|
Ethylene Glycol, Serum SO
|
Facility
|
OP
|
$112.00
|
|
|
Service Code
|
CPT 82693
|
| Hospital Charge Code |
1707207
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.81 |
| Max. Negotiated Rate |
$72.80 |
| Rate for Payer: Aetna Commercial |
$15.64
|
| Rate for Payer: Aetna Medicare |
$22.35
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$5.81
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$14.90
|
| Rate for Payer: Amerigroup Medicare |
$14.90
|
| Rate for Payer: BCBS of TX Blue Advantage |
$24.58
|
| Rate for Payer: BCBS of TX Blue Essentials |
$29.50
|
| Rate for Payer: BCBS of TX Medicare |
$14.90
|
| Rate for Payer: BCBS of TX PPO |
$32.93
|
| Rate for Payer: Cash Price |
$98.56
|
| Rate for Payer: Cash Price |
$98.56
|
| Rate for Payer: Cigna Medicaid |
$14.90
|
| Rate for Payer: Cigna Medicare |
$14.90
|
| Rate for Payer: Employer Direct Commercial |
$14.90
|
| Rate for Payer: Humana Medicare/TRICARE |
$14.90
|
| Rate for Payer: Molina CHIP/Medicaid |
$14.90
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$14.90
|
| Rate for Payer: Molina Medicare |
$14.90
|
| Rate for Payer: Multiplan Auto |
$72.80
|
| Rate for Payer: Multiplan Commercial |
$72.80
|
| Rate for Payer: Multiplan Workers Comp |
$72.80
|
| Rate for Payer: Parkland Medicaid |
$14.90
|
| Rate for Payer: Scott and White EPO/PPO |
$18.62
|
| Rate for Payer: Scott and White Medicare |
$14.90
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$14.90
|
| Rate for Payer: Superior Health Plan EPO |
$14.90
|
| Rate for Payer: Superior Health Plan Medicare |
$14.90
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$14.90
|
| Rate for Payer: Universal American Medicare |
$14.90
|
| Rate for Payer: Wellcare Medicare |
$14.90
|
| Rate for Payer: Wellmed Medicare |
$14.90
|
|
|
etomidate 2 mg/mL IV Sol 10 mL
|
Facility
|
IP
|
$128.17
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
81405158
|
|
Hospital Revenue Code
|
250
|
| Rate for Payer: Cash Price |
$87.16
|
|
|
etomidate 2 mg/mL IV Sol 10 mL
|
Facility
|
OP
|
$128.17
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
81405158
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.54 |
| Max. Negotiated Rate |
$83.31 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$11.54
|
| Rate for Payer: BCBS of TX Blue Advantage |
$38.45
|
| Rate for Payer: BCBS of TX Blue Essentials |
$46.14
|
| Rate for Payer: BCBS of TX PPO |
$51.27
|
| Rate for Payer: Cash Price |
$87.16
|
| Rate for Payer: Multiplan Auto |
$83.31
|
| Rate for Payer: Multiplan Commercial |
$83.31
|
| Rate for Payer: Multiplan Workers Comp |
$83.31
|
| Rate for Payer: Scott and White EPO/PPO |
$64.08
|
| Rate for Payer: Superior Health Plan EPO |
$17.43
|
|
|
etomidate 2 mg/mL IV Soln 20 mL
|
Facility
|
OP
|
$128.17
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
78470396
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.54 |
| Max. Negotiated Rate |
$83.31 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$11.54
|
| Rate for Payer: BCBS of TX Blue Advantage |
$38.45
|
| Rate for Payer: BCBS of TX Blue Essentials |
$46.14
|
| Rate for Payer: BCBS of TX PPO |
$51.27
|
| Rate for Payer: Cash Price |
$87.16
|
| Rate for Payer: Multiplan Auto |
$83.31
|
| Rate for Payer: Multiplan Commercial |
$83.31
|
| Rate for Payer: Multiplan Workers Comp |
$83.31
|
| Rate for Payer: Scott and White EPO/PPO |
$64.08
|
| Rate for Payer: Superior Health Plan EPO |
$17.43
|
|
|
etomidate 2 mg/mL IV Soln 20 mL
|
Facility
|
IP
|
$128.17
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
78470396
|
|
Hospital Revenue Code
|
250
|
| Rate for Payer: Cash Price |
$87.16
|
|
|
EVACUATOR, SMOKE ENDOSCOPIC PLUME PUREVIEW -- DHF
|
Facility
|
OP
|
$93.77
|
|
| Hospital Charge Code |
81746679
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.44 |
| Max. Negotiated Rate |
$60.95 |
| Rate for Payer: Aetna Commercial |
$51.57
