|
IMP PORT INDWELLING -- DHF
|
Facility
|
OP
|
$1,836.33
|
|
|
Service Code
|
HCPCS C1788
|
| Hospital Charge Code |
82402017
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$165.27 |
| Max. Negotiated Rate |
$918.16 |
| Rate for Payer: Aetna Commercial |
$550.90
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$165.27
|
| Rate for Payer: BCBS of TX Blue Advantage |
$550.90
|
| Rate for Payer: BCBS of TX Blue Essentials |
$661.08
|
| Rate for Payer: BCBS of TX PPO |
$734.53
|
| Rate for Payer: Cash Price |
$1,615.97
|
| Rate for Payer: Multiplan Auto |
$918.16
|
| Rate for Payer: Multiplan Commercial |
$918.16
|
| Rate for Payer: Multiplan Workers Comp |
$918.16
|
| Rate for Payer: Scott and White EPO/PPO |
$918.16
|
| Rate for Payer: Superior Health Plan EPO |
$249.74
|
|
|
IMP POUCH DEFIB -- DHF
|
Facility
|
IP
|
$9,006.02
|
|
| Hospital Charge Code |
40230211
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,251.50 |
| Max. Negotiated Rate |
$4,503.01 |
| Rate for Payer: Aetna Commercial |
$2,701.81
|
| Rate for Payer: Cash Price |
$7,925.30
|
| Rate for Payer: Cigna Commercial |
$2,251.50
|
| Rate for Payer: Multiplan Auto |
$4,503.01
|
| Rate for Payer: Multiplan Commercial |
$4,503.01
|
| Rate for Payer: Multiplan Workers Comp |
$4,503.01
|
| Rate for Payer: Scott and White EPO/PPO |
$4,503.01
|
|
|
IMP POUCH DEFIB -- DHF
|
Facility
|
OP
|
$9,006.02
|
|
| Hospital Charge Code |
40230211
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$810.54 |
| Max. Negotiated Rate |
$4,503.01 |
| Rate for Payer: Aetna Commercial |
$2,701.81
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$810.54
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,701.81
|
| Rate for Payer: BCBS of TX Blue Essentials |
$3,242.17
|
| Rate for Payer: BCBS of TX PPO |
$3,602.41
|
| Rate for Payer: Cash Price |
$7,925.30
|
| Rate for Payer: Multiplan Auto |
$4,503.01
|
| Rate for Payer: Multiplan Commercial |
$4,503.01
|
| Rate for Payer: Multiplan Workers Comp |
$4,503.01
|
| Rate for Payer: Scott and White EPO/PPO |
$4,503.01
|
| Rate for Payer: Superior Health Plan EPO |
$1,224.82
|
|
|
IMP PROSTHESIS BREAST -- DHF
|
Facility
|
OP
|
$6,596.38
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
82402025
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$593.67 |
| Max. Negotiated Rate |
$3,298.19 |
| Rate for Payer: Aetna Commercial |
$1,978.91
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$593.67
|
| Rate for Payer: BCBS of TX Blue Advantage |
$1,978.91
|
| Rate for Payer: BCBS of TX Blue Essentials |
$2,374.70
|
| Rate for Payer: BCBS of TX PPO |
$2,638.55
|
| Rate for Payer: Cash Price |
$5,804.81
|
| Rate for Payer: Multiplan Auto |
$3,298.19
|
| Rate for Payer: Multiplan Commercial |
$3,298.19
|
| Rate for Payer: Multiplan Workers Comp |
$3,298.19
|
| Rate for Payer: Scott and White EPO/PPO |
$3,298.19
|
| Rate for Payer: Superior Health Plan EPO |
$897.11
|
|
|
IMP PROSTHESIS BREAST -- DHF
|
Facility
|
IP
|
$6,596.38
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
82402025
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,649.10 |
| Max. Negotiated Rate |
$3,298.19 |
| Rate for Payer: Aetna Commercial |
$1,978.91
|
| Rate for Payer: Cash Price |
$5,804.81
|
| Rate for Payer: Cigna Commercial |
$1,649.10
|
| Rate for Payer: Multiplan Auto |
$3,298.19
|
| Rate for Payer: Multiplan Commercial |
$3,298.19
|
| Rate for Payer: Multiplan Workers Comp |
$3,298.19
|
| Rate for Payer: Scott and White EPO/PPO |
$3,298.19
|
|
|
IMP RECRDR CARD REVEAL -- DHF
|
Facility
|
IP
|
$22,833.49
|
|
|
Service Code
|
HCPCS C1764
|
| Hospital Charge Code |
82403726
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,708.37 |
| Max. Negotiated Rate |
$11,416.74 |
| Rate for Payer: Aetna Commercial |
$6,850.05
|
| Rate for Payer: Cash Price |
$20,093.47
|
| Rate for Payer: Cigna Commercial |
$5,708.37
|
| Rate for Payer: Multiplan Auto |
$11,416.74
|
| Rate for Payer: Multiplan Commercial |
$11,416.74
|
| Rate for Payer: Multiplan Workers Comp |
$11,416.74
|
| Rate for Payer: Scott and White EPO/PPO |
$11,416.74
|
|
|
IMP RECRDR CARD REVEAL -- DHF
|
Facility
|
OP
|
$22,833.49
|
|
|
Service Code
|
HCPCS C1764
|
| Hospital Charge Code |
