|
OTHER O.R. PROCEDURES FOR INJURIES WITH MCC
|
Facility
|
IP
|
$70,670.50
|
|
|
Service Code
|
MSDRG 907
|
| Min. Negotiated Rate |
$29,397.36 |
| Max. Negotiated Rate |
$70,670.50 |
| Rate for Payer: Aetna Commercial |
$41,844.38
|
| Rate for Payer: Aetna Medicare |
$44,096.04
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$29,397.36
|
| Rate for Payer: Amerigroup Medicare |
$29,397.36
|
| Rate for Payer: BCBS of TX Blue Advantage |
$33,265.66
|
| Rate for Payer: BCBS of TX Blue Essentials |
$43,505.94
|
| Rate for Payer: BCBS of TX Medicare |
$29,397.36
|
| Rate for Payer: BCBS of TX PPO |
$48,341.80
|
| Rate for Payer: Cigna Commercial |
$47,907.16
|
| Rate for Payer: Cigna Medicare |
$29,397.36
|
| Rate for Payer: Employer Direct Commercial |
$29,397.36
|
| Rate for Payer: Humana Medicare/TRICARE |
$29,397.36
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$29,397.36
|
| Rate for Payer: Molina Medicare |
$29,397.36
|
| Rate for Payer: Multiplan Auto |
$70,670.50
|
| Rate for Payer: Multiplan Commercial |
$70,670.50
|
| Rate for Payer: Multiplan Workers Comp |
$70,670.50
|
| Rate for Payer: Scott and White EPO/PPO |
$32,545.62
|
| Rate for Payer: Scott and White Medicare |
$29,397.36
|
| Rate for Payer: Superior Health Plan EPO |
$29,397.36
|
| Rate for Payer: Superior Health Plan Medicare |
$29,397.36
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$29,397.36
|
| Rate for Payer: Universal American Medicare |
$29,397.36
|
| Rate for Payer: Wellcare Medicare |
$29,397.36
|
| Rate for Payer: Wellmed Medicare |
$29,397.36
|
|
|
OTHER O.R. PROCEDURES FOR INJURIES WITHOUT CC/MCC
|
Facility
|
IP
|
$25,769.70
|
|
|
Service Code
|
MSDRG 909
|
| Min. Negotiated Rate |
$11,274.60 |
| Max. Negotiated Rate |
$25,769.70 |
| Rate for Payer: Aetna Commercial |
$15,258.38
|
| Rate for Payer: Aetna Medicare |
$18,800.12
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$12,533.41
|
| Rate for Payer: Amerigroup Medicare |
$12,533.41
|
| Rate for Payer: BCBS of TX Blue Advantage |
$11,274.60
|
| Rate for Payer: BCBS of TX Blue Essentials |
$13,676.80
|
| Rate for Payer: BCBS of TX Medicare |
$12,533.41
|
| Rate for Payer: BCBS of TX PPO |
$15,197.04
|
| Rate for Payer: Cigna Commercial |
$17,469.14
|
| Rate for Payer: Cigna Medicare |
$12,533.41
|
| Rate for Payer: Employer Direct Commercial |
$12,533.41
|
| Rate for Payer: Humana Medicare/TRICARE |
$12,533.41
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$12,533.41
|
| Rate for Payer: Molina Medicare |
$12,533.41
|
| Rate for Payer: Multiplan Auto |
$25,769.70
|
| Rate for Payer: Multiplan Commercial |
$25,769.70
|
| Rate for Payer: Multiplan Workers Comp |
$25,769.70
|
| Rate for Payer: Scott and White EPO/PPO |
$11,867.62
|
| Rate for Payer: Scott and White Medicare |
$12,533.41
|
| Rate for Payer: Superior Health Plan EPO |
$12,533.41
|
| Rate for Payer: Superior Health Plan Medicare |
$12,533.41
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$12,533.41
|
| Rate for Payer: Universal American Medicare |
$12,533.41
|
| Rate for Payer: Wellcare Medicare |
$12,533.41
|
| Rate for Payer: Wellmed Medicare |
$12,533.41
|
|
|
OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH CC
|
Facility
|
IP
|
$76,851.20
|
|
|
Service Code
|
MSDRG 958
|
| Min. Negotiated Rate |
$31,718.72 |
| Max. Negotiated Rate |
$76,851.20 |
| Rate for Payer: Aetna Commercial |
$45,504.00
|
| Rate for Payer: Aetna Medicare |
$47,578.08
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$31,718.72
|
| Rate for Payer: Amerigroup Medicare |
$31,718.72
|
| Rate for Payer: BCBS of TX Blue Advantage |
$33,188.26
|
| Rate for Payer: BCBS of TX Blue Essentials |
$43,131.36
|
| Rate for Payer: BCBS of TX Medicare |
$31,718.72
|
| Rate for Payer: BCBS of TX PPO |
$47,925.59
|
| Rate for Payer: Cigna Commercial |
$52,097.02
|
| Rate for Payer: Cigna Medicare |
$31,718.72
|
| Rate for Payer: Employer Direct Commercial |
$31,718.72
|
| Rate for Payer: Humana Medicare/TRICARE |
$31,718.72
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$31,718.72
|
| Rate for Payer: Molina Medicare |
$31,718.72
|
| Rate for Payer: Multiplan Auto |
$76,851.20
|
| Rate for Payer: Multiplan Commercial |
$76,851.20
|
| Rate for Payer: Multiplan Workers Comp |
$76,851.20
|
