|
NM Thyroid Cancer Imaging WB Delay 1
|
Facility
|
OP
|
$2,212.00
|
|
|
Service Code
|
HCPCS 78018
|
| Hospital Charge Code |
3400272
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$280.00 |
| Max. Negotiated Rate |
$1,592.64 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$280.00
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$545.44
|
| Rate for Payer: Amerigroup Medicare |
$545.44
|
| Rate for Payer: BCBS of TX Blue Advantage |
$467.40
|
| Rate for Payer: BCBS of TX Blue Essentials |
$560.87
|
| Rate for Payer: BCBS of TX Medicare |
$545.44
|
| Rate for Payer: BCBS of TX PPO |
$626.03
|
| Rate for Payer: Cash Price |
$1,504.16
|
| Rate for Payer: Cash Price |
$1,504.16
|
| Rate for Payer: Cash Price |
$1,504.16
|
| Rate for Payer: Cigna Commercial |
$1,152.98
|
| Rate for Payer: Cigna Medicaid |
$1,592.64
|
| Rate for Payer: Cigna Medicare |
$545.44
|
| Rate for Payer: Employer Direct Commercial |
$545.44
|
| Rate for Payer: Humana Medicare/TRICARE |
$545.44
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,592.64
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$545.44
|
| Rate for Payer: Molina Medicare |
$545.44
|
| Rate for Payer: Multiplan Auto |
$1,437.80
|
| Rate for Payer: Multiplan Commercial |
$1,437.80
|
| Rate for Payer: Multiplan Workers Comp |
$1,437.80
|
| Rate for Payer: Parkland Medicaid |
$1,592.64
|
| Rate for Payer: Scott and White EPO/PPO |
$350.89
|
| Rate for Payer: Scott and White Medicare |
$545.44
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,592.64
|
| Rate for Payer: Superior Health Plan EPO |
$545.44
|
| Rate for Payer: Superior Health Plan Medicare |
$545.44
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$545.44
|
| Rate for Payer: Universal American Medicare |
$545.44
|
| Rate for Payer: Wellcare Medicare |
$545.44
|
| Rate for Payer: Wellmed Medicare |
$545.44
|
|
|
NM Thyroid Imaging
|
Facility
|
IP
|
$1,026.00
|
|
|
Service Code
|
HCPCS 78013
|
| Hospital Charge Code |
3450001
|
|
Hospital Revenue Code
|
341
|
| Rate for Payer: Cash Price |
$697.68
|
|
|
NM Thyroid Imaging
|
Facility
|
OP
|
$1,026.00
|
|
|
Service Code
|
HCPCS 78013
|
| Hospital Charge Code |
3450001
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$171.74 |
| Max. Negotiated Rate |
$848.90 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$171.74
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$401.59
|
| Rate for Payer: Amerigroup Medicare |
$401.59
|
| Rate for Payer: BCBS of TX Blue Advantage |
$298.52
|
| Rate for Payer: BCBS of TX Blue Essentials |
$358.22
|
| Rate for Payer: BCBS of TX Medicare |
$401.59
|
| Rate for Payer: BCBS of TX PPO |
$399.83
|
| Rate for Payer: Cash Price |
$697.68
|
| Rate for Payer: Cash Price |
$697.68
|
| Rate for Payer: Cash Price |
$697.68
|
| Rate for Payer: Cigna Commercial |
$848.90
|
| Rate for Payer: Cigna Medicaid |
$738.72
|
| Rate for Payer: Cigna Medicare |
$401.59
|
| Rate for Payer: Employer Direct Commercial |
$401.59
|
| Rate for Payer: Humana Medicare/TRICARE |
$401.59
|
| Rate for Payer: Molina CHIP/Medicaid |
$738.72
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$401.59
|
| Rate for Payer: Molina Medicare |
$401.59
|
| Rate for Payer: Multiplan Auto |
$666.90
|
| Rate for Payer: Multiplan Commercial |
$666.90
|
| Rate for Payer: Multiplan Workers Comp |
$666.90
|
| Rate for Payer: Parkland Medicaid |
$738.72
|
| Rate for Payer: Scott and White EPO/PPO |
$211.60
|
| Rate for Payer: Scott and White Medicare |
$401.59
