|
magnesium oxide 400 mg (241.3 mg elemental magnesium) Tab
|
Facility
|
OP
|
$7.65
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
77676264
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.69 |
| Max. Negotiated Rate |
$4.97 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$0.69
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2.30
|
| Rate for Payer: BCBS of TX Blue Essentials |
$2.75
|
| Rate for Payer: BCBS of TX PPO |
$3.06
|
| Rate for Payer: Cash Price |
$5.20
|
| Rate for Payer: Multiplan Auto |
$4.97
|
| Rate for Payer: Multiplan Commercial |
$4.97
|
| Rate for Payer: Multiplan Workers Comp |
$4.97
|
| Rate for Payer: Scott and White EPO/PPO |
$3.82
|
| Rate for Payer: Superior Health Plan EPO |
$1.04
|
|
|
magnesium sulfate 1 gram/D5W 100 mL (PMX)
|
Facility
|
OP
|
$128.17
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
77676782
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$83.31 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$11.54
|
| Rate for Payer: BCBS of TX Blue Advantage |
$0.10
|
| Rate for Payer: BCBS of TX Blue Essentials |
$0.12
|
| Rate for Payer: BCBS of TX PPO |
$0.14
|
| Rate for Payer: Cash Price |
$87.16
|
| Rate for Payer: Cash Price |
$87.16
|
| Rate for Payer: Multiplan Auto |
$83.31
|
| Rate for Payer: Multiplan Commercial |
$83.31
|
| Rate for Payer: Multiplan Workers Comp |
$83.31
|
| Rate for Payer: Scott and White EPO/PPO |
$64.08
|
| Rate for Payer: Superior Health Plan EPO |
$17.43
|
|
|
magnesium sulfate 1 gram/D5W 100 mL (PMX)
|
Facility
|
IP
|
$128.17
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
77676782
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.04 |
| Max. Negotiated Rate |
$64.08 |
| Rate for Payer: Cash Price |
$87.16
|
| Rate for Payer: Cigna Commercial |
$32.04
|
| Rate for Payer: Scott and White EPO/PPO |
$64.08
|
|
|
Magnesium sulfate 2 grams IV Soln 50 mL (PMX)
|
Facility
|
OP
|
$128.17
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
77677593
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$83.31 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$11.54
|
| Rate for Payer: BCBS of TX Blue Advantage |
$0.10
|
| Rate for Payer: BCBS of TX Blue Essentials |
$0.12
|
| Rate for Payer: BCBS of TX PPO |
$0.14
|
| Rate for Payer: Cash Price |
$87.16
|
| Rate for Payer: Cash Price |
$87.16
|
| Rate for Payer: Multiplan Auto |
$83.31
|
| Rate for Payer: Multiplan Commercial |
$83.31
|
| Rate for Payer: Multiplan Workers Comp |
$83.31
|
| Rate for Payer: Scott and White EPO/PPO |
$64.08
|
| Rate for Payer: Superior Health Plan EPO |
$17.43
|
|
|
Magnesium sulfate 2 grams IV Soln 50 mL (PMX)
|
Facility
|
IP
|
$128.17
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
77677593
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.04 |
| Max. Negotiated Rate |
$64.08 |
| Rate for Payer: Cash Price |
$87.16
|
| Rate for Payer: Cigna Commercial |
$32.04
|
| Rate for Payer: Scott and White EPO/PPO |
$64.08
|
|
|
magnesium sulfate 50% Inj Soln 2 mL
|
Facility
|
OP
|
$128.17
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
78740463
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$83.31 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$11.54
|
| Rate for Payer: BCBS of TX Blue Advantage |
$0.10
|
| Rate for Payer: BCBS of TX Blue Essentials |
$0.12
|
| Rate for Payer: BCBS of TX PPO |
$0.14
|
| Rate for Payer: Cash Price |
$87.16
|
| Rate for Payer: Cash Price |
$87.16
|
| Rate for Payer: Multiplan Auto |
$83.31
|
| Rate for Payer: Multiplan Commercial |
$83.31
|
| Rate for Payer: Multiplan Workers Comp |
$83.31
|
| Rate for Payer: Scott and White EPO/PPO |
$64.08
|
| Rate for Payer: Superior Health Plan EPO |
$17.43
|
|
|
magnesium sulfate 50% Inj Soln 2 mL
|
Facility
|
IP
|
$128.17
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
78740463
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.04 |
| Max. Negotiated Rate |
$64.08 |
| Rate for Payer: Cash Price |
$87.16
