|
REPS TRNSV LD RT ATR/VNT
|
Facility
|
OP
|
$6,691.00
|
|
|
Service Code
|
CPT 33215
|
| Hospital Charge Code |
2312932
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$52.13 |
| Max. Negotiated Rate |
$6,983.63 |
| Rate for Payer: Aetna Commercial |
$4,635.00
|
| Rate for Payer: Aetna Medicare |
$4,372.65
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$602.19
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$2,915.10
|
| Rate for Payer: Amerigroup Medicare |
$2,915.10
|
| Rate for Payer: BCBS of TX Blue Advantage |
$4,628.04
|
| Rate for Payer: BCBS of TX Blue Essentials |
$5,542.56
|
| Rate for Payer: BCBS of TX Medicare |
$2,915.10
|
| Rate for Payer: BCBS of TX PPO |
$6,983.63
|
| Rate for Payer: Cash Price |
$5,888.08
|
| Rate for Payer: Cash Price |
$5,888.08
|
| Rate for Payer: Cash Price |
$5,888.08
|
| Rate for Payer: Cigna Commercial |
$6,603.56
|
| Rate for Payer: Cigna Medicaid |
$1,118.22
|
| Rate for Payer: Cigna Medicare |
$2,915.10
|
| Rate for Payer: Employer Direct Commercial |
$2,915.10
|
| Rate for Payer: Humana Medicare/TRICARE |
$2,915.10
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,118.22
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$2,915.10
|
| Rate for Payer: Molina Medicare |
$2,915.10
|
| Rate for Payer: Multiplan Auto |
$4,349.15
|
| Rate for Payer: Multiplan Commercial |
$4,349.15
|
| Rate for Payer: Multiplan Workers Comp |
$4,349.15
|
| Rate for Payer: Parkland Medicaid |
$1,118.22
|
| Rate for Payer: Scott and White EPO/PPO |
$52.13
|
| Rate for Payer: Scott and White Medicare |
$2,915.10
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,118.22
|
| Rate for Payer: Superior Health Plan EPO |
$2,915.10
|
| Rate for Payer: Superior Health Plan Medicare |
$2,915.10
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$2,915.10
|
| Rate for Payer: Universal American Medicare |
$2,915.10
|
| Rate for Payer: Wellcare Medicare |
$2,915.10
|
| Rate for Payer: Wellmed Medicare |
$2,915.10
|
|
|
REPS TRNSV LD RT ATR/VNT
|
Facility
|
IP
|
$6,691.00
|
|
|
Service Code
|
CPT 33215
|
| Hospital Charge Code |
2312932
|
|
Hospital Revenue Code
|
481
|
| Rate for Payer: Cash Price |
$5,888.08
|
|
|
Resection, condyle(s), distal end of phalanx, each toe
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 28153
|
| Hospital Charge Code |
36028153
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$65.29 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$3,090.00
|
| 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: 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 |
$65.29
|
| 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
|
|
|
RESP FUNCT OTH IND 15MIN Minutes
|
Facility
|
OP
|
$158.00
|
|
|
Service Code
|
HCPCS G0238
|
| Hospital Charge Code |
6030238
|
|
Hospital Revenue Code
|
419
|
| Min. Negotiated Rate |
$0.49 |
| Max. Negotiated Rate |
$102.70 |
| Rate for Payer: Aetna Commercial |
$86.90
|
| Rate for Payer: Aetna Medicare |
$40.84
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$14.22
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$27.23
|
| Rate for Payer: Amerigroup Medicare |
$27.23
|
| Rate for Payer: BCBS of TX Blue Advantage |
$17.56
|
| Rate for Payer: BCBS of TX Blue Essentials |
$20.99
|
| Rate for Payer: BCBS of TX Medicare |
$27.23
|
| Rate for Payer: BCBS of TX PPO |
$23.41
|
| Rate for Payer: Cash Price |
$139.04
|
| Rate for Payer: Cash Price |
$139.04
|
| Rate for Payer: Cash Price |
$139.04
|
| Rate for Payer: Cigna Commercial |
$61.69
|
| Rate for Payer: Cigna Medicare |
$27.23
|
| Rate for Payer: Employer Direct Commercial |
$27.23
|
| Rate for Payer: Humana Medicare/TRICARE |
$27.23
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$27.23
|
| Rate for Payer: Molina Medicare |
