|
CHED Paracentesis without imaging BCE
|
Facility
|
OP
|
$2,308.91
|
|
|
Service Code
|
CPT 49082
|
| Hospital Charge Code |
8910647
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$14.83 |
| Max. Negotiated Rate |
$2,200.00 |
| Rate for Payer: Aetna Commercial |
$2,200.00
|
| Rate for Payer: Aetna Medicare |
$1,243.53
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$207.80
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$829.02
|
| Rate for Payer: Amerigroup Medicare |
$829.02
|
| Rate for Payer: BCBS of TX Blue Advantage |
$1,312.49
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,571.84
|
| Rate for Payer: BCBS of TX Medicare |
$829.02
|
| Rate for Payer: BCBS of TX PPO |
$1,980.52
|
| Rate for Payer: Cash Price |
$2,031.84
|
| Rate for Payer: Cash Price |
$2,031.84
|
| Rate for Payer: Cash Price |
$2,031.84
|
| Rate for Payer: Cigna Commercial |
$1,877.98
|
| Rate for Payer: Cigna Medicaid |
$334.95
|
| Rate for Payer: Cigna Medicare |
$829.02
|
| Rate for Payer: Employer Direct Commercial |
$829.02
|
| Rate for Payer: Humana Medicare/TRICARE |
$829.02
|
| Rate for Payer: Molina CHIP/Medicaid |
$334.95
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$829.02
|
| Rate for Payer: Molina Medicare |
$829.02
|
| Rate for Payer: Multiplan Auto |
$1,500.79
|
| Rate for Payer: Multiplan Commercial |
$1,500.79
|
| Rate for Payer: Multiplan Workers Comp |
$1,500.79
|
| Rate for Payer: Parkland Medicaid |
$334.95
|
| Rate for Payer: Scott and White EPO/PPO |
$14.83
|
| Rate for Payer: Scott and White Medicare |
$829.02
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$334.95
|
| Rate for Payer: Superior Health Plan EPO |
$829.02
|
| Rate for Payer: Superior Health Plan Medicare |
$829.02
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$829.02
|
| Rate for Payer: Universal American Medicare |
$829.02
|
| Rate for Payer: Wellcare Medicare |
$829.02
|
| Rate for Payer: Wellmed Medicare |
$829.02
|
|
|
CHED PICC Line Insertion >= 5 Years BCE
|
Facility
|
IP
|
$3,367.48
|
|
|
Service Code
|
CPT 36569
|
| Hospital Charge Code |
8912650
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$2,963.38
|
|
|
CHED PICC Line Insertion >= 5 Years BCE
|
Facility
|
OP
|
$3,367.48
|
|
|
Service Code
|
CPT 36569
|
| Hospital Charge Code |
8912650
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$26.19 |
| Max. Negotiated Rate |
$4,110.45 |
| Rate for Payer: Aetna Commercial |
$1,400.00
|
| Rate for Payer: Aetna Medicare |
$2,197.02
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$303.07
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,464.68
|
| Rate for Payer: Amerigroup Medicare |
$1,464.68
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,723.99
|
| Rate for Payer: BCBS of TX Blue Essentials |
$3,262.26
|
| Rate for Payer: BCBS of TX Medicare |
$1,464.68
|
| Rate for Payer: BCBS of TX PPO |
$4,110.45
|
| Rate for Payer: Cash Price |
$2,963.38
|
| Rate for Payer: Cash Price |
$2,963.38
|
| Rate for Payer: Cash Price |
$2,963.38
|
| Rate for Payer: Cigna Commercial |
$3,317.93
|
| Rate for Payer: Cigna Medicaid |
$446.27
|
| Rate for Payer: Cigna Medicare |
$1,464.68
|
| Rate for Payer: Employer Direct Commercial |
$1,464.68
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,464.68
|
| Rate for Payer: Molina CHIP/Medicaid |
$446.27
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,464.68
|
| Rate for Payer: Molina Medicare |
$1,464.68
|
| Rate for Payer: Multiplan Auto |
$2,188.86
|
| Rate for Payer: Multiplan Commercial |
$2,188.86
|
| Rate for Payer: Multiplan Workers Comp |
$2,188.86
|
| Rate for Payer: Parkland Medicaid |
$446.27
|
| Rate for Payer: Scott and White EPO/PPO |
$26.19
|
| Rate for Payer: Scott and White Medicare |
$1,464.68
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$446.27
|