|
| Rate for Payer: Cigna Commercial |
$32.04
|
| Rate for Payer: Scott and White EPO/PPO |
$64.08
|
|
|
MAJOR BLADDER PROCEDURES WITH CC
|
Facility
|
IP
|
$52,012.50
|
|
|
Service Code
|
MSDRG 654
|
| Min. Negotiated Rate |
$22,389.74 |
| Max. Negotiated Rate |
$52,012.50 |
| Rate for Payer: Aetna Commercial |
$30,796.88
|
| Rate for Payer: Aetna Medicare |
$33,584.61
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$22,389.74
|
| Rate for Payer: Amerigroup Medicare |
$22,389.74
|
| Rate for Payer: BCBS of TX Blue Advantage |
$26,476.82
|
| Rate for Payer: BCBS of TX Blue Essentials |
$29,649.58
|
| Rate for Payer: BCBS of TX Medicare |
$22,389.74
|
| Rate for Payer: BCBS of TX PPO |
$32,945.26
|
| Rate for Payer: Cigna Commercial |
$35,259.00
|
| Rate for Payer: Cigna Medicare |
$22,389.74
|
| Rate for Payer: Employer Direct Commercial |
$22,389.74
|
| Rate for Payer: Humana Medicare/TRICARE |
$22,389.74
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$22,389.74
|
| Rate for Payer: Molina Medicare |
$22,389.74
|
| Rate for Payer: Multiplan Auto |
$52,012.50
|
| Rate for Payer: Multiplan Commercial |
$52,012.50
|
| Rate for Payer: Multiplan Workers Comp |
$52,012.50
|
| Rate for Payer: Scott and White EPO/PPO |
$23,953.12
|
| Rate for Payer: Scott and White Medicare |
$22,389.74
|
| Rate for Payer: Superior Health Plan EPO |
$22,389.74
|
| Rate for Payer: Superior Health Plan Medicare |
$22,389.74
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$22,389.74
|
| Rate for Payer: Universal American Medicare |
$22,389.74
|
| Rate for Payer: Wellcare Medicare |
$22,389.74
|
| Rate for Payer: Wellmed Medicare |
$22,389.74
|
|
|
MAJOR BLADDER PROCEDURES WITH MCC
|
Facility
|
IP
|
$102,858.40
|
|
|
Service Code
|
MSDRG 653
|
| Min. Negotiated Rate |
$41,486.54 |
| Max. Negotiated Rate |
$102,858.40 |
| Rate for Payer: Aetna Commercial |
$60,903.00
|
| Rate for Payer: Aetna Medicare |
$62,229.81
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$41,486.54
|
| Rate for Payer: Amerigroup Medicare |
$41,486.54
|
| Rate for Payer: BCBS of TX Blue Advantage |
$49,450.86
|
| Rate for Payer: BCBS of TX Blue Essentials |
$56,640.99
|
| Rate for Payer: BCBS of TX Medicare |
$41,486.54
|
| Rate for Payer: BCBS of TX PPO |
$62,936.87
|
| Rate for Payer: Cigna Commercial |
$69,727.17
|
| Rate for Payer: Cigna Medicare |
$41,486.54
|
| Rate for Payer: Employer Direct Commercial |
$41,486.54
|
| Rate for Payer: Humana Medicare/TRICARE |
$41,486.54
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$41,486.54
|
| Rate for Payer: Molina Medicare |
$41,486.54
|
| Rate for Payer: Multiplan Auto |
$102,858.40
|
| Rate for Payer: Multiplan Commercial |
$102,858.40
|
| Rate for Payer: Multiplan Workers Comp |
$102,858.40
|
| Rate for Payer: Scott and White EPO/PPO |
$47,369.00
|
| Rate for Payer: Scott and White Medicare |
$41,486.54
|
| Rate for Payer: Superior Health Plan EPO |
$41,486.54
|
| Rate for Payer: Superior Health Plan Medicare |
$41,486.54
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$41,486.54
|
| Rate for Payer: Universal American Medicare |
$41,486.54
|
| Rate for Payer: Wellcare Medicare |
$41,486.54
|
| Rate for Payer: Wellmed Medicare |
$41,486.54
|
|
|
MAJOR BLADDER PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$40,048.20
|
|
|
Service Code
|
MSDRG 655
|
| Min. Negotiated Rate |
$17,896.17 |
| Max. Negotiated Rate |
$40,048.20 |
| Rate for Payer: Aetna Commercial |
$23,712.75
|
| Rate for Payer: Aetna Medicare |
$26,844.26
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$17,896.17
|
| Rate for Payer: Amerigroup Medicare |
$17,896.17
|
| Rate for Payer: BCBS of TX Blue Advantage |
$18,606.10
|
| Rate for Payer: BCBS of TX Blue Essentials |
$21,434.63
|
| Rate for Payer: BCBS of TX Medicare |
$17,896.17
|
| Rate for Payer: BCBS of TX PPO |
$23,817.18
|
| Rate for Payer: Cigna Commercial |
$27,148.46
|
| Rate for Payer: Cigna Medicare |
$17,896.17
|