$27.23
|
| Rate for Payer: Multiplan Auto |
$102.70
|
| Rate for Payer: Multiplan Commercial |
$102.70
|
| Rate for Payer: Multiplan Workers Comp |
$102.70
|
| Rate for Payer: Scott and White EPO/PPO |
$0.49
|
| Rate for Payer: Scott and White Medicare |
$27.23
|
| Rate for Payer: Superior Health Plan EPO |
$27.23
|
| Rate for Payer: Superior Health Plan Medicare |
$27.23
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$27.23
|
| Rate for Payer: Universal American Medicare |
$27.23
|
| Rate for Payer: Wellcare Medicare |
$27.23
|
| Rate for Payer: Wellmed Medicare |
$27.23
|
|
|
Resp Funct Oth Ind 15Min Minutes BCE
|
Facility
|
OP
|
$158.00
|
|
|
Service Code
|
HCPCS G0238
|
| Hospital Charge Code |
6030238
|
|
Hospital Revenue Code
|
419
|
| Min. Negotiated Rate |
$0.49 |
| Max. Negotiated Rate |
$102.70 |
| Rate for Payer: Aetna Commercial |
$86.90
|
| Rate for Payer: Aetna Medicare |
$40.84
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$14.22
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$27.23
|
| Rate for Payer: Amerigroup Medicare |
$27.23
|
| Rate for Payer: BCBS of TX Blue Advantage |
$17.56
|
| Rate for Payer: BCBS of TX Blue Essentials |
$20.99
|
| Rate for Payer: BCBS of TX Medicare |
$27.23
|
| Rate for Payer: BCBS of TX PPO |
$23.41
|
| Rate for Payer: Cash Price |
$139.04
|
| Rate for Payer: Cash Price |
$139.04
|
| Rate for Payer: Cash Price |
$139.04
|
| Rate for Payer: Cigna Commercial |
$61.69
|
| Rate for Payer: Cigna Medicare |
$27.23
|
| Rate for Payer: Employer Direct Commercial |
$27.23
|
| Rate for Payer: Humana Medicare/TRICARE |
$27.23
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$27.23
|
| Rate for Payer: Molina Medicare |
$27.23
|
| Rate for Payer: Multiplan Auto |
$102.70
|
| Rate for Payer: Multiplan Commercial |
$102.70
|
| Rate for Payer: Multiplan Workers Comp |
$102.70
|
| Rate for Payer: Scott and White EPO/PPO |
$0.49
|
| Rate for Payer: Scott and White Medicare |
$27.23
|
| Rate for Payer: Superior Health Plan EPO |
$27.23
|
| Rate for Payer: Superior Health Plan Medicare |
$27.23
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$27.23
|
| Rate for Payer: Universal American Medicare |
$27.23
|
| Rate for Payer: Wellcare Medicare |
$27.23
|
| Rate for Payer: Wellmed Medicare |
$27.23
|
|
|
Resp Funct Oth Ind 15Min Minutes BCE
|
Facility
|
IP
|
$158.00
|
|
|
Service Code
|
HCPCS G0238
|
| Hospital Charge Code |
6030238
|
|
Hospital Revenue Code
|
419
|
| Rate for Payer: Cash Price |
$139.04
|
|
|
Respiratory Culture
|
Facility
|
IP
|
$309.00
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
4107033
|
|
Hospital Revenue Code
|
306
|
| Rate for Payer: Cash Price |
$271.92
|
|
|
Respiratory Culture
|
Facility
|
OP
|
$309.00
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
4107033
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.36 |
| Max. Negotiated Rate |
$200.85 |
| Rate for Payer: Aetna Commercial |
$9.05
|
| Rate for Payer: Aetna Medicare |
$12.93
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$3.36
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$8.62
|
| Rate for Payer: Amerigroup Medicare |
$8.62
|
| Rate for Payer: BCBS of TX Blue Advantage |
$14.22
|
| Rate for Payer: BCBS of TX Blue Essentials |
$17.07
|
| Rate for Payer: BCBS of TX Medicare |
$8.62
|
| Rate for Payer: BCBS of TX PPO |
$19.05
|
| Rate for Payer: Cash Price |
$271.92
|
| Rate for Payer: Cash Price |
$271.92
|
| Rate for Payer: Cigna Medicaid |
$8.62
|
| Rate for Payer: Cigna Medicare |
$8.62
|
| Rate for Payer: Employer Direct Commercial |
$8.62
|
| Rate for Payer: Humana Medicare/TRICARE |
$8.62
|
| Rate for Payer: Molina CHIP/Medicaid |
$8.62
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$8.62
|
| Rate for Payer: Molina Medicare |
