash Price |
$719.84
|
| Rate for Payer: Cash Price |
$719.84
|
| Rate for Payer: Cash Price |
$719.84
|
| Rate for Payer: Cigna Commercial |
$512.01
|
| Rate for Payer: Cigna Medicaid |
$110.15
|
| 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 |
$110.15
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$226.03
|
| Rate for Payer: Molina Medicare |
$226.03
|
| Rate for Payer: Multiplan Auto |
$531.70
|
| Rate for Payer: Multiplan Commercial |
$531.70
|
| Rate for Payer: Multiplan Workers Comp |
$531.70
|
| Rate for Payer: Parkland Medicaid |
$110.15
|
| 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 |
$110.15
|
| 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 Initial Admin Charge 90471 BCE
|
Facility
|
IP
|
$124.00
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
8912627
|
|
Hospital Revenue Code
|
771
|
| Rate for Payer: Cash Price |
$109.12
|
|
|
CHED Initial Admin Charge 90471 BCE
|
Facility
|
OP
|
$124.00
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
8912627
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$1.15 |
| Max. Negotiated Rate |
$145.94 |
| Rate for Payer: Aetna Commercial |
$68.20
|
| Rate for Payer: Aetna Medicare |
$96.64
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$11.16
|
| 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 |
$109.12
|
| Rate for Payer: Cash Price |
$109.12
|
| Rate for Payer: Cash Price |
$109.12
|
| 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 |
$80.60
|
| Rate for Payer: Multiplan Commercial |
$80.60
|
| Rate for Payer: Multiplan Workers Comp |
$80.60
|
| 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 Injections/Nerve Block Blood patch BCE
|
Facility
|
OP
|
$1,339.00
|
|
|
Service Code
|
CPT 62273
|
| Hospital Charge Code |
8912628
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$11.31 |
| Max. Negotiated Rate |
$1,575.13 |
| Rate for Payer: Aetna Commercial |
$1,400.00
|
| Rate for Payer: Aetna Medicare |
$948.68
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$120.51
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$632.45
|
| Rate for Payer: Amerigroup Medicare |
$632.45
|
| Rate for Payer: BCBS of TX Blue Advantage |
$1,043.83
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,250.10
|
| Rate for Payer: BCBS of TX Medicare |
$632.45
|
| Rate for Payer: BCBS of TX PPO |
$1,575.13
|
| Rate for Payer: Cash Price |
$1,178.32
|
| Rate for Payer: Cash Price |
$1,178.32
|
| Rate for Payer: Cash Price |
$1,178.32
|
| Rate for Payer: Cigna Commercial |
$1,432.68
|
| Rate for Payer: Cigna Medicaid |
$262.86
|
| Rate for Payer: Cigna Medicare |
$632.45
|
| Rate for Payer: Employer Direct Commercial |
$632.45
|
| Rate for Payer: Humana Medicare/TRICARE |
$632.45
|
| Rate for Payer: Molina CHIP/Medicaid |
$262.86
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$632.45
|
| Rate for Payer: Molina Medicare |
$632.45
|
| Rate for Payer: Multiplan Auto |
$870.35
|
| Rate for Payer: Multiplan Commercial |
$870.35
|
| Rate for Payer: Multiplan Workers Comp |
$870.35
|
| Rate for Payer: Parkland Medicaid |
$262.86
|
| Rate for Payer: Scott and White EPO/PPO |
$11.31
|
| Rate for Payer: Scott and White Medicare |
$632.45
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$262.86
|
| Rate for Payer: Superior Health Plan EPO |
$632.45
|
| Rate for Payer: Superior Health Plan Medicare |
$632.45
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$632.45
|
| Rate for Payer: Universal American Medicare |
$632.45
|
| Rate for Payer: Wellcare Medicare |
$632.45
|
| Rate for Payer: Wellmed Medicare |
$632.45
|
|
|
CHED Injections/Nerve Block Blood patch BCE
|
Facility
|
IP
|
$1,339.00
|
|
|
Service Code
|
CPT 62273
|
| Hospital Charge Code |
8912628
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$1,178.32
|
|
|
