|
sodium ferric gluconate complex 12.5 mg/mL IV Soln 5 mL
|
Facility
|
IP
|
$128.19
|
|
|
Service Code
|
HCPCS J2916
|
| Hospital Charge Code |
77820216
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.05 |
| Max. Negotiated Rate |
$64.10 |
| Rate for Payer: Cash Price |
$87.17
|
| Rate for Payer: Cigna Commercial |
$32.05
|
| Rate for Payer: Scott and White EPO/PPO |
$64.10
|
|
|
Sodium Level
|
Facility
|
IP
|
$172.00
|
|
|
Service Code
|
CPT 84295
|
| Hospital Charge Code |
1602234
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$151.36
|
|
|
Sodium Level
|
Facility
|
OP
|
$172.00
|
|
|
Service Code
|
CPT 84295
|
| Hospital Charge Code |
1602234
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.88 |
| Max. Negotiated Rate |
$111.80 |
| Rate for Payer: Aetna Commercial |
$5.06
|
| Rate for Payer: Aetna Medicare |
$7.22
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1.88
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$4.81
|
| Rate for Payer: Amerigroup Medicare |
$4.81
|
| Rate for Payer: BCBS of TX Blue Advantage |
$7.94
|
| Rate for Payer: BCBS of TX Blue Essentials |
$9.52
|
| Rate for Payer: BCBS of TX Medicare |
$4.81
|
| Rate for Payer: BCBS of TX PPO |
$10.63
|
| Rate for Payer: Cash Price |
$151.36
|
| Rate for Payer: Cash Price |
$151.36
|
| Rate for Payer: Cigna Medicaid |
$4.81
|
| Rate for Payer: Cigna Medicare |
$4.81
|
| Rate for Payer: Employer Direct Commercial |
$4.81
|
| Rate for Payer: Humana Medicare/TRICARE |
$4.81
|
| Rate for Payer: Molina CHIP/Medicaid |
$4.81
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$4.81
|
| Rate for Payer: Molina Medicare |
$4.81
|
| Rate for Payer: Multiplan Auto |
$111.80
|
| Rate for Payer: Multiplan Commercial |
$111.80
|
| Rate for Payer: Multiplan Workers Comp |
$111.80
|
| Rate for Payer: Parkland Medicaid |
$4.81
|
| Rate for Payer: Scott and White EPO/PPO |
$6.01
|
| Rate for Payer: Scott and White Medicare |
$4.81
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$4.81
|
| Rate for Payer: Superior Health Plan EPO |
$4.81
|
| Rate for Payer: Superior Health Plan Medicare |
$4.81
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$4.81
|
| Rate for Payer: Universal American Medicare |
$4.81
|
| Rate for Payer: Wellcare Medicare |
$4.81
|
| Rate for Payer: Wellmed Medicare |
$4.81
|
|
|
Sodium Level 24 Hour Urine
|
Facility
|
OP
|
$162.00
|
|
|
Service Code
|
CPT 84300
|
| Hospital Charge Code |
1601111
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.97 |
| Max. Negotiated Rate |
$105.30 |
| Rate for Payer: Aetna Commercial |
$5.32
|
| Rate for Payer: Aetna Medicare |
$7.59
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1.97
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$5.06
|
| Rate for Payer: Amerigroup Medicare |
$5.06
|
| Rate for Payer: BCBS of TX Blue Advantage |
$8.35
|
| Rate for Payer: BCBS of TX Blue Essentials |
$10.02
|
| Rate for Payer: BCBS of TX Medicare |
$5.06
|
| Rate for Payer: BCBS of TX PPO |
$11.18
|
| Rate for Payer: Cash Price |
$142.56
|
| Rate for Payer: Cash Price |
$142.56
|
| Rate for Payer: Cigna Medicaid |
$5.06
|
| Rate for Payer: Cigna Medicare |
$5.06
|
| Rate for Payer: Employer Direct Commercial |
$5.06
|
