|
DISORDERS OF PANCREAS EXCEPT MALIGNANCY W CC
|
Facility
|
IP
|
$15,982.80
|
|
|
Service Code
|
MSDRG 439
|
| Min. Negotiated Rate |
$7,360.50 |
| Max. Negotiated Rate |
$15,982.80 |
| Rate for Payer: BCBS of TX Blue Advantage |
$7,415.78
|
| Rate for Payer: BCBS of TX Blue Essentials |
$8,898.07
|
| Rate for Payer: BCBS of TX PPO |
$9,887.13
|
|
|
DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH CC
|
Facility
|
IP
|
$15,982.80
|
|
|
Service Code
|
MSDRG 439
|
| Min. Negotiated Rate |
$7,360.50 |
| Max. Negotiated Rate |
$15,982.80 |
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$10,925.26
|
| Rate for Payer: Amerigroup Medicare |
$10,925.26
|
| Rate for Payer: BCBS of TX Medicare |
$10,925.26
|
| Rate for Payer: Cigna Commercial |
$10,834.66
|
| Rate for Payer: Cigna Medicare |
$10,925.26
|
| Rate for Payer: Employer Direct Commercial |
$10,925.26
|
| Rate for Payer: Humana Medicare/TRICARE |
$10,925.26
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$10,925.26
|
| Rate for Payer: Molina Medicare |
$10,925.26
|
| Rate for Payer: Multiplan Auto |
$15,982.80
|
| Rate for Payer: Multiplan Commercial |
$15,982.80
|
| Rate for Payer: Multiplan Workers Comp |
$15,982.80
|
| Rate for Payer: Scott and White EPO/PPO |
$7,360.50
|
| Rate for Payer: Scott and White Medicare |
$10,925.26
|
| Rate for Payer: Superior Health Plan EPO |
$10,925.26
|
| Rate for Payer: Superior Health Plan Medicare |
$10,925.26
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$10,925.26
|
| Rate for Payer: Universal American Medicare |
$10,925.26
|
| Rate for Payer: Wellcare Medicare |
$10,925.26
|
| Rate for Payer: Wellmed Medicare |
$10,925.26
|
|
|
DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH MCC
|
Facility
|
IP
|
$30,973.80
|
|
|
Service Code
|
MSDRG 438
|
| Min. Negotiated Rate |
$14,088.52 |
| Max. Negotiated Rate |
$30,973.80 |
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$16,707.86
|
| Rate for Payer: Amerigroup Medicare |
$16,707.86
|
| Rate for Payer: BCBS of TX Medicare |
$16,707.86
|
| Rate for Payer: Cigna Commercial |
$20,996.98
|
| Rate for Payer: Cigna Medicare |
$16,707.86
|
| Rate for Payer: Employer Direct Commercial |
$16,707.86
|
| Rate for Payer: Humana Medicare/TRICARE |
$16,707.86
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$16,707.86
|
| Rate for Payer: Molina Medicare |
$16,707.86
|
| Rate for Payer: Multiplan Auto |
$30,973.80
|
| Rate for Payer: Multiplan Commercial |
$30,973.80
|
| Rate for Payer: Multiplan Workers Comp |
$30,973.80
|
| Rate for Payer: Scott and White EPO/PPO |
$14,264.25
|
| Rate for Payer: Scott and White Medicare |
$16,707.86
|
| Rate for Payer: Superior Health Plan EPO |
$16,707.86
|
| Rate for Payer: Superior Health Plan Medicare |
$16,707.86
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$16,707.86
|
| Rate for Payer: Universal American Medicare |
$16,707.86
|
| Rate for Payer: Wellcare Medicare |
$16,707.86
|
| Rate for Payer: Wellmed Medicare |
$16,707.86
|
|
|
DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITHOUT CC/MCC
|
Facility
|
IP
|
$11,806.60
|
|
|
Service Code
|
MSDRG 440
|
| Min. Negotiated Rate |
$5,343.18 |
| Max. Negotiated Rate |
$11,806.60 |
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$9,314.35
|
| Rate for Payer: Amerigroup Medicare |
$9,314.35
|
| Rate for Payer: BCBS of TX Medicare |
$9,314.35
|
| Rate for Payer: Cigna Commercial |
$8,003.63
|
| Rate for Payer: Cigna Medicare |
$9,314.35
|
