|
OPWC Paring/Cutting Benign Lesion Over 4 BCE
|
Facility
|
OP
|
$521.00
|
|
|
Service Code
|
CPT 11057
|
| Hospital Charge Code |
8914558
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3.27 |
| Max. Negotiated Rate |
$414.75 |
| Rate for Payer: Aetna Commercial |
$286.55
|
| Rate for Payer: Aetna Medicare |
$274.64
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$46.89
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$183.09
|
| Rate for Payer: Amerigroup Medicare |
$183.09
|
| Rate for Payer: BCBS of TX Blue Advantage |
$97.03
|
| Rate for Payer: BCBS of TX Blue Essentials |
$116.20
|
| Rate for Payer: BCBS of TX Medicare |
$183.09
|
| Rate for Payer: BCBS of TX PPO |
$146.41
|
| Rate for Payer: Cash Price |
$458.48
|
| Rate for Payer: Cash Price |
$458.48
|
| Rate for Payer: Cash Price |
$458.48
|
| Rate for Payer: Cigna Commercial |
$414.75
|
| Rate for Payer: Cigna Medicaid |
$55.65
|
| 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 |
$55.65
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$183.09
|
| Rate for Payer: Molina Medicare |
$183.09
|
| Rate for Payer: Multiplan Auto |
$338.65
|
| Rate for Payer: Multiplan Commercial |
$338.65
|
| Rate for Payer: Multiplan Workers Comp |
$338.65
|
| Rate for Payer: Parkland Medicaid |
$55.65
|
| Rate for Payer: Scott and White EPO/PPO |
$3.27
|
| Rate for Payer: Scott and White Medicare |
$183.09
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$55.65
|
| 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
|
|
|
OPWC Paring Of Single Callus BCE
|
Facility
|
IP
|
$358.00
|
|
|
Service Code
|
CPT 11055
|
| Hospital Charge Code |
8910564
|
|
Hospital Revenue Code
|
761
|
| Rate for Payer: Cash Price |
$315.04
|
|
|
OPWC Paring Of Single Callus BCE
|
Facility
|
OP
|
$358.00
|
|
|
Service Code
|
CPT 11055
|
| Hospital Charge Code |
8910564
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3.27 |
| Max. Negotiated Rate |
$440.32 |
| Rate for Payer: Aetna Commercial |
$196.90
|
| Rate for Payer: Aetna Medicare |
$274.64
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$32.22
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$183.09
|
| Rate for Payer: Amerigroup Medicare |
$183.09
|
| Rate for Payer: BCBS of TX Blue Advantage |
$291.80
|
| Rate for Payer: BCBS of TX Blue Essentials |
$349.46
|
| Rate for Payer: BCBS of TX Medicare |
$183.09
|
| Rate for Payer: BCBS of TX PPO |
$440.32
|
| Rate for Payer: Cash Price |
$315.04
|
| Rate for Payer: Cash Price |
$315.04
|
| Rate for Payer: Cash Price |
$315.04
|
| Rate for Payer: Cigna Commercial |
$414.75
|
| 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 Dual Medicare/Medicaid |
$183.09
|
| Rate for Payer: Molina Medicare |
$183.09
|
| Rate for Payer: Multiplan Auto |
$232.70
|
| Rate for Payer: Multiplan Commercial |
$232.70
|
| Rate for Payer: Multiplan Workers Comp |
$232.70
|
| Rate for Payer: Scott and White EPO/PPO |
$3.27
|
| Rate for Payer: Scott and White Medicare |
$183.09
|
| 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
|
|
|
OPWC Punch Biopsy Skin, Ea Add BCE
|
Facility
|
IP
|
$346.00
|
|
|
Service Code
|
CPT 11105
|
| Hospital Charge Code |
8912554
|
|
Hospital Revenue Code
|
761
|
| Rate for Payer: Cash Price |
$304.48
|
|
|
OPWC Punch Biopsy Skin, Ea Add BCE