| Rate for Payer: Scott and White EPO/PPO |
$35,392.00
|
| Rate for Payer: Scott and White Medicare |
$31,718.72
|
| Rate for Payer: Superior Health Plan EPO |
$31,718.72
|
| Rate for Payer: Superior Health Plan Medicare |
$31,718.72
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$31,718.72
|
| Rate for Payer: Universal American Medicare |
$31,718.72
|
| Rate for Payer: Wellcare Medicare |
$31,718.72
|
| Rate for Payer: Wellmed Medicare |
$31,718.72
|
|
|
OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH MCC
|
Facility
|
IP
|
$137,417.50
|
|
|
Service Code
|
MSDRG 957
|
| Min. Negotiated Rate |
$54,466.34 |
| Max. Negotiated Rate |
$137,417.50 |
| Rate for Payer: Aetna Commercial |
$81,365.62
|
| Rate for Payer: Aetna Medicare |
$81,699.51
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$54,466.34
|
| Rate for Payer: Amerigroup Medicare |
$54,466.34
|
| Rate for Payer: BCBS of TX Blue Advantage |
$59,268.62
|
| Rate for Payer: BCBS of TX Blue Essentials |
$78,408.92
|
| Rate for Payer: BCBS of TX Medicare |
$54,466.34
|
| Rate for Payer: BCBS of TX PPO |
$87,124.40
|
| Rate for Payer: Cigna Commercial |
$93,154.60
|
| Rate for Payer: Cigna Medicare |
$54,466.34
|
| Rate for Payer: Employer Direct Commercial |
$54,466.34
|
| Rate for Payer: Humana Medicare/TRICARE |
$54,466.34
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$54,466.34
|
| Rate for Payer: Molina Medicare |
$54,466.34
|
| Rate for Payer: Multiplan Auto |
$137,417.50
|
| Rate for Payer: Multiplan Commercial |
$137,417.50
|
| Rate for Payer: Multiplan Workers Comp |
$137,417.50
|
| Rate for Payer: Scott and White EPO/PPO |
$63,284.38
|
| Rate for Payer: Scott and White Medicare |
$54,466.34
|
| Rate for Payer: Superior Health Plan EPO |
$54,466.34
|
| Rate for Payer: Superior Health Plan Medicare |
$54,466.34
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$54,466.34
|
| Rate for Payer: Universal American Medicare |
$54,466.34
|
| Rate for Payer: Wellcare Medicare |
$54,466.34
|
| Rate for Payer: Wellmed Medicare |
$54,466.34
|
|
|
OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC
|
Facility
|
IP
|
$48,115.60
|
|
|
Service Code
|
MSDRG 959
|
| Min. Negotiated Rate |
$20,926.14 |
| Max. Negotiated Rate |
$48,115.60 |
| Rate for Payer: Aetna Commercial |
$28,489.50
|
| Rate for Payer: Aetna Medicare |
$31,389.21
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$20,926.14
|
| Rate for Payer: Amerigroup Medicare |
$20,926.14
|
| Rate for Payer: BCBS of TX Blue Advantage |
$21,736.50
|
| Rate for Payer: BCBS of TX Blue Essentials |
$25,288.77
|
| Rate for Payer: BCBS of TX Medicare |
$20,926.14
|
| Rate for Payer: BCBS of TX PPO |
$28,099.73
|
| Rate for Payer: Cigna Commercial |
$32,617.31
|
| Rate for Payer: Cigna Medicare |
$20,926.14
|
| Rate for Payer: Employer Direct Commercial |
$20,926.14
|
| Rate for Payer: Humana Medicare/TRICARE |
$20,926.14
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$20,926.14
|
| Rate for Payer: Molina Medicare |
$20,926.14
|
| Rate for Payer: Multiplan Auto |
$48,115.60
|
| Rate for Payer: Multiplan Commercial |
$48,115.60
|
| Rate for Payer: Multiplan Workers Comp |
$48,115.60
|
| Rate for Payer: Scott and White EPO/PPO |
$22,158.50
|
| Rate for Payer: Scott and White Medicare |
$20,926.14
|
| Rate for Payer: Superior Health Plan EPO |
$20,926.14
|
| Rate for Payer: Superior Health Plan Medicare |
$20,926.14
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$20,926.14
|
| Rate for Payer: Universal American Medicare |
$20,926.14
|
| Rate for Payer: Wellcare Medicare |
$20,926.14
|
| Rate for Payer: Wellmed Medicare |
$20,926.14
|
|
|
OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH CC
|
Facility
|
IP
|
$35,305.80
|
|
|
Service Code
|
MSDRG 803
|
| Min. Negotiated Rate |
$15,281.34 |
| Max. Negotiated Rate |
$35,305.80 |
| Rate for Payer: Aetna Commercial |
$20,904.75
|
| Rate for Payer: Aetna Medicare |
$24,172.52
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$16,115.01
|
| Rate for Payer: Amerigroup Medicare |
$16,115.01
|
| Rate for Payer: BCBS of TX Blue Advantage |
$15,281.34
|
| Rate for Payer: BCBS of TX Blue Essentials |
$17,770.35
|
| Rate for Payer: BCBS of TX Medicare |
$16,115.01
|
| Rate for Payer: BCBS of TX PPO |
$19,745.60
|
