|
INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH CC OR TPA IN 24 HOURS
|
Facility
|
IP
|
$19,311.60
|
|
|
Service Code
|
MSDRG 065
|
| Min. Negotiated Rate |
$8,870.90 |
| Max. Negotiated Rate |
$19,311.60 |
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$12,164.60
|
| Rate for Payer: Amerigroup Medicare |
$12,164.60
|
| Rate for Payer: BCBS of TX Medicare |
$12,164.60
|
| Rate for Payer: Cigna Commercial |
$13,012.66
|
| Rate for Payer: Cigna Medicare |
$12,164.60
|
| Rate for Payer: Employer Direct Commercial |
$12,164.60
|
| Rate for Payer: Humana Medicare/TRICARE |
$12,164.60
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$12,164.60
|
| Rate for Payer: Molina Medicare |
$12,164.60
|
| Rate for Payer: Multiplan Auto |
$19,311.60
|
| Rate for Payer: Multiplan Commercial |
$19,311.60
|
| Rate for Payer: Multiplan Workers Comp |
$19,311.60
|
| Rate for Payer: Scott and White EPO/PPO |
$8,893.50
|
| Rate for Payer: Scott and White Medicare |
$12,164.60
|
| Rate for Payer: Superior Health Plan EPO |
$12,164.60
|
| Rate for Payer: Superior Health Plan Medicare |
$12,164.60
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$12,164.60
|
| Rate for Payer: Universal American Medicare |
$12,164.60
|
| Rate for Payer: Wellcare Medicare |
$12,164.60
|
| Rate for Payer: Wellmed Medicare |
$12,164.60
|
|
|
INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH MCC
|
Facility
|
IP
|
$37,468.00
|
|
|
Service Code
|
MSDRG 064
|
| Min. Negotiated Rate |
$16,075.12 |
| Max. Negotiated Rate |
$37,468.00 |
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$19,498.74
|
| Rate for Payer: Amerigroup Medicare |
$19,498.74
|
| Rate for Payer: BCBS of TX Medicare |
$19,498.74
|
| Rate for Payer: Cigna Commercial |
$25,901.68
|
| Rate for Payer: Cigna Medicare |
$19,498.74
|
| Rate for Payer: Employer Direct Commercial |
$19,498.74
|
| Rate for Payer: Humana Medicare/TRICARE |
$19,498.74
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$19,498.74
|
| Rate for Payer: Molina Medicare |
$19,498.74
|
| Rate for Payer: Multiplan Auto |
$37,468.00
|
| Rate for Payer: Multiplan Commercial |
$37,468.00
|
| Rate for Payer: Multiplan Workers Comp |
$37,468.00
|
| Rate for Payer: Scott and White EPO/PPO |
$17,255.00
|
| Rate for Payer: Scott and White Medicare |
$19,498.74
|
| Rate for Payer: Superior Health Plan EPO |
$19,498.74
|
| Rate for Payer: Superior Health Plan Medicare |
$19,498.74
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$19,498.74
|
| Rate for Payer: Universal American Medicare |
$19,498.74
|
| Rate for Payer: Wellcare Medicare |
$19,498.74
|
| Rate for Payer: Wellmed Medicare |
$19,498.74
|
|
|
INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITHOUT CC/MCC
|
Facility
|
IP
|
$13,271.50
|
|
|
Service Code
|
MSDRG 066
|
| Min. Negotiated Rate |
$6,111.88 |
| Max. Negotiated Rate |
$13,271.50 |
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$9,776.07
|
| Rate for Payer: Amerigroup Medicare |
$9,776.07
|
| Rate for Payer: BCBS of TX Medicare |
$9,776.07
|
| Rate for Payer: Cigna Commercial |
$8,815.07
|
| Rate for Payer: Cigna Medicare |
$9,776.07
|
| Rate for Payer: Employer Direct Commercial |
