|
adenosine 3 mg/mL IV Soln 2 mL
|
Facility
|
IP
|
$128.17
|
|
|
Service Code
|
HCPCS J0153
|
| Hospital Charge Code |
7602
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.04 |
| Max. Negotiated Rate |
$64.08 |
| Rate for Payer: Cash Price |
$87.16
|
| Rate for Payer: Cigna Commercial |
$32.04
|
| Rate for Payer: Scott and White EPO/PPO |
$64.08
|
|
|
adenosine 3 mg/mL IV Soln 2 mL
|
Facility
|
OP
|
$128.17
|
|
|
Service Code
|
HCPCS J0153
|
| Hospital Charge Code |
7602
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.83 |
| Max. Negotiated Rate |
$92.28 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$11.54
|
| Rate for Payer: BCBS of TX Blue Advantage |
$1.83
|
| Rate for Payer: BCBS of TX Blue Essentials |
$2.19
|
| Rate for Payer: BCBS of TX PPO |
$2.43
|
| Rate for Payer: Cash Price |
$87.16
|
| Rate for Payer: Cash Price |
$87.16
|
| Rate for Payer: Cigna Medicaid |
$92.28
|
| Rate for Payer: Molina CHIP/Medicaid |
$92.28
|
| Rate for Payer: Multiplan Auto |
$83.31
|
| Rate for Payer: Multiplan Commercial |
$83.31
|
| Rate for Payer: Multiplan Workers Comp |
$83.31
|
| Rate for Payer: Parkland Medicaid |
$92.28
|
| Rate for Payer: Scott and White EPO/PPO |
$64.08
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$92.28
|
| Rate for Payer: Superior Health Plan EPO |
$17.43
|
|
|
Adenosine Deaminase,Pleural Fl SO
|
Facility
|
OP
|
$334.00
|
|
|
Service Code
|
HCPCS 84311
|
| Hospital Charge Code |
1708650
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.16 |
| Max. Negotiated Rate |
$240.48 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$3.16
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$8.10
|
| Rate for Payer: Amerigroup Medicare |
$8.10
|
| Rate for Payer: BCBS of TX Blue Advantage |
$100.20
|
| Rate for Payer: BCBS of TX Blue Essentials |
$120.24
|
| Rate for Payer: BCBS of TX Medicare |
$8.10
|
| Rate for Payer: BCBS of TX PPO |
$133.60
|
| Rate for Payer: Cash Price |
$227.12
|
| Rate for Payer: Cash Price |
$227.12
|
| Rate for Payer: Cigna Medicaid |
$240.48
|
| Rate for Payer: Cigna Medicare |
$8.10
|
| Rate for Payer: Employer Direct Commercial |
$8.10
|
| Rate for Payer: Humana Medicare/TRICARE |
$8.10
|
| Rate for Payer: Molina CHIP/Medicaid |
$240.48
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$8.10
|
| Rate for Payer: Molina Medicare |
$8.10
|
| Rate for Payer: Multiplan Auto |
$217.10
|
| Rate for Payer: Multiplan Commercial |
$217.10
|
| Rate for Payer: Multiplan Workers Comp |
$217.10
|
| Rate for Payer: Parkland Medicaid |
$240.48
|
| Rate for Payer: Scott and White EPO/PPO |
$10.12
|
| Rate for Payer: Scott and White Medicare |
$8.10
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$240.48
|
| Rate for Payer: Superior Health Plan EPO |
$8.10
|
| Rate for Payer: Superior Health Plan Medicare |
$8.10
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$8.10
|
| Rate for Payer: Universal American Medicare |
$8.10
|
| Rate for Payer: Wellcare Medicare |
$8.10
|
| Rate for Payer: Wellmed Medicare |
$8.10
|
|
|
Adenosine Deaminase,Pleural Fl SO
|
Facility
|
IP
|
$334.00
|
|
|
Service Code
|
HCPCS 84311
|
| Hospital Charge Code |
1708650
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$227.12
|
|
|
ADHESIVE, SKIN, DERMABOND, ADVANCED, 0.7
|
Facility
|
OP
|
$74.71
|
|
| Hospital Charge Code |
992817
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.72 |
| Max. Negotiated Rate |
$53.79 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$6.72
|
| Rate for Payer: BCBS of TX Blue Advantage |
$22.41
|
| Rate for Payer: BCBS of TX Blue Essentials |
$26.90
|
| Rate for Payer: BCBS of TX PPO |
$29.88
|
| Rate for Payer: Cash Price |
$50.80
|
| Rate for Payer: Cigna Medicaid |
$53.79
|
| Rate for Payer: Molina CHIP/Medicaid |
$53.79
|
| Rate for Payer: Multiplan Auto |
$48.56
|
| Rate for Payer: Multiplan Commercial |
$48.56
|
| Rate for Payer: Multiplan Workers Comp |
$48.56
|
| Rate for Payer: Parkland Medicaid |
$53.79
|
| Rate for Payer: Scott and White EPO/PPO |
$37.35
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$53.79
|
| Rate for Payer: Superior Health Plan EPO |
$10.16
|
|
|
ADHESIVE, SKIN, DERMABOND, ADVANCED, 0.7
|
Facility
|
IP
|
$74.71
|
|
| Hospital Charge Code |
992817
|
|
Hospital Revenue Code
|
272
|
| Rate for Payer: Cash Price |
$50.80
|
