|
Coxsackie Virus Group B Ab SO
|
Facility
|
IP
|
$125.00
|
|
|
Service Code
|
CPT 86658
|
| Hospital Charge Code |
1702323
|
|
Hospital Revenue Code
|
302
|
| Rate for Payer: Cash Price |
$110.00
|
|
|
Coxsackie Virus Group B Ab SO
|
Facility
|
OP
|
$125.00
|
|
|
Service Code
|
CPT 86658
|
| Hospital Charge Code |
1702323
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.08 |
| Max. Negotiated Rate |
$81.25 |
| Rate for Payer: Aetna Commercial |
$13.68
|
| Rate for Payer: Aetna Medicare |
$19.54
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$5.08
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$13.03
|
| Rate for Payer: Amerigroup Medicare |
$13.03
|
| Rate for Payer: BCBS of TX Blue Advantage |
$21.50
|
| Rate for Payer: BCBS of TX Blue Essentials |
$25.80
|
| Rate for Payer: BCBS of TX Medicare |
$13.03
|
| Rate for Payer: BCBS of TX PPO |
$28.80
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cigna Medicaid |
$13.03
|
| Rate for Payer: Cigna Medicare |
$13.03
|
| Rate for Payer: Employer Direct Commercial |
$13.03
|
| Rate for Payer: Humana Medicare/TRICARE |
$13.03
|
| Rate for Payer: Molina CHIP/Medicaid |
$13.03
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$13.03
|
| Rate for Payer: Molina Medicare |
$13.03
|
| Rate for Payer: Multiplan Auto |
$81.25
|
| Rate for Payer: Multiplan Commercial |
$81.25
|
| Rate for Payer: Multiplan Workers Comp |
$81.25
|
| Rate for Payer: Parkland Medicaid |
$13.03
|
| Rate for Payer: Scott and White EPO/PPO |
$16.29
|
| Rate for Payer: Scott and White Medicare |
$13.03
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$13.03
|
| Rate for Payer: Superior Health Plan EPO |
$13.03
|
| Rate for Payer: Superior Health Plan Medicare |
$13.03
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$13.03
|
| Rate for Payer: Universal American Medicare |
$13.03
|
| Rate for Payer: Wellcare Medicare |
$13.03
|
| Rate for Payer: Wellmed Medicare |
$13.03
|
|
|
C-Peptide, Serum SO
|
Facility
|
OP
|
$185.00
|
|
|
Service Code
|
CPT 84681
|
| Hospital Charge Code |
1702141
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.12 |
| Max. Negotiated Rate |
$120.25 |
| Rate for Payer: Aetna Commercial |
$21.86
|
| Rate for Payer: Aetna Medicare |
$31.22
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$8.12
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$20.81
|
| Rate for Payer: Amerigroup Medicare |
$20.81
|
| Rate for Payer: BCBS of TX Blue Advantage |
$34.34
|
| Rate for Payer: BCBS of TX Blue Essentials |
$41.20
|
| Rate for Payer: BCBS of TX Medicare |
$20.81
|
| Rate for Payer: BCBS of TX PPO |
$45.99
|
| Rate for Payer: Cash Price |
$162.80
|
| Rate for Payer: Cash Price |
$162.80
|
| Rate for Payer: Cigna Medicaid |
$20.81
|
| Rate for Payer: Cigna Medicare |
$20.81
|
| Rate for Payer: Employer Direct Commercial |
$20.81
|
| Rate for Payer: Humana Medicare/TRICARE |
$20.81
|
| Rate for Payer: Molina CHIP/Medicaid |
$20.81
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$20.81
|
| Rate for Payer: Molina Medicare |
$20.81
|
| Rate for Payer: Multiplan Auto |
$120.25
|
| Rate for Payer: Multiplan Commercial |
$120.25
|
| Rate for Payer: Multiplan Workers Comp |
$120.25
|
| Rate for Payer: Parkland Medicaid |
$20.81
|
| Rate for Payer: Scott and White EPO/PPO |
$26.01
|
| Rate for Payer: Scott and White Medicare |
$20.81
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$20.81
|
| Rate for Payer: Superior Health Plan EPO |
$20.81
|
| Rate for Payer: Superior Health Plan Medicare |
$20.81
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$20.81
|
| Rate for Payer: Universal American Medicare |
$20.81
|
| Rate for Payer: Wellcare Medicare |
$20.81
|
| Rate for Payer: Wellmed Medicare |
$20.81
|
|
|
C-Peptide, Serum SO
|