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$8.44
|
| Rate for Payer: BCBS of TX Blue Advantage |
$28.13
|
| Rate for Payer: BCBS of TX Blue Essentials |
$33.76
|
| Rate for Payer: BCBS of TX PPO |
$37.51
|
| Rate for Payer: Cash Price |
$82.52
|
| Rate for Payer: Multiplan Auto |
$60.95
|
| Rate for Payer: Multiplan Commercial |
$60.95
|
| Rate for Payer: Multiplan Workers Comp |
$60.95
|
| Rate for Payer: Scott and White EPO/PPO |
$46.88
|
| Rate for Payer: Superior Health Plan EPO |
$12.75
|
|
|
EVACUATOR, SUCTION CLOSED SILICONE 100CC STERILE -- DHF
|
Facility
|
OP
|
$45.40
|
|
| Hospital Charge Code |
81820557
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.09 |
| Max. Negotiated Rate |
$29.51 |
| Rate for Payer: Aetna Commercial |
$24.97
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$4.09
|
| Rate for Payer: BCBS of TX Blue Advantage |
$13.62
|
| Rate for Payer: BCBS of TX Blue Essentials |
$16.34
|
| Rate for Payer: BCBS of TX PPO |
$18.16
|
| Rate for Payer: Cash Price |
$39.95
|
| Rate for Payer: Multiplan Auto |
$29.51
|
| Rate for Payer: Multiplan Commercial |
$29.51
|
| Rate for Payer: Multiplan Workers Comp |
$29.51
|
| Rate for Payer: Scott and White EPO/PPO |
$22.70
|
| Rate for Payer: Superior Health Plan EPO |
$6.17
|
|
|
EVACUATOR, SUCTION CLOSED SILICONE 100CC STERILE -- DHF
|
Facility
|
IP
|
$45.40
|
|
| Hospital Charge Code |
81820557
|
|
Hospital Revenue Code
|
272
|
| Rate for Payer: Cash Price |
$39.95
|
|
|
Evoked Potential Auditory (AEP) BCE
|
Facility
|
OP
|
$1,769.00
|
|
|
Service Code
|
CPT 92652
|
| Hospital Charge Code |
4802587
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$5.13 |
| Max. Negotiated Rate |
$1,149.85 |
| Rate for Payer: Aetna Commercial |
$972.95
|
| Rate for Payer: Aetna Medicare |
$430.59
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$159.21
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$287.06
|
| Rate for Payer: Amerigroup Medicare |
$287.06
|
| Rate for Payer: BCBS of TX Blue Advantage |
$207.54
|
| Rate for Payer: BCBS of TX Blue Essentials |
$249.04
|
| Rate for Payer: BCBS of TX Medicare |
$287.06
|
| Rate for Payer: BCBS of TX PPO |
$277.97
|
| Rate for Payer: Cash Price |
$1,556.72
|
| Rate for Payer: Cash Price |
$1,556.72
|
| Rate for Payer: Cash Price |
$1,556.72
|
| Rate for Payer: Cigna Commercial |
$650.28
|
| Rate for Payer: Cigna Medicare |
$287.06
|
| Rate for Payer: Employer Direct Commercial |
$287.06
|
| Rate for Payer: Humana Medicare/TRICARE |
$287.06
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$287.06
|
| Rate for Payer: Molina Medicare |
$287.06
|
| Rate for Payer: Multiplan Auto |
$1,149.85
|
| Rate for Payer: Multiplan Commercial |
$1,149.85
|
| Rate for Payer: Multiplan Workers Comp |
$1,149.85
|
| Rate for Payer: Scott and White EPO/PPO |
$5.13
|
| Rate for Payer: Scott and White Medicare |
$287.06
|
| Rate for Payer: Superior Health Plan EPO |
$287.06
|
| Rate for Payer: Superior Health Plan Medicare |
$287.06
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$287.06
|
| Rate for Payer: Universal American Medicare |
$287.06
|
| Rate for Payer: Wellcare Medicare |
$287.06
|
| Rate for Payer: Wellmed Medicare |
$287.06
|
|
|
Evoked Potential Auditory (AEP) BCE
|
Facility
|
IP
|
$1,769.00
|
|
|
Service Code
|
CPT 92652
|
| Hospital Charge Code |
4802587
|
|
Hospital Revenue Code
|
471
|
| Rate for Payer: Cash Price |
$1,556.72
|
|
|
Evoked Potential Charges:Visual (VEP) 95930
|
Facility
|
OP
|
$1,247.00
|
|
|
Service Code
|
CPT 95930
|
| Hospital Charge Code |
4805871
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$5.13 |
| Max. Negotiated Rate |
$810.55 |
| Rate for Payer: Aetna Commercial |
$685.85
|
| Rate for Payer: Aetna Medicare |
$430.59
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$112.23
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$287.06
|
| Rate for Payer: Amerigroup Medicare |