| Rate for Payer: Cigna Commercial |
$23,933.62
|
| Rate for Payer: Cigna Medicare |
$16,115.01
|
| Rate for Payer: Employer Direct Commercial |
$16,115.01
|
| Rate for Payer: Humana Medicare/TRICARE |
$16,115.01
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$16,115.01
|
| Rate for Payer: Molina Medicare |
$16,115.01
|
| Rate for Payer: Multiplan Auto |
$35,305.80
|
| Rate for Payer: Multiplan Commercial |
$35,305.80
|
| Rate for Payer: Multiplan Workers Comp |
$35,305.80
|
| Rate for Payer: Scott and White EPO/PPO |
$16,259.25
|
| Rate for Payer: Scott and White Medicare |
$16,115.01
|
| Rate for Payer: Superior Health Plan EPO |
$16,115.01
|
| Rate for Payer: Superior Health Plan Medicare |
$16,115.01
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$16,115.01
|
| Rate for Payer: Universal American Medicare |
$16,115.01
|
| Rate for Payer: Wellcare Medicare |
$16,115.01
|
| Rate for Payer: Wellmed Medicare |
$16,115.01
|
|
|
OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH MCC
|
Facility
|
IP
|
$64,415.70
|
|
|
Service Code
|
MSDRG 802
|
| Min. Negotiated Rate |
$27,200.94 |
| Max. Negotiated Rate |
$64,415.70 |
| Rate for Payer: Aetna Commercial |
$38,140.88
|
| Rate for Payer: Aetna Medicare |
$41,005.78
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$27,337.19
|
| Rate for Payer: Amerigroup Medicare |
$27,337.19
|
| Rate for Payer: BCBS of TX Blue Advantage |
$27,200.94
|
| Rate for Payer: BCBS of TX Blue Essentials |
$34,539.76
|
| Rate for Payer: BCBS of TX Medicare |
$27,337.19
|
| Rate for Payer: BCBS of TX PPO |
$38,379.00
|
| Rate for Payer: Cigna Commercial |
$43,667.06
|
| Rate for Payer: Cigna Medicare |
$27,337.19
|
| Rate for Payer: Employer Direct Commercial |
$27,337.19
|
| Rate for Payer: Humana Medicare/TRICARE |
$27,337.19
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$27,337.19
|
| Rate for Payer: Molina Medicare |
$27,337.19
|
| Rate for Payer: Multiplan Auto |
$64,415.70
|
| Rate for Payer: Multiplan Commercial |
$64,415.70
|
| Rate for Payer: Multiplan Workers Comp |
$64,415.70
|
| Rate for Payer: Scott and White EPO/PPO |
$29,665.12
|
| Rate for Payer: Scott and White Medicare |
$27,337.19
|
| Rate for Payer: Superior Health Plan EPO |
$27,337.19
|
| Rate for Payer: Superior Health Plan Medicare |
$27,337.19
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$27,337.19
|
| Rate for Payer: Universal American Medicare |
$27,337.19
|
| Rate for Payer: Wellcare Medicare |
$27,337.19
|
| Rate for Payer: Wellmed Medicare |
$27,337.19
|
|
|
OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITHOUT CC/MCC
|
Facility
|
IP
|
$22,997.60
|
|
|
Service Code
|
MSDRG 804
|
| Min. Negotiated Rate |
$10,591.00 |
| Max. Negotiated Rate |
$22,997.60 |
| Rate for Payer: Aetna Commercial |
$13,617.00
|
| Rate for Payer: Aetna Medicare |
$17,238.42
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$11,492.28
|
| Rate for Payer: Amerigroup Medicare |
$11,492.28
|
| Rate for Payer: BCBS of TX Blue Advantage |
$10,630.46
|
| Rate for Payer: BCBS of TX Blue Essentials |
$12,697.53
|
| Rate for Payer: BCBS of TX Medicare |
$11,492.28
|
| Rate for Payer: BCBS of TX PPO |
$14,108.91
|
| Rate for Payer: Cigna Commercial |
$15,589.95
|
| Rate for Payer: Cigna Medicare |
$11,492.28
|
| Rate for Payer: Employer Direct Commercial |
$11,492.28
|
| Rate for Payer: Humana Medicare/TRICARE |
$11,492.28
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$11,492.28
|
| Rate for Payer: Molina Medicare |
$11,492.28
|
| Rate for Payer: Multiplan Auto |
$22,997.60
|
| Rate for Payer: Multiplan Commercial |
$22,997.60
|
| Rate for Payer: Multiplan Workers Comp |
$22,997.60
|
| Rate for Payer: Scott and White EPO/PPO |
$10,591.00
|
| Rate for Payer: Scott and White Medicare |
$11,492.28
|
| Rate for Payer: Superior Health Plan EPO |
$11,492.28
|
| Rate for Payer: Superior Health Plan Medicare |
$11,492.28
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$11,492.28
|
| Rate for Payer: Universal American Medicare |
$11,492.28
|
| Rate for Payer: Wellcare Medicare |
$11,492.28
|
| Rate for Payer: Wellmed Medicare |
$11,492.28
|
|
|
OTHER RESPIRATORY SYSTEM DIAGNOSES WITH MCC
|
Facility
|
IP
|
$34,395.70
|
|
|
Service Code
|
MSDRG 205
|
| Min. Negotiated Rate |
$12,599.00 |
