|
NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC
|
Facility
|
IP
|
$64,157.30
|
|
|
Service Code
|
MSDRG 987
|
| Min. Negotiated Rate |
$26,951.11 |
| Max. Negotiated Rate |
$64,157.30 |
| Rate for Payer: Aetna Commercial |
$37,987.88
|
| Rate for Payer: Aetna Medicare |
$40,426.66
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$26,951.11
|
| Rate for Payer: Amerigroup Medicare |
$26,951.11
|
| Rate for Payer: BCBS of TX Blue Advantage |
$28,613.06
|
| Rate for Payer: BCBS of TX Blue Essentials |
$34,389.10
|
| Rate for Payer: BCBS of TX Medicare |
$26,951.11
|
| Rate for Payer: BCBS of TX PPO |
$38,211.59
|
| Rate for Payer: Cigna Commercial |
$43,491.90
|
| Rate for Payer: Cigna Medicare |
$26,951.11
|
| Rate for Payer: Employer Direct Commercial |
$26,951.11
|
| Rate for Payer: Humana Medicare/TRICARE |
$26,951.11
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$26,951.11
|
| Rate for Payer: Molina Medicare |
$26,951.11
|
| Rate for Payer: Multiplan Auto |
$64,157.30
|
| Rate for Payer: Multiplan Commercial |
$64,157.30
|
| Rate for Payer: Multiplan Workers Comp |
$64,157.30
|
| Rate for Payer: Scott and White EPO/PPO |
$29,546.12
|
| Rate for Payer: Scott and White Medicare |
$26,951.11
|
| Rate for Payer: Superior Health Plan EPO |
$26,951.11
|
| Rate for Payer: Superior Health Plan Medicare |
$26,951.11
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$26,951.11
|
| Rate for Payer: Universal American Medicare |
$26,951.11
|
| Rate for Payer: Wellcare Medicare |
$26,951.11
|
| Rate for Payer: Wellmed Medicare |
$26,951.11
|
|
|
NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC
|
Facility
|
IP
|
$20,525.70
|
|
|
Service Code
|
MSDRG 989
|
| Min. Negotiated Rate |
$9,085.04 |
| Max. Negotiated Rate |
$20,525.70 |
| Rate for Payer: Aetna Commercial |
$12,153.38
|
| Rate for Payer: Aetna Medicare |
$15,845.79
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$10,563.86
|
| Rate for Payer: Amerigroup Medicare |
$10,563.86
|
| Rate for Payer: BCBS of TX Blue Advantage |
$9,085.04
|
| Rate for Payer: BCBS of TX Blue Essentials |
$10,738.98
|
| Rate for Payer: BCBS of TX Medicare |
$10,563.86
|
| Rate for Payer: BCBS of TX PPO |
$11,932.67
|
| Rate for Payer: Cigna Commercial |
$13,914.26
|
| Rate for Payer: Cigna Medicare |
$10,563.86
|
| Rate for Payer: Employer Direct Commercial |
$10,563.86
|
| Rate for Payer: Humana Medicare/TRICARE |
$10,563.86
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$10,563.86
|
| Rate for Payer: Molina Medicare |
$10,563.86
|
| Rate for Payer: Multiplan Auto |
$20,525.70
|
| Rate for Payer: Multiplan Commercial |
$20,525.70
|
| Rate for Payer: Multiplan Workers Comp |
$20,525.70
|
| Rate for Payer: Scott and White EPO/PPO |
$9,452.62
|
| Rate for Payer: Scott and White Medicare |
$10,563.86
|
| Rate for Payer: Superior Health Plan EPO |
$10,563.86
|
| Rate for Payer: Superior Health Plan Medicare |
$10,563.86
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$10,563.86
|
| Rate for Payer: Universal American Medicare |
$10,563.86
|
| Rate for Payer: Wellcare Medicare |
$10,563.86
|
| Rate for Payer: Wellmed Medicare |
$10,563.86
|
|
|
NON-MALIGNANT BREAST DISORDERS WITH CC/MCC
|
Facility
|
IP
|
$19,484.50
|
|
|
Service Code
|
MSDRG 600
|
| Min. Negotiated Rate |
$8,679.98 |
| Max. Negotiated Rate |
$19,484.50 |
| Rate for Payer: Aetna Commercial |
$11,536.88
|
| Rate for Payer: Aetna Medicare |
$15,259.20
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$10,172.80
|
| Rate for Payer: Amerigroup Medicare |
$10,172.80
|
| Rate for Payer: BCBS of TX Blue Advantage |
$8,679.98
|
| Rate for Payer: BCBS of TX Blue Essentials |
$9,864.96
|
| Rate for Payer: BCBS of TX Medicare |
$10,172.80
|
| Rate for Payer: BCBS of TX PPO |
$10,961.50
|
| Rate for Payer: Cigna Commercial |