| Rate for Payer: Employer Direct Commercial |
$17,896.17
|
| Rate for Payer: Humana Medicare/TRICARE |
$17,896.17
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$17,896.17
|
| Rate for Payer: Molina Medicare |
$17,896.17
|
| Rate for Payer: Multiplan Auto |
$40,048.20
|
| Rate for Payer: Multiplan Commercial |
$40,048.20
|
| Rate for Payer: Multiplan Workers Comp |
$40,048.20
|
| Rate for Payer: Scott and White EPO/PPO |
$18,443.25
|
| Rate for Payer: Scott and White Medicare |
$17,896.17
|
| Rate for Payer: Superior Health Plan EPO |
$17,896.17
|
| Rate for Payer: Superior Health Plan Medicare |
$17,896.17
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$17,896.17
|
| Rate for Payer: Universal American Medicare |
$17,896.17
|
| Rate for Payer: Wellcare Medicare |
$17,896.17
|
| Rate for Payer: Wellmed Medicare |
$17,896.17
|
|
|
MAJOR CHEST PROCEDURES WITH CC
|
Facility
|
IP
|
$48,457.60
|
|
|
Service Code
|
MSDRG 164
|
| Min. Negotiated Rate |
$21,054.59 |
| Max. Negotiated Rate |
$48,457.60 |
| Rate for Payer: Aetna Commercial |
$28,692.00
|
| Rate for Payer: Aetna Medicare |
$31,581.88
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$21,054.59
|
| Rate for Payer: Amerigroup Medicare |
$21,054.59
|
| Rate for Payer: BCBS of TX Blue Advantage |
$22,202.62
|
| Rate for Payer: BCBS of TX Blue Essentials |
$26,508.48
|
| Rate for Payer: BCBS of TX Medicare |
$21,054.59
|
| Rate for Payer: BCBS of TX PPO |
$29,455.01
|
| Rate for Payer: Cigna Commercial |
$32,849.15
|
| Rate for Payer: Cigna Medicare |
$21,054.59
|
| Rate for Payer: Employer Direct Commercial |
$21,054.59
|
| Rate for Payer: Humana Medicare/TRICARE |
$21,054.59
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$21,054.59
|
| Rate for Payer: Molina Medicare |
$21,054.59
|
| Rate for Payer: Multiplan Auto |
$48,457.60
|
| Rate for Payer: Multiplan Commercial |
$48,457.60
|
| Rate for Payer: Multiplan Workers Comp |
$48,457.60
|
| Rate for Payer: Scott and White EPO/PPO |
$22,316.00
|
| Rate for Payer: Scott and White Medicare |
$21,054.59
|
| Rate for Payer: Superior Health Plan EPO |
$21,054.59
|
| Rate for Payer: Superior Health Plan Medicare |
$21,054.59
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$21,054.59
|
| Rate for Payer: Universal American Medicare |
$21,054.59
|
| Rate for Payer: Wellcare Medicare |
$21,054.59
|
| Rate for Payer: Wellmed Medicare |
$21,054.59
|
|
|
MAJOR CHEST PROCEDURES WITH MCC
|
Facility
|
IP
|
$89,558.40
|
|
|
Service Code
|
MSDRG 163
|
| Min. Negotiated Rate |
$36,491.30 |
| Max. Negotiated Rate |
$89,558.40 |
| Rate for Payer: Aetna Commercial |
$53,028.00
|
| Rate for Payer: Aetna Medicare |
$54,736.95
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$36,491.30
|
| Rate for Payer: Amerigroup Medicare |
$36,491.30
|
| Rate for Payer: BCBS of TX Blue Advantage |
$43,166.84
|
| Rate for Payer: BCBS of TX Blue Essentials |
$50,762.26
|
| Rate for Payer: BCBS of TX Medicare |
$36,491.30
|
| Rate for Payer: BCBS of TX PPO |
$56,404.69
|
| Rate for Payer: Cigna Commercial |
$60,711.17
|
| Rate for Payer: Cigna Medicare |
$36,491.30
|
| Rate for Payer: Employer Direct Commercial |
$36,491.30
|
| Rate for Payer: Humana Medicare/TRICARE |
$36,491.30
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$36,491.30
|
| Rate for Payer: Molina Medicare |
$36,491.30
|
| Rate for Payer: Multiplan Auto |
$89,558.40
|
| Rate for Payer: Multiplan Commercial |
$89,558.40
|
| Rate for Payer: Multiplan Workers Comp |
$89,558.40
|
| Rate for Payer: Scott and White EPO/PPO |
$41,244.00
|
| Rate for Payer: Scott and White Medicare |
$36,491.30
|
| Rate for Payer: Superior Health Plan EPO |
$36,491.30
|
| Rate for Payer: Superior Health Plan Medicare |
$36,491.30
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$36,491.30
|
| Rate for Payer: Universal American Medicare |
$36,491.30
|
| Rate for Payer: Wellcare Medicare |
$36,491.30
|
| Rate for Payer: Wellmed Medicare |
$36,491.30
|
|
|