$8.62
|
| Rate for Payer: Multiplan Auto |
$200.85
|
| Rate for Payer: Multiplan Commercial |
$200.85
|
| Rate for Payer: Multiplan Workers Comp |
$200.85
|
| Rate for Payer: Parkland Medicaid |
$8.62
|
| Rate for Payer: Scott and White EPO/PPO |
$10.78
|
| Rate for Payer: Scott and White Medicare |
$8.62
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$8.62
|
| Rate for Payer: Superior Health Plan EPO |
$8.62
|
| Rate for Payer: Superior Health Plan Medicare |
$8.62
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$8.62
|
| Rate for Payer: Universal American Medicare |
$8.62
|
| Rate for Payer: Wellcare Medicare |
$8.62
|
| Rate for Payer: Wellmed Medicare |
$8.62
|
|
|
RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH CC
|
Facility
|
IP
|
$18,747.30
|
|
|
Service Code
|
MSDRG 178
|
| Min. Negotiated Rate |
$8,633.62 |
| Max. Negotiated Rate |
$18,747.30 |
| Rate for Payer: Aetna Commercial |
$11,100.38
|
| Rate for Payer: Aetna Medicare |
$14,843.90
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$9,895.93
|
| Rate for Payer: Amerigroup Medicare |
$9,895.93
|
| Rate for Payer: BCBS of TX Blue Advantage |
$11,392.42
|
| Rate for Payer: BCBS of TX Blue Essentials |
$13,150.53
|
| Rate for Payer: BCBS of TX Medicare |
$9,895.93
|
| Rate for Payer: BCBS of TX PPO |
$14,612.27
|
| Rate for Payer: Cigna Commercial |
$12,708.70
|
| Rate for Payer: Cigna Medicare |
$9,895.93
|
| Rate for Payer: Employer Direct Commercial |
$9,895.93
|
| Rate for Payer: Humana Medicare/TRICARE |
$9,895.93
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$9,895.93
|
| Rate for Payer: Molina Medicare |
$9,895.93
|
| Rate for Payer: Multiplan Auto |
$18,747.30
|
| Rate for Payer: Multiplan Commercial |
$18,747.30
|
| Rate for Payer: Multiplan Workers Comp |
$18,747.30
|
| Rate for Payer: Scott and White EPO/PPO |
$8,633.62
|
| Rate for Payer: Scott and White Medicare |
$9,895.93
|
| Rate for Payer: Superior Health Plan EPO |
$9,895.93
|
| Rate for Payer: Superior Health Plan Medicare |
$9,895.93
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$9,895.93
|
| Rate for Payer: Universal American Medicare |
$9,895.93
|
| Rate for Payer: Wellcare Medicare |
$9,895.93
|
| Rate for Payer: Wellmed Medicare |
$9,895.93
|
|
|
RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH MCC
|
Facility
|
IP
|
$32,231.60
|
|
|
Service Code
|
MSDRG 177
|
| Min. Negotiated Rate |
$14,843.50 |
| Max. Negotiated Rate |
$32,231.60 |
| Rate for Payer: Aetna Commercial |
$19,084.50
|
| Rate for Payer: Aetna Medicare |
$22,440.60
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$14,960.40
|
| Rate for Payer: Amerigroup Medicare |
$14,960.40
|
| Rate for Payer: BCBS of TX Blue Advantage |
$16,057.92
|
| Rate for Payer: BCBS of TX Blue Essentials |
$18,995.22
|
| Rate for Payer: BCBS of TX Medicare |
$14,960.40
|
| Rate for Payer: BCBS of TX PPO |
$21,106.61
|
| Rate for Payer: Cigna Commercial |
$21,849.63
|
| Rate for Payer: Cigna Medicare |
$14,960.40
|
| Rate for Payer: Employer Direct Commercial |
$14,960.40
|
| Rate for Payer: Humana Medicare/TRICARE |
$14,960.40
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$14,960.40
|
| Rate for Payer: Molina Medicare |
$14,960.40
|
| Rate for Payer: Multiplan Auto |
$32,231.60
|
| Rate for Payer: Multiplan Commercial |
$32,231.60
|
| Rate for Payer: Multiplan Workers Comp |
$32,231.60
|
| Rate for Payer: Scott and White EPO/PPO |
$14,843.50
|
| Rate for Payer: Scott and White Medicare |
$14,960.40
|
| Rate for Payer: Superior Health Plan EPO |
$14,960.40
|
| Rate for Payer: Superior Health Plan Medicare |
$14,960.40
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$14,960.40
|
| Rate for Payer: Universal American Medicare |
$14,960.40
|
