|
SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH MCC
|
Facility
|
IP
|
$118,143.90
|
|
|
Service Code
|
MSDRG 573
|
| Min. Negotiated Rate |
$31,709.92 |
| Max. Negotiated Rate |
$118,143.90 |
| Rate for Payer: Aetna Commercial |
$69,953.62
|
| Rate for Payer: Aetna Medicare |
$70,841.26
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$47,227.51
|
| Rate for Payer: Amerigroup Medicare |
$47,227.51
|
| Rate for Payer: BCBS of TX Blue Advantage |
$31,709.92
|
| Rate for Payer: BCBS of TX Blue Essentials |
$54,190.23
|
| Rate for Payer: BCBS of TX Medicare |
$47,227.51
|
| Rate for Payer: BCBS of TX PPO |
$60,213.70
|
| Rate for Payer: Cigna Commercial |
$80,089.13
|
| Rate for Payer: Cigna Medicare |
$47,227.51
|
| Rate for Payer: Employer Direct Commercial |
$47,227.51
|
| Rate for Payer: Humana Medicare/TRICARE |
$47,227.51
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$47,227.51
|
| Rate for Payer: Molina Medicare |
$47,227.51
|
| Rate for Payer: Multiplan Auto |
$118,143.90
|
| Rate for Payer: Multiplan Commercial |
$118,143.90
|
| Rate for Payer: Multiplan Workers Comp |
$118,143.90
|
| Rate for Payer: Scott and White EPO/PPO |
$54,408.38
|
| Rate for Payer: Scott and White Medicare |
$47,227.51
|
| Rate for Payer: Superior Health Plan EPO |
$47,227.51
|
| Rate for Payer: Superior Health Plan Medicare |
$47,227.51
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$47,227.51
|
| Rate for Payer: Universal American Medicare |
$47,227.51
|
| Rate for Payer: Wellcare Medicare |
$47,227.51
|
| Rate for Payer: Wellmed Medicare |
$47,227.51
|
|
|
SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITHOUT CC/MCC
|
Facility
|
IP
|
$38,874.00
|
|
|
Service Code
|
MSDRG 575
|
| Min. Negotiated Rate |
$12,721.12 |
| Max. Negotiated Rate |
$38,874.00 |
| Rate for Payer: Aetna Commercial |
$23,017.50
|
| Rate for Payer: Aetna Medicare |
$26,182.74
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$17,455.16
|
| Rate for Payer: Amerigroup Medicare |
$17,455.16
|
| Rate for Payer: BCBS of TX Blue Advantage |
$12,721.12
|
| Rate for Payer: BCBS of TX Blue Essentials |
$18,146.99
|
| Rate for Payer: BCBS of TX Medicare |
$17,455.16
|
| Rate for Payer: BCBS of TX PPO |
$20,164.11
|
| Rate for Payer: Cigna Commercial |
$26,352.48
|
| Rate for Payer: Cigna Medicare |
$17,455.16
|
| Rate for Payer: Employer Direct Commercial |
$17,455.16
|
| Rate for Payer: Humana Medicare/TRICARE |
$17,455.16
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$17,455.16
|
| Rate for Payer: Molina Medicare |
$17,455.16
|
| Rate for Payer: Multiplan Auto |
$38,874.00
|
| Rate for Payer: Multiplan Commercial |
$38,874.00
|
| Rate for Payer: Multiplan Workers Comp |
$38,874.00
|
| Rate for Payer: Scott and White EPO/PPO |
$17,902.50
|
| Rate for Payer: Scott and White Medicare |
$17,455.16
|
| Rate for Payer: Superior Health Plan EPO |
$17,455.16
|
| Rate for Payer: Superior Health Plan Medicare |
$17,455.16
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$17,455.16
|
| Rate for Payer: Universal American Medicare |
$17,455.16
|
| Rate for Payer: Wellcare Medicare |
$17,455.16
|
