|
Excision inferior turbinate, partial or complete, any method
|
Facility
|
IP
|
$11,241.00
|
|
|
Service Code
|
HCPCS 30130
|
| Hospital Charge Code |
9900594
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$7,643.88
|
|
|
Excision inferior turbinate, partial or complete, any method
|
Facility
|
OP
|
$11,241.00
|
|
|
Service Code
|
HCPCS 30130
|
| Hospital Charge Code |
9900594
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$886.62 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$886.62
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3,330.57
|
| Rate for Payer: Amerigroup Medicare |
$3,330.57
|
| Rate for Payer: BCBS of TX Blue Advantage |
$4,374.21
|
| Rate for Payer: BCBS of TX Blue Essentials |
$5,238.58
|
| Rate for Payer: BCBS of TX Medicare |
$3,330.57
|
| Rate for Payer: BCBS of TX PPO |
$6,600.61
|
| Rate for Payer: Cash Price |
$7,643.88
|
| Rate for Payer: Cash Price |
$7,643.88
|
| Rate for Payer: Cash Price |
$7,643.88
|
| Rate for Payer: Cigna Commercial |
$7,040.22
|
| Rate for Payer: Cigna Medicaid |
$8,093.52
|
| Rate for Payer: Cigna Medicare |
$3,330.57
|
| Rate for Payer: Employer Direct Commercial |
$3,330.57
|
| Rate for Payer: Humana Medicare/TRICARE |
$3,330.57
|
| Rate for Payer: Molina CHIP/Medicaid |
$8,093.52
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3,330.57
|
| Rate for Payer: Molina Medicare |
$3,330.57
|
| 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 |
$8,093.52
|
| Rate for Payer: Scott and White EPO/PPO |
$5,447.31
|
| Rate for Payer: Scott and White Medicare |
$3,330.57
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$8,093.52
|
| Rate for Payer: Superior Health Plan EPO |
$3,330.57
|
| Rate for Payer: Superior Health Plan Medicare |
$3,330.57
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3,330.57
|
| Rate for Payer: Universal American Medicare |
$3,330.57
|
| Rate for Payer: Wellcare Medicare |
$3,330.57
|
| Rate for Payer: Wellmed Medicare |
$3,330.57
|
|
|
Excision inferior turbinate, partial or complete, any method
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 30130
|
| Hospital Charge Code |
36030130
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$886.62 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$886.62
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3,330.57
|
| Rate for Payer: Amerigroup Medicare |
$3,330.57
|
| Rate for Payer: BCBS of TX Blue Advantage |
$4,374.21
|
| Rate for Payer: BCBS of TX Blue Essentials |
$5,238.58
|
| Rate for Payer: BCBS of TX Medicare |
$3,330.57
|
| Rate for Payer: BCBS of TX PPO |
$6,600.61
|
| Rate for Payer: Cigna Commercial |
$7,040.22
|
| Rate for Payer: Cigna Medicare |
$3,330.57
|
| Rate for Payer: Employer Direct Commercial |
$3,330.57
|
| Rate for Payer: Humana Medicare/TRICARE |
$3,330.57
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3,330.57
|
| Rate for Payer: Molina Medicare |
$3,330.57
|
| 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 |
$5,447.31
|
| Rate for Payer: Scott and White Medicare |
$3,330.57
|
| Rate for Payer: Superior Health Plan EPO |
$3,330.57
|
| Rate for Payer: Superior Health Plan Medicare |
$3,330.57
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3,330.57
|
| Rate for Payer: Universal American Medicare |
$3,330.57
|
| Rate for Payer: Wellcare Medicare |
$3,330.57
|
| Rate for Payer: Wellmed Medicare |
$3,330.57
|
|
|
Excision, interdigital (Morton) neuroma, single, each
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 28080
|
| Hospital Charge Code |
36028080
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$593.04 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$593.04
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,615.32
|
| Rate for Payer: Amerigroup Medicare |
$1,615.32
|
