|
CPT 21336
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 21336
|
| Hospital Charge Code |
36021336
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,088.27 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,088.27
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3,286.91
|
| Rate for Payer: Amerigroup Medicare |
$3,286.91
|
| 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 |
$3,286.91
|
| Rate for Payer: BCBS of TX PPO |
$6,898.37
|
| Rate for Payer: Cigna Commercial |
$6,947.94
|
| Rate for Payer: Cigna Medicare |
$3,286.91
|
| Rate for Payer: Employer Direct Commercial |
$3,286.91
|
| Rate for Payer: Humana Medicare/TRICARE |
$3,286.91
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3,286.91
|
| Rate for Payer: Molina Medicare |
$3,286.91
|
| 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 |
$6,080.78
|
| Rate for Payer: Scott and White Medicare |
$3,286.91
|
| Rate for Payer: Superior Health Plan EPO |
$3,286.91
|
| Rate for Payer: Superior Health Plan Medicare |
$3,286.91
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3,286.91
|
| Rate for Payer: Universal American Medicare |
$3,286.91
|
| Rate for Payer: Wellcare Medicare |
$3,286.91
|
| Rate for Payer: Wellmed Medicare |
$3,286.91
|
|
|
CPT 29425
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 29425
|
| Hospital Charge Code |
36029425
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$35.99 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$35.99
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$280.97
|
| Rate for Payer: Amerigroup Medicare |
$280.97
|
| 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 |
$280.97
|
| Rate for Payer: BCBS of TX PPO |
$114.58
|
| Rate for Payer: Cigna Commercial |
$593.92
|
| Rate for Payer: Cigna Medicare |
$280.97
|
| Rate for Payer: Employer Direct Commercial |
$280.97
|
| Rate for Payer: Humana Medicare/TRICARE |
$280.97
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$280.97
|
| Rate for Payer: Molina Medicare |
$280.97
|
| 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 |
$519.79
|
| Rate for Payer: Scott and White Medicare |
$280.97
|
| Rate for Payer: Superior Health Plan EPO |
$280.97
|
| Rate for Payer: Superior Health Plan Medicare |
$280.97
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$280.97
|
| Rate for Payer: Universal American Medicare |
$280.97
|
| Rate for Payer: Wellcare Medicare |
$280.97
|
| Rate for Payer: Wellmed Medicare |
$280.97
|
|
|
CRANIAL AND PERIPHERAL NERVE DISORDERS WITH MCC
|
Facility
|
IP
|
$30,481.70
|
|
|
Service Code
|
MSDRG 073
|
| Min. Negotiated Rate |
$12,135.46 |
| Max. Negotiated Rate |
$30,481.70 |
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$16,518.03
|
| Rate for Payer: Amerigroup Medicare |
$16,518.03
|
| Rate for Payer: BCBS of TX Medicare |
$16,518.03
|
| Rate for Payer: Cigna Commercial |
$20,663.38
|
| Rate for Payer: Cigna Medicare |
$16,518.03
|
| Rate for Payer: Employer Direct Commercial |
$16,518.03
|
| Rate for Payer: Humana Medicare/TRICARE |
$16,518.03
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$16,518.03
|
| Rate for Payer: Molina Medicare |
$16,518.03
|
| Rate for Payer: Multiplan Auto |
$30,481.70
|
| Rate for Payer: Multiplan Commercial |
$30,481.70
|