| Rate for Payer: Wellmed Medicare |
$17,455.16
|
|
|
SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC
|
Facility
|
IP
|
$35,366.60
|
|
|
Service Code
|
MSDRG 623
|
| Min. Negotiated Rate |
$16,137.84 |
| Max. Negotiated Rate |
$35,366.60 |
| Rate for Payer: Aetna Commercial |
$20,940.75
|
| Rate for Payer: Aetna Medicare |
$24,206.76
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$16,137.84
|
| Rate for Payer: Amerigroup Medicare |
$16,137.84
|
| Rate for Payer: BCBS of TX Blue Advantage |
$16,297.00
|
| Rate for Payer: BCBS of TX Blue Essentials |
$19,845.50
|
| Rate for Payer: BCBS of TX Medicare |
$16,137.84
|
| Rate for Payer: BCBS of TX PPO |
$22,051.41
|
| Rate for Payer: Cigna Commercial |
$23,974.83
|
| Rate for Payer: Cigna Medicare |
$16,137.84
|
| Rate for Payer: Employer Direct Commercial |
$16,137.84
|
| Rate for Payer: Humana Medicare/TRICARE |
$16,137.84
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$16,137.84
|
| Rate for Payer: Molina Medicare |
$16,137.84
|
| Rate for Payer: Multiplan Auto |
$35,366.60
|
| Rate for Payer: Multiplan Commercial |
$35,366.60
|
| Rate for Payer: Multiplan Workers Comp |
$35,366.60
|
| Rate for Payer: Scott and White EPO/PPO |
$16,287.25
|
| Rate for Payer: Scott and White Medicare |
$16,137.84
|
| Rate for Payer: Superior Health Plan EPO |
$16,137.84
|
| Rate for Payer: Superior Health Plan Medicare |
$16,137.84
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$16,137.84
|
| Rate for Payer: Universal American Medicare |
$16,137.84
|
| Rate for Payer: Wellcare Medicare |
$16,137.84
|
| Rate for Payer: Wellmed Medicare |
$16,137.84
|
|
|
SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH MCC
|
Facility
|
IP
|
$72,686.40
|
|
|
Service Code
|
MSDRG 622
|
| Min. Negotiated Rate |
$30,154.49 |
| Max. Negotiated Rate |
$72,686.40 |
| Rate for Payer: Aetna Commercial |
$43,038.00
|
| Rate for Payer: Aetna Medicare |
$45,231.74
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$30,154.49
|
| Rate for Payer: Amerigroup Medicare |
$30,154.49
|
| Rate for Payer: BCBS of TX Blue Advantage |
$31,658.32
|
| Rate for Payer: BCBS of TX Blue Essentials |
$39,191.56
|
| Rate for Payer: BCBS of TX Medicare |
$30,154.49
|
| Rate for Payer: BCBS of TX PPO |
$43,547.87
|
| Rate for Payer: Cigna Commercial |
$49,273.73
|
| Rate for Payer: Cigna Medicare |
$30,154.49
|
| Rate for Payer: Employer Direct Commercial |
$30,154.49
|
| Rate for Payer: Humana Medicare/TRICARE |
$30,154.49
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$30,154.49
|
| Rate for Payer: Molina Medicare |
$30,154.49
|
| Rate for Payer: Multiplan Auto |
$72,686.40
|
| Rate for Payer: Multiplan Commercial |
$72,686.40
|
| Rate for Payer: Multiplan Workers Comp |
$72,686.40
|
| Rate for Payer: Scott and White EPO/PPO |
$33,474.00
|
| Rate for Payer: Scott and White Medicare |
$30,154.49
|
| Rate for Payer: Superior Health Plan EPO |
$30,154.49
|
| Rate for Payer: Superior Health Plan Medicare |
$30,154.49
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$30,154.49
|
| Rate for Payer: Universal American Medicare |
$30,154.49
|
| Rate for Payer: Wellcare Medicare |
