|
ACTH, Plasma SO
|
Facility
|
OP
|
$328.00
|
|
|
Service Code
|
CPT 82024
|
| Hospital Charge Code |
1700889
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.06 |
| Max. Negotiated Rate |
$213.20 |
| Rate for Payer: Aetna Commercial |
$40.55
|
| Rate for Payer: Aetna Medicare |
$57.93
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$15.06
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$38.62
|
| Rate for Payer: Amerigroup Medicare |
$38.62
|
| Rate for Payer: BCBS of TX Blue Advantage |
$63.72
|
| Rate for Payer: BCBS of TX Blue Essentials |
$76.47
|
| Rate for Payer: BCBS of TX Medicare |
$38.62
|
| Rate for Payer: BCBS of TX PPO |
$85.35
|
| Rate for Payer: Cash Price |
$288.64
|
| Rate for Payer: Cash Price |
$288.64
|
| Rate for Payer: Cigna Medicaid |
$38.62
|
| Rate for Payer: Cigna Medicare |
$38.62
|
| Rate for Payer: Employer Direct Commercial |
$38.62
|
| Rate for Payer: Humana Medicare/TRICARE |
$38.62
|
| Rate for Payer: Molina CHIP/Medicaid |
$38.62
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$38.62
|
| Rate for Payer: Molina Medicare |
$38.62
|
| Rate for Payer: Multiplan Auto |
$213.20
|
| Rate for Payer: Multiplan Commercial |
$213.20
|
| Rate for Payer: Multiplan Workers Comp |
$213.20
|
| Rate for Payer: Parkland Medicaid |
$38.62
|
| Rate for Payer: Scott and White EPO/PPO |
$48.28
|
| Rate for Payer: Scott and White Medicare |
$38.62
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$38.62
|
| Rate for Payer: Superior Health Plan EPO |
$38.62
|
| Rate for Payer: Superior Health Plan Medicare |
$38.62
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$38.62
|
| Rate for Payer: Universal American Medicare |
$38.62
|
| Rate for Payer: Wellcare Medicare |
$38.62
|
| Rate for Payer: Wellmed Medicare |
$38.62
|
|
|
ACTH, Plasma SO
|
Facility
|
IP
|
$328.00
|
|
|
Service Code
|
CPT 82024
|
| Hospital Charge Code |
1700889
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$288.64
|
|
|
ACTINOMYCES ANTIBODY
|
Facility
|
IP
|
$74.00
|
|
|
Service Code
|
CPT 86602
|
| Hospital Charge Code |
1740729
|
|
Hospital Revenue Code
|
302
|
| Rate for Payer: Cash Price |
$65.12
|
|
|
ACTINOMYCES ANTIBODY
|
Facility
|
OP
|
$74.00
|
|
|
Service Code
|
CPT 86602
|
| Hospital Charge Code |
1740729
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.97 |
| Max. Negotiated Rate |
$48.10 |
| Rate for Payer: Aetna Commercial |
$10.69
|
| Rate for Payer: Aetna Medicare |
$15.27
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$3.97
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$10.18
|
| Rate for Payer: Amerigroup Medicare |
$10.18
|
| Rate for Payer: BCBS of TX Blue Advantage |
$16.80
|
| Rate for Payer: BCBS of TX Blue Essentials |
$20.16
|
| Rate for Payer: BCBS of TX Medicare |
$10.18
|
| Rate for Payer: BCBS of TX PPO |
$22.50
|
| Rate for Payer: Cash Price |
$65.12
|
| Rate for Payer: Cash Price |
$65.12
|
| Rate for Payer: Cigna Medicaid |
$10.18
|
| Rate for Payer: Cigna Medicare |
$10.18
|
| Rate for Payer: Employer Direct Commercial |
$10.18
|
| Rate for Payer: Humana Medicare/TRICARE |
$10.18
|
| Rate for Payer: Molina CHIP/Medicaid |
$10.18
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$10.18
|
| Rate for Payer: Molina Medicare |
$10.18
|
| Rate for Payer: Multiplan Auto |
$48.10
|
| Rate for Payer: Multiplan Commercial |
$48.10
|
| Rate for Payer: Multiplan Workers Comp |
$48.10
|
| Rate for Payer: Parkland Medicaid |
$10.18
|
| Rate for Payer: Scott and White EPO/PPO |
$12.72
|
| Rate for Payer: Scott and White Medicare |
$10.18
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$10.18
|
| Rate for Payer: Superior Health Plan EPO |
$10.18
|
| Rate for Payer: Superior Health Plan Medicare |
$10.18
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$10.18
|
| Rate for Payer: Universal American Medicare |
$10.18
|
| Rate for Payer: Wellcare Medicare |
$10.18
|
| Rate for Payer: Wellmed Medicare |
$10.18
|
|
|
Actin (Smooth Muscle) Antibody SO
|
Facility
|
IP
|
$195.00
|
|
|
Service Code
|
CPT 86015
|
| Hospital Charge Code |
1706019