Facility
|
IP
|
$185.00
|
|
|
Service Code
|
CPT 84681
|
| Hospital Charge Code |
1702141
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$162.80
|
|
|
CPM PAD
|
Facility
|
IP
|
$87.89
|
|
| Hospital Charge Code |
8570490
|
|
Hospital Revenue Code
|
272
|
| Rate for Payer: Cash Price |
$77.34
|
|
|
CPM PAD
|
Facility
|
OP
|
$87.89
|
|
| Hospital Charge Code |
8570490
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.91 |
| Max. Negotiated Rate |
$57.13 |
| Rate for Payer: Aetna Commercial |
$48.34
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$7.91
|
| Rate for Payer: BCBS of TX Blue Advantage |
$26.37
|
| Rate for Payer: BCBS of TX Blue Essentials |
$31.64
|
| Rate for Payer: BCBS of TX PPO |
$35.16
|
| Rate for Payer: Cash Price |
$77.34
|
| Rate for Payer: Multiplan Auto |
$57.13
|
| Rate for Payer: Multiplan Commercial |
$57.13
|
| Rate for Payer: Multiplan Workers Comp |
$57.13
|
| Rate for Payer: Scott and White EPO/PPO |
$43.94
|
| Rate for Payer: Superior Health Plan EPO |
$11.95
|
|
|
CPR
|
Facility
|
IP
|
$1,150.00
|
|
|
Service Code
|
CPT 92950
|
| Hospital Charge Code |
4619130
|
|
Hospital Revenue Code
|
410
|
| Rate for Payer: Cash Price |
$1,012.00
|
|
|
CPR
|
Facility
|
OP
|
$1,150.00
|
|
|
Service Code
|
CPT 92950
|
| Hospital Charge Code |
4619130
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$5.13 |
| Max. Negotiated Rate |
$747.50 |
| Rate for Payer: Aetna Commercial |
$632.50
|
| Rate for Payer: Aetna Medicare |
$430.59
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$103.50
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$287.06
|
| Rate for Payer: Amerigroup Medicare |
$287.06
|
| Rate for Payer: BCBS of TX Blue Advantage |
$422.68
|
| Rate for Payer: BCBS of TX Blue Essentials |
$506.20
|
| Rate for Payer: BCBS of TX Medicare |
$287.06
|
| Rate for Payer: BCBS of TX PPO |
$637.81
|
| Rate for Payer: Cash Price |
$1,012.00
|
| Rate for Payer: Cash Price |
$1,012.00
|
| Rate for Payer: Cash Price |
$1,012.00
|
| Rate for Payer: Cigna Commercial |
$650.28
|
| Rate for Payer: Cigna Medicare |
$287.06
|
| Rate for Payer: Employer Direct Commercial |
$287.06
|
| Rate for Payer: Humana Medicare/TRICARE |
$287.06
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$287.06
|
| Rate for Payer: Molina Medicare |
$287.06
|
| Rate for Payer: Multiplan Auto |
$747.50
|
| Rate for Payer: Multiplan Commercial |
$747.50
|
| Rate for Payer: Multiplan Workers Comp |
$747.50
|
| Rate for Payer: Scott and White EPO/PPO |
$5.13
|
| Rate for Payer: Scott and White Medicare |
$287.06
|
| Rate for Payer: Superior Health Plan EPO |
$287.06
|
| Rate for Payer: Superior Health Plan Medicare |
$287.06
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$287.06
|
| Rate for Payer: Universal American Medicare |
$287.06
|
| Rate for Payer: Wellcare Medicare |
$287.06
|
| Rate for Payer: Wellmed Medicare |
$287.06
|
|
|
CPT 13100
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 13100
|
| Hospital Charge Code |
36013100
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$12.67 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Medicare |
$861.57
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$216.80
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$574.38
|
| Rate for Payer: Amerigroup Medicare |
$574.38
|
| Rate for Payer: BCBS of TX Blue Advantage |
$830.02
|
| Rate for Payer: BCBS of TX Blue Essentials |
$994.04
|
| Rate for Payer: BCBS of TX Medicare |
$574.38
|
| Rate for Payer: BCBS of TX PPO |
$1,252.49
|
| Rate for Payer: Cigna Commercial |
$1,301.14
|
| Rate for Payer: Cigna Medicaid |
$216.80
|
| Rate for Payer: Cigna Medicare |
$574.38
|
| Rate for Payer: Employer Direct Commercial |
$574.38
|
| Rate for Payer: Humana Medicare/TRICARE |
$574.38