| Rate for Payer: Superior Health Plan EPO |
$1,464.68
|
| Rate for Payer: Superior Health Plan Medicare |
$1,464.68
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,464.68
|
| Rate for Payer: Universal American Medicare |
$1,464.68
|
| Rate for Payer: Wellcare Medicare |
$1,464.68
|
| Rate for Payer: Wellmed Medicare |
$1,464.68
|
|
|
CHED Pneum Initial Admin Charge 90471/G0009 BCE
|
Facility
|
OP
|
$58.00
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
8914631
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$1.15 |
| Max. Negotiated Rate |
$145.94 |
| Rate for Payer: Aetna Commercial |
$31.90
|
| Rate for Payer: Aetna Medicare |
$96.64
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$5.22
|
| 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 |
$51.04
|
| Rate for Payer: Cash Price |
$51.04
|
| Rate for Payer: Cash Price |
$51.04
|
| 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 |
$37.70
|
| Rate for Payer: Multiplan Commercial |
$37.70
|
| Rate for Payer: Multiplan Workers Comp |
$37.70
|
| 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 Pneum Initial Admin Charge 90471/G0009 BCE
|
Facility
|
IP
|
$58.00
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
8914631
|
|
Hospital Revenue Code
|
771
|
| Rate for Payer: Cash Price |
$51.04
|
|
|
CHED PRESSD NONPRESSD INHAL TRMENT BCE
|
Facility
|
OP
|
$385.53
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
8910645
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3.49 |
| Max. Negotiated Rate |
$441.88 |
| Rate for Payer: Aetna Commercial |
$212.04
|
| Rate for Payer: Aetna Medicare |
$292.59
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$34.70
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$195.06
|
| Rate for Payer: Amerigroup Medicare |
$195.06
|
| Rate for Payer: BCBS of TX Blue Advantage |
$320.09
|
| Rate for Payer: BCBS of TX Blue Essentials |
$382.64
|
| Rate for Payer: BCBS of TX Medicare |
$195.06
|
| Rate for Payer: BCBS of TX PPO |
$426.79
|
| Rate for Payer: Cash Price |
$339.27
|
| Rate for Payer: Cash Price |
$339.27
|
| Rate for Payer: Cash Price |
$339.27
|
| Rate for Payer: Cigna Commercial |
$441.88
|
| Rate for Payer: Cigna Medicare |
$195.06
|
| Rate for Payer: Employer Direct Commercial |
$195.06
|
| Rate for Payer: Humana Medicare/TRICARE |
$195.06
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$195.06
|
| Rate for Payer: Molina Medicare |
$195.06
|
| Rate for Payer: Multiplan Auto |
$250.59
|
| Rate for Payer: Multiplan Commercial |
$250.59
|
| Rate for Payer: Multiplan Workers Comp |
$250.59
|
| Rate for Payer: Scott and White EPO/PPO |
$3.49
|
| Rate for Payer: Scott and White Medicare |
$195.06
|
| Rate for Payer: Superior Health Plan EPO |
$195.06
|
| Rate for Payer: Superior Health Plan Medicare |
$195.06
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$195.06
|
| Rate for Payer: Universal American Medicare |
$195.06
|
| Rate for Payer: Wellcare Medicare |
$195.06
|
| Rate for Payer: Wellmed Medicare |
$195.06
|
|
|
CHED PRESSD NONPRESSD INHAL TRMENT BCE
|
Facility
|
IP
|
$385.53
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
8910645
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$339.27
|
|
|
CHED PUNCTURE ASPIRATION CYST BREAST BCE
|
Facility
|
OP
|
$647.00
|
|
|
Service Code
|
CPT 19000
|
| Hospital Charge Code |
8922672
|
|
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 |
$58.23
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$643.45
|
| Rate for Payer: Amerigroup Medicare |
$643.45
|
| Rate for Payer: BCBS of TX Blue Advantage |
$130.18
|
| Rate for Payer: BCBS of TX Blue Essentials |
$155.90
|
| Rate for Payer: BCBS of TX Medicare |
$643.45
|
| Rate for Payer: BCBS of TX PPO |
$196.43
|
| Rate for Payer: Cash Price |
$569.36
|
| Rate for Payer: Cash Price |
$569.36
