|
OPWC Skin Sub Grft Trk/Arm/Leg Ch 1st 100sqcm BCE
|
Facility
|
IP
|
$6,927.00
|
|
|
Service Code
|
CPT 15273
|
| Hospital Charge Code |
8910573
|
|
Hospital Revenue Code
|
761
|
| Rate for Payer: Cash Price |
$6,095.76
|
|
|
OPWC Skin Sub Grft Trk/Arm/Leg Ch 1st 100sqcm BCE
|
Facility
|
OP
|
$6,927.00
|
|
|
Service Code
|
CPT 15273
|
| Hospital Charge Code |
8910573
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$58.68 |
| Max. Negotiated Rate |
$7,502.77 |
| Rate for Payer: Aetna Commercial |
$4,635.00
|
| Rate for Payer: Aetna Medicare |
$4,921.58
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$623.43
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3,281.05
|
| Rate for Payer: Amerigroup Medicare |
$3,281.05
|
| Rate for Payer: BCBS of TX Blue Advantage |
$4,972.07
|
| Rate for Payer: BCBS of TX Blue Essentials |
$5,954.58
|
| Rate for Payer: BCBS of TX Medicare |
$3,281.05
|
| Rate for Payer: BCBS of TX PPO |
$7,502.77
|
| Rate for Payer: Cash Price |
$6,095.76
|
| Rate for Payer: Cash Price |
$6,095.76
|
| Rate for Payer: Cash Price |
$6,095.76
|
| Rate for Payer: Cigna Commercial |
$7,432.53
|
| Rate for Payer: Cigna Medicaid |
$1,457.62
|
| Rate for Payer: Cigna Medicare |
$3,281.05
|
| Rate for Payer: Employer Direct Commercial |
$3,281.05
|
| Rate for Payer: Humana Medicare/TRICARE |
$3,281.05
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,457.62
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3,281.05
|
| Rate for Payer: Molina Medicare |
$3,281.05
|
| Rate for Payer: Multiplan Auto |
$4,502.55
|
| Rate for Payer: Multiplan Commercial |
$4,502.55
|
| Rate for Payer: Multiplan Workers Comp |
$4,502.55
|
| Rate for Payer: Parkland Medicaid |
$1,457.62
|
| Rate for Payer: Scott and White EPO/PPO |
$58.68
|
| Rate for Payer: Scott and White Medicare |
$3,281.05
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,457.62
|
| Rate for Payer: Superior Health Plan EPO |
$3,281.05
|
| Rate for Payer: Superior Health Plan Medicare |
$3,281.05
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3,281.05
|
| Rate for Payer: Universal American Medicare |
$3,281.05
|
| Rate for Payer: Wellcare Medicare |
$3,281.05
|
| Rate for Payer: Wellmed Medicare |
$3,281.05
|
|
|
OPWC Skin Sub Grft Trk/Arm/Leg Ch 1st 25 sqcm BCE
|
Facility
|
OP
|
$3,398.00
|
|
|
Service Code
|
CPT 15271
|
| Hospital Charge Code |
8912556
|
|
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 Trk/Arm/Leg Ch 1st 25 sqcm BCE
|
Facility
|
IP
|
$3,398.00
|
|
|
Service Code
|
CPT 15271
|
| Hospital Charge Code |
8912556
|
|
Hospital Revenue Code
|
761
|
| Rate for Payer: Cash Price |
$2,990.24
|
|
|
OPWC Skin Sub Grft Trk/Arm/Leg Ch ad 25 sqcm BCE
|
Facility
|
IP
|
$977.00
|
|
|
Service Code
|
CPT 15272
|
| Hospital Charge Code |
8910572
|
|
Hospital Revenue Code
|
761
|
| Rate for Payer: Cash Price |
$859.76
|
|
|
OPWC Skin Sub Grft Trk/Arm/Leg Ch ad 25 sqcm BCE
|
Facility
|
OP
|
$977.00
|
|
|
Service Code
|
CPT 15272
|
| Hospital Charge Code |
8910572
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$38.00 |
| Max. Negotiated Rate |
$635.05 |
| Rate for Payer: Aetna Commercial |
$537.35
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$87.93
|
| 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 |
$859.76
|
| Rate for Payer: Cash Price |
$859.76
|
| Rate for Payer: Multiplan Auto |
$635.05
|
| Rate for Payer: Multiplan Commercial |
$635.05
|
| Rate for Payer: Multiplan Workers Comp |
$635.05
|