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$738.72
|
| Rate for Payer: Superior Health Plan EPO |
$401.59
|
| Rate for Payer: Superior Health Plan Medicare |
$401.59
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$401.59
|
| Rate for Payer: Universal American Medicare |
$401.59
|
| Rate for Payer: Wellcare Medicare |
$401.59
|
| Rate for Payer: Wellmed Medicare |
$401.59
|
|
|
NM Thyroid Single/Multi Measure Delay 1
|
Facility
|
OP
|
$1,140.00
|
|
|
Service Code
|
HCPCS 78012
|
| Hospital Charge Code |
3450000
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$81.20 |
| Max. Negotiated Rate |
$848.90 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$81.20
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$401.59
|
| Rate for Payer: Amerigroup Medicare |
$401.59
|
| Rate for Payer: BCBS of TX Blue Advantage |
$123.09
|
| Rate for Payer: BCBS of TX Blue Essentials |
$147.71
|
| Rate for Payer: BCBS of TX Medicare |
$401.59
|
| Rate for Payer: BCBS of TX PPO |
$164.87
|
| Rate for Payer: Cash Price |
$775.20
|
| Rate for Payer: Cash Price |
$775.20
|
| Rate for Payer: Cash Price |
$775.20
|
| Rate for Payer: Cigna Commercial |
$848.90
|
| Rate for Payer: Cigna Medicaid |
$820.80
|
| Rate for Payer: Cigna Medicare |
$401.59
|
| Rate for Payer: Employer Direct Commercial |
$401.59
|
| Rate for Payer: Humana Medicare/TRICARE |
$401.59
|
| Rate for Payer: Molina CHIP/Medicaid |
$820.80
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$401.59
|
| Rate for Payer: Molina Medicare |
$401.59
|
| Rate for Payer: Multiplan Auto |
$741.00
|
| Rate for Payer: Multiplan Commercial |
$741.00
|
| Rate for Payer: Multiplan Workers Comp |
$741.00
|
| Rate for Payer: Parkland Medicaid |
$820.80
|
| Rate for Payer: Scott and White EPO/PPO |
$99.97
|
| Rate for Payer: Scott and White Medicare |
$401.59
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$820.80
|
| Rate for Payer: Superior Health Plan EPO |
$401.59
|
| Rate for Payer: Superior Health Plan Medicare |
$401.59
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$401.59
|
| Rate for Payer: Universal American Medicare |
$401.59
|
| Rate for Payer: Wellcare Medicare |
$401.59
|
| Rate for Payer: Wellmed Medicare |
$401.59
|
|
|
NM Thyroid Single/Multi Measure Delay 1
|
Facility
|
IP
|
$1,140.00
|
|
|
Service Code
|
HCPCS 78012
|
| Hospital Charge Code |
3450000
|
|
Hospital Revenue Code
|
341
|
| Rate for Payer: Cash Price |
$775.20
|
|
|
NM Tumor Loc Limited Delay 1
|
Facility
|
IP
|
$1,895.00
|
|
|
Service Code
|
HCPCS 78800
|
| Hospital Charge Code |
3400355
|
|
Hospital Revenue Code
|
341
|
| Rate for Payer: Cash Price |
$1,288.60
|
|
|
NM Tumor Loc Limited Delay 1
|
Facility
|
OP
|
$1,895.00
|
|
|
Service Code
|
HCPCS 78800
|
| Hospital Charge Code |
3400355
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$228.55 |
| Max. Negotiated Rate |
$1,364.40 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$228.55
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$401.59
|
| Rate for Payer: Amerigroup Medicare |
$401.59
|
| Rate for Payer: BCBS of TX Blue Advantage |
$275.91
|
| Rate for Payer: BCBS of TX Blue Essentials |
$331.10
|
| Rate for Payer: BCBS of TX Medicare |
$401.59
|
| Rate for Payer: BCBS of TX PPO |
$369.56
|
| Rate for Payer: Cash Price |
$1,288.60
|
| Rate for Payer: Cash Price |
$1,288.60
|
| Rate for Payer: Cash Price |
$1,288.60
|
| Rate for Payer: Cigna Commercial |
$848.90
|
| Rate for Payer: Cigna Medicaid |
$1,364.40
|
| Rate for Payer: Cigna Medicare |
$401.59
|