| Rate for Payer: Multiplan Workers Comp |
$30,481.70
|
| Rate for Payer: Scott and White EPO/PPO |
$14,037.62
|
| Rate for Payer: Scott and White Medicare |
$16,518.03
|
| Rate for Payer: Superior Health Plan EPO |
$16,518.03
|
| Rate for Payer: Superior Health Plan Medicare |
$16,518.03
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$16,518.03
|
| Rate for Payer: Universal American Medicare |
$16,518.03
|
| Rate for Payer: Wellcare Medicare |
$16,518.03
|
| Rate for Payer: Wellmed Medicare |
$16,518.03
|
|
|
CRANIAL AND PERIPHERAL NERVE DISORDERS WITHOUT MCC
|
Facility
|
IP
|
$19,585.20
|
|
|
Service Code
|
MSDRG 074
|
| Min. Negotiated Rate |
$8,375.54 |
| Max. Negotiated Rate |
$19,585.20 |
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$12,314.83
|
| Rate for Payer: Amerigroup Medicare |
$12,314.83
|
| Rate for Payer: BCBS of TX Medicare |
$12,314.83
|
| Rate for Payer: Cigna Commercial |
$13,276.70
|
| Rate for Payer: Cigna Medicare |
$12,314.83
|
| Rate for Payer: Employer Direct Commercial |
$12,314.83
|
| Rate for Payer: Humana Medicare/TRICARE |
$12,314.83
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$12,314.83
|
| Rate for Payer: Molina Medicare |
$12,314.83
|
| Rate for Payer: Multiplan Auto |
$19,585.20
|
| Rate for Payer: Multiplan Commercial |
$19,585.20
|
| Rate for Payer: Multiplan Workers Comp |
$19,585.20
|
| Rate for Payer: Scott and White EPO/PPO |
$9,019.50
|
| Rate for Payer: Scott and White Medicare |
$12,314.83
|
| Rate for Payer: Superior Health Plan EPO |
$12,314.83
|
| Rate for Payer: Superior Health Plan Medicare |
$12,314.83
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$12,314.83
|
| Rate for Payer: Universal American Medicare |
$12,314.83
|
| Rate for Payer: Wellcare Medicare |
$12,314.83
|
| Rate for Payer: Wellmed Medicare |
$12,314.83
|
|
|
CRANIAL/FACIAL PROCEDURES W CC/MCC
|
Facility
|
IP
|
$30,137.23
|
|
|
Service Code
|
MSDRG 131
|
| Min. Negotiated Rate |
$22,604.24 |
| Max. Negotiated Rate |
$30,137.23 |
| Rate for Payer: BCBS of TX Blue Advantage |
$22,604.24
|
| Rate for Payer: BCBS of TX Blue Essentials |
$27,122.46
|
| Rate for Payer: BCBS of TX PPO |
$30,137.23
|
|
|
CRANIAL/FACIAL PROCEDURES W/O CC/MCC
|
Facility
|
IP
|
$17,526.93
|
|
|
Service Code
|
MSDRG 132
|
| Min. Negotiated Rate |
$13,145.96 |
| Max. Negotiated Rate |
$17,526.93 |
| Rate for Payer: BCBS of TX Blue Advantage |
$13,145.96
|
| Rate for Payer: BCBS of TX Blue Essentials |
$15,773.62
|
| Rate for Payer: BCBS of TX PPO |
$17,526.93
|
|
|
CRANIAL & PERIPHERAL NERVE DISORDERS W MCC
|
Facility
|
IP
|
$30,481.70
|
|
|
Service Code
|
MSDRG 073
|
| Min. Negotiated Rate |
$12,135.46 |
| Max. Negotiated Rate |
$30,481.70 |
| Rate for Payer: BCBS of TX Blue Advantage |
$12,135.46
|
| Rate for Payer: BCBS of TX Blue Essentials |
$14,561.14
|
| Rate for Payer: BCBS of TX PPO |
$16,179.67
|
|
|
CRANIAL & PERIPHERAL NERVE DISORDERS W/O MCC
|
Facility
|
IP
|
$19,585.20
|
|
|
Service Code
|
MSDRG 074
|
| Min. Negotiated Rate |
$8,375.54 |
| Max. Negotiated Rate |
$19,585.20 |
| Rate for Payer: BCBS of TX Blue Advantage |
$8,375.54
|
| Rate for Payer: BCBS of TX Blue Essentials |
$10,049.67
|
| Rate for Payer: BCBS of TX PPO |
$11,166.74
|
|
|
CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH CC