$9,776.07
|
| Rate for Payer: Humana Medicare/TRICARE |
$9,776.07
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$9,776.07
|
| Rate for Payer: Molina Medicare |
$9,776.07
|
| Rate for Payer: Multiplan Auto |
$13,271.50
|
| Rate for Payer: Multiplan Commercial |
$13,271.50
|
| Rate for Payer: Multiplan Workers Comp |
$13,271.50
|
| Rate for Payer: Scott and White EPO/PPO |
$6,111.88
|
| Rate for Payer: Scott and White Medicare |
$9,776.07
|
| Rate for Payer: Superior Health Plan EPO |
$9,776.07
|
| Rate for Payer: Superior Health Plan Medicare |
$9,776.07
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$9,776.07
|
| Rate for Payer: Universal American Medicare |
$9,776.07
|
| Rate for Payer: Wellcare Medicare |
$9,776.07
|
| Rate for Payer: Wellmed Medicare |
$9,776.07
|
|
|
INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION W MCC
|
Facility
|
IP
|
$37,468.00
|
|
|
Service Code
|
MSDRG 064
|
| Min. Negotiated Rate |
$16,075.12 |
| Max. Negotiated Rate |
$37,468.00 |
| Rate for Payer: BCBS of TX Blue Advantage |
$16,075.12
|
| Rate for Payer: BCBS of TX Blue Essentials |
$19,288.27
|
| Rate for Payer: BCBS of TX PPO |
$21,432.25
|
|
|
INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION W/O CC/MCC
|
Facility
|
IP
|
$13,271.50
|
|
|
Service Code
|
MSDRG 066
|
| Min. Negotiated Rate |
$6,111.88 |
| Max. Negotiated Rate |
$13,271.50 |
| Rate for Payer: BCBS of TX Blue Advantage |
$6,250.48
|
| Rate for Payer: BCBS of TX Blue Essentials |
$7,499.85
|
| Rate for Payer: BCBS of TX PPO |
$8,333.49
|
|
|
INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH CC
|
Facility
|
IP
|
$128,994.80
|
|
|
Service Code
|
MSDRG 021
|
| Min. Negotiated Rate |
$43,558.49 |
| Max. Negotiated Rate |
$128,994.80 |
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$43,558.49
|
| Rate for Payer: Amerigroup Medicare |
$43,558.49
|
| Rate for Payer: BCBS of TX Medicare |
$43,558.49
|
| Rate for Payer: Cigna Commercial |
$68,184.14
|
| Rate for Payer: Cigna Medicare |
$43,558.49
|
| Rate for Payer: Employer Direct Commercial |
$43,558.49
|
| Rate for Payer: Humana Medicare/TRICARE |
$43,558.49
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$43,558.49
|
| Rate for Payer: Molina Medicare |
$43,558.49
|
| Rate for Payer: Multiplan Auto |
$128,994.80
|
| Rate for Payer: Multiplan Commercial |
$128,994.80
|
| Rate for Payer: Multiplan Workers Comp |
$128,994.80
|
| Rate for Payer: Scott and White EPO/PPO |
$59,405.50
|
| Rate for Payer: Scott and White Medicare |
$43,558.49
|
| Rate for Payer: Superior Health Plan EPO |
$43,558.49
|
| Rate for Payer: Superior Health Plan Medicare |
$43,558.49
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$43,558.49
|
| Rate for Payer: Universal American Medicare |
$43,558.49
|
| Rate for Payer: Wellcare Medicare |
$43,558.49
|
| Rate for Payer: Wellmed Medicare |
$43,558.49
|
|
|
INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH MCC
|
Facility
|
IP
|
$176,762.70
|
|
|
Service Code
|
MSDRG 020
|
| Min. Negotiated Rate |
$62,430.71 |
| Max. Negotiated Rate |
$176,762.70 |
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$62,430.71
|
| Rate for Payer: Amerigroup Medicare |
