|
Hep Be Ab SO
|
Facility
|
IP
|
$62.00
|
|
|
Service Code
|
CPT 86707
|
| Hospital Charge Code |
1702703
|
|
Hospital Revenue Code
|
302
|
| Rate for Payer: Cash Price |
$54.56
|
|
|
Hep Be Ab SO
|
Facility
|
OP
|
$62.00
|
|
|
Service Code
|
CPT 86707
|
| Hospital Charge Code |
1702703
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.51 |
| Max. Negotiated Rate |
$40.30 |
| Rate for Payer: Aetna Commercial |
$12.14
|
| Rate for Payer: Aetna Medicare |
$17.36
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$4.51
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$11.57
|
| Rate for Payer: Amerigroup Medicare |
$11.57
|
| Rate for Payer: BCBS of TX Blue Advantage |
$19.09
|
| Rate for Payer: BCBS of TX Blue Essentials |
$22.91
|
| Rate for Payer: BCBS of TX Medicare |
$11.57
|
| Rate for Payer: BCBS of TX PPO |
$25.57
|
| Rate for Payer: Cash Price |
$54.56
|
| Rate for Payer: Cash Price |
$54.56
|
| Rate for Payer: Cigna Medicaid |
$11.57
|
| Rate for Payer: Cigna Medicare |
$11.57
|
| Rate for Payer: Employer Direct Commercial |
$11.57
|
| Rate for Payer: Humana Medicare/TRICARE |
$11.57
|
| Rate for Payer: Molina CHIP/Medicaid |
$11.57
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$11.57
|
| Rate for Payer: Molina Medicare |
$11.57
|
| Rate for Payer: Multiplan Auto |
$40.30
|
| Rate for Payer: Multiplan Commercial |
$40.30
|
| Rate for Payer: Multiplan Workers Comp |
$40.30
|
| Rate for Payer: Parkland Medicaid |
$11.57
|
| Rate for Payer: Scott and White EPO/PPO |
$14.46
|
| Rate for Payer: Scott and White Medicare |
$11.57
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$11.57
|
| Rate for Payer: Superior Health Plan EPO |
$11.57
|
| Rate for Payer: Superior Health Plan Medicare |
$11.57
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$11.57
|
| Rate for Payer: Universal American Medicare |
$11.57
|
| Rate for Payer: Wellcare Medicare |
$11.57
|
| Rate for Payer: Wellmed Medicare |
$11.57
|
|
|
Hep Be Ag SO
|
Facility
|
IP
|
$121.00
|
|
|
Service Code
|
CPT 87350
|
| Hospital Charge Code |
1700384
|
|
Hospital Revenue Code
|
306
|
| Rate for Payer: Cash Price |
$106.48
|
|
|
Hep Be Ag SO
|
Facility
|
OP
|
$121.00
|
|
|
Service Code
|
CPT 87350
|
| Hospital Charge Code |
1700384
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.50 |
| Max. Negotiated Rate |
$78.65 |
| Rate for Payer: Aetna Commercial |
$12.11
|
| Rate for Payer: Aetna Medicare |
$17.30
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$4.50
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$11.53
|
| Rate for Payer: Amerigroup Medicare |
$11.53
|
| 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 |
$11.53
|
| Rate for Payer: BCBS of TX PPO |
$25.48
|
| Rate for Payer: Cash Price |
$106.48
|
| Rate for Payer: Cash Price |
$106.48
|
| Rate for Payer: Cigna Medicaid |
$11.53
|
| Rate for Payer: Cigna Medicare |
$11.53
|
| Rate for Payer: Employer Direct Commercial |
$11.53
|
| Rate for Payer: Humana Medicare/TRICARE |
$11.53
|
| Rate for Payer: Molina CHIP/Medicaid |
$11.53
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$11.53
|
| Rate for Payer: Molina Medicare |
$11.53
|
| Rate for Payer: Multiplan Auto |
$78.65
|
| Rate for Payer: Multiplan Commercial |
$78.65
|
| Rate for Payer: Multiplan Workers Comp |
$78.65
|
