|
OPWC Paring/Cutting Benign Lesion 2-4 BCE
|
Facility
|
IP
|
$403.00
|
|
|
Service Code
|
HCPCS 11056
|
| Hospital Charge Code |
8914557
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$274.04
|
|
|
OPWC Paring/Cutting Benign Lesion 2-4 BCE
|
Facility
|
OP
|
$403.00
|
|
|
Service Code
|
HCPCS 11056
|
| Hospital Charge Code |
8914557
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$36.27 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$36.27
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$201.55
|
| Rate for Payer: Amerigroup Medicare |
$201.55
|
| Rate for Payer: BCBS of TX Blue Advantage |
$291.80
|
| Rate for Payer: BCBS of TX Blue Essentials |
$349.46
|
| Rate for Payer: BCBS of TX Medicare |
$201.55
|
| Rate for Payer: BCBS of TX PPO |
$440.32
|
| Rate for Payer: Cash Price |
$274.04
|
| Rate for Payer: Cash Price |
$274.04
|
| Rate for Payer: Cash Price |
$274.04
|
| Rate for Payer: Cigna Commercial |
$426.04
|
| Rate for Payer: Cigna Medicaid |
$290.16
|
| 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 |
$290.16
|
| 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 |
$290.16
|
| Rate for Payer: Scott and White EPO/PPO |
$338.72
|
| Rate for Payer: Scott and White Medicare |
$201.55
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$290.16
|
| 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 Paring/Cutting Benign Lesion Over 4 BCE
|
Facility
|
IP
|
$521.00
|
|
|
Service Code
|
HCPCS 11057
|
| Hospital Charge Code |
8914558
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$354.28
|
|
|
OPWC Paring/Cutting Benign Lesion Over 4 BCE
|
Facility
|
OP
|
$521.00
|
|
|
Service Code
|
HCPCS 11057
|
| Hospital Charge Code |
8914558
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$55.65 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$55.65
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$201.55
|
| Rate for Payer: Amerigroup Medicare |
$201.55
|
| Rate for Payer: BCBS of TX Blue Advantage |
$97.03
|
| Rate for Payer: BCBS of TX Blue Essentials |
$116.20
|
| Rate for Payer: BCBS of TX Medicare |
$201.55
|
| Rate for Payer: BCBS of TX PPO |
$146.41
|
| Rate for Payer: Cash Price |
$354.28
|
| Rate for Payer: Cash Price |
$354.28
|
| Rate for Payer: Cash Price |
$354.28
|
| Rate for Payer: Cigna Commercial |
$426.04
|
| Rate for Payer: Cigna Medicaid |
$375.12
|
| 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 |
$375.12
|
| 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 |
$375.12
|
| Rate for Payer: Scott and White EPO/PPO |
$338.72
|
| Rate for Payer: Scott and White Medicare |
$201.55
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$375.12
|
| 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 Paring Of Single Callus BCE
|
Facility
|
IP
|
$993.50
|
|
|
Service Code
|
HCPCS 11055
|
| Hospital Charge Code |
8910564
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$675.58
|
|
|
OPWC Paring Of Single Callus BCE
|
Facility
|
OP
|
$993.50
|
|
|
Service Code
|
HCPCS 11055
|
| Hospital Charge Code |
8910564
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$89.42 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$89.42
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$201.55
|
| Rate for Payer: Amerigroup Medicare |
$201.55
|
| Rate for Payer: BCBS of TX Blue Advantage |
$291.80
|
| Rate for Payer: BCBS of TX Blue Essentials |
$349.46
|
| Rate for Payer: BCBS of TX Medicare |
$201.55
|
| Rate for Payer: BCBS of TX PPO |
$440.32
|
| 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 |
$338.72
|
| 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 Punch Biopsy Skin, Ea Add BCE
|
Facility
|
OP
|
$346.00
|
|
|
Service Code
|
HCPCS 11105
|
| Hospital Charge Code |
7150054
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$31.14 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$31.14
|
| Rate for Payer: BCBS of TX Blue Advantage |
$103.80
|
| Rate for Payer: BCBS of TX Blue Essentials |
$124.56
|
| Rate for Payer: BCBS of TX PPO |
$138.40
|
| Rate for Payer: Cash Price |