$62,430.71
|
| Rate for Payer: BCBS of TX Medicare |
$62,430.71
|
| Rate for Payer: Cigna Commercial |
$101,350.14
|
| Rate for Payer: Cigna Medicare |
$62,430.71
|
| Rate for Payer: Employer Direct Commercial |
$62,430.71
|
| Rate for Payer: Humana Medicare/TRICARE |
$62,430.71
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$62,430.71
|
| Rate for Payer: Molina Medicare |
$62,430.71
|
| Rate for Payer: Multiplan Auto |
$176,762.70
|
| Rate for Payer: Multiplan Commercial |
$176,762.70
|
| Rate for Payer: Multiplan Workers Comp |
$176,762.70
|
| Rate for Payer: Scott and White EPO/PPO |
$81,403.88
|
| Rate for Payer: Scott and White Medicare |
$62,430.71
|
| Rate for Payer: Superior Health Plan EPO |
$62,430.71
|
| Rate for Payer: Superior Health Plan Medicare |
$62,430.71
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$62,430.71
|
| Rate for Payer: Universal American Medicare |
$62,430.71
|
| Rate for Payer: Wellcare Medicare |
$62,430.71
|
| Rate for Payer: Wellmed Medicare |
$62,430.71
|
|
|
INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITHOUT CC/MCC
|
Facility
|
IP
|
$82,811.50
|
|
|
Service Code
|
MSDRG 022
|
| Min. Negotiated Rate |
$28,047.33 |
| Max. Negotiated Rate |
$82,811.50 |
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$28,047.33
|
| Rate for Payer: Amerigroup Medicare |
$28,047.33
|
| Rate for Payer: BCBS of TX Medicare |
$28,047.33
|
| Rate for Payer: Cigna Commercial |
$39,607.29
|
| Rate for Payer: Cigna Medicare |
$28,047.33
|
| Rate for Payer: Employer Direct Commercial |
$28,047.33
|
| Rate for Payer: Humana Medicare/TRICARE |
$28,047.33
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$28,047.33
|
| Rate for Payer: Molina Medicare |
$28,047.33
|
| Rate for Payer: Multiplan Auto |
$82,811.50
|
| Rate for Payer: Multiplan Commercial |
$82,811.50
|
| Rate for Payer: Multiplan Workers Comp |
$82,811.50
|
| Rate for Payer: Scott and White EPO/PPO |
$38,136.88
|
| Rate for Payer: Scott and White Medicare |
$28,047.33
|
| Rate for Payer: Superior Health Plan EPO |
$28,047.33
|
| Rate for Payer: Superior Health Plan Medicare |
$28,047.33
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$28,047.33
|
| Rate for Payer: Universal American Medicare |
$28,047.33
|
| Rate for Payer: Wellcare Medicare |
$28,047.33
|
| Rate for Payer: Wellmed Medicare |
$28,047.33
|
|
|
INTRACRANIAL VASCULAR PROCEDURES W PDX HEMORRHAGE W CC
|
Facility
|
IP
|
$128,994.80
|
|
|
Service Code
|
MSDRG 021
|
| Min. Negotiated Rate |
$43,558.49 |
| Max. Negotiated Rate |
$128,994.80 |
| Rate for Payer: BCBS of TX Blue Advantage |
$67,988.16
|
| Rate for Payer: BCBS of TX Blue Essentials |
$81,577.89
|
| Rate for Payer: BCBS of TX PPO |
$90,645.61
|
|
|
INTRACRANIAL VASCULAR PROCEDURES W PDX HEMORRHAGE W MCC
|
Facility
|
IP
|
$176,762.70
|
|
|
Service Code
|
MSDRG 020
|
| Min. Negotiated Rate |
$62,430.71 |
| Max. Negotiated Rate |
$176,762.70 |
| Rate for Payer: BCBS of TX Blue Advantage |
$89,657.58
|
| Rate for Payer: BCBS of TX Blue Essentials |
$107,578.67
|
| Rate for Payer: BCBS of TX PPO |
$119,536.49
|
|
|
INTRACRANIAL VASCULAR PROCEDURES W PDX HEMORRHAGE W/O CC/MCC
|