82403726
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,055.01 |
| Max. Negotiated Rate |
$11,416.74 |
| Rate for Payer: Aetna Commercial |
$6,850.05
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2,055.01
|
| Rate for Payer: BCBS of TX Blue Advantage |
$6,850.05
|
| Rate for Payer: BCBS of TX Blue Essentials |
$8,220.06
|
| Rate for Payer: BCBS of TX PPO |
$9,133.40
|
| Rate for Payer: Cash Price |
$20,093.47
|
| Rate for Payer: Multiplan Auto |
$11,416.74
|
| Rate for Payer: Multiplan Commercial |
$11,416.74
|
| Rate for Payer: Multiplan Workers Comp |
$11,416.74
|
| Rate for Payer: Scott and White EPO/PPO |
$11,416.74
|
| Rate for Payer: Superior Health Plan EPO |
$3,105.35
|
|
|
imp spacer spinal
|
Facility
|
OP
|
$13,500.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
8670509
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,215.00 |
| Max. Negotiated Rate |
$6,750.00 |
| Rate for Payer: Aetna Commercial |
$4,050.00
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,215.00
|
| Rate for Payer: BCBS of TX Blue Advantage |
$4,050.00
|
| Rate for Payer: BCBS of TX Blue Essentials |
$4,860.00
|
| Rate for Payer: BCBS of TX PPO |
$5,400.00
|
| Rate for Payer: Cash Price |
$11,880.00
|
| Rate for Payer: Multiplan Auto |
$6,750.00
|
| Rate for Payer: Multiplan Commercial |
$6,750.00
|
| Rate for Payer: Multiplan Workers Comp |
$6,750.00
|
| Rate for Payer: Scott and White EPO/PPO |
$6,750.00
|
| Rate for Payer: Superior Health Plan EPO |
$1,836.00
|
|
|
imp spacer spinal
|
Facility
|
IP
|
$13,500.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
8670509
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,375.00 |
| Max. Negotiated Rate |
$6,750.00 |
| Rate for Payer: Aetna Commercial |
$4,050.00
|
| Rate for Payer: Cash Price |
$11,880.00
|
| Rate for Payer: Cigna Commercial |
$3,375.00
|
| Rate for Payer: Multiplan Auto |
$6,750.00
|
| Rate for Payer: Multiplan Commercial |
$6,750.00
|
| Rate for Payer: Multiplan Workers Comp |
$6,750.00
|
| Rate for Payer: Scott and White EPO/PPO |
$6,750.00
|
|
|
IMP TENDON TIBIALIS -- DHF
|
Facility
|
OP
|
$18,057.85
|
|
| Hospital Charge Code |
81329484
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,625.21 |
| Max. Negotiated Rate |
$9,028.92 |
| Rate for Payer: Aetna Commercial |
$5,417.36
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,625.21
|
| Rate for Payer: BCBS of TX Blue Advantage |
$5,417.36
|
| Rate for Payer: BCBS of TX Blue Essentials |
$6,500.83
|
| Rate for Payer: BCBS of TX PPO |
$7,223.14
|
| Rate for Payer: Cash Price |
$15,890.91
|
| Rate for Payer: Multiplan Auto |
$9,028.92
|
| Rate for Payer: Multiplan Commercial |
$9,028.92
|
| Rate for Payer: Multiplan Workers Comp |
$9,028.92
|
| Rate for Payer: Scott and White EPO/PPO |
$9,028.92
|
| Rate for Payer: Superior Health Plan EPO |
$2,455.87
|
|
|
IMP TENDON TIBIALIS -- DHF
|
Facility
|
IP
|
$18,057.85
|
|
| Hospital Charge Code |
81329484
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,514.46 |
| Max. Negotiated Rate |
$9,028.92 |
| Rate for Payer: Aetna Commercial |
$5,417.36
|
| Rate for Payer: Cash Price |
$15,890.91
|
| Rate for Payer: Cigna Commercial |
$4,514.46
|
| Rate for Payer: Multiplan Auto |
$9,028.92
|
| Rate for Payer: Multiplan Commercial |
$9,028.92
|
| Rate for Payer: Multiplan Workers Comp |
$9,028.92
|
| Rate for Payer: Scott and White EPO/PPO |
$9,028.92
|
|
|
INACTIVE CODE
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 49901
|
| Hospital Charge Code |
36049901
|
|
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
|
|
|
INBORN AND OTHER DISORDERS OF METABOLISM
|
Facility
|
IP
|
$24,762.70
|
|
|
Service Code
|
MSDRG 642
|
| Min. Negotiated Rate |
$10,375.90 |
| Max. Negotiated Rate |
$24,762.70 |
| Rate for Payer: Aetna Commercial |
$14,662.12
|
| Rate for Payer: Aetna Medicare |
$18,232.82
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$12,155.21
|
| Rate for Payer: Amerigroup Medicare |
$12,155.21
|
| Rate for Payer: BCBS of TX Blue Advantage |
$10,375.90
|
| Rate for Payer: BCBS of TX Blue Essentials |
$13,038.06
|
| Rate for Payer: BCBS of TX Medicare |
$12,155.21
|
| Rate for Payer: BCBS of TX PPO |
$14,487.29
|