$287.06
|
| Rate for Payer: BCBS of TX Blue Advantage |
$87.78
|
| Rate for Payer: BCBS of TX Blue Essentials |
$104.94
|
| Rate for Payer: BCBS of TX Medicare |
$287.06
|
| Rate for Payer: BCBS of TX PPO |
$117.04
|
| Rate for Payer: Cash Price |
$1,097.36
|
| Rate for Payer: Cash Price |
$1,097.36
|
| Rate for Payer: Cash Price |
$1,097.36
|
| Rate for Payer: Cigna Commercial |
$650.28
|
| Rate for Payer: Cigna Medicare |
$287.06
|
| Rate for Payer: Employer Direct Commercial |
$287.06
|
| Rate for Payer: Humana Medicare/TRICARE |
$287.06
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$287.06
|
| Rate for Payer: Molina Medicare |
$287.06
|
| Rate for Payer: Multiplan Auto |
$810.55
|
| Rate for Payer: Multiplan Commercial |
$810.55
|
| Rate for Payer: Multiplan Workers Comp |
$810.55
|
| Rate for Payer: Scott and White EPO/PPO |
$5.13
|
| Rate for Payer: Scott and White Medicare |
$287.06
|
| Rate for Payer: Superior Health Plan EPO |
$287.06
|
| Rate for Payer: Superior Health Plan Medicare |
$287.06
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$287.06
|
| Rate for Payer: Universal American Medicare |
$287.06
|
| Rate for Payer: Wellcare Medicare |
$287.06
|
| Rate for Payer: Wellmed Medicare |
$287.06
|
|
|
Evoked Potential Visual (VEP) 95930 BCE
|
Facility
|
OP
|
$1,247.00
|
|
|
Service Code
|
CPT 95930
|
| Hospital Charge Code |
4805871
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$5.13 |
| Max. Negotiated Rate |
$810.55 |
| Rate for Payer: Aetna Commercial |
$685.85
|
| Rate for Payer: Aetna Medicare |
$430.59
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$112.23
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$287.06
|
| Rate for Payer: Amerigroup Medicare |
$287.06
|
| Rate for Payer: BCBS of TX Blue Advantage |
$87.78
|
| Rate for Payer: BCBS of TX Blue Essentials |
$104.94
|
| Rate for Payer: BCBS of TX Medicare |
$287.06
|
| Rate for Payer: BCBS of TX PPO |
$117.04
|
| Rate for Payer: Cash Price |
$1,097.36
|
| Rate for Payer: Cash Price |
$1,097.36
|
| Rate for Payer: Cash Price |
$1,097.36
|
| Rate for Payer: Cigna Commercial |
$650.28
|
| Rate for Payer: Cigna Medicare |
$287.06
|
| Rate for Payer: Employer Direct Commercial |
$287.06
|
| Rate for Payer: Humana Medicare/TRICARE |
$287.06
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$287.06
|
| Rate for Payer: Molina Medicare |
$287.06
|
| Rate for Payer: Multiplan Auto |
$810.55
|
| Rate for Payer: Multiplan Commercial |
$810.55
|
| Rate for Payer: Multiplan Workers Comp |
$810.55
|
| Rate for Payer: Scott and White EPO/PPO |
$5.13
|
| Rate for Payer: Scott and White Medicare |
$287.06
|
| Rate for Payer: Superior Health Plan EPO |
$287.06
|
| Rate for Payer: Superior Health Plan Medicare |
$287.06
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$287.06
|
| Rate for Payer: Universal American Medicare |
$287.06
|
| Rate for Payer: Wellcare Medicare |
$287.06
|
| Rate for Payer: Wellmed Medicare |
$287.06
|
|
|
Evoked Potential Visual (VEP) 95930 BCE
|
Facility
|
IP
|
$1,247.00
|
|
|
Service Code
|
CPT 95930
|
| Hospital Charge Code |
4805871
|
|
Hospital Revenue Code
|
922
|
| Rate for Payer: Cash Price |
$1,097.36
|
|
|
Exchange of intraocular lens
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 66986
|
| Hospital Charge Code |
36066986
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$47.01 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$3,090.00
|
| Rate for Payer: Aetna Medicare |
$3,196.84
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$849.94
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$2,131.23
|
| Rate for Payer: Amerigroup Medicare |
$2,131.23
|
| Rate for Payer: BCBS of TX Blue Advantage |
$3,376.51
|
| Rate for Payer: BCBS of TX Blue Essentials |
$4,043.72
|
| Rate for Payer: BCBS of TX Medicare |
$2,131.23
|
| Rate for Payer: BCBS of TX PPO |
$5,095.09
|
| Rate for Payer: Cigna Commercial |