$235.28
|
| Rate for Payer: Cash Price |
$235.28
|
| Rate for Payer: Cigna Medicaid |
$249.12
|
| Rate for Payer: Molina CHIP/Medicaid |
$249.12
|
| 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 |
$249.12
|
| Rate for Payer: Scott and White EPO/PPO |
$173.00
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$249.12
|
| Rate for Payer: Superior Health Plan EPO |
$47.06
|
|
|
OPWC Punch Biopsy Skin, Ea Add BCE
|
Facility
|
IP
|
$346.00
|
|
|
Service Code
|
HCPCS 11105
|
| Hospital Charge Code |
7150054
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$235.28
|
|
|
OPWC Punch Biopsy Skn, One Lsn BCE
|
Facility
|
OP
|
$688.00
|
|
|
Service Code
|
HCPCS 11104
|
| Hospital Charge Code |
8910565
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$79.46 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$79.46
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$408.37
|
| Rate for Payer: Amerigroup Medicare |
$408.37
|
| Rate for Payer: BCBS of TX Blue Advantage |
$147.44
|
| Rate for Payer: BCBS of TX Blue Essentials |
$176.58
|
| Rate for Payer: BCBS of TX Medicare |
$408.37
|
| Rate for Payer: BCBS of TX PPO |
$222.49
|
| Rate for Payer: Cash Price |
$467.84
|
| Rate for Payer: Cash Price |
$467.84
|
| Rate for Payer: Cash Price |
$467.84
|
| Rate for Payer: Cigna Commercial |
$863.21
|
| Rate for Payer: Cigna Medicaid |
$495.36
|
| 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 |
$495.36
|
| 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 |
$495.36
|
| Rate for Payer: Scott and White EPO/PPO |
$674.64
|
| Rate for Payer: Scott and White Medicare |
$408.37
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$495.36
|
| 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 Punch Biopsy Skn, One Lsn BCE
|
Facility
|
IP
|
$688.00
|
|
|
Service Code
|
HCPCS 11104
|
| Hospital Charge Code |
8910565
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$467.84
|
|
|
OPWC Puncture Drainage Of Lesion BCE
|
Facility
|
IP
|
$895.00
|
|
|
Service Code
|
HCPCS 10160
|
| Hospital Charge Code |
8910566
|
|
Hospital Revenue Code
|
761
|
| Rate for Payer: Cash Price |
$608.60
|
|
|
OPWC Puncture Drainage Of Lesion BCE
|
Facility
|
OP
|
$895.00
|
|
|
Service Code
|
HCPCS 10160
|
| Hospital Charge Code |
8910566
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$80.55 |
| Max. Negotiated Rate |
$863.21 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$80.55
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$408.37
|
| Rate for Payer: Amerigroup Medicare |
$408.37
|
| Rate for Payer: BCBS of TX Blue Advantage |
$139.23
|
| Rate for Payer: BCBS of TX Blue Essentials |
$166.74
|
| Rate for Payer: BCBS of TX Medicare |
$408.37
|
| Rate for Payer: BCBS of TX PPO |
$210.09
|
| Rate for Payer: Cash Price |
$608.60
|
| Rate for Payer: Cash Price |
$608.60
|
| Rate for Payer: Cash Price |
$608.60
|
| Rate for Payer: Cigna Commercial |
$863.21
|
| Rate for Payer: Cigna Medicaid |
$644.40
|
| 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 |
$644.40
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$408.37
|
| Rate for Payer: Molina Medicare |
$408.37
|
| Rate for Payer: Multiplan Auto |
$581.75
|
| Rate for Payer: Multiplan Commercial |
$581.75
|
| Rate for Payer: Multiplan Workers Comp |
$581.75
|
| Rate for Payer: Parkland Medicaid |
$644.40
|
| Rate for Payer: Scott and White EPO/PPO |
$119.30
|
| Rate for Payer: Scott and White Medicare |
$408.37
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$644.40
|
| 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 Removal Of Nail Bed BCE
|
Facility
|
OP
|
$8,017.06
|
|
|
Service Code
|
HCPCS 11750
|
| Hospital Charge Code |
8910568
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$84.71 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$84.71
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$408.37
|
| Rate for Payer: Amerigroup Medicare |
$408.37
|
| Rate for Payer: BCBS of TX Blue Advantage |
$165.75
|
| Rate for Payer: BCBS of TX Blue Essentials |
