|
WC LC Skin Sub App Trnk/Arm/Leg to 25 sqcm BCE
|
Facility
|
IP
|
$1,845.00
|
|
|
Service Code
|
HCPCS C5271
|
| Hospital Charge Code |
7150901
|
|
Hospital Revenue Code
|
761
|
| Rate for Payer: Cash Price |
$1,623.60
|
|
|
WC LC Skin Sub App Trnk/Arm/Leg up 100sqcm BCE
|
Facility
|
OP
|
$3,676.00
|
|
|
Service Code
|
HCPCS C5273
|
| Hospital Charge Code |
7150903
|
|
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 |
$330.84
|
| 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 |
$3,234.88
|
| Rate for Payer: Cash Price |
$3,234.88
|
| Rate for Payer: Cash Price |
$3,234.88
|
| Rate for Payer: Cigna Commercial |
$3,778.02
|
| 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 Dual Medicare/Medicaid |
$1,667.79
|
| Rate for Payer: Molina Medicare |
$1,667.79
|
| Rate for Payer: Multiplan Auto |
$2,389.40
|
| Rate for Payer: Multiplan Commercial |
$2,389.40
|
| Rate for Payer: Multiplan Workers Comp |
$2,389.40
|
| 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 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
|
|
|
WC LC Skin Sub App Trnk/Arm/Leg up 100sqcm BCE
|
Facility
|
IP
|
$3,676.00
|
|
|
Service Code
|
HCPCS C5273
|
| Hospital Charge Code |
7150903
|
|
Hospital Revenue Code
|
761
|
| Rate for Payer: Cash Price |
$3,234.88
|
|
|
WC Multilayer Compression Wrap Below the Knee Bilat BCE
|
Facility
|
OP
|
$423.00
|
|
|
Service Code
|
CPT 29581 50
|
| Hospital Charge Code |
7150774
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2.58 |
| Max. Negotiated Rate |
$326.44 |
| Rate for Payer: Aetna Commercial |
$232.65
|
| Rate for Payer: Aetna Medicare |
$216.15
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$38.07
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$144.10
|
| Rate for Payer: Amerigroup Medicare |
$144.10
|
| Rate for Payer: BCBS of TX Blue Advantage |
$112.86
|
| Rate for Payer: BCBS of TX Blue Essentials |
$135.16
|
| Rate for Payer: BCBS of TX Medicare |
$144.10
|
| Rate for Payer: BCBS of TX PPO |
$170.30
|
| Rate for Payer: Cash Price |
$372.24
|
| Rate for Payer: Cash Price |
$372.24
|
| Rate for Payer: Cash Price |
$372.24
|
| Rate for Payer: Cigna Commercial |
$326.44
|
| Rate for Payer: Cigna Medicaid |
$56.48
|
| 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 |
$56.48
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$144.10
|
| Rate for Payer: Molina Medicare |
$144.10
|
| Rate for Payer: Multiplan Auto |
$274.95
|
| Rate for Payer: Multiplan Commercial |
$274.95
|
| Rate for Payer: Multiplan Workers Comp |
$274.95
|
| Rate for Payer: Parkland Medicaid |
$56.48
|
| 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 |
$56.48
|
| 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
|
|
|
WC Multilayer Compression Wrap Below the Knee Bilat BCE
|
Facility
|
IP
|
$423.00
|
|
|
Service Code
|
CPT 29581 50
|
| Hospital Charge Code |
7150774
|
|
Hospital Revenue Code
|
761
|
| Rate for Payer: Cash Price |
$372.24
|
|
|
WC Multilayer Compression Wrap Below the Knee LT BCE
|
Facility
|
OP
|
$282.00
|
|
|
Service Code
|
CPT 29581 LT
|
| Hospital Charge Code |
7150830
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2.58 |
| Max. Negotiated Rate |
$326.44 |
| Rate for Payer: Aetna Commercial |
$155.10
|
| Rate for Payer: Aetna Medicare |
$216.15
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$25.38
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$144.10
|
| Rate for Payer: Amerigroup Medicare |
$144.10
|
| Rate for Payer: BCBS of TX Blue Advantage |
$112.86
|
| Rate for Payer: BCBS of TX Blue Essentials |
$135.16
|
| Rate for Payer: BCBS of TX Medicare |
$144.10
|
| Rate for Payer: BCBS of TX PPO |
$170.30
|