| Rate for Payer: Cigna Commercial |
$16,786.50
|
| Rate for Payer: Cigna Medicare |
$12,155.21
|
| Rate for Payer: Employer Direct Commercial |
$12,155.21
|
| Rate for Payer: Humana Medicare/TRICARE |
$12,155.21
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$12,155.21
|
| Rate for Payer: Molina Medicare |
$12,155.21
|
| Rate for Payer: Multiplan Auto |
$24,762.70
|
| Rate for Payer: Multiplan Commercial |
$24,762.70
|
| Rate for Payer: Multiplan Workers Comp |
$24,762.70
|
| Rate for Payer: Scott and White EPO/PPO |
$11,403.88
|
| Rate for Payer: Scott and White Medicare |
$12,155.21
|
| Rate for Payer: Superior Health Plan EPO |
$12,155.21
|
| Rate for Payer: Superior Health Plan Medicare |
$12,155.21
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$12,155.21
|
| Rate for Payer: Universal American Medicare |
$12,155.21
|
| Rate for Payer: Wellcare Medicare |
$12,155.21
|
| Rate for Payer: Wellmed Medicare |
$12,155.21
|
|
|
INCISIONAL BX SKIN SEP/ADDL
|
Facility
|
OP
|
$1,014.00
|
|
|
Service Code
|
CPT 11107
|
| Hospital Charge Code |
7150056
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$38.00 |
| Max. Negotiated Rate |
$659.10 |
| Rate for Payer: Aetna Commercial |
$557.70
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$91.26
|
| Rate for Payer: BCBS of TX Blue Advantage |
$38.00
|
| Rate for Payer: BCBS of TX Blue Essentials |
$45.00
|
| Rate for Payer: BCBS of TX PPO |
$50.00
|
| Rate for Payer: Cash Price |
$892.32
|
| Rate for Payer: Cash Price |
$892.32
|
| Rate for Payer: Multiplan Auto |
$659.10
|
| Rate for Payer: Multiplan Commercial |
$659.10
|
| Rate for Payer: Multiplan Workers Comp |
$659.10
|
| Rate for Payer: Scott and White EPO/PPO |
$507.00
|
| Rate for Payer: Superior Health Plan EPO |
$137.90
|
|
|
INCISIONAL BX SKIN SGL LES
|
Facility
|
OP
|
$1,538.00
|
|
|
Service Code
|
CPT 11106
|
| Hospital Charge Code |
7150052
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$10.27 |
| Max. Negotiated Rate |
$1,400.00 |
| Rate for Payer: Aetna Commercial |
$1,400.00
|
| Rate for Payer: Aetna Medicare |
$861.57
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$138.42
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$574.38
|
| Rate for Payer: Amerigroup Medicare |
$574.38
|
| Rate for Payer: BCBS of TX Blue Advantage |
$194.07
|
| Rate for Payer: BCBS of TX Blue Essentials |
$232.42
|
| Rate for Payer: BCBS of TX Medicare |
$574.38
|
| Rate for Payer: BCBS of TX PPO |
$292.85
|
| Rate for Payer: Cash Price |
$1,353.44
|
| Rate for Payer: Cash Price |
$1,353.44
|
| Rate for Payer: Cash Price |
$1,353.44
|
| Rate for Payer: Cigna Commercial |
$1,301.14
|
| Rate for Payer: Cigna Medicaid |
$98.83
|
| 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 |
$98.83
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$574.38
|
| Rate for Payer: Molina Medicare |
$574.38
|
| Rate for Payer: Multiplan Auto |
$999.70
|
| Rate for Payer: Multiplan Commercial |
$999.70
|
| Rate for Payer: Multiplan Workers Comp |
$999.70
|
| Rate for Payer: Parkland Medicaid |
$98.83
|
| 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 |
$98.83
|
| 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
|
|
|
Incision and drainage below fascia, with or without tendon sheath involvement, foot; single bursal s
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 28002
|
| Hospital Charge Code |
36028002
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$32.42 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$3,090.00
|
| Rate for Payer: Aetna Medicare |
$2,204.79
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$593.04
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,469.86
|
| Rate for Payer: Amerigroup Medicare |
$1,469.86
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,263.50
|
| Rate for Payer: BCBS of TX Blue Essentials |
$2,710.78
|
| Rate for Payer: BCBS of TX Medicare |
$1,469.86
|
| Rate for Payer: BCBS of TX PPO |
$3,415.58
|
| Rate for Payer: Cigna Commercial |
$3,329.66
|
| Rate for Payer: Cigna Medicaid |
$593.04
|
| Rate for Payer: Cigna Medicare |
$1,469.86
|
| Rate for Payer: Employer Direct Commercial |
$1,469.86
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,469.86
|