$13,208.44
|
| Rate for Payer: Cigna Medicare |
$10,172.80
|
| Rate for Payer: Employer Direct Commercial |
$10,172.80
|
| Rate for Payer: Humana Medicare/TRICARE |
$10,172.80
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$10,172.80
|
| Rate for Payer: Molina Medicare |
$10,172.80
|
| Rate for Payer: Multiplan Auto |
$19,484.50
|
| Rate for Payer: Multiplan Commercial |
$19,484.50
|
| Rate for Payer: Multiplan Workers Comp |
$19,484.50
|
| Rate for Payer: Scott and White EPO/PPO |
$8,973.12
|
| Rate for Payer: Scott and White Medicare |
$10,172.80
|
| Rate for Payer: Superior Health Plan EPO |
$10,172.80
|
| Rate for Payer: Superior Health Plan Medicare |
$10,172.80
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$10,172.80
|
| Rate for Payer: Universal American Medicare |
$10,172.80
|
| Rate for Payer: Wellcare Medicare |
$10,172.80
|
| Rate for Payer: Wellmed Medicare |
$10,172.80
|
|
|
NON-MALIGNANT BREAST DISORDERS WITHOUT CC/MCC
|
Facility
|
IP
|
$11,829.40
|
|
|
Service Code
|
MSDRG 601
|
| Min. Negotiated Rate |
$5,447.75 |
| Max. Negotiated Rate |
$11,829.40 |
| Rate for Payer: Aetna Commercial |
$7,004.25
|
| Rate for Payer: Aetna Medicare |
$11,063.22
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$7,375.48
|
| Rate for Payer: Amerigroup Medicare |
$7,375.48
|
| Rate for Payer: BCBS of TX Blue Advantage |
$5,685.46
|
| Rate for Payer: BCBS of TX Blue Essentials |
$6,389.52
|
| Rate for Payer: BCBS of TX Medicare |
$7,375.48
|
| Rate for Payer: BCBS of TX PPO |
$7,099.75
|
| Rate for Payer: Cigna Commercial |
$8,019.09
|
| Rate for Payer: Cigna Medicare |
$7,375.48
|
| Rate for Payer: Employer Direct Commercial |
$7,375.48
|
| Rate for Payer: Humana Medicare/TRICARE |
$7,375.48
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$7,375.48
|
| Rate for Payer: Molina Medicare |
$7,375.48
|
| Rate for Payer: Multiplan Auto |
$11,829.40
|
| Rate for Payer: Multiplan Commercial |
$11,829.40
|
| Rate for Payer: Multiplan Workers Comp |
$11,829.40
|
| Rate for Payer: Scott and White EPO/PPO |
$5,447.75
|
| Rate for Payer: Scott and White Medicare |
$7,375.48
|
| Rate for Payer: Superior Health Plan EPO |
$7,375.48
|
| Rate for Payer: Superior Health Plan Medicare |
$7,375.48
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$7,375.48
|
| Rate for Payer: Universal American Medicare |
$7,375.48
|
| Rate for Payer: Wellcare Medicare |
$7,375.48
|
| Rate for Payer: Wellmed Medicare |
$7,375.48
|
|
|
Non-Selective Debridement
|
Facility
|
OP
|
$358.00
|
|
|
Service Code
|
CPT 97602
|
| Hospital Charge Code |
7150055
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3.27 |
| Max. Negotiated Rate |
$414.75 |
| Rate for Payer: Aetna Commercial |
$196.90
|
| Rate for Payer: Aetna Medicare |
$274.64
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$32.22
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$183.09
|
| Rate for Payer: Amerigroup Medicare |
$183.09
|
| Rate for Payer: BCBS of TX Blue Advantage |
$38.00
|
| Rate for Payer: BCBS of TX Blue Essentials |
$45.00
|
| Rate for Payer: BCBS of TX Medicare |
$183.09
|
| Rate for Payer: BCBS of TX PPO |
$50.00
|
| Rate for Payer: Cash Price |
$315.04
|
| Rate for Payer: Cash Price |
$315.04
|
| Rate for Payer: Cash Price |
$315.04
|
| Rate for Payer: Cigna Commercial |
$414.75
|
| Rate for Payer: Cigna Medicaid |
$27.68
|
| Rate for Payer: Cigna Medicare |
$183.09
|
| Rate for Payer: Employer Direct Commercial |
$183.09
|
| Rate for Payer: Humana Medicare/TRICARE |
$183.09
|
| Rate for Payer: Molina CHIP/Medicaid |
$27.68
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$183.09
|
| Rate for Payer: Molina Medicare |
$183.09
|
| Rate for Payer: Multiplan Auto |
$232.70
|
| Rate for Payer: Multiplan Commercial |
$232.70
|