Facility
|
IP
|
$82,811.50
|
|
|
Service Code
|
MSDRG 022
|
| Min. Negotiated Rate |
$28,047.33 |
| Max. Negotiated Rate |
$82,811.50 |
| Rate for Payer: BCBS of TX Blue Advantage |
$44,354.50
|
| Rate for Payer: BCBS of TX Blue Essentials |
$53,220.24
|
| Rate for Payer: BCBS of TX PPO |
$59,135.89
|
|
|
INTRAOCULAR PROCEDURES W CC/MCC
|
Facility
|
IP
|
$35,843.50
|
|
|
Service Code
|
MSDRG 116
|
| Min. Negotiated Rate |
$14,688.80 |
| Max. Negotiated Rate |
$35,843.50 |
| Rate for Payer: BCBS of TX Blue Advantage |
$14,688.80
|
| Rate for Payer: BCBS of TX Blue Essentials |
$17,624.85
|
| Rate for Payer: BCBS of TX PPO |
$19,583.93
|
|
|
INTRAOCULAR PROCEDURES WITH CC/MCC
|
Facility
|
IP
|
$35,843.50
|
|
|
Service Code
|
MSDRG 116
|
| Min. Negotiated Rate |
$14,688.80 |
| Max. Negotiated Rate |
$35,843.50 |
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$18,011.70
|
| Rate for Payer: Amerigroup Medicare |
$18,011.70
|
| Rate for Payer: BCBS of TX Medicare |
$18,011.70
|
| Rate for Payer: Cigna Commercial |
$23,288.33
|
| Rate for Payer: Cigna Medicare |
$18,011.70
|
| Rate for Payer: Employer Direct Commercial |
$18,011.70
|
| Rate for Payer: Humana Medicare/TRICARE |
$18,011.70
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$18,011.70
|
| Rate for Payer: Molina Medicare |
$18,011.70
|
| Rate for Payer: Multiplan Auto |
$35,843.50
|
| Rate for Payer: Multiplan Commercial |
$35,843.50
|
| Rate for Payer: Multiplan Workers Comp |
$35,843.50
|
| Rate for Payer: Scott and White EPO/PPO |
$16,506.88
|
| Rate for Payer: Scott and White Medicare |
$18,011.70
|
| Rate for Payer: Superior Health Plan EPO |
$18,011.70
|
| Rate for Payer: Superior Health Plan Medicare |
$18,011.70
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$18,011.70
|
| Rate for Payer: Universal American Medicare |
$18,011.70
|
| Rate for Payer: Wellcare Medicare |
$18,011.70
|
| Rate for Payer: Wellmed Medicare |
$18,011.70
|
|
|
INTRAOCULAR PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$18,863.20
|
|
|
Service Code
|
MSDRG 117
|
| Min. Negotiated Rate |
$8,621.50 |
| Max. Negotiated Rate |
$18,863.20 |
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$12,711.35
|
| Rate for Payer: Amerigroup Medicare |
$12,711.35
|
| Rate for Payer: BCBS of TX Medicare |
$12,711.35
|
| Rate for Payer: Cigna Commercial |
$13,973.51
|
| Rate for Payer: Cigna Medicare |
$12,711.35
|
| Rate for Payer: Employer Direct Commercial |
$12,711.35
|
| Rate for Payer: Humana Medicare/TRICARE |
$12,711.35
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$12,711.35
|
| Rate for Payer: Molina Medicare |
$12,711.35
|
| Rate for Payer: Multiplan Auto |
$18,863.20
|
| Rate for Payer: Multiplan Commercial |
$18,863.20
|
| Rate for Payer: Multiplan Workers Comp |
$18,863.20
|
| Rate for Payer: Scott and White EPO/PPO |
$8,687.00
|
| Rate for Payer: Scott and White Medicare |
$12,711.35
|
| Rate for Payer: Superior Health Plan EPO |
$12,711.35
|
| Rate for Payer: Superior Health Plan Medicare |
$12,711.35
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$12,711.35
|
| Rate for Payer: Universal American Medicare |
$12,711.35
|
| Rate for Payer: Wellcare Medicare |