|
| Rate for Payer: Molina CHIP/Medicaid |
$216.80
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$574.38
|
| Rate for Payer: Molina Medicare |
$574.38
|
| 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 |
$216.80
|
| Rate for Payer: Scott and White EPO/PPO |
$12.67
|
| Rate for Payer: Scott and White Medicare |
$574.38
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$216.80
|
| Rate for Payer: Superior Health Plan EPO |
$574.38
|
| Rate for Payer: Superior Health Plan Medicare |
$574.38
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$574.38
|
| Rate for Payer: Universal American Medicare |
$574.38
|
| Rate for Payer: Wellcare Medicare |
$574.38
|
| Rate for Payer: Wellmed Medicare |
$574.38
|
|
|
CPT 21336
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 21336
|
| Hospital Charge Code |
36021336
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$65.29 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$3,090.00
|
| Rate for Payer: Aetna Medicare |
$4,440.36
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,088.27
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$2,960.24
|
| Rate for Payer: Amerigroup Medicare |
$2,960.24
|
| Rate for Payer: BCBS of TX Blue Advantage |
$4,571.54
|
| Rate for Payer: BCBS of TX Blue Essentials |
$5,474.90
|
| Rate for Payer: BCBS of TX Medicare |
$2,960.24
|
| Rate for Payer: BCBS of TX PPO |
$6,898.37
|
| Rate for Payer: Cigna Commercial |
$6,705.80
|
| Rate for Payer: Cigna Medicaid |
$1,088.27
|
| Rate for Payer: Cigna Medicare |
$2,960.24
|
| Rate for Payer: Employer Direct Commercial |
$2,960.24
|
| Rate for Payer: Humana Medicare/TRICARE |
$2,960.24
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,088.27
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$2,960.24
|
| Rate for Payer: Molina Medicare |
$2,960.24
|
| 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 |
$1,088.27
|
| Rate for Payer: Scott and White EPO/PPO |
$65.29
|
| Rate for Payer: Scott and White Medicare |
$2,960.24
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,088.27
|
| Rate for Payer: Superior Health Plan EPO |
$2,960.24
|
| Rate for Payer: Superior Health Plan Medicare |
$2,960.24
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$2,960.24
|
| Rate for Payer: Universal American Medicare |
$2,960.24
|
| Rate for Payer: Wellcare Medicare |
$2,960.24
|
| Rate for Payer: Wellmed Medicare |
$2,960.24
|
|
|
CPT 29425
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 29425
|
| Hospital Charge Code |
36029425
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5.42 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Medicare |
$368.42
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$35.99
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$245.61
|
| Rate for Payer: Amerigroup Medicare |
$245.61
|
| Rate for Payer: BCBS of TX Blue Advantage |
$75.93
|
| Rate for Payer: BCBS of TX Blue Essentials |
$90.94
|
| Rate for Payer: BCBS of TX Medicare |
$245.61
|
| Rate for Payer: BCBS of TX PPO |
$114.58
|
| Rate for Payer: Cigna Commercial |
$556.38
|
| Rate for Payer: Cigna Medicaid |
$35.99
|
| Rate for Payer: Cigna Medicare |
$245.61
|
| Rate for Payer: Employer Direct Commercial |
$245.61
|
| Rate for Payer: Humana Medicare/TRICARE |
$245.61
|
| Rate for Payer: Molina CHIP/Medicaid |
$35.99
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$245.61
|
| Rate for Payer: Molina Medicare |
$245.61
|
| 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 |
$35.99
|
| Rate for Payer: Scott and White EPO/PPO |
$5.42
|
| Rate for Payer: Scott and White Medicare |
$245.61
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$35.99
|
| Rate for Payer: Superior Health Plan EPO |
$245.61
|
| Rate for Payer: Superior Health Plan Medicare |