|
Facility
|
IP
|
$59,074.80
|
|
|
Service Code
|
MSDRG 026
|
| Min. Negotiated Rate |
$25,935.02 |
| Max. Negotiated Rate |
$59,074.80 |
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$27,547.49
|
| Rate for Payer: Amerigroup Medicare |
$27,547.49
|
| Rate for Payer: BCBS of TX Medicare |
$27,547.49
|
| Rate for Payer: Cigna Commercial |
$40,046.50
|
| Rate for Payer: Cigna Medicare |
$27,547.49
|
| Rate for Payer: Employer Direct Commercial |
$27,547.49
|
| Rate for Payer: Humana Medicare/TRICARE |
$27,547.49
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$27,547.49
|
| Rate for Payer: Molina Medicare |
$27,547.49
|
| Rate for Payer: Multiplan Auto |
$59,074.80
|
| Rate for Payer: Multiplan Commercial |
$59,074.80
|
| Rate for Payer: Multiplan Workers Comp |
$59,074.80
|
| Rate for Payer: Scott and White EPO/PPO |
$27,205.50
|
| Rate for Payer: Scott and White Medicare |
$27,547.49
|
| Rate for Payer: Superior Health Plan EPO |
$27,547.49
|
| Rate for Payer: Superior Health Plan Medicare |
$27,547.49
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$27,547.49
|
| Rate for Payer: Universal American Medicare |
$27,547.49
|
| Rate for Payer: Wellcare Medicare |
$27,547.49
|
| Rate for Payer: Wellmed Medicare |
$27,547.49
|
|
|
CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH MCC
|
Facility
|
IP
|
$86,387.30
|
|
|
Service Code
|
MSDRG 025
|
| Min. Negotiated Rate |
$36,786.50 |
| Max. Negotiated Rate |
$86,387.30 |
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$38,082.97
|
| Rate for Payer: Amerigroup Medicare |
$38,082.97
|
| Rate for Payer: BCBS of TX Medicare |
$38,082.97
|
| Rate for Payer: Cigna Commercial |
$58,561.50
|
| Rate for Payer: Cigna Medicare |
$38,082.97
|
| Rate for Payer: Employer Direct Commercial |
$38,082.97
|
| Rate for Payer: Humana Medicare/TRICARE |
$38,082.97
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$38,082.97
|
| Rate for Payer: Molina Medicare |
$38,082.97
|
| Rate for Payer: Multiplan Auto |
$86,387.30
|
| Rate for Payer: Multiplan Commercial |
$86,387.30
|
| Rate for Payer: Multiplan Workers Comp |
$86,387.30
|
| Rate for Payer: Scott and White EPO/PPO |
$39,783.62
|
| Rate for Payer: Scott and White Medicare |
$38,082.97
|
| Rate for Payer: Superior Health Plan EPO |
$38,082.97
|
| Rate for Payer: Superior Health Plan Medicare |
$38,082.97
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$38,082.97
|
| Rate for Payer: Universal American Medicare |
$38,082.97
|
| Rate for Payer: Wellcare Medicare |
$38,082.97
|
| Rate for Payer: Wellmed Medicare |
$38,082.97
|
|
|
CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$47,935.10
|
|
|
Service Code
|
MSDRG 027
|
| Min. Negotiated Rate |
$20,689.02 |
| Max. Negotiated Rate |
$47,935.10 |
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$23,250.48
|
| Rate for Payer: Amerigroup Medicare |
$23,250.48
|
| Rate for Payer: BCBS of TX Medicare |
$23,250.48
|
| Rate for Payer: Cigna Commercial |
$32,494.95
|
| Rate for Payer: Cigna Medicare |
$23,250.48
|
| Rate for Payer: Employer Direct Commercial |
$23,250.48
|
| Rate for Payer: Humana Medicare/TRICARE |
$23,250.48
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$23,250.48
|
| Rate for Payer: Molina Medicare |