| Max. Negotiated Rate |
$34,395.70 |
| Rate for Payer: Aetna Commercial |
$20,365.88
|
| Rate for Payer: Aetna Medicare |
$23,659.78
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$15,773.19
|
| Rate for Payer: Amerigroup Medicare |
$15,773.19
|
| Rate for Payer: BCBS of TX Blue Advantage |
$12,599.00
|
| Rate for Payer: BCBS of TX Blue Essentials |
$15,663.21
|
| Rate for Payer: BCBS of TX Medicare |
$15,773.19
|
| Rate for Payer: BCBS of TX PPO |
$17,404.24
|
| Rate for Payer: Cigna Commercial |
$23,316.66
|
| Rate for Payer: Cigna Medicare |
$15,773.19
|
| Rate for Payer: Employer Direct Commercial |
$15,773.19
|
| Rate for Payer: Humana Medicare/TRICARE |
$15,773.19
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$15,773.19
|
| Rate for Payer: Molina Medicare |
$15,773.19
|
| Rate for Payer: Multiplan Auto |
$34,395.70
|
| Rate for Payer: Multiplan Commercial |
$34,395.70
|
| Rate for Payer: Multiplan Workers Comp |
$34,395.70
|
| Rate for Payer: Scott and White EPO/PPO |
$15,840.12
|
| Rate for Payer: Scott and White Medicare |
$15,773.19
|
| Rate for Payer: Superior Health Plan EPO |
$15,773.19
|
| Rate for Payer: Superior Health Plan Medicare |
$15,773.19
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$15,773.19
|
| Rate for Payer: Universal American Medicare |
$15,773.19
|
| Rate for Payer: Wellcare Medicare |
$15,773.19
|
| Rate for Payer: Wellmed Medicare |
$15,773.19
|
|
|
OTHER RESPIRATORY SYSTEM DIAGNOSES WITHOUT MCC
|
Facility
|
IP
|
$17,356.50
|
|
|
Service Code
|
MSDRG 206
|
| Min. Negotiated Rate |
$7,155.20 |
| Max. Negotiated Rate |
$17,356.50 |
| Rate for Payer: Aetna Commercial |
$10,276.88
|
| Rate for Payer: Aetna Medicare |
$14,060.36
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$9,373.57
|
| Rate for Payer: Amerigroup Medicare |
$9,373.57
|
| Rate for Payer: BCBS of TX Blue Advantage |
$7,155.20
|
| Rate for Payer: BCBS of TX Blue Essentials |
$8,910.46
|
| Rate for Payer: BCBS of TX Medicare |
$9,373.57
|
| Rate for Payer: BCBS of TX PPO |
$9,900.89
|
| Rate for Payer: Cigna Commercial |
$11,765.88
|
| Rate for Payer: Cigna Medicare |
$9,373.57
|
| Rate for Payer: Employer Direct Commercial |
$9,373.57
|
| Rate for Payer: Humana Medicare/TRICARE |
$9,373.57
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$9,373.57
|
| Rate for Payer: Molina Medicare |
$9,373.57
|
| Rate for Payer: Multiplan Auto |
$17,356.50
|
| Rate for Payer: Multiplan Commercial |
$17,356.50
|
| Rate for Payer: Multiplan Workers Comp |
$17,356.50
|
| Rate for Payer: Scott and White EPO/PPO |
$7,993.12
|
| Rate for Payer: Scott and White Medicare |
$9,373.57
|
| Rate for Payer: Superior Health Plan EPO |
$9,373.57
|
| Rate for Payer: Superior Health Plan Medicare |
$9,373.57
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$9,373.57
|
| Rate for Payer: Universal American Medicare |
$9,373.57
|
| Rate for Payer: Wellcare Medicare |
$9,373.57
|
| Rate for Payer: Wellmed Medicare |
$9,373.57
|
|
|
OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH CC
|
Facility
|
IP
|
$34,576.20
|
|
|
Service Code
|
MSDRG 167
|
| Min. Negotiated Rate |
$15,840.97 |
| Max. Negotiated Rate |
$34,576.20 |
| Rate for Payer: Aetna Commercial |
$20,472.75
|
| Rate for Payer: Aetna Medicare |
$23,761.46
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$15,840.97
|
| Rate for Payer: Amerigroup Medicare |
$15,840.97
|
| Rate for Payer: BCBS of TX Blue Advantage |
$16,813.00
|
| Rate for Payer: BCBS of TX Blue Essentials |
$19,581.33
|
| Rate for Payer: BCBS of TX Medicare |
$15,840.97
|
| Rate for Payer: BCBS of TX PPO |
$21,757.88
|
| Rate for Payer: Cigna Commercial |
$23,439.02
|
| Rate for Payer: Cigna Medicare |
$15,840.97
|
| Rate for Payer: Employer Direct Commercial |
$15,840.97
|
| Rate for Payer: Humana Medicare/TRICARE |
$15,840.97
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$15,840.97
|
| Rate for Payer: Molina Medicare |
$15,840.97
|
| Rate for Payer: Multiplan Auto |
$34,576.20
|
| Rate for Payer: Multiplan Commercial |
$34,576.20
|
| Rate for Payer: Multiplan Workers Comp |
$34,576.20
|
| Rate for Payer: Scott and White EPO/PPO |
$15,923.25
|
| Rate for Payer: Scott and White Medicare |
$15,840.97
|
| Rate for Payer: Superior Health Plan EPO |
$15,840.97