| Rate for Payer: Parkland Medicaid |
$11.53
|
| Rate for Payer: Scott and White EPO/PPO |
$14.41
|
| Rate for Payer: Scott and White Medicare |
$11.53
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$11.53
|
| Rate for Payer: Superior Health Plan EPO |
$11.53
|
| Rate for Payer: Superior Health Plan Medicare |
$11.53
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$11.53
|
| Rate for Payer: Universal American Medicare |
$11.53
|
| Rate for Payer: Wellcare Medicare |
$11.53
|
| Rate for Payer: Wellmed Medicare |
$11.53
|
|
|
Hered.Hemochromatosis, DNA SO
|
Facility
|
OP
|
$372.00
|
|
|
Service Code
|
CPT 81256
|
| Hospital Charge Code |
1740952
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$25.49 |
| Max. Negotiated Rate |
$241.80 |
| Rate for Payer: Aetna Commercial |
$68.64
|
| Rate for Payer: Aetna Medicare |
$98.04
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$25.49
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$65.36
|
| Rate for Payer: Amerigroup Medicare |
$65.36
|
| Rate for Payer: BCBS of TX Blue Advantage |
$107.84
|
| Rate for Payer: BCBS of TX Blue Essentials |
$129.41
|
| Rate for Payer: BCBS of TX Medicare |
$65.36
|
| Rate for Payer: BCBS of TX PPO |
$144.45
|
| Rate for Payer: Cash Price |
$327.36
|
| Rate for Payer: Cash Price |
$327.36
|
| Rate for Payer: Cigna Medicaid |
$65.36
|
| Rate for Payer: Cigna Medicare |
$65.36
|
| Rate for Payer: Employer Direct Commercial |
$65.36
|
| Rate for Payer: Humana Medicare/TRICARE |
$65.36
|
| Rate for Payer: Molina CHIP/Medicaid |
$65.36
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$65.36
|
| Rate for Payer: Molina Medicare |
$65.36
|
| Rate for Payer: Multiplan Auto |
$241.80
|
| Rate for Payer: Multiplan Commercial |
$241.80
|
| Rate for Payer: Multiplan Workers Comp |
$241.80
|
| Rate for Payer: Parkland Medicaid |
$65.36
|
| Rate for Payer: Scott and White EPO/PPO |
$81.70
|
| Rate for Payer: Scott and White Medicare |
$65.36
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$65.36
|
| Rate for Payer: Superior Health Plan EPO |
$65.36
|
| Rate for Payer: Superior Health Plan Medicare |
$65.36
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$65.36
|
| Rate for Payer: Universal American Medicare |
$65.36
|
| Rate for Payer: Wellcare Medicare |
$65.36
|
| Rate for Payer: Wellmed Medicare |
$65.36
|
|
|
Hered.Hemochromatosis, DNA SO
|
Facility
|
IP
|
$372.00
|
|
|
Service Code
|
CPT 81256
|
| Hospital Charge Code |
1740952
|
|
Hospital Revenue Code
|
310
|
| Rate for Payer: Cash Price |
$327.36
|
|
|
HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH CC
|
Facility
|
IP
|
$22,669.67
|
|
|
Service Code
|
MSDRG 354
|
| Min. Negotiated Rate |
$14,405.86 |
| Max. Negotiated Rate |
$22,669.67 |
| Rate for Payer: Aetna Commercial |
$19,325.25
|
| Rate for Payer: Aetna Medicare |
$22,669.67
|
| Rate for Payer: BCBS of TX Blue Advantage |
$14,405.86
|
| Rate for Payer: BCBS of TX Blue Essentials |
$17,862.19
|
| Rate for Payer: BCBS of TX PPO |
$19,847.65
|
| Rate for Payer: Cigna Commercial |
$22,125.26
|
|
|
HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH MCC
|
Facility
|
IP
|
$37,664.98
|
|
|
Service Code
|
MSDRG 353
|
| Min. Negotiated Rate |
$24,721.56 |
| Max. Negotiated Rate |
$37,664.98 |
| Rate for Payer: Aetna Commercial |
$32,898.38