|
|
ADHESIVE, SKIN TOPICAL ADVANCED DERMABOND 0.7ML -- DHF
|
Facility
|
IP
|
$289.78
|
|
| Hospital Charge Code |
80220205
|
|
Hospital Revenue Code
|
272
|
| Rate for Payer: Cash Price |
$197.05
|
|
|
ADHESIVE, SKIN TOPICAL ADVANCED DERMABOND 0.7ML -- DHF
|
Facility
|
OP
|
$289.78
|
|
| Hospital Charge Code |
80220205
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$26.08 |
| Max. Negotiated Rate |
$208.64 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$26.08
|
| Rate for Payer: BCBS of TX Blue Advantage |
$86.93
|
| Rate for Payer: BCBS of TX Blue Essentials |
$104.32
|
| Rate for Payer: BCBS of TX PPO |
$115.91
|
| Rate for Payer: Cash Price |
$197.05
|
| Rate for Payer: Cigna Medicaid |
$208.64
|
| Rate for Payer: Molina CHIP/Medicaid |
$208.64
|
| Rate for Payer: Multiplan Auto |
$188.36
|
| Rate for Payer: Multiplan Commercial |
$188.36
|
| Rate for Payer: Multiplan Workers Comp |
$188.36
|
| Rate for Payer: Parkland Medicaid |
$208.64
|
| Rate for Payer: Scott and White EPO/PPO |
$144.89
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$208.64
|
| Rate for Payer: Superior Health Plan EPO |
$39.41
|
|
|
ADHESIVE, SKIN TOPICAL HI VICOSITY PEN X-LARGE -- DHF
|
Facility
|
IP
|
$213.43
|
|
| Hospital Charge Code |
80220007
|
|
Hospital Revenue Code
|
272
|
| Rate for Payer: Cash Price |
$145.13
|
|
|
ADHESIVE, SKIN TOPICAL HI VICOSITY PEN X-LARGE -- DHF
|
Facility
|
OP
|
$213.43
|
|
| Hospital Charge Code |
80220007
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$19.21 |
| Max. Negotiated Rate |
$153.67 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$19.21
|
| Rate for Payer: BCBS of TX Blue Advantage |
$64.03
|
| Rate for Payer: BCBS of TX Blue Essentials |
$76.83
|
| Rate for Payer: BCBS of TX PPO |
$85.37
|
| Rate for Payer: Cash Price |
$145.13
|
| Rate for Payer: Cigna Medicaid |
$153.67
|
| Rate for Payer: Molina CHIP/Medicaid |
$153.67
|
| Rate for Payer: Multiplan Auto |
$138.73
|
| Rate for Payer: Multiplan Commercial |
$138.73
|
| Rate for Payer: Multiplan Workers Comp |
$138.73
|
| Rate for Payer: Parkland Medicaid |
$153.67
|
| Rate for Payer: Scott and White EPO/PPO |
$106.72
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$153.67
|
| Rate for Payer: Superior Health Plan EPO |
$29.03
|
|
|
ADHES TOPICAL SKN 2 -- DHF
|
Facility
|
IP
|
$774.71
|
|
| Hospital Charge Code |
80220213
|
|
Hospital Revenue Code
|
272
|
| Rate for Payer: Cash Price |
$526.80
|
|
|
ADHES TOPICAL SKN 2 -- DHF
|
Facility
|
OP
|
$774.71
|
|
| Hospital Charge Code |
80220213
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$69.72 |
| Max. Negotiated Rate |
$557.79 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$69.72
|
| Rate for Payer: BCBS of TX Blue Advantage |
$232.41
|
| Rate for Payer: BCBS of TX Blue Essentials |
$278.90
|
| Rate for Payer: BCBS of TX PPO |
$309.88
|
| Rate for Payer: Cash Price |
$526.80
|
| Rate for Payer: Cigna Medicaid |
$557.79
|
| Rate for Payer: Molina CHIP/Medicaid |
$557.79
|
| Rate for Payer: Multiplan Auto |
$503.56
|
| Rate for Payer: Multiplan Commercial |
$503.56
|
| Rate for Payer: Multiplan Workers Comp |
$503.56
|
| Rate for Payer: Parkland Medicaid |
$557.79
|
| Rate for Payer: Scott and White EPO/PPO |
$387.36
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$557.79
|
| Rate for Payer: Superior Health Plan EPO |
$105.36
|
|
|
ADH SO
|
Facility
|
IP
|
$289.63
|
|
|
Service Code
|
HCPCS 84588
|
| Hospital Charge Code |
9130979
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$196.95
|
|
|
ADH SO
|
Facility
|
OP
|
$289.63
|
|
|
Service Code
|
HCPCS 84588
|
| Hospital Charge Code |
9130979
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.24 |
| Max. Negotiated Rate |
$208.53 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$13.24
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$33.94
|
| Rate for Payer: Amerigroup Medicare |
$33.94
|
| Rate for Payer: BCBS of TX Blue Advantage |
$86.89
|
| Rate for Payer: BCBS of TX Blue Essentials |
$104.27
|
| Rate for Payer: BCBS of TX Medicare |
$33.94
|
| Rate for Payer: BCBS of TX PPO |
$115.85
|
| Rate for Payer: Cash Price |
$196.95
|
| Rate for Payer: Cash Price |
$196.95
|
| Rate for Payer: Cigna Medicaid |
$208.53
|
| Rate for Payer: Cigna Medicare |
$33.94
|
| Rate for Payer: Employer Direct Commercial |