$23,250.48
|
| Rate for Payer: Multiplan Auto |
$47,935.10
|
| Rate for Payer: Multiplan Commercial |
$47,935.10
|
| Rate for Payer: Multiplan Workers Comp |
$47,935.10
|
| Rate for Payer: Scott and White EPO/PPO |
$22,075.38
|
| Rate for Payer: Scott and White Medicare |
$23,250.48
|
| Rate for Payer: Superior Health Plan EPO |
$23,250.48
|
| Rate for Payer: Superior Health Plan Medicare |
$23,250.48
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$23,250.48
|
| Rate for Payer: Universal American Medicare |
$23,250.48
|
| Rate for Payer: Wellcare Medicare |
$23,250.48
|
| Rate for Payer: Wellmed Medicare |
$23,250.48
|
|
|
CRANIOTOMY & ENDOVASCULAR INTRACRANIAL PROCEDURES W CC
|
Facility
|
IP
|
$59,074.80
|
|
|
Service Code
|
MSDRG 026
|
| Min. Negotiated Rate |
$25,935.02 |
| Max. Negotiated Rate |
$59,074.80 |
| Rate for Payer: BCBS of TX Blue Advantage |
$25,935.02
|
| Rate for Payer: BCBS of TX Blue Essentials |
$31,119.01
|
| Rate for Payer: BCBS of TX PPO |
$34,578.02
|
|
|
CRANIOTOMY & ENDOVASCULAR INTRACRANIAL PROCEDURES W MCC
|
Facility
|
IP
|
$86,387.30
|
|
|
Service Code
|
MSDRG 025
|
| Min. Negotiated Rate |
$36,786.50 |
| Max. Negotiated Rate |
$86,387.30 |
| Rate for Payer: BCBS of TX Blue Advantage |
$36,786.50
|
| Rate for Payer: BCBS of TX Blue Essentials |
$44,139.52
|
| Rate for Payer: BCBS of TX PPO |
$49,045.82
|
|
|
CRANIOTOMY & ENDOVASCULAR INTRACRANIAL PROCEDURES W/O CC/MCC
|
Facility
|
IP
|
$47,935.10
|
|
|
Service Code
|
MSDRG 027
|
| Min. Negotiated Rate |
$20,689.02 |
| Max. Negotiated Rate |
$47,935.10 |
| Rate for Payer: BCBS of TX Blue Advantage |
$20,689.02
|
| Rate for Payer: BCBS of TX Blue Essentials |
$24,824.42
|
| Rate for Payer: BCBS of TX PPO |
$27,583.76
|
|
|
CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA
|
Facility
|
IP
|
$45,914.84
|
|
|
Service Code
|
APR-DRG 9104
|
| Min. Negotiated Rate |
$43,290.12 |
| Max. Negotiated Rate |
$45,914.84 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$43,290.12
|
| Rate for Payer: Cigna Medicaid |
$43,290.12
|
| Rate for Payer: Molina CHIP/Medicaid |
$43,290.12
|
| Rate for Payer: Parkland Medicaid |
$43,290.12
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$45,914.84
|
|
|
CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA
|
Facility
|
IP
|
$17,456.68
|
|
|
Service Code
|
APR-DRG 9103
|
| Min. Negotiated Rate |
$16,458.77 |
| Max. Negotiated Rate |
$17,456.68 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$16,458.77
|
| Rate for Payer: Cigna Medicaid |
$16,458.77
|
| Rate for Payer: Molina CHIP/Medicaid |
$16,458.77
|
| Rate for Payer: Parkland Medicaid |
$16,458.77
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$17,456.68
|
|
|
CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA
|
Facility
|
IP
|
$127,890.90
|
|
|
Service Code
|
MSDRG 955
|
| Min. Negotiated Rate |
$52,433.34 |
| Max. Negotiated Rate |
$127,890.90 |
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$54,092.49
|
| Rate for Payer: Amerigroup Medicare |
$54,092.49
|
| Rate for Payer: BCBS of TX Blue Advantage |
$52,433.34
|
| Rate for Payer: BCBS of TX Blue Essentials |
$62,913.91
|
| Rate for Payer: BCBS of TX Medicare |
$54,092.49
|
| Rate for Payer: BCBS of TX PPO |
$69,907.06
|
| Rate for Payer: Cigna Commercial |
