|
PT Therapeutic Exercise Units BCE
|
Facility
|
OP
|
$152.00
|
|
|
Service Code
|
CPT 97110 GP
|
| Hospital Charge Code |
4252025
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$13.68 |
| Max. Negotiated Rate |
$221.00 |
| Rate for Payer: Aetna Commercial |
$221.00
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$13.68
|
| Rate for Payer: BCBS of TX Blue Advantage |
$54.55
|
| Rate for Payer: BCBS of TX Blue Essentials |
$65.21
|
| Rate for Payer: BCBS of TX PPO |
$72.73
|
| Rate for Payer: Cash Price |
$133.76
|
| Rate for Payer: Cash Price |
$133.76
|
| Rate for Payer: Cash Price |
$133.76
|
| Rate for Payer: Cash Price |
$133.76
|
| Rate for Payer: Cigna Commercial |
$200.00
|
| Rate for Payer: Multiplan Auto |
$98.80
|
| Rate for Payer: Multiplan Commercial |
$98.80
|
| Rate for Payer: Multiplan Workers Comp |
$98.80
|
| Rate for Payer: Scott and White EPO/PPO |
$180.00
|
| Rate for Payer: Superior Health Plan EPO |
$20.67
|
|
|
PT Therapeutic Exercise Units BCE
|
Facility
|
IP
|
$152.00
|
|
|
Service Code
|
CPT 97110 GP
|
| Hospital Charge Code |
4252025
|
|
Hospital Revenue Code
|
420
|
| Rate for Payer: Cash Price |
$133.76
|
|
|
.PTT-LA Incub Mix 117035 SO
|
Facility
|
OP
|
$95.00
|
|
|
Service Code
|
CPT 85732
|
| Hospital Charge Code |
1600337
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$2.52 |
| Max. Negotiated Rate |
$61.75 |
| Rate for Payer: Aetna Commercial |
$6.79
|
| Rate for Payer: Aetna Medicare |
$9.70
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2.52
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$6.47
|
| Rate for Payer: Amerigroup Medicare |
$6.47
|
| Rate for Payer: BCBS of TX Blue Advantage |
$10.68
|
| Rate for Payer: BCBS of TX Blue Essentials |
$12.81
|
| Rate for Payer: BCBS of TX Medicare |
$6.47
|
| Rate for Payer: BCBS of TX PPO |
$14.30
|
| Rate for Payer: Cash Price |
$83.60
|
| Rate for Payer: Cash Price |
$83.60
|
| Rate for Payer: Cigna Medicaid |
$6.47
|
| Rate for Payer: Cigna Medicare |
$6.47
|
| Rate for Payer: Employer Direct Commercial |
$6.47
|
| Rate for Payer: Humana Medicare/TRICARE |
$6.47
|
| Rate for Payer: Molina CHIP/Medicaid |
$6.47
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$6.47
|
| Rate for Payer: Molina Medicare |
$6.47
|
| Rate for Payer: Multiplan Auto |
$61.75
|
| Rate for Payer: Multiplan Commercial |
$61.75
|
| Rate for Payer: Multiplan Workers Comp |
$61.75
|
| Rate for Payer: Parkland Medicaid |
$6.47
|
| Rate for Payer: Scott and White EPO/PPO |
$8.09
|
| Rate for Payer: Scott and White Medicare |
$6.47
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$6.47
|
| Rate for Payer: Superior Health Plan EPO |
$6.47
|
| Rate for Payer: Superior Health Plan Medicare |
$6.47
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$6.47
|
| Rate for Payer: Universal American Medicare |
$6.47
|
| Rate for Payer: Wellcare Medicare |
$6.47
|
| Rate for Payer: Wellmed Medicare |
$6.47
|
|
|
.PTT-LA Mix 117040 SO
|
Facility
|
OP
|
$95.00
|
|
|
Service Code
|
CPT 85732
|
| Hospital Charge Code |
1600337
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$2.52 |