CHED Injections/Nerve Block Injcetion corpora cavernosa BCE
|
Facility
|
IP
|
$799.00
|
|
|
Service Code
|
CPT 54235
|
| Hospital Charge Code |
8910627
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$703.12
|
|
|
CHED Injections/Nerve Block Injcetion corpora cavernosa BCE
|
Facility
|
OP
|
$799.00
|
|
|
Service Code
|
CPT 54235
|
| Hospital Charge Code |
8910627
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$4.04 |
| Max. Negotiated Rate |
$519.35 |
| Rate for Payer: Aetna Commercial |
$439.45
|
| Rate for Payer: Aetna Medicare |
$339.04
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$71.91
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$226.03
|
| Rate for Payer: Amerigroup Medicare |
$226.03
|
| Rate for Payer: BCBS of TX Blue Advantage |
$72.93
|
| Rate for Payer: BCBS of TX Blue Essentials |
$87.34
|
| Rate for Payer: BCBS of TX Medicare |
$226.03
|
| Rate for Payer: BCBS of TX PPO |
$110.05
|
| Rate for Payer: Cash Price |
$703.12
|
| Rate for Payer: Cash Price |
$703.12
|
| Rate for Payer: Cash Price |
$703.12
|
| Rate for Payer: Cigna Commercial |
$512.01
|
| Rate for Payer: Cigna Medicaid |
$35.16
|
| 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 |
$35.16
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$226.03
|
| Rate for Payer: Molina Medicare |
$226.03
|
| Rate for Payer: Multiplan Auto |
$519.35
|
| Rate for Payer: Multiplan Commercial |
$519.35
|
| Rate for Payer: Multiplan Workers Comp |
$519.35
|
| Rate for Payer: Parkland Medicaid |
$35.16
|
| 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 |
$35.16
|
| 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 Injections/Nerve Block Injection trigger point BCE
|
Facility
|
IP
|
$744.00
|
|
|
Service Code
|
CPT 20552
|
| Hospital Charge Code |
8912629
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$654.72
|
|
|
CHED Injections/Nerve Block Injection trigger point BCE
|
Facility
|
OP
|
$744.00
|
|
|
Service Code
|
CPT 20552
|
| Hospital Charge Code |
8912629
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$4.84 |
| Max. Negotiated Rate |
$613.60 |
| Rate for Payer: Aetna Commercial |
$409.20
|
| Rate for Payer: Aetna Medicare |
$406.30
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$66.96
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$270.87
|
| Rate for Payer: Amerigroup Medicare |
$270.87
|
| Rate for Payer: BCBS of TX Blue Advantage |
$50.63
|
| Rate for Payer: BCBS of TX Blue Essentials |
$60.64
|
| Rate for Payer: BCBS of TX Medicare |
$270.87
|
| Rate for Payer: BCBS of TX PPO |
$76.41
|
| Rate for Payer: Cash Price |
$654.72
|
| Rate for Payer: Cash Price |
$654.72
|
| Rate for Payer: Cash Price |
$654.72
|
| Rate for Payer: Cigna Commercial |
$613.60
|
| Rate for Payer: Cigna Medicaid |
$23.26
|
| Rate for Payer: Cigna Medicare |
$270.87
|
| Rate for Payer: Employer Direct Commercial |
$270.87
|
| Rate for Payer: Humana Medicare/TRICARE |
$270.87
|
| Rate for Payer: Molina CHIP/Medicaid |
$23.26
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$270.87
|
| Rate for Payer: Molina Medicare |
$270.87
|
| Rate for Payer: Multiplan Auto |
$483.60
|
| Rate for Payer: Multiplan Commercial |
$483.60
|
| Rate for Payer: Multiplan Workers Comp |
$483.60
|
| Rate for Payer: Parkland Medicaid |
$23.26
|
| Rate for Payer: Scott and White EPO/PPO |
$4.84
|
| Rate for Payer: Scott and White Medicare |
$270.87
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$23.26
|
| Rate for Payer: Superior Health Plan EPO |
$270.87
|
| Rate for Payer: Superior Health Plan Medicare |
$270.87
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$270.87
|
| Rate for Payer: Universal American Medicare |
$270.87
|
| Rate for Payer: Wellcare Medicare |
$270.87
|
| Rate for Payer: Wellmed Medicare |
$270.87
|
|
|