| Rate for Payer: Humana Medicare/TRICARE |
$5.06
|
| Rate for Payer: Molina CHIP/Medicaid |
$5.06
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$5.06
|
| Rate for Payer: Molina Medicare |
$5.06
|
| Rate for Payer: Multiplan Auto |
$105.30
|
| Rate for Payer: Multiplan Commercial |
$105.30
|
| Rate for Payer: Multiplan Workers Comp |
$105.30
|
| Rate for Payer: Parkland Medicaid |
$5.06
|
| Rate for Payer: Scott and White EPO/PPO |
$6.32
|
| Rate for Payer: Scott and White Medicare |
$5.06
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$5.06
|
| Rate for Payer: Superior Health Plan EPO |
$5.06
|
| Rate for Payer: Superior Health Plan Medicare |
$5.06
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$5.06
|
| Rate for Payer: Universal American Medicare |
$5.06
|
| Rate for Payer: Wellcare Medicare |
$5.06
|
| Rate for Payer: Wellmed Medicare |
$5.06
|
|
|
Sodium Level Urine
|
Facility
|
OP
|
$162.00
|
|
|
Service Code
|
CPT 84300
|
| Hospital Charge Code |
1601111
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.97 |
| Max. Negotiated Rate |
$105.30 |
| Rate for Payer: Aetna Commercial |
$5.32
|
| Rate for Payer: Aetna Medicare |
$7.59
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1.97
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$5.06
|
| Rate for Payer: Amerigroup Medicare |
$5.06
|
| Rate for Payer: BCBS of TX Blue Advantage |
$8.35
|
| Rate for Payer: BCBS of TX Blue Essentials |
$10.02
|
| Rate for Payer: BCBS of TX Medicare |
$5.06
|
| Rate for Payer: BCBS of TX PPO |
$11.18
|
| Rate for Payer: Cash Price |
$142.56
|
| Rate for Payer: Cash Price |
$142.56
|
| Rate for Payer: Cigna Medicaid |
$5.06
|
| Rate for Payer: Cigna Medicare |
$5.06
|
| Rate for Payer: Employer Direct Commercial |
$5.06
|
| Rate for Payer: Humana Medicare/TRICARE |
$5.06
|
| Rate for Payer: Molina CHIP/Medicaid |
$5.06
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$5.06
|
| Rate for Payer: Molina Medicare |
$5.06
|
| Rate for Payer: Multiplan Auto |
$105.30
|
| Rate for Payer: Multiplan Commercial |
$105.30
|
| Rate for Payer: Multiplan Workers Comp |
$105.30
|
| Rate for Payer: Parkland Medicaid |
$5.06
|
| Rate for Payer: Scott and White EPO/PPO |
$6.32
|
| Rate for Payer: Scott and White Medicare |
$5.06
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$5.06
|
| Rate for Payer: Superior Health Plan EPO |
$5.06
|
| Rate for Payer: Superior Health Plan Medicare |
$5.06
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$5.06
|
| Rate for Payer: Universal American Medicare |
$5.06
|
| Rate for Payer: Wellcare Medicare |
$5.06
|
| Rate for Payer: Wellmed Medicare |
$5.06
|
|
|
Sodium Level Urine
|
Facility
|
IP
|
$162.00
|
|
|
Service Code
|
CPT 84300
|
| Hospital Charge Code |
1601111
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$142.56
|
|
|
sodium polystyrene sulfonate 15 g/60 mL Oral Susp 60 mL
|
Facility
|
IP
|
$51.60
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
77823134
|
|
Hospital Revenue Code
|
250
|
| Rate for Payer: Cash Price |
$35.09
|
|
|
sodium polystyrene sulfonate 15 g/60 mL Oral Susp 60 mL
|
Facility
|
OP
|
$51.60
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
77823134
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.64 |