|
| Rate for Payer: Cash Price |
$569.36
|
| Rate for Payer: Cigna Commercial |
$1,457.60
|
| Rate for Payer: Cigna Medicaid |
$59.25
|
| 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 |
$59.25
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$643.45
|
| Rate for Payer: Molina Medicare |
$643.45
|
| Rate for Payer: Multiplan Auto |
$420.55
|
| Rate for Payer: Multiplan Commercial |
$420.55
|
| Rate for Payer: Multiplan Workers Comp |
$420.55
|
| Rate for Payer: Parkland Medicaid |
$59.25
|
| 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 |
$59.25
|
| 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 PUNCTURE ASPIRATION CYST BREAST BCE
|
Facility
|
IP
|
$647.00
|
|
|
Service Code
|
CPT 19000
|
| Hospital Charge Code |
8922672
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$569.36
|
|
|
CHED REMOVAL INTRAUTERINE DEVICE IUD BCE
|
Facility
|
OP
|
$2,536.86
|
|
|
Service Code
|
CPT 58301
|
| Hospital Charge Code |
8910648
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$5.25 |
| Max. Negotiated Rate |
$1,648.96 |
| Rate for Payer: Aetna Commercial |
$1,395.27
|
| Rate for Payer: Aetna Medicare |
$440.08
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$228.32
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$293.39
|
| Rate for Payer: Amerigroup Medicare |
$293.39
|
| Rate for Payer: BCBS of TX Blue Advantage |
$87.39
|
| Rate for Payer: BCBS of TX Blue Essentials |
$104.66
|
| Rate for Payer: BCBS of TX Medicare |
$293.39
|
| Rate for Payer: BCBS of TX PPO |
$131.87
|
| Rate for Payer: Cash Price |
$2,232.44
|
| Rate for Payer: Cash Price |
$2,232.44
|
| Rate for Payer: Cash Price |
$2,232.44
|
| Rate for Payer: Cigna Commercial |
$664.62
|
| Rate for Payer: Cigna Medicaid |
$51.22
|
| 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 |
$51.22
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$293.39
|
| Rate for Payer: Molina Medicare |
$293.39
|
| Rate for Payer: Multiplan Auto |
$1,648.96
|
| Rate for Payer: Multiplan Commercial |
$1,648.96
|
| Rate for Payer: Multiplan Workers Comp |
$1,648.96
|
| Rate for Payer: Parkland Medicaid |
$51.22
|
| 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 |
$51.22
|
| 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 REMOVAL INTRAUTERINE DEVICE IUD BCE
|
Facility
|
IP
|
$2,536.86
|
|
|
Service Code
|
CPT 58301
|
| Hospital Charge Code |
8910648
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$2,232.44
|
|
|
CHED REPAIR COMPLEX SCALP/ARM/LEG 2.6-7.5 CM BCE
|
Facility
|
OP
|
$3,028.03
|
|
|
Service Code
|
CPT 13121
|
| Hospital Charge Code |
8914632
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$10.27 |
| Max. Negotiated Rate |
$1,968.22 |
| Rate for Payer: Aetna Commercial |
$1,665.42
|
| Rate for Payer: Aetna Medicare |
$861.57
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$272.52
|
| 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 |
$2,664.67
|
| Rate for Payer: Cash Price |
$2,664.67
|
| Rate for Payer: Cash Price |
$2,664.67
|
| 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 |
$1,968.22
|
| Rate for Payer: Multiplan Commercial |
$1,968.22
|
| Rate for Payer: Multiplan Workers Comp |
$1,968.22
|
| 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 REPAIR COMPLEX SCALP/ARM/LEG 2.6-7.5 CM BCE
|
Facility
|
IP
|
$3,028.03
|
|
|
Service Code
|
CPT 13121
|
| Hospital Charge Code |
8914632
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$2,664.67
|
|
|
CHED REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.6-7.5 CM BCE
|
Facility
|
IP
|
$1,634.82
|
|
|
Service Code
|
CPT 12042
|
| Hospital Charge Code |
8912652
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$1,438.64
|
|
|
CHED REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.6-7.5 CM BCE
|
Facility
|
OP
|
$1,634.82
|
|
|
Service Code
|
CPT 12042