$245.61
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$245.61
|
| Rate for Payer: Universal American Medicare |
$245.61
|
| Rate for Payer: Wellcare Medicare |
$245.61
|
| Rate for Payer: Wellmed Medicare |
$245.61
|
|
|
CRANIAL AND PERIPHERAL NERVE DISORDERS WITH MCC
|
Facility
|
IP
|
$28,747.00
|
|
|
Service Code
|
MSDRG 073
|
| Min. Negotiated Rate |
$11,348.56 |
| Max. Negotiated Rate |
$28,747.00 |
| Rate for Payer: Aetna Commercial |
$17,021.25
|
| Rate for Payer: Aetna Medicare |
$20,477.48
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$13,651.65
|
| Rate for Payer: Amerigroup Medicare |
$13,651.65
|
| Rate for Payer: BCBS of TX Blue Advantage |
$11,348.56
|
| Rate for Payer: BCBS of TX Blue Essentials |
$14,561.14
|
| Rate for Payer: BCBS of TX Medicare |
$13,651.65
|
| Rate for Payer: BCBS of TX PPO |
$16,179.67
|
| Rate for Payer: Cigna Commercial |
$19,487.44
|
| Rate for Payer: Cigna Medicare |
$13,651.65
|
| Rate for Payer: Employer Direct Commercial |
$13,651.65
|
| Rate for Payer: Humana Medicare/TRICARE |
$13,651.65
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$13,651.65
|
| Rate for Payer: Molina Medicare |
$13,651.65
|
| Rate for Payer: Multiplan Auto |
$28,747.00
|
| Rate for Payer: Multiplan Commercial |
$28,747.00
|
| Rate for Payer: Multiplan Workers Comp |
$28,747.00
|
| Rate for Payer: Scott and White EPO/PPO |
$13,238.75
|
| Rate for Payer: Scott and White Medicare |
$13,651.65
|
| Rate for Payer: Superior Health Plan EPO |
$13,651.65
|
| Rate for Payer: Superior Health Plan Medicare |
$13,651.65
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$13,651.65
|
| Rate for Payer: Universal American Medicare |
$13,651.65
|
| Rate for Payer: Wellcare Medicare |
$13,651.65
|
| Rate for Payer: Wellmed Medicare |
$13,651.65
|
|
|
CRANIAL AND PERIPHERAL NERVE DISORDERS WITHOUT MCC
|
Facility
|
IP
|
$19,497.80
|
|
|
Service Code
|
MSDRG 074
|
| Min. Negotiated Rate |
$7,903.40 |
| Max. Negotiated Rate |
$19,497.80 |
| Rate for Payer: Aetna Commercial |
$11,544.75
|
| Rate for Payer: Aetna Medicare |
$15,266.73
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$10,177.82
|
| Rate for Payer: Amerigroup Medicare |
$10,177.82
|
| Rate for Payer: BCBS of TX Blue Advantage |
$7,903.40
|
| Rate for Payer: BCBS of TX Blue Essentials |
$10,049.67
|
| Rate for Payer: BCBS of TX Medicare |
$10,177.82
|
| Rate for Payer: BCBS of TX PPO |
$11,166.74
|
| Rate for Payer: Cigna Commercial |
$13,217.46
|
| Rate for Payer: Cigna Medicare |
$10,177.82
|
| Rate for Payer: Employer Direct Commercial |
$10,177.82
|
| Rate for Payer: Humana Medicare/TRICARE |
$10,177.82
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$10,177.82
|
| Rate for Payer: Molina Medicare |
$10,177.82
|
| Rate for Payer: Multiplan Auto |
$19,497.80
|
| Rate for Payer: Multiplan Commercial |
$19,497.80
|
| Rate for Payer: Multiplan Workers Comp |
$19,497.80
|
| Rate for Payer: Scott and White EPO/PPO |
$8,979.25
|
| Rate for Payer: Scott and White Medicare |
$10,177.82
|
| Rate for Payer: Superior Health Plan EPO |
$10,177.82
|
| Rate for Payer: Superior Health Plan Medicare |
$10,177.82
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$10,177.82
|
| Rate for Payer: Universal American Medicare |
$10,177.82
|
| Rate for Payer: Wellcare Medicare |
$10,177.82
|
| Rate for Payer: Wellmed Medicare |
$10,177.82
|
|
|
CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH CC
|
Facility
|
IP
|
$56,108.90
|
|
|
Service Code
|
MSDRG 026
|
| Min. Negotiated Rate |
$23,928.27 |
| Max. Negotiated Rate |
$56,108.90 |
| Rate for Payer: Aetna Commercial |
$33,222.38
|
| Rate for Payer: Aetna Medicare |
$35,892.40
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$23,928.27
|
| Rate for Payer: Amerigroup Medicare |