CHED Injections/Nerve Block Lumbar puncture - Diagnostic BCE
|
Facility
|
IP
|
$1,261.00
|
|
|
Service Code
|
CPT 62270
|
| Hospital Charge Code |
8912630
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$1,109.68
|
|
|
CHED Injections/Nerve Block Lumbar puncture - Diagnostic BCE
|
Facility
|
OP
|
$1,261.00
|
|
|
Service Code
|
CPT 62270
|
| Hospital Charge Code |
8912630
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$11.31 |
| Max. Negotiated Rate |
$1,575.13 |
| Rate for Payer: Aetna Commercial |
$1,400.00
|
| Rate for Payer: Aetna Medicare |
$948.68
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$113.49
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$632.45
|
| Rate for Payer: Amerigroup Medicare |
$632.45
|
| Rate for Payer: BCBS of TX Blue Advantage |
$1,043.83
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,250.10
|
| Rate for Payer: BCBS of TX Medicare |
$632.45
|
| Rate for Payer: BCBS of TX PPO |
$1,575.13
|
| Rate for Payer: Cash Price |
$1,109.68
|
| Rate for Payer: Cash Price |
$1,109.68
|
| Rate for Payer: Cash Price |
$1,109.68
|
| Rate for Payer: Cigna Commercial |
$1,432.68
|
| Rate for Payer: Cigna Medicaid |
$262.86
|
| Rate for Payer: Cigna Medicare |
$632.45
|
| Rate for Payer: Employer Direct Commercial |
$632.45
|
| Rate for Payer: Humana Medicare/TRICARE |
$632.45
|
| Rate for Payer: Molina CHIP/Medicaid |
$262.86
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$632.45
|
| Rate for Payer: Molina Medicare |
$632.45
|
| Rate for Payer: Multiplan Auto |
$819.65
|
| Rate for Payer: Multiplan Commercial |
$819.65
|
| Rate for Payer: Multiplan Workers Comp |
$819.65
|
| Rate for Payer: Parkland Medicaid |
$262.86
|
| Rate for Payer: Scott and White EPO/PPO |
$11.31
|
| Rate for Payer: Scott and White Medicare |
$632.45
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$262.86
|
| Rate for Payer: Superior Health Plan EPO |
$632.45
|
| Rate for Payer: Superior Health Plan Medicare |
$632.45
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$632.45
|
| Rate for Payer: Universal American Medicare |
$632.45
|
| Rate for Payer: Wellcare Medicare |
$632.45
|
| Rate for Payer: Wellmed Medicare |
$632.45
|
|
|
CHED Injections/Nerve Block Nerve block, peripheral BCE
|
Facility
|
OP
|
$1,261.00
|
|
|
Service Code
|
CPT 64450
|
| Hospital Charge Code |
8910628
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$11.31 |
| Max. Negotiated Rate |
$1,432.68 |
| Rate for Payer: Aetna Commercial |
$1,400.00
|
| Rate for Payer: Aetna Medicare |
$948.68
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$113.49
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$632.45
|
| Rate for Payer: Amerigroup Medicare |
$632.45
|
| Rate for Payer: BCBS of TX Blue Advantage |
$80.76
|
| Rate for Payer: BCBS of TX Blue Essentials |
$96.72
|
| Rate for Payer: BCBS of TX Medicare |
$632.45
|
| Rate for Payer: BCBS of TX PPO |
$121.87
|
| Rate for Payer: Cash Price |
$1,109.68
|
| Rate for Payer: Cash Price |
$1,109.68
|
| Rate for Payer: Cash Price |
$1,109.68
|
| Rate for Payer: Cigna Commercial |
$1,432.68
|
| Rate for Payer: Cigna Medicaid |
$39.31
|
| Rate for Payer: Cigna Medicare |
$632.45
|
| Rate for Payer: Employer Direct Commercial |
$632.45
|
| Rate for Payer: Humana Medicare/TRICARE |
$632.45
|
| Rate for Payer: Molina CHIP/Medicaid |
$39.31
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$632.45
|
| Rate for Payer: Molina Medicare |
$632.45
|
| Rate for Payer: Multiplan Auto |
$819.65
|
| Rate for Payer: Multiplan Commercial |
$819.65
|
| Rate for Payer: Multiplan Workers Comp |
$819.65
|
| Rate for Payer: Parkland Medicaid |
$39.31
|
| Rate for Payer: Scott and White EPO/PPO |
$11.31
|
| Rate for Payer: Scott and White Medicare |
$632.45
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$39.31
|