| Max. Negotiated Rate |
$61.75 |
| Rate for Payer: Aetna Commercial |
$6.79
|
| Rate for Payer: Aetna Medicare |
$9.70
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2.52
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$6.47
|
| Rate for Payer: Amerigroup Medicare |
$6.47
|
| Rate for Payer: BCBS of TX Blue Advantage |
$10.68
|
| Rate for Payer: BCBS of TX Blue Essentials |
$12.81
|
| Rate for Payer: BCBS of TX Medicare |
$6.47
|
| Rate for Payer: BCBS of TX PPO |
$14.30
|
| Rate for Payer: Cash Price |
$83.60
|
| Rate for Payer: Cash Price |
$83.60
|
| Rate for Payer: Cigna Medicaid |
$6.47
|
| Rate for Payer: Cigna Medicare |
$6.47
|
| Rate for Payer: Employer Direct Commercial |
$6.47
|
| Rate for Payer: Humana Medicare/TRICARE |
$6.47
|
| Rate for Payer: Molina CHIP/Medicaid |
$6.47
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$6.47
|
| Rate for Payer: Molina Medicare |
$6.47
|
| Rate for Payer: Multiplan Auto |
$61.75
|
| Rate for Payer: Multiplan Commercial |
$61.75
|
| Rate for Payer: Multiplan Workers Comp |
$61.75
|
| Rate for Payer: Parkland Medicaid |
$6.47
|
| Rate for Payer: Scott and White EPO/PPO |
$8.09
|
| Rate for Payer: Scott and White Medicare |
$6.47
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$6.47
|
| Rate for Payer: Superior Health Plan EPO |
$6.47
|
| Rate for Payer: Superior Health Plan Medicare |
$6.47
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$6.47
|
| Rate for Payer: Universal American Medicare |
$6.47
|
| Rate for Payer: Wellcare Medicare |
$6.47
|
| Rate for Payer: Wellmed Medicare |
$6.47
|
|
|
.PTT-LA Mix 117040 SO
|
Facility
|
IP
|
$95.00
|
|
|
Service Code
|
CPT 85732
|
| Hospital Charge Code |
1600337
|
|
Hospital Revenue Code
|
305
|
| Rate for Payer: Cash Price |
$83.60
|
|
|
PT Ultrasound Assistant Units
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
CPT 97035 CQ,GP
|
| Hospital Charge Code |
4252060
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$9.90 |
| Max. Negotiated Rate |
$221.00 |
| Rate for Payer: Aetna Commercial |
$221.00
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$9.90
|
| Rate for Payer: BCBS of TX Blue Advantage |
$24.46
|
| Rate for Payer: BCBS of TX Blue Essentials |
$29.24
|
| Rate for Payer: BCBS of TX PPO |
$32.62
|
| Rate for Payer: Cash Price |
$96.80
|
| Rate for Payer: Cash Price |
$96.80
|
| Rate for Payer: Cash Price |
$96.80
|
| Rate for Payer: Cash Price |
$96.80
|
| Rate for Payer: Cigna Commercial |
$200.00
|
| Rate for Payer: Multiplan Auto |
$71.50
|
| Rate for Payer: Multiplan Commercial |
$71.50
|
| Rate for Payer: Multiplan Workers Comp |
$71.50
|
| Rate for Payer: Scott and White EPO/PPO |
$180.00
|
| Rate for Payer: Superior Health Plan EPO |
$14.96
|
|
|
PT Ultrasound Assistant Units BCE
|
Facility
|
IP
|
$110.00
|
|
|
Service Code
|
CPT 97035 CQ,GP
|
| Hospital Charge Code |
4252060
|
|
Hospital Revenue Code
|
420
|
| Rate for Payer: Cash Price |
$96.80
|
|
|
PT Ultrasound Assistant Units BCE
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
CPT 97035 CQ,GP
|
| Hospital Charge Code |
4252060