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$171.60
|
|
|
Actin (Smooth Muscle) Antibody SO
|
Facility
|
OP
|
$195.00
|
|
|
Service Code
|
CPT 86015
|
| Hospital Charge Code |
1706019
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.50 |
| Max. Negotiated Rate |
$126.75 |
| Rate for Payer: Aetna Commercial |
$12.11
|
| Rate for Payer: Aetna Medicare |
$18.08
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$4.50
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$12.05
|
| Rate for Payer: Amerigroup Medicare |
$12.05
|
| Rate for Payer: BCBS of TX Blue Advantage |
$19.02
|
| Rate for Payer: BCBS of TX Blue Essentials |
$22.83
|
| Rate for Payer: BCBS of TX Medicare |
$12.05
|
| Rate for Payer: BCBS of TX PPO |
$25.48
|
| Rate for Payer: Cash Price |
$171.60
|
| Rate for Payer: Cash Price |
$171.60
|
| Rate for Payer: Cigna Medicaid |
$12.05
|
| Rate for Payer: Cigna Medicare |
$12.05
|
| Rate for Payer: Employer Direct Commercial |
$12.05
|
| Rate for Payer: Humana Medicare/TRICARE |
$12.05
|
| Rate for Payer: Molina CHIP/Medicaid |
$12.05
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$12.05
|
| Rate for Payer: Molina Medicare |
$12.05
|
| Rate for Payer: Multiplan Auto |
$126.75
|
| Rate for Payer: Multiplan Commercial |
$126.75
|
| Rate for Payer: Multiplan Workers Comp |
$126.75
|
| Rate for Payer: Parkland Medicaid |
$12.05
|
| Rate for Payer: Scott and White EPO/PPO |
$15.06
|
| Rate for Payer: Scott and White Medicare |
$12.05
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$12.05
|
| Rate for Payer: Superior Health Plan EPO |
$12.05
|
| Rate for Payer: Superior Health Plan Medicare |
$12.05
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$12.05
|
| Rate for Payer: Universal American Medicare |
$12.05
|
| Rate for Payer: Wellcare Medicare |
$12.05
|
| Rate for Payer: Wellmed Medicare |
$12.05
|
|
|
ACTISHIELD AMNIOTIC MEMBRANE 4X8CM
|
Facility
|
OP
|
$474.94
|
|
|
Service Code
|
HCPCS C1765
|
| Hospital Charge Code |
145563
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$42.74 |
| Max. Negotiated Rate |
$237.47 |
| Rate for Payer: Aetna Commercial |
$142.48
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$42.74
|
| Rate for Payer: Cash Price |
$417.95
|
| Rate for Payer: Multiplan Auto |
$237.47
|
| Rate for Payer: Multiplan Commercial |
$237.47
|
| Rate for Payer: Multiplan Workers Comp |
$237.47
|
| Rate for Payer: Scott and White EPO/PPO |
$237.47
|
| Rate for Payer: Superior Health Plan EPO |
$64.59
|
|
|
ACTISHIELD AMNIOTIC MEMBRANE 4X8CM
|
Facility
|
IP
|
$474.94
|
|
|
Service Code
|
HCPCS C1765
|
| Hospital Charge Code |
145563
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$118.74 |
| Max. Negotiated Rate |
$237.47 |
| Rate for Payer: Aetna Commercial |
$142.48
|
| Rate for Payer: Cash Price |
$417.95
|
| Rate for Payer: Cigna Commercial |
$118.74
|
| Rate for Payer: Multiplan Auto |
$237.47
|
| Rate for Payer: Multiplan Commercial |
$237.47
|
| Rate for Payer: Multiplan Workers Comp |
$237.47
|
| Rate for Payer: Scott and White EPO/PPO |
$237.47
|
|
|
.Activated Clotting Time (POCT)
|
Facility
|
IP
|
$141.00
|
|
|
Service Code
|
CPT 85347
|
| Hospital Charge Code |
4105347
|
|
Hospital Revenue Code
|
305
|
| Rate for Payer: Cash Price |
$124.08
|
|
|
.Activated Clotting Time (POCT)
|
Facility
|
OP
|
$141.00
|
|
|
Service Code
|
CPT 85347
|
| Hospital Charge Code |
4105347
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$1.67 |
| Max. Negotiated Rate |
$91.65 |
| Rate for Payer: Aetna Commercial |
$4.50
|
| Rate for Payer: Aetna Medicare |
$6.42
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1.67
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$4.28
|
| Rate for Payer: Amerigroup Medicare |
$4.28
|
| Rate for Payer: BCBS of TX Blue Advantage |
$7.06
|
| Rate for Payer: BCBS of TX Blue Essentials |
$8.47
|
| Rate for Payer: BCBS of TX Medicare |
$4.28
|
| Rate for Payer: BCBS of TX PPO |
$9.46
|
| Rate for Payer: Cash Price |
$124.08
|
| Rate for Payer: Cash Price |
$124.08
|
| Rate for Payer: Cigna Medicaid |
$4.28
|
