|
PERC VERT 1BD CTHOR/IMG
|
Facility
|
OP
|
$1,479.00
|
|
|
Service Code
|
CPT 22510
|
| Hospital Charge Code |
4614478
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,088.27 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$4,635.00
|
| Rate for Payer: Aetna Medicare |
$4,440.36
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,088.27
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$2,960.24
|
| Rate for Payer: Amerigroup Medicare |
$2,960.24
|
| Rate for Payer: BCBS of TX Blue Advantage |
$4,571.54
|
| Rate for Payer: BCBS of TX Blue Essentials |
$5,474.90
|
| Rate for Payer: BCBS of TX Medicare |
$2,960.24
|
| Rate for Payer: BCBS of TX PPO |
$6,898.37
|
| Rate for Payer: Cash Price |
$1,301.52
|
| Rate for Payer: Cash Price |
$1,301.52
|
| Rate for Payer: Cigna Commercial |
$6,705.80
|
| Rate for Payer: Cigna Medicaid |
$1,088.27
|
| Rate for Payer: Cigna Medicare |
$2,960.24
|
| Rate for Payer: Employer Direct Commercial |
$2,960.24
|
| Rate for Payer: Humana Medicare/TRICARE |
$2,960.24
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,088.27
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$2,960.24
|
| Rate for Payer: Molina Medicare |
$2,960.24
|
| 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 |
$1,088.27
|
| Rate for Payer: Scott and White EPO/PPO |
$5,476.44
|
| Rate for Payer: Scott and White Medicare |
$2,960.24
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,088.27
|
| Rate for Payer: Superior Health Plan EPO |
$2,960.24
|
| Rate for Payer: Superior Health Plan Medicare |
$2,960.24
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$2,960.24
|
| Rate for Payer: Universal American Medicare |
$2,960.24
|
| Rate for Payer: Wellcare Medicare |
$2,960.24
|
| Rate for Payer: Wellmed Medicare |
$2,960.24
|
|
|
PERC VERT 1BD CTHOR/IMG
|
Facility
|
IP
|
$1,479.00
|
|
|
Service Code
|
CPT 22510
|
| Hospital Charge Code |
4614478
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$1,301.52
|
|
|
PERC VERT 1 BD LSAC/IMG
|
Facility
|
IP
|
$1,479.00
|
|
|
Service Code
|
CPT 22511
|
| Hospital Charge Code |
4614479
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$1,301.52
|
|
|
PERC VERT 1 BD LSAC/IMG
|
Facility
|
OP
|
$1,479.00
|
|
|
Service Code
|
CPT 22511
|
| Hospital Charge Code |
4614479
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,088.27 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$4,635.00
|
| Rate for Payer: Aetna Medicare |
$4,440.36
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,088.27
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$2,960.24
|
| Rate for Payer: Amerigroup Medicare |
$2,960.24
|
| Rate for Payer: BCBS of TX Blue Advantage |
$4,571.54
|
| Rate for Payer: BCBS of TX Blue Essentials |
$5,474.90
|
| Rate for Payer: BCBS of TX Medicare |
$2,960.24
|
| Rate for Payer: BCBS of TX PPO |
$6,898.37
|
| Rate for Payer: Cash Price |
$1,301.52
|
| Rate for Payer: Cash Price |
$1,301.52
|
| Rate for Payer: Cigna Commercial |
$6,705.80
|
| Rate for Payer: Cigna Medicaid |
$1,088.27
|
| Rate for Payer: Cigna Medicare |
$2,960.24
|
| Rate for Payer: Employer Direct Commercial |
$2,960.24
|
| Rate for Payer: Humana Medicare/TRICARE |
$2,960.24
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,088.27
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$2,960.24
|
| Rate for Payer: Molina Medicare |
$2,960.24
|
| 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 |
$1,088.27
|
| Rate for Payer: Scott and White EPO/PPO |
$5,476.44
|
| Rate for Payer: Scott and White Medicare |
$2,960.24
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,088.27