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$9.90 |
| Max. Negotiated Rate |
$221.00 |
| Rate for Payer: Aetna Commercial |
$221.00
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$9.90
|
| Rate for Payer: BCBS of TX Blue Advantage |
$24.46
|
| Rate for Payer: BCBS of TX Blue Essentials |
$29.24
|
| Rate for Payer: BCBS of TX PPO |
$32.62
|
| Rate for Payer: Cash Price |
$96.80
|
| Rate for Payer: Cash Price |
$96.80
|
| Rate for Payer: Cash Price |
$96.80
|
| Rate for Payer: Cash Price |
$96.80
|
| Rate for Payer: Cigna Commercial |
$200.00
|
| Rate for Payer: Multiplan Auto |
$71.50
|
| Rate for Payer: Multiplan Commercial |
$71.50
|
| Rate for Payer: Multiplan Workers Comp |
$71.50
|
| Rate for Payer: Scott and White EPO/PPO |
$180.00
|
| Rate for Payer: Superior Health Plan EPO |
$14.96
|
|
|
PT Ultrasound Units
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
CPT 97035 GP
|
| Hospital Charge Code |
4252024
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$9.90 |
| Max. Negotiated Rate |
$221.00 |
| Rate for Payer: Aetna Commercial |
$221.00
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$9.90
|
| Rate for Payer: BCBS of TX Blue Advantage |
$24.46
|
| Rate for Payer: BCBS of TX Blue Essentials |
$29.24
|
| Rate for Payer: BCBS of TX PPO |
$32.62
|
| Rate for Payer: Cash Price |
$96.80
|
| Rate for Payer: Cash Price |
$96.80
|
| Rate for Payer: Cash Price |
$96.80
|
| Rate for Payer: Cash Price |
$96.80
|
| Rate for Payer: Cigna Commercial |
$200.00
|
| Rate for Payer: Multiplan Auto |
$71.50
|
| Rate for Payer: Multiplan Commercial |
$71.50
|
| Rate for Payer: Multiplan Workers Comp |
$71.50
|
| Rate for Payer: Scott and White EPO/PPO |
$180.00
|
| Rate for Payer: Superior Health Plan EPO |
$14.96
|
|
|
PT Ultrasound Units BCE
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
CPT 97035 GP
|
| Hospital Charge Code |
4252024
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$9.90 |
| Max. Negotiated Rate |
$221.00 |
| Rate for Payer: Aetna Commercial |
$221.00
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$9.90
|
| Rate for Payer: BCBS of TX Blue Advantage |
$24.46
|
| Rate for Payer: BCBS of TX Blue Essentials |
$29.24
|
| Rate for Payer: BCBS of TX PPO |
$32.62
|
| Rate for Payer: Cash Price |
$96.80
|
| Rate for Payer: Cash Price |
$96.80
|
| Rate for Payer: Cash Price |
$96.80
|
| Rate for Payer: Cash Price |
$96.80
|
| Rate for Payer: Cigna Commercial |
$200.00
|
| Rate for Payer: Multiplan Auto |
$71.50
|
| Rate for Payer: Multiplan Commercial |
$71.50
|
| Rate for Payer: Multiplan Workers Comp |
$71.50
|
| Rate for Payer: Scott and White EPO/PPO |
$180.00
|
| Rate for Payer: Superior Health Plan EPO |
$14.96
|
|
|
PT Ultrasound Units BCE
|
Facility
|
IP
|
$110.00
|
|
|
Service Code
|
CPT 97035 GP
|
| Hospital Charge Code |
4252024
|
|
Hospital Revenue Code
|
420
|
| Rate for Payer: Cash Price |
$96.80
|
|
|
PT Unattended E-Stim Assistant Units
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
HCPCS G0283 CQ,GP
|
| Hospital Charge Code |
4252047
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$14.40 |
| Max. Negotiated Rate |
