|
Neonate DAT
|
Facility
|
IP
|
$142.00
|
|
|
Service Code
|
CPT 86880
|
| Hospital Charge Code |
2403103
|
|
Hospital Revenue Code
|
302
|
| Rate for Payer: Cash Price |
$124.96
|
|
|
Neonate DAT
|
Facility
|
OP
|
$142.00
|
|
|
Service Code
|
CPT 86880
|
| Hospital Charge Code |
2403103
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$126.71 |
| Rate for Payer: Aetna Commercial |
$5.65
|
| Rate for Payer: Aetna Medicare |
$83.91
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2.10
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$55.94
|
| Rate for Payer: Amerigroup Medicare |
$55.94
|
| Rate for Payer: BCBS of TX Blue Advantage |
$55.16
|
| Rate for Payer: BCBS of TX Blue Essentials |
$66.19
|
| Rate for Payer: BCBS of TX Medicare |
$55.94
|
| Rate for Payer: BCBS of TX PPO |
$73.88
|
| Rate for Payer: Cash Price |
$124.96
|
| Rate for Payer: Cash Price |
$124.96
|
| Rate for Payer: Cash Price |
$124.96
|
| Rate for Payer: Cigna Commercial |
$126.71
|
| Rate for Payer: Cigna Medicaid |
$5.39
|
| Rate for Payer: Cigna Medicare |
$55.94
|
| Rate for Payer: Employer Direct Commercial |
$55.94
|
| Rate for Payer: Humana Medicare/TRICARE |
$55.94
|
| Rate for Payer: Molina CHIP/Medicaid |
$5.39
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$55.94
|
| Rate for Payer: Molina Medicare |
$55.94
|
| Rate for Payer: Multiplan Auto |
$92.30
|
| Rate for Payer: Multiplan Commercial |
$92.30
|
| Rate for Payer: Multiplan Workers Comp |
$92.30
|
| Rate for Payer: Parkland Medicaid |
$5.39
|
| Rate for Payer: Scott and White EPO/PPO |
$6.74
|
| Rate for Payer: Scott and White Medicare |
$55.94
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$5.39
|
| Rate for Payer: Superior Health Plan EPO |
$55.94
|
| Rate for Payer: Superior Health Plan Medicare |
$55.94
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$55.94
|
| Rate for Payer: Universal American Medicare |
$55.94
|
| Rate for Payer: Wellcare Medicare |
$55.94
|
| Rate for Payer: Wellmed Medicare |
$55.94
|
|
|
NEONATES, DIED OR TRANSFERRED TO ANOTHER ACUTE CARE FACILITY
|
Facility
|
IP
|
$34,568.60
|
|
|
Service Code
|
MSDRG 789
|
| Min. Negotiated Rate |
$13,741.94 |
| Max. Negotiated Rate |
$34,568.60 |
| Rate for Payer: Aetna Commercial |
$20,468.25
|
| Rate for Payer: Aetna Medicare |
$23,757.21
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$15,838.14
|
| Rate for Payer: Amerigroup Medicare |
$15,838.14
|
| Rate for Payer: BCBS of TX Blue Advantage |
$13,741.94
|
| Rate for Payer: BCBS of TX Blue Essentials |
$17,167.72
|
| Rate for Payer: BCBS of TX Medicare |
$15,838.14
|
| Rate for Payer: BCBS of TX PPO |
$19,075.98
|
| Rate for Payer: Cigna Commercial |
$23,433.87
|
| Rate for Payer: Cigna Medicare |
$15,838.14
|
| Rate for Payer: Employer Direct Commercial |
$15,838.14
|
| Rate for Payer: Humana Medicare/TRICARE |
$15,838.14
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$15,838.14
|
| Rate for Payer: Molina Medicare |
$15,838.14
|
| Rate for Payer: Multiplan Auto |
$34,568.60
|
| Rate for Payer: Multiplan Commercial |
$34,568.60
|
| Rate for Payer: Multiplan Workers Comp |
$34,568.60
|
| Rate for Payer: Scott and White EPO/PPO |
$15,919.75
|
| Rate for Payer: Scott and White Medicare |
$15,838.14
|