|
| Rate for Payer: Aetna Medicare |
$35,584.15
|
| Rate for Payer: BCBS of TX Blue Advantage |
$24,721.56
|
| Rate for Payer: BCBS of TX Blue Essentials |
$30,605.12
|
| Rate for Payer: BCBS of TX PPO |
$34,007.01
|
| Rate for Payer: Cigna Commercial |
$37,664.98
|
|
|
HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITHOUT CC/MCC
|
Facility
|
IP
|
$18,867.56
|
|
|
Service Code
|
MSDRG 355
|
| Min. Negotiated Rate |
$10,920.28 |
| Max. Negotiated Rate |
$18,867.56 |
| Rate for Payer: Aetna Commercial |
$15,329.25
|
| Rate for Payer: Aetna Medicare |
$18,867.56
|
| Rate for Payer: BCBS of TX Blue Advantage |
$10,920.28
|
| Rate for Payer: BCBS of TX Blue Essentials |
$13,980.18
|
| Rate for Payer: BCBS of TX PPO |
$15,534.14
|
| Rate for Payer: Cigna Commercial |
$17,550.29
|
|
|
HERPES SIMPLEX, AMPLIFIED
|
Facility
|
OP
|
$573.00
|
|
|
Service Code
|
CPT 87529
|
| Hospital Charge Code |
1709013
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$13.69 |
| Max. Negotiated Rate |
$372.45 |
| Rate for Payer: Aetna Commercial |
$36.84
|
| Rate for Payer: Aetna Medicare |
$52.63
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$13.69
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$35.09
|
| Rate for Payer: Amerigroup Medicare |
$35.09
|
| Rate for Payer: BCBS of TX Blue Advantage |
$57.90
|
| Rate for Payer: BCBS of TX Blue Essentials |
$69.48
|
| Rate for Payer: BCBS of TX Medicare |
$35.09
|
| Rate for Payer: BCBS of TX PPO |
$77.55
|
| Rate for Payer: Cash Price |
$504.24
|
| Rate for Payer: Cash Price |
$504.24
|
| Rate for Payer: Cigna Medicaid |
$35.09
|
| Rate for Payer: Cigna Medicare |
$35.09
|
| Rate for Payer: Employer Direct Commercial |
$35.09
|
| Rate for Payer: Humana Medicare/TRICARE |
$35.09
|
| Rate for Payer: Molina CHIP/Medicaid |
$35.09
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$35.09
|
| Rate for Payer: Molina Medicare |
$35.09
|
| Rate for Payer: Multiplan Auto |
$372.45
|
| Rate for Payer: Multiplan Commercial |
$372.45
|
| Rate for Payer: Multiplan Workers Comp |
$372.45
|
| Rate for Payer: Parkland Medicaid |
$35.09
|
| Rate for Payer: Scott and White EPO/PPO |
$43.86
|
| Rate for Payer: Scott and White Medicare |
$35.09
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$35.09
|
| Rate for Payer: Superior Health Plan EPO |
$35.09
|
| Rate for Payer: Superior Health Plan Medicare |
$35.09
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$35.09
|
| Rate for Payer: Universal American Medicare |
$35.09
|
| Rate for Payer: Wellcare Medicare |
$35.09
|
| Rate for Payer: Wellmed Medicare |
$35.09
|
|
|
Herpes Simplex Virus by PCR
|
Facility
|
IP
|
$573.00
|
|
|
Service Code
|
CPT 87529
|
| Hospital Charge Code |
4107529
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$504.24
|
|
|
Herpes Simplex Virus by PCR
|
Facility
|
OP
|
$573.00
|
|
|
Service Code
|
CPT 87529
|
| Hospital Charge Code |
4107529
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.69 |
| Max. Negotiated Rate |
$372.45 |
| Rate for Payer: Aetna Commercial |
$36.84
|
| Rate for Payer: Aetna Medicare |
$52.63
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$13.69
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$35.09
|
| Rate for Payer: Amerigroup Medicare |
$35.09
|
| Rate for Payer: BCBS of TX Blue Advantage |
