|
OPWC EST PT Visit Level 4 (46-60 Min) BCE
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 99214
|
| Hospital Charge Code |
8910551
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$35.10 |
| Max. Negotiated Rate |
$280.80 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$35.10
|
| Rate for Payer: BCBS of TX Blue Advantage |
$117.00
|
| Rate for Payer: BCBS of TX Blue Essentials |
$140.40
|
| Rate for Payer: BCBS of TX PPO |
$156.00
|
| Rate for Payer: Cash Price |
$265.20
|
| Rate for Payer: Cigna Medicaid |
$280.80
|
| Rate for Payer: Molina CHIP/Medicaid |
$280.80
|
| Rate for Payer: Multiplan Auto |
$253.50
|
| Rate for Payer: Multiplan Commercial |
$253.50
|
| Rate for Payer: Multiplan Workers Comp |
$253.50
|
| Rate for Payer: Parkland Medicaid |
$280.80
|
| Rate for Payer: Scott and White EPO/PPO |
$195.00
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$280.80
|
|
|
OPWC EST PT Visit Level 5 (60+ Min) BCE
|
Facility
|
IP
|
$426.00
|
|
|
Service Code
|
HCPCS 99215
|
| Hospital Charge Code |
8914542
|
|
Hospital Revenue Code
|
510
|
| Rate for Payer: Cash Price |
$289.68
|
|
|
OPWC EST PT Visit Level 5 (60+ Min) BCE
|
Facility
|
OP
|
$426.00
|
|
|
Service Code
|
HCPCS 99215
|
| Hospital Charge Code |
8914542
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$38.34 |
| Max. Negotiated Rate |
$306.72 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$38.34
|
| Rate for Payer: BCBS of TX Blue Advantage |
$127.80
|
| Rate for Payer: BCBS of TX Blue Essentials |
$153.36
|
| Rate for Payer: BCBS of TX PPO |
$170.40
|
| Rate for Payer: Cash Price |
$289.68
|
| Rate for Payer: Cigna Medicaid |
$306.72
|
| Rate for Payer: Molina CHIP/Medicaid |
$306.72
|
| Rate for Payer: Multiplan Auto |
$276.90
|
| Rate for Payer: Multiplan Commercial |
$276.90
|
| Rate for Payer: Multiplan Workers Comp |
$276.90
|
| Rate for Payer: Parkland Medicaid |
$306.72
|
| Rate for Payer: Scott and White EPO/PPO |
$213.00
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$306.72
|
|
|
OPWC Extremity Study Bilateral 1-2 Levels BCE
|
Facility
|
IP
|
$720.00
|
|
|
Service Code
|
HCPCS 93922
|
| Hospital Charge Code |
8910553
|
|
Hospital Revenue Code
|
921
|
| Rate for Payer: Cash Price |
$489.60
|
|
|
OPWC Extremity Study Bilateral 1-2 Levels BCE
|
Facility
|
OP
|
$720.00
|
|
|
Service Code
|
HCPCS 93922
|
| Hospital Charge Code |
8910553
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$64.80 |
| Max. Negotiated Rate |
$518.40 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$64.80
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$133.65
|
| Rate for Payer: Amerigroup Medicare |
$133.65
|
| Rate for Payer: BCBS of TX Blue Advantage |
$216.00
|
| Rate for Payer: BCBS of TX Blue Essentials |
$259.20
|
| Rate for Payer: BCBS of TX Medicare |
$133.65
|
| Rate for Payer: BCBS of TX PPO |
$288.00
|
| Rate for Payer: Cash Price |
$489.60
|
| Rate for Payer: Cash Price |
$489.60
|
| Rate for Payer: Cash Price |
$489.60
|
| Rate for Payer: Cigna Commercial |
$282.53
|
| Rate for Payer: Cigna Medicaid |
$518.40
|
| Rate for Payer: Cigna Medicare |
$133.65
|
| Rate for Payer: Employer Direct Commercial |
$133.65
|
| Rate for Payer: Humana Medicare/TRICARE |
$133.65
|
| Rate for Payer: Molina CHIP/Medicaid |
$518.40
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$133.65
|
| Rate for Payer: Molina Medicare |
$133.65
|
| Rate for Payer: Multiplan Auto |
$468.00
|
| Rate for Payer: Multiplan Commercial |