| 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 |
$1,615.32
|
| Rate for Payer: BCBS of TX PPO |
$3,415.58
|
| Rate for Payer: Cigna Commercial |
$3,414.49
|
| Rate for Payer: Cigna Medicare |
$1,615.32
|
| Rate for Payer: Employer Direct Commercial |
$1,615.32
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,615.32
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,615.32
|
| Rate for Payer: Molina Medicare |
$1,615.32
|
| 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 |
$2,719.24
|
| Rate for Payer: Scott and White Medicare |
$1,615.32
|
| Rate for Payer: Superior Health Plan EPO |
$1,615.32
|
| Rate for Payer: Superior Health Plan Medicare |
$1,615.32
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,615.32
|
| Rate for Payer: Universal American Medicare |
$1,615.32
|
| Rate for Payer: Wellcare Medicare |
$1,615.32
|
| Rate for Payer: Wellmed Medicare |
$1,615.32
|
|
|
Excision, interdigital (Morton) neuroma, single, each
|
Facility
|
OP
|
$5,569.40
|
|
|
Service Code
|
HCPCS 28080
|
| Hospital Charge Code |
9900467
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$593.04 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$593.04
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,615.32
|
| Rate for Payer: Amerigroup Medicare |
$1,615.32
|
| 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 |
$1,615.32
|
| Rate for Payer: BCBS of TX PPO |
$3,415.58
|
| Rate for Payer: Cash Price |
$3,787.19
|
| Rate for Payer: Cash Price |
$3,787.19
|
| Rate for Payer: Cash Price |
$3,787.19
|
| Rate for Payer: Cigna Commercial |
$3,414.49
|
| Rate for Payer: Cigna Medicaid |
$4,009.97
|
| Rate for Payer: Cigna Medicare |
$1,615.32
|
| Rate for Payer: Employer Direct Commercial |
$1,615.32
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,615.32
|
| Rate for Payer: Molina CHIP/Medicaid |
$4,009.97
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,615.32
|
| Rate for Payer: Molina Medicare |
$1,615.32
|
| 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 |
$4,009.97
|
| Rate for Payer: Scott and White EPO/PPO |
$2,719.24
|
| Rate for Payer: Scott and White Medicare |
$1,615.32
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$4,009.97
|
| Rate for Payer: Superior Health Plan EPO |
$1,615.32
|
| Rate for Payer: Superior Health Plan Medicare |
$1,615.32
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,615.32
|
| Rate for Payer: Universal American Medicare |
$1,615.32
|
| Rate for Payer: Wellcare Medicare |
$1,615.32
|
| Rate for Payer: Wellmed Medicare |
$1,615.32
|
|
|
Excision, interdigital (Morton) neuroma, single, each
|
Facility
|
IP
|
$5,569.40
|
|
|
Service Code
|
HCPCS 28080
|
| Hospital Charge Code |
9900467
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$3,787.19
|
|
|
Excision, ischial pressure ulcer, with ostectomy, in preparation for muscle or myocutaneous flap or skin graft closure
|
Facility
|
IP
|
$6,950.12
|
|
|
Service Code
|
HCPCS 15946
|
| Hospital Charge Code |
993998
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$4,726.08
|
|
|
Excision, ischial pressure ulcer, with ostectomy, in preparation for muscle or myocutaneous flap or skin graft closure
|
Facility
|
OP
|
$6,950.12
|
|
|
Service Code
|
HCPCS 15946
|
| Hospital Charge Code |
993998
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$709.01 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$709.01
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$2,072.68
|
| Rate for Payer: Amerigroup Medicare |
$2,072.68
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,709.98
|
| Rate for Payer: BCBS of TX Blue Essentials |
$3,245.48
|
| Rate for Payer: BCBS of TX Medicare |
$2,072.68
|
| Rate for Payer: BCBS of TX PPO |
$4,089.30
|
| Rate for Payer: Cash Price |
$4,726.08
|
| Rate for Payer: Cash Price |