| Rate for Payer: Wellcare Medicare |
$14,960.40
|
| Rate for Payer: Wellmed Medicare |
$14,960.40
|
|
|
RESPIRATORY INFECTIONS AND INFLAMMATIONS WITHOUT CC/MCC
|
Facility
|
IP
|
$14,502.70
|
|
|
Service Code
|
MSDRG 179
|
| Min. Negotiated Rate |
$6,678.88 |
| Max. Negotiated Rate |
$14,502.70 |
| Rate for Payer: Aetna Commercial |
$8,587.12
|
| Rate for Payer: Aetna Medicare |
$12,452.61
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$8,301.74
|
| Rate for Payer: Amerigroup Medicare |
$8,301.74
|
| Rate for Payer: BCBS of TX Blue Advantage |
$8,019.50
|
| Rate for Payer: BCBS of TX Blue Essentials |
$9,508.96
|
| Rate for Payer: BCBS of TX Medicare |
$8,301.74
|
| Rate for Payer: BCBS of TX PPO |
$10,565.92
|
| Rate for Payer: Cigna Commercial |
$9,831.30
|
| Rate for Payer: Cigna Medicare |
$8,301.74
|
| Rate for Payer: Employer Direct Commercial |
$8,301.74
|
| Rate for Payer: Humana Medicare/TRICARE |
$8,301.74
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$8,301.74
|
| Rate for Payer: Molina Medicare |
$8,301.74
|
| Rate for Payer: Multiplan Auto |
$14,502.70
|
| Rate for Payer: Multiplan Commercial |
$14,502.70
|
| Rate for Payer: Multiplan Workers Comp |
$14,502.70
|
| Rate for Payer: Scott and White EPO/PPO |
$6,678.88
|
| Rate for Payer: Scott and White Medicare |
$8,301.74
|
| Rate for Payer: Superior Health Plan EPO |
$8,301.74
|
| Rate for Payer: Superior Health Plan Medicare |
$8,301.74
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$8,301.74
|
| Rate for Payer: Universal American Medicare |
$8,301.74
|
| Rate for Payer: Wellcare Medicare |
$8,301.74
|
| Rate for Payer: Wellmed Medicare |
$8,301.74
|
|
|
RESPIRATORY NEOPLASMS WITH CC
|
Facility
|
IP
|
$20,920.90
|
|
|
Service Code
|
MSDRG 181
|
| Min. Negotiated Rate |
$9,634.62 |
| Max. Negotiated Rate |
$20,920.90 |
| Rate for Payer: Aetna Commercial |
$12,387.38
|
| Rate for Payer: Aetna Medicare |
$16,068.44
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$10,712.29
|
| Rate for Payer: Amerigroup Medicare |
$10,712.29
|
| Rate for Payer: BCBS of TX Blue Advantage |
$10,007.82
|
| Rate for Payer: BCBS of TX Blue Essentials |
$11,772.95
|
| Rate for Payer: BCBS of TX Medicare |
$10,712.29
|
| Rate for Payer: BCBS of TX PPO |
$13,081.56
|
| Rate for Payer: Cigna Commercial |
$14,182.17
|
| Rate for Payer: Cigna Medicare |
$10,712.29
|
| Rate for Payer: Employer Direct Commercial |
$10,712.29
|
| Rate for Payer: Humana Medicare/TRICARE |
$10,712.29
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$10,712.29
|
| Rate for Payer: Molina Medicare |
$10,712.29
|
| Rate for Payer: Multiplan Auto |
$20,920.90
|
| Rate for Payer: Multiplan Commercial |
$20,920.90
|
| Rate for Payer: Multiplan Workers Comp |
$20,920.90
|
| Rate for Payer: Scott and White EPO/PPO |
$9,634.62
|
| Rate for Payer: Scott and White Medicare |
$10,712.29
|
| Rate for Payer: Superior Health Plan EPO |
$10,712.29
|
| Rate for Payer: Superior Health Plan Medicare |
$10,712.29
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$10,712.29
|
| Rate for Payer: Universal American Medicare |
$10,712.29
|
| Rate for Payer: Wellcare Medicare |
$10,712.29
|
| Rate for Payer: Wellmed Medicare |
$10,712.29
|
|
|
RESPIRATORY NEOPLASMS WITH MCC
|
Facility
|
IP
|
$33,025.80
|
|
|
Service Code
|
MSDRG 180
|
| Min. Negotiated Rate |
$14,599.36 |
| Max. Negotiated Rate |
$33,025.80 |
| Rate for Payer: Aetna Commercial |
$19,554.75
|
| Rate for Payer: Aetna Medicare |
$22,888.04
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$15,258.69
|
| Rate for Payer: Amerigroup Medicare |
$15,258.69
|
| Rate for Payer: BCBS of TX Blue Advantage |
$14,599.36
|
| Rate for Payer: BCBS of TX Blue Essentials |
$17,501.02
|
| Rate for Payer: BCBS of TX Medicare |
$15,258.69