| Rate for Payer: Cigna Medicare |
$4.28
|
| Rate for Payer: Employer Direct Commercial |
$4.28
|
| Rate for Payer: Humana Medicare/TRICARE |
$4.28
|
| Rate for Payer: Molina CHIP/Medicaid |
$4.28
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$4.28
|
| Rate for Payer: Molina Medicare |
$4.28
|
| Rate for Payer: Multiplan Auto |
$91.65
|
| Rate for Payer: Multiplan Commercial |
$91.65
|
| Rate for Payer: Multiplan Workers Comp |
$91.65
|
| Rate for Payer: Parkland Medicaid |
$4.28
|
| Rate for Payer: Scott and White EPO/PPO |
$5.35
|
| Rate for Payer: Scott and White Medicare |
$4.28
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$4.28
|
| Rate for Payer: Superior Health Plan EPO |
$4.28
|
| Rate for Payer: Superior Health Plan Medicare |
$4.28
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$4.28
|
| Rate for Payer: Universal American Medicare |
$4.28
|
| Rate for Payer: Wellcare Medicare |
$4.28
|
| Rate for Payer: Wellmed Medicare |
$4.28
|
|
|
ACUTE ADJUSTMENT REACTION AND PSYCHOSOCIAL DYSFUNCTION
|
Facility
|
IP
|
$18,137.40
|
|
|
Service Code
|
MSDRG 880
|
| Min. Negotiated Rate |
$6,367.44 |
| Max. Negotiated Rate |
$18,137.40 |
| Rate for Payer: Aetna Commercial |
$10,739.25
|
| Rate for Payer: Aetna Medicare |
$14,500.30
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$9,666.87
|
| Rate for Payer: Amerigroup Medicare |
$9,666.87
|
| Rate for Payer: BCBS of TX Blue Advantage |
$6,367.44
|
| Rate for Payer: BCBS of TX Blue Essentials |
$8,369.74
|
| Rate for Payer: BCBS of TX Medicare |
$9,666.87
|
| Rate for Payer: BCBS of TX PPO |
$9,300.07
|
| Rate for Payer: Cigna Commercial |
$12,295.25
|
| Rate for Payer: Cigna Medicare |
$9,666.87
|
| Rate for Payer: Employer Direct Commercial |
$9,666.87
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$9,666.87
|
| Rate for Payer: Molina Medicare |
$9,666.87
|
| Rate for Payer: Multiplan Auto |
$18,137.40
|
| Rate for Payer: Multiplan Commercial |
$18,137.40
|
| Rate for Payer: Multiplan Workers Comp |
$18,137.40
|
| Rate for Payer: Scott and White EPO/PPO |
$8,352.75
|
| Rate for Payer: Scott and White Medicare |
$9,666.87
|
| Rate for Payer: Superior Health Plan EPO |
$9,666.87
|
| Rate for Payer: Superior Health Plan Medicare |
$9,666.87
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$9,666.87
|
| Rate for Payer: Universal American Medicare |
$9,666.87
|
| Rate for Payer: Wellcare Medicare |
$9,666.87
|
| Rate for Payer: Wellmed Medicare |
$9,666.87
|
|
|
ACUTE AND SUBACUTE ENDOCARDITIS WITH CC
|
Facility
|
IP
|
$28,076.30
|
|
|
Service Code
|
MSDRG 289
|
| Min. Negotiated Rate |
$12,929.88 |
| Max. Negotiated Rate |
$28,076.30 |
| Rate for Payer: Aetna Commercial |
$16,624.12
|
| Rate for Payer: Aetna Medicare |
$20,099.58
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$13,399.72
|
| Rate for Payer: Amerigroup Medicare |
$13,399.72
|
| Rate for Payer: BCBS of TX Blue Advantage |
$13,349.78
|
| Rate for Payer: BCBS of TX Blue Essentials |
$17,644.46
|
| Rate for Payer: BCBS of TX Medicare |
$13,399.72
|
| Rate for Payer: BCBS of TX PPO |
$19,605.71
|
| Rate for Payer: Cigna Commercial |
$19,032.78
|
| Rate for Payer: Cigna Medicare |
$13,399.72
|
| Rate for Payer: Employer Direct Commercial |
$13,399.72
|
| Rate for Payer: Humana Medicare/TRICARE |
$13,399.72
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$13,399.72
|
| Rate for Payer: Molina Medicare |
$13,399.72
|
| Rate for Payer: Multiplan Auto |
$28,076.30
|
| Rate for Payer: Multiplan Commercial |
$28,076.30
|
| Rate for Payer: Multiplan Workers Comp |
$28,076.30
|
| Rate for Payer: Scott and White EPO/PPO |
$12,929.88
|
| Rate for Payer: Scott and White Medicare |
$13,399.72
|
| Rate for Payer: Superior Health Plan EPO |
$13,399.72
|
| Rate for Payer: Superior Health Plan Medicare |
$13,399.72
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$13,399.72
|
| Rate for Payer: Universal American Medicare |
$13,399.72
|
| Rate for Payer: Wellcare Medicare |
$13,399.72
|
| Rate for Payer: Wellmed Medicare |
$13,399.72
|
|
|
ACUTE AND SUBACUTE ENDOCARDITIS WITH MCC