$86,696.57
|
| Rate for Payer: Cigna Medicare |
$54,092.49
|
| Rate for Payer: Employer Direct Commercial |
$54,092.49
|
| Rate for Payer: Humana Medicare/TRICARE |
$54,092.49
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$54,092.49
|
| Rate for Payer: Molina Medicare |
$54,092.49
|
| Rate for Payer: Multiplan Auto |
$127,890.90
|
| Rate for Payer: Multiplan Commercial |
$127,890.90
|
| Rate for Payer: Multiplan Workers Comp |
$127,890.90
|
| Rate for Payer: Scott and White EPO/PPO |
$58,897.12
|
| Rate for Payer: Scott and White Medicare |
$54,092.49
|
| Rate for Payer: Superior Health Plan EPO |
$54,092.49
|
| Rate for Payer: Superior Health Plan Medicare |
$54,092.49
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$54,092.49
|
| Rate for Payer: Universal American Medicare |
$54,092.49
|
| Rate for Payer: Wellcare Medicare |
$54,092.49
|
| Rate for Payer: Wellmed Medicare |
$54,092.49
|
|
|
CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA
|
Facility
|
IP
|
$12,874.97
|
|
|
Service Code
|
APR-DRG 9101
|
| Min. Negotiated Rate |
$12,138.97 |
| Max. Negotiated Rate |
$12,874.97 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$12,138.97
|
| Rate for Payer: Cigna Medicaid |
$12,138.97
|
| Rate for Payer: Molina CHIP/Medicaid |
$12,138.97
|
| Rate for Payer: Parkland Medicaid |
$12,138.97
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$12,874.97
|
|
|
CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA
|
Facility
|
IP
|
$13,335.14
|
|
|
Service Code
|
APR-DRG 9102
|
| Min. Negotiated Rate |
$12,572.84 |
| Max. Negotiated Rate |
$13,335.14 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$12,572.84
|
| Rate for Payer: Cigna Medicaid |
$12,572.84
|
| Rate for Payer: Molina CHIP/Medicaid |
$12,572.84
|
| Rate for Payer: Parkland Medicaid |
$12,572.84
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$13,335.14
|
|
|
CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITH MCC OR ANTINEOPLASTIC IMPLANT OR EPILEPSY WITH NEUROSTIMULATOR
|
Facility
|
IP
|
$108,875.70
|
|
|
Service Code
|
MSDRG 023
|
| Min. Negotiated Rate |
$46,757.60 |
| Max. Negotiated Rate |
$108,875.70 |
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$46,757.60
|
| Rate for Payer: Amerigroup Medicare |
$46,757.60
|
| Rate for Payer: BCBS of TX Medicare |
$46,757.60
|
| Rate for Payer: Cigna Commercial |
$73,806.26
|
| Rate for Payer: Cigna Medicare |
$46,757.60
|
| Rate for Payer: Employer Direct Commercial |
$46,757.60
|
| Rate for Payer: Humana Medicare/TRICARE |
$46,757.60
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$46,757.60
|
| Rate for Payer: Molina Medicare |
$46,757.60
|
| Rate for Payer: Multiplan Auto |
$108,875.70
|
| Rate for Payer: Multiplan Commercial |
$108,875.70
|
| Rate for Payer: Multiplan Workers Comp |
$108,875.70
|
| Rate for Payer: Scott and White EPO/PPO |
$50,140.12
|
| Rate for Payer: Scott and White Medicare |
$46,757.60
|
| Rate for Payer: Superior Health Plan EPO |
$46,757.60
|
| Rate for Payer: Superior Health Plan Medicare |
$46,757.60
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$46,757.60
|
| Rate for Payer: Universal American Medicare |
$46,757.60
|
| Rate for Payer: Wellcare Medicare |
$46,757.60
|
| Rate for Payer: Wellmed Medicare |