$33.94
|
| Rate for Payer: Humana Medicare/TRICARE |
$33.94
|
| Rate for Payer: Molina CHIP/Medicaid |
$208.53
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$33.94
|
| Rate for Payer: Molina Medicare |
$33.94
|
| Rate for Payer: Multiplan Auto |
$188.26
|
| Rate for Payer: Multiplan Commercial |
$188.26
|
| Rate for Payer: Multiplan Workers Comp |
$188.26
|
| Rate for Payer: Parkland Medicaid |
$208.53
|
| Rate for Payer: Scott and White EPO/PPO |
$42.42
|
| Rate for Payer: Scott and White Medicare |
$33.94
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$208.53
|
| Rate for Payer: Superior Health Plan EPO |
$33.94
|
| Rate for Payer: Superior Health Plan Medicare |
$33.94
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$33.94
|
| Rate for Payer: Universal American Medicare |
$33.94
|
| Rate for Payer: Wellcare Medicare |
$33.94
|
| Rate for Payer: Wellmed Medicare |
$33.94
|
|
|
Adjacent tissue transfer or rearrangement, any area defect 30.1 sq cm to 60.0 sq cm
|
Facility
|
OP
|
$17,863.74
|
|
|
Service Code
|
HCPCS 14301
|
| Hospital Charge Code |
9900121
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,457.62 |
| Max. Negotiated Rate |
$12,861.89 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,457.62
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3,559.87
|
| Rate for Payer: Amerigroup Medicare |
$3,559.87
|
| 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 |
$3,559.87
|
| Rate for Payer: BCBS of TX PPO |
$7,502.77
|
| Rate for Payer: Cash Price |
$12,147.34
|
| Rate for Payer: Cash Price |
$12,147.34
|
| Rate for Payer: Cash Price |
$12,147.34
|
| Rate for Payer: Cigna Commercial |
$7,524.93
|
| Rate for Payer: Cigna Medicaid |
$12,861.89
|
| Rate for Payer: Cigna Medicare |
$3,559.87
|
| Rate for Payer: Employer Direct Commercial |
$3,559.87
|
| Rate for Payer: Humana Medicare/TRICARE |
$3,559.87
|
| Rate for Payer: Molina CHIP/Medicaid |
$12,861.89
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3,559.87
|
| Rate for Payer: Molina Medicare |
$3,559.87
|
| 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 |
$12,861.89
|
| Rate for Payer: Scott and White EPO/PPO |
$6,069.94
|
| Rate for Payer: Scott and White Medicare |
$3,559.87
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$12,861.89
|
| Rate for Payer: Superior Health Plan EPO |
$3,559.87
|
| Rate for Payer: Superior Health Plan Medicare |
$3,559.87
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3,559.87
|
| Rate for Payer: Universal American Medicare |
$3,559.87
|
| Rate for Payer: Wellcare Medicare |
$3,559.87
|
| Rate for Payer: Wellmed Medicare |
$3,559.87
|
|
|
Adjacent tissue transfer or rearrangement, any area defect 30.1 sq cm to 60.0 sq cm
|
Facility
|
IP
|
$17,863.74
|
|
|
Service Code
|
HCPCS 14301
|
| Hospital Charge Code |
9900121
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$12,147.34
|
|
|
Adjacent tissue transfer or rearrangement, any area defect 30.1 sq cm to 60.0 sq cm
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 14301
|
| Hospital Charge Code |
36014301
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,457.62 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,457.62
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3,559.87
|
| Rate for Payer: Amerigroup Medicare |
$3,559.87
|
| 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 |
$3,559.87
|
| Rate for Payer: BCBS of TX PPO |
$7,502.77
|
| Rate for Payer: Cigna Commercial |
$7,524.93
|
| Rate for Payer: Cigna Medicare |
$3,559.87
|
| Rate for Payer: Employer Direct Commercial |
$3,559.87
|
| Rate for Payer: Humana Medicare/TRICARE |
$3,559.87
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3,559.87
|
| Rate for Payer: Molina Medicare |
$3,559.87
|
| 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 |
$6,069.94
|
| Rate for Payer: Scott and White Medicare |
$3,559.87
|
| Rate for Payer: Superior Health Plan EPO |
$3,559.87
|
| Rate for Payer: Superior Health Plan Medicare |
$3,559.87
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3,559.87
|
| Rate for Payer: Universal American Medicare |
$3,559.87
|
| Rate for Payer: Wellcare Medicare |
$3,559.87
|
| Rate for Payer: Wellmed Medicare |
$3,559.87
|
|
|
Adjacent tissue transfer or rearrangement, eyelids, nose, ears and/or lips defect 10.1 sq cm to 30.