|
| Rate for Payer: BCBS of TX PPO |
$19,446.34
|
| Rate for Payer: Cigna Commercial |
$22,388.02
|
| Rate for Payer: Cigna Medicare |
$15,258.69
|
| Rate for Payer: Employer Direct Commercial |
$15,258.69
|
| Rate for Payer: Humana Medicare/TRICARE |
$15,258.69
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$15,258.69
|
| Rate for Payer: Molina Medicare |
$15,258.69
|
| Rate for Payer: Multiplan Auto |
$33,025.80
|
| Rate for Payer: Multiplan Commercial |
$33,025.80
|
| Rate for Payer: Multiplan Workers Comp |
$33,025.80
|
| Rate for Payer: Scott and White EPO/PPO |
$15,209.25
|
| Rate for Payer: Scott and White Medicare |
$15,258.69
|
| Rate for Payer: Superior Health Plan EPO |
$15,258.69
|
| Rate for Payer: Superior Health Plan Medicare |
$15,258.69
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$15,258.69
|
| Rate for Payer: Universal American Medicare |
$15,258.69
|
| Rate for Payer: Wellcare Medicare |
$15,258.69
|
| Rate for Payer: Wellmed Medicare |
$15,258.69
|
|
|
RESPIRATORY NEOPLASMS WITHOUT CC/MCC
|
Facility
|
IP
|
$14,421.00
|
|
|
Service Code
|
MSDRG 182
|
| Min. Negotiated Rate |
$6,641.25 |
| Max. Negotiated Rate |
$14,421.00 |
| Rate for Payer: Aetna Commercial |
$8,538.75
|
| Rate for Payer: Aetna Medicare |
$12,832.60
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$8,555.07
|
| Rate for Payer: Amerigroup Medicare |
$8,555.07
|
| Rate for Payer: BCBS of TX Blue Advantage |
$7,023.62
|
| Rate for Payer: BCBS of TX Blue Essentials |
$8,204.64
|
| Rate for Payer: BCBS of TX Medicare |
$8,555.07
|
| Rate for Payer: BCBS of TX PPO |
$9,116.62
|
| Rate for Payer: Cigna Commercial |
$9,775.92
|
| Rate for Payer: Cigna Medicare |
$8,555.07
|
| Rate for Payer: Employer Direct Commercial |
$8,555.07
|
| Rate for Payer: Humana Medicare/TRICARE |
$8,555.07
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$8,555.07
|
| Rate for Payer: Molina Medicare |
$8,555.07
|
| Rate for Payer: Multiplan Auto |
$14,421.00
|
| Rate for Payer: Multiplan Commercial |
$14,421.00
|
| Rate for Payer: Multiplan Workers Comp |
$14,421.00
|
| Rate for Payer: Scott and White EPO/PPO |
$6,641.25
|
| Rate for Payer: Scott and White Medicare |
$8,555.07
|
| Rate for Payer: Superior Health Plan EPO |
$8,555.07
|
| Rate for Payer: Superior Health Plan Medicare |
$8,555.07
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$8,555.07
|
| Rate for Payer: Universal American Medicare |
$8,555.07
|
| Rate for Payer: Wellcare Medicare |
$8,555.07
|
| Rate for Payer: Wellmed Medicare |
$8,555.07
|
|
|
Respiratory Profile, PCR SO
|
Facility
|
IP
|
$348.00
|
|
|
Service Code
|
CPT 87581
|
| Hospital Charge Code |
1709070
|
|
Hospital Revenue Code
|
306
|
| Rate for Payer: Cash Price |
$306.24
|
|
|
Respiratory Profile, PCR SO
|
Facility
|
OP
|
$348.00
|
|
|
Service Code
|
CPT 87581
|
| Hospital Charge Code |
1709070
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$13.69 |
| Max. Negotiated Rate |
$226.20 |
| Rate for Payer: Aetna Commercial |
$36.84
|
| Rate for Payer: Aetna Medicare |
$52.64
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$13.69
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$35.09
|
| Rate for Payer: Amerigroup Medicare |
$35.09
|
| Rate for Payer: BCBS of TX Blue Advantage |
$57.90
|
| Rate for Payer: BCBS of TX Blue Essentials |
$69.48
|
| Rate for Payer: BCBS of TX Medicare |
$35.09
|
| Rate for Payer: BCBS of TX PPO |
$77.55
|
| Rate for Payer: Cash Price |
$306.24
|
| Rate for Payer: Cash Price |
$306.24
|
| Rate for Payer: Cigna Medicaid |
$35.09
|
| Rate for Payer: Cigna Medicare |
$35.09
|
| Rate for Payer: Employer Direct Commercial |
$35.09
|
| Rate for Payer: Humana Medicare/TRICARE |
$35.09
|
| Rate for Payer: Molina CHIP/Medicaid |
$35.09