| Rate for Payer: Multiplan Workers Comp |
$232.70
|
| Rate for Payer: Parkland Medicaid |
$27.68
|
| Rate for Payer: Scott and White EPO/PPO |
$3.27
|
| Rate for Payer: Scott and White Medicare |
$183.09
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$27.68
|
| Rate for Payer: Superior Health Plan EPO |
$183.09
|
| Rate for Payer: Superior Health Plan Medicare |
$183.09
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$183.09
|
| Rate for Payer: Universal American Medicare |
$183.09
|
| Rate for Payer: Wellcare Medicare |
$183.09
|
| Rate for Payer: Wellmed Medicare |
$183.09
|
|
|
NONSPECIFIC CEREBROVASCULAR DISORDERS WITH CC
|
Facility
|
IP
|
$20,174.20
|
|
|
Service Code
|
MSDRG 071
|
| Min. Negotiated Rate |
$8,436.60 |
| Max. Negotiated Rate |
$20,174.20 |
| Rate for Payer: Aetna Commercial |
$11,945.25
|
| Rate for Payer: Aetna Medicare |
$15,647.76
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$10,431.84
|
| Rate for Payer: Amerigroup Medicare |
$10,431.84
|
| Rate for Payer: BCBS of TX Blue Advantage |
$8,436.60
|
| Rate for Payer: BCBS of TX Blue Essentials |
$10,172.47
|
| Rate for Payer: BCBS of TX Medicare |
$10,431.84
|
| Rate for Payer: BCBS of TX PPO |
$11,303.18
|
| Rate for Payer: Cigna Commercial |
$13,675.98
|
| Rate for Payer: Cigna Medicare |
$10,431.84
|
| Rate for Payer: Employer Direct Commercial |
$10,431.84
|
| Rate for Payer: Humana Medicare/TRICARE |
$10,431.84
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$10,431.84
|
| Rate for Payer: Molina Medicare |
$10,431.84
|
| Rate for Payer: Multiplan Auto |
$20,174.20
|
| Rate for Payer: Multiplan Commercial |
$20,174.20
|
| Rate for Payer: Multiplan Workers Comp |
$20,174.20
|
| Rate for Payer: Scott and White EPO/PPO |
$9,290.75
|
| Rate for Payer: Scott and White Medicare |
$10,431.84
|
| Rate for Payer: Superior Health Plan EPO |
$10,431.84
|
| Rate for Payer: Superior Health Plan Medicare |
$10,431.84
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$10,431.84
|
| Rate for Payer: Universal American Medicare |
$10,431.84
|
| Rate for Payer: Wellcare Medicare |
$10,431.84
|
| Rate for Payer: Wellmed Medicare |
$10,431.84
|
|
|
NONSPECIFIC CEREBROVASCULAR DISORDERS WITH MCC
|
Facility
|
IP
|
$34,000.50
|
|
|
Service Code
|
MSDRG 070
|
| Min. Negotiated Rate |
$14,004.24 |
| Max. Negotiated Rate |
$34,000.50 |
| Rate for Payer: Aetna Commercial |
$20,131.88
|
| Rate for Payer: Aetna Medicare |
$23,437.12
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$15,624.75
|
| Rate for Payer: Amerigroup Medicare |
$15,624.75
|
| Rate for Payer: BCBS of TX Blue Advantage |
$14,004.24
|
| Rate for Payer: BCBS of TX Blue Essentials |
$16,977.85
|
| Rate for Payer: BCBS of TX Medicare |
$15,624.75
|
| Rate for Payer: BCBS of TX PPO |
$18,865.01
|
| Rate for Payer: Cigna Commercial |
$23,048.76
|
| Rate for Payer: Cigna Medicare |
$15,624.75
|
| Rate for Payer: Employer Direct Commercial |
$15,624.75
|
| Rate for Payer: Humana Medicare/TRICARE |
$15,624.75
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$15,624.75
|
| Rate for Payer: Molina Medicare |
$15,624.75
|
| Rate for Payer: Multiplan Auto |
$34,000.50
|
| Rate for Payer: Multiplan Commercial |
$34,000.50
|
| Rate for Payer: Multiplan Workers Comp |
$34,000.50
|
| Rate for Payer: Scott and White EPO/PPO |
$15,658.12
|
| Rate for Payer: Scott and White Medicare |
$15,624.75
|
| Rate for Payer: Superior Health Plan EPO |
$15,624.75
|
| Rate for Payer: Superior Health Plan Medicare |
$15,624.75
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$15,624.75
|
| Rate for Payer: Universal American Medicare |
$15,624.75
|
| Rate for Payer: Wellcare Medicare |
$15,624.75
|
| Rate for Payer: Wellmed Medicare |
$15,624.75
|
|
|
NONSPECIFIC CEREBROVASCULAR DISORDERS WITHOUT CC/MCC
|
Facility
|