| Rate for Payer: Molina CHIP/Medicaid |
$593.04
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,469.86
|
| Rate for Payer: Molina Medicare |
$1,469.86
|
| Rate for Payer: Multiplan Auto |
$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 |
$593.04
|
| Rate for Payer: Scott and White EPO/PPO |
$32.42
|
| Rate for Payer: Scott and White Medicare |
$1,469.86
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$593.04
|
| Rate for Payer: Superior Health Plan EPO |
$1,469.86
|
| Rate for Payer: Superior Health Plan Medicare |
$1,469.86
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,469.86
|
| Rate for Payer: Universal American Medicare |
$1,469.86
|
| Rate for Payer: Wellcare Medicare |
$1,469.86
|
| Rate for Payer: Wellmed Medicare |
$1,469.86
|
|
|
Incision and drainage, complex, postoperative wound infection
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 10180
|
| Hospital Charge Code |
36010180
|
|
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
|
|
|
Incision and drainage, deep abscess, bursa, or hematoma, thigh or knee region
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 27301
|
| Hospital Charge Code |
36027301
|
|
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
|
|
|
Incision and drainage, forearm and/or wrist; deep abscess or hematoma
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 25028
|
| Hospital Charge Code |
36025028
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$65.29 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$3,090.00
|
| Rate for Payer: Aetna Medicare |
$4,440.36
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,088.27
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$2,960.24
|
| Rate for Payer: Amerigroup Medicare |
$2,960.24
|
| Rate for Payer: BCBS of TX Blue Advantage |
$4,571.54
|
| Rate for Payer: BCBS of TX Blue Essentials |
$5,474.90
|
| Rate for Payer: BCBS of TX Medicare |
$2,960.24
|
| Rate for Payer: BCBS of TX PPO |
$6,898.37
|
| Rate for Payer: Cigna Commercial |
$6,705.80
|
| Rate for Payer: Cigna Medicaid |
$1,088.27
|
| Rate for Payer: Cigna Medicare |
$2,960.24
|
| Rate for Payer: Employer Direct Commercial |
$2,960.24
|
| Rate for Payer: Humana Medicare/TRICARE |
$2,960.24
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,088.27
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$2,960.24
|
| Rate for Payer: Molina Medicare |
$2,960.24
|
| 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 |
$1,088.27
|
| Rate for Payer: Scott and White EPO/PPO |
$65.29
|
| Rate for Payer: Scott and White Medicare |
$2,960.24
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,088.27
|
| Rate for Payer: Superior Health Plan EPO |
$2,960.24
|
| Rate for Payer: Superior Health Plan Medicare |
$2,960.24
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$2,960.24
|
| Rate for Payer: Universal American Medicare |
$2,960.24
|
| Rate for Payer: Wellcare Medicare |
$2,960.24
|
| Rate for Payer: Wellmed Medicare |
$2,960.24
|
|
|
Incision and drainage, leg or ankle; deep abscess or hematoma
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 27603
|
| Hospital Charge Code |
36027603
|
|
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
|
|
|
Incision and drainage of abscess (eg, carbuncle, suppurative hidradenitis, cutaneous or subcutaneous
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 10061
|
| Hospital Charge Code |
36010061
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$8.04 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Medicare |
$547.00
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$98.28
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$364.67
|
| Rate for Payer: Amerigroup Medicare |
$364.67
|
| 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 |
$364.67
|
| Rate for Payer: BCBS of TX PPO |
$291.03
|
| Rate for Payer: Cigna Commercial |
$826.08
|
| Rate for Payer: Cigna Medicaid |
$98.28
|
| 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 |
$98.28
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$364.67
|
| Rate for Payer: Molina Medicare |
$364.67
|
| 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 |
$98.28
|
| Rate for Payer: Scott and White EPO/PPO |
$8.04
|