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$35.09
|
| Rate for Payer: Molina Medicare |
$35.09
|
| Rate for Payer: Multiplan Auto |
$226.20
|
| Rate for Payer: Multiplan Commercial |
$226.20
|
| Rate for Payer: Multiplan Workers Comp |
$226.20
|
| Rate for Payer: Parkland Medicaid |
$35.09
|
| Rate for Payer: Scott and White EPO/PPO |
$43.86
|
| Rate for Payer: Scott and White Medicare |
$35.09
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$35.09
|
| Rate for Payer: Superior Health Plan EPO |
$35.09
|
| Rate for Payer: Superior Health Plan Medicare |
$35.09
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$35.09
|
| Rate for Payer: Universal American Medicare |
$35.09
|
| Rate for Payer: Wellcare Medicare |
$35.09
|
| Rate for Payer: Wellmed Medicare |
$35.09
|
|
|
RESPIRATORY SIGNS AND SYMPTOMS
|
Facility
|
IP
|
$15,635.10
|
|
|
Service Code
|
MSDRG 204
|
| Min. Negotiated Rate |
$6,381.20 |
| Max. Negotiated Rate |
$15,635.10 |
| Rate for Payer: Aetna Commercial |
$9,257.62
|
| Rate for Payer: Aetna Medicare |
$13,090.54
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$8,727.03
|
| Rate for Payer: Amerigroup Medicare |
$8,727.03
|
| Rate for Payer: BCBS of TX Blue Advantage |
$6,381.20
|
| Rate for Payer: BCBS of TX Blue Essentials |
$7,920.86
|
| Rate for Payer: BCBS of TX Medicare |
$8,727.03
|
| Rate for Payer: BCBS of TX PPO |
$8,801.30
|
| Rate for Payer: Cigna Commercial |
$10,598.95
|
| Rate for Payer: Cigna Medicare |
$8,727.03
|
| Rate for Payer: Employer Direct Commercial |
$8,727.03
|
| Rate for Payer: Humana Medicare/TRICARE |
$8,727.03
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$8,727.03
|
| Rate for Payer: Molina Medicare |
$8,727.03
|
| Rate for Payer: Multiplan Auto |
$15,635.10
|
| Rate for Payer: Multiplan Commercial |
$15,635.10
|
| Rate for Payer: Multiplan Workers Comp |
$15,635.10
|
| Rate for Payer: Scott and White EPO/PPO |
$7,200.38
|
| Rate for Payer: Scott and White Medicare |
$8,727.03
|
| Rate for Payer: Superior Health Plan EPO |
$8,727.03
|
| Rate for Payer: Superior Health Plan Medicare |
$8,727.03
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$8,727.03
|
| Rate for Payer: Universal American Medicare |
$8,727.03
|
| Rate for Payer: Wellcare Medicare |
$8,727.03
|
| Rate for Payer: Wellmed Medicare |
$8,727.03
|
|
|
Respiratory Syncytial Virus
|
Facility
|
OP
|
$202.00
|
|
|
Service Code
|
CPT 87807
|
| Hospital Charge Code |
1604271
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$5.11 |
| Max. Negotiated Rate |
$131.30 |
| Rate for Payer: Aetna Commercial |
$13.76
|
| Rate for Payer: Aetna Medicare |
$19.65
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$5.11
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$13.10
|
| Rate for Payer: Amerigroup Medicare |
$13.10
|
| Rate for Payer: BCBS of TX Blue Advantage |
$21.62
|
| Rate for Payer: BCBS of TX Blue Essentials |
$25.94
|
| Rate for Payer: BCBS of TX Medicare |
$13.10
|
| Rate for Payer: BCBS of TX PPO |
$28.95
|
| Rate for Payer: Cash Price |
$177.76
|
| Rate for Payer: Cash Price |
$177.76
|
| Rate for Payer: Cigna Medicaid |
$13.10
|
| Rate for Payer: Cigna Medicare |
$13.10
|
| Rate for Payer: Employer Direct Commercial |
$13.10
|
| Rate for Payer: Humana Medicare/TRICARE |
$13.10
|
| Rate for Payer: Molina CHIP/Medicaid |
$13.10
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$13.10
|
| Rate for Payer: Molina Medicare |
$13.10
|
| Rate for Payer: Multiplan Auto |
$131.30
|
| Rate for Payer: Multiplan Commercial |
$131.30
|
| Rate for Payer: Multiplan Workers Comp |
$131.30
|
| Rate for Payer: Parkland Medicaid |
$13.10
|
| Rate for Payer: Scott and White EPO/PPO |
$16.38
|
| Rate for Payer: Scott and White Medicare |
$13.10