| Max. Negotiated Rate |
$33.54 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$4.64
|
| Rate for Payer: BCBS of TX Blue Advantage |
$15.48
|
| Rate for Payer: BCBS of TX Blue Essentials |
$18.58
|
| Rate for Payer: BCBS of TX PPO |
$20.64
|
| Rate for Payer: Cash Price |
$35.09
|
| Rate for Payer: Multiplan Auto |
$33.54
|
| Rate for Payer: Multiplan Commercial |
$33.54
|
| Rate for Payer: Multiplan Workers Comp |
$33.54
|
| Rate for Payer: Scott and White EPO/PPO |
$25.80
|
| Rate for Payer: Superior Health Plan EPO |
$7.02
|
|
|
SOFT TISSUE PROCEDURES WITH CC
|
Facility
|
IP
|
$32,978.30
|
|
|
Service Code
|
MSDRG 501
|
| Min. Negotiated Rate |
$14,049.82 |
| Max. Negotiated Rate |
$32,978.30 |
| Rate for Payer: Aetna Commercial |
$19,526.62
|
| Rate for Payer: Aetna Medicare |
$22,861.24
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$15,240.83
|
| Rate for Payer: Amerigroup Medicare |
$15,240.83
|
| Rate for Payer: BCBS of TX Blue Advantage |
$14,049.82
|
| Rate for Payer: BCBS of TX Blue Essentials |
$17,412.28
|
| Rate for Payer: BCBS of TX Medicare |
$15,240.83
|
| Rate for Payer: BCBS of TX PPO |
$19,347.73
|
| Rate for Payer: Cigna Commercial |
$22,355.82
|
| Rate for Payer: Cigna Medicare |
$15,240.83
|
| Rate for Payer: Employer Direct Commercial |
$15,240.83
|
| Rate for Payer: Humana Medicare/TRICARE |
$15,240.83
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$15,240.83
|
| Rate for Payer: Molina Medicare |
$15,240.83
|
| Rate for Payer: Multiplan Auto |
$32,978.30
|
| Rate for Payer: Multiplan Commercial |
$32,978.30
|
| Rate for Payer: Multiplan Workers Comp |
$32,978.30
|
| Rate for Payer: Scott and White EPO/PPO |
$15,187.38
|
| Rate for Payer: Scott and White Medicare |
$15,240.83
|
| Rate for Payer: Superior Health Plan EPO |
$15,240.83
|
| Rate for Payer: Superior Health Plan Medicare |
$15,240.83
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$15,240.83
|
| Rate for Payer: Universal American Medicare |
$15,240.83
|
| Rate for Payer: Wellcare Medicare |
$15,240.83
|
| Rate for Payer: Wellmed Medicare |
$15,240.83
|
|
|
SOFT TISSUE PROCEDURES WITH MCC
|
Facility
|
IP
|
$61,613.20
|
|
|
Service Code
|
MSDRG 500
|
| Min. Negotiated Rate |
$25,995.60 |
| Max. Negotiated Rate |
$61,613.20 |
| Rate for Payer: Aetna Commercial |
$36,481.50
|
| Rate for Payer: Aetna Medicare |
$38,993.40
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$25,995.60
|
| Rate for Payer: Amerigroup Medicare |
$25,995.60
|
| Rate for Payer: BCBS of TX Blue Advantage |
$26,856.08
|
| Rate for Payer: BCBS of TX Blue Essentials |
$31,658.69
|
| Rate for Payer: BCBS of TX Medicare |
$25,995.60
|
| Rate for Payer: BCBS of TX PPO |
$35,177.69
|
| Rate for Payer: Cigna Commercial |
$41,767.26
|
| Rate for Payer: Cigna Medicare |
$25,995.60
|
| Rate for Payer: Employer Direct Commercial |
$25,995.60
|
| Rate for Payer: Humana Medicare/TRICARE |
$25,995.60
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$25,995.60
|
| Rate for Payer: Molina Medicare |
$25,995.60
|
| Rate for Payer: Multiplan Auto |
$61,613.20
|
| Rate for Payer: Multiplan Commercial |
$61,613.20
|
| Rate for Payer: Multiplan Workers Comp |
$61,613.20
|
| Rate for Payer: Scott and White EPO/PPO |
