|
Excision of lesion of tongue with closure; anterior two-thirds
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 41112
|
| Hospital Charge Code |
36041112
|
|
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 lesion of tongue with closure; anterior two-thirds
|
Facility
|
IP
|
$9,577.37
|
|
|
Service Code
|
HCPCS 41112
|
| Hospital Charge Code |
9900646
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$6,512.61
|
|
|
Excision of lesion of tongue with closure; with local tongue flap
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 41114
|
| Hospital Charge Code |
36041114
|
|
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 lesion of tongue with closure; with local tongue flap
|
Facility
|
OP
|
$14,225.15
|
|
|
Service Code
|
HCPCS 41114
|
| Hospital Charge Code |
9900647
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$886.62 |
| Max. Negotiated Rate |
$10,242.11 |
| 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 |
$9,673.10
|
| Rate for Payer: Cash Price |
$9,673.10
|
| Rate for Payer: Cash Price |
$9,673.10
|
| Rate for Payer: Cigna Commercial |
$7,040.22
|
| Rate for Payer: Cigna Medicaid |
$10,242.11
|
| 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 |
$10,242.11
|
| 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 |
$10,242.11
|
| 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 |
$10,242.11
|
| 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 lesion of tongue with closure; with local tongue flap
|
Facility
|
IP
|
$14,225.15
|
|
|
Service Code
|
HCPCS 41114
|
| Hospital Charge Code |
9900647
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$9,673.10
|
|
|
Excision of lesion of tongue without closure
|
Facility
|
IP
|
$14,225.15
|
|
|
Service Code
|
HCPCS 41110
|
| Hospital Charge Code |
9900645
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$9,673.10
|
|
|
Excision of lesion of tongue without closure
|
Facility
|
OP
|
$14,225.15
|
|
|
Service Code
|
HCPCS 41110
|
| Hospital Charge Code |
9900645
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$142.30 |
| Max. Negotiated Rate |
$10,242.11 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$142.30
|
| 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 |
$272.41
|
| Rate for Payer: BCBS of TX Blue Essentials |
$326.24
|
| Rate for Payer: BCBS of TX Medicare |
$3,330.57
|
| Rate for Payer: BCBS of TX PPO |
$411.06
|
| Rate for Payer: Cash Price |
$9,673.10
|
| Rate for Payer: Cash Price |
$9,673.10
|
| Rate for Payer: Cash Price |
$9,673.10
|
| Rate for Payer: Cigna Commercial |
$7,040.22
|
| Rate for Payer: Cigna Medicaid |
$10,242.11
|
| 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 |
$10,242.11
|
| 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 |
$10,242.11
|
| 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 |
$10,242.11
|
| 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 lesion of tongue without closure
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 41110
|
| Hospital Charge Code |
36041110
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$142.30 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$142.30
|
| 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 |
$272.41
|
| Rate for Payer: BCBS of TX Blue Essentials |
$326.24
|
| Rate for Payer: BCBS of TX Medicare |
$3,330.57
|
| Rate for Payer: BCBS of TX PPO |
$411.06
|
| 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 lesion, tendon, tendon sheath, or capsule
|
Facility
|
IP
|
$6,265.58
|
|
|
Service Code
|
HCPCS 28092
|
| Hospital Charge Code |
9900470
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$4,260.59
|
|
|
Excision of lesion, tendon, tendon sheath, or capsule
|
Facility
|
OP
|
$6,265.58
|
|
|
Service Code
|
HCPCS 28092
|
| Hospital Charge Code |
9900470
|
|
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 |
$4,260.59
|
| Rate for Payer: Cash Price |
$4,260.59
|
| Rate for Payer: Cash Price |
$4,260.59
|
| Rate for Payer: Cigna Commercial |
$3,414.49
|
| Rate for Payer: Cigna Medicaid |
$4,511.22
|
| 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 |
$4,511.22
|
| 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 |
$4,511.22
|
| 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 |
$4,511.22
|
| 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 of lesion, tendon, tendon sheath, or capsule
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 28092
|
| Hospital Charge Code |
36028092
|
|
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 of lesion, tendon, tendon sheath, or capsule (including synovectomy) (eg, cyst or ganglion)
|
Facility
|
IP
|
$6,265.58
|
|
|
Service Code
|
HCPCS 28090
|
| Hospital Charge Code |
9900469
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$4,260.59
|
|
|
Excision of lesion, tendon, tendon sheath, or capsule (including synovectomy) (eg, cyst or ganglion)
|
Facility
|
OP
|
$6,265.58
|
|
|
Service Code
|
HCPCS 28090
|
| Hospital Charge Code |
9900469
|
|
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 |
$4,260.59
|
| Rate for Payer: Cash Price |
$4,260.59
|
| Rate for Payer: Cash Price |