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$13.10
|
| Rate for Payer: Superior Health Plan EPO |
$13.10
|
| Rate for Payer: Superior Health Plan Medicare |
$13.10
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$13.10
|
| Rate for Payer: Universal American Medicare |
$13.10
|
| Rate for Payer: Wellcare Medicare |
$13.10
|
| Rate for Payer: Wellmed Medicare |
$13.10
|
|
|
Respiratory Syncytial Virus
|
Facility
|
IP
|
$202.00
|
|
|
Service Code
|
CPT 87807
|
| Hospital Charge Code |
1604271
|
|
Hospital Revenue Code
|
306
|
| Rate for Payer: Cash Price |
$177.76
|
|
|
RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT <=96 HOURS
|
Facility
|
IP
|
$51,372.20
|
|
|
Service Code
|
MSDRG 208
|
| Min. Negotiated Rate |
$19,866.86 |
| Max. Negotiated Rate |
$51,372.20 |
| Rate for Payer: Aetna Commercial |
$30,417.75
|
| Rate for Payer: Aetna Medicare |
$33,223.90
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$22,149.27
|
| Rate for Payer: Amerigroup Medicare |
$22,149.27
|
| Rate for Payer: BCBS of TX Blue Advantage |
$19,866.86
|
| Rate for Payer: BCBS of TX Blue Essentials |
$25,151.53
|
| Rate for Payer: BCBS of TX Medicare |
$22,149.27
|
| Rate for Payer: BCBS of TX PPO |
$27,947.23
|
| Rate for Payer: Cigna Commercial |
$34,824.94
|
| Rate for Payer: Cigna Medicare |
$22,149.27
|
| Rate for Payer: Employer Direct Commercial |
$22,149.27
|
| Rate for Payer: Humana Medicare/TRICARE |
$22,149.27
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$22,149.27
|
| Rate for Payer: Molina Medicare |
$22,149.27
|
| Rate for Payer: Multiplan Auto |
$51,372.20
|
| Rate for Payer: Multiplan Commercial |
$51,372.20
|
| Rate for Payer: Multiplan Workers Comp |
$51,372.20
|
| Rate for Payer: Scott and White EPO/PPO |
$23,658.25
|
| Rate for Payer: Scott and White Medicare |
$22,149.27
|
| Rate for Payer: Superior Health Plan EPO |
$22,149.27
|
| Rate for Payer: Superior Health Plan Medicare |
$22,149.27
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$22,149.27
|
| Rate for Payer: Universal American Medicare |
$22,149.27
|
| Rate for Payer: Wellcare Medicare |
$22,149.27
|
| Rate for Payer: Wellmed Medicare |
$22,149.27
|
|
|
RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT >96 HOURS
|
Facility
|
IP
|
$131,252.00
|
|
|
Service Code
|
MSDRG 207
|
| Min. Negotiated Rate |
$45,893.04 |
| Max. Negotiated Rate |
$131,252.00 |
| Rate for Payer: Aetna Commercial |
$77,715.00
|
| Rate for Payer: Aetna Medicare |
$78,226.02
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$52,150.68
|
| Rate for Payer: Amerigroup Medicare |
$52,150.68
|
| Rate for Payer: BCBS of TX Blue Advantage |
$45,893.04
|
| Rate for Payer: BCBS of TX Blue Essentials |
$57,750.28
|
| Rate for Payer: BCBS of TX Medicare |
$52,150.68
|
| Rate for Payer: BCBS of TX PPO |
$64,169.47
|
| Rate for Payer: Cigna Commercial |
$88,975.04
|
| Rate for Payer: Cigna Medicare |
$52,150.68
|
| Rate for Payer: Employer Direct Commercial |
$52,150.68
|
| Rate for Payer: Humana Medicare/TRICARE |
$52,150.68
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$52,150.68
|
| Rate for Payer: Molina Medicare |
$52,150.68
|
| Rate for Payer: Multiplan Auto |
$131,252.00
|
| Rate for Payer: Multiplan Commercial |
$131,252.00
|
| Rate for Payer: Multiplan Workers Comp |
$131,252.00
|
| Rate for Payer: Scott and White EPO/PPO |
$60,445.00
|
| Rate for Payer: Scott and White Medicare |
$52,150.68
|
| Rate for Payer: Superior Health Plan EPO |
$52,150.68
|
| Rate for Payer: Superior Health Plan Medicare |
$52,150.68
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$52,150.68
|
| Rate for Payer: Universal American Medicare |
$52,150.68
|
| Rate for Payer: Wellcare Medicare |
$52,150.68
|
| Rate for Payer: Wellmed Medicare |
$52,150.68
|
|
|