$28,374.50
|
| Rate for Payer: Scott and White Medicare |
$25,995.60
|
| Rate for Payer: Superior Health Plan EPO |
$25,995.60
|
| Rate for Payer: Superior Health Plan Medicare |
$25,995.60
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$25,995.60
|
| Rate for Payer: Universal American Medicare |
$25,995.60
|
| Rate for Payer: Wellcare Medicare |
$25,995.60
|
| Rate for Payer: Wellmed Medicare |
$25,995.60
|
|
|
SOFT TISSUE PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$26,271.30
|
|
|
Service Code
|
MSDRG 502
|
| Min. Negotiated Rate |
$10,344.94 |
| Max. Negotiated Rate |
$26,271.30 |
| Rate for Payer: Aetna Commercial |
$15,555.38
|
| Rate for Payer: Aetna Medicare |
$19,082.73
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$12,721.82
|
| Rate for Payer: Amerigroup Medicare |
$12,721.82
|
| Rate for Payer: BCBS of TX Blue Advantage |
$10,344.94
|
| Rate for Payer: BCBS of TX Blue Essentials |
$13,322.86
|
| Rate for Payer: BCBS of TX Medicare |
$12,721.82
|
| Rate for Payer: BCBS of TX PPO |
$14,803.75
|
| Rate for Payer: Cigna Commercial |
$17,809.18
|
| Rate for Payer: Cigna Medicare |
$12,721.82
|
| Rate for Payer: Employer Direct Commercial |
$12,721.82
|
| Rate for Payer: Humana Medicare/TRICARE |
$12,721.82
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$12,721.82
|
| Rate for Payer: Molina Medicare |
$12,721.82
|
| Rate for Payer: Multiplan Auto |
$26,271.30
|
| Rate for Payer: Multiplan Commercial |
$26,271.30
|
| Rate for Payer: Multiplan Workers Comp |
$26,271.30
|
| Rate for Payer: Scott and White EPO/PPO |
$12,098.62
|
| Rate for Payer: Scott and White Medicare |
$12,721.82
|
| Rate for Payer: Superior Health Plan EPO |
$12,721.82
|
| Rate for Payer: Superior Health Plan Medicare |
$12,721.82
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$12,721.82
|
| Rate for Payer: Universal American Medicare |
$12,721.82
|
| Rate for Payer: Wellcare Medicare |
$12,721.82
|
| Rate for Payer: Wellmed Medicare |
$12,721.82
|
|
|
SONIC ANCHOR SYSTEM
|
Facility
|
OP
|
$2,007.59
|
|
| Hospital Charge Code |
114023
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$180.68 |
| Max. Negotiated Rate |
$1,304.93 |
| Rate for Payer: Aetna Commercial |
$1,104.17
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$180.68
|
| Rate for Payer: BCBS of TX Blue Advantage |
$602.28
|
| Rate for Payer: BCBS of TX Blue Essentials |
$722.73
|
| Rate for Payer: BCBS of TX PPO |
$803.04
|
| Rate for Payer: Cash Price |
$1,766.68
|
| Rate for Payer: Multiplan Auto |
$1,304.93
|
| Rate for Payer: Multiplan Commercial |
$1,304.93
|
| Rate for Payer: Multiplan Workers Comp |
$1,304.93
|
| Rate for Payer: Scott and White EPO/PPO |
$1,003.80
|
| Rate for Payer: Superior Health Plan EPO |
$273.03
|
|
|
SONIC ANCHOR SYSTEM
|
Facility
|
IP
|
$2,007.59
|
|
| Hospital Charge Code |
114023
|
|
Hospital Revenue Code
|
272
|
| Rate for Payer: Cash Price |
$1,766.68
|
|
|
Sp bone algrft morsel add-on
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 20930
|
| Hospital Charge Code |
36020930
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$10,000.00 |
| Max. Negotiated Rate |
$10,000.00 |
| 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
|
|