$4,260.59
|
| Rate for Payer: Cigna Commercial |
$3,414.49
|
| Rate for Payer: Cigna Medicaid |
$4,511.22
|
| 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 |
$4,511.22
|
| 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 |
$4,511.22
|
| 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 |
$4,511.22
|
| 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 of lesion, tendon, tendon sheath, or capsule (including synovectomy) (eg, cyst or ganglion)
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 28090
|
| Hospital Charge Code |
36028090
|
|
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 of lingual frenum (frenectomy)
|
Facility
|
IP
|
$4,734.77
|
|
|
Service Code
|
HCPCS 41115
|
| Hospital Charge Code |
9900648
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$3,219.64
|
|
|
Excision of lingual frenum (frenectomy)
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 41115
|
| Hospital Charge Code |
36041115
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$162.23 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$162.23
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,558.65
|
| Rate for Payer: Amerigroup Medicare |
$1,558.65
|
| Rate for Payer: BCBS of TX Blue Advantage |
$314.01
|
| Rate for Payer: BCBS of TX Blue Essentials |
$376.06
|
| Rate for Payer: BCBS of TX Medicare |
$1,558.65
|
| Rate for Payer: BCBS of TX PPO |
$473.84
|
| Rate for Payer: Cigna Commercial |
$3,294.71
|
| Rate for Payer: Cigna Medicare |
$1,558.65
|
| Rate for Payer: Employer Direct Commercial |
$1,558.65
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,558.65
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,558.65
|
| Rate for Payer: Molina Medicare |
$1,558.65
|
| 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 |
$2,580.23
|
| Rate for Payer: Scott and White Medicare |
$1,558.65
|
| Rate for Payer: Superior Health Plan EPO |
$1,558.65
|
| Rate for Payer: Superior Health Plan Medicare |
$1,558.65
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,558.65
|
| Rate for Payer: Universal American Medicare |
$1,558.65
|
| Rate for Payer: Wellcare Medicare |
$1,558.65
|
| Rate for Payer: Wellmed Medicare |
$1,558.65
|
|
|
Excision of lingual frenum (frenectomy)
|
Facility
|
OP
|
$4,734.77
|
|
|
Service Code
|
HCPCS 41115
|
| Hospital Charge Code |
9900648
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$162.23 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$162.23
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,558.65
|
| Rate for Payer: Amerigroup Medicare |
$1,558.65
|
| Rate for Payer: BCBS of TX Blue Advantage |
$314.01
|
| Rate for Payer: BCBS of TX Blue Essentials |
$376.06
|
| Rate for Payer: BCBS of TX Medicare |
$1,558.65
|
| Rate for Payer: BCBS of TX PPO |
$473.84
|
| Rate for Payer: Cash Price |
$3,219.64
|
| Rate for Payer: Cash Price |
$3,219.64
|
| Rate for Payer: Cash Price |
$3,219.64
|
| Rate for Payer: Cigna Commercial |
$3,294.71
|
| Rate for Payer: Cigna Medicaid |
$3,409.03
|
| Rate for Payer: Cigna Medicare |
$1,558.65
|
| Rate for Payer: Employer Direct Commercial |
$1,558.65
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,558.65
|
| Rate for Payer: Molina CHIP/Medicaid |
$3,409.03
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,558.65
|
| Rate for Payer: Molina Medicare |
$1,558.65
|
| 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 |
$3,409.03
|
| Rate for Payer: Scott and White EPO/PPO |
$2,580.23
|
| Rate for Payer: Scott and White Medicare |
$1,558.65
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$3,409.03
|
| Rate for Payer: Superior Health Plan EPO |
$1,558.65
|
| Rate for Payer: Superior Health Plan Medicare |
$1,558.65
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,558.65
|
| Rate for Payer: Universal American Medicare |
$1,558.65
|
| Rate for Payer: Wellcare Medicare |
$1,558.65
|
| Rate for Payer: Wellmed Medicare |
$1,558.65
|
|
|
Excision of lip; V-excision with primary direct linear closure
|
Facility
|
IP
|
$14,225.15
|
|
|
Service Code
|
HCPCS 40520
|
| Hospital Charge Code |
9900639
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$9,673.10
|
|
|
Excision of lip; V-excision with primary direct linear closure
|
Facility
|
OP
|
$14,225.15
|
|
|
Service Code
|
HCPCS 40520
|
| Hospital Charge Code |
9900639
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$886.62 |
| Max. Negotiated Rate |
$10,242.11 |
| 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 |
$9,673.10
|
| Rate for Payer: Cash Price |
$9,673.10
|
| Rate for Payer: Cash Price |
$9,673.10
|
| Rate for Payer: Cigna Commercial |
$7,040.22
|
| Rate for Payer: Cigna Medicaid |
$10,242.11
|
| 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 |
$10,242.11
|
| 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 |
$10,242.11
|
| 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 |
$10,242.11
|
| 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 lip; V-excision with primary direct linear closure
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 40520
|
| Hospital Charge Code |
36040520
|