$4,827.84
|
| Rate for Payer: Cigna Medicaid |
$849.94
|
| Rate for Payer: Cigna Medicare |
$2,131.23
|
| Rate for Payer: Employer Direct Commercial |
$2,131.23
|
| Rate for Payer: Humana Medicare/TRICARE |
$2,131.23
|
| Rate for Payer: Molina CHIP/Medicaid |
$849.94
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$2,131.23
|
| Rate for Payer: Molina Medicare |
$2,131.23
|
| Rate for Payer: Multiplan Auto |
$10,000.00
|
| Rate for Payer: Multiplan Commercial |
$10,000.00
|
| Rate for Payer: Multiplan Workers Comp |
$10,000.00
|
| Rate for Payer: Parkland Medicaid |
$849.94
|
| Rate for Payer: Scott and White EPO/PPO |
$47.01
|
| Rate for Payer: Scott and White Medicare |
$2,131.23
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$849.94
|
| Rate for Payer: Superior Health Plan EPO |
$2,131.23
|
| Rate for Payer: Superior Health Plan Medicare |
$2,131.23
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$2,131.23
|
| Rate for Payer: Universal American Medicare |
$2,131.23
|
| Rate for Payer: Wellcare Medicare |
$2,131.23
|
| Rate for Payer: Wellmed Medicare |
$2,131.23
|
|
|
Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, h
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 11426
|
| Hospital Charge Code |
36011426
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$57.32 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$3,090.00
|
| Rate for Payer: Aetna Medicare |
$3,898.02
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$815.20
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$2,598.68
|
| Rate for Payer: Amerigroup Medicare |
$2,598.68
|
| Rate for Payer: BCBS of TX Blue Advantage |
$3,872.55
|
| Rate for Payer: BCBS of TX Blue Essentials |
$4,637.78
|
| Rate for Payer: BCBS of TX Medicare |
$2,598.68
|
| Rate for Payer: BCBS of TX PPO |
$5,843.60
|
| Rate for Payer: Cigna Commercial |
$5,886.75
|
| Rate for Payer: Cigna Medicaid |
$815.20
|
| Rate for Payer: Cigna Medicare |
$2,598.68
|
| Rate for Payer: Employer Direct Commercial |
$2,598.68
|
| Rate for Payer: Humana Medicare/TRICARE |
$2,598.68
|
| Rate for Payer: Molina CHIP/Medicaid |
$815.20
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$2,598.68
|
| Rate for Payer: Molina Medicare |
$2,598.68
|
| Rate for Payer: Multiplan Auto |
$10,000.00
|
| Rate for Payer: Multiplan Commercial |
$10,000.00
|
| Rate for Payer: Multiplan Workers Comp |
$10,000.00
|
| Rate for Payer: Parkland Medicaid |
$815.20
|
| Rate for Payer: Scott and White EPO/PPO |
$57.32
|
| Rate for Payer: Scott and White Medicare |
$2,598.68
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$815.20
|
| Rate for Payer: Superior Health Plan EPO |
$2,598.68
|
| Rate for Payer: Superior Health Plan Medicare |
$2,598.68
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$2,598.68
|
| Rate for Payer: Universal American Medicare |
$2,598.68
|
| Rate for Payer: Wellcare Medicare |
$2,598.68
|
| Rate for Payer: Wellmed Medicare |
$2,598.68
|
|
|
Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, h
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 11420
|
| Hospital Charge Code |
36011420
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$32.70 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$1,400.00
|
| Rate for Payer: Aetna Medicare |
$2,224.11
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$74.19
|
| 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 |
$148.26
|
| Rate for Payer: BCBS of TX Blue Essentials |
$177.56
|
| Rate for Payer: BCBS of TX Medicare |
$1,482.74
|
| Rate for Payer: BCBS of TX PPO |
$223.73
|
| Rate for Payer: Cigna Commercial |
$3,358.84
|
| Rate for Payer: Cigna Medicaid |
$74.19
|
| 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 |
$74.19
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,482.74
|
| Rate for Payer: Molina Medicare |
$1,482.74
|
| Rate for Payer: Multiplan Auto |
$10,000.00
|