|
| Rate for Payer: Superior Health Plan Medicare |
$15,840.97
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$15,840.97
|
| Rate for Payer: Universal American Medicare |
$15,840.97
|
| Rate for Payer: Wellcare Medicare |
$15,840.97
|
| Rate for Payer: Wellmed Medicare |
$15,840.97
|
|
|
OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH MCC
|
Facility
|
IP
|
$77,098.20
|
|
|
Service Code
|
MSDRG 166
|
| Min. Negotiated Rate |
$30,583.32 |
| Max. Negotiated Rate |
$77,098.20 |
| Rate for Payer: Aetna Commercial |
$45,650.25
|
| Rate for Payer: Aetna Medicare |
$47,717.22
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$31,811.48
|
| Rate for Payer: Amerigroup Medicare |
$31,811.48
|
| Rate for Payer: BCBS of TX Blue Advantage |
$30,583.32
|
| Rate for Payer: BCBS of TX Blue Essentials |
$36,095.86
|
| Rate for Payer: BCBS of TX Medicare |
$31,811.48
|
| Rate for Payer: BCBS of TX PPO |
$40,108.07
|
| Rate for Payer: Cigna Commercial |
$52,264.46
|
| Rate for Payer: Cigna Medicare |
$31,811.48
|
| Rate for Payer: Employer Direct Commercial |
$31,811.48
|
| Rate for Payer: Humana Medicare/TRICARE |
$31,811.48
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$31,811.48
|
| Rate for Payer: Molina Medicare |
$31,811.48
|
| Rate for Payer: Multiplan Auto |
$77,098.20
|
| Rate for Payer: Multiplan Commercial |
$77,098.20
|
| Rate for Payer: Multiplan Workers Comp |
$77,098.20
|
| Rate for Payer: Scott and White EPO/PPO |
$35,505.75
|
| Rate for Payer: Scott and White Medicare |
$31,811.48
|
| Rate for Payer: Superior Health Plan EPO |
$31,811.48
|
| Rate for Payer: Superior Health Plan Medicare |
$31,811.48
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$31,811.48
|
| Rate for Payer: Universal American Medicare |
$31,811.48
|
| Rate for Payer: Wellcare Medicare |
$31,811.48
|
| Rate for Payer: Wellmed Medicare |
$31,811.48
|
|
|
OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$25,758.30
|
|
|
Service Code
|
MSDRG 168
|
| Min. Negotiated Rate |
$11,488.74 |
| Max. Negotiated Rate |
$25,758.30 |
| Rate for Payer: Aetna Commercial |
$15,251.62
|
| Rate for Payer: Aetna Medicare |
$18,793.70
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$12,529.13
|
| Rate for Payer: Amerigroup Medicare |
$12,529.13
|
| Rate for Payer: BCBS of TX Blue Advantage |
$11,488.74
|
| Rate for Payer: BCBS of TX Blue Essentials |
$13,843.97
|
| Rate for Payer: BCBS of TX Medicare |
$12,529.13
|
| Rate for Payer: BCBS of TX PPO |
$15,382.79
|
| Rate for Payer: Cigna Commercial |
$17,461.42
|
| Rate for Payer: Cigna Medicare |
$12,529.13
|
| Rate for Payer: Employer Direct Commercial |
$12,529.13
|
| Rate for Payer: Humana Medicare/TRICARE |
$12,529.13
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$12,529.13
|
| Rate for Payer: Molina Medicare |
$12,529.13
|
| Rate for Payer: Multiplan Auto |
$25,758.30
|
| Rate for Payer: Multiplan Commercial |
$25,758.30
|
| Rate for Payer: Multiplan Workers Comp |
$25,758.30
|
| Rate for Payer: Scott and White EPO/PPO |
$11,862.38
|
| Rate for Payer: Scott and White Medicare |
$12,529.13
|
| Rate for Payer: Superior Health Plan EPO |
$12,529.13
|
| Rate for Payer: Superior Health Plan Medicare |
$12,529.13
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$12,529.13
|
| Rate for Payer: Universal American Medicare |
$12,529.13
|
| Rate for Payer: Wellcare Medicare |
$12,529.13
|
| Rate for Payer: Wellmed Medicare |
$12,529.13
|
|
|
OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH CC
|
Facility
|
IP
|
$33,185.40
|
|
|
Service Code
|
MSDRG 580
|
| Min. Negotiated Rate |
$14,175.38 |
| Max. Negotiated Rate |
$33,185.40 |
| Rate for Payer: Aetna Commercial |
$19,649.25
|
| Rate for Payer: Aetna Medicare |
$22,977.93
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$15,318.62
|
| Rate for Payer: Amerigroup Medicare |
$15,318.62
|
| Rate for Payer: BCBS of TX Blue Advantage |
$14,175.38
|
| Rate for Payer: BCBS of TX Blue Essentials |
$16,405.15
|
| Rate for Payer: BCBS of TX Medicare |
$15,318.62
|
| Rate for Payer: BCBS of TX PPO |
$18,228.65
|
| Rate for Payer: Cigna Commercial |
$22,496.21
|
| Rate for Payer: Cigna Medicare |
$15,318.62
|
| Rate for Payer: Employer Direct Commercial |
$15,318.62
|
| Rate for Payer: Humana Medicare/TRICARE |