$198.50
|
| Rate for Payer: BCBS of TX Medicare |
$408.37
|
| Rate for Payer: BCBS of TX PPO |
$250.11
|
| Rate for Payer: Cash Price |
$5,451.60
|
| Rate for Payer: Cash Price |
$5,451.60
|
| Rate for Payer: Cash Price |
$5,451.60
|
| Rate for Payer: Cigna Commercial |
$863.21
|
| Rate for Payer: Cigna Medicaid |
$5,772.28
|
| 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 |
$5,772.28
|
| 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 |
$5,772.28
|
| Rate for Payer: Scott and White EPO/PPO |
$674.64
|
| Rate for Payer: Scott and White Medicare |
$408.37
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$5,772.28
|
| 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 Removal Of Nail Bed BCE
|
Facility
|
IP
|
$8,017.06
|
|
|
Service Code
|
HCPCS 11750
|
| Hospital Charge Code |
8910568
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$5,451.60
|
|
|
OPWC Removal Of Skin Lesion BCE
|
Facility
|
OP
|
$2,477.00
|
|
|
Service Code
|
HCPCS 11200
|
| Hospital Charge Code |
8910567
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$201.55 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$222.93
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$201.55
|
| Rate for Payer: Amerigroup Medicare |
$201.55
|
| Rate for Payer: BCBS of TX Blue Advantage |
$291.80
|
| Rate for Payer: BCBS of TX Blue Essentials |
$349.46
|
| Rate for Payer: BCBS of TX Medicare |
$201.55
|
| Rate for Payer: BCBS of TX PPO |
$440.32
|
| Rate for Payer: Cash Price |
$1,684.36
|
| Rate for Payer: Cash Price |
$1,684.36
|
| Rate for Payer: Cash Price |
$1,684.36
|
| Rate for Payer: Cigna Commercial |
$426.04
|
| Rate for Payer: Cigna Medicaid |
$1,783.44
|
| 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 |
$1,783.44
|
| 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 |
$1,783.44
|
| Rate for Payer: Scott and White EPO/PPO |
$338.72
|
| Rate for Payer: Scott and White Medicare |
$201.55
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,783.44
|
| 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 Removal Of Skin Lesion BCE
|
Facility
|
IP
|
$2,477.00
|
|
|
Service Code
|
HCPCS 11200
|
| Hospital Charge Code |
8910567
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$1,684.36
|
|
|
OPWC Remove Foreign Body, Simple BCE
|
Facility
|
OP
|
$2,057.12
|
|
|
Service Code
|
HCPCS 10120
|
| Hospital Charge Code |
8910569
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$86.38 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$86.38
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$408.37
|
| Rate for Payer: Amerigroup Medicare |
$408.37
|
| Rate for Payer: BCBS of TX Blue Advantage |
$178.41
|
| Rate for Payer: BCBS of TX Blue Essentials |
$213.66
|
| Rate for Payer: BCBS of TX Medicare |
$408.37
|
| Rate for Payer: BCBS of TX PPO |
$269.21
|
| Rate for Payer: Cash Price |
$1,398.84
|
| Rate for Payer: Cash Price |
$1,398.84
|
| Rate for Payer: Cash Price |
$1,398.84
|
| Rate for Payer: Cigna Commercial |
$863.21
|
| Rate for Payer: Cigna Medicaid |
$1,481.13
|
| 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 |
$1,481.13
|
| 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 |
$1,481.13
|
| Rate for Payer: Scott and White EPO/PPO |
$674.64
|
| Rate for Payer: Scott and White Medicare |
$408.37
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,481.13
|
| 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 Remove Foreign Body, Simple BCE
|
Facility
|
IP
|
$2,057.12
|
|
|
Service Code
|
HCPCS 10120
|
| Hospital Charge Code |
8910569
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$1,398.84
|
|
|
OPWC Sel Sharp Deb <=20 Sq cm BCE
|
Facility
|
OP
|
$794.80
|
|
|
Service Code
|
HCPCS 97597
|
| Hospital Charge Code |
8912555
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$43.09 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$71.53
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$201.55
|
| Rate for Payer: Amerigroup Medicare |
$201.55
|
| Rate for Payer: BCBS of TX Blue Advantage |
$238.44