$468.00
|
| Rate for Payer: Multiplan Workers Comp |
$468.00
|
| Rate for Payer: Parkland Medicaid |
$518.40
|
| Rate for Payer: Scott and White EPO/PPO |
$360.00
|
| Rate for Payer: Scott and White Medicare |
$133.65
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$518.40
|
| Rate for Payer: Superior Health Plan EPO |
$133.65
|
| Rate for Payer: Superior Health Plan Medicare |
$133.65
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$133.65
|
| Rate for Payer: Universal American Medicare |
$133.65
|
| Rate for Payer: Wellcare Medicare |
$133.65
|
| Rate for Payer: Wellmed Medicare |
$133.65
|
|
|
OPWC Extremity Study Bilateral 3+ Levels BCE
|
Facility
|
OP
|
$1,579.00
|
|
|
Service Code
|
HCPCS 93923
|
| Hospital Charge Code |
8910554
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$142.11 |
| Max. Negotiated Rate |
$1,136.88 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$142.11
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$216.91
|
| Rate for Payer: Amerigroup Medicare |
$216.91
|
| Rate for Payer: BCBS of TX Blue Advantage |
$473.70
|
| Rate for Payer: BCBS of TX Blue Essentials |
$568.44
|
| Rate for Payer: BCBS of TX Medicare |
$216.91
|
| Rate for Payer: BCBS of TX PPO |
$631.60
|
| Rate for Payer: Cash Price |
$1,073.72
|
| Rate for Payer: Cash Price |
$1,073.72
|
| Rate for Payer: Cash Price |
$1,073.72
|
| Rate for Payer: Cigna Commercial |
$458.51
|
| Rate for Payer: Cigna Medicaid |
$1,136.88
|
| Rate for Payer: Cigna Medicare |
$216.91
|
| Rate for Payer: Employer Direct Commercial |
$216.91
|
| Rate for Payer: Humana Medicare/TRICARE |
$216.91
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,136.88
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$216.91
|
| Rate for Payer: Molina Medicare |
$216.91
|
| Rate for Payer: Multiplan Auto |
$1,026.35
|
| Rate for Payer: Multiplan Commercial |
$1,026.35
|
| Rate for Payer: Multiplan Workers Comp |
$1,026.35
|
| Rate for Payer: Parkland Medicaid |
$1,136.88
|
| Rate for Payer: Scott and White EPO/PPO |
$789.50
|
| Rate for Payer: Scott and White Medicare |
$216.91
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,136.88
|
| Rate for Payer: Superior Health Plan EPO |
$216.91
|
| Rate for Payer: Superior Health Plan Medicare |
$216.91
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$216.91
|
| Rate for Payer: Universal American Medicare |
$216.91
|
| Rate for Payer: Wellcare Medicare |
$216.91
|
| Rate for Payer: Wellmed Medicare |
$216.91
|
|
|
OPWC Extremity Study Bilateral 3+ Levels BCE
|
Facility
|
IP
|
$1,579.00
|
|
|
Service Code
|
HCPCS 93923
|
| Hospital Charge Code |
8910554
|
|
Hospital Revenue Code
|
921
|
| Rate for Payer: Cash Price |
$1,073.72
|
|
|
OPWC Glucose Blood Test BCE
|
Facility
|
IP
|
$43.00
|
|
|
Service Code
|
HCPCS 82962
|
| Hospital Charge Code |
1690014
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$29.24
|
|
|
OPWC Glucose Blood Test BCE
|
Facility
|
OP
|
$43.00
|
|
|
Service Code
|
HCPCS 82962
|
| Hospital Charge Code |
1690014
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.28 |
| Max. Negotiated Rate |
$30.96 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1.28
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3.28
|
| Rate for Payer: Amerigroup Medicare |
$3.28
|
| Rate for Payer: BCBS of TX Blue Advantage |
$12.90
|
| Rate for Payer: BCBS of TX Blue Essentials |
$15.48
|
| Rate for Payer: BCBS of TX Medicare |
$3.28
|
| Rate for Payer: BCBS of TX PPO |