| Rate for Payer: Multiplan Commercial |
$10,000.00
|
| Rate for Payer: Multiplan Workers Comp |
$10,000.00
|
| Rate for Payer: Parkland Medicaid |
$74.19
|
| Rate for Payer: Scott and White EPO/PPO |
$32.70
|
| Rate for Payer: Scott and White Medicare |
$1,482.74
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$74.19
|
| 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
|
|
|
Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, h
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 11422
|
| Hospital Charge Code |
36011422
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$32.70 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$1,400.00
|
| Rate for Payer: Aetna Medicare |
$2,224.11
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$95.79
|
| 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 |
$192.87
|
| Rate for Payer: BCBS of TX Blue Essentials |
$230.98
|
| Rate for Payer: BCBS of TX Medicare |
$1,482.74
|
| Rate for Payer: BCBS of TX PPO |
$291.03
|
| Rate for Payer: Cigna Commercial |
$3,358.84
|
| Rate for Payer: Cigna Medicaid |
$95.79
|
| 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 |
$95.79
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,482.74
|
| Rate for Payer: Molina Medicare |
$1,482.74
|
| Rate for Payer: Multiplan Auto |
$10,000.00
|
| Rate for Payer: Multiplan Commercial |
$10,000.00
|
| Rate for Payer: Multiplan Workers Comp |
$10,000.00
|
| Rate for Payer: Parkland Medicaid |
$95.79
|
| Rate for Payer: Scott and White EPO/PPO |
$32.70
|
| Rate for Payer: Scott and White Medicare |
$1,482.74
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$95.79
|
| 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
|
|
|
Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 11406
|
| Hospital Charge Code |
36011406
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$32.70 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$2,200.00
|
| Rate for Payer: Aetna Medicare |
$2,224.11
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$486.45
|
| 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: 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 |
$10,000.00
|
| Rate for Payer: Multiplan Commercial |
$10,000.00
|
| Rate for Payer: Multiplan Workers Comp |
$10,000.00
|
| Rate for Payer: Parkland Medicaid |
$486.45
|
| Rate for Payer: Scott and White EPO/PPO |
$32.70
|
| 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
|
|
|
Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 11400
|
| Hospital Charge Code |
36011400
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$14.19 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$1,400.00
|
| Rate for Payer: Aetna Medicare |
$965.18
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$77.79
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$643.45
|
| Rate for Payer: Amerigroup Medicare |
$643.45
|
| Rate for Payer: BCBS of TX Blue Advantage |
$154.29
|
| Rate for Payer: BCBS of TX Blue Essentials |
$184.78
|
| Rate for Payer: BCBS of TX Medicare |
$643.45
|
| Rate for Payer: BCBS of TX PPO |
$232.82
|
| Rate for Payer: Cigna Commercial |
$1,457.60
|
| Rate for Payer: Cigna Medicaid |
$77.79
|
| 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 |
$77.79
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$643.45
|
| Rate for Payer: Molina Medicare |
$643.45
|
| Rate for Payer: Multiplan Auto |
$10,000.00
|
| Rate for Payer: Multiplan Commercial |
$10,000.00
|
| Rate for Payer: Multiplan Workers Comp |
$10,000.00
|
| Rate for Payer: Parkland Medicaid |
$77.79
|
| Rate for Payer: Scott and White EPO/PPO |
$14.19
|
| Rate for Payer: Scott and White Medicare |
$643.45
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$77.79
|
| 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
|
|
|
Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 11404
|
| Hospital Charge Code |
36011404