$30,154.49
|
| Rate for Payer: Wellmed Medicare |
$30,154.49
|
|
|
SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CC/MCC
|
Facility
|
IP
|
$21,175.50
|
|
|
Service Code
|
MSDRG 624
|
| Min. Negotiated Rate |
$9,220.92 |
| Max. Negotiated Rate |
$21,175.50 |
| Rate for Payer: Aetna Commercial |
$12,538.12
|
| Rate for Payer: Aetna Medicare |
$16,211.88
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$10,807.92
|
| Rate for Payer: Amerigroup Medicare |
$10,807.92
|
| Rate for Payer: BCBS of TX Blue Advantage |
$9,220.92
|
| Rate for Payer: BCBS of TX Blue Essentials |
$13,373.42
|
| Rate for Payer: BCBS of TX Medicare |
$10,807.92
|
| Rate for Payer: BCBS of TX PPO |
$14,859.94
|
| Rate for Payer: Cigna Commercial |
$14,354.76
|
| Rate for Payer: Cigna Medicare |
$10,807.92
|
| Rate for Payer: Employer Direct Commercial |
$10,807.92
|
| Rate for Payer: Humana Medicare/TRICARE |
$10,807.92
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$10,807.92
|
| Rate for Payer: Molina Medicare |
$10,807.92
|
| Rate for Payer: Multiplan Auto |
$21,175.50
|
| Rate for Payer: Multiplan Commercial |
$21,175.50
|
| Rate for Payer: Multiplan Workers Comp |
$21,175.50
|
| Rate for Payer: Scott and White EPO/PPO |
$9,751.88
|
| Rate for Payer: Scott and White Medicare |
$10,807.92
|
| Rate for Payer: Superior Health Plan EPO |
$10,807.92
|
| Rate for Payer: Superior Health Plan Medicare |
$10,807.92
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$10,807.92
|
| Rate for Payer: Universal American Medicare |
$10,807.92
|
| Rate for Payer: Wellcare Medicare |
$10,807.92
|
| Rate for Payer: Wellmed Medicare |
$10,807.92
|
|
|
SKIN GRAFTS FOR INJURIES WITH CC/MCC
|
Facility
|
IP
|
$61,867.80
|
|
|
Service Code
|
MSDRG 904
|
| Min. Negotiated Rate |
$26,091.21 |
| Max. Negotiated Rate |
$61,867.80 |
| Rate for Payer: Aetna Commercial |
$36,632.25
|
| Rate for Payer: Aetna Medicare |
$39,136.82
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$26,091.21
|
| Rate for Payer: Amerigroup Medicare |
$26,091.21
|
| Rate for Payer: BCBS of TX Blue Advantage |
$28,057.50
|
| Rate for Payer: BCBS of TX Blue Essentials |
$33,289.09
|
| Rate for Payer: BCBS of TX Medicare |
$26,091.21
|
| Rate for Payer: BCBS of TX PPO |
$36,989.32
|
| Rate for Payer: Cigna Commercial |
$41,939.86
|
| Rate for Payer: Cigna Medicare |
$26,091.21
|
| Rate for Payer: Employer Direct Commercial |
$26,091.21
|
| Rate for Payer: Humana Medicare/TRICARE |
$26,091.21
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$26,091.21
|
| Rate for Payer: Molina Medicare |
$26,091.21
|
| Rate for Payer: Multiplan Auto |
$61,867.80
|
| Rate for Payer: Multiplan Commercial |
$61,867.80
|
| Rate for Payer: Multiplan Workers Comp |
$61,867.80
|
| Rate for Payer: Scott and White EPO/PPO |
$28,491.75
|
| Rate for Payer: Scott and White Medicare |
$26,091.21
|
| Rate for Payer: Superior Health Plan EPO |
$26,091.21
|
| Rate for Payer: Superior Health Plan Medicare |
$26,091.21
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$26,091.21
|
| Rate for Payer: Universal American Medicare |
$26,091.21
|
| Rate for Payer: Wellcare Medicare |