$200.00 |
| Rate for Payer: Aetna Commercial |
$88.00
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$14.40
|
| Rate for Payer: BCBS of TX Blue Advantage |
$25.09
|
| Rate for Payer: BCBS of TX Blue Essentials |
$29.99
|
| Rate for Payer: BCBS of TX PPO |
$33.45
|
| Rate for Payer: Cash Price |
$140.80
|
| Rate for Payer: Cash Price |
$140.80
|
| Rate for Payer: Cash Price |
$140.80
|
| Rate for Payer: Cash Price |
$140.80
|
| Rate for Payer: Cigna Commercial |
$200.00
|
| 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: Scott and White EPO/PPO |
$180.00
|
| Rate for Payer: Superior Health Plan EPO |
$21.76
|
|
|
PT Unattended E-Stim Assistant Units BCE
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
HCPCS G0283 CQ,GP
|
| Hospital Charge Code |
4252047
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$14.40 |
| Max. Negotiated Rate |
$200.00 |
| Rate for Payer: Aetna Commercial |
$88.00
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$14.40
|
| Rate for Payer: BCBS of TX Blue Advantage |
$25.09
|
| Rate for Payer: BCBS of TX Blue Essentials |
$29.99
|
| Rate for Payer: BCBS of TX PPO |
$33.45
|
| Rate for Payer: Cash Price |
$140.80
|
| Rate for Payer: Cash Price |
$140.80
|
| Rate for Payer: Cash Price |
$140.80
|
| Rate for Payer: Cash Price |
$140.80
|
| Rate for Payer: Cigna Commercial |
$200.00
|
| 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: Scott and White EPO/PPO |
$180.00
|
| Rate for Payer: Superior Health Plan EPO |
$21.76
|
|
|
PT Unattended E-Stim Assistant Units BCE
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
HCPCS G0283 CQ,GP
|
| Hospital Charge Code |
4252047
|
|
Hospital Revenue Code
|
420
|
| Rate for Payer: Cash Price |
$140.80
|
|
|
PT Unattended E-Stim Units
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
HCPCS G0283 GP
|
| Hospital Charge Code |
4252020
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$14.40 |
| Max. Negotiated Rate |
$200.00 |
| Rate for Payer: Aetna Commercial |
$88.00
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$14.40
|
| Rate for Payer: BCBS of TX Blue Advantage |
$25.09
|
| Rate for Payer: BCBS of TX Blue Essentials |
$29.99
|
| Rate for Payer: BCBS of TX PPO |
$33.45
|
| Rate for Payer: Cash Price |
$140.80
|
| Rate for Payer: Cash Price |
$140.80
|
| Rate for Payer: Cash Price |
$140.80
|
| Rate for Payer: Cash Price |
$140.80
|
| Rate for Payer: Cigna Commercial |
$200.00
|
| 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: Scott and White EPO/PPO |
$180.00
|
| Rate for Payer: Superior Health Plan EPO |
$21.76
|
|
|
PT Unattended E-Stim Units BCE
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
HCPCS G0283 GP
|
| Hospital Charge Code |
4252020
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$14.40 |
| Max. Negotiated Rate |
$200.00 |
| Rate for Payer: Aetna Commercial |
$88.00
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$14.40
|
| Rate for Payer: BCBS of TX Blue Advantage |
$25.09
|
| Rate for Payer: BCBS of TX Blue Essentials |
$29.99
|
| Rate for Payer: BCBS of TX PPO |
$33.45
|
| Rate for Payer: Cash Price |
$140.80