|
| Rate for Payer: BCBS of TX Blue Essentials |
$286.13
|
| Rate for Payer: BCBS of TX Medicare |
$201.55
|
| Rate for Payer: BCBS of TX PPO |
$317.92
|
| Rate for Payer: Cash Price |
$540.46
|
| Rate for Payer: Cash Price |
$540.46
|
| Rate for Payer: Cash Price |
$540.46
|
| Rate for Payer: Cigna Commercial |
$426.04
|
| Rate for Payer: Cigna Medicaid |
$572.26
|
| 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 |
$572.26
|
| 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 |
$572.26
|
| Rate for Payer: Scott and White EPO/PPO |
$43.09
|
| Rate for Payer: Scott and White Medicare |
$201.55
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$572.26
|
| 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 Sel Sharp Deb <=20 Sq cm BCE
|
Facility
|
IP
|
$794.80
|
|
|
Service Code
|
HCPCS 97597
|
| Hospital Charge Code |
8912555
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$540.46
|
|
|
OPWC Sel Sharp Deb Each Addl 20 cm BCE
|
Facility
|
IP
|
$351.00
|
|
|
Service Code
|
HCPCS 97598
|
| Hospital Charge Code |
8910571
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$238.68
|
|
|
OPWC Sel Sharp Deb Each Addl 20 cm BCE
|
Facility
|
OP
|
$351.00
|
|
|
Service Code
|
HCPCS 97598
|
| Hospital Charge Code |
8910571
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$29.85 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$31.59
|
| Rate for Payer: BCBS of TX Blue Advantage |
$105.30
|
| Rate for Payer: BCBS of TX Blue Essentials |
$126.36
|
| Rate for Payer: BCBS of TX PPO |
$140.40
|
| Rate for Payer: Cash Price |
$238.68
|
| Rate for Payer: Cash Price |
$238.68
|
| Rate for Payer: Cash Price |
$238.68
|
| Rate for Payer: Cigna Medicaid |
$252.72
|
| Rate for Payer: Molina CHIP/Medicaid |
$252.72
|
| 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 |
$252.72
|
| Rate for Payer: Scott and White EPO/PPO |
$29.85
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$252.72
|
| Rate for Payer: Superior Health Plan EPO |
$47.74
|
|
|
OPWC Skin Sub Graft Face/Neck/Nk/Fh/G First 25 Sq cm BCE
|
Facility
|
IP
|
$7,316.92
|
|
|
Service Code
|
HCPCS 15275
|
| Hospital Charge Code |
8912557
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$4,975.51
|
|
|
OPWC Skin Sub Graft Face/Neck/Nk/Fh/G First 25 Sq cm BCE
|
Facility
|
OP
|
$7,316.92
|
|
|
Service Code
|
HCPCS 15275
|
| Hospital Charge Code |
8912557
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$71.16 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$71.16
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$742.44
|
| Rate for Payer: Amerigroup Medicare |
$742.44
|
| 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 |
$742.44
|
| 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 |
$1,569.38
|
| Rate for Payer: Cigna Medicaid |
$5,268.18
|
| 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 |
$5,268.18
|
| 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 |
$5,268.18
|
| Rate for Payer: Scott and White EPO/PPO |
$3,085.41
|
| Rate for Payer: Scott and White Medicare |
$742.44
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$5,268.18
|
| 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 Skin Sub Grft Fce/Nck/FH/G Ch ad 20sqcm BCE
|
Facility
|
OP
|
$10,292.16
|
|
|
Service Code
|
HCPCS 15276
|
| Hospital Charge Code |
8910575
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$926.29 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$926.29
|
| Rate for Payer: BCBS of TX Blue Advantage |
$3,087.65
|
| Rate for Payer: BCBS of TX Blue Essentials |
$3,705.18
|
| Rate for Payer: BCBS of TX PPO |
$4,116.86
|
| Rate for Payer: Cash Price |
$6,998.67
|
| Rate for Payer: Cash Price |
$6,998.67
|
| Rate for Payer: Cigna Medicaid |
$7,410.36
|
| Rate for Payer: Molina CHIP/Medicaid |
$7,410.36
|
| 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 |
$7,410.36
|
| Rate for Payer: Scott and White EPO/PPO |
$5,146.08
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$7,410.36
|
| Rate for Payer: Superior Health Plan EPO |
$1,399.73
|
|