$23,928.27
|
| Rate for Payer: BCBS of TX Blue Advantage |
$25,561.78
|
| Rate for Payer: BCBS of TX Blue Essentials |
$31,119.01
|
| Rate for Payer: BCBS of TX Medicare |
$23,928.27
|
| Rate for Payer: BCBS of TX PPO |
$34,578.02
|
| Rate for Payer: Cigna Commercial |
$38,035.93
|
| Rate for Payer: Cigna Medicare |
$23,928.27
|
| Rate for Payer: Employer Direct Commercial |
$23,928.27
|
| Rate for Payer: Humana Medicare/TRICARE |
$23,928.27
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$23,928.27
|
| Rate for Payer: Molina Medicare |
$23,928.27
|
| Rate for Payer: Multiplan Auto |
$56,108.90
|
| Rate for Payer: Multiplan Commercial |
$56,108.90
|
| Rate for Payer: Multiplan Workers Comp |
$56,108.90
|
| Rate for Payer: Scott and White EPO/PPO |
$25,839.62
|
| Rate for Payer: Scott and White Medicare |
$23,928.27
|
| Rate for Payer: Superior Health Plan EPO |
$23,928.27
|
| Rate for Payer: Superior Health Plan Medicare |
$23,928.27
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$23,928.27
|
| Rate for Payer: Universal American Medicare |
$23,928.27
|
| Rate for Payer: Wellcare Medicare |
$23,928.27
|
| Rate for Payer: Wellmed Medicare |
$23,928.27
|
|
|
CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH MCC
|
Facility
|
IP
|
$83,904.00
|
|
|
Service Code
|
MSDRG 025
|
| Min. Negotiated Rate |
$34,367.64 |
| Max. Negotiated Rate |
$83,904.00 |
| Rate for Payer: Aetna Commercial |
$49,680.00
|
| Rate for Payer: Aetna Medicare |
$51,551.46
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$34,367.64
|
| Rate for Payer: Amerigroup Medicare |
$34,367.64
|
| Rate for Payer: BCBS of TX Blue Advantage |
$36,475.18
|
| Rate for Payer: BCBS of TX Blue Essentials |
$44,139.52
|
| Rate for Payer: BCBS of TX Medicare |
$34,367.64
|
| Rate for Payer: BCBS of TX PPO |
$49,045.82
|
| Rate for Payer: Cigna Commercial |
$56,878.08
|
| Rate for Payer: Cigna Medicare |
$34,367.64
|
| Rate for Payer: Employer Direct Commercial |
$34,367.64
|
| Rate for Payer: Humana Medicare/TRICARE |
$34,367.64
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$34,367.64
|
| Rate for Payer: Molina Medicare |
$34,367.64
|
| Rate for Payer: Multiplan Auto |
$83,904.00
|
| Rate for Payer: Multiplan Commercial |
$83,904.00
|
| Rate for Payer: Multiplan Workers Comp |
$83,904.00
|
| Rate for Payer: Scott and White EPO/PPO |
$38,640.00
|
| Rate for Payer: Scott and White Medicare |
$34,367.64
|
| Rate for Payer: Superior Health Plan EPO |
$34,367.64
|
| Rate for Payer: Superior Health Plan Medicare |
$34,367.64
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$34,367.64
|
| Rate for Payer: Universal American Medicare |
$34,367.64
|
| Rate for Payer: Wellcare Medicare |
$34,367.64
|
| Rate for Payer: Wellmed Medicare |
$34,367.64
|
|
|
CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$46,225.10
|
|
|
Service Code
|
MSDRG 027
|
| Min. Negotiated Rate |
$20,216.10 |
| Max. Negotiated Rate |
$46,225.10 |
| Rate for Payer: Aetna Commercial |
$27,370.12
|
| Rate for Payer: Aetna Medicare |
$30,324.15
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$20,216.10
|
| Rate for Payer: Amerigroup Medicare |
$20,216.10
|
| Rate for Payer: BCBS of TX Blue Advantage |
$20,434.46
|
| Rate for Payer: BCBS of TX Blue Essentials |
$24,824.42
|
| Rate for Payer: BCBS of TX Medicare |
$20,216.10
|
| Rate for Payer: BCBS of TX PPO |
$27,583.76
|
| Rate for Payer: Cigna Commercial |
$31,335.75
|
| Rate for Payer: Cigna Medicare |
$20,216.10
|
| Rate for Payer: Employer Direct Commercial |
$20,216.10
|
| Rate for Payer: Humana Medicare/TRICARE |
$20,216.10
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$20,216.10
|
| Rate for Payer: Molina Medicare |
$20,216.10
|
| Rate for Payer: Multiplan Auto |
$46,225.10
|