$4,726.08
|
| Rate for Payer: Cash Price |
$4,726.08
|
| Rate for Payer: Cigna Commercial |
$4,381.27
|
| Rate for Payer: Cigna Medicaid |
$5,004.09
|
| Rate for Payer: Cigna Medicare |
$2,072.68
|
| Rate for Payer: Employer Direct Commercial |
$2,072.68
|
| Rate for Payer: Humana Medicare/TRICARE |
$2,072.68
|
| Rate for Payer: Molina CHIP/Medicaid |
$5,004.09
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$2,072.68
|
| Rate for Payer: Molina Medicare |
$2,072.68
|
| 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 |
$5,004.09
|
| Rate for Payer: Scott and White EPO/PPO |
$3,085.41
|
| Rate for Payer: Scott and White Medicare |
$2,072.68
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$5,004.09
|
| Rate for Payer: Superior Health Plan EPO |
$2,072.68
|
| Rate for Payer: Superior Health Plan Medicare |
$2,072.68
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$2,072.68
|
| Rate for Payer: Universal American Medicare |
$2,072.68
|
| Rate for Payer: Wellcare Medicare |
$2,072.68
|
| Rate for Payer: Wellmed Medicare |
$2,072.68
|
|
|
Excision, ischial pressure ulcer, with skin flap closure; with ostectomy
|
Facility
|
OP
|
$7,316.92
|
|
|
Service Code
|
HCPCS 15945
|
| Hospital Charge Code |
991169
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$709.01 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$709.01
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$2,072.68
|
| Rate for Payer: Amerigroup Medicare |
$2,072.68
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,709.98
|
| Rate for Payer: BCBS of TX Blue Essentials |
$3,245.48
|
| Rate for Payer: BCBS of TX Medicare |
$2,072.68
|
| Rate for Payer: BCBS of TX PPO |
$4,089.30
|
| Rate for Payer: Cash Price |
$4,975.51
|
| Rate for Payer: Cash Price |
$4,975.51
|
| Rate for Payer: Cash Price |
$4,975.51
|
| Rate for Payer: Cigna Commercial |
$4,381.27
|
| Rate for Payer: Cigna Medicaid |
$5,268.18
|
| Rate for Payer: Cigna Medicare |
$2,072.68
|
| Rate for Payer: Employer Direct Commercial |
$2,072.68
|
| Rate for Payer: Humana Medicare/TRICARE |
$2,072.68
|
| Rate for Payer: Molina CHIP/Medicaid |
$5,268.18
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$2,072.68
|
| Rate for Payer: Molina Medicare |
$2,072.68
|
| 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 |
$5,268.18
|
| Rate for Payer: Scott and White EPO/PPO |
$3,085.41
|
| Rate for Payer: Scott and White Medicare |
$2,072.68
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$5,268.18
|
| Rate for Payer: Superior Health Plan EPO |
$2,072.68
|
| Rate for Payer: Superior Health Plan Medicare |
$2,072.68
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$2,072.68
|
| Rate for Payer: Universal American Medicare |
$2,072.68
|
| Rate for Payer: Wellcare Medicare |
$2,072.68
|
| Rate for Payer: Wellmed Medicare |
$2,072.68
|
|
|
Excision, ischial pressure ulcer, with skin flap closure; with ostectomy
|
Facility
|
IP
|
$7,316.92
|
|
|
Service Code
|
HCPCS 15945
|
| Hospital Charge Code |
991169
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$4,975.51
|
|
|
Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; excised diameter 2.1
|
Facility
|
IP
|
$5,855.96
|
|
|
Service Code
|
HCPCS 11643
|
| Hospital Charge Code |
9900098
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$3,982.05
|
|
|
Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; excised diameter 2.1
|
Facility
|
OP
|
$5,855.96
|
|
|
Service Code
|
HCPCS 11643
|
| Hospital Charge Code |
9900098
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$152.26 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$152.26
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,659.12
|
| Rate for Payer: Amerigroup Medicare |
$1,659.12
|
| Rate for Payer: BCBS of TX Blue Advantage |