|
Facility
|
IP
|
$6,003.76
|
|
|
Service Code
|
HCPCS 14061
|
| Hospital Charge Code |
9900120
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$4,082.56
|
|
|
Adjacent tissue transfer or rearrangement, eyelids, nose, ears and/or lips defect 10.1 sq cm to 30.
|
Facility
|
OP
|
$6,003.76
|
|
|
Service Code
|
HCPCS 14061
|
| Hospital Charge Code |
9900120
|
|
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 |
$4,082.56
|
| Rate for Payer: Cash Price |
$4,082.56
|
| Rate for Payer: Cash Price |
$4,082.56
|
| Rate for Payer: Cigna Commercial |
$4,381.27
|
| Rate for Payer: Cigna Medicaid |
$4,322.71
|
| 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 |
$4,322.71
|
| 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 |
$4,322.71
|
| 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 |
$4,322.71
|
| 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
|
|
|
Adjacent tissue transfer or rearrangement, eyelids, nose, ears and/or lips defect 10.1 sq cm to 30.
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 14061
|
| Hospital Charge Code |
36014061
|
|
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: Cigna Commercial |
$4,381.27
|
| 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 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: Scott and White EPO/PPO |
$3,085.41
|
| Rate for Payer: Scott and White Medicare |
$2,072.68
|
| 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
|
|
|
Adjacent tissue transfer or rearrangement, eyelids, nose, ears and/or lips; defect 10 sq cm or less
|
Facility
|
IP
|
$7,316.92
|
|
|
Service Code
|
HCPCS 14060
|
| Hospital Charge Code |
994167
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$4,975.51
|
|
|
Adjacent tissue transfer or rearrangement, eyelids, nose, ears and/or lips; defect 10 sq cm or less
|
Facility
|
OP
|
$7,316.92
|
|
|
Service Code
|
HCPCS 14060
|
| Hospital Charge Code |
994167
|
|
Hospital Revenue Code
|
361
|
| 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
|
|
|
Adjacent tissue transfer or rearrangement, forehead, cheeks, chin, mouth, neck, axillae, genitalia,
|
Facility
|
OP
|
$5,524.00
|
|
|
Service Code
|
HCPCS 14040
|
| Hospital Charge Code |
9900119
|
|
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 |
$3,756.32
|
| Rate for Payer: Cash Price |
$3,756.32
|
| Rate for Payer: Cash Price |
$3,756.32
|
| Rate for Payer: Cigna Commercial |
$4,381.27
|
| Rate for Payer: Cigna Medicaid |
$3,977.28
|
| 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 |
$3,977.28
|
| 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 |
$3,977.28
|
| 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 |
$3,977.28
|
| 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
|
|
|
Adjacent tissue transfer or rearrangement, forehead, cheeks, chin, mouth, neck, axillae, genitalia,
|
Facility
|
IP
|
$5,524.00
|
|
|
Service Code
|
HCPCS 14040
|
| Hospital Charge Code |
9900119
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$3,756.32
|
|
|
Adjacent tissue transfer or rearrangement, forehead, cheeks, chin, mouth, neck, axillae, genitalia,
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 14040
|
| Hospital Charge Code |
36014040
|
|
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: Cigna Commercial |
$4,381.27
|
| 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 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: Scott and White EPO/PPO |
$3,085.41
|
| Rate for Payer: Scott and White Medicare |
$2,072.68
|
| 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
|
|