| Rate for Payer: Employer Direct Commercial |
$401.59
|
| Rate for Payer: Humana Medicare/TRICARE |
$401.59
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,364.40
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$401.59
|
| Rate for Payer: Molina Medicare |
$401.59
|
| Rate for Payer: Multiplan Auto |
$1,231.75
|
| Rate for Payer: Multiplan Commercial |
$1,231.75
|
| Rate for Payer: Multiplan Workers Comp |
$1,231.75
|
| Rate for Payer: Parkland Medicaid |
$1,364.40
|
| Rate for Payer: Scott and White EPO/PPO |
$286.85
|
| Rate for Payer: Scott and White Medicare |
$401.59
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,364.40
|
| Rate for Payer: Superior Health Plan EPO |
$401.59
|
| Rate for Payer: Superior Health Plan Medicare |
$401.59
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$401.59
|
| Rate for Payer: Universal American Medicare |
$401.59
|
| Rate for Payer: Wellcare Medicare |
$401.59
|
| Rate for Payer: Wellmed Medicare |
$401.59
|
|
|
NM Tumor Loc Multiple Areas Delay 1
|
Facility
|
IP
|
$2,052.00
|
|
|
Service Code
|
HCPCS 78801
|
| Hospital Charge Code |
3400004
|
|
Hospital Revenue Code
|
341
|
| Rate for Payer: Cash Price |
$1,395.36
|
|
|
NM Tumor Loc Multiple Areas Delay 1
|
Facility
|
OP
|
$2,052.00
|
|
|
Service Code
|
HCPCS 78801
|
| Hospital Charge Code |
3400004
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$244.59 |
| Max. Negotiated Rate |
$1,477.44 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$244.59
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$401.59
|
| Rate for Payer: Amerigroup Medicare |
$401.59
|
| Rate for Payer: BCBS of TX Blue Advantage |
$374.63
|
| Rate for Payer: BCBS of TX Blue Essentials |
$449.56
|
| Rate for Payer: BCBS of TX Medicare |
$401.59
|
| Rate for Payer: BCBS of TX PPO |
$501.78
|
| Rate for Payer: Cash Price |
$1,395.36
|
| Rate for Payer: Cash Price |
$1,395.36
|
| Rate for Payer: Cash Price |
$1,395.36
|
| Rate for Payer: Cigna Commercial |
$848.90
|
| Rate for Payer: Cigna Medicaid |
$1,477.44
|
| Rate for Payer: Cigna Medicare |
$401.59
|
| Rate for Payer: Employer Direct Commercial |
$401.59
|
| Rate for Payer: Humana Medicare/TRICARE |
$401.59
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,477.44
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$401.59
|
| Rate for Payer: Molina Medicare |
$401.59
|
| Rate for Payer: Multiplan Auto |
$1,333.80
|
| Rate for Payer: Multiplan Commercial |
$1,333.80
|
| Rate for Payer: Multiplan Workers Comp |
$1,333.80
|
| Rate for Payer: Parkland Medicaid |
$1,477.44
|
| Rate for Payer: Scott and White EPO/PPO |
$307.59
|
| Rate for Payer: Scott and White Medicare |
$401.59
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,477.44
|
| Rate for Payer: Superior Health Plan EPO |
$401.59
|
| Rate for Payer: Superior Health Plan Medicare |
$401.59
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$401.59
|
| Rate for Payer: Universal American Medicare |
$401.59
|
| Rate for Payer: Wellcare Medicare |
$401.59
|
| Rate for Payer: Wellmed Medicare |
$401.59
|
|
|
NM Tumor Loc WB 1 Day Delay 1
|
Facility
|
OP
|
$2,321.00
|
|
|
Service Code
|
HCPCS 78802
|
| Hospital Charge Code |
3400058
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$275.66 |
| Max. Negotiated Rate |
$1,671.12 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$275.66
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$545.44
|
| Rate for Payer: Amerigroup Medicare |
$545.44
|
| Rate for Payer: BCBS of TX Blue Advantage |