$313.41
|
| Rate for Payer: BCBS of TX Blue Essentials |
$375.34
|
| Rate for Payer: BCBS of TX Medicare |
$1,659.12
|
| Rate for Payer: BCBS of TX PPO |
$472.93
|
| Rate for Payer: Cash Price |
$3,982.05
|
| Rate for Payer: Cash Price |
$3,982.05
|
| Rate for Payer: Cash Price |
$3,982.05
|
| Rate for Payer: Cigna Commercial |
$3,507.10
|
| Rate for Payer: Cigna Medicaid |
$4,216.29
|
| Rate for Payer: Cigna Medicare |
$1,659.12
|
| Rate for Payer: Employer Direct Commercial |
$1,659.12
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,659.12
|
| Rate for Payer: Molina CHIP/Medicaid |
$4,216.29
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,659.12
|
| Rate for Payer: Molina Medicare |
$1,659.12
|
| 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 |
$4,216.29
|
| Rate for Payer: Scott and White EPO/PPO |
$2,743.07
|
| Rate for Payer: Scott and White Medicare |
$1,659.12
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$4,216.29
|
| Rate for Payer: Superior Health Plan EPO |
$1,659.12
|
| Rate for Payer: Superior Health Plan Medicare |
$1,659.12
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,659.12
|
| Rate for Payer: Universal American Medicare |
$1,659.12
|
| Rate for Payer: Wellcare Medicare |
$1,659.12
|
| Rate for Payer: Wellmed Medicare |
$1,659.12
|
|
|
Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; excised diameter 2.1
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 11643
|
| Hospital Charge Code |
36011643
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$152.26 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$152.26
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,659.12
|
| Rate for Payer: Amerigroup Medicare |
$1,659.12
|
| Rate for Payer: BCBS of TX Blue Advantage |
$313.41
|
| Rate for Payer: BCBS of TX Blue Essentials |
$375.34
|
| Rate for Payer: BCBS of TX Medicare |
$1,659.12
|
| Rate for Payer: BCBS of TX PPO |
$472.93
|
| Rate for Payer: Cigna Commercial |
$3,507.10
|
| Rate for Payer: Cigna Medicare |
$1,659.12
|
| Rate for Payer: Employer Direct Commercial |
$1,659.12
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,659.12
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,659.12
|
| Rate for Payer: Molina Medicare |
$1,659.12
|
| 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 |
$2,743.07
|
| Rate for Payer: Scott and White Medicare |
$1,659.12
|
| Rate for Payer: Superior Health Plan EPO |
$1,659.12
|
| Rate for Payer: Superior Health Plan Medicare |
$1,659.12
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,659.12
|
| Rate for Payer: Universal American Medicare |
$1,659.12
|
| Rate for Payer: Wellcare Medicare |
$1,659.12
|
| Rate for Payer: Wellmed Medicare |
$1,659.12
|
|
|
Excision, nasal polyp(s), extensive
|
Facility
|
OP
|
$8,381.94
|
|
|
Service Code
|
HCPCS 30115
|
| Hospital Charge Code |
9900592
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$886.62 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$886.62
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3,330.57
|
| Rate for Payer: Amerigroup Medicare |
$3,330.57
|
| Rate for Payer: BCBS of TX Blue Advantage |
$4,374.21
|
| Rate for Payer: BCBS of TX Blue Essentials |
$5,238.58
|
| Rate for Payer: BCBS of TX Medicare |
$3,330.57
|
| Rate for Payer: BCBS of TX PPO |
$6,600.61
|
| Rate for Payer: Cash Price |
$5,699.72
|
| Rate for Payer: Cash Price |
$5,699.72
|
| Rate for Payer: Cash Price |
$5,699.72
|
| Rate for Payer: Cigna Commercial |
$7,040.22
|
| Rate for Payer: Cigna Medicaid |
$6,035.00
|
| Rate for Payer: Cigna Medicare |
$3,330.57
|
| Rate for Payer: Employer Direct Commercial |
$3,330.57
|
| Rate for Payer: Humana Medicare/TRICARE |
$3,330.57
|
| Rate for Payer: Molina CHIP/Medicaid |
$6,035.00
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3,330.57