$57.90
|
| Rate for Payer: BCBS of TX Blue Essentials |
$69.48
|
| Rate for Payer: BCBS of TX Medicare |
$35.09
|
| Rate for Payer: BCBS of TX PPO |
$77.55
|
| Rate for Payer: Cash Price |
$504.24
|
| Rate for Payer: Cash Price |
$504.24
|
| Rate for Payer: Cigna Medicaid |
$35.09
|
| Rate for Payer: Cigna Medicare |
$35.09
|
| Rate for Payer: Employer Direct Commercial |
$35.09
|
| Rate for Payer: Humana Medicare/TRICARE |
$35.09
|
| Rate for Payer: Molina CHIP/Medicaid |
$35.09
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$35.09
|
| Rate for Payer: Molina Medicare |
$35.09
|
| Rate for Payer: Multiplan Auto |
$372.45
|
| Rate for Payer: Multiplan Commercial |
$372.45
|
| Rate for Payer: Multiplan Workers Comp |
$372.45
|
| Rate for Payer: Parkland Medicaid |
$35.09
|
| Rate for Payer: Scott and White EPO/PPO |
$43.86
|
| Rate for Payer: Scott and White Medicare |
$35.09
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$35.09
|
| Rate for Payer: Superior Health Plan EPO |
$35.09
|
| Rate for Payer: Superior Health Plan Medicare |
$35.09
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$35.09
|
| Rate for Payer: Universal American Medicare |
$35.09
|
| Rate for Payer: Wellcare Medicare |
$35.09
|
| Rate for Payer: Wellmed Medicare |
$35.09
|
|
|
Hexagonal Phase Phospholipid SO
|
Facility
|
IP
|
$121.00
|
|
|
Service Code
|
CPT 85598
|
| Hospital Charge Code |
1740994
|
|
Hospital Revenue Code
|
305
|
| Rate for Payer: Cash Price |
$106.48
|
|
|
Hexagonal Phase Phospholipid SO
|
Facility
|
OP
|
$121.00
|
|
|
Service Code
|
CPT 85598
|
| Hospital Charge Code |
1740994
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$7.01 |
| Max. Negotiated Rate |
$78.65 |
| Rate for Payer: Aetna Commercial |
$18.88
|
| Rate for Payer: Aetna Medicare |
$26.97
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$7.01
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$17.98
|
| Rate for Payer: Amerigroup Medicare |
$17.98
|
| Rate for Payer: BCBS of TX Blue Advantage |
$29.67
|
| Rate for Payer: BCBS of TX Blue Essentials |
$35.60
|
| Rate for Payer: BCBS of TX Medicare |
$17.98
|
| Rate for Payer: BCBS of TX PPO |
$39.74
|
| Rate for Payer: Cash Price |
$106.48
|
| Rate for Payer: Cash Price |
$106.48
|
| Rate for Payer: Cigna Medicaid |
$17.98
|
| Rate for Payer: Cigna Medicare |
$17.98
|
| Rate for Payer: Employer Direct Commercial |
$17.98
|
| Rate for Payer: Humana Medicare/TRICARE |
$17.98
|
| Rate for Payer: Molina CHIP/Medicaid |
$17.98
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$17.98
|
| Rate for Payer: Molina Medicare |
$17.98
|
| Rate for Payer: Multiplan Auto |
$78.65
|
| Rate for Payer: Multiplan Commercial |
$78.65
|
| Rate for Payer: Multiplan Workers Comp |
$78.65
|
| Rate for Payer: Parkland Medicaid |
$17.98
|
| Rate for Payer: Scott and White EPO/PPO |
$22.48
|
| Rate for Payer: Scott and White Medicare |
$17.98
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$17.98
|
| Rate for Payer: Superior Health Plan EPO |
$17.98
|
| Rate for Payer: Superior Health Plan Medicare |
$17.98
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$17.98
|
| Rate for Payer: Universal American Medicare |
$17.98
|
| Rate for Payer: Wellcare Medicare |
$17.98
|
| Rate for Payer: Wellmed Medicare |
$17.98
|
|
|