$482.26
|
| Rate for Payer: BCBS of TX Blue Essentials |
$578.71
|
| Rate for Payer: BCBS of TX Medicare |
$545.44
|
| Rate for Payer: BCBS of TX PPO |
$645.94
|
| Rate for Payer: Cash Price |
$1,578.28
|
| Rate for Payer: Cash Price |
$1,578.28
|
| Rate for Payer: Cash Price |
$1,578.28
|
| Rate for Payer: Cigna Commercial |
$1,152.98
|
| Rate for Payer: Cigna Medicaid |
$1,671.12
|
| Rate for Payer: Cigna Medicare |
$545.44
|
| Rate for Payer: Employer Direct Commercial |
$545.44
|
| Rate for Payer: Humana Medicare/TRICARE |
$545.44
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,671.12
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$545.44
|
| Rate for Payer: Molina Medicare |
$545.44
|
| Rate for Payer: Multiplan Auto |
$1,508.65
|
| Rate for Payer: Multiplan Commercial |
$1,508.65
|
| Rate for Payer: Multiplan Workers Comp |
$1,508.65
|
| Rate for Payer: Parkland Medicaid |
$1,671.12
|
| Rate for Payer: Scott and White EPO/PPO |
$347.57
|
| Rate for Payer: Scott and White Medicare |
$545.44
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,671.12
|
| Rate for Payer: Superior Health Plan EPO |
$545.44
|
| Rate for Payer: Superior Health Plan Medicare |
$545.44
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$545.44
|
| Rate for Payer: Universal American Medicare |
$545.44
|
| Rate for Payer: Wellcare Medicare |
$545.44
|
| Rate for Payer: Wellmed Medicare |
$545.44
|
|
|
NM Tumor Loc WB 1 Day Delay 1
|
Facility
|
IP
|
$2,321.00
|
|
|
Service Code
|
HCPCS 78802
|
| Hospital Charge Code |
3400058
|
|
Hospital Revenue Code
|
341
|
| Rate for Payer: Cash Price |
$1,578.28
|
|
|
NM Tumor Loc WB 2+ Days Delay 1
|
Facility
|
IP
|
$4,039.00
|
|
|
Service Code
|
HCPCS 78804
|
| Hospital Charge Code |
3400007
|
|
Hospital Revenue Code
|
341
|
| Rate for Payer: Cash Price |
$2,746.52
|
|
|
NM Tumor Loc WB 2+ Days Delay 1
|
Facility
|
OP
|
$4,039.00
|
|
|
Service Code
|
HCPCS 78804
|
| Hospital Charge Code |
3400007
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$545.44 |
| Max. Negotiated Rate |
$2,908.08 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$571.03
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$545.44
|
| Rate for Payer: Amerigroup Medicare |
$545.44
|
| Rate for Payer: BCBS of TX Blue Advantage |
$886.02
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,063.22
|
| Rate for Payer: BCBS of TX Medicare |
$545.44
|
| Rate for Payer: BCBS of TX PPO |
$1,186.73
|
| Rate for Payer: Cash Price |
$2,746.52
|
| Rate for Payer: Cash Price |
$2,746.52
|
| Rate for Payer: Cash Price |
$2,746.52
|
| Rate for Payer: Cigna Commercial |
$1,152.98
|
| Rate for Payer: Cigna Medicaid |
$2,908.08
|
| Rate for Payer: Cigna Medicare |
$545.44
|
| Rate for Payer: Employer Direct Commercial |
$545.44
|
| Rate for Payer: Humana Medicare/TRICARE |
$545.44
|
| Rate for Payer: Molina CHIP/Medicaid |
$2,908.08
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$545.44
|
| Rate for Payer: Molina Medicare |
$545.44
|
| Rate for Payer: Multiplan Auto |
$2,625.35
|
| Rate for Payer: Multiplan Commercial |
$2,625.35
|
| Rate for Payer: Multiplan Workers Comp |
$2,625.35
|
| Rate for Payer: Parkland Medicaid |
$2,908.08
|
| Rate for Payer: Scott and White EPO/PPO |
$724.01
|
| Rate for Payer: Scott and White Medicare |
$545.44
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$2,908.08
|
| Rate for Payer: Superior Health Plan EPO |
$545.44
|
| Rate for Payer: Superior Health Plan Medicare |
$545.44