$26,091.21
|
| Rate for Payer: Wellmed Medicare |
$26,091.21
|
|
|
SKIN GRAFTS FOR INJURIES WITHOUT CC/MCC
|
Facility
|
IP
|
$30,090.30
|
|
|
Service Code
|
MSDRG 905
|
| Min. Negotiated Rate |
$11,866.28 |
| Max. Negotiated Rate |
$30,090.30 |
| Rate for Payer: Aetna Commercial |
$17,816.62
|
| Rate for Payer: Aetna Medicare |
$21,234.24
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$14,156.16
|
| Rate for Payer: Amerigroup Medicare |
$14,156.16
|
| Rate for Payer: BCBS of TX Blue Advantage |
$11,866.28
|
| Rate for Payer: BCBS of TX Blue Essentials |
$18,256.37
|
| Rate for Payer: BCBS of TX Medicare |
$14,156.16
|
| Rate for Payer: BCBS of TX PPO |
$20,285.65
|
| Rate for Payer: Cigna Commercial |
$20,398.06
|
| Rate for Payer: Cigna Medicare |
$14,156.16
|
| Rate for Payer: Employer Direct Commercial |
$14,156.16
|
| Rate for Payer: Humana Medicare/TRICARE |
$14,156.16
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$14,156.16
|
| Rate for Payer: Molina Medicare |
$14,156.16
|
| Rate for Payer: Multiplan Auto |
$30,090.30
|
| Rate for Payer: Multiplan Commercial |
$30,090.30
|
| Rate for Payer: Multiplan Workers Comp |
$30,090.30
|
| Rate for Payer: Scott and White EPO/PPO |
$13,857.38
|
| Rate for Payer: Scott and White Medicare |
$14,156.16
|
| Rate for Payer: Superior Health Plan EPO |
$14,156.16
|
| Rate for Payer: Superior Health Plan Medicare |
$14,156.16
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$14,156.16
|
| Rate for Payer: Universal American Medicare |
$14,156.16
|
| Rate for Payer: Wellcare Medicare |
$14,156.16
|
| Rate for Payer: Wellmed Medicare |
$14,156.16
|
|
|
Skin Sub Graft Face/Neck/Nk/Fh/G First 25 Sq cm
|
Facility
|
OP
|
$3,398.00
|
|
|
Service Code
|
CPT 15275
|
| Hospital Charge Code |
7150814
|
|
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
|
|
|
Skin Sub Grft Fce/Nck/FH/G Ch ad 20sqcm
|
Facility
|
OP
|
$1,476.00
|
|
|
Service Code
|
CPT 15276
|
| Hospital Charge Code |
7150815
|
|
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
|
|
|
Skin Sub Grft Trk/Arm/Leg Ch 1st 100sqcm
|
Facility
|
OP
|
$6,927.00
|
|
|
Service Code
|
CPT 15273
|
| Hospital Charge Code |
7150812
|
|
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
|
|
|
Skin Sub Grft Trk/Arm/Leg Ch 1st 25 sqcm
|
Facility
|
OP
|
$3,398.00
|
|
|
Service Code
|
CPT 15271
|
| Hospital Charge Code |
7150810
|
|
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
|
|
|
Skin Sub Grft Trk/Arm/Leg Ch ad 25 sqcm
|
Facility
|
OP
|
$977.00
|
|
|
Service Code
|
CPT 15272
|
| Hospital Charge Code |
7150811
|
|
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
|
|
|
Skin Sub Grft Trnk/Arm/Leg Ch ad 100sqcm
|
Facility
|
OP
|
$3,438.00
|
|
|
Service Code
|
CPT 15274
|
| Hospital Charge Code |
7150813
|
|
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
|
|
|
SKIN ULCERS WITH CC
|
Facility
|
IP
|
$22,988.10
|
|
|
Service Code
|
MSDRG 593
|
| Min. Negotiated Rate |
$8,585.38 |
| Max. Negotiated Rate |
$22,988.10 |
| Rate for Payer: Aetna Commercial |
$13,611.38
|
| Rate for Payer: Aetna Medicare |
$17,233.05
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$11,488.70
