|
Chemodenervation of muscle(s) muscle(s) innervated by facial, trigeminal, cervical spinal and acces
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 64615
|
| Hospital Charge Code |
36064615
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$59.25 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$59.25
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$308.35
|
| Rate for Payer: Amerigroup Medicare |
$308.35
|
| Rate for Payer: BCBS of TX Blue Advantage |
$113.91
|
| Rate for Payer: BCBS of TX Blue Essentials |
$136.42
|
| Rate for Payer: BCBS of TX Medicare |
$308.35
|
| Rate for Payer: BCBS of TX PPO |
$171.89
|
| Rate for Payer: Cigna Commercial |
$651.79
|
| Rate for Payer: Cigna Medicare |
$308.35
|
| Rate for Payer: Employer Direct Commercial |
$308.35
|
| Rate for Payer: Humana Medicare/TRICARE |
$308.35
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$308.35
|
| Rate for Payer: Molina Medicare |
$308.35
|
| 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: Scott and White EPO/PPO |
$501.11
|
| Rate for Payer: Scott and White Medicare |
$308.35
|
| Rate for Payer: Superior Health Plan EPO |
$308.35
|
| Rate for Payer: Superior Health Plan Medicare |
$308.35
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$308.35
|
| Rate for Payer: Universal American Medicare |
$308.35
|
| Rate for Payer: Wellcare Medicare |
$308.35
|
| Rate for Payer: Wellmed Medicare |
$308.35
|
|
|
Chemodenervation of muscle(s) muscle(s) innervated by facial, trigeminal, cervical spinal and acces
|
Facility
|
IP
|
$1,567.02
|
|
|
Service Code
|
HCPCS 64615
|
| Hospital Charge Code |
9900821
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$1,065.57
|
|
|
Chemodenervation of one extremity 5 or more muscles
|
Facility
|
OP
|
$10,882.70
|
|
|
Service Code
|
HCPCS 64644
|
| Hospital Charge Code |
9900834
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$85.54 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$85.54
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$709.10
|
| Rate for Payer: Amerigroup Medicare |
$709.10
|
| Rate for Payer: BCBS of TX Blue Advantage |
$162.72
|
| Rate for Payer: BCBS of TX Blue Essentials |
$194.88
|
| Rate for Payer: BCBS of TX Medicare |
$709.10
|
| Rate for Payer: BCBS of TX PPO |
$245.55
|
| Rate for Payer: Cash Price |
$7,400.24
|
| Rate for Payer: Cash Price |
$7,400.24
|
| Rate for Payer: Cash Price |
$7,400.24
|
| Rate for Payer: Cigna Commercial |
$1,498.91
|
| Rate for Payer: Cigna Medicaid |
$7,835.54
|
| Rate for Payer: Cigna Medicare |
$709.10
|
| Rate for Payer: Employer Direct Commercial |
$709.10
|
| Rate for Payer: Humana Medicare/TRICARE |
$709.10
|
| Rate for Payer: Molina CHIP/Medicaid |
$7,835.54
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$709.10
|
| Rate for Payer: Molina Medicare |
$709.10
|
| 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 |
$7,835.54
|
| Rate for Payer: Scott and White EPO/PPO |
$1,170.03
|
| Rate for Payer: Scott and White Medicare |
$709.10
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$7,835.54
|
| Rate for Payer: Superior Health Plan EPO |
$709.10
|
| Rate for Payer: Superior Health Plan Medicare |
$709.10
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$709.10
|
| Rate for Payer: Universal American Medicare |
$709.10
|
| Rate for Payer: Wellcare Medicare |
$709.10
|
| Rate for Payer: Wellmed Medicare |
$709.10
|
|
|
Chemodenervation of one extremity 5 or more muscles
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 64644
|
| Hospital Charge Code |