$17.20
|
| Rate for Payer: Cash Price |
$29.24
|
| Rate for Payer: Cash Price |
$29.24
|
| Rate for Payer: Cigna Medicaid |
$30.96
|
| Rate for Payer: Cigna Medicare |
$3.28
|
| Rate for Payer: Employer Direct Commercial |
$3.28
|
| Rate for Payer: Humana Medicare/TRICARE |
$3.28
|
| Rate for Payer: Molina CHIP/Medicaid |
$30.96
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3.28
|
| Rate for Payer: Molina Medicare |
$3.28
|
| Rate for Payer: Multiplan Auto |
$27.95
|
| Rate for Payer: Multiplan Commercial |
$27.95
|
| Rate for Payer: Multiplan Workers Comp |
$27.95
|
| Rate for Payer: Parkland Medicaid |
$30.96
|
| Rate for Payer: Scott and White EPO/PPO |
$4.10
|
| Rate for Payer: Scott and White Medicare |
$3.28
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$30.96
|
| Rate for Payer: Superior Health Plan EPO |
$3.28
|
| Rate for Payer: Superior Health Plan Medicare |
$3.28
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3.28
|
| Rate for Payer: Universal American Medicare |
$3.28
|
| Rate for Payer: Wellcare Medicare |
$3.28
|
| Rate for Payer: Wellmed Medicare |
$3.28
|
|
|
OPWC Hyperbaric O2 Full Body Chmbr/30Min BCE
|
Facility
|
IP
|
$582.00
|
|
| Hospital Charge Code |
8910556
|
|
Hospital Revenue Code
|
413
|
| Rate for Payer: Cash Price |
$395.76
|
|
|
OPWC Hyperbaric O2 Full Body Chmbr/30Min BCE
|
Facility
|
OP
|
$582.00
|
|
| Hospital Charge Code |
8910556
|
|
Hospital Revenue Code
|
413
|
| Min. Negotiated Rate |
$52.38 |
| Max. Negotiated Rate |
$419.04 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$52.38
|
| Rate for Payer: BCBS of TX Blue Advantage |
$174.60
|
| Rate for Payer: BCBS of TX Blue Essentials |
$209.52
|
| Rate for Payer: BCBS of TX PPO |
$232.80
|
| Rate for Payer: Cash Price |
$395.76
|
| Rate for Payer: Cash Price |
$395.76
|
| Rate for Payer: Cigna Medicaid |
$419.04
|
| Rate for Payer: Molina CHIP/Medicaid |
$419.04
|
| Rate for Payer: Multiplan Auto |
$378.30
|
| Rate for Payer: Multiplan Commercial |
$378.30
|
| Rate for Payer: Multiplan Workers Comp |
$378.30
|
| Rate for Payer: Parkland Medicaid |
$419.04
|
| Rate for Payer: Scott and White EPO/PPO |
$180.00
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$419.04
|
| Rate for Payer: Superior Health Plan EPO |
$79.15
|
|
|
OPWC I&D Abscess, Comp Or Mult BCE
|
Facility
|
OP
|
$2,238.42
|
|
|
Service Code
|
HCPCS 10061
|
| Hospital Charge Code |
8914545
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$98.28 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$98.28
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$408.37
|
| Rate for Payer: Amerigroup Medicare |
$408.37
|
| Rate for Payer: BCBS of TX Blue Advantage |
$192.87
|
| Rate for Payer: BCBS of TX Blue Essentials |
$230.98
|
| Rate for Payer: BCBS of TX Medicare |
$408.37
|
| Rate for Payer: BCBS of TX PPO |
$291.03
|
| Rate for Payer: Cash Price |
$1,522.13
|
| Rate for Payer: Cash Price |
$1,522.13
|
| Rate for Payer: Cash Price |
$1,522.13
|
| Rate for Payer: Cigna Commercial |
$863.21
|
| Rate for Payer: Cigna Medicaid |
$1,611.66
|
| Rate for Payer: Cigna Medicare |
$408.37
|
| Rate for Payer: Employer Direct Commercial |
$408.37
|
| Rate for Payer: Humana Medicare/TRICARE |
$408.37
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,611.66
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$408.37
|
| Rate for Payer: Molina Medicare |
$408.37
|
| 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 |
$1,611.66