|
Speed trap graft prepkit
|
Facility
|
IP
|
$490.32
|
|
| Hospital Charge Code |
8602528
|
|
Hospital Revenue Code
|
270
|
| Rate for Payer: Cash Price |
$431.48
|
|
|
Speed trap graft prepkit
|
Facility
|
OP
|
$490.32
|
|
| Hospital Charge Code |
8602528
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$44.13 |
| Max. Negotiated Rate |
$318.71 |
| Rate for Payer: Aetna Commercial |
$269.68
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$44.13
|
| Rate for Payer: BCBS of TX Blue Advantage |
$147.10
|
| Rate for Payer: BCBS of TX Blue Essentials |
$176.52
|
| Rate for Payer: BCBS of TX PPO |
$196.13
|
| Rate for Payer: Cash Price |
$431.48
|
| Rate for Payer: Multiplan Auto |
$318.71
|
| Rate for Payer: Multiplan Commercial |
$318.71
|
| Rate for Payer: Multiplan Workers Comp |
$318.71
|
| Rate for Payer: Scott and White EPO/PPO |
$245.16
|
| Rate for Payer: Superior Health Plan EPO |
$66.68
|
|
|
SPHINCTRTOME/HYDRATOME -- DHF
|
Facility
|
OP
|
$1,770.60
|
|
| Hospital Charge Code |
80341126
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$159.35 |
| Max. Negotiated Rate |
$1,150.89 |
| Rate for Payer: Aetna Commercial |
$973.83
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$159.35
|
| Rate for Payer: BCBS of TX Blue Advantage |
$531.18
|
| Rate for Payer: BCBS of TX Blue Essentials |
$637.42
|
| Rate for Payer: BCBS of TX PPO |
$708.24
|
| Rate for Payer: Cash Price |
$1,558.13
|
| Rate for Payer: Multiplan Auto |
$1,150.89
|
| Rate for Payer: Multiplan Commercial |
$1,150.89
|
| Rate for Payer: Multiplan Workers Comp |
$1,150.89
|
| Rate for Payer: Scott and White EPO/PPO |
$885.30
|
| Rate for Payer: Superior Health Plan EPO |
$240.80
|
|
|
SPHINCTRTOME/HYDRATOME -- DHF
|
Facility
|
IP
|
$1,770.60
|
|
| Hospital Charge Code |
80341126
|
|
Hospital Revenue Code
|
272
|
| Rate for Payer: Cash Price |
$1,558.13
|
|
|
SPINAL DISORDERS AND INJURIES WITH CC/MCC
|
Facility
|
IP
|
$36,945.50
|
|
|
Service Code
|
MSDRG 052
|
| Min. Negotiated Rate |
$13,629.28 |
| Max. Negotiated Rate |
$36,945.50 |
| Rate for Payer: Aetna Commercial |
$21,875.62
|
| Rate for Payer: Aetna Medicare |
$25,096.26
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$16,730.84
|
| Rate for Payer: Amerigroup Medicare |
$16,730.84
|
| Rate for Payer: BCBS of TX Blue Advantage |
$13,629.28
|
| Rate for Payer: BCBS of TX Blue Essentials |
$17,546.43
|
| Rate for Payer: BCBS of TX Medicare |
$16,730.84
|
| Rate for Payer: BCBS of TX PPO |
$19,496.79
|
| Rate for Payer: Cigna Commercial |
$25,045.16
|
| Rate for Payer: Cigna Medicare |
$16,730.84
|
| Rate for Payer: Employer Direct Commercial |
$16,730.84
|
| Rate for Payer: Humana Medicare/TRICARE |
$16,730.84
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$16,730.84
|
| Rate for Payer: Molina Medicare |
$16,730.84
|
| Rate for Payer: Multiplan Auto |
$36,945.50
|
| Rate for Payer: Multiplan Commercial |
$36,945.50
|
| Rate for Payer: Multiplan Workers Comp |
$36,945.50
|
| Rate for Payer: Scott and White EPO/PPO |
$17,014.38
|
| Rate for Payer: Scott and White Medicare |
$16,730.84
|
| Rate for Payer: Superior Health Plan EPO |
$16,730.84
|
| Rate for Payer: Superior Health Plan Medicare |
$16,730.84