| Rate for Payer: Scott and White EPO/PPO |
$488.50
|
| Rate for Payer: Superior Health Plan EPO |
$132.87
|
|
|
OPWC Skin Sub Grft Trnk/Arm/Leg Ch ad 100sqcm BCE
|
Facility
|
OP
|
$3,438.00
|
|
|
Service Code
|
CPT 15274
|
| Hospital Charge Code |
8910574
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$38.00 |
| Max. Negotiated Rate |
$2,234.70 |
| Rate for Payer: Aetna Commercial |
$1,890.90
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$309.42
|
| 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 |
$3,025.44
|
| Rate for Payer: Cash Price |
$3,025.44
|
| Rate for Payer: Multiplan Auto |
$2,234.70
|
| Rate for Payer: Multiplan Commercial |
$2,234.70
|
| Rate for Payer: Multiplan Workers Comp |
$2,234.70
|
| Rate for Payer: Scott and White EPO/PPO |
$1,719.00
|
| Rate for Payer: Superior Health Plan EPO |
$467.57
|
|
|
OPWC Skin Sub Grft Trnk/Arm/Leg Ch ad 100sqcm BCE
|
Facility
|
IP
|
$3,438.00
|
|
|
Service Code
|
CPT 15274
|
| Hospital Charge Code |
8910574
|
|
Hospital Revenue Code
|
761
|
| Rate for Payer: Cash Price |
$3,025.44
|
|
|
OPWC Strapping Una Boot Lt BCE
|
Facility
|
IP
|
$353.00
|
|
|
Service Code
|
CPT 29580 LT
|
| Hospital Charge Code |
8910576
|
|
Hospital Revenue Code
|
761
|
| Rate for Payer: Cash Price |
$310.64
|
|
|
OPWC Strapping Una Boot Lt BCE
|
Facility
|
OP
|
$353.00
|
|
|
Service Code
|
CPT 29580 LT
|
| Hospital Charge Code |
8910576
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2.58 |
| Max. Negotiated Rate |
$326.44 |
| Rate for Payer: Aetna Commercial |
$194.15
|
| Rate for Payer: Aetna Medicare |
$216.15
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$31.77
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$144.10
|
| Rate for Payer: Amerigroup Medicare |
$144.10
|
| Rate for Payer: BCBS of TX Blue Advantage |
$70.51
|
| Rate for Payer: BCBS of TX Blue Essentials |
$84.44
|
| Rate for Payer: BCBS of TX Medicare |
$144.10
|
| Rate for Payer: BCBS of TX PPO |
$106.39
|
| Rate for Payer: Cash Price |
$310.64
|
| Rate for Payer: Cash Price |
$310.64
|
| Rate for Payer: Cash Price |
$310.64
|
| Rate for Payer: Cigna Commercial |
$326.44
|
| Rate for Payer: Cigna Medicaid |
$35.16
|
| Rate for Payer: Cigna Medicare |
$144.10
|
| Rate for Payer: Employer Direct Commercial |
$144.10
|
| Rate for Payer: Humana Medicare/TRICARE |
$144.10
|
| Rate for Payer: Molina CHIP/Medicaid |
$35.16
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$144.10
|
| Rate for Payer: Molina Medicare |
$144.10
|
| Rate for Payer: Multiplan Auto |
$229.45
|
| Rate for Payer: Multiplan Commercial |
$229.45
|
| Rate for Payer: Multiplan Workers Comp |
$229.45
|
| Rate for Payer: Parkland Medicaid |
$35.16
|
| Rate for Payer: Scott and White EPO/PPO |
$2.58
|
| Rate for Payer: Scott and White Medicare |
$144.10
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$35.16
|
| Rate for Payer: Superior Health Plan EPO |
$144.10
|
| Rate for Payer: Superior Health Plan Medicare |
$144.10
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$144.10
|
| Rate for Payer: Universal American Medicare |
$144.10
|
| Rate for Payer: Wellcare Medicare |
$144.10
|
| Rate for Payer: Wellmed Medicare |
$144.10
|
|
|
OPWC Strapping Una Boot Rt BCE
|
Facility
|
IP
|
$353.00
|
|
|
Service Code
|
CPT 29580 RT
|
| Hospital Charge Code |
8912558
|
|
Hospital Revenue Code
|
761
|
| Rate for Payer: Cash Price |
$310.64
|
|
|
OPWC Strapping Una Boot Rt BCE
|
Facility
|
OP
|
$353.00
|
|
|
Service Code
|