|
| Rate for Payer: Superior Health Plan EPO |
$2,960.24
|
| Rate for Payer: Superior Health Plan Medicare |
$2,960.24
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$2,960.24
|
| Rate for Payer: Universal American Medicare |
$2,960.24
|
| Rate for Payer: Wellcare Medicare |
$2,960.24
|
| Rate for Payer: Wellmed Medicare |
$2,960.24
|
|
|
PE(Rfx IFE), Random Ur SO
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
CPT 84156
|
| Hospital Charge Code |
1605823
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.43 |
| Max. Negotiated Rate |
$104.00 |
| Rate for Payer: Aetna Commercial |
$3.85
|
| Rate for Payer: Aetna Medicare |
$5.50
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1.43
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3.67
|
| Rate for Payer: Amerigroup Medicare |
$3.67
|
| Rate for Payer: BCBS of TX Blue Advantage |
$6.06
|
| Rate for Payer: BCBS of TX Blue Essentials |
$7.27
|
| Rate for Payer: BCBS of TX Medicare |
$3.67
|
| Rate for Payer: BCBS of TX PPO |
$8.11
|
| Rate for Payer: Cash Price |
$140.80
|
| Rate for Payer: Cash Price |
$140.80
|
| Rate for Payer: Cigna Medicaid |
$3.67
|
| Rate for Payer: Cigna Medicare |
$3.67
|
| Rate for Payer: Employer Direct Commercial |
$3.67
|
| Rate for Payer: Humana Medicare/TRICARE |
$3.67
|
| Rate for Payer: Molina CHIP/Medicaid |
$3.67
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3.67
|
| Rate for Payer: Molina Medicare |
$3.67
|
| Rate for Payer: Multiplan Auto |
$104.00
|
| Rate for Payer: Multiplan Commercial |
$104.00
|
| Rate for Payer: Multiplan Workers Comp |
$104.00
|
| Rate for Payer: Parkland Medicaid |
$3.67
|
| Rate for Payer: Scott and White EPO/PPO |
$4.59
|
| Rate for Payer: Scott and White Medicare |
$3.67
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$3.67
|
| Rate for Payer: Superior Health Plan EPO |
$3.67
|
| Rate for Payer: Superior Health Plan Medicare |
$3.67
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3.67
|
| Rate for Payer: Universal American Medicare |
$3.67
|
| Rate for Payer: Wellcare Medicare |
$3.67
|
| Rate for Payer: Wellmed Medicare |
$3.67
|
|
|
PERICARDIOCENTESIS W/IMAGING WHEN PERFORMED
|
Facility
|
OP
|
$3,059.00
|
|
|
Service Code
|
CPT 33016
|
| Hospital Charge Code |
4613010
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$446.27 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$1,400.00
|
| Rate for Payer: Aetna Medicare |
$2,197.02
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$446.27
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,464.68
|
| Rate for Payer: Amerigroup Medicare |
$1,464.68
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,723.99
|
| Rate for Payer: BCBS of TX Blue Essentials |
$3,262.26
|
| Rate for Payer: BCBS of TX Medicare |
$1,464.68
|
| Rate for Payer: BCBS of TX PPO |
$4,110.45
|
| Rate for Payer: Cash Price |
$2,691.92
|
| Rate for Payer: Cash Price |
$2,691.92
|
| Rate for Payer: Cigna Commercial |
$3,317.93
|
| Rate for Payer: Cigna Medicaid |
$446.27
|
| Rate for Payer: Cigna Medicare |
$1,464.68
|
| Rate for Payer: Employer Direct Commercial |
$1,464.68
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,464.68
|
| Rate for Payer: Molina CHIP/Medicaid |
$446.27
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,464.68
|
| Rate for Payer: Molina Medicare |
$1,464.68
|
| 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 |
$446.27
|
| Rate for Payer: Scott and White EPO/PPO |
$2,709.66
|
| Rate for Payer: Scott and White Medicare |
$1,464.68
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$446.27
|