$15,318.62
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$15,318.62
|
| Rate for Payer: Molina Medicare |
$15,318.62
|
| Rate for Payer: Multiplan Auto |
$33,185.40
|
| Rate for Payer: Multiplan Commercial |
$33,185.40
|
| Rate for Payer: Multiplan Workers Comp |
$33,185.40
|
| Rate for Payer: Scott and White EPO/PPO |
$15,282.75
|
| Rate for Payer: Scott and White Medicare |
$15,318.62
|
| Rate for Payer: Superior Health Plan EPO |
$15,318.62
|
| Rate for Payer: Superior Health Plan Medicare |
$15,318.62
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$15,318.62
|
| Rate for Payer: Universal American Medicare |
$15,318.62
|
| Rate for Payer: Wellcare Medicare |
$15,318.62
|
| Rate for Payer: Wellmed Medicare |
$15,318.62
|
|
|
OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH MCC
|
Facility
|
IP
|
$63,501.80
|
|
|
Service Code
|
MSDRG 579
|
| Min. Negotiated Rate |
$23,390.28 |
| Max. Negotiated Rate |
$63,501.80 |
| Rate for Payer: Aetna Commercial |
$37,599.75
|
| Rate for Payer: Aetna Medicare |
$40,057.38
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$26,704.92
|
| Rate for Payer: Amerigroup Medicare |
$26,704.92
|
| Rate for Payer: BCBS of TX Blue Advantage |
$23,390.28
|
| Rate for Payer: BCBS of TX Blue Essentials |
$28,870.50
|
| Rate for Payer: BCBS of TX Medicare |
$26,704.92
|
| Rate for Payer: BCBS of TX PPO |
$32,079.57
|
| Rate for Payer: Cigna Commercial |
$43,047.54
|
| Rate for Payer: Cigna Medicare |
$26,704.92
|
| Rate for Payer: Employer Direct Commercial |
$26,704.92
|
| Rate for Payer: Humana Medicare/TRICARE |
$26,704.92
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$26,704.92
|
| Rate for Payer: Molina Medicare |
$26,704.92
|
| Rate for Payer: Multiplan Auto |
$63,501.80
|
| Rate for Payer: Multiplan Commercial |
$63,501.80
|
| Rate for Payer: Multiplan Workers Comp |
$63,501.80
|
| Rate for Payer: Scott and White EPO/PPO |
$29,244.25
|
| Rate for Payer: Scott and White Medicare |
$26,704.92
|
| Rate for Payer: Superior Health Plan EPO |
$26,704.92
|
| Rate for Payer: Superior Health Plan Medicare |
$26,704.92
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$26,704.92
|
| Rate for Payer: Universal American Medicare |
$26,704.92
|
| Rate for Payer: Wellcare Medicare |
$26,704.92
|
| Rate for Payer: Wellmed Medicare |
$26,704.92
|
|
|
OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$25,587.30
|
|
|
Service Code
|
MSDRG 581
|
| Min. Negotiated Rate |
$10,892.76 |
| Max. Negotiated Rate |
$25,587.30 |
| Rate for Payer: Aetna Commercial |
$15,150.38
|
| Rate for Payer: Aetna Medicare |
$18,697.38
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$12,464.92
|
| Rate for Payer: Amerigroup Medicare |
$12,464.92
|
| Rate for Payer: BCBS of TX Blue Advantage |
$10,892.76
|
| Rate for Payer: BCBS of TX Blue Essentials |
$12,758.41
|
| Rate for Payer: BCBS of TX Medicare |
$12,464.92
|
| Rate for Payer: BCBS of TX PPO |
$14,176.56
|
| Rate for Payer: Cigna Commercial |
$17,345.50
|
| Rate for Payer: Cigna Medicare |
$12,464.92
|
| Rate for Payer: Employer Direct Commercial |
$12,464.92
|
| Rate for Payer: Humana Medicare/TRICARE |
$12,464.92
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$12,464.92
|
| Rate for Payer: Molina Medicare |
$12,464.92
|
| Rate for Payer: Multiplan Auto |
$25,587.30
|
| Rate for Payer: Multiplan Commercial |
$25,587.30
|
| Rate for Payer: Multiplan Workers Comp |
$25,587.30
|
| Rate for Payer: Scott and White EPO/PPO |
$11,783.62
|
| Rate for Payer: Scott and White Medicare |
$12,464.92
|
| Rate for Payer: Superior Health Plan EPO |
$12,464.92
|
| Rate for Payer: Superior Health Plan Medicare |
$12,464.92
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$12,464.92
|
| Rate for Payer: Universal American Medicare |
$12,464.92
|
| Rate for Payer: Wellcare Medicare |
$12,464.92
|
| Rate for Payer: Wellmed Medicare |
$12,464.92
|
|
|
OTHER VASCULAR PROCEDURES WITH CC
|
Facility
|
IP
|
$48,470.90
|
|
|
Service Code
|
MSDRG 253
|
| Min. Negotiated Rate |
$21,059.58 |
| Max. Negotiated Rate |
$48,470.90 |
| Rate for Payer: Aetna Commercial |
$28,699.88
|
| Rate for Payer: Aetna Medicare |
$31,589.37
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$21,059.58
|
| Rate for Payer: Amerigroup Medicare |