| Rate for Payer: Superior Health Plan EPO |
$632.45
|
| Rate for Payer: Superior Health Plan Medicare |
$632.45
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$632.45
|
| Rate for Payer: Universal American Medicare |
$632.45
|
| Rate for Payer: Wellcare Medicare |
$632.45
|
| Rate for Payer: Wellmed Medicare |
$632.45
|
|
|
CHED Injections/Nerve Block Nerve block, peripheral BCE
|
Facility
|
IP
|
$1,261.00
|
|
|
Service Code
|
CPT 64450
|
| Hospital Charge Code |
8910628
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$1,109.68
|
|
|
CHED Injections/Nerve Block Nerve block, trigeminal BCE
|
Facility
|
IP
|
$535.00
|
|
|
Service Code
|
CPT 64400
|
| Hospital Charge Code |
8910629
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$470.80
|
|
|
CHED Injections/Nerve Block Nerve block, trigeminal BCE
|
Facility
|
OP
|
$535.00
|
|
|
Service Code
|
CPT 64400
|
| Hospital Charge Code |
8910629
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$4.84 |
| Max. Negotiated Rate |
$613.60 |
| Rate for Payer: Aetna Commercial |
$294.25
|
| Rate for Payer: Aetna Medicare |
$406.30
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$48.15
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$270.87
|
| Rate for Payer: Amerigroup Medicare |
$270.87
|
| Rate for Payer: BCBS of TX Blue Advantage |
$127.77
|
| Rate for Payer: BCBS of TX Blue Essentials |
$153.02
|
| Rate for Payer: BCBS of TX Medicare |
$270.87
|
| Rate for Payer: BCBS of TX PPO |
$192.81
|
| Rate for Payer: Cash Price |
$470.80
|
| Rate for Payer: Cash Price |
$470.80
|
| Rate for Payer: Cash Price |
$470.80
|
| Rate for Payer: Cigna Commercial |
$613.60
|
| Rate for Payer: Cigna Medicaid |
$67.55
|
| Rate for Payer: Cigna Medicare |
$270.87
|
| Rate for Payer: Employer Direct Commercial |
$270.87
|
| Rate for Payer: Humana Medicare/TRICARE |
$270.87
|
| Rate for Payer: Molina CHIP/Medicaid |
$67.55
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$270.87
|
| Rate for Payer: Molina Medicare |
$270.87
|
| Rate for Payer: Multiplan Auto |
$347.75
|
| Rate for Payer: Multiplan Commercial |
$347.75
|
| Rate for Payer: Multiplan Workers Comp |
$347.75
|
| Rate for Payer: Parkland Medicaid |
$67.55
|
| Rate for Payer: Scott and White EPO/PPO |
$4.84
|
| Rate for Payer: Scott and White Medicare |
$270.87
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$67.55
|
| Rate for Payer: Superior Health Plan EPO |
$270.87
|
| Rate for Payer: Superior Health Plan Medicare |
$270.87
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$270.87
|
| Rate for Payer: Universal American Medicare |
$270.87
|
| Rate for Payer: Wellcare Medicare |
$270.87
|
| Rate for Payer: Wellmed Medicare |
$270.87
|
|
|
CHED Injections/Nerve Block Sacroiliac Joint Arthrography BC
|
Facility
|
IP
|
$2,500.00
|
|
|
Service Code
|
CPT 27096
|
| Hospital Charge Code |
8914608
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$2,200.00
|
|
|
CHED Injections/Nerve Block Sacroiliac Joint Arthrography BC
|
Facility
|
OP
|
$2,500.00
|
|
|
Service Code
|
CPT 27096
|
| Hospital Charge Code |
8914608
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$143.24 |
| Max. Negotiated Rate |
$1,625.00 |
| Rate for Payer: Aetna Commercial |
$1,375.00
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$225.00
|
| Rate for Payer: BCBS of TX Blue Advantage |
$143.24
|
| Rate for Payer: BCBS of TX Blue Essentials |
$171.54
|
| Rate for Payer: BCBS of TX PPO |
$216.14
|
| Rate for Payer: Cash Price |
$2,200.00
|
| Rate for Payer: Cash Price |
$2,200.00
|
| Rate for Payer: Multiplan Auto |
$1,625.00
|
| Rate for Payer: Multiplan Commercial |
$1,625.00
|
| Rate for Payer: Multiplan Workers Comp |
$1,625.00
|
| Rate for Payer: Scott and White EPO/PPO |
$1,250.00
|
| Rate for Payer: Superior Health Plan EPO |
$340.00
|
|