| Rate for Payer: Superior Health Plan EPO |
$1,464.68
|
| Rate for Payer: Superior Health Plan Medicare |
$1,464.68
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,464.68
|
| Rate for Payer: Universal American Medicare |
$1,464.68
|
| Rate for Payer: Wellcare Medicare |
$1,464.68
|
| Rate for Payer: Wellmed Medicare |
$1,464.68
|
|
|
PERICARDIOCENTESIS W/IMAGING WHEN PERFORMED
|
Facility
|
IP
|
$3,059.00
|
|
|
Service Code
|
CPT 33016
|
| Hospital Charge Code |
4613010
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$2,691.92
|
|
|
PERIPHERAL ARTERIAL DISEASE REHAB Units
|
Facility
|
OP
|
$164.00
|
|
|
Service Code
|
CPT 93668
|
| Hospital Charge Code |
1100050
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$14.76 |
| Max. Negotiated Rate |
$126.71 |
| Rate for Payer: Aetna Commercial |
$90.20
|
| Rate for Payer: Aetna Medicare |
$83.91
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$14.76
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$55.94
|
| Rate for Payer: Amerigroup Medicare |
$55.94
|
| Rate for Payer: BCBS of TX Blue Advantage |
$31.35
|
| Rate for Payer: BCBS of TX Blue Essentials |
$37.48
|
| Rate for Payer: BCBS of TX Medicare |
$55.94
|
| Rate for Payer: BCBS of TX PPO |
$41.81
|
| Rate for Payer: Cash Price |
$144.32
|
| Rate for Payer: Cash Price |
$144.32
|
| Rate for Payer: Cash Price |
$144.32
|
| Rate for Payer: Cigna Commercial |
$126.71
|
| 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 Dual Medicare/Medicaid |
$55.94
|
| Rate for Payer: Molina Medicare |
$55.94
|
| Rate for Payer: Multiplan Auto |
$106.60
|
| Rate for Payer: Multiplan Commercial |
$106.60
|
| Rate for Payer: Multiplan Workers Comp |
$106.60
|
| Rate for Payer: Scott and White EPO/PPO |
$18.09
|
| Rate for Payer: Scott and White Medicare |
$55.94
|
| 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
|
|
|
Peripheral Arterial Disease Rehab Units BCE
|
Facility
|
OP
|
$164.00
|
|
|
Service Code
|
CPT 93668
|
| Hospital Charge Code |
1100050
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$14.76 |
| Max. Negotiated Rate |
$126.71 |
| Rate for Payer: Aetna Commercial |
$90.20
|
| Rate for Payer: Aetna Medicare |
$83.91
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$14.76
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$55.94
|
| Rate for Payer: Amerigroup Medicare |
$55.94
|
| Rate for Payer: BCBS of TX Blue Advantage |
$31.35
|
| Rate for Payer: BCBS of TX Blue Essentials |
$37.48
|
| Rate for Payer: BCBS of TX Medicare |
$55.94
|
| Rate for Payer: BCBS of TX PPO |
$41.81
|
| Rate for Payer: Cash Price |
$144.32
|
| Rate for Payer: Cash Price |
$144.32
|
| Rate for Payer: Cash Price |
$144.32
|
| Rate for Payer: Cigna Commercial |
$126.71
|
| 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 Dual Medicare/Medicaid |
$55.94
|
| Rate for Payer: Molina Medicare |
$55.94
|
| Rate for Payer: Multiplan Auto |
$106.60
|
| Rate for Payer: Multiplan Commercial |
$106.60
|
| Rate for Payer: Multiplan Workers Comp |
$106.60
|
| Rate for Payer: Scott and White EPO/PPO |
$18.09
|
| Rate for Payer: Scott and White Medicare |
$55.94
|
| 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
|
|
|
Peripheral Arterial Disease Rehab Units BCE
|
Facility
|
IP
|
$164.00
|
|
|
Service Code
|
CPT 93668
|
| Hospital Charge Code |
1100050
|
|
Hospital Revenue Code
|
480
|
| Rate for Payer: Cash Price |
$144.32
|
|
|
PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH CC OR PERIPHERAL NEUROSTIMULATOR
|
Facility
|
IP
|
$28,731.42
|
|
|
Service Code
|
MSDRG 041
|
| Min. Negotiated Rate |
$18,247.48 |
| Max. Negotiated Rate |