|
| Rate for Payer: Cash Price |
$140.80
|
| Rate for Payer: Cash Price |
$140.80
|
| Rate for Payer: Cash Price |
$140.80
|
| Rate for Payer: Cigna Commercial |
$200.00
|
| 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: Scott and White EPO/PPO |
$180.00
|
| Rate for Payer: Superior Health Plan EPO |
$21.76
|
|
|
PT Unattended E-Stim Units BCE
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
HCPCS G0283 GP
|
| Hospital Charge Code |
4252020
|
|
Hospital Revenue Code
|
420
|
| Rate for Payer: Cash Price |
$140.80
|
|
|
PT Work Hardening-Each Addl Hour Assistant Units
|
Facility
|
OP
|
$175.00
|
|
|
Service Code
|
CPT 97546 CQ,GP
|
| Hospital Charge Code |
5715508
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$15.75 |
| Max. Negotiated Rate |
$221.00 |
| Rate for Payer: Aetna Commercial |
$221.00
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$15.75
|
| Rate for Payer: BCBS of TX Blue Advantage |
$82.15
|
| Rate for Payer: BCBS of TX Blue Essentials |
$98.20
|
| Rate for Payer: BCBS of TX PPO |
$109.53
|
| Rate for Payer: Cash Price |
$154.00
|
| Rate for Payer: Cash Price |
$154.00
|
| Rate for Payer: Cash Price |
$154.00
|
| Rate for Payer: Cash Price |
$154.00
|
| Rate for Payer: Cigna Commercial |
$200.00
|
| Rate for Payer: Multiplan Auto |
$113.75
|
| Rate for Payer: Multiplan Commercial |
$113.75
|
| Rate for Payer: Multiplan Workers Comp |
$113.75
|
| Rate for Payer: Scott and White EPO/PPO |
$180.00
|
| Rate for Payer: Superior Health Plan EPO |
$23.80
|
|
|
PT Work Hardening-Each Addl Hour Assistant Units BCE
|
Facility
|
OP
|
$175.00
|
|
|
Service Code
|
CPT 97546 CQ,GP
|
| Hospital Charge Code |
5715508
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$15.75 |
| Max. Negotiated Rate |
$221.00 |
| Rate for Payer: Aetna Commercial |
$221.00
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$15.75
|
| Rate for Payer: BCBS of TX Blue Advantage |
$82.15
|
| Rate for Payer: BCBS of TX Blue Essentials |
$98.20
|
| Rate for Payer: BCBS of TX PPO |
$109.53
|
| Rate for Payer: Cash Price |
$154.00
|
| Rate for Payer: Cash Price |
$154.00
|
| Rate for Payer: Cash Price |
$154.00
|
| Rate for Payer: Cash Price |
$154.00
|
| Rate for Payer: Cigna Commercial |
$200.00
|
| Rate for Payer: Multiplan Auto |
$113.75
|
| Rate for Payer: Multiplan Commercial |
$113.75
|
| Rate for Payer: Multiplan Workers Comp |
$113.75
|
| Rate for Payer: Scott and White EPO/PPO |
$180.00
|
| Rate for Payer: Superior Health Plan EPO |
$23.80
|
|
|
PT Work Hardening-Each Addl Hour Assistant Units BCE
|
Facility
|
IP
|
$175.00
|
|
|
Service Code
|
CPT 97546 CQ,GP
|
| Hospital Charge Code |
5715508
|
|
Hospital Revenue Code
|
420
|
| Rate for Payer: Cash Price |
$154.00
|
|
|
PT Work Hardening-Each Addl Hour Units
|
Facility
|
OP
|
$175.00
|
|
|
Service Code
|
CPT 97546 GP
|
| Hospital Charge Code |
5715508
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$15.75 |
| Max. Negotiated Rate |
$221.00 |
| Rate for Payer: Aetna Commercial |
$221.00
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$15.75
|
| Rate for Payer: BCBS of TX Blue Advantage |