CPT 29580 RT
|
| Hospital Charge Code |
8912558
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2.58 |
| Max. Negotiated Rate |
$326.44 |
| Rate for Payer: Aetna Commercial |
$194.15
|
| Rate for Payer: Aetna Medicare |
$216.15
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$31.77
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$144.10
|
| Rate for Payer: Amerigroup Medicare |
$144.10
|
| Rate for Payer: BCBS of TX Blue Advantage |
$70.51
|
| Rate for Payer: BCBS of TX Blue Essentials |
$84.44
|
| Rate for Payer: BCBS of TX Medicare |
$144.10
|
| Rate for Payer: BCBS of TX PPO |
$106.39
|
| Rate for Payer: Cash Price |
$310.64
|
| Rate for Payer: Cash Price |
$310.64
|
| Rate for Payer: Cash Price |
$310.64
|
| Rate for Payer: Cigna Commercial |
$326.44
|
| Rate for Payer: Cigna Medicaid |
$35.16
|
| Rate for Payer: Cigna Medicare |
$144.10
|
| Rate for Payer: Employer Direct Commercial |
$144.10
|
| Rate for Payer: Humana Medicare/TRICARE |
$144.10
|
| Rate for Payer: Molina CHIP/Medicaid |
$35.16
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$144.10
|
| Rate for Payer: Molina Medicare |
$144.10
|
| Rate for Payer: Multiplan Auto |
$229.45
|
| Rate for Payer: Multiplan Commercial |
$229.45
|
| Rate for Payer: Multiplan Workers Comp |
$229.45
|
| Rate for Payer: Parkland Medicaid |
$35.16
|
| Rate for Payer: Scott and White EPO/PPO |
$2.58
|
| Rate for Payer: Scott and White Medicare |
$144.10
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$35.16
|
| Rate for Payer: Superior Health Plan EPO |
$144.10
|
| Rate for Payer: Superior Health Plan Medicare |
$144.10
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$144.10
|
| Rate for Payer: Universal American Medicare |
$144.10
|
| Rate for Payer: Wellcare Medicare |
$144.10
|
| Rate for Payer: Wellmed Medicare |
$144.10
|
|
|
OPWC Tangntl Bx Skin Ea Sep/Addl BCE
|
Facility
|
IP
|
$399.00
|
|
|
Service Code
|
CPT 11103
|
| Hospital Charge Code |
8914561
|
|
Hospital Revenue Code
|
761
|
| Rate for Payer: Cash Price |
$351.12
|
|
|
OPWC Tangntl Bx Skin Ea Sep/Addl BCE
|
Facility
|
OP
|
$399.00
|
|
|
Service Code
|
CPT 11103
|
| Hospital Charge Code |
8914561
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$35.91 |
| Max. Negotiated Rate |
$259.35 |
| Rate for Payer: Aetna Commercial |
$219.45
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$35.91
|
| 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 |
$351.12
|
| Rate for Payer: Cash Price |
$351.12
|
| 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 |
$199.50
|
| Rate for Payer: Superior Health Plan EPO |
$54.26
|
|
|
OPWC Tangntl Bx Skin Single Les BCE
|
Facility
|
OP
|
$715.00
|
|
|
Service Code
|
CPT 11102
|
| Hospital Charge Code |
8912559
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3.27 |
| Max. Negotiated Rate |
$464.75 |
| Rate for Payer: Aetna Commercial |
$393.25
|
| Rate for Payer: Aetna Medicare |
$274.64
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$64.35
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$183.09
|
| Rate for Payer: Amerigroup Medicare |
$183.09
|
| Rate for Payer: BCBS of TX Blue Advantage |
$126.57
|
| Rate for Payer: BCBS of TX Blue Essentials |
$151.58
|
| Rate for Payer: BCBS of TX Medicare |
$183.09
|
| Rate for Payer: BCBS of TX PPO |
$190.99
|
| Rate for Payer: Cash Price |
$629.20
|
| Rate for Payer: Cash Price |
$629.20
|
| Rate for Payer: Cash Price |
$629.20
|
| Rate for Payer: Cigna Commercial |
$414.75
|