36064644
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$85.54 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$85.54
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$709.10
|
| Rate for Payer: Amerigroup Medicare |
$709.10
|
| Rate for Payer: BCBS of TX Blue Advantage |
$162.72
|
| Rate for Payer: BCBS of TX Blue Essentials |
$194.88
|
| Rate for Payer: BCBS of TX Medicare |
$709.10
|
| Rate for Payer: BCBS of TX PPO |
$245.55
|
| Rate for Payer: Cigna Commercial |
$1,498.91
|
| Rate for Payer: Cigna Medicare |
$709.10
|
| Rate for Payer: Employer Direct Commercial |
$709.10
|
| Rate for Payer: Humana Medicare/TRICARE |
$709.10
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$709.10
|
| Rate for Payer: Molina Medicare |
$709.10
|
| 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: Scott and White EPO/PPO |
$1,170.03
|
| Rate for Payer: Scott and White Medicare |
$709.10
|
| Rate for Payer: Superior Health Plan EPO |
$709.10
|
| Rate for Payer: Superior Health Plan Medicare |
$709.10
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$709.10
|
| Rate for Payer: Universal American Medicare |
$709.10
|
| Rate for Payer: Wellcare Medicare |
$709.10
|
| Rate for Payer: Wellmed Medicare |
$709.10
|
|
|
Chemodenervation of one extremity 5 or more muscles
|
Facility
|
IP
|
$10,882.70
|
|
|
Service Code
|
HCPCS 64644
|
| Hospital Charge Code |
9900834
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$7,400.24
|
|
|
CHEMOTHERAPY FOR ACUTE LEUKEMIA
|
Facility
|
IP
|
$4,034.04
|
|
|
Service Code
|
APR-DRG 6951
|
| Min. Negotiated Rate |
$3,803.43 |
| Max. Negotiated Rate |
$4,034.04 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$3,803.43
|
| Rate for Payer: Cigna Medicaid |
$3,803.43
|
| Rate for Payer: Molina CHIP/Medicaid |
$3,803.43
|
| Rate for Payer: Parkland Medicaid |
$3,803.43
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$4,034.04
|
|
|
CHEMOTHERAPY FOR ACUTE LEUKEMIA
|
Facility
|
IP
|
$4,751.07
|
|
|
Service Code
|
APR-DRG 6952
|
| Min. Negotiated Rate |
$4,479.48 |
| Max. Negotiated Rate |
$4,751.07 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$4,479.48
|
| Rate for Payer: Cigna Medicaid |
$4,479.48
|
| Rate for Payer: Molina CHIP/Medicaid |
$4,479.48
|
| Rate for Payer: Parkland Medicaid |
$4,479.48
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$4,751.07
|
|
|
CHEMOTHERAPY FOR ACUTE LEUKEMIA
|
Facility
|
IP
|
$14,217.38
|
|
|
Service Code
|
APR-DRG 6953
|
| Min. Negotiated Rate |
$13,404.65 |
| Max. Negotiated Rate |
$14,217.38 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$13,404.65
|
| Rate for Payer: Cigna Medicaid |
$13,404.65
|
| Rate for Payer: Molina CHIP/Medicaid |
$13,404.65
|
| Rate for Payer: Parkland Medicaid |
$13,404.65
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$14,217.38
|
|
|
CHEMOTHERAPY FOR ACUTE LEUKEMIA
|
Facility
|
IP
|
$41,615.26
|
|
|
Service Code
|
APR-DRG 6954
|
| Min. Negotiated Rate |
$39,236.33 |
| Max. Negotiated Rate |
$41,615.26 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$39,236.33
|
| Rate for Payer: Cigna Medicaid |
$39,236.33
|
| Rate for Payer: Molina CHIP/Medicaid |
$39,236.33
|
| Rate for Payer: Parkland Medicaid |
$39,236.33
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$41,615.26
|
|
|
Chemotherapy Inf up to 1 Hour Single or Initial Drug 96413
|
Facility
|
OP
|
$555.00
|
|
|
Service Code
|
HCPCS 96413
|
| Hospital Charge Code |
1500271
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$49.95 |
| Max. Negotiated Rate |