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$16,730.84
|
| Rate for Payer: Universal American Medicare |
$16,730.84
|
| Rate for Payer: Wellcare Medicare |
$16,730.84
|
| Rate for Payer: Wellmed Medicare |
$16,730.84
|
|
|
SPINAL DISORDERS AND INJURIES WITHOUT CC/MCC
|
Facility
|
IP
|
$18,692.20
|
|
|
Service Code
|
MSDRG 053
|
| Min. Negotiated Rate |
$7,394.28 |
| Max. Negotiated Rate |
$18,692.20 |
| Rate for Payer: Aetna Commercial |
$11,067.75
|
| Rate for Payer: Aetna Medicare |
$14,812.88
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$9,875.25
|
| Rate for Payer: Amerigroup Medicare |
$9,875.25
|
| Rate for Payer: BCBS of TX Blue Advantage |
$7,394.28
|
| Rate for Payer: BCBS of TX Blue Essentials |
$9,432.60
|
| Rate for Payer: BCBS of TX Medicare |
$9,875.25
|
| Rate for Payer: BCBS of TX PPO |
$10,481.07
|
| Rate for Payer: Cigna Commercial |
$12,671.34
|
| Rate for Payer: Cigna Medicare |
$9,875.25
|
| Rate for Payer: Employer Direct Commercial |
$9,875.25
|
| Rate for Payer: Humana Medicare/TRICARE |
$9,875.25
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$9,875.25
|
| Rate for Payer: Molina Medicare |
$9,875.25
|
| Rate for Payer: Multiplan Auto |
$18,692.20
|
| Rate for Payer: Multiplan Commercial |
$18,692.20
|
| Rate for Payer: Multiplan Workers Comp |
$18,692.20
|
| Rate for Payer: Scott and White EPO/PPO |
$8,608.25
|
| Rate for Payer: Scott and White Medicare |
$9,875.25
|
| Rate for Payer: Superior Health Plan EPO |
$9,875.25
|
| Rate for Payer: Superior Health Plan Medicare |
$9,875.25
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$9,875.25
|
| Rate for Payer: Universal American Medicare |
$9,875.25
|
| Rate for Payer: Wellcare Medicare |
$9,875.25
|
| Rate for Payer: Wellmed Medicare |
$9,875.25
|
|
|
SPINAL FUSION EXCEPT CERVICAL WITH MCC
|
Facility
|
IP
|
$126,013.70
|
|
|
Service Code
|
MSDRG 459
|
| Min. Negotiated Rate |
$50,183.27 |
| Max. Negotiated Rate |
$126,013.70 |
| Rate for Payer: Aetna Commercial |
$74,613.38
|
| Rate for Payer: Aetna Medicare |
$75,274.90
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$50,183.27
|
| Rate for Payer: Amerigroup Medicare |
$50,183.27
|
| Rate for Payer: BCBS of TX Blue Advantage |
$56,357.52
|
| Rate for Payer: BCBS of TX Blue Essentials |
$65,884.75
|
| Rate for Payer: BCBS of TX Medicare |
$50,183.27
|
| Rate for Payer: BCBS of TX PPO |
$73,208.12
|
| Rate for Payer: Cigna Commercial |
$85,424.02
|
| Rate for Payer: Cigna Medicare |
$50,183.27
|
| Rate for Payer: Employer Direct Commercial |
$50,183.27
|
| Rate for Payer: Humana Medicare/TRICARE |
$50,183.27
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$50,183.27
|
| Rate for Payer: Molina Medicare |
$50,183.27
|
| Rate for Payer: Multiplan Auto |
$126,013.70
|
| Rate for Payer: Multiplan Commercial |
$126,013.70
|
| Rate for Payer: Multiplan Workers Comp |
$126,013.70
|
| Rate for Payer: Scott and White EPO/PPO |
$58,032.62
|
| Rate for Payer: Scott and White Medicare |
$50,183.27
|
| Rate for Payer: Superior Health Plan EPO |
$50,183.27
|
| Rate for Payer: Superior Health Plan Medicare |
$50,183.27
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$50,183.27
|
| Rate for Payer: Universal American Medicare |
$50,183.27
|