| Rate for Payer: Multiplan Commercial |
$46,225.10
|
| Rate for Payer: Multiplan Workers Comp |
$46,225.10
|
| Rate for Payer: Scott and White EPO/PPO |
$21,287.88
|
| Rate for Payer: Scott and White Medicare |
$20,216.10
|
| Rate for Payer: Superior Health Plan EPO |
$20,216.10
|
| Rate for Payer: Superior Health Plan Medicare |
$20,216.10
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$20,216.10
|
| Rate for Payer: Universal American Medicare |
$20,216.10
|
| Rate for Payer: Wellcare Medicare |
$20,216.10
|
| Rate for Payer: Wellmed Medicare |
$20,216.10
|
|
|
CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA
|
Facility
|
IP
|
$115,713.80
|
|
|
Service Code
|
MSDRG 955
|
| Min. Negotiated Rate |
$46,314.81 |
| Max. Negotiated Rate |
$115,713.80 |
| Rate for Payer: Aetna Commercial |
$68,514.75
|
| Rate for Payer: Aetna Medicare |
$69,472.22
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$46,314.81
|
| Rate for Payer: Amerigroup Medicare |
$46,314.81
|
| Rate for Payer: BCBS of TX Blue Advantage |
$47,162.40
|
| Rate for Payer: BCBS of TX Blue Essentials |
$62,913.91
|
| Rate for Payer: BCBS of TX Medicare |
$46,314.81
|
| Rate for Payer: BCBS of TX PPO |
$69,907.06
|
| Rate for Payer: Cigna Commercial |
$78,441.78
|
| Rate for Payer: Cigna Medicare |
$46,314.81
|
| Rate for Payer: Employer Direct Commercial |
$46,314.81
|
| Rate for Payer: Humana Medicare/TRICARE |
$46,314.81
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$46,314.81
|
| Rate for Payer: Molina Medicare |
$46,314.81
|
| Rate for Payer: Multiplan Auto |
$115,713.80
|
| Rate for Payer: Multiplan Commercial |
$115,713.80
|
| Rate for Payer: Multiplan Workers Comp |
$115,713.80
|
| Rate for Payer: Scott and White EPO/PPO |
$53,289.25
|
| Rate for Payer: Scott and White Medicare |
$46,314.81
|
| Rate for Payer: Superior Health Plan EPO |
$46,314.81
|
| Rate for Payer: Superior Health Plan Medicare |
$46,314.81
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$46,314.81
|
| Rate for Payer: Universal American Medicare |
$46,314.81
|
| Rate for Payer: Wellcare Medicare |
$46,314.81
|
| Rate for Payer: Wellmed Medicare |
$46,314.81
|
|
|
CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITH MCC OR CHEMOTHERAPY IMPLANT OR EPILEPSY WITH NEUROSTIMULATOR
|
Facility
|
IP
|
$107,707.20
|
|
|
Service Code
|
MSDRG 023
|
| Min. Negotiated Rate |
$43,307.67 |
| Max. Negotiated Rate |
$107,707.20 |
| Rate for Payer: Aetna Commercial |
$63,774.00
|
| Rate for Payer: Aetna Medicare |
$64,961.50
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$43,307.67
|
| Rate for Payer: Amerigroup Medicare |
$43,307.67
|
| Rate for Payer: BCBS of TX Blue Advantage |
$46,235.32
|
| Rate for Payer: BCBS of TX Blue Essentials |
$56,342.77
|
| Rate for Payer: BCBS of TX Medicare |
$43,307.67
|
| Rate for Payer: BCBS of TX PPO |
$62,605.51
|
| Rate for Payer: Cigna Commercial |
$73,014.14
|
| Rate for Payer: Cigna Medicare |
$43,307.67
|
| Rate for Payer: Employer Direct Commercial |
$43,307.67
|
| Rate for Payer: Humana Medicare/TRICARE |
$43,307.67
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$43,307.67
|
| Rate for Payer: Molina Medicare |
$43,307.67
|
| Rate for Payer: Multiplan Auto |
$107,707.20
|
| Rate for Payer: Multiplan Commercial |
$107,707.20
|
| Rate for Payer: Multiplan Workers Comp |
$107,707.20
|
| Rate for Payer: Scott and White EPO/PPO |
$49,602.00
|
| Rate for Payer: Scott and White Medicare |
$43,307.67
|
| Rate for Payer: Superior Health Plan EPO |
$43,307.67
|
| Rate for Payer: Superior Health Plan Medicare |
$43,307.67
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$43,307.67
|
| Rate for Payer: Universal American Medicare |
$43,307.67
|
| Rate for Payer: Wellcare Medicare |
$43,307.67
|