|
| Rate for Payer: Amerigroup Medicare |
$11,488.70
|
| Rate for Payer: BCBS of TX Blue Advantage |
$8,585.38
|
| Rate for Payer: BCBS of TX Blue Essentials |
$11,654.28
|
| Rate for Payer: BCBS of TX Medicare |
$11,488.70
|
| Rate for Payer: BCBS of TX PPO |
$12,949.70
|
| Rate for Payer: Cigna Commercial |
$15,583.51
|
| Rate for Payer: Cigna Medicare |
$11,488.70
|
| Rate for Payer: Employer Direct Commercial |
$11,488.70
|
| Rate for Payer: Humana Medicare/TRICARE |
$11,488.70
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$11,488.70
|
| Rate for Payer: Molina Medicare |
$11,488.70
|
| Rate for Payer: Multiplan Auto |
$22,988.10
|
| Rate for Payer: Multiplan Commercial |
$22,988.10
|
| Rate for Payer: Multiplan Workers Comp |
$22,988.10
|
| Rate for Payer: Scott and White EPO/PPO |
$10,586.62
|
| Rate for Payer: Scott and White Medicare |
$11,488.70
|
| Rate for Payer: Superior Health Plan EPO |
$11,488.70
|
| Rate for Payer: Superior Health Plan Medicare |
$11,488.70
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$11,488.70
|
| Rate for Payer: Universal American Medicare |
$11,488.70
|
| Rate for Payer: Wellcare Medicare |
$11,488.70
|
| Rate for Payer: Wellmed Medicare |
$11,488.70
|
|
|
SKIN ULCERS WITH MCC
|
Facility
|
IP
|
$39,711.90
|
|
|
Service Code
|
MSDRG 592
|
| Min. Negotiated Rate |
$12,113.96 |
| Max. Negotiated Rate |
$39,711.90 |
| Rate for Payer: Aetna Commercial |
$23,513.62
|
| Rate for Payer: Aetna Medicare |
$26,654.80
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$17,769.87
|
| Rate for Payer: Amerigroup Medicare |
$17,769.87
|
| Rate for Payer: BCBS of TX Blue Advantage |
$12,113.96
|
| Rate for Payer: BCBS of TX Blue Essentials |
$17,626.92
|
| Rate for Payer: BCBS of TX Medicare |
$17,769.87
|
| Rate for Payer: BCBS of TX PPO |
$19,586.22
|
| Rate for Payer: Cigna Commercial |
$26,920.49
|
| Rate for Payer: Cigna Medicare |
$17,769.87
|
| Rate for Payer: Employer Direct Commercial |
$17,769.87
|
| Rate for Payer: Humana Medicare/TRICARE |
$17,769.87
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$17,769.87
|
| Rate for Payer: Molina Medicare |
$17,769.87
|
| Rate for Payer: Multiplan Auto |
$39,711.90
|
| Rate for Payer: Multiplan Commercial |
$39,711.90
|
| Rate for Payer: Multiplan Workers Comp |
$39,711.90
|
| Rate for Payer: Scott and White EPO/PPO |
$18,288.38
|
| Rate for Payer: Scott and White Medicare |
$17,769.87
|
| Rate for Payer: Superior Health Plan EPO |
$17,769.87
|
| Rate for Payer: Superior Health Plan Medicare |
$17,769.87
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$17,769.87
|
| Rate for Payer: Universal American Medicare |
$17,769.87
|
| Rate for Payer: Wellcare Medicare |
$17,769.87
|
| Rate for Payer: Wellmed Medicare |
$17,769.87
|
|
|
SKIN ULCERS WITHOUT CC/MCC
|
Facility
|
IP
|
$14,960.60
|
|
|
Service Code
|
MSDRG 594
|
| Min. Negotiated Rate |
$6,321.86 |
| Max. Negotiated Rate |
$14,960.60 |
| Rate for Payer: Aetna Commercial |
$8,858.25
|
| Rate for Payer: Aetna Medicare |
$12,710.58
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$8,473.72
|
| Rate for Payer: Amerigroup Medicare |