| Rate for Payer: Cigna Medicaid |
$64.23
|
| 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 |
$64.23
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$183.09
|
| Rate for Payer: Molina Medicare |
$183.09
|
| Rate for Payer: Multiplan Auto |
$464.75
|
| Rate for Payer: Multiplan Commercial |
$464.75
|
| Rate for Payer: Multiplan Workers Comp |
$464.75
|
| Rate for Payer: Parkland Medicaid |
$64.23
|
| 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 |
$64.23
|
| 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 Tangntl Bx Skin Single Les BCE
|
Facility
|
IP
|
$715.00
|
|
|
Service Code
|
CPT 11102
|
| Hospital Charge Code |
8912559
|
|
Hospital Revenue Code
|
761
|
| Rate for Payer: Cash Price |
$629.20
|
|
|
OPWC Tobacco Counsel >10Min Symtomatic BCE
|
Facility
|
OP
|
$97.00
|
|
|
Service Code
|
CPT 99407
|
| Hospital Charge Code |
8910577
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.47 |
| Max. Negotiated Rate |
$63.05 |
| Rate for Payer: Aetna Commercial |
$53.35
|
| Rate for Payer: Aetna Medicare |
$39.36
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$8.73
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$26.24
|
| Rate for Payer: Amerigroup Medicare |
$26.24
|
| 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 |
$26.24
|
| Rate for Payer: BCBS of TX PPO |
$50.00
|
| Rate for Payer: Cash Price |
$85.36
|
| Rate for Payer: Cash Price |
$85.36
|
| Rate for Payer: Cash Price |
$85.36
|
| Rate for Payer: Cigna Commercial |
$59.45
|
| Rate for Payer: Cigna Medicaid |
$20.07
|
| Rate for Payer: Cigna Medicare |
$26.24
|
| Rate for Payer: Employer Direct Commercial |
$26.24
|
| Rate for Payer: Humana Medicare/TRICARE |
$26.24
|
| Rate for Payer: Molina CHIP/Medicaid |
$20.07
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$26.24
|
| Rate for Payer: Molina Medicare |
$26.24
|
| Rate for Payer: Multiplan Auto |
$63.05
|
| Rate for Payer: Multiplan Commercial |
$63.05
|
| Rate for Payer: Multiplan Workers Comp |
$63.05
|
| Rate for Payer: Parkland Medicaid |
$20.07
|
| Rate for Payer: Scott and White EPO/PPO |
$0.47
|
| Rate for Payer: Scott and White Medicare |
$26.24
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$20.07
|
| Rate for Payer: Superior Health Plan EPO |
$26.24
|
| Rate for Payer: Superior Health Plan Medicare |
$26.24
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$26.24
|
| Rate for Payer: Universal American Medicare |
$26.24
|
| Rate for Payer: Wellcare Medicare |
$26.24
|
| Rate for Payer: Wellmed Medicare |
$26.24
|
|
|
OPWC Tobacco Counsel >10Min Symtomatic BCE
|
Facility
|
IP
|
$97.00
|
|
|
Service Code
|
CPT 99407
|
| Hospital Charge Code |
8910577
|
|
Hospital Revenue Code
|
761
|
| Rate for Payer: Cash Price |
$85.36
|
|
|
OPWC Trim Nails Any Number BCE
|
Facility
|
IP
|
$191.00
|
|
|
Service Code
|
CPT 11719
|
| Hospital Charge Code |
8910578
|
|
Hospital Revenue Code
|
761
|
| Rate for Payer: Cash Price |
$168.08
|
|
|
OPWC Trim Nails Any Number BCE
|
Facility
|
OP
|
$191.00
|
|
|
Service Code
|
CPT 11719
|
| Hospital Charge Code |
8910578
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$138.63 |
| Rate for Payer: Aetna Commercial |
$105.05
|
| Rate for Payer: Aetna Medicare |
$83.91
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$17.19
|
| 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 |
$168.08
|
| Rate for Payer: Cash Price |
$168.08
|
| Rate for Payer: Cash Price |
$168.08
|
| 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 |