| Rate for Payer: Wellmed Medicare |
$43,307.67
|
|
|
CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITHOUT MCC
|
Facility
|
IP
|
$71,987.20
|
|
|
Service Code
|
MSDRG 024
|
| Min. Negotiated Rate |
$29,891.87 |
| Max. Negotiated Rate |
$71,987.20 |
| Rate for Payer: Aetna Commercial |
$42,624.00
|
| Rate for Payer: Aetna Medicare |
$44,837.80
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$29,891.87
|
| Rate for Payer: Amerigroup Medicare |
$29,891.87
|
| Rate for Payer: BCBS of TX Blue Advantage |
$34,498.04
|
| Rate for Payer: BCBS of TX Blue Essentials |
$40,444.29
|
| Rate for Payer: BCBS of TX Medicare |
$29,891.87
|
| Rate for Payer: BCBS of TX PPO |
$44,939.84
|
| Rate for Payer: Cigna Commercial |
$48,799.74
|
| Rate for Payer: Cigna Medicare |
$29,891.87
|
| Rate for Payer: Employer Direct Commercial |
$29,891.87
|
| Rate for Payer: Humana Medicare/TRICARE |
$29,891.87
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$29,891.87
|
| Rate for Payer: Molina Medicare |
$29,891.87
|
| Rate for Payer: Multiplan Auto |
$71,987.20
|
| Rate for Payer: Multiplan Commercial |
$71,987.20
|
| Rate for Payer: Multiplan Workers Comp |
$71,987.20
|
| Rate for Payer: Scott and White EPO/PPO |
$33,152.00
|
| Rate for Payer: Scott and White Medicare |
$29,891.87
|
| Rate for Payer: Superior Health Plan EPO |
$29,891.87
|
| Rate for Payer: Superior Health Plan Medicare |
$29,891.87
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$29,891.87
|
| Rate for Payer: Universal American Medicare |
$29,891.87
|
| Rate for Payer: Wellcare Medicare |
$29,891.87
|
| Rate for Payer: Wellmed Medicare |
$29,891.87
|
|
|
C-Reactive Protein
|
Facility
|
OP
|
$282.00
|
|
|
Service Code
|
CPT 86140
|
| Hospital Charge Code |
1601384
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.02 |
| Max. Negotiated Rate |
$183.30 |
| Rate for Payer: Aetna Commercial |
$5.44
|
| Rate for Payer: Aetna Medicare |
$7.77
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2.02
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$5.18
|
| Rate for Payer: Amerigroup Medicare |
$5.18
|
| Rate for Payer: BCBS of TX Blue Advantage |
$8.55
|
| Rate for Payer: BCBS of TX Blue Essentials |
$10.26
|
| Rate for Payer: BCBS of TX Medicare |
$5.18
|
| Rate for Payer: BCBS of TX PPO |
$11.45
|
| Rate for Payer: Cash Price |
$248.16
|
| Rate for Payer: Cash Price |
$248.16
|
| Rate for Payer: Cigna Medicaid |
$5.18
|
| Rate for Payer: Cigna Medicare |
$5.18
|
| Rate for Payer: Employer Direct Commercial |
$5.18
|
| Rate for Payer: Humana Medicare/TRICARE |
$5.18
|
| Rate for Payer: Molina CHIP/Medicaid |
$5.18
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$5.18
|
| Rate for Payer: Molina Medicare |
$5.18
|
| Rate for Payer: Multiplan Auto |
$183.30
|
| Rate for Payer: Multiplan Commercial |
$183.30
|
| Rate for Payer: Multiplan Workers Comp |
$183.30
|
| Rate for Payer: Parkland Medicaid |
$5.18
|
| Rate for Payer: Scott and White EPO/PPO |
$6.48
|
| Rate for Payer: Scott and White Medicare |
$5.18
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$5.18
|
| Rate for Payer: Superior Health Plan EPO |
$5.18
|
| Rate for Payer: Superior Health Plan Medicare |
$5.18
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$5.18
|
| Rate for Payer: Universal American Medicare |
$5.18
|
| Rate for Payer: Wellcare Medicare |
$5.18
|
| Rate for Payer: Wellmed Medicare |
$5.18
|
|
|
C-Reactive Protein
|
Facility
|
IP
|
$282.00
|
|
|
Service Code
|
CPT 86140
|
| Hospital Charge Code |
1601384
|
|
Hospital Revenue Code
|
302
|
| Rate for Payer: Cash Price |
$248.16
|
|
|
C-Reactive Protein, Cardiac SO
|
Facility
|
OP
|
$154.00
|
|
|
Service Code
|
CPT 86141
|
| Hospital Charge Code |
1739614
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.05 |