| Rate for Payer: Superior Health Plan EPO |
$15,838.14
|
| Rate for Payer: Superior Health Plan Medicare |
$15,838.14
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$15,838.14
|
| Rate for Payer: Universal American Medicare |
$15,838.14
|
| Rate for Payer: Wellcare Medicare |
$15,838.14
|
| Rate for Payer: Wellmed Medicare |
$15,838.14
|
|
|
NEONATE WITH OTHER SIGNIFICANT PROBLEMS
|
Facility
|
IP
|
$28,308.10
|
|
|
Service Code
|
MSDRG 794
|
| Min. Negotiated Rate |
$11,252.24 |
| Max. Negotiated Rate |
$28,308.10 |
| Rate for Payer: Aetna Commercial |
$16,761.38
|
| Rate for Payer: Aetna Medicare |
$20,230.22
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$13,486.81
|
| Rate for Payer: Amerigroup Medicare |
$13,486.81
|
| Rate for Payer: BCBS of TX Blue Advantage |
$11,252.24
|
| Rate for Payer: BCBS of TX Blue Essentials |
$14,057.57
|
| Rate for Payer: BCBS of TX Medicare |
$13,486.81
|
| Rate for Payer: BCBS of TX PPO |
$15,620.13
|
| Rate for Payer: Cigna Commercial |
$19,189.91
|
| Rate for Payer: Cigna Medicare |
$13,486.81
|
| Rate for Payer: Employer Direct Commercial |
$13,486.81
|
| Rate for Payer: Humana Medicare/TRICARE |
$13,486.81
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$13,486.81
|
| Rate for Payer: Molina Medicare |
$13,486.81
|
| Rate for Payer: Multiplan Auto |
$28,308.10
|
| Rate for Payer: Multiplan Commercial |
$28,308.10
|
| Rate for Payer: Multiplan Workers Comp |
$28,308.10
|
| Rate for Payer: Scott and White EPO/PPO |
$13,036.62
|
| Rate for Payer: Scott and White Medicare |
$13,486.81
|
| Rate for Payer: Superior Health Plan EPO |
$13,486.81
|
| Rate for Payer: Superior Health Plan Medicare |
$13,486.81
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$13,486.81
|
| Rate for Payer: Universal American Medicare |
$13,486.81
|
| Rate for Payer: Wellcare Medicare |
$13,486.81
|
| Rate for Payer: Wellmed Medicare |
$13,486.81
|
|
|
neostigmine 1 mg/mL IV Soln 10 mL (Bloxiverz)
|
Facility
|
IP
|
$128.00
|
|
|
Service Code
|
HCPCS J2710
|
| Hospital Charge Code |
77723323
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.00 |
| Max. Negotiated Rate |
$64.00 |
| Rate for Payer: Cash Price |
$87.04
|
| Rate for Payer: Cigna Commercial |
$32.00
|
| Rate for Payer: Scott and White EPO/PPO |
$64.00
|
|
|
neostigmine 1 mg/mL IV Soln 10 mL (Bloxiverz)
|
Facility
|
OP
|
$128.00
|
|
|
Service Code
|
HCPCS J2710
|
| Hospital Charge Code |
77723323
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.30 |
| Max. Negotiated Rate |
$83.20 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$11.52
|
| Rate for Payer: BCBS of TX Blue Advantage |
$1.30
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1.57
|
| Rate for Payer: BCBS of TX PPO |
$1.74
|
| Rate for Payer: Cash Price |
$87.04
|
| Rate for Payer: Cash Price |
$87.04
|
| Rate for Payer: Multiplan Auto |
$83.20
|
| Rate for Payer: Multiplan Commercial |
$83.20
|
| Rate for Payer: Multiplan Workers Comp |
$83.20
|
| Rate for Payer: Scott and White EPO/PPO |
$64.00
|
| Rate for Payer: Superior Health Plan EPO |
$17.41
|
|
|
NEPHELOMETRY EA ANALYTE NES
|
Facility
|
IP
|
$185.00
|
|
|
Service Code
|
CPT 83883
|
| Hospital Charge Code |
1706530
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$162.80
|
|
|
NEPHELOMETRY EA ANALYTE NES