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$545.44
|
| Rate for Payer: Universal American Medicare |
$545.44
|
| Rate for Payer: Wellcare Medicare |
$545.44
|
| Rate for Payer: Wellmed Medicare |
$545.44
|
|
|
NM Ureteral Reflux Study
|
Facility
|
IP
|
$1,787.00
|
|
|
Service Code
|
HCPCS 78740
|
| Hospital Charge Code |
3400132
|
|
Hospital Revenue Code
|
341
|
| Rate for Payer: Cash Price |
$1,215.16
|
|
|
NM Ureteral Reflux Study
|
Facility
|
OP
|
$1,787.00
|
|
|
Service Code
|
HCPCS 78740
|
| Hospital Charge Code |
3400132
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$209.50 |
| Max. Negotiated Rate |
$1,286.64 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$209.50
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$401.59
|
| Rate for Payer: Amerigroup Medicare |
$401.59
|
| Rate for Payer: BCBS of TX Blue Advantage |
$327.66
|
| Rate for Payer: BCBS of TX Blue Essentials |
$393.19
|
| Rate for Payer: BCBS of TX Medicare |
$401.59
|
| Rate for Payer: BCBS of TX PPO |
$438.86
|
| Rate for Payer: Cash Price |
$1,215.16
|
| Rate for Payer: Cash Price |
$1,215.16
|
| Rate for Payer: Cash Price |
$1,215.16
|
| Rate for Payer: Cigna Commercial |
$848.90
|
| Rate for Payer: Cigna Medicaid |
$1,286.64
|
| Rate for Payer: Cigna Medicare |
$401.59
|
| Rate for Payer: Employer Direct Commercial |
$401.59
|
| Rate for Payer: Humana Medicare/TRICARE |
$401.59
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,286.64
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$401.59
|
| Rate for Payer: Molina Medicare |
$401.59
|
| Rate for Payer: Multiplan Auto |
$1,161.55
|
| Rate for Payer: Multiplan Commercial |
$1,161.55
|
| Rate for Payer: Multiplan Workers Comp |
$1,161.55
|
| Rate for Payer: Parkland Medicaid |
$1,286.64
|
| Rate for Payer: Scott and White EPO/PPO |
$259.85
|
| Rate for Payer: Scott and White Medicare |
$401.59
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,286.64
|
| Rate for Payer: Superior Health Plan EPO |
$401.59
|
| Rate for Payer: Superior Health Plan Medicare |
$401.59
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$401.59
|
| Rate for Payer: Universal American Medicare |
$401.59
|
| Rate for Payer: Wellcare Medicare |
$401.59
|
| Rate for Payer: Wellmed Medicare |
$401.59
|
|
|
.Nocardia Susceptibility Broth 18285 SO
|
Facility
|
IP
|
$251.00
|
|
|
Service Code
|
HCPCS 87186
|
| Hospital Charge Code |
1604610
|
|
Hospital Revenue Code
|
306
|
| Rate for Payer: Cash Price |
$170.68
|
|
|
.Nocardia Susceptibility Broth 18285 SO
|
Facility
|
OP
|
$251.00
|
|
|
Service Code
|
HCPCS 87186
|
| Hospital Charge Code |
1604610
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.37 |
| Max. Negotiated Rate |
$180.72 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$3.37
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$8.65
|
| Rate for Payer: Amerigroup Medicare |
$8.65
|
| Rate for Payer: BCBS of TX Blue Advantage |
$75.30
|
| Rate for Payer: BCBS of TX Blue Essentials |
$90.36
|
| Rate for Payer: BCBS of TX Medicare |
$8.65
|
| Rate for Payer: BCBS of TX PPO |
$100.40
|
| Rate for Payer: Cash Price |
$170.68
|
| Rate for Payer: Cash Price |
$170.68
|
| Rate for Payer: Cigna Medicaid |
$180.72
|
| Rate for Payer: Cigna Medicare |
$8.65
|
| Rate for Payer: Employer Direct Commercial |
$8.65
|
| Rate for Payer: Humana Medicare/TRICARE |
$8.65
|
| Rate for Payer: Molina CHIP/Medicaid |
$180.72
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$8.65
|
| Rate for Payer: Molina Medicare |
$8.65
|
| Rate for Payer: Multiplan Auto |