|
Facility
|
IP
|
$49,267.00
|
|
|
Service Code
|
MSDRG 288
|
| Min. Negotiated Rate |
$21,358.60 |
| Max. Negotiated Rate |
$49,267.00 |
| Rate for Payer: Aetna Commercial |
$29,171.25
|
| Rate for Payer: Aetna Medicare |
$32,037.90
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$21,358.60
|
| Rate for Payer: Amerigroup Medicare |
$21,358.60
|
| Rate for Payer: BCBS of TX Blue Advantage |
$23,884.78
|
| Rate for Payer: BCBS of TX Blue Essentials |
$27,800.42
|
| Rate for Payer: BCBS of TX Medicare |
$21,358.60
|
| Rate for Payer: BCBS of TX PPO |
$30,890.55
|
| Rate for Payer: Cigna Commercial |
$33,397.84
|
| Rate for Payer: Cigna Medicare |
$21,358.60
|
| Rate for Payer: Employer Direct Commercial |
$21,358.60
|
| Rate for Payer: Humana Medicare/TRICARE |
$21,358.60
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$21,358.60
|
| Rate for Payer: Molina Medicare |
$21,358.60
|
| Rate for Payer: Multiplan Auto |
$49,267.00
|
| Rate for Payer: Multiplan Commercial |
$49,267.00
|
| Rate for Payer: Multiplan Workers Comp |
$49,267.00
|
| Rate for Payer: Scott and White EPO/PPO |
$22,688.75
|
| Rate for Payer: Scott and White Medicare |
$21,358.60
|
| Rate for Payer: Superior Health Plan EPO |
$21,358.60
|
| Rate for Payer: Superior Health Plan Medicare |
$21,358.60
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$21,358.60
|
| Rate for Payer: Universal American Medicare |
$21,358.60
|
| Rate for Payer: Wellcare Medicare |
$21,358.60
|
| Rate for Payer: Wellmed Medicare |
$21,358.60
|
|
|
ACUTE AND SUBACUTE ENDOCARDITIS WITHOUT CC/MCC
|
Facility
|
IP
|
$19,478.80
|
|
|
Service Code
|
MSDRG 290
|
| Min. Negotiated Rate |
$8,970.50 |
| Max. Negotiated Rate |
$19,478.80 |
| Rate for Payer: Aetna Commercial |
$11,533.50
|
| Rate for Payer: Aetna Medicare |
$15,897.18
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$10,598.12
|
| Rate for Payer: Amerigroup Medicare |
$10,598.12
|
| Rate for Payer: BCBS of TX Blue Advantage |
$10,840.30
|
| Rate for Payer: BCBS of TX Blue Essentials |
$10,436.64
|
| Rate for Payer: BCBS of TX Medicare |
$10,598.12
|
| Rate for Payer: BCBS of TX PPO |
$11,596.71
|
| Rate for Payer: Cigna Commercial |
$13,204.58
|
| Rate for Payer: Cigna Medicare |
$10,598.12
|
| Rate for Payer: Employer Direct Commercial |
$10,598.12
|
| Rate for Payer: Humana Medicare/TRICARE |
$10,598.12
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$10,598.12
|
| Rate for Payer: Molina Medicare |
$10,598.12
|
| Rate for Payer: Multiplan Auto |
$19,478.80
|
| Rate for Payer: Multiplan Commercial |
$19,478.80
|
| Rate for Payer: Multiplan Workers Comp |
$19,478.80
|
| Rate for Payer: Scott and White EPO/PPO |
$8,970.50
|
| Rate for Payer: Scott and White Medicare |
$10,598.12
|
| Rate for Payer: Superior Health Plan EPO |
$10,598.12
|
| Rate for Payer: Superior Health Plan Medicare |
$10,598.12
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$10,598.12
|
| Rate for Payer: Universal American Medicare |
$10,598.12
|
| Rate for Payer: Wellcare Medicare |
$10,598.12
|
| Rate for Payer: Wellmed Medicare |
$10,598.12
|
|
|
ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITH CC
|
Facility
|
IP
|
$42,474.50
|
|
|
Service Code
|
MSDRG 835
|
| Min. Negotiated Rate |
$18,807.44 |
| Max. Negotiated Rate |
$42,474.50 |
| Rate for Payer: Aetna Commercial |
$25,149.38
|
| Rate for Payer: Aetna Medicare |
$28,211.16
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$18,807.44
|
| Rate for Payer: Amerigroup Medicare |
$18,807.44
|
| Rate for Payer: BCBS of TX Blue Advantage |
$19,364.62
|
| Rate for Payer: BCBS of TX Blue Essentials |
$22,041.38
|
| Rate for Payer: BCBS of TX Medicare |
$18,807.44
|
| Rate for Payer: BCBS of TX PPO |
$24,491.38
|
| Rate for Payer: Cigna Commercial |
$28,793.24
|
| Rate for Payer: Cigna Medicare |
$18,807.44
|
| Rate for Payer: Employer Direct Commercial |
$18,807.44
|
| Rate for Payer: Humana Medicare/TRICARE |
$18,807.44
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$18,807.44
|
| Rate for Payer: Molina Medicare |
$18,807.44
|