$21,059.58
|
| Rate for Payer: BCBS of TX Blue Advantage |
$22,739.26
|
| Rate for Payer: BCBS of TX Blue Essentials |
$26,770.58
|
| Rate for Payer: BCBS of TX Medicare |
$21,059.58
|
| Rate for Payer: BCBS of TX PPO |
$29,746.24
|
| Rate for Payer: Cigna Commercial |
$32,858.17
|
| Rate for Payer: Cigna Medicare |
$21,059.58
|
| Rate for Payer: Employer Direct Commercial |
$21,059.58
|
| Rate for Payer: Humana Medicare/TRICARE |
$21,059.58
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$21,059.58
|
| Rate for Payer: Molina Medicare |
$21,059.58
|
| Rate for Payer: Multiplan Auto |
$48,470.90
|
| Rate for Payer: Multiplan Commercial |
$48,470.90
|
| Rate for Payer: Multiplan Workers Comp |
$48,470.90
|
| Rate for Payer: Scott and White EPO/PPO |
$22,322.12
|
| Rate for Payer: Scott and White Medicare |
$21,059.58
|
| Rate for Payer: Superior Health Plan EPO |
$21,059.58
|
| Rate for Payer: Superior Health Plan Medicare |
$21,059.58
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$21,059.58
|
| Rate for Payer: Universal American Medicare |
$21,059.58
|
| Rate for Payer: Wellcare Medicare |
$21,059.58
|
| Rate for Payer: Wellmed Medicare |
$21,059.58
|
|
|
OTHER VASCULAR PROCEDURES WITH MCC
|
Facility
|
IP
|
$63,722.20
|
|
|
Service Code
|
MSDRG 252
|
| Min. Negotiated Rate |
$26,787.69 |
| Max. Negotiated Rate |
$63,722.20 |
| Rate for Payer: Aetna Commercial |
$37,730.25
|
| Rate for Payer: Aetna Medicare |
$40,181.54
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$26,787.69
|
| Rate for Payer: Amerigroup Medicare |
$26,787.69
|
| Rate for Payer: BCBS of TX Blue Advantage |
$28,488.36
|
| Rate for Payer: BCBS of TX Blue Essentials |
$33,637.88
|
| Rate for Payer: BCBS of TX Medicare |
$26,787.69
|
| Rate for Payer: BCBS of TX PPO |
$37,376.87
|
| Rate for Payer: Cigna Commercial |
$43,196.94
|
| Rate for Payer: Cigna Medicare |
$26,787.69
|
| Rate for Payer: Employer Direct Commercial |
$26,787.69
|
| Rate for Payer: Humana Medicare/TRICARE |
$26,787.69
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$26,787.69
|
| Rate for Payer: Molina Medicare |
$26,787.69
|
| Rate for Payer: Multiplan Auto |
$63,722.20
|
| Rate for Payer: Multiplan Commercial |
$63,722.20
|
| Rate for Payer: Multiplan Workers Comp |
$63,722.20
|
| Rate for Payer: Scott and White EPO/PPO |
$29,345.75
|
| Rate for Payer: Scott and White Medicare |
$26,787.69
|
| Rate for Payer: Superior Health Plan EPO |
$26,787.69
|
| Rate for Payer: Superior Health Plan Medicare |
$26,787.69
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$26,787.69
|
| Rate for Payer: Universal American Medicare |
$26,787.69
|
| Rate for Payer: Wellcare Medicare |
$26,787.69
|
| Rate for Payer: Wellmed Medicare |
$26,787.69
|
|
|
OTHER VASCULAR PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$32,966.90
|
|
|
Service Code
|
MSDRG 254
|
| Min. Negotiated Rate |
$15,182.12 |
| Max. Negotiated Rate |
$32,966.90 |
| Rate for Payer: Aetna Commercial |
$19,519.88
|
| Rate for Payer: Aetna Medicare |
$22,854.84
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$15,236.56
|
| Rate for Payer: Amerigroup Medicare |
$15,236.56
|
| Rate for Payer: BCBS of TX Blue Advantage |
$15,277.04
|
| Rate for Payer: BCBS of TX Blue Essentials |
$18,677.39
|
| Rate for Payer: BCBS of TX Medicare |
$15,236.56
|
| Rate for Payer: BCBS of TX PPO |
$20,753.46
|
| Rate for Payer: Cigna Commercial |
$22,348.09
|
| Rate for Payer: Cigna Medicare |
$15,236.56
|
| Rate for Payer: Employer Direct Commercial |
$15,236.56
|
| Rate for Payer: Humana Medicare/TRICARE |
$15,236.56
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$15,236.56
|
| Rate for Payer: Molina Medicare |
$15,236.56
|
| Rate for Payer: Multiplan Auto |
$32,966.90
|
| Rate for Payer: Multiplan Commercial |
$32,966.90
|
| Rate for Payer: Multiplan Workers Comp |
$32,966.90
|
| Rate for Payer: Scott and White EPO/PPO |
$15,182.12
|
| Rate for Payer: Scott and White Medicare |
$15,236.56
|
| Rate for Payer: Superior Health Plan EPO |
$15,236.56
|
| Rate for Payer: Superior Health Plan Medicare |
$15,236.56
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$15,236.56
|
| Rate for Payer: Universal American Medicare |
$15,236.56
|
| Rate for Payer: Wellcare Medicare |