$124.15
|
| Rate for Payer: Multiplan Commercial |
$124.15
|
| Rate for Payer: Multiplan Workers Comp |
$124.15
|
| 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 Unna Boot Bilateral BCE
|
Facility
|
OP
|
$530.00
|
|
|
Service Code
|
CPT 29580 50
|
| Hospital Charge Code |
8910579
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2.58 |
| Max. Negotiated Rate |
$344.50 |
| Rate for Payer: Aetna Commercial |
$291.50
|
| Rate for Payer: Aetna Medicare |
$216.15
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$47.70
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$144.10
|
| Rate for Payer: Amerigroup Medicare |
$144.10
|
| Rate for Payer: BCBS of TX Blue Advantage |
$70.51
|
| Rate for Payer: BCBS of TX Blue Essentials |
$84.44
|
| Rate for Payer: BCBS of TX Medicare |
$144.10
|
| Rate for Payer: BCBS of TX PPO |
$106.39
|
| Rate for Payer: Cash Price |
$466.40
|
| Rate for Payer: Cash Price |
$466.40
|
| Rate for Payer: Cash Price |
$466.40
|
| Rate for Payer: Cigna Commercial |
$326.44
|
| Rate for Payer: Cigna Medicaid |
$35.16
|
| Rate for Payer: Cigna Medicare |
$144.10
|
| Rate for Payer: Employer Direct Commercial |
$144.10
|
| Rate for Payer: Humana Medicare/TRICARE |
$144.10
|
| Rate for Payer: Molina CHIP/Medicaid |
$35.16
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$144.10
|
| Rate for Payer: Molina Medicare |
$144.10
|
| Rate for Payer: Multiplan Auto |
$344.50
|
| Rate for Payer: Multiplan Commercial |
$344.50
|
| Rate for Payer: Multiplan Workers Comp |
$344.50
|
| Rate for Payer: Parkland Medicaid |
$35.16
|
| Rate for Payer: Scott and White EPO/PPO |
$2.58
|
| Rate for Payer: Scott and White Medicare |
$144.10
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$35.16
|
| Rate for Payer: Superior Health Plan EPO |
$144.10
|
| Rate for Payer: Superior Health Plan Medicare |
$144.10
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$144.10
|
| Rate for Payer: Universal American Medicare |
$144.10
|
| Rate for Payer: Wellcare Medicare |
$144.10
|
| Rate for Payer: Wellmed Medicare |
$144.10
|
|
|
OPWC Unna Boot Bilateral BCE
|
Facility
|
IP
|
$530.00
|
|
|
Service Code
|
CPT 29580 50
|
| Hospital Charge Code |
8910579
|
|
Hospital Revenue Code
|
761
|
| Rate for Payer: Cash Price |
$466.40
|
|
|
ORBITAL PROCEDURES WITH CC/MCC
|
Facility
|
IP
|
$47,638.70
|
|
|
Service Code
|
MSDRG 113
|
| Min. Negotiated Rate |
$18,035.92 |
| Max. Negotiated Rate |
$47,638.70 |
| Rate for Payer: Aetna Commercial |
$28,207.12
|
| Rate for Payer: Aetna Medicare |
$31,120.53
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$20,747.02
|
| Rate for Payer: Amerigroup Medicare |
$20,747.02
|
| Rate for Payer: BCBS of TX Blue Advantage |
$18,035.92
|
| Rate for Payer: BCBS of TX Blue Essentials |
$23,761.56
|
| Rate for Payer: BCBS of TX Medicare |
$20,747.02
|
| Rate for Payer: BCBS of TX PPO |
$26,402.76
|
| Rate for Payer: Cigna Commercial |
$32,294.02
|
| Rate for Payer: Cigna Medicare |
$20,747.02
|
| Rate for Payer: Employer Direct Commercial |
$20,747.02
|
| Rate for Payer: Humana Medicare/TRICARE |
$20,747.02
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$20,747.02
|
| Rate for Payer: Molina Medicare |
$20,747.02
|
| Rate for Payer: Multiplan Auto |
$47,638.70
|
| Rate for Payer: Multiplan Commercial |
$47,638.70
|
| Rate for Payer: Multiplan Workers Comp |
$47,638.70
|
| Rate for Payer: Scott and White EPO/PPO |
$21,938.88
|