| Rate for Payer: Scott and White Medicare |
$364.67
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$98.28
|
| 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
|
|
|
Incision and drainage of abscess (eg, carbuncle, suppurative hidradenitis, cutaneous or subcutaneous
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 10060
|
| Hospital Charge Code |
36010060
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4.04 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Medicare |
$274.64
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$65.06
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$183.09
|
| Rate for Payer: Amerigroup Medicare |
$183.09
|
| Rate for Payer: BCBS of TX Blue Advantage |
$125.97
|
| Rate for Payer: BCBS of TX Blue Essentials |
$150.86
|
| Rate for Payer: BCBS of TX Medicare |
$183.09
|
| Rate for Payer: BCBS of TX PPO |
$190.08
|
| Rate for Payer: Cigna Commercial |
$414.75
|
| Rate for Payer: Cigna Medicaid |
$65.06
|
| 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 |
$65.06
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$183.09
|
| Rate for Payer: Molina Medicare |
$183.09
|
| 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 |
$65.06
|
| Rate for Payer: Scott and White EPO/PPO |
$4.04
|
| Rate for Payer: Scott and White Medicare |
$183.09
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$65.06
|
| 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
|
|
|
Incision and drainage of hematoma, seroma or fluid collection
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 10140
|
| Hospital Charge Code |
36010140
|
|
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 |
$90.81
|
| 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 |
$183.82
|
| Rate for Payer: BCBS of TX Blue Essentials |
$220.14
|
| Rate for Payer: BCBS of TX Medicare |
$1,482.74
|
| Rate for Payer: BCBS of TX PPO |
$277.38
|
| Rate for Payer: Cigna Commercial |
$3,358.84
|
| Rate for Payer: Cigna Medicaid |
$90.81
|
| 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 |
$90.81
|
| 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 |
$90.81
|
| 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 |
$90.81
|
| 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
|
|
|
Incision and drainage, pelvis or hip joint area; deep abscess or hematoma
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 26990
|
| Hospital Charge Code |
36026990
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$65.29 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$3,090.00
|
| Rate for Payer: Aetna Medicare |
$4,440.36
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,088.27
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$2,960.24
|
| Rate for Payer: Amerigroup Medicare |
$2,960.24
|
| Rate for Payer: BCBS of TX Blue Advantage |
$4,571.54
|
| Rate for Payer: BCBS of TX Blue Essentials |
$5,474.90
|
| Rate for Payer: BCBS of TX Medicare |
$2,960.24
|
| Rate for Payer: BCBS of TX PPO |
$6,898.37
|
| Rate for Payer: Cigna Commercial |
$6,705.80
|
| Rate for Payer: Cigna Medicaid |
$1,088.27
|
| Rate for Payer: Cigna Medicare |
$2,960.24
|
| Rate for Payer: Employer Direct Commercial |
$2,960.24
|
| Rate for Payer: Humana Medicare/TRICARE |
$2,960.24
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,088.27
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$2,960.24
|
| Rate for Payer: Molina Medicare |
$2,960.24
|
| 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 |
$1,088.27
|
| Rate for Payer: Scott and White EPO/PPO |
$65.29
|
| Rate for Payer: Scott and White Medicare |
$2,960.24
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,088.27
|
| Rate for Payer: Superior Health Plan EPO |
$2,960.24
|
| Rate for Payer: Superior Health Plan Medicare |
$2,960.24
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$2,960.24
|
| Rate for Payer: Universal American Medicare |
$2,960.24
|
| Rate for Payer: Wellcare Medicare |
$2,960.24
|
| Rate for Payer: Wellmed Medicare |
$2,960.24
|
|
|
Incision and drainage, upper arm or elbow area bursa
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 23931
|
| Hospital Charge Code |
36023931
|
|
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
|
|