|
Facility
|
OP
|
$346.00
|
|
|
Service Code
|
CPT 11105
|
| Hospital Charge Code |
8912554
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$31.14 |
| Max. Negotiated Rate |
$224.90 |
| Rate for Payer: Aetna Commercial |
$190.30
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$31.14
|
| 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 |
$304.48
|
| Rate for Payer: Cash Price |
$304.48
|
| Rate for Payer: Multiplan Auto |
$224.90
|
| Rate for Payer: Multiplan Commercial |
$224.90
|
| Rate for Payer: Multiplan Workers Comp |
$224.90
|
| Rate for Payer: Scott and White EPO/PPO |
$173.00
|
| Rate for Payer: Superior Health Plan EPO |
$47.06
|
|
|
OPWC Punch Biopsy Skn, One Lsn BCE
|
Facility
|
IP
|
$688.00
|
|
|
Service Code
|
CPT 11104
|
| Hospital Charge Code |
8910565
|
|
Hospital Revenue Code
|
761
|
| Rate for Payer: Cash Price |
$605.44
|
|
|
OPWC Punch Biopsy Skn, One Lsn BCE
|
Facility
|
OP
|
$688.00
|
|
|
Service Code
|
CPT 11104
|
| Hospital Charge Code |
8910565
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$6.52 |
| Max. Negotiated Rate |
$826.08 |
| Rate for Payer: Aetna Commercial |
$378.40
|
| Rate for Payer: Aetna Medicare |
$547.00
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$61.92
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$364.67
|
| Rate for Payer: Amerigroup Medicare |
$364.67
|
| Rate for Payer: BCBS of TX Blue Advantage |
$147.44
|
| Rate for Payer: BCBS of TX Blue Essentials |
$176.58
|
| Rate for Payer: BCBS of TX Medicare |
$364.67
|
| Rate for Payer: BCBS of TX PPO |
$222.49
|
| Rate for Payer: Cash Price |
$605.44
|
| Rate for Payer: Cash Price |
$605.44
|
| Rate for Payer: Cash Price |
$605.44
|
| Rate for Payer: Cigna Commercial |
$826.08
|
| Rate for Payer: Cigna Medicaid |
$79.46
|
| 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 |
$79.46
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$364.67
|
| Rate for Payer: Molina Medicare |
$364.67
|
| Rate for Payer: Multiplan Auto |
$447.20
|
| Rate for Payer: Multiplan Commercial |
$447.20
|
| Rate for Payer: Multiplan Workers Comp |
$447.20
|
| Rate for Payer: Parkland Medicaid |
$79.46
|
| Rate for Payer: Scott and White EPO/PPO |
$6.52
|
| Rate for Payer: Scott and White Medicare |
$364.67
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$79.46
|
| 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
|
|
|
OPWC Puncture Drainage Of Lesion BCE
|
Facility
|
OP
|
$895.00
|
|
|
Service Code
|
CPT 10160
|
| Hospital Charge Code |
8910566
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$6.52 |
| Max. Negotiated Rate |
$826.08 |
| Rate for Payer: Aetna Commercial |
$492.25
|
| Rate for Payer: Aetna Medicare |
$547.00
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$80.55
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$364.67
|
| Rate for Payer: Amerigroup Medicare |
$364.67
|
| Rate for Payer: BCBS of TX Blue Advantage |
$139.23
|
| Rate for Payer: BCBS of TX Blue Essentials |
$166.74
|
| Rate for Payer: BCBS of TX Medicare |
$364.67
|
| Rate for Payer: BCBS of TX PPO |
$210.09
|
| Rate for Payer: Cash Price |
$787.60
|
| Rate for Payer: Cash Price |
$787.60
|
| Rate for Payer: Cash Price |
$787.60
|
| Rate for Payer: Cigna Commercial |
$826.08
|