| Rate for Payer: Employer Direct Commercial |
$9,314.35
|
| Rate for Payer: Humana Medicare/TRICARE |
$9,314.35
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$9,314.35
|
| Rate for Payer: Molina Medicare |
$9,314.35
|
| Rate for Payer: Multiplan Auto |
$11,806.60
|
| Rate for Payer: Multiplan Commercial |
$11,806.60
|
| Rate for Payer: Multiplan Workers Comp |
$11,806.60
|
| Rate for Payer: Scott and White EPO/PPO |
$5,437.25
|
| Rate for Payer: Scott and White Medicare |
$9,314.35
|
| Rate for Payer: Superior Health Plan EPO |
$9,314.35
|
| Rate for Payer: Superior Health Plan Medicare |
$9,314.35
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$9,314.35
|
| Rate for Payer: Universal American Medicare |
$9,314.35
|
| Rate for Payer: Wellcare Medicare |
$9,314.35
|
| Rate for Payer: Wellmed Medicare |
$9,314.35
|
|
|
DISORDERS OF PANCREAS EXCEPT MALIGNANCY W MCC
|
Facility
|
IP
|
$30,973.80
|
|
|
Service Code
|
MSDRG 438
|
| Min. Negotiated Rate |
$14,088.52 |
| Max. Negotiated Rate |
$30,973.80 |
| Rate for Payer: BCBS of TX Blue Advantage |
$14,088.52
|
| Rate for Payer: BCBS of TX Blue Essentials |
$16,904.59
|
| Rate for Payer: BCBS of TX PPO |
$18,783.60
|
|
|
DISORDERS OF PANCREAS EXCEPT MALIGNANCY W/O CC/MCC
|
Facility
|
IP
|
$11,806.60
|
|
|
Service Code
|
MSDRG 440
|
| Min. Negotiated Rate |
$5,343.18 |
| Max. Negotiated Rate |
$11,806.60 |
| Rate for Payer: BCBS of TX Blue Advantage |
$5,343.18
|
| Rate for Payer: BCBS of TX Blue Essentials |
$6,411.19
|
| Rate for Payer: BCBS of TX PPO |
$7,123.83
|
|
|
DISORDERS OF PERSONALITY AND IMPULSE CONTROL
|
Facility
|
IP
|
$2,071.90
|
|
|
Service Code
|
APR-DRG 7522
|
| Min. Negotiated Rate |
$1,953.46 |
| Max. Negotiated Rate |
$2,071.90 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,953.46
|
| Rate for Payer: Cigna Medicaid |
$1,953.46
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,953.46
|
| Rate for Payer: Parkland Medicaid |
$1,953.46
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$2,071.90
|
|
|
DISORDERS OF PERSONALITY AND IMPULSE CONTROL
|
Facility
|
IP
|
$37,359.70
|
|
|
Service Code
|
MSDRG 883
|
| Min. Negotiated Rate |
$11,351.14 |
| Max. Negotiated Rate |
$37,359.70 |
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$19,171.15
|
| Rate for Payer: Amerigroup Medicare |
$19,171.15
|
| Rate for Payer: BCBS of TX Medicare |
$19,171.15
|
| Rate for Payer: Cigna Commercial |
$25,325.94
|
| Rate for Payer: Cigna Medicare |
$19,171.15
|
| Rate for Payer: Employer Direct Commercial |
$19,171.15
|
| Rate for Payer: Humana Medicare/TRICARE |
$19,171.15
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$19,171.15
|
| Rate for Payer: Molina Medicare |
$19,171.15
|
| Rate for Payer: Multiplan Auto |
$37,359.70
|
| Rate for Payer: Multiplan Commercial |
$37,359.70
|
| Rate for Payer: Multiplan Workers Comp |
$37,359.70
|
| Rate for Payer: Scott and White EPO/PPO |
$17,205.12
|
| Rate for Payer: Scott and White Medicare |
$19,171.15
|
| Rate for Payer: Superior Health Plan EPO |
$19,171.15
|
| Rate for Payer: Superior Health Plan Medicare |
$19,171.15
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$19,171.15
|
| Rate for Payer: Universal American Medicare |
$19,171.15
|
| Rate for Payer: Wellcare Medicare |
$19,171.15
|
| Rate for Payer: Wellmed Medicare |
$19,171.15
|
|
|
DISORDERS OF PERSONALITY AND IMPULSE CONTROL
|
Facility
|
IP
|
$1,735.45
|
|
|
Service Code
|
APR-DRG 7521
|
| Min. Negotiated Rate |