|
Facility
|
OP
|
$185.00
|
|
|
Service Code
|
CPT 83883
|
| Hospital Charge Code |
1706530
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.30 |
| Max. Negotiated Rate |
$120.25 |
| Rate for Payer: Aetna Commercial |
$14.28
|
| Rate for Payer: Aetna Medicare |
$20.40
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$5.30
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$13.60
|
| Rate for Payer: Amerigroup Medicare |
$13.60
|
| Rate for Payer: BCBS of TX Blue Advantage |
$22.44
|
| Rate for Payer: BCBS of TX Blue Essentials |
$26.93
|
| Rate for Payer: BCBS of TX Medicare |
$13.60
|
| Rate for Payer: BCBS of TX PPO |
$30.06
|
| Rate for Payer: Cash Price |
$162.80
|
| Rate for Payer: Cash Price |
$162.80
|
| Rate for Payer: Cigna Medicaid |
$13.60
|
| Rate for Payer: Cigna Medicare |
$13.60
|
| Rate for Payer: Employer Direct Commercial |
$13.60
|
| Rate for Payer: Humana Medicare/TRICARE |
$13.60
|
| Rate for Payer: Molina CHIP/Medicaid |
$13.60
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$13.60
|
| Rate for Payer: Molina Medicare |
$13.60
|
| Rate for Payer: Multiplan Auto |
$120.25
|
| Rate for Payer: Multiplan Commercial |
$120.25
|
| Rate for Payer: Multiplan Workers Comp |
$120.25
|
| Rate for Payer: Parkland Medicaid |
$13.60
|
| Rate for Payer: Scott and White EPO/PPO |
$17.00
|
| Rate for Payer: Scott and White Medicare |
$13.60
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$13.60
|
| Rate for Payer: Superior Health Plan EPO |
$13.60
|
| Rate for Payer: Superior Health Plan Medicare |
$13.60
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$13.60
|
| Rate for Payer: Universal American Medicare |
$13.60
|
| Rate for Payer: Wellcare Medicare |
$13.60
|
| Rate for Payer: Wellmed Medicare |
$13.60
|
|
|
Nerve repair; with synthetic conduit or vein allograft (eg, nerve tube), each nerve
|
Facility
|
OP
|
$13,882.71
|
|
|
Service Code
|
CPT 64910
|
| Hospital Charge Code |
36064910
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$134.37 |
| Max. Negotiated Rate |
$13,882.71 |
| Rate for Payer: Aetna Commercial |
$6,077.00
|
| Rate for Payer: Aetna Medicare |
$9,138.30
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$3,104.96
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$6,092.20
|
| Rate for Payer: Amerigroup Medicare |
$6,092.20
|
| Rate for Payer: BCBS of TX Blue Advantage |
$9,200.05
|
| Rate for Payer: BCBS of TX Blue Essentials |
$11,018.02
|
| Rate for Payer: BCBS of TX Medicare |
$6,092.20
|
| Rate for Payer: BCBS of TX PPO |
$13,882.71
|
| Rate for Payer: Cigna Commercial |
$13,800.59
|
| Rate for Payer: Cigna Medicaid |
$3,104.96
|
| Rate for Payer: Cigna Medicare |
$6,092.20
|
| Rate for Payer: Employer Direct Commercial |
$6,092.20
|
| Rate for Payer: Humana Medicare/TRICARE |
$6,092.20
|
| Rate for Payer: Molina CHIP/Medicaid |
$3,104.96
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$6,092.20
|
| Rate for Payer: Molina Medicare |
$6,092.20
|
| 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 |
$3,104.96
|
| Rate for Payer: Scott and White EPO/PPO |
$134.37
|
| Rate for Payer: Scott and White Medicare |
$6,092.20
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$3,104.96
|
| Rate for Payer: Superior Health Plan EPO |
$6,092.20