| Rate for Payer: Cigna Medicaid |
$67.83
|
| 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 |
$67.83
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$364.67
|
| Rate for Payer: Molina Medicare |
$364.67
|
| Rate for Payer: Multiplan Auto |
$581.75
|
| Rate for Payer: Multiplan Commercial |
$581.75
|
| Rate for Payer: Multiplan Workers Comp |
$581.75
|
| Rate for Payer: Parkland Medicaid |
$67.83
|
| Rate for Payer: Scott and White EPO/PPO |
$6.52
|
| Rate for Payer: Scott and White Medicare |
$364.67
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$67.83
|
| 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
|
|
|
OPWC Puncture Drainage Of Lesion BCE
|
Facility
|
IP
|
$895.00
|
|
|
Service Code
|
CPT 10160
|
| Hospital Charge Code |
8910566
|
|
Hospital Revenue Code
|
761
|
| Rate for Payer: Cash Price |
$787.60
|
|
|
OPWC Removal Of Ear Wax By Instru Unilat BCE
|
Facility
|
IP
|
$1,639.00
|
|
|
Service Code
|
CPT 69210
|
| Hospital Charge Code |
8914559
|
|
Hospital Revenue Code
|
761
|
| Rate for Payer: Cash Price |
$1,442.32
|
|
|
OPWC Removal Of Ear Wax By Instru Unilat BCE
|
Facility
|
OP
|
$1,639.00
|
|
|
Service Code
|
CPT 69210
|
| Hospital Charge Code |
8914559
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$1,065.35 |
| Rate for Payer: Aetna Commercial |
$901.45
|
| Rate for Payer: Aetna Medicare |
$83.91
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$147.51
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$55.94
|
| Rate for Payer: Amerigroup Medicare |
$55.94
|
| Rate for Payer: BCBS of TX Blue Advantage |
$91.87
|
| Rate for Payer: BCBS of TX Blue Essentials |
$110.02
|
| Rate for Payer: BCBS of TX Medicare |
$55.94
|
| Rate for Payer: BCBS of TX PPO |
$138.63
|
| Rate for Payer: Cash Price |
$1,442.32
|
| Rate for Payer: Cash Price |
$1,442.32
|
| Rate for Payer: Cash Price |
$1,442.32
|
| Rate for Payer: Cigna Commercial |
$126.71
|
| Rate for Payer: Cigna Medicare |
$55.94
|
| Rate for Payer: Employer Direct Commercial |
$55.94
|
| Rate for Payer: Humana Medicare/TRICARE |
$55.94
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$55.94
|
| Rate for Payer: Molina Medicare |
$55.94
|
| Rate for Payer: Multiplan Auto |
$1,065.35
|
| Rate for Payer: Multiplan Commercial |
$1,065.35
|
| Rate for Payer: Multiplan Workers Comp |
$1,065.35
|
| Rate for Payer: Scott and White EPO/PPO |
$1.00
|
| Rate for Payer: Scott and White Medicare |
$55.94
|
| Rate for Payer: Superior Health Plan EPO |
$55.94
|
| Rate for Payer: Superior Health Plan Medicare |
$55.94
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$55.94
|
| Rate for Payer: Universal American Medicare |
$55.94
|
| Rate for Payer: Wellcare Medicare |
$55.94
|
| Rate for Payer: Wellmed Medicare |
$55.94
|
|
|
OPWC Removal Of Nail Bed BCE
|
Facility
|
OP
|
$4,009.00
|
|
|
Service Code
|
CPT 11750
|
| Hospital Charge Code |
8910568
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$6.52 |
| Max. Negotiated Rate |
$2,605.85 |
| Rate for Payer: Aetna Commercial |
$2,204.95
|
| Rate for Payer: Aetna Medicare |
$547.00
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$360.81
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$364.67
|
| Rate for Payer: Amerigroup Medicare |
$364.67
|
| 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 |