$163.15
|
| Rate for Payer: Multiplan Commercial |
$163.15
|
| Rate for Payer: Multiplan Workers Comp |
$163.15
|
| Rate for Payer: Parkland Medicaid |
$180.72
|
| Rate for Payer: Scott and White EPO/PPO |
$10.81
|
| Rate for Payer: Scott and White Medicare |
$8.65
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$180.72
|
| Rate for Payer: Superior Health Plan EPO |
$8.65
|
| Rate for Payer: Superior Health Plan Medicare |
$8.65
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$8.65
|
| Rate for Payer: Universal American Medicare |
$8.65
|
| Rate for Payer: Wellcare Medicare |
$8.65
|
| Rate for Payer: Wellmed Medicare |
$8.65
|
|
|
NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH CC
|
Facility
|
IP
|
$39,599.80
|
|
|
Service Code
|
MSDRG 098
|
| Min. Negotiated Rate |
$15,914.30 |
| Max. Negotiated Rate |
$39,599.80 |
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$21,579.47
|
| Rate for Payer: Amerigroup Medicare |
$21,579.47
|
| Rate for Payer: BCBS of TX Medicare |
$21,579.47
|
| Rate for Payer: Cigna Commercial |
$29,558.31
|
| Rate for Payer: Cigna Medicare |
$21,579.47
|
| Rate for Payer: Employer Direct Commercial |
$21,579.47
|
| Rate for Payer: Humana Medicare/TRICARE |
$21,579.47
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$21,579.47
|
| Rate for Payer: Molina Medicare |
$21,579.47
|
| Rate for Payer: Multiplan Auto |
$39,599.80
|
| Rate for Payer: Multiplan Commercial |
$39,599.80
|
| Rate for Payer: Multiplan Workers Comp |
$39,599.80
|
| Rate for Payer: Scott and White EPO/PPO |
$18,236.75
|
| Rate for Payer: Scott and White Medicare |
$21,579.47
|
| Rate for Payer: Superior Health Plan EPO |
$21,579.47
|
| Rate for Payer: Superior Health Plan Medicare |
$21,579.47
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$21,579.47
|
| Rate for Payer: Universal American Medicare |
$21,579.47
|
| Rate for Payer: Wellcare Medicare |
$21,579.47
|
| Rate for Payer: Wellmed Medicare |
$21,579.47
|
|
|
NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH MCC
|
Facility
|
IP
|
$73,875.80
|
|
|
Service Code
|
MSDRG 097
|
| Min. Negotiated Rate |
$30,434.54 |
| Max. Negotiated Rate |
$73,875.80 |
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$31,231.05
|
| Rate for Payer: Amerigroup Medicare |
$31,231.05
|
| Rate for Payer: BCBS of TX Medicare |
$31,231.05
|
| Rate for Payer: Cigna Commercial |
$46,519.98
|
| Rate for Payer: Cigna Medicare |
$31,231.05
|
| Rate for Payer: Employer Direct Commercial |
$31,231.05
|
| Rate for Payer: Humana Medicare/TRICARE |
$31,231.05
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$31,231.05
|
| Rate for Payer: Molina Medicare |
$31,231.05
|
| Rate for Payer: Multiplan Auto |
$73,875.80
|
| Rate for Payer: Multiplan Commercial |
$73,875.80
|
| Rate for Payer: Multiplan Workers Comp |
$73,875.80
|
| Rate for Payer: Scott and White EPO/PPO |
$34,021.75
|
| Rate for Payer: Scott and White Medicare |
$31,231.05
|
| Rate for Payer: Superior Health Plan EPO |
$31,231.05
|
| Rate for Payer: Superior Health Plan Medicare |
$31,231.05
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$31,231.05
|
| Rate for Payer: Universal American Medicare |
$31,231.05
|
| Rate for Payer: Wellcare Medicare |
$31,231.05
|
| Rate for Payer: Wellmed Medicare |
$31,231.05
|
|
|
NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITHOUT CC/MCC
|
Facility
|
IP
|
$26,571.50
|
|
|
Service Code
|
MSDRG 099
|
| Min. Negotiated Rate |
$10,946.94 |
| Max. Negotiated Rate |
$26,571.50 |