|
| Rate for Payer: Superior Health Plan Medicare |
$6,092.20
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$6,092.20
|
| Rate for Payer: Universal American Medicare |
$6,092.20
|
| Rate for Payer: Wellcare Medicare |
$6,092.20
|
| Rate for Payer: Wellmed Medicare |
$6,092.20
|
|
|
NERVOUS SYSTEM NEOPLASMS WITH MCC
|
Facility
|
IP
|
$27,996.50
|
|
|
Service Code
|
MSDRG 054
|
| Min. Negotiated Rate |
$11,450.04 |
| Max. Negotiated Rate |
$27,996.50 |
| Rate for Payer: Aetna Commercial |
$16,576.88
|
| Rate for Payer: Aetna Medicare |
$20,054.64
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$13,369.76
|
| Rate for Payer: Amerigroup Medicare |
$13,369.76
|
| Rate for Payer: BCBS of TX Blue Advantage |
$11,450.04
|
| Rate for Payer: BCBS of TX Blue Essentials |
$13,586.00
|
| Rate for Payer: BCBS of TX Medicare |
$13,369.76
|
| Rate for Payer: BCBS of TX PPO |
$15,096.14
|
| Rate for Payer: Cigna Commercial |
$18,978.68
|
| Rate for Payer: Cigna Medicare |
$13,369.76
|
| Rate for Payer: Employer Direct Commercial |
$13,369.76
|
| Rate for Payer: Humana Medicare/TRICARE |
$13,369.76
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$13,369.76
|
| Rate for Payer: Molina Medicare |
$13,369.76
|
| Rate for Payer: Multiplan Auto |
$27,996.50
|
| Rate for Payer: Multiplan Commercial |
$27,996.50
|
| Rate for Payer: Multiplan Workers Comp |
$27,996.50
|
| Rate for Payer: Scott and White EPO/PPO |
$12,893.12
|
| Rate for Payer: Scott and White Medicare |
$13,369.76
|
| Rate for Payer: Superior Health Plan EPO |
$13,369.76
|
| Rate for Payer: Superior Health Plan Medicare |
$13,369.76
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$13,369.76
|
| Rate for Payer: Universal American Medicare |
$13,369.76
|
| Rate for Payer: Wellcare Medicare |
$13,369.76
|
| Rate for Payer: Wellmed Medicare |
$13,369.76
|
|
|
NERVOUS SYSTEM NEOPLASMS WITHOUT MCC
|
Facility
|
IP
|
$20,390.80
|
|
|
Service Code
|
MSDRG 055
|
| Min. Negotiated Rate |
$8,833.06 |
| Max. Negotiated Rate |
$20,390.80 |
| Rate for Payer: Aetna Commercial |
$12,073.50
|
| Rate for Payer: Aetna Medicare |
$15,769.78
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$10,513.19
|
| Rate for Payer: Amerigroup Medicare |
$10,513.19
|
| Rate for Payer: BCBS of TX Blue Advantage |
$8,833.06
|
| Rate for Payer: BCBS of TX Blue Essentials |
$10,806.06
|
| Rate for Payer: BCBS of TX Medicare |
$10,513.19
|
| Rate for Payer: BCBS of TX PPO |
$12,007.20
|
| Rate for Payer: Cigna Commercial |
$13,822.82
|
| Rate for Payer: Cigna Medicare |
$10,513.19
|
| Rate for Payer: Employer Direct Commercial |
$10,513.19
|
| Rate for Payer: Humana Medicare/TRICARE |
$10,513.19
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$10,513.19
|
| Rate for Payer: Molina Medicare |
$10,513.19
|
| Rate for Payer: Multiplan Auto |
$20,390.80
|
| Rate for Payer: Multiplan Commercial |
$20,390.80
|
| Rate for Payer: Multiplan Workers Comp |
$20,390.80
|
| Rate for Payer: Scott and White EPO/PPO |
$9,390.50
|
| Rate for Payer: Scott and White Medicare |
$10,513.19
|
| Rate for Payer: Superior Health Plan EPO |
$10,513.19
|
| Rate for Payer: Superior Health Plan Medicare |
$10,513.19
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$10,513.19
|
| Rate for Payer: Universal American Medicare |