.Hex Phase Phospholipid 117020 SO
|
Facility
|
OP
|
$121.00
|
|
|
Service Code
|
CPT 85598
|
| Hospital Charge Code |
1740994
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$7.01 |
| Max. Negotiated Rate |
$78.65 |
| Rate for Payer: Aetna Commercial |
$18.88
|
| Rate for Payer: Aetna Medicare |
$26.97
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$7.01
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$17.98
|
| Rate for Payer: Amerigroup Medicare |
$17.98
|
| Rate for Payer: BCBS of TX Blue Advantage |
$29.67
|
| Rate for Payer: BCBS of TX Blue Essentials |
$35.60
|
| Rate for Payer: BCBS of TX Medicare |
$17.98
|
| Rate for Payer: BCBS of TX PPO |
$39.74
|
| Rate for Payer: Cash Price |
$106.48
|
| Rate for Payer: Cash Price |
$106.48
|
| Rate for Payer: Cigna Medicaid |
$17.98
|
| Rate for Payer: Cigna Medicare |
$17.98
|
| Rate for Payer: Employer Direct Commercial |
$17.98
|
| Rate for Payer: Humana Medicare/TRICARE |
$17.98
|
| Rate for Payer: Molina CHIP/Medicaid |
$17.98
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$17.98
|
| Rate for Payer: Molina Medicare |
$17.98
|
| Rate for Payer: Multiplan Auto |
$78.65
|
| Rate for Payer: Multiplan Commercial |
$78.65
|
| Rate for Payer: Multiplan Workers Comp |
$78.65
|
| Rate for Payer: Parkland Medicaid |
$17.98
|
| Rate for Payer: Scott and White EPO/PPO |
$22.48
|
| Rate for Payer: Scott and White Medicare |
$17.98
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$17.98
|
| Rate for Payer: Superior Health Plan EPO |
$17.98
|
| Rate for Payer: Superior Health Plan Medicare |
$17.98
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$17.98
|
| Rate for Payer: Universal American Medicare |
$17.98
|
| Rate for Payer: Wellcare Medicare |
$17.98
|
| Rate for Payer: Wellmed Medicare |
$17.98
|
|
|
Hgb Fractionation Cascade SO
|
Facility
|
OP
|
$199.00
|
|
|
Service Code
|
CPT 83020
|
| Hospital Charge Code |
8546509
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.02 |
| Max. Negotiated Rate |
$129.35 |
| Rate for Payer: Aetna Commercial |
$13.51
|
| Rate for Payer: Aetna Medicare |
$19.30
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$5.02
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$12.87
|
| Rate for Payer: Amerigroup Medicare |
$12.87
|
| Rate for Payer: BCBS of TX Blue Advantage |
$21.24
|
| Rate for Payer: BCBS of TX Blue Essentials |
$25.48
|
| Rate for Payer: BCBS of TX Medicare |
$12.87
|
| Rate for Payer: BCBS of TX PPO |
$28.44
|
| Rate for Payer: Cash Price |
$175.12
|
| Rate for Payer: Cash Price |
$175.12
|
| Rate for Payer: Cigna Medicaid |
$12.87
|
| Rate for Payer: Cigna Medicare |
$12.87
|
| Rate for Payer: Employer Direct Commercial |
$12.87
|
| Rate for Payer: Humana Medicare/TRICARE |
$12.87
|
| Rate for Payer: Molina CHIP/Medicaid |
$12.87
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$12.87
|
| Rate for Payer: Molina Medicare |
$12.87
|
| Rate for Payer: Multiplan Auto |
$129.35
|
| Rate for Payer: Multiplan Commercial |
$129.35
|
| Rate for Payer: Multiplan Workers Comp |
$129.35
|
| Rate for Payer: Parkland Medicaid |
$12.87
|
| Rate for Payer: Scott and White EPO/PPO |
$16.09
|
| Rate for Payer: Scott and White Medicare |
$12.87
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$12.87
|
| Rate for Payer: Superior Health Plan EPO |