$82.15
|
| Rate for Payer: BCBS of TX Blue Essentials |
$98.20
|
| Rate for Payer: BCBS of TX PPO |
$109.53
|
| Rate for Payer: Cash Price |
$154.00
|
| Rate for Payer: Cash Price |
$154.00
|
| Rate for Payer: Cash Price |
$154.00
|
| Rate for Payer: Cash Price |
$154.00
|
| Rate for Payer: Cigna Commercial |
$200.00
|
| Rate for Payer: Multiplan Auto |
$113.75
|
| Rate for Payer: Multiplan Commercial |
$113.75
|
| Rate for Payer: Multiplan Workers Comp |
$113.75
|
| Rate for Payer: Scott and White EPO/PPO |
$180.00
|
| Rate for Payer: Superior Health Plan EPO |
$23.80
|
|
|
PT Work Hardening-Each Addl Hour Units BCE
|
Facility
|
OP
|
$175.00
|
|
|
Service Code
|
CPT 97546 GP
|
| Hospital Charge Code |
5715508
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$15.75 |
| Max. Negotiated Rate |
$221.00 |
| Rate for Payer: Aetna Commercial |
$221.00
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$15.75
|
| Rate for Payer: BCBS of TX Blue Advantage |
$82.15
|
| Rate for Payer: BCBS of TX Blue Essentials |
$98.20
|
| Rate for Payer: BCBS of TX PPO |
$109.53
|
| Rate for Payer: Cash Price |
$154.00
|
| Rate for Payer: Cash Price |
$154.00
|
| Rate for Payer: Cash Price |
$154.00
|
| Rate for Payer: Cash Price |
$154.00
|
| Rate for Payer: Cigna Commercial |
$200.00
|
| Rate for Payer: Multiplan Auto |
$113.75
|
| Rate for Payer: Multiplan Commercial |
$113.75
|
| Rate for Payer: Multiplan Workers Comp |
$113.75
|
| Rate for Payer: Scott and White EPO/PPO |
$180.00
|
| Rate for Payer: Superior Health Plan EPO |
$23.80
|
|
|
PULMONARY EDEMA AND RESPIRATORY FAILURE
|
Facility
|
IP
|
$23,408.00
|
|
|
Service Code
|
MSDRG 189
|
| Min. Negotiated Rate |
$10,436.10 |
| Max. Negotiated Rate |
$23,408.00 |
| Rate for Payer: Aetna Commercial |
$13,860.00
|
| Rate for Payer: Aetna Medicare |
$17,469.62
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$11,646.41
|
| Rate for Payer: Amerigroup Medicare |
$11,646.41
|
| Rate for Payer: BCBS of TX Blue Advantage |
$10,436.10
|
| Rate for Payer: BCBS of TX Blue Essentials |
$12,747.06
|
| Rate for Payer: BCBS of TX Medicare |
$11,646.41
|
| Rate for Payer: BCBS of TX PPO |
$14,163.95
|
| Rate for Payer: Cigna Commercial |
$15,868.16
|
| Rate for Payer: Cigna Medicare |
$11,646.41
|
| Rate for Payer: Employer Direct Commercial |
$11,646.41
|
| Rate for Payer: Humana Medicare/TRICARE |
$11,646.41
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$11,646.41
|
| Rate for Payer: Molina Medicare |
$11,646.41
|
| Rate for Payer: Multiplan Auto |
$23,408.00
|
| Rate for Payer: Multiplan Commercial |
$23,408.00
|
| Rate for Payer: Multiplan Workers Comp |
$23,408.00
|
| Rate for Payer: Scott and White EPO/PPO |
$10,780.00
|
| Rate for Payer: Scott and White Medicare |
$11,646.41
|
| Rate for Payer: Superior Health Plan EPO |
$11,646.41
|
| Rate for Payer: Superior Health Plan Medicare |
$11,646.41
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$11,646.41
|
| Rate for Payer: Universal American Medicare |
$11,646.41
|
| Rate for Payer: Wellcare Medicare |
$11,646.41
|
| Rate for Payer: Wellmed Medicare |
$11,646.41
|