$701.38 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$49.95
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$331.81
|
| Rate for Payer: Amerigroup Medicare |
$331.81
|
| Rate for Payer: BCBS of TX Blue Advantage |
$166.50
|
| Rate for Payer: BCBS of TX Blue Essentials |
$199.80
|
| Rate for Payer: BCBS of TX Medicare |
$331.81
|
| Rate for Payer: BCBS of TX PPO |
$222.00
|
| Rate for Payer: Cash Price |
$377.40
|
| Rate for Payer: Cash Price |
$377.40
|
| Rate for Payer: Cash Price |
$377.40
|
| Rate for Payer: Cigna Commercial |
$701.38
|
| Rate for Payer: Cigna Medicaid |
$399.60
|
| Rate for Payer: Cigna Medicare |
$331.81
|
| Rate for Payer: Employer Direct Commercial |
$331.81
|
| Rate for Payer: Humana Medicare/TRICARE |
$331.81
|
| Rate for Payer: Molina CHIP/Medicaid |
$399.60
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$331.81
|
| Rate for Payer: Molina Medicare |
$331.81
|
| Rate for Payer: Multiplan Auto |
$360.75
|
| Rate for Payer: Multiplan Commercial |
$360.75
|
| Rate for Payer: Multiplan Workers Comp |
$360.75
|
| Rate for Payer: Parkland Medicaid |
$399.60
|
| Rate for Payer: Scott and White EPO/PPO |
$159.60
|
| Rate for Payer: Scott and White Medicare |
$331.81
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$399.60
|
| Rate for Payer: Superior Health Plan EPO |
$331.81
|
| Rate for Payer: Superior Health Plan Medicare |
$331.81
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$331.81
|
| Rate for Payer: Universal American Medicare |
$331.81
|
| Rate for Payer: Wellcare Medicare |
$331.81
|
| Rate for Payer: Wellmed Medicare |
$331.81
|
|
|
Chemotherapy Inf up to 1 Hour Single or Initial Drug 96413
|
Facility
|
IP
|
$555.00
|
|
|
Service Code
|
HCPCS 96413
|
| Hospital Charge Code |
1500271
|
|
Hospital Revenue Code
|
335
|
| Rate for Payer: Cash Price |
$377.40
|
|
|
Chemotherapy Infusion Each Additional Hour 96415
|
Facility
|
IP
|
$124.00
|
|
|
Service Code
|
HCPCS 96415
|
| Hospital Charge Code |
1500289
|
|
Hospital Revenue Code
|
335
|
| Rate for Payer: Cash Price |
$84.32
|
|
|
Chemotherapy Infusion Each Additional Hour 96415
|
Facility
|
OP
|
$124.00
|
|
|
Service Code
|
HCPCS 96415
|
| Hospital Charge Code |
1500289
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$11.16 |
| Max. Negotiated Rate |
$152.89 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$11.16
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$72.33
|
| Rate for Payer: Amerigroup Medicare |
$72.33
|
| Rate for Payer: BCBS of TX Blue Advantage |
$37.20
|
| Rate for Payer: BCBS of TX Blue Essentials |
$44.64
|
| Rate for Payer: BCBS of TX Medicare |
$72.33
|
| Rate for Payer: BCBS of TX PPO |
$49.60
|
| Rate for Payer: Cash Price |
$84.32
|
| Rate for Payer: Cash Price |
$84.32
|
| Rate for Payer: Cash Price |
$84.32
|
| Rate for Payer: Cigna Commercial |
$152.89
|
| Rate for Payer: Cigna Medicaid |
$89.28
|
| Rate for Payer: Cigna Medicare |
$72.33
|
| Rate for Payer: Employer Direct Commercial |
$72.33
|
| Rate for Payer: Humana Medicare/TRICARE |
$72.33
|
| Rate for Payer: Molina CHIP/Medicaid |
$89.28
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$72.33
|
| Rate for Payer: Molina Medicare |
$72.33
|
| Rate for Payer: Multiplan Auto |
$80.60
|
| Rate for Payer: Multiplan Commercial |
$80.60
|
| Rate for Payer: Multiplan Workers Comp |
$80.60
|
| Rate for Payer: Parkland Medicaid |
$89.28
|
| Rate for Payer: Scott and White EPO/PPO |
$34.14
|
| Rate for Payer: Scott and White Medicare |
$72.33
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$89.28