IP
|
$14,877.00
|
|
|
Service Code
|
MSDRG 072
|
| Min. Negotiated Rate |
$6,324.44 |
| Max. Negotiated Rate |
$14,877.00 |
| Rate for Payer: Aetna Commercial |
$8,808.75
|
| Rate for Payer: Aetna Medicare |
$12,663.46
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$8,442.31
|
| Rate for Payer: Amerigroup Medicare |
$8,442.31
|
| Rate for Payer: BCBS of TX Blue Advantage |
$6,324.44
|
| Rate for Payer: BCBS of TX Blue Essentials |
$7,656.70
|
| Rate for Payer: BCBS of TX Medicare |
$8,442.31
|
| Rate for Payer: BCBS of TX PPO |
$8,507.77
|
| Rate for Payer: Cigna Commercial |
$10,085.04
|
| Rate for Payer: Cigna Medicare |
$8,442.31
|
| Rate for Payer: Employer Direct Commercial |
$8,442.31
|
| Rate for Payer: Humana Medicare/TRICARE |
$8,442.31
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$8,442.31
|
| Rate for Payer: Molina Medicare |
$8,442.31
|
| Rate for Payer: Multiplan Auto |
$14,877.00
|
| Rate for Payer: Multiplan Commercial |
$14,877.00
|
| Rate for Payer: Multiplan Workers Comp |
$14,877.00
|
| Rate for Payer: Scott and White EPO/PPO |
$6,851.25
|
| Rate for Payer: Scott and White Medicare |
$8,442.31
|
| Rate for Payer: Superior Health Plan EPO |
$8,442.31
|
| Rate for Payer: Superior Health Plan Medicare |
$8,442.31
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$8,442.31
|
| Rate for Payer: Universal American Medicare |
$8,442.31
|
| Rate for Payer: Wellcare Medicare |
$8,442.31
|
| Rate for Payer: Wellmed Medicare |
$8,442.31
|
|
|
NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITH MCC
|
Facility
|
IP
|
$26,921.10
|
|
|
Service Code
|
MSDRG 067
|
| Min. Negotiated Rate |
$11,501.64 |
| Max. Negotiated Rate |
$26,921.10 |
| Rate for Payer: Aetna Commercial |
$15,940.12
|
| Rate for Payer: Aetna Medicare |
$19,448.79
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$12,965.86
|
| Rate for Payer: Amerigroup Medicare |
$12,965.86
|
| Rate for Payer: BCBS of TX Blue Advantage |
$11,501.64
|
| Rate for Payer: BCBS of TX Blue Essentials |
$15,492.95
|
| Rate for Payer: BCBS of TX Medicare |
$12,965.86
|
| Rate for Payer: BCBS of TX PPO |
$17,215.05
|
| Rate for Payer: Cigna Commercial |
$18,249.67
|
| Rate for Payer: Cigna Medicare |
$12,965.86
|
| Rate for Payer: Employer Direct Commercial |
$12,965.86
|
| Rate for Payer: Humana Medicare/TRICARE |
$12,965.86
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$12,965.86
|
| Rate for Payer: Molina Medicare |
$12,965.86
|
| Rate for Payer: Multiplan Auto |
$26,921.10
|
| Rate for Payer: Multiplan Commercial |
$26,921.10
|
| Rate for Payer: Multiplan Workers Comp |
$26,921.10
|
| Rate for Payer: Scott and White EPO/PPO |
$12,397.88
|
| Rate for Payer: Scott and White Medicare |
$12,965.86
|
| Rate for Payer: Superior Health Plan EPO |
$12,965.86
|
| Rate for Payer: Superior Health Plan Medicare |
$12,965.86
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$12,965.86
|
| Rate for Payer: Universal American Medicare |
$12,965.86
|
| Rate for Payer: Wellcare Medicare |
$12,965.86
|
| Rate for Payer: Wellmed Medicare |
$12,965.86
|
|
|
NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITHOUT MCC
|
Facility
|
IP
|
$16,549.00
|
|
|
Service Code
|
MSDRG 068
|
| Min. Negotiated Rate |
$7,445.88 |
| Max. Negotiated Rate |
$16,549.00 |
| Rate for Payer: Aetna Commercial |
$9,798.75
|
| Rate for Payer: Aetna Medicare |
$13,605.44
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$9,070.29
|
| Rate for Payer: Amerigroup Medicare |
$9,070.29
|
| Rate for Payer: BCBS of TX Blue Advantage |
$7,445.88
|
| Rate for Payer: BCBS of TX Blue Essentials |
$9,273.69
|
| Rate for Payer: BCBS of TX Medicare |
$9,070.29
|
| Rate for Payer: BCBS of TX PPO |
$10,304.49
|
| Rate for Payer: Cigna Commercial |
$11,218.48
|
| Rate for Payer: Cigna Medicare |