|
| Rate for Payer: Scott and White EPO/PPO |
$755.48
|
| Rate for Payer: Scott and White Medicare |
$408.37
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,611.66
|
| Rate for Payer: Superior Health Plan EPO |
$408.37
|
| Rate for Payer: Superior Health Plan Medicare |
$408.37
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$408.37
|
| Rate for Payer: Universal American Medicare |
$408.37
|
| Rate for Payer: Wellcare Medicare |
$408.37
|
| Rate for Payer: Wellmed Medicare |
$408.37
|
|
|
OPWC I&D Abscess, Comp Or Mult BCE
|
Facility
|
IP
|
$2,238.42
|
|
|
Service Code
|
HCPCS 10061
|
| Hospital Charge Code |
8914545
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$1,522.13
|
|
|
OPWC I&D Abscess, Simple BCE
|
Facility
|
OP
|
$993.50
|
|
|
Service Code
|
HCPCS 10060
|
| Hospital Charge Code |
8914544
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$65.06 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$65.06
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$201.55
|
| Rate for Payer: Amerigroup Medicare |
$201.55
|
| Rate for Payer: BCBS of TX Blue Advantage |
$125.97
|
| Rate for Payer: BCBS of TX Blue Essentials |
$150.86
|
| Rate for Payer: BCBS of TX Medicare |
$201.55
|
| Rate for Payer: BCBS of TX PPO |
$190.08
|
| Rate for Payer: Cash Price |
$675.58
|
| Rate for Payer: Cash Price |
$675.58
|
| Rate for Payer: Cash Price |
$675.58
|
| Rate for Payer: Cigna Commercial |
$426.04
|
| Rate for Payer: Cigna Medicaid |
$715.32
|
| Rate for Payer: Cigna Medicare |
$201.55
|
| Rate for Payer: Employer Direct Commercial |
$201.55
|
| Rate for Payer: Humana Medicare/TRICARE |
$201.55
|
| Rate for Payer: Molina CHIP/Medicaid |
$715.32
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$201.55
|
| Rate for Payer: Molina Medicare |
$201.55
|
| 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 |
$715.32
|
| Rate for Payer: Scott and White EPO/PPO |
$372.87
|
| Rate for Payer: Scott and White Medicare |
$201.55
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$715.32
|
| Rate for Payer: Superior Health Plan EPO |
$201.55
|
| Rate for Payer: Superior Health Plan Medicare |
$201.55
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$201.55
|
| Rate for Payer: Universal American Medicare |
$201.55
|
| Rate for Payer: Wellcare Medicare |
$201.55
|
| Rate for Payer: Wellmed Medicare |
$201.55
|
|
|
OPWC I&D Abscess, Simple BCE
|
Facility
|
IP
|
$993.50
|
|
|
Service Code
|
HCPCS 10060
|
| Hospital Charge Code |
8914544
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$675.58
|
|
|
OPWC I&D Hematoma/Seroma BCE
|
Facility
|
IP
|
$6,773.30
|
|
|
Service Code
|
HCPCS 10140
|
| Hospital Charge Code |
7150105
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$4,605.84
|
|
|
OPWC I&D Hematoma/Seroma BCE
|
Facility
|
OP
|
$6,773.30
|
|
|
Service Code
|
HCPCS 10140
|
| Hospital Charge Code |
7150105
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$90.81 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$90.81
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,659.12
|
| Rate for Payer: Amerigroup Medicare |
$1,659.12
|
| Rate for Payer: BCBS of TX Blue Advantage |
$183.82
|
| Rate for Payer: BCBS of TX Blue Essentials |
$220.14
|
| Rate for Payer: BCBS of TX Medicare |
$1,659.12
|
| Rate for Payer: BCBS of TX PPO |
$277.38
|
| Rate for Payer: Cash Price |
$4,605.84
|
| Rate for Payer: Cash Price |
$4,605.84
|
| Rate for Payer: Cash Price |
$4,605.84
|
