|
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 |
$447.50
|
| 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 |
$755.48
|
| 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
|
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 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 |
$372.87
|
| 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 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 <=20 Sq cm BCE
|
Facility
|
OP
|
$794.80
|
|
|
Service Code
|
HCPCS 97597
|
| Hospital Charge Code |
8912555
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$71.53 |
| 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 |
$397.40
|
| 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 Each Addl 20 cm BCE
|
Facility
|
OP
|
$351.00
|
|
|
Service Code
|
HCPCS 97598
|
| Hospital Charge Code |
8910571
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$31.59 |
| 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: 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 |
$175.50
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$252.72
|
| Rate for Payer: Superior Health Plan EPO |
$47.74
|
|
|
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 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 |
$1,373.51
|
| 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 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 Grft Fce/Nck/FH/G Ch ad 20sqcm BCE
|
Facility
|
IP
|
$10,292.16
|
|
|
Service Code
|
HCPCS 15276
|
| Hospital Charge Code |
8910575
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$6,998.67
|
|
|
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
|
|
|
OPWC Skin Sub Grft Trk/Arm/Leg Ch 1st 100sqcm BCE
|
Facility
|
IP
|
$6,927.00
|
|
|
Service Code
|
HCPCS 15273
|
| Hospital Charge Code |
8910573
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$4,710.36
|
|
|
OPWC Skin Sub Grft Trk/Arm/Leg Ch 1st 100sqcm BCE
|
Facility
|
OP
|
$6,927.00
|
|
|
Service Code
|
HCPCS 15273
|
| Hospital Charge Code |
8910573
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,565.86 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,565.86
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$2,072.68
|
| Rate for Payer: Amerigroup Medicare |
$2,072.68
|
| Rate for Payer: BCBS of TX Blue Advantage |
$4,972.07
|
| Rate for Payer: BCBS of TX Blue Essentials |
$5,954.58
|
| Rate for Payer: BCBS of TX Medicare |
$2,072.68
|
| Rate for Payer: BCBS of TX PPO |
$7,502.77
|
| Rate for Payer: Cash Price |
$4,710.36
|
| Rate for Payer: Cash Price |
$4,710.36
|
| Rate for Payer: Cash Price |
$4,710.36
|
| Rate for Payer: Cigna Commercial |
$4,381.27
|
| Rate for Payer: Cigna Medicaid |
$4,987.44
|
| Rate for Payer: Cigna Medicare |
$2,072.68
|
| Rate for Payer: Employer Direct Commercial |
$2,072.68
|
| Rate for Payer: Humana Medicare/TRICARE |
$2,072.68
|
| Rate for Payer: Molina CHIP/Medicaid |
$4,987.44
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$2,072.68
|
| Rate for Payer: Molina Medicare |
$2,072.68
|
| Rate for Payer: Multiplan Auto |
$10,000.00
|
| Rate for Payer: Multiplan Commercial |
$10,000.00
|
| Rate for Payer: Multiplan Workers Comp |
$10,000.00
|
| Rate for Payer: Parkland Medicaid |
$4,987.44
|
| Rate for Payer: Scott and White EPO/PPO |
$3,834.46
|
| Rate for Payer: Scott and White Medicare |
$2,072.68
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$4,987.44
|
| Rate for Payer: Superior Health Plan EPO |
$2,072.68
|
| Rate for Payer: Superior Health Plan Medicare |
$2,072.68
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$2,072.68
|
| Rate for Payer: Universal American Medicare |
$2,072.68
|
| Rate for Payer: Wellcare Medicare |
$2,072.68
|
| Rate for Payer: Wellmed Medicare |
$2,072.68
|
|
|
OPWC Skin Sub Grft Trk/Arm/Leg Ch 1st 25 sqcm BCE
|
Facility
|
IP
|
$10,292.16
|
|
|
Service Code
|
HCPCS 15271
|
| Hospital Charge Code |
8912556
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$6,998.67
|
|
|
OPWC Skin Sub Grft Trk/Arm/Leg Ch 1st 25 sqcm BCE
|
Facility
|
OP
|
$10,292.16
|
|
|
Service Code
|
HCPCS 15271
|
| Hospital Charge Code |
8912556
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$742.44 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$784.87
|
| 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 |
$6,998.67
|
| Rate for Payer: Cash Price |
$6,998.67
|
| Rate for Payer: Cash Price |
$6,998.67
|
| Rate for Payer: Cigna Commercial |
$1,569.38
|
| Rate for Payer: Cigna Medicaid |
$7,410.36
|
| 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 |
$7,410.36
|
| 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 |
$7,410.36
|
| 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 |
$7,410.36
|
| 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 Skin Sub Grft Trk/Arm/Leg Ch ad 25 sqcm BCE
|
Facility
|
IP
|
$977.00
|
|
|
Service Code
|
HCPCS 15272
|
| Hospital Charge Code |
8910572
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$664.36
|
|
|
OPWC Skin Sub Grft Trk/Arm/Leg Ch ad 25 sqcm BCE
|
Facility
|
OP
|
$977.00
|
|
|
Service Code
|