$1,636.24 |
| Max. Negotiated Rate |
$1,735.45 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,636.24
|
| Rate for Payer: Cigna Medicaid |
$1,636.24
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,636.24
|
| Rate for Payer: Parkland Medicaid |
$1,636.24
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,735.45
|
|
|
DISORDERS OF PERSONALITY AND IMPULSE CONTROL
|
Facility
|
IP
|
$13,937.51
|
|
|
Service Code
|
APR-DRG 7524
|
| Min. Negotiated Rate |
$13,140.77 |
| Max. Negotiated Rate |
$13,937.51 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$13,140.77
|
| Rate for Payer: Cigna Medicaid |
$13,140.77
|
| Rate for Payer: Molina CHIP/Medicaid |
$13,140.77
|
| Rate for Payer: Parkland Medicaid |
$13,140.77
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$13,937.51
|
|
|
DISORDERS OF PERSONALITY AND IMPULSE CONTROL
|
Facility
|
IP
|
$5,109.40
|
|
|
Service Code
|
APR-DRG 7523
|
| Min. Negotiated Rate |
$4,817.32 |
| Max. Negotiated Rate |
$5,109.40 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$4,817.32
|
| Rate for Payer: Cigna Medicaid |
$4,817.32
|
| Rate for Payer: Molina CHIP/Medicaid |
$4,817.32
|
| Rate for Payer: Parkland Medicaid |
$4,817.32
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$5,109.40
|
|
|
DISORDERS OF PERSONALITY & IMPULSE CONTROL
|
Facility
|
IP
|
$37,359.70
|
|
|
Service Code
|
MSDRG 883
|
| Min. Negotiated Rate |
$11,351.14 |
| Max. Negotiated Rate |
$37,359.70 |
| Rate for Payer: BCBS of TX Blue Advantage |
$11,351.14
|
| Rate for Payer: BCBS of TX Blue Essentials |
$13,620.05
|
| Rate for Payer: BCBS of TX PPO |
$15,133.97
|
|
|
DISORDERS OF THE BILIARY TRACT W CC
|
Facility
|
IP
|
$20,793.60
|
|
|
Service Code
|
MSDRG 445
|
| Min. Negotiated Rate |
$9,181.36 |
| Max. Negotiated Rate |
$20,793.60 |
| Rate for Payer: BCBS of TX Blue Advantage |
$9,181.36
|
| Rate for Payer: BCBS of TX Blue Essentials |
$11,016.56
|
| Rate for Payer: BCBS of TX PPO |
$12,241.10
|
|
|
DISORDERS OF THE BILIARY TRACT WITH CC
|
Facility
|
IP
|
$20,793.60
|
|
|
Service Code
|
MSDRG 445
|
| Min. Negotiated Rate |
$9,181.36 |
| Max. Negotiated Rate |
$20,793.60 |
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$12,780.96
|
| Rate for Payer: Amerigroup Medicare |
$12,780.96
|
| Rate for Payer: BCBS of TX Medicare |
$12,780.96
|
| Rate for Payer: Cigna Commercial |
$14,095.87
|
| Rate for Payer: Cigna Medicare |
$12,780.96
|
| Rate for Payer: Employer Direct Commercial |
$12,780.96
|
| Rate for Payer: Humana Medicare/TRICARE |
$12,780.96
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$12,780.96
|
| Rate for Payer: Molina Medicare |
$12,780.96
|
| Rate for Payer: Multiplan Auto |
$20,793.60
|
| Rate for Payer: Multiplan Commercial |
$20,793.60
|
| Rate for Payer: Multiplan Workers Comp |
$20,793.60
|
| Rate for Payer: Scott and White EPO/PPO |
$9,576.00
|
| Rate for Payer: Scott and White Medicare |
$12,780.96
|
| Rate for Payer: Superior Health Plan EPO |
$12,780.96
|
| Rate for Payer: Superior Health Plan Medicare |
$12,780.96
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$12,780.96
|
| Rate for Payer: Universal American Medicare |
$12,780.96
|
| Rate for Payer: Wellcare Medicare |
$12,780.96
|
| Rate for Payer: Wellmed Medicare |
$12,780.96
|
|
|
DISORDERS OF THE BILIARY TRACT WITH MCC
|
Facility
|
IP
|
$31,747.10
|
|
|
Service Code
|
MSDRG 444
|
| Min. Negotiated Rate |
$13,853.74 |
| Max. Negotiated Rate |
$31,747.10 |