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$32.70 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$2,200.00
|
| Rate for Payer: Aetna Medicare |
$2,224.11
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$486.45
|
| 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: 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 |
$10,000.00
|
| Rate for Payer: Multiplan Commercial |
$10,000.00
|
| Rate for Payer: Multiplan Workers Comp |
$10,000.00
|
| Rate for Payer: Parkland Medicaid |
$486.45
|
| Rate for Payer: Scott and White EPO/PPO |
$32.70
|
| 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
|
|
|
Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty)
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 15847
|
| Hospital Charge Code |
36015847
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$10,000.00 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Multiplan Auto |
$10,000.00
|
| Rate for Payer: Multiplan Commercial |
$10,000.00
|
| Rate for Payer: Multiplan Workers Comp |
$10,000.00
|
|
|
Excision, excessive skin and subcutaneous tissue (includes lipectomy) abdomen, infraumbilical panni
|
Facility
|
OP
|
$13,509.82
|
|
|
Service Code
|
CPT 15830
|
| Hospital Charge Code |
36015830
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$131.54 |
| Max. Negotiated Rate |
$13,509.82 |
| Rate for Payer: Aetna Commercial |
$6,077.00
|
| Rate for Payer: Aetna Medicare |
$8,945.76
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,845.21
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$5,963.84
|
| Rate for Payer: Amerigroup Medicare |
$5,963.84
|
| Rate for Payer: BCBS of TX Blue Advantage |
$8,746.27
|
| Rate for Payer: BCBS of TX Blue Essentials |
$10,474.58
|
| Rate for Payer: BCBS of TX Medicare |
$5,963.84
|
| Rate for Payer: BCBS of TX PPO |
$13,197.97
|
| Rate for Payer: Cigna Commercial |
$13,509.82
|
| Rate for Payer: Cigna Medicaid |
$1,845.21
|
| Rate for Payer: Cigna Medicare |
$5,963.84
|
| Rate for Payer: Employer Direct Commercial |
$5,963.84
|
| Rate for Payer: Humana Medicare/TRICARE |
$5,963.84
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,845.21
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$5,963.84
|
| Rate for Payer: Molina Medicare |
$5,963.84
|
| Rate for Payer: Multiplan Auto |
$10,000.00
|
| Rate for Payer: Multiplan Commercial |
$10,000.00
|
| Rate for Payer: Multiplan Workers Comp |
$10,000.00
|
| Rate for Payer: Parkland Medicaid |
$1,845.21
|
| Rate for Payer: Scott and White EPO/PPO |
$131.54
|
| Rate for Payer: Scott and White Medicare |
$5,963.84
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,845.21
|
| Rate for Payer: Superior Health Plan EPO |
$5,963.84
|
| Rate for Payer: Superior Health Plan Medicare |
$5,963.84
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$5,963.84
|
| Rate for Payer: Universal American Medicare |
$5,963.84
|
| Rate for Payer: Wellcare Medicare |
$5,963.84
|
| Rate for Payer: Wellmed Medicare |
$5,963.84
|
|
|
Excision, excessive skin and subcutaneous tissue (includes lipectomy) arm
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 15836
|
| Hospital Charge Code |
36015836
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$57.32 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$2,200.00
|
| Rate for Payer: Aetna Medicare |
$3,898.02
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$2,598.68
|
| Rate for Payer: Amerigroup Medicare |
$2,598.68
|
| Rate for Payer: BCBS of TX Blue Advantage |
$3,872.55
|
| Rate for Payer: BCBS of TX Blue Essentials |
$4,637.78
|
| Rate for Payer: BCBS of TX Medicare |
$2,598.68
|
| Rate for Payer: BCBS of TX PPO |
$5,843.60
|
| Rate for Payer: Cigna Commercial |
$5,886.75
|
| Rate for Payer: Cigna Medicare |
$2,598.68
|
| Rate for Payer: Employer Direct Commercial |
$2,598.68
|
| Rate for Payer: Humana Medicare/TRICARE |
$2,598.68
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$2,598.68