| Rate for Payer: Multiplan Auto |
$42,474.50
|
| Rate for Payer: Multiplan Commercial |
$42,474.50
|
| Rate for Payer: Multiplan Workers Comp |
$42,474.50
|
| Rate for Payer: Scott and White EPO/PPO |
$19,560.62
|
| Rate for Payer: Scott and White Medicare |
$18,807.44
|
| Rate for Payer: Superior Health Plan EPO |
$18,807.44
|
| Rate for Payer: Superior Health Plan Medicare |
$18,807.44
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$18,807.44
|
| Rate for Payer: Universal American Medicare |
$18,807.44
|
| Rate for Payer: Wellcare Medicare |
$18,807.44
|
| Rate for Payer: Wellmed Medicare |
$18,807.44
|
|
|
ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITH MCC
|
Facility
|
IP
|
$106,381.00
|
|
|
Service Code
|
MSDRG 834
|
| Min. Negotiated Rate |
$42,809.58 |
| Max. Negotiated Rate |
$106,381.00 |
| Rate for Payer: Aetna Commercial |
$62,988.75
|
| Rate for Payer: Aetna Medicare |
$64,214.37
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$42,809.58
|
| Rate for Payer: Amerigroup Medicare |
$42,809.58
|
| Rate for Payer: BCBS of TX Blue Advantage |
$48,431.76
|
| Rate for Payer: BCBS of TX Blue Essentials |
$56,834.99
|
| Rate for Payer: BCBS of TX Medicare |
$42,809.58
|
| Rate for Payer: BCBS of TX PPO |
$63,152.43
|
| Rate for Payer: Cigna Commercial |
$72,115.12
|
| Rate for Payer: Cigna Medicare |
$42,809.58
|
| Rate for Payer: Employer Direct Commercial |
$42,809.58
|
| Rate for Payer: Humana Medicare/TRICARE |
$42,809.58
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$42,809.58
|
| Rate for Payer: Molina Medicare |
$42,809.58
|
| Rate for Payer: Multiplan Auto |
$106,381.00
|
| Rate for Payer: Multiplan Commercial |
$106,381.00
|
| Rate for Payer: Multiplan Workers Comp |
$106,381.00
|
| Rate for Payer: Scott and White EPO/PPO |
$48,991.25
|
| Rate for Payer: Scott and White Medicare |
$42,809.58
|
| Rate for Payer: Superior Health Plan EPO |
$42,809.58
|
| Rate for Payer: Superior Health Plan Medicare |
$42,809.58
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$42,809.58
|
| Rate for Payer: Universal American Medicare |
$42,809.58
|
| Rate for Payer: Wellcare Medicare |
$42,809.58
|
| Rate for Payer: Wellmed Medicare |
$42,809.58
|
|
|
ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$22,748.70
|
|
|
Service Code
|
MSDRG 836
|
| Min. Negotiated Rate |
$10,402.56 |
| Max. Negotiated Rate |
$22,748.70 |
| Rate for Payer: Aetna Commercial |
$13,469.62
|
| Rate for Payer: Aetna Medicare |
$19,395.26
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$12,930.17
|
| Rate for Payer: Amerigroup Medicare |
$12,930.17
|
| Rate for Payer: BCBS of TX Blue Advantage |
$10,402.56
|
| Rate for Payer: BCBS of TX Blue Essentials |
$12,512.82
|
| Rate for Payer: BCBS of TX Medicare |
$12,930.17
|
| Rate for Payer: BCBS of TX PPO |
$13,903.67
|
| Rate for Payer: Cigna Commercial |
$15,421.22
|
| Rate for Payer: Cigna Medicare |
$12,930.17
|
| Rate for Payer: Employer Direct Commercial |
$12,930.17
|
| Rate for Payer: Humana Medicare/TRICARE |
$12,930.17
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$12,930.17
|
| Rate for Payer: Molina Medicare |
$12,930.17
|
| Rate for Payer: Multiplan Auto |
$22,748.70
|
| Rate for Payer: Multiplan Commercial |
$22,748.70
|
| Rate for Payer: Multiplan Workers Comp |
$22,748.70
|
| Rate for Payer: Scott and White EPO/PPO |
$10,476.38
|
| Rate for Payer: Scott and White Medicare |
$12,930.17
|
| Rate for Payer: Superior Health Plan EPO |
$12,930.17
|
| Rate for Payer: Superior Health Plan Medicare |
$12,930.17
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$12,930.17
|
| Rate for Payer: Universal American Medicare |
$12,930.17
|
| Rate for Payer: Wellcare Medicare |
$12,930.17
|
| Rate for Payer: Wellmed Medicare |
$12,930.17
|
|
|
ACUTE MAJOR EYE INFECTIONS WITH CC/MCC
|
Facility
|
IP
|
$24,342.80
|
|
|
Service Code
|
MSDRG 121
|
| Min. Negotiated Rate |
$9,093.64 |
| Max. Negotiated Rate |
$24,342.80 |
| Rate for Payer: Aetna Commercial |
$14,413.50
|
| Rate for Payer: Aetna Medicare |
$17,996.25