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$17,006.15
|
| Rate for Payer: Amerigroup Medicare |
$17,006.15
|
| Rate for Payer: BCBS of TX Medicare |
$17,006.15
|
| Rate for Payer: Cigna Commercial |
$21,521.19
|
| Rate for Payer: Cigna Medicare |
$17,006.15
|
| Rate for Payer: Employer Direct Commercial |
$17,006.15
|
| Rate for Payer: Humana Medicare/TRICARE |
$17,006.15
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$17,006.15
|
| Rate for Payer: Molina Medicare |
$17,006.15
|
| Rate for Payer: Multiplan Auto |
$31,747.10
|
| Rate for Payer: Multiplan Commercial |
$31,747.10
|
| Rate for Payer: Multiplan Workers Comp |
$31,747.10
|
| Rate for Payer: Scott and White EPO/PPO |
$14,620.38
|
| Rate for Payer: Scott and White Medicare |
$17,006.15
|
| Rate for Payer: Superior Health Plan EPO |
$17,006.15
|
| Rate for Payer: Superior Health Plan Medicare |
$17,006.15
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$17,006.15
|
| Rate for Payer: Universal American Medicare |
$17,006.15
|
| Rate for Payer: Wellcare Medicare |
$17,006.15
|
| Rate for Payer: Wellmed Medicare |
$17,006.15
|
|
|
DISORDERS OF THE BILIARY TRACT WITHOUT CC/MCC
|
Facility
|
IP
|
$15,718.70
|
|
|
Service Code
|
MSDRG 446
|
| Min. Negotiated Rate |
$6,837.00 |
| Max. Negotiated Rate |
$15,718.70 |
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$10,823.39
|
| Rate for Payer: Amerigroup Medicare |
$10,823.39
|
| Rate for Payer: BCBS of TX Medicare |
$10,823.39
|
| Rate for Payer: Cigna Commercial |
$10,655.62
|
| Rate for Payer: Cigna Medicare |
$10,823.39
|
| Rate for Payer: Employer Direct Commercial |
$10,823.39
|
| Rate for Payer: Humana Medicare/TRICARE |
$10,823.39
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$10,823.39
|
| Rate for Payer: Molina Medicare |
$10,823.39
|
| Rate for Payer: Multiplan Auto |
$15,718.70
|
| Rate for Payer: Multiplan Commercial |
$15,718.70
|
| Rate for Payer: Multiplan Workers Comp |
$15,718.70
|
| Rate for Payer: Scott and White EPO/PPO |
$7,238.88
|
| Rate for Payer: Scott and White Medicare |
$10,823.39
|
| Rate for Payer: Superior Health Plan EPO |
$10,823.39
|
| Rate for Payer: Superior Health Plan Medicare |
$10,823.39
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$10,823.39
|
| Rate for Payer: Universal American Medicare |
$10,823.39
|
| Rate for Payer: Wellcare Medicare |
$10,823.39
|
| Rate for Payer: Wellmed Medicare |
$10,823.39
|
|
|
DISORDERS OF THE BILIARY TRACT W MCC
|
Facility
|
IP
|
$31,747.10
|
|
|
Service Code
|
MSDRG 444
|
| Min. Negotiated Rate |
$13,853.74 |
| Max. Negotiated Rate |
$31,747.10 |
| Rate for Payer: BCBS of TX Blue Advantage |
$13,853.74
|
| Rate for Payer: BCBS of TX Blue Essentials |
$16,622.88
|
| Rate for Payer: BCBS of TX PPO |
$18,470.58
|
|
|
DISORDERS OF THE BILIARY TRACT W/O CC/MCC
|
Facility
|
IP
|
$15,718.70
|
|
|
Service Code
|
MSDRG 446
|
| Min. Negotiated Rate |
$6,837.00 |
| Max. Negotiated Rate |
$15,718.70 |
| Rate for Payer: BCBS of TX Blue Advantage |
$6,837.00
|
| Rate for Payer: BCBS of TX Blue Essentials |
$8,203.60
|
| Rate for Payer: BCBS of TX PPO |
$9,115.47
|
|
|
DISP INSTR KIT FOR SM JNT S-TAK
|
Facility
|
OP
|
$1,098.68
|
|
| Hospital Charge Code |
992608
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$98.88 |
| Max. Negotiated Rate |
$791.05 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$98.88
|
| Rate for Payer: BCBS of TX Blue Advantage |
$329.60
|
| Rate for Payer: BCBS of TX Blue Essentials |
$395.52