| Rate for Payer: Wellcare Medicare |
$50,183.27
|
| Rate for Payer: Wellmed Medicare |
$50,183.27
|
|
|
SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC
|
Facility
|
IP
|
$69,500.10
|
|
|
Service Code
|
MSDRG 460
|
| Min. Negotiated Rate |
$28,957.79 |
| Max. Negotiated Rate |
$69,500.10 |
| Rate for Payer: Aetna Commercial |
$41,151.38
|
| Rate for Payer: Aetna Medicare |
$43,436.68
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$28,957.79
|
| Rate for Payer: Amerigroup Medicare |
$28,957.79
|
| Rate for Payer: BCBS of TX Blue Advantage |
$34,308.84
|
| Rate for Payer: BCBS of TX Blue Essentials |
$41,662.96
|
| Rate for Payer: BCBS of TX Medicare |
$28,957.79
|
| Rate for Payer: BCBS of TX PPO |
$46,293.98
|
| Rate for Payer: Cigna Commercial |
$47,113.75
|
| Rate for Payer: Cigna Medicare |
$28,957.79
|
| Rate for Payer: Employer Direct Commercial |
$28,957.79
|
| Rate for Payer: Humana Medicare/TRICARE |
$28,957.79
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$28,957.79
|
| Rate for Payer: Molina Medicare |
$28,957.79
|
| Rate for Payer: Multiplan Auto |
$69,500.10
|
| Rate for Payer: Multiplan Commercial |
$69,500.10
|
| Rate for Payer: Multiplan Workers Comp |
$69,500.10
|
| Rate for Payer: Scott and White EPO/PPO |
$32,006.62
|
| Rate for Payer: Scott and White Medicare |
$28,957.79
|
| Rate for Payer: Superior Health Plan EPO |
$28,957.79
|
| Rate for Payer: Superior Health Plan Medicare |
$28,957.79
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$28,957.79
|
| Rate for Payer: Universal American Medicare |
$28,957.79
|
| Rate for Payer: Wellcare Medicare |
$28,957.79
|
| Rate for Payer: Wellmed Medicare |
$28,957.79
|
|
|
SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITH CC
|
Facility
|
IP
|
$115,430.70
|
|
|
Service Code
|
MSDRG 457
|
| Min. Negotiated Rate |
$46,208.49 |
| Max. Negotiated Rate |
$115,430.70 |
| Rate for Payer: Aetna Commercial |
$68,347.12
|
| Rate for Payer: Aetna Medicare |
$69,312.74
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$46,208.49
|
| Rate for Payer: Amerigroup Medicare |
$46,208.49
|
| Rate for Payer: BCBS of TX Blue Advantage |
$60,649.78
|
| Rate for Payer: BCBS of TX Blue Essentials |
$67,533.73
|
| Rate for Payer: BCBS of TX Medicare |
$46,208.49
|
| Rate for Payer: BCBS of TX PPO |
$75,040.38
|
| Rate for Payer: Cigna Commercial |
$78,249.86
|
| Rate for Payer: Cigna Medicare |
$46,208.49
|
| Rate for Payer: Employer Direct Commercial |
$46,208.49
|
| Rate for Payer: Humana Medicare/TRICARE |
$46,208.49
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$46,208.49
|
| Rate for Payer: Molina Medicare |
$46,208.49
|
| Rate for Payer: Multiplan Auto |
$115,430.70
|
| Rate for Payer: Multiplan Commercial |
$115,430.70
|
| Rate for Payer: Multiplan Workers Comp |
$115,430.70
|
| Rate for Payer: Scott and White EPO/PPO |
$53,158.88
|
| Rate for Payer: Scott and White Medicare |
$46,208.49
|
| Rate for Payer: Superior Health Plan EPO |
$46,208.49
|
| Rate for Payer: Superior Health Plan Medicare |
$46,208.49
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$46,208.49
|
| Rate for Payer: Universal American Medicare |
$46,208.49
|
| Rate for Payer: Wellcare Medicare |
$46,208.49
|