|
|
PULMONARY EMBOLISM WITH MCC OR ACUTE COR PULMONALE
|
Facility
|
IP
|
$26,657.00
|
|
|
Service Code
|
MSDRG 175
|
| Min. Negotiated Rate |
$12,276.25 |
| Max. Negotiated Rate |
$26,657.00 |
| Rate for Payer: Aetna Commercial |
$15,783.75
|
| Rate for Payer: Aetna Medicare |
$19,300.00
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$12,866.67
|
| Rate for Payer: Amerigroup Medicare |
$12,866.67
|
| Rate for Payer: BCBS of TX Blue Advantage |
$12,657.48
|
| Rate for Payer: BCBS of TX Blue Essentials |
$15,116.30
|
| Rate for Payer: BCBS of TX Medicare |
$12,866.67
|
| Rate for Payer: BCBS of TX PPO |
$16,796.54
|
| Rate for Payer: Cigna Commercial |
$18,070.64
|
| Rate for Payer: Cigna Medicare |
$12,866.67
|
| Rate for Payer: Employer Direct Commercial |
$12,866.67
|
| Rate for Payer: Humana Medicare/TRICARE |
$12,866.67
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$12,866.67
|
| Rate for Payer: Molina Medicare |
$12,866.67
|
| Rate for Payer: Multiplan Auto |
$26,657.00
|
| Rate for Payer: Multiplan Commercial |
$26,657.00
|
| Rate for Payer: Multiplan Workers Comp |
$26,657.00
|
| Rate for Payer: Scott and White EPO/PPO |
$12,276.25
|
| Rate for Payer: Scott and White Medicare |
$12,866.67
|
| Rate for Payer: Superior Health Plan EPO |
$12,866.67
|
| Rate for Payer: Superior Health Plan Medicare |
$12,866.67
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$12,866.67
|
| Rate for Payer: Universal American Medicare |
$12,866.67
|
| Rate for Payer: Wellcare Medicare |
$12,866.67
|
| Rate for Payer: Wellmed Medicare |
$12,866.67
|
|
|
PULMONARY EMBOLISM WITHOUT MCC
|
Facility
|
IP
|
$15,496.40
|
|
|
Service Code
|
MSDRG 176
|
| Min. Negotiated Rate |
$7,136.50 |
| Max. Negotiated Rate |
$15,496.40 |
| Rate for Payer: Aetna Commercial |
$9,175.50
|
| Rate for Payer: Aetna Medicare |
$13,012.44
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$8,674.96
|
| Rate for Payer: Amerigroup Medicare |
$8,674.96
|
| Rate for Payer: BCBS of TX Blue Advantage |
$7,850.94
|
| Rate for Payer: BCBS of TX Blue Essentials |
$9,276.78
|
| Rate for Payer: BCBS of TX Medicare |
$8,674.96
|
| Rate for Payer: BCBS of TX PPO |
$10,307.93
|
| Rate for Payer: Cigna Commercial |
$10,504.93
|
| Rate for Payer: Cigna Medicare |
$8,674.96
|
| Rate for Payer: Employer Direct Commercial |
$8,674.96
|
| Rate for Payer: Humana Medicare/TRICARE |
$8,674.96
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$8,674.96
|
| Rate for Payer: Molina Medicare |
$8,674.96
|
| Rate for Payer: Multiplan Auto |
$15,496.40
|
| Rate for Payer: Multiplan Commercial |
$15,496.40
|
| Rate for Payer: Multiplan Workers Comp |
$15,496.40
|
| Rate for Payer: Scott and White EPO/PPO |
$7,136.50
|
| Rate for Payer: Scott and White Medicare |
$8,674.96
|
| Rate for Payer: Superior Health Plan EPO |
$8,674.96
|
| Rate for Payer: Superior Health Plan Medicare |
$8,674.96
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$8,674.96
|
| Rate for Payer: Universal American Medicare |
$8,674.96
|
| Rate for Payer: Wellcare Medicare |
$8,674.96
|
| Rate for Payer: Wellmed Medicare |
$8,674.96
|
|