MAJOR CHEST PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$35,651.60
|
|
|
Service Code
|
MSDRG 165
|
| Min. Negotiated Rate |
$15,392.28 |
| Max. Negotiated Rate |
$35,651.60 |
| Rate for Payer: Aetna Commercial |
$21,109.50
|
| Rate for Payer: Aetna Medicare |
$24,367.32
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$16,244.88
|
| Rate for Payer: Amerigroup Medicare |
$16,244.88
|
| Rate for Payer: BCBS of TX Blue Advantage |
$15,392.28
|
| Rate for Payer: BCBS of TX Blue Essentials |
$19,114.92
|
| Rate for Payer: BCBS of TX Medicare |
$16,244.88
|
| Rate for Payer: BCBS of TX PPO |
$21,239.62
|
| Rate for Payer: Cigna Commercial |
$24,168.03
|
| Rate for Payer: Cigna Medicare |
$16,244.88
|
| Rate for Payer: Employer Direct Commercial |
$16,244.88
|
| Rate for Payer: Humana Medicare/TRICARE |
$16,244.88
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$16,244.88
|
| Rate for Payer: Molina Medicare |
$16,244.88
|
| Rate for Payer: Multiplan Auto |
$35,651.60
|
| Rate for Payer: Multiplan Commercial |
$35,651.60
|
| Rate for Payer: Multiplan Workers Comp |
$35,651.60
|
| Rate for Payer: Scott and White EPO/PPO |
$16,418.50
|
| Rate for Payer: Scott and White Medicare |
$16,244.88
|
| Rate for Payer: Superior Health Plan EPO |
$16,244.88
|
| Rate for Payer: Superior Health Plan Medicare |
$16,244.88
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$16,244.88
|
| Rate for Payer: Universal American Medicare |
$16,244.88
|
| Rate for Payer: Wellcare Medicare |
$16,244.88
|
| Rate for Payer: Wellmed Medicare |
$16,244.88
|
|
|
MAJOR CHEST TRAUMA WITH CC
|
Facility
|
IP
|
$19,986.10
|
|
|
Service Code
|
MSDRG 184
|
| Min. Negotiated Rate |
$8,480.46 |
| Max. Negotiated Rate |
$19,986.10 |
| Rate for Payer: Aetna Commercial |
$11,833.88
|
| Rate for Payer: Aetna Medicare |
$15,541.82
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$10,361.21
|
| Rate for Payer: Amerigroup Medicare |
$10,361.21
|
| Rate for Payer: BCBS of TX Blue Advantage |
$8,480.46
|
| Rate for Payer: BCBS of TX Blue Essentials |
$10,364.40
|
| Rate for Payer: BCBS of TX Medicare |
$10,361.21
|
| Rate for Payer: BCBS of TX PPO |
$11,516.45
|
| Rate for Payer: Cigna Commercial |
$13,548.47
|
| Rate for Payer: Cigna Medicare |
$10,361.21
|
| Rate for Payer: Employer Direct Commercial |
$10,361.21
|
| Rate for Payer: Humana Medicare/TRICARE |
$10,361.21
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$10,361.21
|
| Rate for Payer: Molina Medicare |
$10,361.21
|
| Rate for Payer: Multiplan Auto |
$19,986.10
|
| Rate for Payer: Multiplan Commercial |
$19,986.10
|
| Rate for Payer: Multiplan Workers Comp |
$19,986.10
|
| Rate for Payer: Scott and White EPO/PPO |
$9,204.12
|
| Rate for Payer: Scott and White Medicare |
$10,361.21
|
| Rate for Payer: Superior Health Plan EPO |
$10,361.21
|
| Rate for Payer: Superior Health Plan Medicare |
$10,361.21
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$10,361.21
|
| Rate for Payer: Universal American Medicare |
$10,361.21
|
| Rate for Payer: Wellcare Medicare |
$10,361.21
|
| Rate for Payer: Wellmed Medicare |
$10,361.21
|
|
|
MAJOR CHEST TRAUMA WITH MCC
|
Facility
|
IP
|
$29,915.50
|
|
|
Service Code
|
MSDRG 183
|
| Min. Negotiated Rate |
$12,825.18 |
| Max. Negotiated Rate |
$29,915.50 |
| Rate for Payer: Aetna Commercial |
$17,713.12
|
| Rate for Payer: Aetna Medicare |
$21,135.75
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$14,090.50
|
| Rate for Payer: Amerigroup Medicare |
$14,090.50
|
| Rate for Payer: BCBS of TX Blue Advantage |
$12,825.18
|
| Rate for Payer: BCBS of TX Blue Essentials |
$15,384.60
|
| Rate for Payer: BCBS of TX Medicare |
$14,090.50
|
| Rate for Payer: BCBS of TX PPO |
$17,094.66
|
| Rate for Payer: Cigna Commercial |
$20,279.56
|
| Rate for Payer: Cigna Medicare |
$14,090.50
|
| Rate for Payer: Employer Direct Commercial |
$14,090.50
|
| Rate for Payer: Humana Medicare/TRICARE |
$14,090.50