|
| Rate for Payer: Molina Medicare |
$3,330.57
|
| 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 |
$6,035.00
|
| Rate for Payer: Scott and White EPO/PPO |
$5,447.31
|
| Rate for Payer: Scott and White Medicare |
$3,330.57
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$6,035.00
|
| Rate for Payer: Superior Health Plan EPO |
$3,330.57
|
| Rate for Payer: Superior Health Plan Medicare |
$3,330.57
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3,330.57
|
| Rate for Payer: Universal American Medicare |
$3,330.57
|
| Rate for Payer: Wellcare Medicare |
$3,330.57
|
| Rate for Payer: Wellmed Medicare |
$3,330.57
|
|
|
Excision, nasal polyp(s), extensive
|
Facility
|
IP
|
$8,381.94
|
|
|
Service Code
|
HCPCS 30115
|
| Hospital Charge Code |
9900592
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$5,699.72
|
|
|
Excision, nasal polyp(s), extensive
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 30115
|
| Hospital Charge Code |
36030115
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$886.62 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$886.62
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3,330.57
|
| Rate for Payer: Amerigroup Medicare |
$3,330.57
|
| Rate for Payer: BCBS of TX Blue Advantage |
$4,374.21
|
| Rate for Payer: BCBS of TX Blue Essentials |
$5,238.58
|
| Rate for Payer: BCBS of TX Medicare |
$3,330.57
|
| Rate for Payer: BCBS of TX PPO |
$6,600.61
|
| Rate for Payer: Cigna Commercial |
$7,040.22
|
| Rate for Payer: Cigna Medicare |
$3,330.57
|
| Rate for Payer: Employer Direct Commercial |
$3,330.57
|
| Rate for Payer: Humana Medicare/TRICARE |
$3,330.57
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3,330.57
|
| Rate for Payer: Molina Medicare |
$3,330.57
|
| 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 |
$5,447.31
|
| Rate for Payer: Scott and White Medicare |
$3,330.57
|
| Rate for Payer: Superior Health Plan EPO |
$3,330.57
|
| Rate for Payer: Superior Health Plan Medicare |
$3,330.57
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3,330.57
|
| Rate for Payer: Universal American Medicare |
$3,330.57
|
| Rate for Payer: Wellcare Medicare |
$3,330.57
|
| Rate for Payer: Wellmed Medicare |
$3,330.57
|
|
|
Excision of benign tumor or cyst of maxilla or zygoma by enucleation and curettage
|
Facility
|
IP
|
$17,229.45
|
|
|
Service Code
|
HCPCS 21030
|
| Hospital Charge Code |
9900190
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$11,716.03
|
|
|
Excision of benign tumor or cyst of maxilla or zygoma by enucleation and curettage
|
Facility
|
OP
|
$12,570.48
|
|
|
Service Code
|
CPT 21030
|
| Hospital Charge Code |
36021030
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$231.72 |
| Max. Negotiated Rate |
$12,570.48 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$231.72
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$5,946.81
|
| Rate for Payer: Amerigroup Medicare |
$5,946.81
|
| Rate for Payer: BCBS of TX Blue Advantage |
$524.35
|
| Rate for Payer: BCBS of TX Blue Essentials |
$627.96
|
| Rate for Payer: BCBS of TX Medicare |
$5,946.81
|
| Rate for Payer: BCBS of TX PPO |
$791.23
|
| Rate for Payer: Cigna Commercial |
$12,570.48
|
| Rate for Payer: Cigna Medicare |
$5,946.81
|
| Rate for Payer: Employer Direct Commercial |
$5,946.81
|
| Rate for Payer: Humana Medicare/TRICARE |
$5,946.81
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$5,946.81
|
| Rate for Payer: Molina Medicare |
$5,946.81
|
| 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 |
$9,908.12
|
| Rate for Payer: Scott and White Medicare |
$5,946.81
|
| Rate for Payer: Superior Health Plan EPO |
$5,946.81
|
| Rate for Payer: Superior Health Plan Medicare |
$5,946.81
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$5,946.81