$10,513.19
|
| Rate for Payer: Wellcare Medicare |
$10,513.19
|
| Rate for Payer: Wellmed Medicare |
$10,513.19
|
|
|
NET RETRIEVAL FOREIGN BODY 230CM
|
Facility
|
IP
|
$385.90
|
|
|
Service Code
|
HCPCS C1773
|
| Hospital Charge Code |
136730
|
|
Hospital Revenue Code
|
272
|
| Rate for Payer: Cash Price |
$339.59
|
|
|
NET RETRIEVAL FOREIGN BODY 230CM
|
Facility
|
OP
|
$385.90
|
|
|
Service Code
|
HCPCS C1773
|
| Hospital Charge Code |
136730
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$34.73 |
| Max. Negotiated Rate |
$250.84 |
| Rate for Payer: Aetna Commercial |
$212.24
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$34.73
|
| Rate for Payer: BCBS of TX Blue Advantage |
$115.77
|
| Rate for Payer: BCBS of TX Blue Essentials |
$138.92
|
| Rate for Payer: BCBS of TX PPO |
$154.36
|
| Rate for Payer: Cash Price |
$339.59
|
| Rate for Payer: Multiplan Auto |
$250.84
|
| Rate for Payer: Multiplan Commercial |
$250.84
|
| Rate for Payer: Multiplan Workers Comp |
$250.84
|
| Rate for Payer: Scott and White EPO/PPO |
$192.95
|
| Rate for Payer: Superior Health Plan EPO |
$52.48
|
|
|
NEUMOTHORAX CATH KIT
|
Facility
|
IP
|
$572.04
|
|
| Hospital Charge Code |
104581
|
|
Hospital Revenue Code
|
272
|
| Rate for Payer: Cash Price |
$503.40
|
|
|
NEUMOTHORAX CATH KIT
|
Facility
|
OP
|
$572.04
|
|
| Hospital Charge Code |
104581
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$51.48 |
| Max. Negotiated Rate |
$371.83 |
| Rate for Payer: Aetna Commercial |
$314.62
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$51.48
|
| Rate for Payer: BCBS of TX Blue Advantage |
$171.61
|
| Rate for Payer: BCBS of TX Blue Essentials |
$205.93
|
| Rate for Payer: BCBS of TX PPO |
$228.82
|
| Rate for Payer: Cash Price |
$503.40
|
| Rate for Payer: Multiplan Auto |
$371.83
|
| Rate for Payer: Multiplan Commercial |
$371.83
|
| Rate for Payer: Multiplan Workers Comp |
$371.83
|
| Rate for Payer: Scott and White EPO/PPO |
$286.02
|
| Rate for Payer: Superior Health Plan EPO |
$77.80
|
|
|
NEUROFLEX PER 0.5CM -- DHF
|
Facility
|
OP
|
$1,623.39
|
|
|
Service Code
|
HCPCS C9355
|
| Hospital Charge Code |
40242547
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$146.11 |
| Max. Negotiated Rate |
$811.70 |
| Rate for Payer: Aetna Commercial |
$487.02
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$146.11
|
| Rate for Payer: BCBS of TX Blue Advantage |
$487.02
|
| Rate for Payer: BCBS of TX Blue Essentials |
$584.42
|
| Rate for Payer: BCBS of TX PPO |
$649.36
|
| Rate for Payer: Cash Price |
$1,428.58
|
| Rate for Payer: Multiplan Auto |
$811.70
|
| Rate for Payer: Multiplan Commercial |
$811.70
|
| Rate for Payer: Multiplan Workers Comp |
$811.70
|
| Rate for Payer: Scott and White EPO/PPO |
$811.70
|
| Rate for Payer: Superior Health Plan EPO |
$220.78
|
|
|
NEUROFLEX PER 0.5CM -- DHF
|
Facility
|
IP
|
$1,623.39
|
|
|
Service Code
|
HCPCS C9355
|
| Hospital Charge Code |
40242547
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$405.85 |
| Max. Negotiated Rate |
$811.70 |
| Rate for Payer: Aetna Commercial |
$487.02
|
| Rate for Payer: Cash Price |
$1,428.58
|
| Rate for Payer: Cigna Commercial |
$405.85
|
| Rate for Payer: Multiplan Auto |
$811.70
|
| Rate for Payer: Multiplan Commercial |