$9,070.29
|
| Rate for Payer: Employer Direct Commercial |
$9,070.29
|
| Rate for Payer: Humana Medicare/TRICARE |
$9,070.29
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$9,070.29
|
| Rate for Payer: Molina Medicare |
$9,070.29
|
| Rate for Payer: Multiplan Auto |
$16,549.00
|
| Rate for Payer: Multiplan Commercial |
$16,549.00
|
| Rate for Payer: Multiplan Workers Comp |
$16,549.00
|
| Rate for Payer: Scott and White EPO/PPO |
$7,621.25
|
| Rate for Payer: Scott and White Medicare |
$9,070.29
|
| Rate for Payer: Superior Health Plan EPO |
$9,070.29
|
| Rate for Payer: Superior Health Plan Medicare |
$9,070.29
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$9,070.29
|
| Rate for Payer: Universal American Medicare |
$9,070.29
|
| Rate for Payer: Wellcare Medicare |
$9,070.29
|
| Rate for Payer: Wellmed Medicare |
$9,070.29
|
|
|
NONTRAUMATIC STUPOR AND COMA WITH MCC
|
Facility
|
IP
|
$41,965.30
|
|
|
Service Code
|
MSDRG 080
|
| Min. Negotiated Rate |
$10,806.76 |
| Max. Negotiated Rate |
$41,965.30 |
| Rate for Payer: Aetna Commercial |
$24,847.88
|
| Rate for Payer: Aetna Medicare |
$27,924.30
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$18,616.20
|
| Rate for Payer: Amerigroup Medicare |
$18,616.20
|
| Rate for Payer: BCBS of TX Blue Advantage |
$10,806.76
|
| Rate for Payer: BCBS of TX Blue Essentials |
$19,387.34
|
| Rate for Payer: BCBS of TX Medicare |
$18,616.20
|
| Rate for Payer: BCBS of TX PPO |
$21,542.32
|
| Rate for Payer: Cigna Commercial |
$28,448.06
|
| Rate for Payer: Cigna Medicare |
$18,616.20
|
| Rate for Payer: Employer Direct Commercial |
$18,616.20
|
| Rate for Payer: Humana Medicare/TRICARE |
$18,616.20
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$18,616.20
|
| Rate for Payer: Molina Medicare |
$18,616.20
|
| Rate for Payer: Multiplan Auto |
$41,965.30
|
| Rate for Payer: Multiplan Commercial |
$41,965.30
|
| Rate for Payer: Multiplan Workers Comp |
$41,965.30
|
| Rate for Payer: Scott and White EPO/PPO |
$19,326.12
|
| Rate for Payer: Scott and White Medicare |
$18,616.20
|
| Rate for Payer: Superior Health Plan EPO |
$18,616.20
|
| Rate for Payer: Superior Health Plan Medicare |
$18,616.20
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$18,616.20
|
| Rate for Payer: Universal American Medicare |
$18,616.20
|
| Rate for Payer: Wellcare Medicare |
$18,616.20
|
| Rate for Payer: Wellmed Medicare |
$18,616.20
|
|
|
NONTRAUMATIC STUPOR AND COMA WITHOUT MCC
|
Facility
|
IP
|
$17,280.50
|
|
|
Service Code
|
MSDRG 081
|
| Min. Negotiated Rate |
$6,583.30 |
| Max. Negotiated Rate |
$17,280.50 |
| Rate for Payer: Aetna Commercial |
$10,231.88
|
| Rate for Payer: Aetna Medicare |
$14,017.53
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$9,345.02
|
| Rate for Payer: Amerigroup Medicare |
$9,345.02
|
| Rate for Payer: BCBS of TX Blue Advantage |
$6,583.30
|
| Rate for Payer: BCBS of TX Blue Essentials |
$8,818.62
|
| Rate for Payer: BCBS of TX Medicare |
$9,345.02
|
| Rate for Payer: BCBS of TX PPO |
$9,798.84
|
| Rate for Payer: Cigna Commercial |
$11,714.36
|
| Rate for Payer: Cigna Medicare |
$9,345.02
|
| Rate for Payer: Employer Direct Commercial |
$9,345.02
|
| Rate for Payer: Humana Medicare/TRICARE |
$9,345.02
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$9,345.02
|
| Rate for Payer: Molina Medicare |
$9,345.02
|
| Rate for Payer: Multiplan Auto |
$17,280.50
|
| Rate for Payer: Multiplan Commercial |
$17,280.50
|
| Rate for Payer: Multiplan Workers Comp |
$17,280.50
|
| Rate for Payer: Scott and White EPO/PPO |
$7,958.12
|
| Rate for Payer: Scott and White Medicare |
$9,345.02
|
| Rate for Payer: Superior Health Plan EPO |
$9,345.02
|
| Rate for Payer: Superior Health Plan Medicare |
$9,345.02
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$9,345.02