|
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 nail and nail matrix, partial or complete (eg, ingrown or deformed nail), for permanent
|
Facility
|
IP
|
$8,017.06
|
|
|
Service Code
|
HCPCS 11750
|
| Hospital Charge Code |
9900100
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$5,451.60
|
|
|
Excision of nail and nail matrix, partial or complete (eg, ingrown or deformed nail), for permanent
|
Facility
|
OP
|
$8,017.06
|
|
|
Service Code
|
HCPCS 11750
|
| Hospital Charge Code |
9900100
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$84.71 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$84.71
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$408.37
|
| Rate for Payer: Amerigroup Medicare |
$408.37
|
| Rate for Payer: BCBS of TX Blue Advantage |
$165.75
|
| Rate for Payer: BCBS of TX Blue Essentials |
$198.50
|
| Rate for Payer: BCBS of TX Medicare |
$408.37
|
| Rate for Payer: BCBS of TX PPO |
$250.11
|
| Rate for Payer: Cash Price |
$5,451.60
|
| Rate for Payer: Cash Price |
$5,451.60
|
| Rate for Payer: Cash Price |
$5,451.60
|
| Rate for Payer: Cigna Commercial |
$863.21
|
| Rate for Payer: Cigna Medicaid |
$5,772.28
|
| Rate for Payer: Cigna Medicare |
$408.37
|
| Rate for Payer: Employer Direct Commercial |
$408.37
|
| Rate for Payer: Humana Medicare/TRICARE |
$408.37
|
| Rate for Payer: Molina CHIP/Medicaid |
$5,772.28
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$408.37
|
| Rate for Payer: Molina Medicare |
$408.37
|
| 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 |
$5,772.28
|
| Rate for Payer: Scott and White EPO/PPO |
$674.64
|
| Rate for Payer: Scott and White Medicare |
$408.37
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$5,772.28
|
| Rate for Payer: Superior Health Plan EPO |
$408.37
|
| Rate for Payer: Superior Health Plan Medicare |
$408.37
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$408.37
|
| Rate for Payer: Universal American Medicare |
$408.37
|
| Rate for Payer: Wellcare Medicare |
$408.37
|
| Rate for Payer: Wellmed Medicare |
$408.37
|
|
|
Excision of nail and nail matrix, partial or complete (eg, ingrown or deformed nail), for permanent
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 11750
|
| Hospital Charge Code |
36011750
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$84.71 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$84.71
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$408.37
|
| Rate for Payer: Amerigroup Medicare |
$408.37
|
| Rate for Payer: BCBS of TX Blue Advantage |
$165.75
|
| Rate for Payer: BCBS of TX Blue Essentials |
$198.50
|
| Rate for Payer: BCBS of TX Medicare |
$408.37
|
| Rate for Payer: BCBS of TX PPO |
$250.11
|
| Rate for Payer: Cigna Commercial |
$863.21
|
| Rate for Payer: Cigna Medicare |
$408.37
|
| Rate for Payer: Employer Direct Commercial |
$408.37
|
| Rate for Payer: Humana Medicare/TRICARE |
$408.37
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$408.37
|
| Rate for Payer: Molina Medicare |
$408.37
|
| 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 |
$674.64
|
| Rate for Payer: Scott and White Medicare |
$408.37
|
| Rate for Payer: Superior Health Plan EPO |
$408.37
|
| Rate for Payer: Superior Health Plan Medicare |
$408.37
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$408.37
|
| Rate for Payer: Universal American Medicare |
$408.37
|
| Rate for Payer: Wellcare Medicare |
$408.37
|
| Rate for Payer: Wellmed Medicare |
$408.37
|
|
|
Excision of neuroma hand or foot, except digital nerve
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 64782
|
| Hospital Charge Code |
36064782
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$659.94 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$659.94
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,961.62
|
| Rate for Payer: Amerigroup Medicare |
$1,961.62
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,871.31
|
| Rate for Payer: BCBS of TX Blue Essentials |
$3,438.70
|
| Rate for Payer: BCBS of TX Medicare |
$1,961.62
|
| Rate for Payer: BCBS of TX PPO |
$4,332.76
|
| Rate for Payer: Cigna Commercial |
$4,146.52
|
| Rate for Payer: Cigna Medicare |
$1,961.62
|
| Rate for Payer: Employer Direct Commercial |
$1,961.62
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,961.62
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,961.62
|
| Rate for Payer: Molina Medicare |
$1,961.62
|
| 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 |
$3,266.71
|
| Rate for Payer: Scott and White Medicare |
$1,961.62
|
| Rate for Payer: Superior Health Plan EPO |
$1,961.62
|
| Rate for Payer: Superior Health Plan Medicare |
$1,961.62
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,961.62
|
| Rate for Payer: Universal American Medicare |
$1,961.62
|
| Rate for Payer: Wellcare Medicare |
$1,961.62
|
| Rate for Payer: Wellmed Medicare |
$1,961.62
|
|
|
Excision of neuroma hand or foot, except digital nerve
|
Facility
|
IP
|
$16,645.00
|
|
|
Service Code
|
HCPCS 64782
|
| Hospital Charge Code |
9900846
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$11,318.60
|
|