$811.70
|
| Rate for Payer: Multiplan Workers Comp |
$811.70
|
| Rate for Payer: Scott and White EPO/PPO |
$811.70
|
|
|
NEUROLOGICAL EYE DISORDERS
|
Facility
|
IP
|
$15,276.00
|
|
|
Service Code
|
MSDRG 123
|
| Min. Negotiated Rate |
$6,223.82 |
| Max. Negotiated Rate |
$15,276.00 |
| Rate for Payer: Aetna Commercial |
$9,045.00
|
| Rate for Payer: Aetna Medicare |
$12,888.26
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$8,592.17
|
| Rate for Payer: Amerigroup Medicare |
$8,592.17
|
| Rate for Payer: BCBS of TX Blue Advantage |
$6,223.82
|
| Rate for Payer: BCBS of TX Blue Essentials |
$7,769.18
|
| Rate for Payer: BCBS of TX Medicare |
$8,592.17
|
| Rate for Payer: BCBS of TX PPO |
$8,632.75
|
| Rate for Payer: Cigna Commercial |
$10,355.52
|
| Rate for Payer: Cigna Medicare |
$8,592.17
|
| Rate for Payer: Employer Direct Commercial |
$8,592.17
|
| Rate for Payer: Humana Medicare/TRICARE |
$8,592.17
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$8,592.17
|
| Rate for Payer: Molina Medicare |
$8,592.17
|
| Rate for Payer: Multiplan Auto |
$15,276.00
|
| Rate for Payer: Multiplan Commercial |
$15,276.00
|
| Rate for Payer: Multiplan Workers Comp |
$15,276.00
|
| Rate for Payer: Scott and White EPO/PPO |
$7,035.00
|
| Rate for Payer: Scott and White Medicare |
$8,592.17
|
| Rate for Payer: Superior Health Plan EPO |
$8,592.17
|
| Rate for Payer: Superior Health Plan Medicare |
$8,592.17
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$8,592.17
|
| Rate for Payer: Universal American Medicare |
$8,592.17
|
| Rate for Payer: Wellcare Medicare |
$8,592.17
|
| Rate for Payer: Wellmed Medicare |
$8,592.17
|
|
|
NEUROMATRIX PER 0.5CM -- DHF
|
Facility
|
OP
|
$972.23
|
|
|
Service Code
|
HCPCS C9355
|
| Hospital Charge Code |
40285595
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$87.50 |
| Max. Negotiated Rate |
$486.12 |
| Rate for Payer: Aetna Commercial |
$291.67
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$87.50
|
| Rate for Payer: BCBS of TX Blue Advantage |
$291.67
|
| Rate for Payer: BCBS of TX Blue Essentials |
$350.00
|
| Rate for Payer: BCBS of TX PPO |
$388.89
|
| Rate for Payer: Cash Price |
$855.56
|
| Rate for Payer: Multiplan Auto |
$486.12
|
| Rate for Payer: Multiplan Commercial |
$486.12
|
| Rate for Payer: Multiplan Workers Comp |
$486.12
|
| Rate for Payer: Scott and White EPO/PPO |
$486.12
|
| Rate for Payer: Superior Health Plan EPO |
$132.22
|
|
|
NEUROMATRIX PER 0.5CM -- DHF
|
Facility
|
IP
|
$972.23
|
|
|
Service Code
|
HCPCS C9355
|
| Hospital Charge Code |
40285595
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$243.06 |
| Max. Negotiated Rate |
$486.12 |
| Rate for Payer: Aetna Commercial |
$291.67
|
| Rate for Payer: Cash Price |
$855.56
|
| Rate for Payer: Cigna Commercial |
$243.06
|
| Rate for Payer: Multiplan Auto |
$486.12
|
| Rate for Payer: Multiplan Commercial |
$486.12
|
| Rate for Payer: Multiplan Workers Comp |
$486.12
|
| Rate for Payer: Scott and White EPO/PPO |
$486.12
|
|
|
Neuroplasty digital, 1 or both, same digit
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 64702
|
| Hospital Charge Code |
36064702
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$38.95 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$3,090.00