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$11,997.50
|
| Rate for Payer: Amerigroup Medicare |
$11,997.50
|
| Rate for Payer: BCBS of TX Blue Advantage |
$9,093.64
|
| Rate for Payer: BCBS of TX Blue Essentials |
$10,930.92
|
| Rate for Payer: BCBS of TX Medicare |
$11,997.50
|
| Rate for Payer: BCBS of TX PPO |
$12,145.93
|
| Rate for Payer: Cigna Commercial |
$16,501.86
|
| Rate for Payer: Cigna Medicare |
$11,997.50
|
| Rate for Payer: Employer Direct Commercial |
$11,997.50
|
| Rate for Payer: Humana Medicare/TRICARE |
$11,997.50
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$11,997.50
|
| Rate for Payer: Molina Medicare |
$11,997.50
|
| Rate for Payer: Multiplan Auto |
$24,342.80
|
| Rate for Payer: Multiplan Commercial |
$24,342.80
|
| Rate for Payer: Multiplan Workers Comp |
$24,342.80
|
| Rate for Payer: Scott and White EPO/PPO |
$11,210.50
|
| Rate for Payer: Scott and White Medicare |
$11,997.50
|
| Rate for Payer: Superior Health Plan EPO |
$11,997.50
|
| Rate for Payer: Superior Health Plan Medicare |
$11,997.50
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$11,997.50
|
| Rate for Payer: Universal American Medicare |
$11,997.50
|
| Rate for Payer: Wellcare Medicare |
$11,997.50
|
| Rate for Payer: Wellmed Medicare |
$11,997.50
|
|
|
ACUTE MAJOR EYE INFECTIONS WITHOUT CC/MCC
|
Facility
|
IP
|
$14,145.50
|
|
|
Service Code
|
MSDRG 122
|
| Min. Negotiated Rate |
$5,542.70 |
| Max. Negotiated Rate |
$14,145.50 |
| Rate for Payer: Aetna Commercial |
$8,375.62
|
| Rate for Payer: Aetna Medicare |
$12,251.37
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$8,167.58
|
| Rate for Payer: Amerigroup Medicare |
$8,167.58
|
| Rate for Payer: BCBS of TX Blue Advantage |
$5,542.70
|
| Rate for Payer: BCBS of TX Blue Essentials |
$7,283.15
|
| Rate for Payer: BCBS of TX Medicare |
$8,167.58
|
| Rate for Payer: BCBS of TX PPO |
$8,092.70
|
| Rate for Payer: Cigna Commercial |
$9,589.16
|
| Rate for Payer: Cigna Medicare |
$8,167.58
|
| Rate for Payer: Employer Direct Commercial |
$8,167.58
|
| Rate for Payer: Humana Medicare/TRICARE |
$8,167.58
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$8,167.58
|
| Rate for Payer: Molina Medicare |
$8,167.58
|
| Rate for Payer: Multiplan Auto |
$14,145.50
|
| Rate for Payer: Multiplan Commercial |
$14,145.50
|
| Rate for Payer: Multiplan Workers Comp |
$14,145.50
|
| Rate for Payer: Scott and White EPO/PPO |
$6,514.38
|
| Rate for Payer: Scott and White Medicare |
$8,167.58
|
| Rate for Payer: Superior Health Plan EPO |
$8,167.58
|
| Rate for Payer: Superior Health Plan Medicare |
$8,167.58
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$8,167.58
|
| Rate for Payer: Universal American Medicare |
$8,167.58
|
| Rate for Payer: Wellcare Medicare |
$8,167.58
|
| Rate for Payer: Wellmed Medicare |
$8,167.58
|
|
|
ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH CC
|
Facility
|
IP
|
$17,347.00
|
|
|
Service Code
|
MSDRG 281
|
| Min. Negotiated Rate |
$7,988.75 |
| Max. Negotiated Rate |
$17,347.00 |
| Rate for Payer: Aetna Commercial |
$10,271.25
|
| Rate for Payer: Aetna Medicare |
$14,055.02
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$9,370.01
|
| Rate for Payer: Amerigroup Medicare |
$9,370.01
|
| Rate for Payer: BCBS of TX Blue Advantage |
$8,572.48
|
| Rate for Payer: BCBS of TX Blue Essentials |
$10,108.49
|
| Rate for Payer: BCBS of TX Medicare |
$9,370.01
|
| Rate for Payer: BCBS of TX PPO |
$11,232.09
|
| Rate for Payer: Cigna Commercial |
$11,759.44
|
| Rate for Payer: Cigna Medicare |
$9,370.01
|
| Rate for Payer: Employer Direct Commercial |
$9,370.01
|
| Rate for Payer: Humana Medicare/TRICARE |
$9,370.01
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$9,370.01
|
| Rate for Payer: Molina Medicare |
$9,370.01
|
| Rate for Payer: Multiplan Auto |
$17,347.00
|
| Rate for Payer: Multiplan Commercial |
$17,347.00
|
| Rate for Payer: Multiplan Workers Comp |
$17,347.00
|
| Rate for Payer: Scott and White EPO/PPO |
$7,988.75
|
| Rate for Payer: Scott and White Medicare |
$9,370.01
|
| Rate for Payer: Superior Health Plan EPO |