| Rate for Payer: Cash Price |
$248.16
|
| Rate for Payer: Cash Price |
$248.16
|
| Rate for Payer: Cash Price |
$248.16
|
| Rate for Payer: Cigna Commercial |
$326.44
|
| Rate for Payer: Cigna Medicaid |
$56.48
|
| 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 |
$56.48
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$144.10
|
| Rate for Payer: Molina Medicare |
$144.10
|
| Rate for Payer: Multiplan Auto |
$183.30
|
| Rate for Payer: Multiplan Commercial |
$183.30
|
| Rate for Payer: Multiplan Workers Comp |
$183.30
|
| Rate for Payer: Parkland Medicaid |
$56.48
|
| 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 |
$56.48
|
| 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
|
|
|
WC Multilayer Compression Wrap Below the Knee LT BCE
|
Facility
|
IP
|
$282.00
|
|
|
Service Code
|
CPT 29581 LT
|
| Hospital Charge Code |
7150830
|
|
Hospital Revenue Code
|
761
|
| Rate for Payer: Cash Price |
$248.16
|
|
|
WC Multilayer Compression Wrap Below the Knee RT BCE
|
Facility
|
IP
|
$282.00
|
|
|
Service Code
|
CPT 29581 RT
|
| Hospital Charge Code |
7150829
|
|
Hospital Revenue Code
|
761
|
| Rate for Payer: Cash Price |
$248.16
|
|
|
WC Multilayer Compression Wrap Below the Knee RT BCE
|
Facility
|
OP
|
$282.00
|
|
|
Service Code
|
CPT 29581 RT
|
| Hospital Charge Code |
7150829
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2.58 |
| Max. Negotiated Rate |
$326.44 |
| Rate for Payer: Aetna Commercial |
$155.10
|
| Rate for Payer: Aetna Medicare |
$216.15
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$25.38
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$144.10
|
| Rate for Payer: Amerigroup Medicare |
$144.10
|
| Rate for Payer: BCBS of TX Blue Advantage |
$112.86
|
| Rate for Payer: BCBS of TX Blue Essentials |
$135.16
|
| Rate for Payer: BCBS of TX Medicare |
$144.10
|
| Rate for Payer: BCBS of TX PPO |
$170.30
|
| Rate for Payer: Cash Price |
$248.16
|
| Rate for Payer: Cash Price |
$248.16
|
| Rate for Payer: Cash Price |
$248.16
|
| Rate for Payer: Cigna Commercial |
$326.44
|
| Rate for Payer: Cigna Medicaid |
$56.48
|
| 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 |
$56.48
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$144.10
|
| Rate for Payer: Molina Medicare |
$144.10
|
| Rate for Payer: Multiplan Auto |
$183.30
|
| Rate for Payer: Multiplan Commercial |
$183.30
|
| Rate for Payer: Multiplan Workers Comp |
$183.30
|
| Rate for Payer: Parkland Medicaid |
$56.48
|
| 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 |
$56.48
|
| 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
|
|
|
WC Nail Debride 1-5 BCE
|
Facility
|
OP
|
$203.00
|
|
|
Service Code
|
CPT 11720
|
| Hospital Charge Code |
7150246
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$138.63 |
| Rate for Payer: Aetna Commercial |
$111.65
|
| Rate for Payer: Aetna Medicare |
$83.91
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$18.27
|
| 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 |
$178.64
|
| Rate for Payer: Cash Price |
$178.64
|
| Rate for Payer: Cash Price |
$178.64
|
| 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 |
$131.95
|
| Rate for Payer: Multiplan Commercial |
$131.95
|
| Rate for Payer: Multiplan Workers Comp |
$131.95
|
| 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
|
|
|
WC Nail Debride 1-5 BCE
|
Facility
|
IP
|
$203.00
|
|
|
Service Code
|
CPT 11720
|
| Hospital Charge Code |
7150246
|
|
Hospital Revenue Code
|
761
|
| Rate for Payer: Cash Price |
$178.64
|
|
|
WC Nail Debridement 6 or more BCE
|
Facility
|
OP
|
$415.00
|
|
|
Service Code
|
CPT 11721
|
| Hospital Charge Code |
7150253