|
| Rate for Payer: Aetna Medicare |
$2,648.68
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$659.94
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,765.79
|
| Rate for Payer: Amerigroup Medicare |
$1,765.79
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,871.31
|
| Rate for Payer: BCBS of TX Blue Essentials |
$3,438.70
|
| Rate for Payer: BCBS of TX Medicare |
$1,765.79
|
| Rate for Payer: BCBS of TX PPO |
$4,332.76
|
| Rate for Payer: Cigna Commercial |
$4,000.01
|
| Rate for Payer: Cigna Medicaid |
$659.94
|
| Rate for Payer: Cigna Medicare |
$1,765.79
|
| Rate for Payer: Employer Direct Commercial |
$1,765.79
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,765.79
|
| Rate for Payer: Molina CHIP/Medicaid |
$659.94
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,765.79
|
| Rate for Payer: Molina Medicare |
$1,765.79
|
| 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 |
$659.94
|
| Rate for Payer: Scott and White EPO/PPO |
$38.95
|
| Rate for Payer: Scott and White Medicare |
$1,765.79
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$659.94
|
| Rate for Payer: Superior Health Plan EPO |
$1,765.79
|
| Rate for Payer: Superior Health Plan Medicare |
$1,765.79
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,765.79
|
| Rate for Payer: Universal American Medicare |
$1,765.79
|
| Rate for Payer: Wellcare Medicare |
$1,765.79
|
| Rate for Payer: Wellmed Medicare |
$1,765.79
|
|
|
Neuroplasty, major peripheral nerve, arm or leg, open other than specified
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 64708
|
| Hospital Charge Code |
36064708
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$38.95 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$3,090.00
|
| Rate for Payer: Aetna Medicare |
$2,648.68
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$659.94
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,765.79
|
| Rate for Payer: Amerigroup Medicare |
$1,765.79
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,871.31
|
| Rate for Payer: BCBS of TX Blue Essentials |
$3,438.70
|
| Rate for Payer: BCBS of TX Medicare |
$1,765.79
|
| Rate for Payer: BCBS of TX PPO |
$4,332.76
|
| Rate for Payer: Cigna Commercial |
$4,000.01
|
| Rate for Payer: Cigna Medicaid |
$659.94
|
| Rate for Payer: Cigna Medicare |
$1,765.79
|
| Rate for Payer: Employer Direct Commercial |
$1,765.79
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,765.79
|
| Rate for Payer: Molina CHIP/Medicaid |
$659.94
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,765.79
|
| Rate for Payer: Molina Medicare |
$1,765.79
|
| 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 |
$659.94
|
| Rate for Payer: Scott and White EPO/PPO |
$38.95
|
| Rate for Payer: Scott and White Medicare |
$1,765.79
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$659.94
|
| Rate for Payer: Superior Health Plan EPO |
$1,765.79
|
| Rate for Payer: Superior Health Plan Medicare |
$1,765.79
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,765.79
|
| Rate for Payer: Universal American Medicare |
$1,765.79
|
| Rate for Payer: Wellcare Medicare |
$1,765.79
|
| Rate for Payer: Wellmed Medicare |
$1,765.79
|
|
|
Neuroplasty; nerve of hand or foot
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 64704