$28,731.42 |
| Rate for Payer: Aetna Commercial |
$25,095.38
|
| Rate for Payer: Aetna Medicare |
$28,159.78
|
| Rate for Payer: BCBS of TX Blue Advantage |
$18,247.48
|
| Rate for Payer: BCBS of TX Blue Essentials |
$24,336.33
|
| Rate for Payer: BCBS of TX PPO |
$27,041.41
|
| Rate for Payer: Cigna Commercial |
$28,731.42
|
|
|
PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH MCC
|
Facility
|
IP
|
$49,594.44
|
|
|
Service Code
|
MSDRG 040
|
| Min. Negotiated Rate |
$31,920.62 |
| Max. Negotiated Rate |
$49,594.44 |
| Rate for Payer: Aetna Commercial |
$43,318.12
|
| Rate for Payer: Aetna Medicare |
$45,498.29
|
| Rate for Payer: BCBS of TX Blue Advantage |
$31,920.62
|
| Rate for Payer: BCBS of TX Blue Essentials |
$40,535.10
|
| Rate for Payer: BCBS of TX PPO |
$45,040.74
|
| Rate for Payer: Cigna Commercial |
$49,594.44
|
|
|
PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$22,905.13
|
|
|
Service Code
|
MSDRG 042
|
| Min. Negotiated Rate |
$16,326.24 |
| Max. Negotiated Rate |
$22,905.13 |
| Rate for Payer: Aetna Commercial |
$19,572.75
|
| Rate for Payer: Aetna Medicare |
$22,905.13
|
| Rate for Payer: BCBS of TX Blue Advantage |
$16,326.24
|
| Rate for Payer: BCBS of TX Blue Essentials |
$19,312.01
|
| Rate for Payer: BCBS of TX PPO |
$21,458.62
|
| Rate for Payer: Cigna Commercial |
$22,408.62
|
|
|
Peripherally Inserted Central Catheter Insertion
|
Facility
|
OP
|
$4,307.00
|
|
|
Service Code
|
CPT 36569
|
| Hospital Charge Code |
2170090
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$446.27 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$1,400.00
|
| Rate for Payer: Aetna Medicare |
$2,197.02
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$446.27
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,464.68
|
| Rate for Payer: Amerigroup Medicare |
$1,464.68
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,723.99
|
| Rate for Payer: BCBS of TX Blue Essentials |
$3,262.26
|
| Rate for Payer: BCBS of TX Medicare |
$1,464.68
|
| Rate for Payer: BCBS of TX PPO |
$4,110.45
|
| Rate for Payer: Cash Price |
$3,790.16
|
| Rate for Payer: Cash Price |
$3,790.16
|
| Rate for Payer: Cigna Commercial |
$3,317.93
|
| Rate for Payer: Cigna Medicaid |
$446.27
|
| Rate for Payer: Cigna Medicare |
$1,464.68
|
| Rate for Payer: Employer Direct Commercial |
$1,464.68
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,464.68
|
| Rate for Payer: Molina CHIP/Medicaid |
$446.27
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,464.68
|
| Rate for Payer: Molina Medicare |
$1,464.68
|
| 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 |
$446.27
|
| Rate for Payer: Scott and White EPO/PPO |
$2,709.66
|
| Rate for Payer: Scott and White Medicare |
$1,464.68
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$446.27
|
| Rate for Payer: Superior Health Plan EPO |
$1,464.68
|
| Rate for Payer: Superior Health Plan Medicare |
$1,464.68
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,464.68
|
| Rate for Payer: Universal American Medicare |
$1,464.68
|
| Rate for Payer: Wellcare Medicare |
$1,464.68
|
| Rate for Payer: Wellmed Medicare |
$1,464.68
|
|
|
PERIPHERAL VASCULAR DISORDERS WITH CC
|
Facility
|
IP
|
$15,703.44
|
|
|
Service Code
|
MSDRG 300
|
| Min. Negotiated Rate |
$8,666.22 |
| Max. Negotiated Rate |
$15,703.44 |
| Rate for Payer: Aetna Commercial |
$12,003.75
|
| Rate for Payer: Aetna Medicare |
$15,703.44
|
| Rate for Payer: BCBS of TX Blue Advantage |
$8,666.22
|
| Rate for Payer: BCBS of TX Blue Essentials |
$10,563.56
|
| Rate for Payer: BCBS of TX PPO |
$11,737.74
|