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$14,090.50
|
| Rate for Payer: Molina Medicare |
$14,090.50
|
| Rate for Payer: Multiplan Auto |
$29,915.50
|
| Rate for Payer: Multiplan Commercial |
$29,915.50
|
| Rate for Payer: Multiplan Workers Comp |
$29,915.50
|
| Rate for Payer: Scott and White EPO/PPO |
$13,776.88
|
| Rate for Payer: Scott and White Medicare |
$14,090.50
|
| Rate for Payer: Superior Health Plan EPO |
$14,090.50
|
| Rate for Payer: Superior Health Plan Medicare |
$14,090.50
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$14,090.50
|
| Rate for Payer: Universal American Medicare |
$14,090.50
|
| Rate for Payer: Wellcare Medicare |
$14,090.50
|
| Rate for Payer: Wellmed Medicare |
$14,090.50
|
|
|
MAJOR CHEST TRAUMA WITHOUT CC/MCC
|
Facility
|
IP
|
$14,358.30
|
|
|
Service Code
|
MSDRG 185
|
| Min. Negotiated Rate |
$6,241.02 |
| Max. Negotiated Rate |
$14,358.30 |
| Rate for Payer: Aetna Commercial |
$8,501.62
|
| Rate for Payer: Aetna Medicare |
$12,371.22
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$8,247.48
|
| Rate for Payer: Amerigroup Medicare |
$8,247.48
|
| Rate for Payer: BCBS of TX Blue Advantage |
$6,241.02
|
| Rate for Payer: BCBS of TX Blue Essentials |
$7,556.60
|
| Rate for Payer: BCBS of TX Medicare |
$8,247.48
|
| Rate for Payer: BCBS of TX PPO |
$8,396.55
|
| Rate for Payer: Cigna Commercial |
$9,733.42
|
| Rate for Payer: Cigna Medicare |
$8,247.48
|
| Rate for Payer: Employer Direct Commercial |
$8,247.48
|
| Rate for Payer: Humana Medicare/TRICARE |
$8,247.48
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$8,247.48
|
| Rate for Payer: Molina Medicare |
$8,247.48
|
| Rate for Payer: Multiplan Auto |
$14,358.30
|
| Rate for Payer: Multiplan Commercial |
$14,358.30
|
| Rate for Payer: Multiplan Workers Comp |
$14,358.30
|
| Rate for Payer: Scott and White EPO/PPO |
$6,612.38
|
| Rate for Payer: Scott and White Medicare |
$8,247.48
|
| Rate for Payer: Superior Health Plan EPO |
$8,247.48
|
| Rate for Payer: Superior Health Plan Medicare |
$8,247.48
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$8,247.48
|
| Rate for Payer: Universal American Medicare |
$8,247.48
|
| Rate for Payer: Wellcare Medicare |
$8,247.48
|
| Rate for Payer: Wellmed Medicare |
$8,247.48
|
|
|
MAJOR ESOPHAGEAL DISORDERS WITH CC
|
Facility
|
IP
|
$18,777.70
|
|
|
Service Code
|
MSDRG 369
|
| Min. Negotiated Rate |
$8,647.62 |
| Max. Negotiated Rate |
$18,777.70 |
| Rate for Payer: Aetna Commercial |
$11,118.38
|
| Rate for Payer: Aetna Medicare |
$14,861.02
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$9,907.35
|
| Rate for Payer: Amerigroup Medicare |
$9,907.35
|
| Rate for Payer: BCBS of TX Blue Advantage |
$9,091.92
|
| Rate for Payer: BCBS of TX Blue Essentials |
$11,441.71
|
| Rate for Payer: BCBS of TX Medicare |
$9,907.35
|
| Rate for Payer: BCBS of TX PPO |
$12,713.50
|
| Rate for Payer: Cigna Commercial |
$12,729.30
|
| Rate for Payer: Cigna Medicare |
$9,907.35
|
| Rate for Payer: Employer Direct Commercial |
$9,907.35
|
| Rate for Payer: Humana Medicare/TRICARE |
$9,907.35
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$9,907.35
|
| Rate for Payer: Molina Medicare |
$9,907.35
|
| Rate for Payer: Multiplan Auto |
$18,777.70
|
| Rate for Payer: Multiplan Commercial |
$18,777.70
|
| Rate for Payer: Multiplan Workers Comp |
$18,777.70
|
| Rate for Payer: Scott and White EPO/PPO |
$8,647.62
|
| Rate for Payer: Scott and White Medicare |
$9,907.35
|
| Rate for Payer: Superior Health Plan EPO |
$9,907.35
|
| Rate for Payer: Superior Health Plan Medicare |
$9,907.35
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$9,907.35
|
| Rate for Payer: Universal American Medicare |
$9,907.35
|
| Rate for Payer: Wellcare Medicare |
$9,907.35
|
| Rate for Payer: Wellmed Medicare |
$9,907.35
|
|
|
MAJOR ESOPHAGEAL DISORDERS WITH MCC
|
Facility
|
IP
|
$31,388.00
|
|
|
Service Code
|
MSDRG 368
|
| Min. Negotiated Rate |
$14,455.00 |
| Max. Negotiated Rate |
$31,388.00 |