|
| Hospital Charge Code |
8912652
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$6.52 |
| Max. Negotiated Rate |
$1,062.63 |
| Rate for Payer: Aetna Commercial |
$899.15
|
| Rate for Payer: Aetna Medicare |
$547.00
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$147.13
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$364.67
|
| Rate for Payer: Amerigroup Medicare |
$364.67
|
| Rate for Payer: BCBS of TX Blue Advantage |
$269.62
|
| Rate for Payer: BCBS of TX Blue Essentials |
$322.90
|
| Rate for Payer: BCBS of TX Medicare |
$364.67
|
| Rate for Payer: BCBS of TX PPO |
$406.85
|
| Rate for Payer: Cash Price |
$1,438.64
|
| Rate for Payer: Cash Price |
$1,438.64
|
| Rate for Payer: Cash Price |
$1,438.64
|
| 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 |
$1,062.63
|
| Rate for Payer: Multiplan Commercial |
$1,062.63
|
| Rate for Payer: Multiplan Workers Comp |
$1,062.63
|
| 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 REPAIR INTERMEDIATE S A T E 12.6-20.0CM BCE
|
Facility
|
OP
|
$2,495.00
|
|
|
Service Code
|
CPT 12035
|
| Hospital Charge Code |
8910649
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$6.52 |
| Max. Negotiated Rate |
$1,621.75 |
| Rate for Payer: Aetna Commercial |
$1,372.25
|
| Rate for Payer: Aetna Medicare |
$547.00
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$224.55
|
| 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 |
$2,195.60
|
| Rate for Payer: Cash Price |
$2,195.60
|
| Rate for Payer: Cash Price |
$2,195.60
|
| 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 |
$1,621.75
|
| Rate for Payer: Multiplan Commercial |
$1,621.75
|
| Rate for Payer: Multiplan Workers Comp |
$1,621.75
|
| 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 REPAIR INTERMEDIATE S A T E 12.6-20.0CM BCE
|
Facility
|
IP
|
$2,495.00
|
|
|
Service Code
|
CPT 12035
|
| Hospital Charge Code |
8910649
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$2,195.60
|
|
|
CHED REPAIR INTERMEDIATE WOUNDS S/A/T/E EXCL HAND/FEET 7.6 C
|
Facility
|
IP
|
$2,164.94
|
|
|
Service Code
|
CPT 12034
|
| Hospital Charge Code |
8914633
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$1,905.15
|
|
|
CHED REPAIR INTERMEDIATE WOUNDS S/A/T/E EXCL HAND/FEET 7.6 C
|
Facility
|
OP
|
$2,164.94
|
|
|
Service Code
|
CPT 12034
|
| Hospital Charge Code |
8914633
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$6.52 |
| Max. Negotiated Rate |
$1,407.21 |
| Rate for Payer: Aetna Commercial |
$1,190.72
|
| Rate for Payer: Aetna Medicare |
$547.00
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$194.84
|
| 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 |
$1,905.15
|
| Rate for Payer: Cash Price |
$1,905.15
|
| Rate for Payer: Cash Price |
$1,905.15
|
| 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 |
$1,407.21
|
| Rate for Payer: Multiplan Commercial |
$1,407.21
|
| Rate for Payer: Multiplan Workers Comp |
$1,407.21
|
| 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 REPAIR INTERM F/E/E/N/L/MUC 5.1-7.5 CM BCE
|
Facility
|
IP
|
$1,569.58
|
|
|
Service Code
|
CPT 12053
|
| Hospital Charge Code |
8912651
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$1,381.23
|
|
|
CHED REPAIR INTERM F/E/E/N/L/MUC 5.1-7.5 CM BCE
|
Facility
|
OP
|
$1,569.58
|
|
|
Service Code
|
CPT 12053
|
| Hospital Charge Code |
8912651
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$6.52 |
| Max. Negotiated Rate |
$1,020.23 |
| Rate for Payer: Aetna Commercial |
$863.27
|
| Rate for Payer: Aetna Medicare |
$547.00
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$141.26
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$364.67
|
| Rate for Payer: Amerigroup Medicare |
$364.67
|
| Rate for Payer: BCBS of TX Blue Advantage |
$269.62
|
| Rate for Payer: BCBS of TX Blue Essentials |
$322.90
|