$364.67
|
| Rate for Payer: BCBS of TX PPO |
$250.11
|
| Rate for Payer: Cash Price |
$3,527.92
|
| Rate for Payer: Cash Price |
$3,527.92
|
| Rate for Payer: Cash Price |
$3,527.92
|
| Rate for Payer: Cigna Commercial |
$826.08
|
| Rate for Payer: Cigna Medicaid |
$84.71
|
| 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 |
$84.71
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$364.67
|
| Rate for Payer: Molina Medicare |
$364.67
|
| Rate for Payer: Multiplan Auto |
$2,605.85
|
| Rate for Payer: Multiplan Commercial |
$2,605.85
|
| Rate for Payer: Multiplan Workers Comp |
$2,605.85
|
| Rate for Payer: Parkland Medicaid |
$84.71
|
| Rate for Payer: Scott and White EPO/PPO |
$6.52
|
| Rate for Payer: Scott and White Medicare |
$364.67
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$84.71
|
| 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
|
|
|
OPWC Removal Of Nail Bed BCE
|
Facility
|
IP
|
$4,009.00
|
|
|
Service Code
|
CPT 11750
|
| Hospital Charge Code |
8910568
|
|
Hospital Revenue Code
|
761
|
| Rate for Payer: Cash Price |
$3,527.92
|
|
|
OPWC Removal Of Skin Lesion BCE
|
Facility
|
OP
|
$2,477.00
|
|
|
Service Code
|
CPT 11200
|
| Hospital Charge Code |
8910567
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3.27 |
| Max. Negotiated Rate |
$1,610.05 |
| Rate for Payer: Aetna Commercial |
$1,362.35
|
| Rate for Payer: Aetna Medicare |
$274.64
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$222.93
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$183.09
|
| Rate for Payer: Amerigroup Medicare |
$183.09
|
| Rate for Payer: BCBS of TX Blue Advantage |
$291.80
|
| Rate for Payer: BCBS of TX Blue Essentials |
$349.46
|
| Rate for Payer: BCBS of TX Medicare |
$183.09
|
| Rate for Payer: BCBS of TX PPO |
$440.32
|
| Rate for Payer: Cash Price |
$2,179.76
|
| Rate for Payer: Cash Price |
$2,179.76
|
| Rate for Payer: Cash Price |
$2,179.76
|
| Rate for Payer: Cigna Commercial |
$414.75
|
| 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 Dual Medicare/Medicaid |
$183.09
|
| Rate for Payer: Molina Medicare |
$183.09
|
| Rate for Payer: Multiplan Auto |
$1,610.05
|
| Rate for Payer: Multiplan Commercial |
$1,610.05
|
| Rate for Payer: Multiplan Workers Comp |
$1,610.05
|
| Rate for Payer: Scott and White EPO/PPO |
$3.27
|
| Rate for Payer: Scott and White Medicare |
$183.09
|
| 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
|
|
|
OPWC Removal Of Skin Lesion BCE
|
Facility
|
IP
|
$2,477.00
|
|
|
Service Code
|
CPT 11200
|
| Hospital Charge Code |
8910567
|
|
Hospital Revenue Code
|
761
|
| Rate for Payer: Cash Price |
$2,179.76
|
|
|
OPWC Remove Foreign Body, Simple BCE
|
Facility
|
OP
|
$1,029.00
|
|
|
Service Code
|
CPT 10120
|
| Hospital Charge Code |
8910569
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$6.52 |
| Max. Negotiated Rate |
$826.08 |
| Rate for Payer: Aetna Commercial |
$565.95
|
| Rate for Payer: Aetna Medicare |
$547.00
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$92.61
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$364.67
|
| Rate for Payer: Amerigroup Medicare |
$364.67
|
| Rate for Payer: BCBS of TX Blue Advantage |
$178.41
|
| Rate for Payer: BCBS of TX Blue Essentials |
$213.66
|