|
| Hospital Charge Code |
36064704
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$38.95 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$3,090.00
|
| Rate for Payer: Aetna Medicare |
$2,648.68
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$659.94
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,765.79
|
| Rate for Payer: Amerigroup Medicare |
$1,765.79
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,871.31
|
| Rate for Payer: BCBS of TX Blue Essentials |
$3,438.70
|
| Rate for Payer: BCBS of TX Medicare |
$1,765.79
|
| Rate for Payer: BCBS of TX PPO |
$4,332.76
|
| Rate for Payer: Cigna Commercial |
$4,000.01
|
| Rate for Payer: Cigna Medicaid |
$659.94
|
| Rate for Payer: Cigna Medicare |
$1,765.79
|
| Rate for Payer: Employer Direct Commercial |
$1,765.79
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,765.79
|
| Rate for Payer: Molina CHIP/Medicaid |
$659.94
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,765.79
|
| Rate for Payer: Molina Medicare |
$1,765.79
|
| 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 |
$659.94
|
| Rate for Payer: Scott and White EPO/PPO |
$38.95
|
| Rate for Payer: Scott and White Medicare |
$1,765.79
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$659.94
|
| Rate for Payer: Superior Health Plan EPO |
$1,765.79
|
| Rate for Payer: Superior Health Plan Medicare |
$1,765.79
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,765.79
|
| Rate for Payer: Universal American Medicare |
$1,765.79
|
| Rate for Payer: Wellcare Medicare |
$1,765.79
|
| Rate for Payer: Wellmed Medicare |
$1,765.79
|
|
|
NEUROSES EXCEPT DEPRESSIVE
|
Facility
|
IP
|
$17,846.70
|
|
|
Service Code
|
MSDRG 882
|
| Min. Negotiated Rate |
$6,284.02 |
| Max. Negotiated Rate |
$17,846.70 |
| Rate for Payer: Aetna Commercial |
$10,567.12
|
| Rate for Payer: Aetna Medicare |
$14,336.52
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$9,557.68
|
| Rate for Payer: Amerigroup Medicare |
$9,557.68
|
| Rate for Payer: BCBS of TX Blue Advantage |
$6,284.02
|
| Rate for Payer: BCBS of TX Blue Essentials |
$7,997.22
|
| Rate for Payer: BCBS of TX Medicare |
$9,557.68
|
| Rate for Payer: BCBS of TX PPO |
$8,886.15
|
| Rate for Payer: Cigna Commercial |
$12,098.18
|
| Rate for Payer: Cigna Medicare |
$9,557.68
|
| Rate for Payer: Employer Direct Commercial |
$9,557.68
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$9,557.68
|
| Rate for Payer: Molina Medicare |
$9,557.68
|
| Rate for Payer: Multiplan Auto |
$17,846.70
|
| Rate for Payer: Multiplan Commercial |
$17,846.70
|
| Rate for Payer: Multiplan Workers Comp |
$17,846.70
|
| Rate for Payer: Scott and White EPO/PPO |
$8,218.88
|
| Rate for Payer: Scott and White Medicare |
$9,557.68
|
| Rate for Payer: Superior Health Plan EPO |
$9,557.68
|
| Rate for Payer: Superior Health Plan Medicare |
$9,557.68
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$9,557.68
|
| Rate for Payer: Universal American Medicare |
$9,557.68
|
| Rate for Payer: Wellcare Medicare |
$9,557.68
|
| Rate for Payer: Wellmed Medicare |
$9,557.68
|
|
|
Newborn Screen 2
|
Facility
|
IP
|
$138.00
|
|
|
Service Code
|
CPT 99001
|
| Hospital Charge Code |
4201300
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$121.44
|
|