|
| Rate for Payer: BCBS of TX PPO |
$439.47
|
| Rate for Payer: Cash Price |
$747.10
|
| Rate for Payer: Cigna Medicaid |
$791.05
|
| Rate for Payer: Molina CHIP/Medicaid |
$791.05
|
| Rate for Payer: Multiplan Auto |
$714.14
|
| Rate for Payer: Multiplan Commercial |
$714.14
|
| Rate for Payer: Multiplan Workers Comp |
$714.14
|
| Rate for Payer: Parkland Medicaid |
$791.05
|
| Rate for Payer: Scott and White EPO/PPO |
$549.34
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$791.05
|
| Rate for Payer: Superior Health Plan EPO |
$149.42
|
|
|
DISP INSTR KIT FOR SM JNT S-TAK
|
Facility
|
IP
|
$1,098.68
|
|
| Hospital Charge Code |
992608
|
|
Hospital Revenue Code
|
272
|
| Rate for Payer: Cash Price |
$747.10
|
|
|
DISP INSTR, KIT FOR TENO SCREW
|
Facility
|
OP
|
$1,475.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
992603
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$132.79 |
| Max. Negotiated Rate |
$1,062.36 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$132.79
|
| Rate for Payer: BCBS of TX Blue Advantage |
$442.65
|
| Rate for Payer: BCBS of TX Blue Essentials |
$531.18
|
| Rate for Payer: BCBS of TX PPO |
$590.20
|
| Rate for Payer: Cash Price |
$1,003.34
|
| Rate for Payer: Cigna Medicaid |
$1,062.36
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,062.36
|
| Rate for Payer: Multiplan Auto |
$737.75
|
| Rate for Payer: Multiplan Commercial |
$737.75
|
| Rate for Payer: Multiplan Workers Comp |
$737.75
|
| Rate for Payer: Parkland Medicaid |
$1,062.36
|
| Rate for Payer: Scott and White EPO/PPO |
$737.75
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,062.36
|
| Rate for Payer: Superior Health Plan EPO |
$200.67
|
|
|
DISP INSTR, KIT FOR TENO SCREW
|
Facility
|
IP
|
$1,475.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
992603
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$368.88 |
| Max. Negotiated Rate |
$737.75 |
| Rate for Payer: Cash Price |
$1,003.34
|
| Rate for Payer: Cigna Commercial |
$368.88
|
| Rate for Payer: Multiplan Auto |
$737.75
|
| Rate for Payer: Multiplan Commercial |
$737.75
|
| Rate for Payer: Multiplan Workers Comp |
$737.75
|
| Rate for Payer: Scott and White EPO/PPO |
$737.75
|
|
|
DISP INSTRS KIT FOR MINI S-TAK
|
Facility
|
OP
|
$1,325.68
|
|
| Hospital Charge Code |
992611
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$119.31 |
| Max. Negotiated Rate |
$954.49 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$119.31
|
| Rate for Payer: BCBS of TX Blue Advantage |
$397.70
|
| Rate for Payer: BCBS of TX Blue Essentials |
$477.24
|
| Rate for Payer: BCBS of TX PPO |
$530.27
|
| Rate for Payer: Cash Price |
$901.46
|
| Rate for Payer: Cigna Medicaid |
$954.49
|
| Rate for Payer: Molina CHIP/Medicaid |
$954.49
|
| Rate for Payer: Multiplan Auto |
$861.69
|
| Rate for Payer: Multiplan Commercial |
$861.69
|
| Rate for Payer: Multiplan Workers Comp |
$861.69
|
| Rate for Payer: Parkland Medicaid |
$954.49
|
| Rate for Payer: Scott and White EPO/PPO |
$662.84
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$954.49
|
| Rate for Payer: Superior Health Plan EPO |
$180.29
|
|
|
DISP INSTRS KIT FOR MINI S-TAK
|
Facility
|
IP
|
$1,325.68
|
|
| Hospital Charge Code |
992611
|
|
Hospital Revenue Code
|
272
|
| Rate for Payer: Cash Price |
$901.46
|
|
|
Disposable Exhalation Port
|
Facility
|
IP
|
$154.36
|
|
| Hospital Charge Code |
993633
|
|
Hospital Revenue Code
|
270
|
| Rate for Payer: Cash Price |
$104.96
|
|