|
| Rate for Payer: Universal American Medicare |
$5,946.81
|
| Rate for Payer: Wellcare Medicare |
$5,946.81
|
| Rate for Payer: Wellmed Medicare |
$5,946.81
|
|
|
Excision of benign tumor or cyst of maxilla or zygoma by enucleation and curettage
|
Facility
|
OP
|
$17,229.45
|
|
|
Service Code
|
HCPCS 21030
|
| Hospital Charge Code |
9900190
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$231.72 |
| Max. Negotiated Rate |
$12,570.48 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$231.72
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$5,946.81
|
| Rate for Payer: Amerigroup Medicare |
$5,946.81
|
| Rate for Payer: BCBS of TX Blue Advantage |
$524.35
|
| Rate for Payer: BCBS of TX Blue Essentials |
$627.96
|
| Rate for Payer: BCBS of TX Medicare |
$5,946.81
|
| Rate for Payer: BCBS of TX PPO |
$791.23
|
| Rate for Payer: Cash Price |
$11,716.03
|
| Rate for Payer: Cash Price |
$11,716.03
|
| Rate for Payer: Cash Price |
$11,716.03
|
| Rate for Payer: Cigna Commercial |
$12,570.48
|
| Rate for Payer: Cigna Medicaid |
$12,405.20
|
| Rate for Payer: Cigna Medicare |
$5,946.81
|
| Rate for Payer: Employer Direct Commercial |
$5,946.81
|
| Rate for Payer: Humana Medicare/TRICARE |
$5,946.81
|
| Rate for Payer: Molina CHIP/Medicaid |
$12,405.20
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$5,946.81
|
| Rate for Payer: Molina Medicare |
$5,946.81
|
| 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 |
$12,405.20
|
| Rate for Payer: Scott and White EPO/PPO |
$9,908.12
|
| Rate for Payer: Scott and White Medicare |
$5,946.81
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$12,405.20
|
| Rate for Payer: Superior Health Plan EPO |
$5,946.81
|
| Rate for Payer: Superior Health Plan Medicare |
$5,946.81
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$5,946.81
|
| Rate for Payer: Universal American Medicare |
$5,946.81
|
| Rate for Payer: Wellcare Medicare |
$5,946.81
|
| Rate for Payer: Wellmed Medicare |
$5,946.81
|
|
|
Excision of chest wall tumor including rib(s)
|
Facility
|
OP
|
$10,829.40
|
|
|
Service Code
|
HCPCS 21601
|
| Hospital Charge Code |
9900201
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$974.65 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$974.65
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$2,917.95
|
| Rate for Payer: Amerigroup Medicare |
$2,917.95
|
| 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 |
$2,917.95
|
| Rate for Payer: BCBS of TX PPO |
$5,843.60
|
| Rate for Payer: Cash Price |
$7,363.99
|
| Rate for Payer: Cash Price |
$7,363.99
|
| Rate for Payer: Cash Price |
$7,363.99
|
| Rate for Payer: Cigna Commercial |
$6,168.03
|
| Rate for Payer: Cigna Medicaid |
$7,797.17
|
| Rate for Payer: Cigna Medicare |
$2,917.95
|
| Rate for Payer: Employer Direct Commercial |
$2,917.95
|
| Rate for Payer: Humana Medicare/TRICARE |
$2,917.95
|
| Rate for Payer: Molina CHIP/Medicaid |
$7,797.17
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$2,917.95
|
| Rate for Payer: Molina Medicare |
$2,917.95
|
| 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 |
$7,797.17
|
| Rate for Payer: Scott and White EPO/PPO |
$4,807.56
|
| Rate for Payer: Scott and White Medicare |
$2,917.95
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$7,797.17
|
| Rate for Payer: Superior Health Plan EPO |
$2,917.95
|
| Rate for Payer: Superior Health Plan Medicare |
$2,917.95
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$2,917.95
|
| Rate for Payer: Universal American Medicare |
$2,917.95
|
| Rate for Payer: Wellcare Medicare |
$2,917.95
|
| Rate for Payer: Wellmed Medicare |
$2,917.95
|
|
|
Excision of chest wall tumor including rib(s)
|
Facility
|
IP
|
$10,829.40
|
|
|
Service Code
|
HCPCS 21601
|
| Hospital Charge Code |
9900201