|
| Rate for Payer: Universal American Medicare |
$9,345.02
|
| Rate for Payer: Wellcare Medicare |
$9,345.02
|
| Rate for Payer: Wellmed Medicare |
$9,345.02
|
|
|
norepinephrine 8 mg-NaCl 0.9% 250 mL
|
Facility
|
IP
|
$128.00
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
78415626
|
|
Hospital Revenue Code
|
250
|
| Rate for Payer: Cash Price |
$87.04
|
|
|
norepinephrine 8 mg-NaCl 0.9% 250 mL
|
Facility
|
OP
|
$128.00
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
78415626
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.52 |
| Max. Negotiated Rate |
$83.20 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$11.52
|
| Rate for Payer: BCBS of TX Blue Advantage |
$38.40
|
| Rate for Payer: BCBS of TX Blue Essentials |
$46.08
|
| Rate for Payer: BCBS of TX PPO |
$51.20
|
| 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
|
|
|
NORMAL NEWBORN
|
Facility
|
IP
|
$6,441.18
|
|
|
Service Code
|
MSDRG 795
|
| Min. Negotiated Rate |
$1,523.06 |
| Max. Negotiated Rate |
$6,441.18 |
| Rate for Payer: Aetna Commercial |
$2,269.12
|
| Rate for Payer: Aetna Medicare |
$6,441.18
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$4,294.12
|
| Rate for Payer: Amerigroup Medicare |
$4,294.12
|
| Rate for Payer: BCBS of TX Blue Advantage |
$1,523.06
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,902.82
|
| Rate for Payer: BCBS of TX Medicare |
$4,294.12
|
| Rate for Payer: BCBS of TX PPO |
$2,114.33
|
| Rate for Payer: Cigna Commercial |
$2,597.90
|
| Rate for Payer: Cigna Medicare |
$4,294.12
|
| Rate for Payer: Employer Direct Commercial |
$4,294.12
|
| Rate for Payer: Humana Medicare/TRICARE |
$4,294.12
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$4,294.12
|
| Rate for Payer: Molina Medicare |
$4,294.12
|
| Rate for Payer: Multiplan Auto |
$3,832.30
|
| Rate for Payer: Multiplan Commercial |
$3,832.30
|
| Rate for Payer: Multiplan Workers Comp |
$3,832.30
|
| Rate for Payer: Scott and White EPO/PPO |
$1,764.88
|
| Rate for Payer: Scott and White Medicare |
$4,294.12
|
| Rate for Payer: Superior Health Plan EPO |
$4,294.12
|
| Rate for Payer: Superior Health Plan Medicare |
$4,294.12
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$4,294.12
|
| Rate for Payer: Universal American Medicare |
$4,294.12
|
| Rate for Payer: Wellcare Medicare |
$4,294.12
|
| Rate for Payer: Wellmed Medicare |
$4,294.12
|
|
|
nortriptyline 25 mg Cap
|
Facility
|
IP
|
$8.00
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
77730046
|
|
Hospital Revenue Code
|
250
|
| Rate for Payer: Cash Price |
$5.44
|
|
|
nortriptyline 25 mg Cap
|
Facility
|
OP
|
$8.00
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
77730046
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.72 |
| Max. Negotiated Rate |
$5.20 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$0.72
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2.40
|
| Rate for Payer: BCBS of TX Blue Essentials |
$2.88
|
| Rate for Payer: BCBS of TX PPO |
$3.20
|
| Rate for Payer: Cash Price |
$5.44
|
| Rate for Payer: Multiplan Auto |
$5.20
|
| Rate for Payer: Multiplan Commercial |
$5.20
|
| Rate for Payer: Multiplan Workers Comp |
$5.20
|
| Rate for Payer: Scott and White EPO/PPO |
$4.00
|
| Rate for Payer: Superior Health Plan EPO |
$1.09
|
|
|
Npwt Dme <= 50 Sq cm
|
Facility
|
OP
|
$304.00
|
|
|
Service Code
|
CPT 97605
|
| Hospital Charge Code |
7150618
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3.27 |
| Max. Negotiated Rate |
$414.75 |
| Rate for Payer: Aetna Commercial |
$167.20
|
| Rate for Payer: Aetna Medicare |
$274.64
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$27.36
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$183.09
|
| Rate for Payer: Amerigroup Medicare |
$183.09
|
| Rate for Payer: BCBS of TX Blue Advantage |