$9,370.01
|
| Rate for Payer: Superior Health Plan Medicare |
$9,370.01
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$9,370.01
|
| Rate for Payer: Universal American Medicare |
$9,370.01
|
| Rate for Payer: Wellcare Medicare |
$9,370.01
|
| Rate for Payer: Wellmed Medicare |
$9,370.01
|
|
|
ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH MCC
|
Facility
|
IP
|
$30,143.50
|
|
|
Service Code
|
MSDRG 280
|
| Min. Negotiated Rate |
$13,881.88 |
| Max. Negotiated Rate |
$30,143.50 |
| Rate for Payer: Aetna Commercial |
$17,848.12
|
| Rate for Payer: Aetna Medicare |
$21,264.20
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$14,176.13
|
| Rate for Payer: Amerigroup Medicare |
$14,176.13
|
| Rate for Payer: BCBS of TX Blue Advantage |
$14,403.28
|
| Rate for Payer: BCBS of TX Blue Essentials |
$17,099.61
|
| Rate for Payer: BCBS of TX Medicare |
$14,176.13
|
| Rate for Payer: BCBS of TX PPO |
$19,000.31
|
| Rate for Payer: Cigna Commercial |
$20,434.12
|
| Rate for Payer: Cigna Medicare |
$14,176.13
|
| Rate for Payer: Employer Direct Commercial |
$14,176.13
|
| Rate for Payer: Humana Medicare/TRICARE |
$14,176.13
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$14,176.13
|
| Rate for Payer: Molina Medicare |
$14,176.13
|
| Rate for Payer: Multiplan Auto |
$30,143.50
|
| Rate for Payer: Multiplan Commercial |
$30,143.50
|
| Rate for Payer: Multiplan Workers Comp |
$30,143.50
|
| Rate for Payer: Scott and White EPO/PPO |
$13,881.88
|
| Rate for Payer: Scott and White Medicare |
$14,176.13
|
| Rate for Payer: Superior Health Plan EPO |
$14,176.13
|
| Rate for Payer: Superior Health Plan Medicare |
$14,176.13
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$14,176.13
|
| Rate for Payer: Universal American Medicare |
$14,176.13
|
| Rate for Payer: Wellcare Medicare |
$14,176.13
|
| Rate for Payer: Wellmed Medicare |
$14,176.13
|
|
|
ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITHOUT CC/MCC
|
Facility
|
IP
|
$13,643.90
|
|
|
Service Code
|
MSDRG 282
|
| Min. Negotiated Rate |
$6,283.38 |
| Max. Negotiated Rate |
$13,643.90 |
| Rate for Payer: Aetna Commercial |
$8,078.62
|
| Rate for Payer: Aetna Medicare |
$11,968.77
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$7,979.18
|
| Rate for Payer: Amerigroup Medicare |
$7,979.18
|
| Rate for Payer: BCBS of TX Blue Advantage |
$6,418.18
|
| Rate for Payer: BCBS of TX Blue Essentials |
$7,728.93
|
| Rate for Payer: BCBS of TX Medicare |
$7,979.18
|
| Rate for Payer: BCBS of TX PPO |
$8,588.03
|
| Rate for Payer: Cigna Commercial |
$9,249.13
|
| Rate for Payer: Cigna Medicare |
$7,979.18
|
| Rate for Payer: Employer Direct Commercial |
$7,979.18
|
| Rate for Payer: Humana Medicare/TRICARE |
$7,979.18
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$7,979.18
|
| Rate for Payer: Molina Medicare |
$7,979.18
|
| Rate for Payer: Multiplan Auto |
$13,643.90
|
| Rate for Payer: Multiplan Commercial |
$13,643.90
|
| Rate for Payer: Multiplan Workers Comp |
$13,643.90
|
| Rate for Payer: Scott and White EPO/PPO |
$6,283.38
|
| Rate for Payer: Scott and White Medicare |
$7,979.18
|
| Rate for Payer: Superior Health Plan EPO |
$7,979.18
|
| Rate for Payer: Superior Health Plan Medicare |
$7,979.18
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$7,979.18
|
| Rate for Payer: Universal American Medicare |
$7,979.18
|
| Rate for Payer: Wellcare Medicare |
$7,979.18
|
| Rate for Payer: Wellmed Medicare |
$7,979.18
|
|
|
ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH CC
|
Facility
|
IP
|
$14,054.30
|
|
|
Service Code
|
MSDRG 284
|
| Min. Negotiated Rate |
$6,472.38 |
| Max. Negotiated Rate |
$14,054.30 |
| Rate for Payer: Aetna Commercial |
$8,321.62
|
| Rate for Payer: Aetna Medicare |
$12,200.00
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$8,133.33
|
| Rate for Payer: Amerigroup Medicare |
$8,133.33
|
| Rate for Payer: BCBS of TX Blue Advantage |
$6,487.84
|
| Rate for Payer: BCBS of TX Blue Essentials |
$7,910.55
|
| Rate for Payer: BCBS of TX Medicare |
$8,133.33
|
| Rate for Payer: BCBS of TX PPO |
$8,789.84