$8,473.72
|
| Rate for Payer: BCBS of TX Blue Advantage |
$6,321.86
|
| Rate for Payer: BCBS of TX Blue Essentials |
$8,360.45
|
| Rate for Payer: BCBS of TX Medicare |
$8,473.72
|
| Rate for Payer: BCBS of TX PPO |
$9,289.75
|
| Rate for Payer: Cigna Commercial |
$10,141.71
|
| Rate for Payer: Cigna Medicare |
$8,473.72
|
| Rate for Payer: Employer Direct Commercial |
$8,473.72
|
| Rate for Payer: Humana Medicare/TRICARE |
$8,473.72
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$8,473.72
|
| Rate for Payer: Molina Medicare |
$8,473.72
|
| Rate for Payer: Multiplan Auto |
$14,960.60
|
| Rate for Payer: Multiplan Commercial |
$14,960.60
|
| Rate for Payer: Multiplan Workers Comp |
$14,960.60
|
| Rate for Payer: Scott and White EPO/PPO |
$6,889.75
|
| Rate for Payer: Scott and White Medicare |
$8,473.72
|
| Rate for Payer: Superior Health Plan EPO |
$8,473.72
|
| Rate for Payer: Superior Health Plan Medicare |
$8,473.72
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$8,473.72
|
| Rate for Payer: Universal American Medicare |
$8,473.72
|
| Rate for Payer: Wellcare Medicare |
$8,473.72
|
| Rate for Payer: Wellmed Medicare |
$8,473.72
|
|
|
SLEEVE, ENDOPATH BLADELESS 5MM X 100MM L -- DHF
|
Facility
|
OP
|
$624.98
|
|
| Hospital Charge Code |
80828155
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$56.25 |
| Max. Negotiated Rate |
$406.24 |
| Rate for Payer: Aetna Commercial |
$343.74
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$56.25
|
| Rate for Payer: BCBS of TX Blue Advantage |
$187.49
|
| Rate for Payer: BCBS of TX Blue Essentials |
$224.99
|
| Rate for Payer: BCBS of TX PPO |
$249.99
|
| Rate for Payer: Cash Price |
$549.98
|
| Rate for Payer: Multiplan Auto |
$406.24
|
| Rate for Payer: Multiplan Commercial |
$406.24
|
| Rate for Payer: Multiplan Workers Comp |
$406.24
|
| Rate for Payer: Scott and White EPO/PPO |
$312.49
|
| Rate for Payer: Superior Health Plan EPO |
$85.00
|
|
|
SLEEVE, ENDOPATH BLADELESS W/OPTIVIEW 12MMX100MM -- DHF
|
Facility
|
OP
|
$624.98
|
|
| Hospital Charge Code |
80828155
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$56.25 |
| Max. Negotiated Rate |
$406.24 |
| Rate for Payer: Aetna Commercial |
$343.74
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$56.25
|
| Rate for Payer: BCBS of TX Blue Advantage |
$187.49
|
| Rate for Payer: BCBS of TX Blue Essentials |
$224.99
|
| Rate for Payer: BCBS of TX PPO |
$249.99
|
| Rate for Payer: Cash Price |
$549.98
|
| Rate for Payer: Multiplan Auto |
$406.24
|
| Rate for Payer: Multiplan Commercial |
$406.24
|
| Rate for Payer: Multiplan Workers Comp |
$406.24
|
| Rate for Payer: Scott and White EPO/PPO |
$312.49
|
| Rate for Payer: Superior Health Plan EPO |
$85.00
|
|
|
SLEEVE GLIDESCOPE -- DHF
|
Facility
|
OP
|
$85.81
|
|
| Hospital Charge Code |
82067596
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.72 |
| Max. Negotiated Rate |
$55.78 |
| Rate for Payer: Aetna Commercial |
$47.20
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$7.72
|
| Rate for Payer: BCBS of TX Blue Advantage |
$25.74
|
| Rate for Payer: BCBS of TX Blue Essentials |
$30.89