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$269.75 |
| Rate for Payer: Aetna Commercial |
$228.25
|
| Rate for Payer: Aetna Medicare |
$83.91
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$37.35
|
| 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 |
$365.20
|
| Rate for Payer: Cash Price |
$365.20
|
| Rate for Payer: Cash Price |
$365.20
|
| 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 |
$269.75
|
| Rate for Payer: Multiplan Commercial |
$269.75
|
| Rate for Payer: Multiplan Workers Comp |
$269.75
|
| 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
|
|
|
WC Nail Debridement 6 or more BCE
|
Facility
|
IP
|
$415.00
|
|
|
Service Code
|
CPT 11721
|
| Hospital Charge Code |
7150253
|
|
Hospital Revenue Code
|
761
|
| Rate for Payer: Cash Price |
$365.20
|
|
|
WC New PT Visit Level 2 BCE
|
Facility
|
IP
|
$272.00
|
|
|
Service Code
|
CPT 99202
|
| Hospital Charge Code |
7150451
|
|
Hospital Revenue Code
|
510
|
| Rate for Payer: Cash Price |
$239.36
|
|
|
WC New PT Visit Level 2 BCE
|
Facility
|
OP
|
$272.00
|
|
|
Service Code
|
CPT 99202
|
| Hospital Charge Code |
7150451
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$24.48 |
| Max. Negotiated Rate |
$176.80 |
| Rate for Payer: Aetna Commercial |
$149.60
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$24.48
|
| Rate for Payer: BCBS of TX Blue Advantage |
$89.68
|
| Rate for Payer: BCBS of TX Blue Essentials |
$107.20
|
| Rate for Payer: BCBS of TX PPO |
$119.57
|
| Rate for Payer: Cash Price |
$239.36
|
| Rate for Payer: Cash Price |
$239.36
|
| Rate for Payer: Cigna Medicaid |
$37.80
|
| Rate for Payer: Molina CHIP/Medicaid |
$37.80
|
| Rate for Payer: Multiplan Auto |
$176.80
|
| Rate for Payer: Multiplan Commercial |
$176.80
|
| Rate for Payer: Multiplan Workers Comp |
$176.80
|
| Rate for Payer: Parkland Medicaid |
$37.80
|
| Rate for Payer: Scott and White EPO/PPO |
$136.00
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$37.80
|
|
|
WC New PT Visit Level 3 BCE
|
Facility
|
OP
|
$411.00
|
|
|
Service Code
|
CPT 99203
|
| Hospital Charge Code |
7150469
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$36.99 |
| Max. Negotiated Rate |
$267.15 |
| Rate for Payer: Aetna Commercial |
$226.05
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$36.99
|
| Rate for Payer: BCBS of TX Blue Advantage |
$134.82
|
| Rate for Payer: BCBS of TX Blue Essentials |
$161.16
|
| Rate for Payer: BCBS of TX PPO |
$179.75
|
| Rate for Payer: Cash Price |
$361.68
|
| Rate for Payer: Cash Price |
$361.68
|
| Rate for Payer: Cigna Medicaid |
$51.08
|
| Rate for Payer: Molina CHIP/Medicaid |
$51.08
|
| Rate for Payer: Multiplan Auto |
$267.15
|
| Rate for Payer: Multiplan Commercial |
$267.15
|
| Rate for Payer: Multiplan Workers Comp |
$267.15
|
| Rate for Payer: Parkland Medicaid |
$51.08
|
| Rate for Payer: Scott and White EPO/PPO |
$205.50
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$51.08
|
|
|
WC New PT Visit Level 3 BCE
|
Facility
|
IP
|
$411.00
|
|
|
Service Code
|
CPT 99203
|
| Hospital Charge Code |
7150469
|
|
Hospital Revenue Code
|
510
|
| Rate for Payer: Cash Price |
$361.68
|
|
|
WC New PT Visit Level 4 BCE
|
Facility
|
OP
|
$488.00
|
|
|
Service Code
|
CPT 99204
|
| Hospital Charge Code |
7150477
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$43.92 |
| Max. Negotiated Rate |
$317.20 |
| Rate for Payer: Aetna Commercial |
$268.40
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$43.92
|
| Rate for Payer: BCBS of TX Blue Advantage |
$228.25
|
| Rate for Payer: BCBS of TX Blue Essentials |
$272.85
|
| Rate for Payer: BCBS of TX PPO |
$304.34
|
| Rate for Payer: Cash Price |
$429.44
|