$12.87
|
| Rate for Payer: Superior Health Plan Medicare |
$12.87
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$12.87
|
| Rate for Payer: Universal American Medicare |
$12.87
|
| Rate for Payer: Wellcare Medicare |
$12.87
|
| Rate for Payer: Wellmed Medicare |
$12.87
|
|
|
Hgb Fractionation Cascade SO
|
Facility
|
IP
|
$199.00
|
|
|
Service Code
|
CPT 83020
|
| Hospital Charge Code |
8546509
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$175.12
|
|
|
HHV 6 IgG Antibodies SO
|
Facility
|
OP
|
$163.00
|
|
|
Service Code
|
CPT 86790
|
| Hospital Charge Code |
1703651
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.02 |
| Max. Negotiated Rate |
$105.95 |
| Rate for Payer: Aetna Commercial |
$13.53
|
| Rate for Payer: Aetna Medicare |
$19.32
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$5.02
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$12.88
|
| Rate for Payer: Amerigroup Medicare |
$12.88
|
| Rate for Payer: BCBS of TX Blue Advantage |
$21.25
|
| Rate for Payer: BCBS of TX Blue Essentials |
$25.50
|
| Rate for Payer: BCBS of TX Medicare |
$12.88
|
| Rate for Payer: BCBS of TX PPO |
$28.46
|
| Rate for Payer: Cash Price |
$143.44
|
| Rate for Payer: Cash Price |
$143.44
|
| Rate for Payer: Cigna Medicaid |
$12.88
|
| Rate for Payer: Cigna Medicare |
$12.88
|
| Rate for Payer: Employer Direct Commercial |
$12.88
|
| Rate for Payer: Humana Medicare/TRICARE |
$12.88
|
| Rate for Payer: Molina CHIP/Medicaid |
$12.88
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$12.88
|
| Rate for Payer: Molina Medicare |
$12.88
|
| Rate for Payer: Multiplan Auto |
$105.95
|
| Rate for Payer: Multiplan Commercial |
$105.95
|
| Rate for Payer: Multiplan Workers Comp |
$105.95
|
| Rate for Payer: Parkland Medicaid |
$12.88
|
| Rate for Payer: Scott and White EPO/PPO |
$16.10
|
| Rate for Payer: Scott and White Medicare |
$12.88
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$12.88
|
| Rate for Payer: Superior Health Plan EPO |
$12.88
|
| Rate for Payer: Superior Health Plan Medicare |
$12.88
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$12.88
|
| Rate for Payer: Universal American Medicare |
$12.88
|
| Rate for Payer: Wellcare Medicare |
$12.88
|
| Rate for Payer: Wellmed Medicare |
$12.88
|
|
|
HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH CC
|
Facility
|
IP
|
$26,724.71
|
|
|
Service Code
|
MSDRG 481
|
| Min. Negotiated Rate |
$17,230.96 |
| Max. Negotiated Rate |
$26,724.71 |
| Rate for Payer: Aetna Commercial |
$23,342.62
|
| Rate for Payer: Aetna Medicare |
$26,492.08
|
| Rate for Payer: BCBS of TX Blue Advantage |
$17,230.96
|
| Rate for Payer: BCBS of TX Blue Essentials |
$21,280.87
|
| Rate for Payer: BCBS of TX PPO |
$23,646.33
|
| Rate for Payer: Cigna Commercial |
$26,724.71
|
|
|
HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH MCC
|
Facility
|
IP
|
$37,981.83
|
|
|
Service Code
|
MSDRG 480
|
| Min. Negotiated Rate |
$25,812.04 |
| Max. Negotiated Rate |
$37,981.83 |
| Rate for Payer: Aetna Commercial |
$33,175.12
|
| Rate for Payer: Aetna Medicare |
$35,847.46
|
| Rate for Payer: BCBS of TX Blue Advantage |
$25,812.04
|
| Rate for Payer: BCBS of TX Blue Essentials |
$31,270.70
|
| Rate for Payer: BCBS of TX PPO |
$34,746.57
|
| Rate for Payer: Cigna Commercial |
$37,981.83