|
| Rate for Payer: Superior Health Plan EPO |
$72.33
|
| Rate for Payer: Superior Health Plan Medicare |
$72.33
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$72.33
|
| Rate for Payer: Universal American Medicare |
$72.33
|
| Rate for Payer: Wellcare Medicare |
$72.33
|
| Rate for Payer: Wellmed Medicare |
$72.33
|
|
|
CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS OR WITH HIGH DOSE CHEMOTHERAPY AGENT WITH MCC
|
Facility
|
IP
|
$102,261.80
|
|
|
Service Code
|
MSDRG 837
|
| Min. Negotiated Rate |
$39,970.92 |
| Max. Negotiated Rate |
$102,261.80 |
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$39,970.92
|
| Rate for Payer: Amerigroup Medicare |
$39,970.92
|
| Rate for Payer: BCBS of TX Medicare |
$39,970.92
|
| Rate for Payer: Cigna Commercial |
$61,879.38
|
| Rate for Payer: Cigna Medicare |
$39,970.92
|
| Rate for Payer: Employer Direct Commercial |
$39,970.92
|
| Rate for Payer: Humana Medicare/TRICARE |
$39,970.92
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$39,970.92
|
| Rate for Payer: Molina Medicare |
$39,970.92
|
| Rate for Payer: Multiplan Auto |
$102,261.80
|
| Rate for Payer: Multiplan Commercial |
$102,261.80
|
| Rate for Payer: Multiplan Workers Comp |
$102,261.80
|
| Rate for Payer: Scott and White EPO/PPO |
$47,094.25
|
| Rate for Payer: Scott and White Medicare |
$39,970.92
|
| Rate for Payer: Superior Health Plan EPO |
$39,970.92
|
| Rate for Payer: Superior Health Plan Medicare |
$39,970.92
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$39,970.92
|
| Rate for Payer: Universal American Medicare |
$39,970.92
|
| Rate for Payer: Wellcare Medicare |
$39,970.92
|
| Rate for Payer: Wellmed Medicare |
$39,970.92
|
|
|
CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC OR HIGH DOSE CHEMOTHERAPY AGENT
|
Facility
|
IP
|
$42,257.90
|
|
|
Service Code
|
MSDRG 838
|
| Min. Negotiated Rate |
$19,460.88 |
| Max. Negotiated Rate |
$42,257.90 |
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$20,058.69
|
| Rate for Payer: Amerigroup Medicare |
$20,058.69
|
| Rate for Payer: BCBS of TX Medicare |
$20,058.69
|
| Rate for Payer: Cigna Commercial |
$26,885.71
|
| Rate for Payer: Cigna Medicare |
$20,058.69
|
| Rate for Payer: Employer Direct Commercial |
$20,058.69
|
| Rate for Payer: Humana Medicare/TRICARE |
$20,058.69
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$20,058.69
|
| Rate for Payer: Molina Medicare |
$20,058.69
|
| Rate for Payer: Multiplan Auto |
$42,257.90
|
| Rate for Payer: Multiplan Commercial |
$42,257.90
|
| Rate for Payer: Multiplan Workers Comp |
$42,257.90
|
| Rate for Payer: Scott and White EPO/PPO |
$19,460.88
|
| Rate for Payer: Scott and White Medicare |
$20,058.69
|
| Rate for Payer: Superior Health Plan EPO |
$20,058.69
|
| Rate for Payer: Superior Health Plan Medicare |
$20,058.69
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$20,058.69
|
| Rate for Payer: Universal American Medicare |
$20,058.69
|
| Rate for Payer: Wellcare Medicare |
$20,058.69
|
| Rate for Payer: Wellmed Medicare |
$20,058.69
|
|
|
CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC
|
Facility
|
IP
|
$26,119.30
|
|
|
Service Code
|
MSDRG 839
|
| Min. Negotiated Rate |
$10,800.74 |
| Max. Negotiated Rate |
$26,119.30 |
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$15,342.46
|
| Rate for Payer: Amerigroup Medicare |
$15,342.46
|
| Rate for Payer: BCBS of TX Medicare |
$15,342.46
|
| Rate for Payer: Cigna Commercial |
$18,597.43
|
| Rate for Payer: Cigna Medicare |
$15,342.46