| Rate for Payer: Cigna Commercial |
$13,742.96
|
|
|
PERIPHERAL VASCULAR DISORDERS WITH MCC
|
Facility
|
IP
|
$21,153.96
|
|
|
Service Code
|
MSDRG 299
|
| Min. Negotiated Rate |
$12,178.46 |
| Max. Negotiated Rate |
$21,153.96 |
| Rate for Payer: Aetna Commercial |
$17,732.25
|
| Rate for Payer: Aetna Medicare |
$21,153.96
|
| Rate for Payer: BCBS of TX Blue Advantage |
$12,178.46
|
| Rate for Payer: BCBS of TX Blue Essentials |
$14,966.68
|
| Rate for Payer: BCBS of TX PPO |
$16,630.29
|
| Rate for Payer: Cigna Commercial |
$20,301.46
|
|
|
PERIPHERAL VASCULAR DISORDERS WITHOUT CC/MCC
|
Facility
|
IP
|
$11,879.94
|
|
|
Service Code
|
MSDRG 301
|
| Min. Negotiated Rate |
$6,223.82 |
| Max. Negotiated Rate |
$11,879.94 |
| Rate for Payer: Aetna Commercial |
$7,985.25
|
| Rate for Payer: Aetna Medicare |
$11,879.94
|
| Rate for Payer: BCBS of TX Blue Advantage |
$6,223.82
|
| Rate for Payer: BCBS of TX Blue Essentials |
$7,493.66
|
| Rate for Payer: BCBS of TX PPO |
$8,326.61
|
| Rate for Payer: Cigna Commercial |
$9,142.22
|
|
|
Periprosthetic capsulectomy, breast
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 19371
|
| Hospital Charge Code |
36019371
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$963.66 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$4,635.00
|
| Rate for Payer: Aetna Medicare |
$5,229.02
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$963.66
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3,486.01
|
| Rate for Payer: Amerigroup Medicare |
$3,486.01
|
| Rate for Payer: BCBS of TX Blue Advantage |
$5,059.35
|
| Rate for Payer: BCBS of TX Blue Essentials |
$6,059.10
|
| Rate for Payer: BCBS of TX Medicare |
$3,486.01
|
| Rate for Payer: BCBS of TX PPO |
$7,634.47
|
| Rate for Payer: Cigna Commercial |
$7,896.82
|
| Rate for Payer: Cigna Medicaid |
$963.66
|
| Rate for Payer: Cigna Medicare |
$3,486.01
|
| Rate for Payer: Employer Direct Commercial |
$3,486.01
|
| Rate for Payer: Humana Medicare/TRICARE |
$3,486.01
|
| Rate for Payer: Molina CHIP/Medicaid |
$963.66
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3,486.01
|
| Rate for Payer: Molina Medicare |
$3,486.01
|
| 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 |
$963.66
|
| Rate for Payer: Scott and White EPO/PPO |
$6,449.12
|
| Rate for Payer: Scott and White Medicare |
$3,486.01
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$963.66
|
| Rate for Payer: Superior Health Plan EPO |
$3,486.01
|
| Rate for Payer: Superior Health Plan Medicare |
$3,486.01
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3,486.01
|
| Rate for Payer: Universal American Medicare |
$3,486.01
|
| Rate for Payer: Wellcare Medicare |
$3,486.01
|
| Rate for Payer: Wellmed Medicare |
$3,486.01
|
|
|
PERITONEAL ADHESIOLYSIS WITH CC
|
Facility
|
IP
|
$27,116.26
|
|
|
Service Code
|
MSDRG 336
|
| Min. Negotiated Rate |
$20,157.54 |
| Max. Negotiated Rate |
$27,116.26 |
| Rate for Payer: Aetna Commercial |
$23,684.62
|
| Rate for Payer: Aetna Medicare |
$26,817.51
|
| Rate for Payer: BCBS of TX Blue Advantage |
$20,157.54
|
| Rate for Payer: BCBS of TX Blue Essentials |
$23,715.13
|
| Rate for Payer: BCBS of TX PPO |
$26,351.16
|
| Rate for Payer: Cigna Commercial |
$27,116.26
|
|
|
PERITONEAL ADHESIOLYSIS WITH MCC
|
Facility
|
IP
|
$46,574.89
|
|
|
Service Code
|
MSDRG 335
|
| Min. Negotiated Rate |
$35,290.10 |
| Max. Negotiated Rate |
$46,574.89 |
| Rate for Payer: Aetna Commercial |
$40,218.75
|
| Rate for Payer: Aetna Medicare |
$42,549.29
|
| Rate for Payer: BCBS of TX Blue Advantage |
$35,290.10
|
| Rate for Payer: BCBS of TX Blue Essentials |