$12,711.35
|
| Rate for Payer: Wellmed Medicare |
$12,711.35
|
|
|
INTRAOCULAR PROCEDURES W/O CC/MCC
|
Facility
|
IP
|
$18,863.20
|
|
|
Service Code
|
MSDRG 117
|
| Min. Negotiated Rate |
$8,621.50 |
| Max. Negotiated Rate |
$18,863.20 |
| Rate for Payer: BCBS of TX Blue Advantage |
$8,621.50
|
| Rate for Payer: BCBS of TX Blue Essentials |
$10,344.80
|
| Rate for Payer: BCBS of TX PPO |
$11,494.67
|
|
|
Intraoperative epicardial cardiac ultrasound
|
Facility
|
IP
|
$3,825.00
|
|
|
Service Code
|
HCPCS 76987
|
| Hospital Charge Code |
994175
|
|
Hospital Revenue Code
|
480
|
| Rate for Payer: Cash Price |
$2,601.00
|
|
|
Intraoperative epicardial cardiac ultrasound
|
Facility
|
OP
|
$3,825.00
|
|
|
Service Code
|
HCPCS 76987
|
| Hospital Charge Code |
994175
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$157.11 |
| Max. Negotiated Rate |
$2,754.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$344.25
|
| Rate for Payer: BCBS of TX Blue Advantage |
$157.11
|
| Rate for Payer: BCBS of TX Blue Essentials |
$188.54
|
| Rate for Payer: BCBS of TX PPO |
$210.44
|
| Rate for Payer: Cash Price |
$2,601.00
|
| Rate for Payer: Cash Price |
$2,601.00
|
| Rate for Payer: Cigna Medicaid |
$2,754.00
|
| Rate for Payer: Molina CHIP/Medicaid |
$2,754.00
|
| Rate for Payer: Multiplan Auto |
$2,486.25
|
| Rate for Payer: Multiplan Commercial |
$2,486.25
|
| Rate for Payer: Multiplan Workers Comp |
$2,486.25
|
| Rate for Payer: Parkland Medicaid |
$2,754.00
|
| Rate for Payer: Scott and White EPO/PPO |
$1,912.50
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$2,754.00
|
| Rate for Payer: Superior Health Plan EPO |
$520.20
|
|
|
INTRAVASCULAR STENT 1ST ARTERY
|
Facility
|
IP
|
$24,854.00
|
|
|
Service Code
|
HCPCS 37236
|
| Hospital Charge Code |
2350071
|
|
Hospital Revenue Code
|
481
|
| Rate for Payer: Cash Price |
$16,900.72
|
|
|
INTRAVASCULAR STENT 1ST ARTERY
|
Facility
|
OP
|
$24,854.00
|
|
|
Service Code
|
HCPCS 37236
|
| Hospital Charge Code |
2350071
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$520.49 |
| Max. Negotiated Rate |
$24,969.37 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2,236.86
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$11,596.79
|
| Rate for Payer: Amerigroup Medicare |
$11,596.79
|
| Rate for Payer: BCBS of TX Blue Advantage |
$16,547.16
|
| Rate for Payer: BCBS of TX Blue Essentials |
$19,816.96
|
| Rate for Payer: BCBS of TX Medicare |
$11,596.79
|
| Rate for Payer: BCBS of TX PPO |
$24,969.37
|
| Rate for Payer: Cash Price |
$16,900.72
|
| Rate for Payer: Cash Price |
$16,900.72
|
| Rate for Payer: Cash Price |
$16,900.72
|
| Rate for Payer: Cigna Commercial |
$24,513.51
|
| Rate for Payer: Cigna Medicaid |
$17,894.88
|
| Rate for Payer: Cigna Medicare |
$11,596.79
|
| Rate for Payer: Employer Direct Commercial |
$11,596.79
|
| Rate for Payer: Humana Medicare/TRICARE |
$11,596.79
|
| Rate for Payer: Molina CHIP/Medicaid |
$17,894.88
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$11,596.79
|
| Rate for Payer: Molina Medicare |
$11,596.79
|
| Rate for Payer: Multiplan Auto |
$16,155.10
|
| Rate for Payer: Multiplan Commercial |
$16,155.10
|