|
| Rate for Payer: Employer Direct Commercial |
$15,342.46
|
| Rate for Payer: Humana Medicare/TRICARE |
$15,342.46
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$15,342.46
|
| Rate for Payer: Molina Medicare |
$15,342.46
|
| Rate for Payer: Multiplan Auto |
$26,119.30
|
| Rate for Payer: Multiplan Commercial |
$26,119.30
|
| Rate for Payer: Multiplan Workers Comp |
$26,119.30
|
| Rate for Payer: Scott and White EPO/PPO |
$12,028.62
|
| Rate for Payer: Scott and White Medicare |
$15,342.46
|
| Rate for Payer: Superior Health Plan EPO |
$15,342.46
|
| Rate for Payer: Superior Health Plan Medicare |
$15,342.46
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$15,342.46
|
| Rate for Payer: Universal American Medicare |
$15,342.46
|
| Rate for Payer: Wellcare Medicare |
$15,342.46
|
| Rate for Payer: Wellmed Medicare |
$15,342.46
|
|
|
CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC
|
Facility
|
IP
|
$23,143.90
|
|
|
Service Code
|
MSDRG 847
|
| Min. Negotiated Rate |
$10,658.38 |
| Max. Negotiated Rate |
$23,143.90 |
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$14,347.92
|
| Rate for Payer: Amerigroup Medicare |
$14,347.92
|
| Rate for Payer: BCBS of TX Medicare |
$14,347.92
|
| Rate for Payer: Cigna Commercial |
$16,849.62
|
| Rate for Payer: Cigna Medicare |
$14,347.92
|
| Rate for Payer: Employer Direct Commercial |
$14,347.92
|
| Rate for Payer: Humana Medicare/TRICARE |
$14,347.92
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$14,347.92
|
| Rate for Payer: Molina Medicare |
$14,347.92
|
| Rate for Payer: Multiplan Auto |
$23,143.90
|
| Rate for Payer: Multiplan Commercial |
$23,143.90
|
| Rate for Payer: Multiplan Workers Comp |
$23,143.90
|
| Rate for Payer: Scott and White EPO/PPO |
$10,658.38
|
| Rate for Payer: Scott and White Medicare |
$14,347.92
|
| Rate for Payer: Superior Health Plan EPO |
$14,347.92
|
| Rate for Payer: Superior Health Plan Medicare |
$14,347.92
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$14,347.92
|
| Rate for Payer: Universal American Medicare |
$14,347.92
|
| Rate for Payer: Wellcare Medicare |
$14,347.92
|
| Rate for Payer: Wellmed Medicare |
$14,347.92
|
|
|
CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH MCC
|
Facility
|
IP
|
$45,771.00
|
|
|
Service Code
|
MSDRG 846
|
| Min. Negotiated Rate |
$21,078.75 |
| Max. Negotiated Rate |
$45,771.00 |
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$23,760.58
|
| Rate for Payer: Amerigroup Medicare |
$23,760.58
|
| Rate for Payer: BCBS of TX Medicare |
$23,760.58
|
| Rate for Payer: Cigna Commercial |
$33,391.40
|
| Rate for Payer: Cigna Medicare |
$23,760.58
|
| Rate for Payer: Employer Direct Commercial |
$23,760.58
|
| Rate for Payer: Humana Medicare/TRICARE |
$23,760.58
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$23,760.58
|
| Rate for Payer: Molina Medicare |
$23,760.58
|
| Rate for Payer: Multiplan Auto |
$45,771.00
|
| Rate for Payer: Multiplan Commercial |
$45,771.00
|
| Rate for Payer: Multiplan Workers Comp |
$45,771.00
|
| Rate for Payer: Scott and White EPO/PPO |
$21,078.75
|
| Rate for Payer: Scott and White Medicare |
$23,760.58
|
| Rate for Payer: Superior Health Plan EPO |
$23,760.58
|
| Rate for Payer: Superior Health Plan Medicare |
$23,760.58
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$23,760.58
|
| Rate for Payer: Universal American Medicare |
$23,760.58
|
| Rate for Payer: Wellcare Medicare |
$23,760.58
|
| Rate for Payer: Wellmed Medicare |
$23,760.58
|
|
|
CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC
|
Facility
|
IP
|
$17,652.90
|
|
|
Service Code
|
MSDRG 848
|
| Min. Negotiated Rate |
$8,020.36 |
| Max. Negotiated Rate |
$17,652.90 |
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$10,985.35
|
| Rate for Payer: Amerigroup Medicare |
$10,985.35
|
| Rate for Payer: BCBS of TX Medicare |
$10,985.35
|
| Rate for Payer: Cigna Commercial |
$10,940.27
|
| Rate for Payer: Cigna Medicare |
$10,985.35
|
| Rate for Payer: Employer Direct Commercial |
$10,985.35
|
| Rate for Payer: Humana Medicare/TRICARE |
$10,985.35
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$10,985.35
|
| Rate for Payer: Molina Medicare |
$10,985.35
|
| Rate for Payer: Multiplan Auto |
$17,652.90
|
| Rate for Payer: Multiplan Commercial |
$17,652.90
|
| Rate for Payer: Multiplan Workers Comp |
$17,652.90
|
| Rate for Payer: Scott and White EPO/PPO |
$8,129.62
|
| Rate for Payer: Scott and White Medicare |
$10,985.35
|
| Rate for Payer: Superior Health Plan EPO |
$10,985.35
|
| Rate for Payer: Superior Health Plan Medicare |
$10,985.35
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$10,985.35
|
| Rate for Payer: Universal American Medicare |
$10,985.35
|
| Rate for Payer: Wellcare Medicare |
$10,985.35
|
| Rate for Payer: Wellmed Medicare |
$10,985.35
|
|
|
CHEMOTHERAPY W/O ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS W CC
|
Facility
|
IP
|
$23,143.90
|
|
|
Service Code
|
MSDRG 847
|
| Min. Negotiated Rate |
$10,658.38 |
| Max. Negotiated Rate |
$23,143.90 |
| Rate for Payer: BCBS of TX Blue Advantage |
$11,407.90
|
| Rate for Payer: BCBS of TX Blue Essentials |
$13,688.15
|
| Rate for Payer: BCBS of TX PPO |
$15,209.65
|
|
|
CHEMOTHERAPY W/O ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS W MCC
|
Facility
|
IP
|
$45,771.00
|
|
|
Service Code
|
MSDRG 846
|
| Min. Negotiated Rate |
$21,078.75 |
| Max. Negotiated Rate |
$45,771.00 |
| Rate for Payer: BCBS of TX Blue Advantage |
$24,233.94
|
| Rate for Payer: BCBS of TX Blue Essentials |
$29,077.91
|
| Rate for Payer: BCBS of TX PPO |
$32,310.04
|
|
|
CHEMOTHERAPY W/O ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS W/O CC/MCC
|
Facility
|
IP
|
$17,652.90
|
|
|
Service Code
|
MSDRG 848
|
| Min. Negotiated Rate |
$8,020.36 |
| Max. Negotiated Rate |
$17,652.90 |
| Rate for Payer: BCBS of TX Blue Advantage |
$8,020.36
|
| Rate for Payer: BCBS of TX Blue Essentials |
$9,623.50
|
| Rate for Payer: BCBS of TX PPO |
$10,693.19
|
|
|
CHEMO W ACUTE LEUKEMIA AS SDX OR W HIGH DOSE CHEMO AGENT W MCC
|
Facility
|
IP
|
$102,261.80
|
|
|
Service Code
|
MSDRG 837
|
| Min. Negotiated Rate |
$39,970.92 |
| Max. Negotiated Rate |
$102,261.80 |
| Rate for Payer: BCBS of TX Blue Advantage |
$46,217.26
|
| Rate for Payer: BCBS of TX Blue Essentials |
$55,455.34
|
| Rate for Payer: BCBS of TX PPO |
$61,619.43
|
|
|
CHEMO W ACUTE LEUKEMIA AS SDX W CC OR HIGH DOSE CHEMO AGENT
|
Facility
|
IP
|
$42,257.90
|
|
|
Service Code
|
MSDRG 838
|
| Min. Negotiated Rate |
$19,460.88 |
| Max. Negotiated Rate |
$42,257.90 |
| Rate for Payer: BCBS of TX Blue Advantage |
$20,232.36
|
| Rate for Payer: BCBS of TX Blue Essentials |
$24,276.48
|
| Rate for Payer: BCBS of TX PPO |
$26,974.91
|
|
|
CHEMO W ACUTE LEUKEMIA AS SDX W/O CC/MCC
|
Facility
|
IP
|
$26,119.30
|
|
|
Service Code
|
MSDRG 839
|
| Min. Negotiated Rate |
$10,800.74 |
| Max. Negotiated Rate |
$26,119.30 |
| Rate for Payer: BCBS of TX Blue Advantage |
$10,800.74
|
| Rate for Payer: BCBS of TX Blue Essentials |
$12,959.63
|
| Rate for Payer: BCBS of TX PPO |
$14,400.15
|
|