| Rate for Payer: Aetna Commercial |
$18,585.00
|
| Rate for Payer: Aetna Medicare |
$21,965.32
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$14,643.55
|
| Rate for Payer: Amerigroup Medicare |
$14,643.55
|
| Rate for Payer: BCBS of TX Blue Advantage |
$16,128.44
|
| Rate for Payer: BCBS of TX Blue Essentials |
$20,060.14
|
| Rate for Payer: BCBS of TX Medicare |
$14,643.55
|
| Rate for Payer: BCBS of TX PPO |
$22,289.90
|
| Rate for Payer: Cigna Commercial |
$21,277.76
|
| Rate for Payer: Cigna Medicare |
$14,643.55
|
| Rate for Payer: Employer Direct Commercial |
$14,643.55
|
| Rate for Payer: Humana Medicare/TRICARE |
$14,643.55
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$14,643.55
|
| Rate for Payer: Molina Medicare |
$14,643.55
|
| Rate for Payer: Multiplan Auto |
$31,388.00
|
| Rate for Payer: Multiplan Commercial |
$31,388.00
|
| Rate for Payer: Multiplan Workers Comp |
$31,388.00
|
| Rate for Payer: Scott and White EPO/PPO |
$14,455.00
|
| Rate for Payer: Scott and White Medicare |
$14,643.55
|
| Rate for Payer: Superior Health Plan EPO |
$14,643.55
|
| Rate for Payer: Superior Health Plan Medicare |
$14,643.55
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$14,643.55
|
| Rate for Payer: Universal American Medicare |
$14,643.55
|
| Rate for Payer: Wellcare Medicare |
$14,643.55
|
| Rate for Payer: Wellmed Medicare |
$14,643.55
|
|
|
MAJOR ESOPHAGEAL DISORDERS WITHOUT CC/MCC
|
Facility
|
IP
|
$14,130.30
|
|
|
Service Code
|
MSDRG 370
|
| Min. Negotiated Rate |
$6,450.00 |
| Max. Negotiated Rate |
$14,130.30 |
| Rate for Payer: Aetna Commercial |
$8,366.62
|
| Rate for Payer: Aetna Medicare |
$12,242.78
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$8,161.85
|
| Rate for Payer: Amerigroup Medicare |
$8,161.85
|
| Rate for Payer: BCBS of TX Blue Advantage |
$6,450.00
|
| Rate for Payer: BCBS of TX Blue Essentials |
$7,670.11
|
| Rate for Payer: BCBS of TX Medicare |
$8,161.85
|
| Rate for Payer: BCBS of TX PPO |
$8,522.68
|
| Rate for Payer: Cigna Commercial |
$9,578.86
|
| Rate for Payer: Cigna Medicare |
$8,161.85
|
| Rate for Payer: Employer Direct Commercial |
$8,161.85
|
| Rate for Payer: Humana Medicare/TRICARE |
$8,161.85
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$8,161.85
|
| Rate for Payer: Molina Medicare |
$8,161.85
|
| Rate for Payer: Multiplan Auto |
$14,130.30
|
| Rate for Payer: Multiplan Commercial |
$14,130.30
|
| Rate for Payer: Multiplan Workers Comp |
$14,130.30
|
| Rate for Payer: Scott and White EPO/PPO |
$6,507.38
|
| Rate for Payer: Scott and White Medicare |
$8,161.85
|
| Rate for Payer: Superior Health Plan EPO |
$8,161.85
|
| Rate for Payer: Superior Health Plan Medicare |
$8,161.85
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$8,161.85
|
| Rate for Payer: Universal American Medicare |
$8,161.85
|
| Rate for Payer: Wellcare Medicare |
$8,161.85
|
| Rate for Payer: Wellmed Medicare |
$8,161.85
|
|
|
MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH CC
|
Facility
|
IP
|
$19,803.70
|
|
|
Service Code
|
MSDRG 372
|
| Min. Negotiated Rate |
$9,120.12 |
| Max. Negotiated Rate |
$19,803.70 |
| Rate for Payer: Aetna Commercial |
$11,725.88
|
| Rate for Payer: Aetna Medicare |
$15,439.06
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$10,292.71
|
| Rate for Payer: Amerigroup Medicare |
$10,292.71
|
| Rate for Payer: BCBS of TX Blue Advantage |
$9,337.88
|
| Rate for Payer: BCBS of TX Blue Essentials |
$10,715.25
|
| Rate for Payer: BCBS of TX Medicare |
$10,292.71
|
| Rate for Payer: BCBS of TX PPO |
$11,906.29
|
| Rate for Payer: Cigna Commercial |
$13,424.82
|
| Rate for Payer: Cigna Medicare |
$10,292.71
|
| Rate for Payer: Employer Direct Commercial |
$10,292.71
|
| Rate for Payer: Humana Medicare/TRICARE |
$10,292.71
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$10,292.71
|
| Rate for Payer: Molina Medicare |
$10,292.71
|
| Rate for Payer: Multiplan Auto |
$19,803.70
|