|
| Rate for Payer: Molina Medicare |
$2,598.68
|
| Rate for Payer: Multiplan Auto |
$10,000.00
|
| Rate for Payer: Multiplan Commercial |
$10,000.00
|
| Rate for Payer: Multiplan Workers Comp |
$10,000.00
|
| Rate for Payer: Scott and White EPO/PPO |
$57.32
|
| Rate for Payer: Scott and White Medicare |
$2,598.68
|
| Rate for Payer: Superior Health Plan EPO |
$2,598.68
|
| Rate for Payer: Superior Health Plan Medicare |
$2,598.68
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$2,598.68
|
| Rate for Payer: Universal American Medicare |
$2,598.68
|
| Rate for Payer: Wellcare Medicare |
$2,598.68
|
| Rate for Payer: Wellmed Medicare |
$2,598.68
|
|
|
Excision, excessive skin and subcutaneous tissue (includes lipectomy) forearm or hand
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 15837
|
| Hospital Charge Code |
36015837
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$57.32 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$2,200.00
|
| Rate for Payer: Aetna Medicare |
$3,898.02
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$2,598.68
|
| Rate for Payer: Amerigroup Medicare |
$2,598.68
|
| Rate for Payer: BCBS of TX Blue Advantage |
$3,872.55
|
| Rate for Payer: BCBS of TX Blue Essentials |
$4,637.78
|
| Rate for Payer: BCBS of TX Medicare |
$2,598.68
|
| Rate for Payer: BCBS of TX PPO |
$5,843.60
|
| Rate for Payer: Cigna Commercial |
$5,886.75
|
| Rate for Payer: Cigna Medicare |
$2,598.68
|
| Rate for Payer: Employer Direct Commercial |
$2,598.68
|
| Rate for Payer: Humana Medicare/TRICARE |
$2,598.68
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$2,598.68
|
| Rate for Payer: Molina Medicare |
$2,598.68
|
| Rate for Payer: Multiplan Auto |
$10,000.00
|
| Rate for Payer: Multiplan Commercial |
$10,000.00
|
| Rate for Payer: Multiplan Workers Comp |
$10,000.00
|
| Rate for Payer: Scott and White EPO/PPO |
$57.32
|
| Rate for Payer: Scott and White Medicare |
$2,598.68
|
| Rate for Payer: Superior Health Plan EPO |
$2,598.68
|
| Rate for Payer: Superior Health Plan Medicare |
$2,598.68
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$2,598.68
|
| Rate for Payer: Universal American Medicare |
$2,598.68
|
| Rate for Payer: Wellcare Medicare |
$2,598.68
|
| Rate for Payer: Wellmed Medicare |
$2,598.68
|
|
|
Excision, excessive skin and subcutaneous tissue (includes lipectomy) other area
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 15839
|
| Hospital Charge Code |
36015839
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$57.32 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$2,200.00
|
| Rate for Payer: Aetna Medicare |
$3,898.02
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$2,598.68
|
| Rate for Payer: Amerigroup Medicare |
$2,598.68
|
| Rate for Payer: BCBS of TX Blue Advantage |
$3,872.55
|
| Rate for Payer: BCBS of TX Blue Essentials |
$4,637.78
|
| Rate for Payer: BCBS of TX Medicare |
$2,598.68
|
| Rate for Payer: BCBS of TX PPO |
$5,843.60
|
| Rate for Payer: Cigna Commercial |
$5,886.75
|
| Rate for Payer: Cigna Medicare |
$2,598.68
|
| Rate for Payer: Employer Direct Commercial |
$2,598.68
|
| Rate for Payer: Humana Medicare/TRICARE |
$2,598.68
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$2,598.68
|
| Rate for Payer: Molina Medicare |
$2,598.68
|
| Rate for Payer: Multiplan Auto |
$10,000.00
|
| Rate for Payer: Multiplan Commercial |
$10,000.00
|
| Rate for Payer: Multiplan Workers Comp |
$10,000.00
|
| Rate for Payer: Scott and White EPO/PPO |
$57.32
|
| Rate for Payer: Scott and White Medicare |
$2,598.68
|
| Rate for Payer: Superior Health Plan EPO |
$2,598.68
|
| Rate for Payer: Superior Health Plan Medicare |
$2,598.68
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$2,598.68
|
| Rate for Payer: Universal American Medicare |
$2,598.68
|
| Rate for Payer: Wellcare Medicare |
$2,598.68
|
| Rate for Payer: Wellmed Medicare |
$2,598.68
|
|