|
| Rate for Payer: BCBS of TX PPO |
$34.32
|
| Rate for Payer: Cash Price |
$75.51
|
| Rate for Payer: Multiplan Auto |
$55.78
|
| Rate for Payer: Multiplan Commercial |
$55.78
|
| Rate for Payer: Multiplan Workers Comp |
$55.78
|
| Rate for Payer: Scott and White EPO/PPO |
$42.90
|
| Rate for Payer: Superior Health Plan EPO |
$11.67
|
|
|
SLEEVE GLIDESCOPE -- DHF
|
Facility
|
IP
|
$85.81
|
|
| Hospital Charge Code |
82067596
|
|
Hospital Revenue Code
|
272
|
| Rate for Payer: Cash Price |
$75.51
|
|
|
SLEEVE Kii 5X100 CFF02
|
Facility
|
IP
|
$408.60
|
|
| Hospital Charge Code |
80810344
|
|
Hospital Revenue Code
|
272
|
| Rate for Payer: Cash Price |
$359.57
|
|
|
SLEEVE Kii 5X100 CFF02
|
Facility
|
OP
|
$408.60
|
|
| Hospital Charge Code |
80810344
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$36.77 |
| Max. Negotiated Rate |
$265.59 |
| Rate for Payer: Aetna Commercial |
$224.73
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$36.77
|
| Rate for Payer: BCBS of TX Blue Advantage |
$122.58
|
| Rate for Payer: BCBS of TX Blue Essentials |
$147.10
|
| Rate for Payer: BCBS of TX PPO |
$163.44
|
| Rate for Payer: Cash Price |
$359.57
|
| Rate for Payer: Multiplan Auto |
$265.59
|
| Rate for Payer: Multiplan Commercial |
$265.59
|
| Rate for Payer: Multiplan Workers Comp |
$265.59
|
| Rate for Payer: Scott and White EPO/PPO |
$204.30
|
| Rate for Payer: Superior Health Plan EPO |
$55.57
|
|
|
SLEEVE, SHOULDER TRACTN/ROTATN FOAM W/VELCRO STRLE -- DHF
|
Facility
|
IP
|
$583.71
|
|
| Hospital Charge Code |
81771446
|
|
Hospital Revenue Code
|
272
|
| Rate for Payer: Cash Price |
$513.66
|
|
|
SLEEVE, SHOULDER TRACTN/ROTATN FOAM W/VELCRO STRLE -- DHF
|
Facility
|
OP
|
$583.71
|
|
| Hospital Charge Code |
81771446
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$52.53 |
| Max. Negotiated Rate |
$379.41 |
| Rate for Payer: Aetna Commercial |
$321.04
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$52.53
|
| Rate for Payer: BCBS of TX Blue Advantage |
$175.11
|
| Rate for Payer: BCBS of TX Blue Essentials |
$210.14
|
| Rate for Payer: BCBS of TX PPO |
$233.48
|
| Rate for Payer: Cash Price |
$513.66
|
| Rate for Payer: Multiplan Auto |
$379.41
|
| Rate for Payer: Multiplan Commercial |
$379.41
|
| Rate for Payer: Multiplan Workers Comp |
$379.41
|
| Rate for Payer: Scott and White EPO/PPO |
$291.86
|
| Rate for Payer: Superior Health Plan EPO |
$79.38
|
|
|
SLEEVE SKIN ARM REGULAR
|
Facility
|
OP
|
$16.34
|
|
| Hospital Charge Code |
8576467
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.47 |
| Max. Negotiated Rate |
$10.62 |
| Rate for Payer: Aetna Commercial |
$8.99
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1.47
|
| Rate for Payer: BCBS of TX Blue Advantage |
$4.90
|
| Rate for Payer: BCBS of TX Blue Essentials |
$5.88
|
| Rate for Payer: BCBS of TX PPO |
$6.54
|
| Rate for Payer: Cash Price |
$14.38
|
| Rate for Payer: Multiplan Auto |
$10.62
|
| Rate for Payer: Multiplan Commercial |
$10.62
|
| Rate for Payer: Multiplan Workers Comp |
$10.62
|
| Rate for Payer: Scott and White EPO/PPO |
$8.17
|
| Rate for Payer: Superior Health Plan EPO |
$2.22
|
|