| Rate for Payer: Multiplan Commercial |
$19,803.70
|
| Rate for Payer: Multiplan Workers Comp |
$19,803.70
|
| Rate for Payer: Scott and White EPO/PPO |
$9,120.12
|
| Rate for Payer: Scott and White Medicare |
$10,292.71
|
| Rate for Payer: Superior Health Plan EPO |
$10,292.71
|
| Rate for Payer: Superior Health Plan Medicare |
$10,292.71
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$10,292.71
|
| Rate for Payer: Universal American Medicare |
$10,292.71
|
| Rate for Payer: Wellcare Medicare |
$10,292.71
|
| Rate for Payer: Wellmed Medicare |
$10,292.71
|
|
|
MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH MCC
|
Facility
|
IP
|
$33,206.30
|
|
|
Service Code
|
MSDRG 371
|
| Min. Negotiated Rate |
$15,041.40 |
| Max. Negotiated Rate |
$33,206.30 |
| Rate for Payer: Aetna Commercial |
$19,661.62
|
| Rate for Payer: Aetna Medicare |
$22,989.70
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$15,326.47
|
| Rate for Payer: Amerigroup Medicare |
$15,326.47
|
| Rate for Payer: BCBS of TX Blue Advantage |
$15,041.40
|
| Rate for Payer: BCBS of TX Blue Essentials |
$17,942.68
|
| Rate for Payer: BCBS of TX Medicare |
$15,326.47
|
| Rate for Payer: BCBS of TX PPO |
$19,937.08
|
| Rate for Payer: Cigna Commercial |
$22,510.38
|
| Rate for Payer: Cigna Medicare |
$15,326.47
|
| Rate for Payer: Employer Direct Commercial |
$15,326.47
|
| Rate for Payer: Humana Medicare/TRICARE |
$15,326.47
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$15,326.47
|
| Rate for Payer: Molina Medicare |
$15,326.47
|
| Rate for Payer: Multiplan Auto |
$33,206.30
|
| Rate for Payer: Multiplan Commercial |
$33,206.30
|
| Rate for Payer: Multiplan Workers Comp |
$33,206.30
|
| Rate for Payer: Scott and White EPO/PPO |
$15,292.38
|
| Rate for Payer: Scott and White Medicare |
$15,326.47
|
| Rate for Payer: Superior Health Plan EPO |
$15,326.47
|
| Rate for Payer: Superior Health Plan Medicare |
$15,326.47
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$15,326.47
|
| Rate for Payer: Universal American Medicare |
$15,326.47
|
| Rate for Payer: Wellcare Medicare |
$15,326.47
|
| Rate for Payer: Wellmed Medicare |
$15,326.47
|
|
|
MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITHOUT CC/MCC
|
Facility
|
IP
|
$13,613.50
|
|
|
Service Code
|
MSDRG 373
|
| Min. Negotiated Rate |
$6,269.38 |
| Max. Negotiated Rate |
$13,613.50 |
| Rate for Payer: Aetna Commercial |
$8,060.62
|
| Rate for Payer: Aetna Medicare |
$11,951.66
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$7,967.77
|
| Rate for Payer: Amerigroup Medicare |
$7,967.77
|
| Rate for Payer: BCBS of TX Blue Advantage |
$6,615.98
|
| Rate for Payer: BCBS of TX Blue Essentials |
$7,817.67
|
| Rate for Payer: BCBS of TX Medicare |
$7,967.77
|
| Rate for Payer: BCBS of TX PPO |
$8,686.64
|
| Rate for Payer: Cigna Commercial |
$9,228.52
|
| Rate for Payer: Cigna Medicare |
$7,967.77
|
| Rate for Payer: Employer Direct Commercial |
$7,967.77
|
| Rate for Payer: Humana Medicare/TRICARE |
$7,967.77
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$7,967.77
|
| Rate for Payer: Molina Medicare |
$7,967.77
|
| Rate for Payer: Multiplan Auto |
$13,613.50
|
| Rate for Payer: Multiplan Commercial |
$13,613.50
|
| Rate for Payer: Multiplan Workers Comp |
$13,613.50
|
| Rate for Payer: Scott and White EPO/PPO |
$6,269.38
|
| Rate for Payer: Scott and White Medicare |
$7,967.77
|
| Rate for Payer: Superior Health Plan EPO |
$7,967.77
|
| Rate for Payer: Superior Health Plan Medicare |
$7,967.77
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$7,967.77
|
| Rate for Payer: Universal American Medicare |
$7,967.77
|
| Rate for Payer: Wellcare Medicare |
$7,967.77
|
| Rate for Payer: Wellmed Medicare |
$7,967.77
|
|
|
MAJOR HEAD AND NECK PROCEDURES WITH CC
|
Facility
|
IP
|
$39,362.30
|
|
|
Service Code
|
MSDRG 141
|
| Min. Negotiated Rate |
$17,638.55 |
| Max. Negotiated Rate |
$39,362.30 |
| Rate for Payer: Aetna Commercial |
$23,306.62
|
| Rate for Payer: Aetna Medicare |