| Rate for Payer: Cigna Commercial |
$3,507.10
|
| Rate for Payer: Cigna Medicaid |
$4,876.78
|
| Rate for Payer: Cigna Medicare |
$1,659.12
|
| Rate for Payer: Employer Direct Commercial |
$1,659.12
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,659.12
|
| Rate for Payer: Molina CHIP/Medicaid |
$4,876.78
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,659.12
|
| Rate for Payer: Molina Medicare |
$1,659.12
|
| 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 |
$4,876.78
|
| Rate for Payer: Scott and White EPO/PPO |
$3,069.37
|
| Rate for Payer: Scott and White Medicare |
$1,659.12
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$4,876.78
|
| Rate for Payer: Superior Health Plan EPO |
$1,659.12
|
| Rate for Payer: Superior Health Plan Medicare |
$1,659.12
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,659.12
|
| Rate for Payer: Universal American Medicare |
$1,659.12
|
| Rate for Payer: Wellcare Medicare |
$1,659.12
|
| Rate for Payer: Wellmed Medicare |
$1,659.12
|
|
|
OPWC Incisional Bx Skin Sep/Addl BCE
|
Facility
|
IP
|
$1,014.00
|
|
|
Service Code
|
HCPCS 11107
|
| Hospital Charge Code |
8914546
|
|
Hospital Revenue Code
|
761
|
| Rate for Payer: Cash Price |
$689.52
|
|
|
OPWC Incisional Bx Skin Sep/Addl BCE
|
Facility
|
OP
|
$1,014.00
|
|
|
Service Code
|
HCPCS 11107
|
| Hospital Charge Code |
8914546
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$38.00 |
| Max. Negotiated Rate |
$730.08 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$91.26
|
| 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 |
$689.52
|
| Rate for Payer: Cash Price |
$689.52
|
| Rate for Payer: Cigna Medicaid |
$730.08
|
| Rate for Payer: Molina CHIP/Medicaid |
$730.08
|
| Rate for Payer: Multiplan Auto |
$659.10
|
| Rate for Payer: Multiplan Commercial |
$659.10
|
| Rate for Payer: Multiplan Workers Comp |
$659.10
|
| Rate for Payer: Parkland Medicaid |
$730.08
|
| Rate for Payer: Scott and White EPO/PPO |
$507.00
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$730.08
|
| Rate for Payer: Superior Health Plan EPO |
$137.90
|
|
|
OPWC Incisional Bx Skin Sgl Les BCE
|
Facility
|
IP
|
$1,538.00
|
|
|
Service Code
|
HCPCS 11106
|
| Hospital Charge Code |
8912549
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$1,045.84
|
|
|
OPWC Incisional Bx Skin Sgl Les BCE
|
Facility
|
IP
|
$1,538.00
|
|
|
Service Code
|
HCPCS 11106
|
| Hospital Charge Code |
7150052
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$1,045.84
|
|
|
OPWC Incisional Bx Skin Sgl Les BCE
|
Facility
|
OP
|
$1,538.00
|
|
|
Service Code
|
HCPCS 11106
|
| Hospital Charge Code |
7150052
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$98.83 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$98.83
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$742.44
|
| Rate for Payer: Amerigroup Medicare |
$742.44
|
| Rate for Payer: BCBS of TX Blue Advantage |
$194.07
|
| Rate for Payer: BCBS of TX Blue Essentials |
$232.42
|
| Rate for Payer: BCBS of TX Medicare |
$742.44
|
| Rate for Payer: BCBS of TX PPO |
$292.85
|
| Rate for Payer: Cash Price |
$1,045.84
|
| Rate for Payer: Cash Price |
$1,045.84
|
| Rate for Payer: Cash Price |
$1,045.84
|
| Rate for Payer: Cigna Commercial |
$1,569.38
|
| Rate for Payer: Cigna Medicaid |
$1,107.36
|
| Rate for Payer: Cigna Medicare |
$742.44
|
| Rate for Payer: Employer Direct Commercial |
$742.44
|
| Rate for Payer: Humana Medicare/TRICARE |
$742.44
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,107.36