$38.00
|
| Rate for Payer: BCBS of TX Blue Essentials |
$45.00
|
| Rate for Payer: BCBS of TX Medicare |
$183.09
|
| Rate for Payer: BCBS of TX PPO |
$50.00
|
| Rate for Payer: Cash Price |
$267.52
|
| Rate for Payer: Cash Price |
$267.52
|
| Rate for Payer: Cash Price |
$267.52
|
| Rate for Payer: Cigna Commercial |
$414.75
|
| Rate for Payer: Cigna Medicare |
$183.09
|
| Rate for Payer: Employer Direct Commercial |
$183.09
|
| Rate for Payer: Humana Medicare/TRICARE |
$183.09
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$183.09
|
| Rate for Payer: Molina Medicare |
$183.09
|
| Rate for Payer: Multiplan Auto |
$197.60
|
| Rate for Payer: Multiplan Commercial |
$197.60
|
| Rate for Payer: Multiplan Workers Comp |
$197.60
|
| Rate for Payer: Scott and White EPO/PPO |
$3.27
|
| Rate for Payer: Scott and White Medicare |
$183.09
|
| Rate for Payer: Superior Health Plan EPO |
$183.09
|
| Rate for Payer: Superior Health Plan Medicare |
$183.09
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$183.09
|
| Rate for Payer: Universal American Medicare |
$183.09
|
| Rate for Payer: Wellcare Medicare |
$183.09
|
| Rate for Payer: Wellmed Medicare |
$183.09
|
|
|
Npwt Dme >50 Sq cm
|
Facility
|
OP
|
$400.00
|
|
|
Service Code
|
CPT 97606
|
| Hospital Charge Code |
7150626
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$6.52 |
| Max. Negotiated Rate |
$826.08 |
| Rate for Payer: Aetna Commercial |
$220.00
|
| Rate for Payer: Aetna Medicare |
$547.00
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$36.00
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$364.67
|
| Rate for Payer: Amerigroup Medicare |
$364.67
|
| Rate for Payer: BCBS of TX Blue Advantage |
$38.00
|
| Rate for Payer: BCBS of TX Blue Essentials |
$45.00
|
| Rate for Payer: BCBS of TX Medicare |
$364.67
|
| Rate for Payer: BCBS of TX PPO |
$50.00
|
| Rate for Payer: Cash Price |
$352.00
|
| Rate for Payer: Cash Price |
$352.00
|
| Rate for Payer: Cash Price |
$352.00
|
| Rate for Payer: Cigna Commercial |
$826.08
|
| Rate for Payer: Cigna Medicare |
$364.67
|
| Rate for Payer: Employer Direct Commercial |
$364.67
|
| Rate for Payer: Humana Medicare/TRICARE |
$364.67
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$364.67
|
| Rate for Payer: Molina Medicare |
$364.67
|
| Rate for Payer: Multiplan Auto |
$260.00
|
| Rate for Payer: Multiplan Commercial |
$260.00
|
| Rate for Payer: Multiplan Workers Comp |
$260.00
|
| Rate for Payer: Scott and White EPO/PPO |
$6.52
|
| Rate for Payer: Scott and White Medicare |
$364.67
|
| Rate for Payer: Superior Health Plan EPO |
$364.67
|
| Rate for Payer: Superior Health Plan Medicare |
$364.67
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$364.67
|
| Rate for Payer: Universal American Medicare |
$364.67
|
| Rate for Payer: Wellcare Medicare |
$364.67
|
| Rate for Payer: Wellmed Medicare |
$364.67
|
|
|
Npwt Nondme <= 50 Sq cm
|
Facility
|
OP
|
$688.00
|
|
|
Service Code
|
CPT 97607
|
| Hospital Charge Code |
7150921
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$6.52 |
| Max. Negotiated Rate |
$826.08 |
| Rate for Payer: Aetna Commercial |
$378.40
|
| Rate for Payer: Aetna Medicare |
$547.00
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$61.92
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$364.67
|
| Rate for Payer: Amerigroup Medicare |
$364.67
|
| Rate for Payer: BCBS of TX Blue Advantage |
$38.00
|
| Rate for Payer: BCBS of TX Blue Essentials |
$45.00
|
| Rate for Payer: BCBS of TX Medicare |
$364.67
|
| Rate for Payer: BCBS of TX PPO |
$50.00
|
| Rate for Payer: Cash Price |
$605.44
|
| Rate for Payer: Cash Price |
$605.44
|
| Rate for Payer: Cash Price |
$605.44
|
| Rate for Payer: Cigna Commercial |
$826.08
|
| Rate for Payer: Cigna Medicare |
$364.67
|