$15,236.56
|
| Rate for Payer: Wellmed Medicare |
$15,236.56
|
|
|
OT Iontophoresis Assistant Units
|
Facility
|
OP
|
$111.00
|
|
|
Service Code
|
CPT 97033 CO,GO
|
| Hospital Charge Code |
5810015
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$9.99 |
| Max. Negotiated Rate |
$221.00 |
| Rate for Payer: Aetna Commercial |
$221.00
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$9.99
|
| Rate for Payer: BCBS of TX Blue Advantage |
$36.99
|
| Rate for Payer: BCBS of TX Blue Essentials |
$44.22
|
| Rate for Payer: BCBS of TX PPO |
$49.32
|
| Rate for Payer: Cash Price |
$97.68
|
| Rate for Payer: Cash Price |
$97.68
|
| Rate for Payer: Cash Price |
$97.68
|
| Rate for Payer: Cash Price |
$97.68
|
| Rate for Payer: Cigna Commercial |
$200.00
|
| Rate for Payer: Multiplan Auto |
$72.15
|
| Rate for Payer: Multiplan Commercial |
$72.15
|
| Rate for Payer: Multiplan Workers Comp |
$72.15
|
| Rate for Payer: Scott and White EPO/PPO |
$180.00
|
| Rate for Payer: Superior Health Plan EPO |
$15.10
|
|
|
OT Iontophoresis Assistant Units BCE
|
Facility
|
OP
|
$111.00
|
|
|
Service Code
|
CPT 97033 CO,GO
|
| Hospital Charge Code |
5810015
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$9.99 |
| Max. Negotiated Rate |
$221.00 |
| Rate for Payer: Aetna Commercial |
$221.00
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$9.99
|
| Rate for Payer: BCBS of TX Blue Advantage |
$36.99
|
| Rate for Payer: BCBS of TX Blue Essentials |
$44.22
|
| Rate for Payer: BCBS of TX PPO |
$49.32
|
| Rate for Payer: Cash Price |
$97.68
|
| Rate for Payer: Cash Price |
$97.68
|
| Rate for Payer: Cash Price |
$97.68
|
| Rate for Payer: Cash Price |
$97.68
|
| Rate for Payer: Cigna Commercial |
$200.00
|
| Rate for Payer: Multiplan Auto |
$72.15
|
| Rate for Payer: Multiplan Commercial |
$72.15
|
| Rate for Payer: Multiplan Workers Comp |
$72.15
|
| Rate for Payer: Scott and White EPO/PPO |
$180.00
|
| Rate for Payer: Superior Health Plan EPO |
$15.10
|
|
|
OT Iontophoresis Assistant Units BCE
|
Facility
|
IP
|
$111.00
|
|
|
Service Code
|
CPT 97033 CO,GO
|
| Hospital Charge Code |
5810015
|
|
Hospital Revenue Code
|
430
|
| Rate for Payer: Cash Price |
$97.68
|
|
|
OT Iontophoresis Units
|
Facility
|
OP
|
$111.00
|
|
|
Service Code
|
CPT 97033 GO
|
| Hospital Charge Code |
5815272
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$9.99 |
| Max. Negotiated Rate |
$221.00 |
| Rate for Payer: Aetna Commercial |
$221.00
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$9.99
|
| Rate for Payer: BCBS of TX Blue Advantage |
$36.99
|
| Rate for Payer: BCBS of TX Blue Essentials |
$44.22
|
| Rate for Payer: BCBS of TX PPO |
$49.32
|
| Rate for Payer: Cash Price |
$97.68
|
| Rate for Payer: Cash Price |
$97.68
|
| Rate for Payer: Cash Price |
$97.68
|
| Rate for Payer: Cash Price |
$97.68
|
| Rate for Payer: Cigna Commercial |
$200.00
|
| Rate for Payer: Multiplan Auto |
$72.15
|
| Rate for Payer: Multiplan Commercial |
$72.15
|
| Rate for Payer: Multiplan Workers Comp |
$72.15
|
| Rate for Payer: Scott and White EPO/PPO |
$180.00
|
| Rate for Payer: Superior Health Plan EPO |
$15.10
|
|
|
OT Iontophoresis Units BCE
|
Facility
|
IP
|
$111.00
|
|
|
Service Code
|
CPT 97033 GO
|
| Hospital Charge Code |
5815272
|
|
Hospital Revenue Code
|
430
|
| Rate for Payer: Cash Price |
$97.68
|
|
|
OT Iontophoresis Units BCE
|
Facility
|
OP
|
$111.00
|
|
|
Service Code
|
CPT 97033 GO
|
| Hospital Charge Code |
5815272
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$9.99 |
| Max. Negotiated Rate |
$221.00 |
| Rate for Payer: Aetna Commercial |
$221.00
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$9.99
|
| Rate for Payer: BCBS of TX Blue Advantage |
$36.99
|
| Rate for Payer: BCBS of TX Blue Essentials |
$44.22
|
| Rate for Payer: BCBS of TX PPO |
$49.32
|
| Rate for Payer: Cash Price |
$97.68
|
| Rate for Payer: Cash Price |
$97.68
|
| Rate for Payer: Cash Price |
$97.68
|
| Rate for Payer: Cash Price |
$97.68
|
| Rate for Payer: Cigna Commercial |
$200.00
|
| Rate for Payer: Multiplan Auto |
$72.15
|
| Rate for Payer: Multiplan Commercial |
$72.15
|
| Rate for Payer: Multiplan Workers Comp |
$72.15
|
| Rate for Payer: Scott and White EPO/PPO |
$180.00
|
| Rate for Payer: Superior Health Plan EPO |
$15.10
|
|