| Max. Negotiated Rate |
$100.10 |
| Rate for Payer: Aetna Commercial |
$13.60
|
| Rate for Payer: Aetna Medicare |
$19.42
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$5.05
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$12.95
|
| Rate for Payer: Amerigroup Medicare |
$12.95
|
| Rate for Payer: BCBS of TX Blue Advantage |
$21.37
|
| Rate for Payer: BCBS of TX Blue Essentials |
$25.64
|
| Rate for Payer: BCBS of TX Medicare |
$12.95
|
| Rate for Payer: BCBS of TX PPO |
$28.62
|
| Rate for Payer: Cash Price |
$135.52
|
| Rate for Payer: Cash Price |
$135.52
|
| Rate for Payer: Cigna Medicaid |
$12.95
|
| Rate for Payer: Cigna Medicare |
$12.95
|
| Rate for Payer: Employer Direct Commercial |
$12.95
|
| Rate for Payer: Humana Medicare/TRICARE |
$12.95
|
| Rate for Payer: Molina CHIP/Medicaid |
$12.95
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$12.95
|
| Rate for Payer: Molina Medicare |
$12.95
|
| Rate for Payer: Multiplan Auto |
$100.10
|
| Rate for Payer: Multiplan Commercial |
$100.10
|
| Rate for Payer: Multiplan Workers Comp |
$100.10
|
| Rate for Payer: Parkland Medicaid |
$12.95
|
| Rate for Payer: Scott and White EPO/PPO |
$16.19
|
| Rate for Payer: Scott and White Medicare |
$12.95
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$12.95
|
| Rate for Payer: Superior Health Plan EPO |
$12.95
|
| Rate for Payer: Superior Health Plan Medicare |
$12.95
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$12.95
|
| Rate for Payer: Universal American Medicare |
$12.95
|
| Rate for Payer: Wellcare Medicare |
$12.95
|
| Rate for Payer: Wellmed Medicare |
$12.95
|
|
|
C-Reactive Protein, Cardiac SO
|
Facility
|
IP
|
$154.00
|
|
|
Service Code
|
CPT 86141
|
| Hospital Charge Code |
1739614
|
|
Hospital Revenue Code
|
302
|
| Rate for Payer: Cash Price |
$135.52
|
|
|
Creatine Kinase
|
Facility
|
OP
|
$277.00
|
|
|
Service Code
|
CPT 82550
|
| Hospital Charge Code |
1601756
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.54 |
| Max. Negotiated Rate |
$180.05 |
| Rate for Payer: Aetna Commercial |
$6.84
|
| Rate for Payer: Aetna Medicare |
$9.76
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2.54
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$6.51
|
| Rate for Payer: Amerigroup Medicare |
$6.51
|
| Rate for Payer: BCBS of TX Blue Advantage |
$10.74
|
| Rate for Payer: BCBS of TX Blue Essentials |
$12.89
|
| Rate for Payer: BCBS of TX Medicare |
$6.51
|
| Rate for Payer: BCBS of TX PPO |
$14.39
|
| Rate for Payer: Cash Price |
$243.76
|
| Rate for Payer: Cash Price |
$243.76
|
| Rate for Payer: Cigna Medicaid |
$6.51
|
| Rate for Payer: Cigna Medicare |
$6.51
|
| Rate for Payer: Employer Direct Commercial |
$6.51
|
| Rate for Payer: Humana Medicare/TRICARE |
$6.51
|
| Rate for Payer: Molina CHIP/Medicaid |
$6.51
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$6.51
|
| Rate for Payer: Molina Medicare |
$6.51
|
| Rate for Payer: Multiplan Auto |
$180.05
|
| Rate for Payer: Multiplan Commercial |
$180.05
|
| Rate for Payer: Multiplan Workers Comp |
$180.05
|
| Rate for Payer: Parkland Medicaid |
$6.51
|
| Rate for Payer: Scott and White EPO/PPO |
$8.14
|
| Rate for Payer: Scott and White Medicare |
$6.51
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$6.51
|
| Rate for Payer: Superior Health Plan EPO |
$6.51
|
| Rate for Payer: Superior Health Plan Medicare |
$6.51
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$6.51
|
| Rate for Payer: Universal American Medicare |
$6.51
|
| Rate for Payer: Wellcare Medicare |
$6.51
|
| Rate for Payer: Wellmed Medicare |
$6.51
|
|
|
Creatine Kinase
|
Facility
|
IP
|
$277.00
|
|
|
Service Code
|
CPT 82550
|
| Hospital Charge Code |
1601756
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$243.76
|
|