|
| Rate for Payer: Cigna Commercial |
$9,527.34
|
| Rate for Payer: Cigna Medicare |
$8,133.33
|
| Rate for Payer: Employer Direct Commercial |
$8,133.33
|
| Rate for Payer: Humana Medicare/TRICARE |
$8,133.33
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$8,133.33
|
| Rate for Payer: Molina Medicare |
$8,133.33
|
| Rate for Payer: Multiplan Auto |
$14,054.30
|
| Rate for Payer: Multiplan Commercial |
$14,054.30
|
| Rate for Payer: Multiplan Workers Comp |
$14,054.30
|
| Rate for Payer: Scott and White EPO/PPO |
$6,472.38
|
| Rate for Payer: Scott and White Medicare |
$8,133.33
|
| Rate for Payer: Superior Health Plan EPO |
$8,133.33
|
| Rate for Payer: Superior Health Plan Medicare |
$8,133.33
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$8,133.33
|
| Rate for Payer: Universal American Medicare |
$8,133.33
|
| Rate for Payer: Wellcare Medicare |
$8,133.33
|
| Rate for Payer: Wellmed Medicare |
$8,133.33
|
|
|
ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH MCC
|
Facility
|
IP
|
$37,456.60
|
|
|
Service Code
|
MSDRG 283
|
| Min. Negotiated Rate |
$14,555.50 |
| Max. Negotiated Rate |
$37,456.60 |
| Rate for Payer: Aetna Commercial |
$22,178.25
|
| Rate for Payer: Aetna Medicare |
$25,384.20
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$16,922.80
|
| Rate for Payer: Amerigroup Medicare |
$16,922.80
|
| Rate for Payer: BCBS of TX Blue Advantage |
$14,555.50
|
| Rate for Payer: BCBS of TX Blue Essentials |
$18,622.70
|
| Rate for Payer: BCBS of TX Medicare |
$16,922.80
|
| Rate for Payer: BCBS of TX PPO |
$20,692.69
|
| Rate for Payer: Cigna Commercial |
$25,391.63
|
| Rate for Payer: Cigna Medicare |
$16,922.80
|
| Rate for Payer: Employer Direct Commercial |
$16,922.80
|
| Rate for Payer: Humana Medicare/TRICARE |
$16,922.80
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$16,922.80
|
| Rate for Payer: Molina Medicare |
$16,922.80
|
| Rate for Payer: Multiplan Auto |
$37,456.60
|
| Rate for Payer: Multiplan Commercial |
$37,456.60
|
| Rate for Payer: Multiplan Workers Comp |
$37,456.60
|
| Rate for Payer: Scott and White EPO/PPO |
$17,249.75
|
| Rate for Payer: Scott and White Medicare |
$16,922.80
|
| Rate for Payer: Superior Health Plan EPO |
$16,922.80
|
| Rate for Payer: Superior Health Plan Medicare |
$16,922.80
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$16,922.80
|
| Rate for Payer: Universal American Medicare |
$16,922.80
|
| Rate for Payer: Wellcare Medicare |
$16,922.80
|
| Rate for Payer: Wellmed Medicare |
$16,922.80
|
|
|
ACUTE MYOCARDIAL INFARCTION, EXPIRED WITHOUT CC/MCC
|
Facility
|
IP
|
$9,513.26
|
|
|
Service Code
|
MSDRG 285
|
| Min. Negotiated Rate |
$4,276.12 |
| Max. Negotiated Rate |
$9,513.26 |
| Rate for Payer: Aetna Commercial |
$5,497.88
|
| Rate for Payer: Aetna Medicare |
$9,513.26
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$6,342.17
|
| Rate for Payer: Amerigroup Medicare |
$6,342.17
|
| Rate for Payer: BCBS of TX Blue Advantage |
$4,463.40
|
| Rate for Payer: BCBS of TX Blue Essentials |
$6,154.25
|
| Rate for Payer: BCBS of TX Medicare |
$6,342.17
|
| Rate for Payer: BCBS of TX PPO |
$6,838.32
|
| Rate for Payer: Cigna Commercial |
$6,294.46
|
| Rate for Payer: Cigna Medicare |
$6,342.17
|
| Rate for Payer: Employer Direct Commercial |
$6,342.17
|
| Rate for Payer: Humana Medicare/TRICARE |
$6,342.17
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$6,342.17
|
| Rate for Payer: Molina Medicare |
$6,342.17
|
| Rate for Payer: Multiplan Auto |
$9,285.30
|
| Rate for Payer: Multiplan Commercial |
$9,285.30
|
| Rate for Payer: Multiplan Workers Comp |
$9,285.30
|
| Rate for Payer: Scott and White EPO/PPO |
$4,276.12
|
| Rate for Payer: Scott and White Medicare |
$6,342.17
|
| Rate for Payer: Superior Health Plan EPO |
$6,342.17
|
| Rate for Payer: Superior Health Plan Medicare |
$6,342.17
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$6,342.17
|
| Rate for Payer: Universal American Medicare |
$6,342.17
|
| Rate for Payer: Wellcare Medicare |
$6,342.17
|
| Rate for Payer: Wellmed Medicare |
$6,342.17
|
|