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$742.44
|
| Rate for Payer: Molina Medicare |
$742.44
|
| 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 |
$1,107.36
|
| Rate for Payer: Scott and White EPO/PPO |
$1,373.51
|
| Rate for Payer: Scott and White Medicare |
$742.44
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,107.36
|
| Rate for Payer: Superior Health Plan EPO |
$742.44
|
| Rate for Payer: Superior Health Plan Medicare |
$742.44
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$742.44
|
| Rate for Payer: Universal American Medicare |
$742.44
|
| Rate for Payer: Wellcare Medicare |
$742.44
|
| Rate for Payer: Wellmed Medicare |
$742.44
|
|
|
OPWC Incisional Bx Skin Sgl Les BCE
|
Facility
|
OP
|
$1,538.00
|
|
|
Service Code
|
HCPCS 11106
|
| Hospital Charge Code |
8912549
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$98.83 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$98.83
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$742.44
|
| Rate for Payer: Amerigroup Medicare |
$742.44
|
| Rate for Payer: BCBS of TX Blue Advantage |
$194.07
|
| Rate for Payer: BCBS of TX Blue Essentials |
$232.42
|
| Rate for Payer: BCBS of TX Medicare |
$742.44
|
| Rate for Payer: BCBS of TX PPO |
$292.85
|
| Rate for Payer: Cash Price |
$1,045.84
|
| Rate for Payer: Cash Price |
$1,045.84
|
| Rate for Payer: Cash Price |
$1,045.84
|
| Rate for Payer: Cigna Commercial |
$1,569.38
|
| Rate for Payer: Cigna Medicaid |
$1,107.36
|
| Rate for Payer: Cigna Medicare |
$742.44
|
| Rate for Payer: Employer Direct Commercial |
$742.44
|
| Rate for Payer: Humana Medicare/TRICARE |
$742.44
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,107.36
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$742.44
|
| Rate for Payer: Molina Medicare |
$742.44
|
| 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 |
$1,107.36
|
| Rate for Payer: Scott and White EPO/PPO |
$1,373.51
|
| Rate for Payer: Scott and White Medicare |
$742.44
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,107.36
|
| Rate for Payer: Superior Health Plan EPO |
$742.44
|
| Rate for Payer: Superior Health Plan Medicare |
$742.44
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$742.44
|
| Rate for Payer: Universal American Medicare |
$742.44
|
| Rate for Payer: Wellcare Medicare |
$742.44
|
| Rate for Payer: Wellmed Medicare |
$742.44
|
|
|
OPWC LC Skin Sub App Face/Nck/HF ad 100sqcm BCE
|
Facility
|
OP
|
$4,073.00
|
|
| Hospital Charge Code |
8914552
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$38.00 |
| Max. Negotiated Rate |
$2,932.56 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$366.57
|
| 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 |
$2,769.64
|
| Rate for Payer: Cash Price |
$2,769.64
|
| Rate for Payer: Cigna Medicaid |
$2,932.56
|
| Rate for Payer: Molina CHIP/Medicaid |
$2,932.56
|
| Rate for Payer: Multiplan Auto |
$2,647.45
|
| Rate for Payer: Multiplan Commercial |
$2,647.45
|
| Rate for Payer: Multiplan Workers Comp |
$2,647.45
|
| Rate for Payer: Parkland Medicaid |
$2,932.56
|
| Rate for Payer: Scott and White EPO/PPO |
$2,036.50
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$2,932.56
|
| Rate for Payer: Superior Health Plan EPO |
$553.93
|
|
|
OPWC LC Skin Sub App Face/Nck/HF ad 100sqcm BCE
|
Facility
|
IP
|
$4,073.00
|
|
| Hospital Charge Code |
8914552
|
|
Hospital Revenue Code
|
761
|
| Rate for Payer: Cash Price |
$2,769.64
|
|