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$7,363.99
|
|
|
Excision of chest wall tumor including rib(s)
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 21601
|
| Hospital Charge Code |
36021601
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,917.95 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$2,917.95
|
| Rate for Payer: Amerigroup Medicare |
$2,917.95
|
| 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 |
$2,917.95
|
| Rate for Payer: BCBS of TX PPO |
$5,843.60
|
| Rate for Payer: Cigna Commercial |
$6,168.03
|
| Rate for Payer: Cigna Medicare |
$2,917.95
|
| Rate for Payer: Employer Direct Commercial |
$2,917.95
|
| Rate for Payer: Humana Medicare/TRICARE |
$2,917.95
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$2,917.95
|
| Rate for Payer: Molina Medicare |
$2,917.95
|
| 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 |
$4,807.56
|
| Rate for Payer: Scott and White Medicare |
$2,917.95
|
| Rate for Payer: Superior Health Plan EPO |
$2,917.95
|
| Rate for Payer: Superior Health Plan Medicare |
$2,917.95
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$2,917.95
|
| Rate for Payer: Universal American Medicare |
$2,917.95
|
| Rate for Payer: Wellcare Medicare |
$2,917.95
|
| Rate for Payer: Wellmed Medicare |
$2,917.95
|
|
|
Excision of cyst, fibroadenoma, or other benign or malignant tumor, aberrant breast tissue, duct lesion, nipple or areolar lesion (except 19300), open, male or female, 1 or more lesions
|
Facility
|
OP
|
$14,527.16
|
|
|
Service Code
|
HCPCS 19120
|
| Hospital Charge Code |
991139
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$963.66 |
| Max. Negotiated Rate |
$10,459.56 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$963.66
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3,933.28
|
| Rate for Payer: Amerigroup Medicare |
$3,933.28
|
| Rate for Payer: BCBS of TX Blue Advantage |
$5,059.35
|
| Rate for Payer: BCBS of TX Blue Essentials |
$6,059.10
|
| Rate for Payer: BCBS of TX Medicare |
$3,933.28
|
| Rate for Payer: BCBS of TX PPO |
$7,634.47
|
| Rate for Payer: Cash Price |
$9,878.47
|
| Rate for Payer: Cash Price |
$9,878.47
|
| Rate for Payer: Cash Price |
$9,878.47
|
| Rate for Payer: Cigna Commercial |
$8,314.23
|
| Rate for Payer: Cigna Medicaid |
$10,459.56
|
| Rate for Payer: Cigna Medicare |
$3,933.28
|
| Rate for Payer: Employer Direct Commercial |
$3,933.28
|
| Rate for Payer: Humana Medicare/TRICARE |
$3,933.28
|
| Rate for Payer: Molina CHIP/Medicaid |
$10,459.56
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3,933.28
|
| Rate for Payer: Molina Medicare |
$3,933.28
|
| 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 |
$10,459.56
|
| Rate for Payer: Scott and White EPO/PPO |
$6,449.12
|
| Rate for Payer: Scott and White Medicare |
$3,933.28
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$10,459.56
|
| Rate for Payer: Superior Health Plan EPO |
$3,933.28
|
| Rate for Payer: Superior Health Plan Medicare |
$3,933.28
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3,933.28
|
| Rate for Payer: Universal American Medicare |
$3,933.28
|
| Rate for Payer: Wellcare Medicare |
$3,933.28
|
| Rate for Payer: Wellmed Medicare |
$3,933.28
|
|
|
Excision of cyst, fibroadenoma, or other benign or malignant tumor, aberrant breast tissue, duct lesion, nipple or areolar lesion (except 19300), open, male or female, 1 or more lesions
|
Facility
|
IP
|
$14,527.16
|
|
|
Service Code
|
HCPCS 19120
|
| Hospital Charge Code |
991139
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$9,878.47
|
|
|
Excision of ganglion, wrist (dorsal or volar) primary
|
Facility
|
IP
|
$6,961.75
|
|
|
Service Code
|
HCPCS 25111
|
| Hospital Charge Code |
9900271
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$4,733.99
|
|