| Rate for Payer: BCBS of TX Medicare |
$364.67
|
| Rate for Payer: BCBS of TX PPO |
$269.21
|
| Rate for Payer: Cash Price |
$905.52
|
| Rate for Payer: Cash Price |
$905.52
|
| Rate for Payer: Cash Price |
$905.52
|
| Rate for Payer: Cigna Commercial |
$826.08
|
| Rate for Payer: Cigna Medicaid |
$86.38
|
| 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 |
$86.38
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$364.67
|
| Rate for Payer: Molina Medicare |
$364.67
|
| Rate for Payer: Multiplan Auto |
$668.85
|
| Rate for Payer: Multiplan Commercial |
$668.85
|
| Rate for Payer: Multiplan Workers Comp |
$668.85
|
| Rate for Payer: Parkland Medicaid |
$86.38
|
| Rate for Payer: Scott and White EPO/PPO |
$6.52
|
| Rate for Payer: Scott and White Medicare |
$364.67
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$86.38
|
| 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
|
|
|
OPWC Remove Foreign Body, Simple BCE
|
Facility
|
IP
|
$1,029.00
|
|
|
Service Code
|
CPT 10120
|
| Hospital Charge Code |
8910569
|
|
Hospital Revenue Code
|
761
|
| Rate for Payer: Cash Price |
$905.52
|
|
|
OPWC Sel Sharp Deb <=20 Sq cm BCE
|
Facility
|
OP
|
$399.00
|
|
|
Service Code
|
CPT 97597
|
| Hospital Charge Code |
8912555
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3.27 |
| Max. Negotiated Rate |
$414.75 |
| Rate for Payer: Aetna Commercial |
$219.45
|
| Rate for Payer: Aetna Medicare |
$274.64
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$35.91
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$183.09
|
| Rate for Payer: Amerigroup Medicare |
$183.09
|
| 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 Medicare |
$183.09
|
| Rate for Payer: BCBS of TX PPO |
$50.00
|
| Rate for Payer: Cash Price |
$351.12
|
| Rate for Payer: Cash Price |
$351.12
|
| Rate for Payer: Cash Price |
$351.12
|
| Rate for Payer: Cigna Commercial |
$414.75
|
| 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 Dual Medicare/Medicaid |
$183.09
|
| Rate for Payer: Molina Medicare |
$183.09
|
| Rate for Payer: Multiplan Auto |
$259.35
|
| Rate for Payer: Multiplan Commercial |
$259.35
|
| Rate for Payer: Multiplan Workers Comp |
$259.35
|
| Rate for Payer: Scott and White EPO/PPO |
$3.27
|
| Rate for Payer: Scott and White Medicare |
$183.09
|
| 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
|
|
|
OPWC Sel Sharp Deb <=20 Sq cm BCE
|
Facility
|
IP
|
$399.00
|
|
|
Service Code
|
CPT 97597
|
| Hospital Charge Code |
8912555
|
|
Hospital Revenue Code
|
761
|
| Rate for Payer: Cash Price |
$351.12
|
|
|
OPWC Sel Sharp Deb Each Addl 20 cm BCE
|
Facility
|
IP
|
$351.00
|
|
|
Service Code
|
CPT 97598
|
| Hospital Charge Code |
8910571
|
|
Hospital Revenue Code
|
761
|
| Rate for Payer: Cash Price |
$308.88
|
|
|
OPWC Sel Sharp Deb Each Addl 20 cm BCE
|
Facility
|
OP
|
$351.00
|
|
|
Service Code
|
CPT 97598
|
| Hospital Charge Code |
8910571
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$31.59 |
| Max. Negotiated Rate |
$228.15 |
| Rate for Payer: Aetna Commercial |
$193.05
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$31.59
|
| 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 |
$308.88
|
| Rate for Payer: Cash Price |
$308.88
|
| Rate for Payer: Multiplan Auto |
$228.15
|
| Rate for Payer: Multiplan Commercial |