$46,757.60
|
|
|
CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITHOUT MCC
|
Facility
|
IP
|
$74,326.10
|
|
|
Service Code
|
MSDRG 024
|
| Min. Negotiated Rate |
$33,430.50 |
| Max. Negotiated Rate |
$74,326.10 |
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$33,430.50
|
| Rate for Payer: Amerigroup Medicare |
$33,430.50
|
| Rate for Payer: BCBS of TX Medicare |
$33,430.50
|
| Rate for Payer: Cigna Commercial |
$50,385.27
|
| Rate for Payer: Cigna Medicare |
$33,430.50
|
| Rate for Payer: Employer Direct Commercial |
$33,430.50
|
| Rate for Payer: Humana Medicare/TRICARE |
$33,430.50
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$33,430.50
|
| Rate for Payer: Molina Medicare |
$33,430.50
|
| Rate for Payer: Multiplan Auto |
$74,326.10
|
| Rate for Payer: Multiplan Commercial |
$74,326.10
|
| Rate for Payer: Multiplan Workers Comp |
$74,326.10
|
| Rate for Payer: Scott and White EPO/PPO |
$34,229.12
|
| Rate for Payer: Scott and White Medicare |
$33,430.50
|
| Rate for Payer: Superior Health Plan EPO |
$33,430.50
|
| Rate for Payer: Superior Health Plan Medicare |
$33,430.50
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$33,430.50
|
| Rate for Payer: Universal American Medicare |
$33,430.50
|
| Rate for Payer: Wellcare Medicare |
$33,430.50
|
| Rate for Payer: Wellmed Medicare |
$33,430.50
|
|
|
CRANIOTOMY W MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PDX W MCC OR CHEMOTHERAPY IMPLANT OR EPILEPSY W NEUROSTIMULATOR
|
Facility
|
IP
|
$108,875.70
|
|
|
Service Code
|
MSDRG 023
|
| Min. Negotiated Rate |
$46,757.60 |
| Max. Negotiated Rate |
$108,875.70 |
| Rate for Payer: BCBS of TX Blue Advantage |
$46,956.86
|
| Rate for Payer: BCBS of TX Blue Essentials |
$56,342.77
|
| Rate for Payer: BCBS of TX PPO |
$62,605.51
|
|
|
CRANIO W MAJOR DEV IMPL/ACUTE COMPLEX CNS PDX W/O MCC
|
Facility
|
IP
|
$74,326.10
|
|
|
Service Code
|
MSDRG 024
|
| Min. Negotiated Rate |
$33,430.50 |
| Max. Negotiated Rate |
$74,326.10 |
| Rate for Payer: BCBS of TX Blue Advantage |
$33,706.84
|
| Rate for Payer: BCBS of TX Blue Essentials |
$40,444.29
|
| Rate for Payer: BCBS of TX PPO |
$44,939.84
|
|
|
C-Reactive Protein
|
Facility
|
IP
|
$282.00
|
|
|
Service Code
|
HCPCS 86140
|
| Hospital Charge Code |
1601384
|
|
Hospital Revenue Code
|
302
|
| Rate for Payer: Cash Price |
$191.76
|
|
|
C-Reactive Protein
|
Facility
|
OP
|
$282.00
|
|
|
Service Code
|
HCPCS 86140
|
| Hospital Charge Code |
1601384
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.02 |
| Max. Negotiated Rate |
$203.04 |
| 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 |
$84.60
|
| Rate for Payer: BCBS of TX Blue Essentials |
$101.52
|
| Rate for Payer: BCBS of TX Medicare |
$5.18
|
| Rate for Payer: BCBS of TX PPO |
$112.80
|
| Rate for Payer: Cash Price |
$191.76
|
| Rate for Payer: Cash Price |
$191.76
|
| Rate for Payer: Cigna Medicaid |
$203.04
|
| 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 |
$203.04
|
| 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 |
$203.04
|
| Rate for Payer: Scott and White EPO/PPO |
$6.47
|
| Rate for Payer: Scott and White Medicare |
$5.18
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$203.04
|
| 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
|
|