| Rate for Payer: Wellmed Medicare |
$46,208.49
|
|
|
SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITH MCC
|
Facility
|
IP
|
$160,158.60
|
|
|
Service Code
|
MSDRG 456
|
| Min. Negotiated Rate |
$63,007.50 |
| Max. Negotiated Rate |
$160,158.60 |
| Rate for Payer: Aetna Commercial |
$94,830.75
|
| Rate for Payer: Aetna Medicare |
$94,511.25
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$63,007.50
|
| Rate for Payer: Amerigroup Medicare |
$63,007.50
|
| Rate for Payer: BCBS of TX Blue Advantage |
$85,275.88
|
| Rate for Payer: BCBS of TX Blue Essentials |
$94,162.94
|
| Rate for Payer: BCBS of TX Medicare |
$63,007.50
|
| Rate for Payer: BCBS of TX PPO |
$104,629.54
|
| Rate for Payer: Cigna Commercial |
$108,570.67
|
| Rate for Payer: Cigna Medicare |
$63,007.50
|
| Rate for Payer: Employer Direct Commercial |
$63,007.50
|
| Rate for Payer: Humana Medicare/TRICARE |
$63,007.50
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$63,007.50
|
| Rate for Payer: Molina Medicare |
$63,007.50
|
| Rate for Payer: Multiplan Auto |
$160,158.60
|
| Rate for Payer: Multiplan Commercial |
$160,158.60
|
| Rate for Payer: Multiplan Workers Comp |
$160,158.60
|
| Rate for Payer: Scott and White EPO/PPO |
$73,757.25
|
| Rate for Payer: Scott and White Medicare |
$63,007.50
|
| Rate for Payer: Superior Health Plan EPO |
$63,007.50
|
| Rate for Payer: Superior Health Plan Medicare |
$63,007.50
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$63,007.50
|
| Rate for Payer: Universal American Medicare |
$63,007.50
|
| Rate for Payer: Wellcare Medicare |
$63,007.50
|
| Rate for Payer: Wellmed Medicare |
$63,007.50
|
|
|
SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITHOUT CC/MCC
|
Facility
|
IP
|
$86,089.00
|
|
|
Service Code
|
MSDRG 458
|
| Min. Negotiated Rate |
$35,188.27 |
| Max. Negotiated Rate |
$86,089.00 |
| Rate for Payer: Aetna Commercial |
$50,973.75
|
| Rate for Payer: Aetna Medicare |
$52,782.40
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$35,188.27
|
| Rate for Payer: Amerigroup Medicare |
$35,188.27
|
| Rate for Payer: BCBS of TX Blue Advantage |
$45,914.54
|
| Rate for Payer: BCBS of TX Blue Essentials |
$52,845.66
|
| Rate for Payer: BCBS of TX Medicare |
$35,188.27
|
| Rate for Payer: BCBS of TX PPO |
$58,719.68
|
| Rate for Payer: Cigna Commercial |
$58,359.28
|
| Rate for Payer: Cigna Medicare |
$35,188.27
|
| Rate for Payer: Employer Direct Commercial |
$35,188.27
|
| Rate for Payer: Humana Medicare/TRICARE |
$35,188.27
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$35,188.27
|
| Rate for Payer: Molina Medicare |
$35,188.27
|
| Rate for Payer: Multiplan Auto |
$86,089.00
|
| Rate for Payer: Multiplan Commercial |
$86,089.00
|
| Rate for Payer: Multiplan Workers Comp |
$86,089.00
|
| Rate for Payer: Scott and White EPO/PPO |
$39,646.25
|
| Rate for Payer: Scott and White Medicare |
$35,188.27
|
| Rate for Payer: Superior Health Plan EPO |
$35,188.27
|
| Rate for Payer: Superior Health Plan Medicare |
$35,188.27
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$35,188.27
|
| Rate for Payer: Universal American Medicare |
$35,188.27
|
| Rate for Payer: Wellcare Medicare |
$35,188.27
|
| Rate for Payer: Wellmed Medicare |
$35,188.27
|
|