| Rate for Payer: Multiplan Workers Comp |
$16,155.10
|
| Rate for Payer: Parkland Medicaid |
$17,894.88
|
| Rate for Payer: Scott and White EPO/PPO |
$520.49
|
| Rate for Payer: Scott and White Medicare |
$11,596.79
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$17,894.88
|
| Rate for Payer: Superior Health Plan EPO |
$11,596.79
|
| Rate for Payer: Superior Health Plan Medicare |
$11,596.79
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$11,596.79
|
| Rate for Payer: Universal American Medicare |
$11,596.79
|
| Rate for Payer: Wellcare Medicare |
$11,596.79
|
| Rate for Payer: Wellmed Medicare |
$11,596.79
|
|
|
Intravenous infusion, hydration; each additional hour (List separately in addition to code for prima
|
Facility
|
OP
|
$122.61
|
|
|
Service Code
|
HCPCS 96361
|
| Hospital Charge Code |
8932542
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$11.03 |
| Max. Negotiated Rate |
$99.43 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$11.03
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$47.04
|
| Rate for Payer: Amerigroup Medicare |
$47.04
|
| Rate for Payer: BCBS of TX Blue Advantage |
$36.78
|
| Rate for Payer: BCBS of TX Blue Essentials |
$44.14
|
| Rate for Payer: BCBS of TX Medicare |
$47.04
|
| Rate for Payer: BCBS of TX PPO |
$49.04
|
| Rate for Payer: Cash Price |
$83.37
|
| Rate for Payer: Cash Price |
$83.37
|
| Rate for Payer: Cash Price |
$83.37
|
| Rate for Payer: Cigna Commercial |
$99.43
|
| Rate for Payer: Cigna Medicaid |
$88.28
|
| Rate for Payer: Cigna Medicare |
$47.04
|
| Rate for Payer: Employer Direct Commercial |
$47.04
|
| Rate for Payer: Humana Medicare/TRICARE |
$47.04
|
| Rate for Payer: Molina CHIP/Medicaid |
$88.28
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$47.04
|
| Rate for Payer: Molina Medicare |
$47.04
|
| Rate for Payer: Multiplan Auto |
$79.70
|
| Rate for Payer: Multiplan Commercial |
$79.70
|
| Rate for Payer: Multiplan Workers Comp |
$79.70
|
| Rate for Payer: Parkland Medicaid |
$88.28
|
| Rate for Payer: Scott and White EPO/PPO |
$15.21
|
| Rate for Payer: Scott and White Medicare |
$47.04
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$88.28
|
| Rate for Payer: Superior Health Plan EPO |
$47.04
|
| Rate for Payer: Superior Health Plan Medicare |
$47.04
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$47.04
|
| Rate for Payer: Universal American Medicare |
$47.04
|
| Rate for Payer: Wellcare Medicare |
$47.04
|
| Rate for Payer: Wellmed Medicare |
$47.04
|
|
|
Intravenous infusion, hydration; each additional hour (List separately in addition to code for prima
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 96361
|
| Hospital Charge Code |
36096361
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$15.21 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$47.04
|
| Rate for Payer: Amerigroup Medicare |
$47.04
|
| Rate for Payer: BCBS of TX Medicare |
$47.04
|
| Rate for Payer: Cigna Commercial |
$99.43
|
| Rate for Payer: Cigna Medicare |
$47.04
|
| Rate for Payer: Employer Direct Commercial |
$47.04
|
| Rate for Payer: Humana Medicare/TRICARE |
$47.04
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$47.04