$26,457.82
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$17,638.55
|
| Rate for Payer: Amerigroup Medicare |
$17,638.55
|
| Rate for Payer: BCBS of TX Medicare |
$17,638.55
|
| Rate for Payer: Cigna Commercial |
$26,683.50
|
| Rate for Payer: Cigna Medicare |
$17,638.55
|
| Rate for Payer: Employer Direct Commercial |
$17,638.55
|
| Rate for Payer: Humana Medicare/TRICARE |
$17,638.55
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$17,638.55
|
| Rate for Payer: Molina Medicare |
$17,638.55
|
| Rate for Payer: Multiplan Auto |
$39,362.30
|
| Rate for Payer: Multiplan Commercial |
$39,362.30
|
| Rate for Payer: Multiplan Workers Comp |
$39,362.30
|
| Rate for Payer: Scott and White EPO/PPO |
$18,127.38
|
| Rate for Payer: Scott and White Medicare |
$17,638.55
|
| Rate for Payer: Superior Health Plan EPO |
$17,638.55
|
| Rate for Payer: Superior Health Plan Medicare |
$17,638.55
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$17,638.55
|
| Rate for Payer: Universal American Medicare |
$17,638.55
|
| Rate for Payer: Wellcare Medicare |
$17,638.55
|
| Rate for Payer: Wellmed Medicare |
$17,638.55
|
|
|
MAJOR HEAD AND NECK PROCEDURES WITH MCC
|
Facility
|
IP
|
$71,783.90
|
|
|
Service Code
|
MSDRG 140
|
| Min. Negotiated Rate |
$29,815.53 |
| Max. Negotiated Rate |
$71,783.90 |
| Rate for Payer: Aetna Commercial |
$42,503.62
|
| Rate for Payer: Aetna Medicare |
$44,723.30
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$29,815.53
|
| Rate for Payer: Amerigroup Medicare |
$29,815.53
|
| Rate for Payer: BCBS of TX Medicare |
$29,815.53
|
| Rate for Payer: Cigna Commercial |
$48,661.93
|
| Rate for Payer: Cigna Medicare |
$29,815.53
|
| Rate for Payer: Employer Direct Commercial |
$29,815.53
|
| Rate for Payer: Humana Medicare/TRICARE |
$29,815.53
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$29,815.53
|
| Rate for Payer: Molina Medicare |
$29,815.53
|
| Rate for Payer: Multiplan Auto |
$71,783.90
|
| Rate for Payer: Multiplan Commercial |
$71,783.90
|
| Rate for Payer: Multiplan Workers Comp |
$71,783.90
|
| Rate for Payer: Scott and White EPO/PPO |
$33,058.38
|
| Rate for Payer: Scott and White Medicare |
$29,815.53
|
| Rate for Payer: Superior Health Plan EPO |
$29,815.53
|
| Rate for Payer: Superior Health Plan Medicare |
$29,815.53
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$29,815.53
|
| Rate for Payer: Universal American Medicare |
$29,815.53
|
| Rate for Payer: Wellcare Medicare |
$29,815.53
|
| Rate for Payer: Wellmed Medicare |
$29,815.53
|
|
|
MAJOR HEAD AND NECK PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$29,355.00
|
|
|
Service Code
|
MSDRG 142
|
| Min. Negotiated Rate |
$13,518.75 |
| Max. Negotiated Rate |
$29,355.00 |
| Rate for Payer: Aetna Commercial |
$17,381.25
|
| Rate for Payer: Aetna Medicare |
$20,819.98
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$13,879.99
|
| Rate for Payer: Amerigroup Medicare |
$13,879.99
|
| Rate for Payer: BCBS of TX Medicare |
$13,879.99
|
| Rate for Payer: Cigna Commercial |
$19,899.60
|
| Rate for Payer: Cigna Medicare |
$13,879.99
|
| Rate for Payer: Employer Direct Commercial |
$13,879.99
|
| Rate for Payer: Humana Medicare/TRICARE |
$13,879.99
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$13,879.99
|
| Rate for Payer: Molina Medicare |
$13,879.99
|
| Rate for Payer: Multiplan Auto |
$29,355.00
|
| Rate for Payer: Multiplan Commercial |
$29,355.00
|
| Rate for Payer: Multiplan Workers Comp |
$29,355.00
|
| Rate for Payer: Scott and White EPO/PPO |
$13,518.75
|
| Rate for Payer: Scott and White Medicare |
$13,879.99
|
| Rate for Payer: Superior Health Plan EPO |
$13,879.99
|
| Rate for Payer: Superior Health Plan Medicare |
$13,879.99
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$13,879.99
|
| Rate for Payer: Universal American Medicare |
$13,879.99
|
| Rate for Payer: Wellcare Medicare |
$13,879.99
|
| Rate for Payer: Wellmed Medicare |
$13,879.99
|
|