$228.15
|
| Rate for Payer: Multiplan Workers Comp |
$228.15
|
| Rate for Payer: Scott and White EPO/PPO |
$175.50
|
| Rate for Payer: Superior Health Plan EPO |
$47.74
|
|
|
OPWC Skin Sub Graft Face/Neck/Nk/Fh/G First 25 Sq cm BCE
|
Facility
|
IP
|
$3,398.00
|
|
|
Service Code
|
CPT 15275
|
| Hospital Charge Code |
8912557
|
|
Hospital Revenue Code
|
761
|
| Rate for Payer: Cash Price |
$2,990.24
|
|
|
OPWC Skin Sub Graft Face/Neck/Nk/Fh/G First 25 Sq cm BCE
|
Facility
|
OP
|
$3,398.00
|
|
|
Service Code
|
CPT 15275
|
| Hospital Charge Code |
8912557
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$29.83 |
| Max. Negotiated Rate |
$4,089.30 |
| Rate for Payer: Aetna Commercial |
$2,200.00
|
| Rate for Payer: Aetna Medicare |
$2,501.68
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$305.82
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,667.79
|
| Rate for Payer: Amerigroup Medicare |
$1,667.79
|
| 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 |
$1,667.79
|
| Rate for Payer: BCBS of TX PPO |
$4,089.30
|
| Rate for Payer: Cash Price |
$2,990.24
|
| Rate for Payer: Cash Price |
$2,990.24
|
| Rate for Payer: Cash Price |
$2,990.24
|
| Rate for Payer: Cigna Commercial |
$3,778.02
|
| Rate for Payer: Cigna Medicaid |
$709.01
|
| Rate for Payer: Cigna Medicare |
$1,667.79
|
| Rate for Payer: Employer Direct Commercial |
$1,667.79
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,667.79
|
| Rate for Payer: Molina CHIP/Medicaid |
$709.01
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,667.79
|
| Rate for Payer: Molina Medicare |
$1,667.79
|
| Rate for Payer: Multiplan Auto |
$2,208.70
|
| Rate for Payer: Multiplan Commercial |
$2,208.70
|
| Rate for Payer: Multiplan Workers Comp |
$2,208.70
|
| Rate for Payer: Parkland Medicaid |
$709.01
|
| Rate for Payer: Scott and White EPO/PPO |
$29.83
|
| Rate for Payer: Scott and White Medicare |
$1,667.79
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$709.01
|
| Rate for Payer: Superior Health Plan EPO |
$1,667.79
|
| Rate for Payer: Superior Health Plan Medicare |
$1,667.79
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,667.79
|
| Rate for Payer: Universal American Medicare |
$1,667.79
|
| Rate for Payer: Wellcare Medicare |
$1,667.79
|
| Rate for Payer: Wellmed Medicare |
$1,667.79
|
|
|
OPWC Skin Sub Grft Fce/Nck/FH/G Ch ad 20sqcm BCE
|
Facility
|
OP
|
$1,476.00
|
|
|
Service Code
|
CPT 15276
|
| Hospital Charge Code |
8910575
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$38.00 |
| Max. Negotiated Rate |
$959.40 |
| Rate for Payer: Aetna Commercial |
$811.80
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$132.84
|
| 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 |
$1,298.88
|
| Rate for Payer: Cash Price |
$1,298.88
|
| Rate for Payer: Multiplan Auto |
$959.40
|
| Rate for Payer: Multiplan Commercial |
$959.40
|
| Rate for Payer: Multiplan Workers Comp |
$959.40
|
| Rate for Payer: Scott and White EPO/PPO |
$738.00
|
| Rate for Payer: Superior Health Plan EPO |
$200.74
|
|
|
OPWC Skin Sub Grft Fce/Nck/FH/G Ch ad 20sqcm BCE
|
Facility
|
IP
|
$1,476.00
|
|
|
Service Code
|
CPT 15276
|
| Hospital Charge Code |
8910575
|
|
Hospital Revenue Code
|
761
|
| Rate for Payer: Cash Price |
$1,298.88
|
|