| Rate for Payer: Scott and White Medicare |
$20,747.02
|
| Rate for Payer: Superior Health Plan EPO |
$20,747.02
|
| Rate for Payer: Superior Health Plan Medicare |
$20,747.02
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$20,747.02
|
| Rate for Payer: Universal American Medicare |
$20,747.02
|
| Rate for Payer: Wellcare Medicare |
$20,747.02
|
| Rate for Payer: Wellmed Medicare |
$20,747.02
|
|
|
ORBITAL PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$23,404.20
|
|
|
Service Code
|
MSDRG 114
|
| Min. Negotiated Rate |
$10,279.58 |
| Max. Negotiated Rate |
$23,404.20 |
| Rate for Payer: Aetna Commercial |
$13,857.75
|
| Rate for Payer: Aetna Medicare |
$17,467.47
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$11,644.98
|
| Rate for Payer: Amerigroup Medicare |
$11,644.98
|
| Rate for Payer: BCBS of TX Blue Advantage |
$10,279.58
|
| Rate for Payer: BCBS of TX Blue Essentials |
$12,951.38
|
| Rate for Payer: BCBS of TX Medicare |
$11,644.98
|
| Rate for Payer: BCBS of TX PPO |
$14,390.98
|
| Rate for Payer: Cigna Commercial |
$15,865.58
|
| Rate for Payer: Cigna Medicare |
$11,644.98
|
| Rate for Payer: Employer Direct Commercial |
$11,644.98
|
| Rate for Payer: Humana Medicare/TRICARE |
$11,644.98
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$11,644.98
|
| Rate for Payer: Molina Medicare |
$11,644.98
|
| Rate for Payer: Multiplan Auto |
$23,404.20
|
| Rate for Payer: Multiplan Commercial |
$23,404.20
|
| Rate for Payer: Multiplan Workers Comp |
$23,404.20
|
| Rate for Payer: Scott and White EPO/PPO |
$10,778.25
|
| Rate for Payer: Scott and White Medicare |
$11,644.98
|
| Rate for Payer: Superior Health Plan EPO |
$11,644.98
|
| Rate for Payer: Superior Health Plan Medicare |
$11,644.98
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$11,644.98
|
| Rate for Payer: Universal American Medicare |
$11,644.98
|
| Rate for Payer: Wellcare Medicare |
$11,644.98
|
| Rate for Payer: Wellmed Medicare |
$11,644.98
|
|
|
ORGANIC DISTURBANCES AND INTELLECTUAL DISABILITY
|
Facility
|
IP
|
$33,381.10
|
|
|
Service Code
|
MSDRG 884
|
| Min. Negotiated Rate |
$10,107.58 |
| Max. Negotiated Rate |
$33,381.10 |
| Rate for Payer: Aetna Commercial |
$19,765.12
|
| Rate for Payer: Aetna Medicare |
$23,088.20
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$15,392.13
|
| Rate for Payer: Amerigroup Medicare |
$15,392.13
|
| Rate for Payer: BCBS of TX Blue Advantage |
$10,107.58
|
| Rate for Payer: BCBS of TX Blue Essentials |
$13,908.98
|
| Rate for Payer: BCBS of TX Medicare |
$15,392.13
|
| Rate for Payer: BCBS of TX PPO |
$15,455.02
|
| Rate for Payer: Cigna Commercial |
$22,628.87
|
| Rate for Payer: Cigna Medicare |
$15,392.13
|
| Rate for Payer: Employer Direct Commercial |
$15,392.13
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$15,392.13
|
| Rate for Payer: Molina Medicare |
$15,392.13
|
| Rate for Payer: Multiplan Auto |
$33,381.10
|
| Rate for Payer: Multiplan Commercial |
$33,381.10
|
| Rate for Payer: Multiplan Workers Comp |
$33,381.10
|
| Rate for Payer: Scott and White EPO/PPO |
$15,372.88
|
| Rate for Payer: Scott and White Medicare |
$15,392.13
|
| Rate for Payer: Superior Health Plan EPO |
$15,392.13
|
| Rate for Payer: Superior Health Plan Medicare |
$15,392.13
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$15,392.13
|
| Rate for Payer: Universal American Medicare |
$15,392.13
|
| Rate for Payer: Wellcare Medicare |
$15,392.13
|
| Rate for Payer: Wellmed Medicare |
$15,392.13
|
|