| Rate for Payer: Cash Price |
$429.44
|
| Rate for Payer: Cigna Medicaid |
$74.74
|
| Rate for Payer: Molina CHIP/Medicaid |
$74.74
|
| Rate for Payer: Multiplan Auto |
$317.20
|
| Rate for Payer: Multiplan Commercial |
$317.20
|
| Rate for Payer: Multiplan Workers Comp |
$317.20
|
| Rate for Payer: Parkland Medicaid |
$74.74
|
| Rate for Payer: Scott and White EPO/PPO |
$244.00
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$74.74
|
|
|
WC New PT Visit Level 4 BCE
|
Facility
|
IP
|
$488.00
|
|
|
Service Code
|
CPT 99204
|
| Hospital Charge Code |
7150477
|
|
Hospital Revenue Code
|
510
|
| Rate for Payer: Cash Price |
$429.44
|
|
|
WC New PT Visit Level 5 BCE
|
Facility
|
OP
|
$596.00
|
|
|
Service Code
|
CPT 99205
|
| Hospital Charge Code |
7150485
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$53.64 |
| Max. Negotiated Rate |
$397.16 |
| Rate for Payer: Aetna Commercial |
$327.80
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$53.64
|
| Rate for Payer: BCBS of TX Blue Advantage |
$297.87
|
| Rate for Payer: BCBS of TX Blue Essentials |
$356.08
|
| Rate for Payer: BCBS of TX PPO |
$397.16
|
| Rate for Payer: Cash Price |
$524.48
|
| Rate for Payer: Cash Price |
$524.48
|
| Rate for Payer: Cigna Medicaid |
$92.92
|
| Rate for Payer: Molina CHIP/Medicaid |
$92.92
|
| Rate for Payer: Multiplan Auto |
$387.40
|
| Rate for Payer: Multiplan Commercial |
$387.40
|
| Rate for Payer: Multiplan Workers Comp |
$387.40
|
| Rate for Payer: Parkland Medicaid |
$92.92
|
| Rate for Payer: Scott and White EPO/PPO |
$298.00
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$92.92
|
|
|
WC New PT Visit Level 5 BCE
|
Facility
|
IP
|
$596.00
|
|
|
Service Code
|
CPT 99205
|
| Hospital Charge Code |
7150485
|
|
Hospital Revenue Code
|
510
|
| Rate for Payer: Cash Price |
$524.48
|
|
|
WC Non-Selective Debridement BCE
|
Facility
|
OP
|
$358.00
|
|
|
Service Code
|
CPT 97602
|
| Hospital Charge Code |
7150055
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3.27 |
| Max. Negotiated Rate |
$414.75 |
| 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 |
$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 |
$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 Medicaid |
$27.68
|
| 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 |
$27.68
|
| 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: Parkland Medicaid |
$27.68
|
| 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 |
$27.68
|
| 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
|
|
|
WC Non-Selective Debridement BCE
|
Facility
|
IP
|
$358.00
|
|
|
Service Code
|
CPT 97602
|
| Hospital Charge Code |
7150055
|
|
Hospital Revenue Code
|
761
|
| Rate for Payer: Cash Price |
$315.04
|
|
|
WC Npwt Dme <= 50 Sq cm BCE
|
Facility
|
OP
|
$304.00
|
|
|
Service Code
|
CPT 97605
|
| Hospital Charge Code |
7150618
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3.27 |
| Max. Negotiated Rate |
$414.75 |
| Rate for Payer: Aetna Commercial |
$167.20
|
| Rate for Payer: Aetna Medicare |
$274.64
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$27.36
|
| 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 |
$267.52
|
| Rate for Payer: Cash Price |
$267.52
|
| Rate for Payer: Cash Price |
$267.52
|
| 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 |
$197.60
|
| Rate for Payer: Multiplan Commercial |
$197.60
|
| Rate for Payer: Multiplan Workers Comp |
$197.60
|
| 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
|
|
|
WC Npwt Dme <= 50 Sq cm BCE
|
Facility
|
IP
|
$304.00
|
|
|
Service Code
|
CPT 97605
|
| Hospital Charge Code |
7150618
|
|
Hospital Revenue Code
|
761
|
| Rate for Payer: Cash Price |
$267.52
|
|