RESPIRATORY THERAPY- EA 15 MIN Units
|
Facility
|
OP
|
$54.00
|
|
|
Service Code
|
HCPCS G0237
|
| Hospital Charge Code |
6030239
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$0.49 |
| Max. Negotiated Rate |
$61.69 |
| Rate for Payer: Aetna Commercial |
$29.70
|
| Rate for Payer: Aetna Medicare |
$40.84
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$4.86
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$27.23
|
| Rate for Payer: Amerigroup Medicare |
$27.23
|
| Rate for Payer: BCBS of TX Blue Advantage |
$16.93
|
| Rate for Payer: BCBS of TX Blue Essentials |
$20.24
|
| Rate for Payer: BCBS of TX Medicare |
$27.23
|
| Rate for Payer: BCBS of TX PPO |
$22.57
|
| Rate for Payer: Cash Price |
$47.52
|
| Rate for Payer: Cash Price |
$47.52
|
| Rate for Payer: Cash Price |
$47.52
|
| Rate for Payer: Cigna Commercial |
$61.69
|
| Rate for Payer: Cigna Medicare |
$27.23
|
| Rate for Payer: Employer Direct Commercial |
$27.23
|
| Rate for Payer: Humana Medicare/TRICARE |
$27.23
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$27.23
|
| Rate for Payer: Molina Medicare |
$27.23
|
| Rate for Payer: Multiplan Auto |
$35.10
|
| Rate for Payer: Multiplan Commercial |
$35.10
|
| Rate for Payer: Multiplan Workers Comp |
$35.10
|
| Rate for Payer: Scott and White EPO/PPO |
$0.49
|
| Rate for Payer: Scott and White Medicare |
$27.23
|
| Rate for Payer: Superior Health Plan EPO |
$27.23
|
| Rate for Payer: Superior Health Plan Medicare |
$27.23
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$27.23
|
| Rate for Payer: Universal American Medicare |
$27.23
|
| Rate for Payer: Wellcare Medicare |
$27.23
|
| Rate for Payer: Wellmed Medicare |
$27.23
|
|
|
RESPIRATORY THERAPY- EA 15 MIN Units
|
Facility
|
IP
|
$54.00
|
|
|
Service Code
|
HCPCS G0237
|
| Hospital Charge Code |
6030239
|
|
Hospital Revenue Code
|
410
|
| Rate for Payer: Cash Price |
$47.52
|
|
|
Respiratory Therapy- Ea 15 Min Units BCE
|
Facility
|
IP
|
$87.00
|
|
|
Service Code
|
HCPCS G0239
|
| Hospital Charge Code |
6030239
|
|
Hospital Revenue Code
|
410
|
| Rate for Payer: Cash Price |
$76.56
|
|
|
Respiratory Therapy- Ea 15 Min Units BCE
|
Facility
|
OP
|
$87.00
|
|
|
Service Code
|
HCPCS G0239
|
| Hospital Charge Code |
6030239
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$83.09 |
| Rate for Payer: Aetna Commercial |
$47.85
|
| Rate for Payer: Aetna Medicare |
$55.02
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$7.83
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$36.68
|
| Rate for Payer: Amerigroup Medicare |
$36.68
|
| Rate for Payer: BCBS of TX Blue Advantage |
$21.94
|
| Rate for Payer: BCBS of TX Blue Essentials |
$26.23
|
| Rate for Payer: BCBS of TX Medicare |
$36.68
|
| Rate for Payer: BCBS of TX PPO |
$29.26
|
| Rate for Payer: Cash Price |
$76.56
|
| Rate for Payer: Cash Price |
$76.56
|
| Rate for Payer: Cash Price |
$76.56
|
| Rate for Payer: Cigna Commercial |
$83.09
|
| Rate for Payer: Cigna Medicare |
$36.68
|
| Rate for Payer: Employer Direct Commercial |
$36.68
|
| Rate for Payer: Humana Medicare/TRICARE |
$36.68
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$36.68
|
| Rate for Payer: Molina Medicare |
$36.68
|
| Rate for Payer: Multiplan Auto |
$56.55
|
| Rate for Payer: Multiplan Commercial |
$56.55
|
| Rate for Payer: Multiplan Workers Comp |
$56.55
|
| Rate for Payer: Scott and White EPO/PPO |
$0.66
|
| Rate for Payer: Scott and White Medicare |
$36.68
|
| Rate for Payer: Superior Health Plan EPO |
$36.68
|
| Rate for Payer: Superior Health Plan Medicare |
$36.68
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$36.68
|
| Rate for Payer: Universal American Medicare |
$36.68
|
| Rate for Payer: Wellcare Medicare |
$36.68
|
| Rate for Payer: Wellmed Medicare |
$36.68
|
|