| Rate for Payer: BCBS of TX Medicare |
$364.67
|
| Rate for Payer: BCBS of TX PPO |
$406.85
|
| Rate for Payer: Cash Price |
$1,381.23
|
| Rate for Payer: Cash Price |
$1,381.23
|
| Rate for Payer: Cash Price |
$1,381.23
|
| 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 |
$1,020.23
|
| Rate for Payer: Multiplan Commercial |
$1,020.23
|
| Rate for Payer: Multiplan Workers Comp |
$1,020.23
|
| 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 REPAIR LAC 2.5 CM OR LESS FLOOR OF MOUTH AND/OR ANT TWO
|
Facility
|
OP
|
$814.48
|
|
|
Service Code
|
CPT 41250
|
| Hospital Charge Code |
8912653
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$6.52 |
| Max. Negotiated Rate |
$825.46 |
| Rate for Payer: Aetna Commercial |
$447.96
|
| Rate for Payer: Aetna Medicare |
$546.58
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$73.30
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$364.39
|
| Rate for Payer: Amerigroup Medicare |
$364.39
|
| 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 |
$364.39
|
| Rate for Payer: BCBS of TX PPO |
$274.76
|
| Rate for Payer: Cash Price |
$716.74
|
| Rate for Payer: Cash Price |
$716.74
|
| Rate for Payer: Cash Price |
$716.74
|
| 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 |
$529.41
|
| Rate for Payer: Multiplan Commercial |
$529.41
|
| Rate for Payer: Multiplan Workers Comp |
$529.41
|
| 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 REPAIR LAC 2.5 CM OR LESS FLOOR OF MOUTH AND/OR ANT TWO
|
Facility
|
IP
|
$814.48
|
|
|
Service Code
|
CPT 41250
|
| Hospital Charge Code |
8912653
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$716.74
|
|
|
CHED REPAIR LIP FULL THICKNESS VERMILION ONLY BCE
|
Facility
|
IP
|
$2,794.28
|
|
|
Service Code
|
CPT 40650
|
| Hospital Charge Code |
8912654
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$2,458.97
|
|
|
CHED REPAIR LIP FULL THICKNESS VERMILION ONLY BCE
|
Facility
|
OP
|
$2,794.28
|
|
|
Service Code
|
CPT 40650
|
| Hospital Charge Code |
8912654
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$9.00 |
| Max. Negotiated Rate |
$1,816.28 |
| Rate for Payer: Aetna Commercial |
$1,536.85
|
| Rate for Payer: Aetna Medicare |
$754.78
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$251.49
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$503.19
|
| Rate for Payer: Amerigroup Medicare |
$503.19
|
| Rate for Payer: BCBS of TX Blue Advantage |
$737.67
|
| Rate for Payer: BCBS of TX Blue Essentials |
$883.44
|
| Rate for Payer: BCBS of TX Medicare |
$503.19
|
| Rate for Payer: BCBS of TX PPO |
$1,113.13
|
| Rate for Payer: Cash Price |
$2,458.97
|
| Rate for Payer: Cash Price |
$2,458.97
|
| Rate for Payer: Cash Price |
$2,458.97
|
| Rate for Payer: Cigna Commercial |
$1,139.87
|
| Rate for Payer: Cigna Medicaid |
$187.22
|
| Rate for Payer: Cigna Medicare |
$503.19
|
| Rate for Payer: Employer Direct Commercial |
$503.19
|
| Rate for Payer: Humana Medicare/TRICARE |
$503.19
|
| Rate for Payer: Molina CHIP/Medicaid |
$187.22
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$503.19
|
| Rate for Payer: Molina Medicare |
$503.19
|
| Rate for Payer: Multiplan Auto |
$1,816.28
|
| Rate for Payer: Multiplan Commercial |
$1,816.28
|
| Rate for Payer: Multiplan Workers Comp |
$1,816.28
|
| Rate for Payer: Parkland Medicaid |
$187.22
|
| Rate for Payer: Scott and White EPO/PPO |
$9.00
|
| Rate for Payer: Scott and White Medicare |
$503.19
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$187.22
|
| Rate for Payer: Superior Health Plan EPO |
$503.19
|
| Rate for Payer: Superior Health Plan Medicare |
$503.19
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$503.19
|
| Rate for Payer: Universal American Medicare |
$503.19
|
| Rate for Payer: Wellcare Medicare |
$503.19
|
| Rate for Payer: Wellmed Medicare |
$503.19
|
|