|
| Rate for Payer: Molina Medicare |
$47.04
|
| 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: Scott and White EPO/PPO |
$15.21
|
| Rate for Payer: Scott and White Medicare |
$47.04
|
| Rate for Payer: Superior Health Plan EPO |
$47.04
|
| Rate for Payer: Superior Health Plan Medicare |
$47.04
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$47.04
|
| Rate for Payer: Universal American Medicare |
$47.04
|
| Rate for Payer: Wellcare Medicare |
$47.04
|
| Rate for Payer: Wellmed Medicare |
$47.04
|
|
|
Intravenous infusion, hydration; each additional hour (List separately in addition to code for prima
|
Facility
|
IP
|
$122.61
|
|
|
Service Code
|
HCPCS 96361
|
| Hospital Charge Code |
7003593
|
|
Hospital Revenue Code
|
260
|
| Rate for Payer: Cash Price |
$83.37
|
|
|
Intravenous infusion, hydration; each additional hour (List separately in addition to code for prima
|
Facility
|
OP
|
$122.61
|
|
|
Service Code
|
HCPCS 96361
|
| Hospital Charge Code |
7003593
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$11.03 |
| Max. Negotiated Rate |
$99.43 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$11.03
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$47.04
|
| Rate for Payer: Amerigroup Medicare |
$47.04
|
| Rate for Payer: BCBS of TX Blue Advantage |
$36.78
|
| Rate for Payer: BCBS of TX Blue Essentials |
$44.14
|
| Rate for Payer: BCBS of TX Medicare |
$47.04
|
| Rate for Payer: BCBS of TX PPO |
$49.04
|
| Rate for Payer: Cash Price |
$83.37
|
| Rate for Payer: Cash Price |
$83.37
|
| Rate for Payer: Cash Price |
$83.37
|
| Rate for Payer: Cigna Commercial |
$99.43
|
| Rate for Payer: Cigna Medicaid |
$88.28
|
| Rate for Payer: Cigna Medicare |
$47.04
|
| Rate for Payer: Employer Direct Commercial |
$47.04
|
| Rate for Payer: Humana Medicare/TRICARE |
$47.04
|
| Rate for Payer: Molina CHIP/Medicaid |
$88.28
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$47.04
|
| Rate for Payer: Molina Medicare |
$47.04
|
| Rate for Payer: Multiplan Auto |
$79.70
|
| Rate for Payer: Multiplan Commercial |
$79.70
|
| Rate for Payer: Multiplan Workers Comp |
$79.70
|
| Rate for Payer: Parkland Medicaid |
$88.28
|
| Rate for Payer: Scott and White EPO/PPO |
$15.21
|
| Rate for Payer: Scott and White Medicare |
$47.04
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$88.28
|
| Rate for Payer: Superior Health Plan EPO |
$47.04
|
| Rate for Payer: Superior Health Plan Medicare |
$47.04
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$47.04
|
| Rate for Payer: Universal American Medicare |
$47.04
|
| Rate for Payer: Wellcare Medicare |
$47.04
|
| Rate for Payer: Wellmed Medicare |
$47.04
|
|
|
Intravenous infusion, hydration; each additional hour (List separately in addition to code for prima
|
Facility
|
IP
|
$122.61
|
|
|
Service Code
|
HCPCS 96361
|
| Hospital Charge Code |
8932542
|
|
Hospital Revenue Code
|
260
|
| Rate for Payer: Cash Price |
$83.37
|
|
|
Intravenous infusion, hydration; initial, 31 minutes to 1 hour
|
Facility
|
IP
|
$626.79
|
|
|
Service Code
|
HCPCS 96360
|
| Hospital Charge Code |
9900910
|
|
Hospital Revenue Code
|
260
|
| Rate for Payer: Cash Price |
$426.22
|
|