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$14,745.15
|
| Rate for Payer: Amerigroup Medicare |
$14,745.15
|
| Rate for Payer: BCBS of TX Medicare |
$14,745.15
|
| Rate for Payer: Cigna Commercial |
$17,547.71
|
| Rate for Payer: Cigna Medicare |
$14,745.15
|
| Rate for Payer: Employer Direct Commercial |
$14,745.15
|
| Rate for Payer: Humana Medicare/TRICARE |
$14,745.15
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$14,745.15
|
| Rate for Payer: Molina Medicare |
$14,745.15
|
| Rate for Payer: Multiplan Auto |
$26,571.50
|
| Rate for Payer: Multiplan Commercial |
$26,571.50
|
| Rate for Payer: Multiplan Workers Comp |
$26,571.50
|
| Rate for Payer: Scott and White EPO/PPO |
$12,236.88
|
| Rate for Payer: Scott and White Medicare |
$14,745.15
|
| Rate for Payer: Superior Health Plan EPO |
$14,745.15
|
| Rate for Payer: Superior Health Plan Medicare |
$14,745.15
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$14,745.15
|
| Rate for Payer: Universal American Medicare |
$14,745.15
|
| Rate for Payer: Wellcare Medicare |
$14,745.15
|
| Rate for Payer: Wellmed Medicare |
$14,745.15
|
|
|
NON-BACTERIAL INFECTIONS OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS
|
Facility
|
IP
|
$2,953.01
|
|
|
Service Code
|
APR-DRG 0501
|
| Min. Negotiated Rate |
$2,784.20 |
| Max. Negotiated Rate |
$2,953.01 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2,784.20
|
| Rate for Payer: Cigna Medicaid |
$2,784.20
|
| Rate for Payer: Molina CHIP/Medicaid |
$2,784.20
|
| Rate for Payer: Parkland Medicaid |
$2,784.20
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$2,953.01
|
|
|
NON-BACTERIAL INFECTIONS OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS
|
Facility
|
IP
|
$30,561.74
|
|
|
Service Code
|
APR-DRG 0504
|
| Min. Negotiated Rate |
$28,814.68 |
| Max. Negotiated Rate |
$30,561.74 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$28,814.68
|
| Rate for Payer: Cigna Medicaid |
$28,814.68
|
| Rate for Payer: Molina CHIP/Medicaid |
$28,814.68
|
| Rate for Payer: Parkland Medicaid |
$28,814.68
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$30,561.74
|
|
|
NON-BACTERIAL INFECTIONS OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS
|
Facility
|
IP
|
$15,548.86
|
|
|
Service Code
|
APR-DRG 0503
|
| Min. Negotiated Rate |
$14,660.01 |
| Max. Negotiated Rate |
$15,548.86 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$14,660.01
|
| Rate for Payer: Cigna Medicaid |
$14,660.01
|
| Rate for Payer: Molina CHIP/Medicaid |
$14,660.01
|
| Rate for Payer: Parkland Medicaid |
$14,660.01
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$15,548.86
|
|
|
NON-BACTERIAL INFECTIONS OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS
|
Facility
|
IP
|
$10,020.78
|
|
|
Service Code
|
APR-DRG 0502
|
| Min. Negotiated Rate |
$9,447.94 |
| Max. Negotiated Rate |
$10,020.78 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$9,447.94
|
| Rate for Payer: Cigna Medicaid |
$9,447.94
|
| Rate for Payer: Molina CHIP/Medicaid |
$9,447.94
|
| Rate for Payer: Parkland Medicaid |
$9,447.94
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$10,020.78
|
|
|
NON-BACTERIAL INFECT OF NERVOUS SYS EXC VIRAL MENINGITIS W CC
|
Facility
|
IP
|
$39,599.80
|
|
|
Service Code
|
MSDRG 098
|
| Min. Negotiated Rate |
$15,914.30 |
| Max. Negotiated Rate |
$39,599.80 |
| Rate for Payer: BCBS of TX Blue Advantage |
$15,914.30
|
| Rate for Payer: BCBS of TX Blue Essentials |
$19,095.31
|
| Rate for Payer: BCBS of TX PPO |
$21,217.83
|
|