$41,915.78
|
| Rate for Payer: BCBS of TX PPO |
$46,574.89
|
| Rate for Payer: Cigna Commercial |
$46,046.00
|
|
|
PERITONEAL ADHESIOLYSIS WITHOUT CC/MCC
|
Facility
|
IP
|
$20,299.76
|
|
|
Service Code
|
MSDRG 337
|
| Min. Negotiated Rate |
$13,942.32 |
| Max. Negotiated Rate |
$20,299.76 |
| Rate for Payer: Aetna Commercial |
$16,834.50
|
| Rate for Payer: Aetna Medicare |
$20,299.76
|
| Rate for Payer: BCBS of TX Blue Advantage |
$13,942.32
|
| Rate for Payer: BCBS of TX Blue Essentials |
$16,544.45
|
| Rate for Payer: BCBS of TX PPO |
$18,383.44
|
| Rate for Payer: Cigna Commercial |
$19,273.63
|
|
|
Peritoneal Dialysis Treatment Complete
|
Facility
|
IP
|
$5,866.00
|
|
|
Service Code
|
CPT 90945
|
| Hospital Charge Code |
810001
|
|
Hospital Revenue Code
|
804
|
| Rate for Payer: Cash Price |
$5,162.08
|
|
|
Peritoneal Dialysis Treatment Complete
|
Facility
|
OP
|
$5,866.00
|
|
|
Service Code
|
CPT 90945
|
| Hospital Charge Code |
810001
|
|
Hospital Revenue Code
|
804
|
| Min. Negotiated Rate |
$104.41 |
| Max. Negotiated Rate |
$3,812.90 |
| Rate for Payer: Aetna Commercial |
$3,226.30
|
| Rate for Payer: Aetna Medicare |
$607.59
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$527.94
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$405.06
|
| Rate for Payer: Amerigroup Medicare |
$405.06
|
| Rate for Payer: BCBS of TX Blue Advantage |
$1,759.80
|
| Rate for Payer: BCBS of TX Blue Essentials |
$2,111.76
|
| Rate for Payer: BCBS of TX Medicare |
$405.06
|
| Rate for Payer: BCBS of TX PPO |
$2,346.40
|
| Rate for Payer: Cash Price |
$5,162.08
|
| Rate for Payer: Cash Price |
$5,162.08
|
| Rate for Payer: Cash Price |
$5,162.08
|
| Rate for Payer: Cigna Commercial |
$917.59
|
| Rate for Payer: Cigna Medicare |
$405.06
|
| Rate for Payer: Employer Direct Commercial |
$405.06
|
| Rate for Payer: Humana Medicare/TRICARE |
$405.06
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$405.06
|
| Rate for Payer: Molina Medicare |
$405.06
|
| Rate for Payer: Multiplan Auto |
$3,812.90
|
| Rate for Payer: Multiplan Commercial |
$3,812.90
|
| Rate for Payer: Multiplan Workers Comp |
$3,812.90
|
| Rate for Payer: Scott and White EPO/PPO |
$104.41
|
| Rate for Payer: Scott and White Medicare |
$405.06
|
| Rate for Payer: Superior Health Plan EPO |
$405.06
|
| Rate for Payer: Superior Health Plan Medicare |
$405.06
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$405.06
|
| Rate for Payer: Universal American Medicare |
$405.06
|
| Rate for Payer: Wellcare Medicare |
$405.06
|
| Rate for Payer: Wellmed Medicare |
$405.06
|
|
|
PERMANENT CARDIAC PACEMAKER IMPLANT WITH CC
|
Facility
|
IP
|
$29,335.49
|
|
|
Service Code
|
MSDRG 243
|
| Min. Negotiated Rate |
$22,650.68 |
| Max. Negotiated Rate |
$29,335.49 |
| Rate for Payer: Aetna Commercial |
$25,623.00
|
| Rate for Payer: Aetna Medicare |
$28,661.79
|
| Rate for Payer: BCBS of TX Blue Advantage |
$22,650.68
|
| Rate for Payer: BCBS of TX Blue Essentials |
$26,357.82
|
| Rate for Payer: BCBS of TX PPO |
$29,287.60
|
| Rate for Payer: Cigna Commercial |
$29,335.49
|
|
|
PERMANENT CARDIAC PACEMAKER IMPLANT WITH MCC
|
Facility
|
IP
|
$44,501.69
|
|
|
Service Code
|
MSDRG 242
|
| Min. Negotiated Rate |
$31,824.30 |
| Max. Negotiated Rate |
$44,501.69 |
| Rate for Payer: Aetna Commercial |
$38,869.88
|
| Rate for Payer: Aetna Medicare |
$41,265.86
|
| Rate for Payer: BCBS of TX Blue Advantage |
$31,824.30
|
| Rate for Payer: BCBS of TX Blue Essentials |
$38,561.07
|
| Rate for Payer: BCBS of TX PPO |
$42,847.30
|
| Rate for Payer: Cigna Commercial |
$44,501.69
|
|