HCPCS 15272
|
| Hospital Charge Code |
8910572
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$87.93 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$87.93
|
| Rate for Payer: BCBS of TX Blue Advantage |
$293.10
|
| Rate for Payer: BCBS of TX Blue Essentials |
$351.72
|
| Rate for Payer: BCBS of TX PPO |
$390.80
|
| Rate for Payer: Cash Price |
$664.36
|
| Rate for Payer: Cash Price |
$664.36
|
| Rate for Payer: Cigna Medicaid |
$703.44
|
| Rate for Payer: Molina CHIP/Medicaid |
$703.44
|
| 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 |
$703.44
|
| Rate for Payer: Scott and White EPO/PPO |
$488.50
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$703.44
|
| Rate for Payer: Superior Health Plan EPO |
$132.87
|
|
|
OPWC Skin Sub Grft Trnk/Arm/Leg Ch ad 100sqcm BCE
|
Facility
|
OP
|
$3,438.00
|
|
|
Service Code
|
HCPCS 15274
|
| Hospital Charge Code |
8910574
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$309.42 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$309.42
|
| Rate for Payer: BCBS of TX Blue Advantage |
$1,031.40
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,237.68
|
| Rate for Payer: BCBS of TX PPO |
$1,375.20
|
| Rate for Payer: Cash Price |
$2,337.84
|
| Rate for Payer: Cash Price |
$2,337.84
|
| Rate for Payer: Cigna Medicaid |
$2,475.36
|
| Rate for Payer: Molina CHIP/Medicaid |
$2,475.36
|
| 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 |
$2,475.36
|
| Rate for Payer: Scott and White EPO/PPO |
$1,719.00
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$2,475.36
|
| Rate for Payer: Superior Health Plan EPO |
$467.57
|
|
|
OPWC Skin Sub Grft Trnk/Arm/Leg Ch ad 100sqcm BCE
|
Facility
|
IP
|
$3,438.00
|
|
|
Service Code
|
HCPCS 15274
|
| Hospital Charge Code |
8910574
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$2,337.84
|
|
|
OPWC Strapping Una Boot Lt BCE
|
Facility
|
IP
|
$993.50
|
|
|
Service Code
|
HCPCS 29580
|
| Hospital Charge Code |
8910576
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$675.58
|
|
|
OPWC Strapping Una Boot Lt BCE
|
Facility
|
OP
|
$993.50
|
|
|
Service Code
|
HCPCS 29580
|
| Hospital Charge Code |
8910576
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$33.12 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$33.12
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$163.24
|
| Rate for Payer: Amerigroup Medicare |
$163.24
|
| Rate for Payer: BCBS of TX Blue Advantage |
$70.51
|
| Rate for Payer: BCBS of TX Blue Essentials |
$84.44
|
| Rate for Payer: BCBS of TX Medicare |
$163.24
|
| Rate for Payer: BCBS of TX PPO |
$106.39
|
| 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 |
$345.06
|
| Rate for Payer: Cigna Medicaid |
$715.32
|
| Rate for Payer: Cigna Medicare |
$163.24
|
| Rate for Payer: Employer Direct Commercial |
$163.24
|
| Rate for Payer: Humana Medicare/TRICARE |
$163.24
|
| Rate for Payer: Molina CHIP/Medicaid |
$715.32
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$163.24
|
| Rate for Payer: Molina Medicare |
$163.24
|
| 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 |
$301.99
|
| Rate for Payer: Scott and White Medicare |
$163.24
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$715.32
|
| Rate for Payer: Superior Health Plan EPO |
$163.24
|
| Rate for Payer: Superior Health Plan Medicare |
$163.24
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$163.24
|
| Rate for Payer: Universal American Medicare |
$163.24
|
| Rate for Payer: Wellcare Medicare |
$163.24
|
| Rate for Payer: Wellmed Medicare |
$163.24
|
|
|
OPWC Strapping Una Boot Rt BCE
|
Facility
|
OP
|
$993.50
|
|
|
Service Code
|
HCPCS 29580
|
| Hospital Charge Code |
8912558
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$33.12 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$33.12
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$163.24
|
| Rate for Payer: Amerigroup Medicare |
$163.24
|
| Rate for Payer: BCBS of TX Blue Advantage |
$70.51
|
| Rate for Payer: BCBS of TX Blue Essentials |
$84.44
|
| Rate for Payer: BCBS of TX Medicare |
$163.24
|
| Rate for Payer: BCBS of TX PPO |
$106.39
|
| 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 |
$345.06
|
| Rate for Payer: Cigna Medicaid |
$715.32
|
| Rate for Payer: Cigna Medicare |
$163.24
|
| Rate for Payer: Employer Direct Commercial |
$163.24
|
| Rate for Payer: Humana Medicare/TRICARE |
$163.24
|
| Rate for Payer: Molina CHIP/Medicaid |
$715.32
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$163.24
|
| Rate for Payer: Molina Medicare |
$163.24
|
| 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 |
$301.99
|
| Rate for Payer: Scott and White Medicare |
$163.24
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$715.32
|
| Rate for Payer: Superior Health Plan EPO |
$163.24
|
| Rate for Payer: Superior Health Plan Medicare |
$163.24
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$163.24
|
| Rate for Payer: Universal American Medicare |
$163.24
|
| Rate for Payer: Wellcare Medicare |
$163.24
|
| Rate for Payer: Wellmed Medicare |
$163.24
|
|