| Rate for Payer: Employer Direct Commercial |
$364.67
|
| Rate for Payer: Humana Medicare/TRICARE |
$364.67
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$364.67
|
| Rate for Payer: Molina Medicare |
$364.67
|
| Rate for Payer: Multiplan Auto |
$447.20
|
| Rate for Payer: Multiplan Commercial |
$447.20
|
| Rate for Payer: Multiplan Workers Comp |
$447.20
|
| Rate for Payer: Scott and White EPO/PPO |
$6.52
|
| Rate for Payer: Scott and White Medicare |
$364.67
|
| Rate for Payer: Superior Health Plan EPO |
$364.67
|
| Rate for Payer: Superior Health Plan Medicare |
$364.67
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$364.67
|
| Rate for Payer: Universal American Medicare |
$364.67
|
| Rate for Payer: Wellcare Medicare |
$364.67
|
| Rate for Payer: Wellmed Medicare |
$364.67
|
|
|
NT-proBNP SO
|
Facility
|
IP
|
$499.00
|
|
|
Service Code
|
CPT 83880
|
| Hospital Charge Code |
8486564
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$439.12
|
|
|
NT-proBNP SO
|
Facility
|
OP
|
$499.00
|
|
|
Service Code
|
CPT 83880
|
| Hospital Charge Code |
8486564
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.31 |
| Max. Negotiated Rate |
$324.35 |
| Rate for Payer: Aetna Commercial |
$41.23
|
| Rate for Payer: Aetna Medicare |
$58.89
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$15.31
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$39.26
|
| Rate for Payer: Amerigroup Medicare |
$39.26
|
| Rate for Payer: BCBS of TX Blue Advantage |
$64.78
|
| Rate for Payer: BCBS of TX Blue Essentials |
$77.73
|
| Rate for Payer: BCBS of TX Medicare |
$39.26
|
| Rate for Payer: BCBS of TX PPO |
$86.76
|
| Rate for Payer: Cash Price |
$439.12
|
| Rate for Payer: Cash Price |
$439.12
|
| Rate for Payer: Cigna Medicaid |
$39.26
|
| Rate for Payer: Cigna Medicare |
$39.26
|
| Rate for Payer: Employer Direct Commercial |
$39.26
|
| Rate for Payer: Humana Medicare/TRICARE |
$39.26
|
| Rate for Payer: Molina CHIP/Medicaid |
$39.26
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$39.26
|
| Rate for Payer: Molina Medicare |
$39.26
|
| Rate for Payer: Multiplan Auto |
$324.35
|
| Rate for Payer: Multiplan Commercial |
$324.35
|
| Rate for Payer: Multiplan Workers Comp |
$324.35
|
| Rate for Payer: Parkland Medicaid |
$39.26
|
| Rate for Payer: Scott and White EPO/PPO |
$49.08
|
| Rate for Payer: Scott and White Medicare |
$39.26
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$39.26
|
| Rate for Payer: Superior Health Plan EPO |
$39.26
|
| Rate for Payer: Superior Health Plan Medicare |
$39.26
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$39.26
|
| Rate for Payer: Universal American Medicare |
$39.26
|
| Rate for Payer: Wellcare Medicare |
$39.26
|
| Rate for Payer: Wellmed Medicare |
$39.26
|
|
|
NTRAPX C FFR W/3D FUNCJL MAP
|
Facility
|
IP
|
$11,321.53
|
|
|
Service Code
|
CPT 0523T
|
| Hospital Charge Code |
8850574
|
|
Hospital Revenue Code
|
481
|
| Rate for Payer: Cash Price |
$9,962.95
|
|
|
NTRAPX C FFR W/3D FUNCJL MAP
|
Facility
|
OP
|
$11,321.53
|
|
|
Service Code
|
CPT 0523T
|
| Hospital Charge Code |
8850574
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,018.94 |
| Max. Negotiated Rate |
$7,358.99 |
| Rate for Payer: Aetna Commercial |
$6,226.84
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,018.94
|
| Rate for Payer: Cash Price |
$9,962.95
|
| Rate for Payer: Multiplan Auto |
$7,358.99
|
| Rate for Payer: Multiplan Commercial |
$7,358.99
|
| Rate for Payer: Multiplan Workers Comp |
$7,358.99
|
| Rate for Payer: Scott and White EPO/PPO |
$5,660.76
|
| Rate for Payer: Superior Health Plan EPO |
$1,539.73
|
|
|
Nursemaid Elbow Child w/ Manipulation
|
Facility
|
IP
|
$777.00
|
|
|
Service Code
|
CPT 24640
|
| Hospital Charge Code |
8398504
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$683.76
|
|