|
|
|
HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITHOUT CC/MCC
|
Facility
|
IP
|
$21,284.55
|
|
|
Service Code
|
MSDRG 482
|
| Min. Negotiated Rate |
$14,055.84 |
| Max. Negotiated Rate |
$21,284.55 |
| Rate for Payer: Aetna Commercial |
$17,869.50
|
| Rate for Payer: Aetna Medicare |
$21,284.55
|
| Rate for Payer: BCBS of TX Blue Advantage |
$14,055.84
|
| Rate for Payer: BCBS of TX Blue Essentials |
$17,175.98
|
| Rate for Payer: BCBS of TX PPO |
$19,085.16
|
| Rate for Payer: Cigna Commercial |
$20,458.59
|
|
|
Hip Arthro w/Labral Repair
|
Facility
|
OP
|
$15,074.51
|
|
|
Service Code
|
CPT 29916
|
| Hospital Charge Code |
36029916
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,398.52 |
| Max. Negotiated Rate |
$15,074.51 |
| Rate for Payer: Aetna Commercial |
$7,210.00
|
| Rate for Payer: Aetna Medicare |
$9,814.08
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2,398.52
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$6,542.72
|
| Rate for Payer: Amerigroup Medicare |
$6,542.72
|
| Rate for Payer: BCBS of TX Blue Advantage |
$9,989.86
|
| Rate for Payer: BCBS of TX Blue Essentials |
$11,963.90
|
| Rate for Payer: BCBS of TX Medicare |
$6,542.72
|
| Rate for Payer: BCBS of TX PPO |
$15,074.51
|
| Rate for Payer: Cigna Commercial |
$14,821.16
|
| Rate for Payer: Cigna Medicaid |
$2,398.52
|
| Rate for Payer: Cigna Medicare |
$6,542.72
|
| Rate for Payer: Employer Direct Commercial |
$6,542.72
|
| Rate for Payer: Humana Medicare/TRICARE |
$6,542.72
|
| Rate for Payer: Molina CHIP/Medicaid |
$2,398.52
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$6,542.72
|
| Rate for Payer: Molina Medicare |
$6,542.72
|
| Rate for Payer: Multiplan Auto |
$10,000.00
|
| Rate for Payer: Multiplan Commercial |
$10,000.00
|
| Rate for Payer: Multiplan Workers Comp |
$10,000.00
|
| Rate for Payer: Parkland Medicaid |
$2,398.52
|
| Rate for Payer: Scott and White EPO/PPO |
$12,104.03
|
| Rate for Payer: Scott and White Medicare |
$6,542.72
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$2,398.52
|
| Rate for Payer: Superior Health Plan EPO |
$6,542.72
|
| Rate for Payer: Superior Health Plan Medicare |
$6,542.72
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$6,542.72
|
| Rate for Payer: Universal American Medicare |
$6,542.72
|
| Rate for Payer: Wellcare Medicare |
$6,542.72
|
| Rate for Payer: Wellmed Medicare |
$6,542.72
|
|
|
HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITH MCC
|
Facility
|
IP
|
$38,565.30
|
|
|
Service Code
|
MSDRG 521
|
| Min. Negotiated Rate |
$33,684.75 |
| Max. Negotiated Rate |
$38,565.30 |
| Rate for Payer: Aetna Commercial |
$33,684.75
|
| Rate for Payer: Aetna Medicare |
$36,332.36
|
| Rate for Payer: Cigna Commercial |
$38,565.30
|
|
|
HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITHOUT MCC
|
Facility
|
IP
|
$27,205.14
|
|
|
Service Code
|
MSDRG 522
|
| Min. Negotiated Rate |
$23,762.25 |
| Max. Negotiated Rate |
$27,205.14 |
| Rate for Payer: Aetna Commercial |
$23,762.25
|
| Rate for Payer: Aetna Medicare |
$26,891.35
|
| Rate for Payer: Cigna Commercial |
$27,205.14
|
|
|
HIS BUNDLE RECORDING
|
Facility
|
IP
|
$6,825.00
|
|
|
Service Code
|
CPT 93600
|
| Hospital Charge Code |
4613600
|
|
Hospital Revenue Code
|
480
|
| Rate for Payer: Cash Price |
$6,006.00
|
|
