|
CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH CC
|
Facility
|
IP
|
$35,754.20
|
|
|
Service Code
|
MSDRG 261
|
| Min. Negotiated Rate |
$16,283.42 |
| Max. Negotiated Rate |
$35,754.20 |
| Rate for Payer: Aetna Commercial |
$21,170.25
|
| Rate for Payer: Aetna Medicare |
$24,425.13
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$16,283.42
|
| Rate for Payer: Amerigroup Medicare |
$16,283.42
|
| Rate for Payer: BCBS of TX Blue Advantage |
$16,842.24
|
| Rate for Payer: BCBS of TX Blue Essentials |
$20,553.38
|
| Rate for Payer: BCBS of TX Medicare |
$16,283.42
|
| Rate for Payer: BCBS of TX PPO |
$22,837.98
|
| Rate for Payer: Cigna Commercial |
$24,237.58
|
| Rate for Payer: Cigna Medicare |
$16,283.42
|
| Rate for Payer: Employer Direct Commercial |
$16,283.42
|
| Rate for Payer: Humana Medicare/TRICARE |
$16,283.42
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$16,283.42
|
| Rate for Payer: Molina Medicare |
$16,283.42
|
| Rate for Payer: Multiplan Auto |
$35,754.20
|
| Rate for Payer: Multiplan Commercial |
$35,754.20
|
| Rate for Payer: Multiplan Workers Comp |
$35,754.20
|
| Rate for Payer: Scott and White EPO/PPO |
$16,465.75
|
| Rate for Payer: Scott and White Medicare |
$16,283.42
|
| Rate for Payer: Superior Health Plan EPO |
$16,283.42
|
| Rate for Payer: Superior Health Plan Medicare |
$16,283.42
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$16,283.42
|
| Rate for Payer: Universal American Medicare |
$16,283.42
|
| Rate for Payer: Wellcare Medicare |
$16,283.42
|
| Rate for Payer: Wellmed Medicare |
$16,283.42
|
|
|
CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH MCC
|
Facility
|
IP
|
$62,988.80
|
|
|
Service Code
|
MSDRG 260
|
| Min. Negotiated Rate |
$26,512.24 |
| Max. Negotiated Rate |
$62,988.80 |
| Rate for Payer: Aetna Commercial |
$37,296.00
|
| Rate for Payer: Aetna Medicare |
$39,768.36
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$26,512.24
|
| Rate for Payer: Amerigroup Medicare |
$26,512.24
|
| Rate for Payer: BCBS of TX Blue Advantage |
$32,365.24
|
| Rate for Payer: BCBS of TX Blue Essentials |
$37,349.62
|
| Rate for Payer: BCBS of TX Medicare |
$26,512.24
|
| Rate for Payer: BCBS of TX PPO |
$41,501.19
|
| Rate for Payer: Cigna Commercial |
$42,699.78
|
| Rate for Payer: Cigna Medicare |
$26,512.24
|
| Rate for Payer: Employer Direct Commercial |
$26,512.24
|
| Rate for Payer: Humana Medicare/TRICARE |
$26,512.24
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$26,512.24
|
| Rate for Payer: Molina Medicare |
$26,512.24
|
| Rate for Payer: Multiplan Auto |
$62,988.80
|
| Rate for Payer: Multiplan Commercial |
$62,988.80
|
| Rate for Payer: Multiplan Workers Comp |
$62,988.80
|
| Rate for Payer: Scott and White EPO/PPO |
$29,008.00
|
| Rate for Payer: Scott and White Medicare |
$26,512.24
|
| Rate for Payer: Superior Health Plan EPO |
$26,512.24
|
| Rate for Payer: Superior Health Plan Medicare |
$26,512.24
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$26,512.24
|
| Rate for Payer: Universal American Medicare |
$26,512.24
|
| Rate for Payer: Wellcare Medicare |
$26,512.24
|
| Rate for Payer: Wellmed Medicare |
$26,512.24
|
|
|
CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITHOUT CC/MCC
|
Facility
|
IP
|
$31,260.70
|
|
|
Service Code
|
MSDRG 262
|
| Min. Negotiated Rate |
$13,773.76 |
| Max. Negotiated Rate |
$31,260.70 |
| Rate for Payer: Aetna Commercial |
$18,509.62
|
| Rate for Payer: Aetna Medicare |
$21,893.62
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$14,595.75
|
| Rate for Payer: Amerigroup Medicare |
$14,595.75
|
| Rate for Payer: BCBS of TX Blue Advantage |
$13,773.76
|
| Rate for Payer: BCBS of TX Blue Essentials |
$16,829.26
|
| Rate for Payer: BCBS of TX Medicare |
$14,595.75
|
| Rate for Payer: BCBS of TX PPO |
$18,699.90
|
| Rate for Payer: Cigna Commercial |
$21,191.46
|
| Rate for Payer: Cigna Medicare |
$14,595.75
|
| Rate for Payer: Employer Direct Commercial |
$14,595.75
|
| Rate for Payer: Humana Medicare/TRICARE |
$14,595.75
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$14,595.75
|
| Rate for Payer: Molina Medicare |
$14,595.75
|
| Rate for Payer: Multiplan Auto |
$31,260.70
|
| Rate for Payer: Multiplan Commercial |
$31,260.70
|
| Rate for Payer: Multiplan Workers Comp |
$31,260.70
|
| Rate for Payer: Scott and White EPO/PPO |
$14,396.38
|
| Rate for Payer: Scott and White Medicare |
$14,595.75
|
| Rate for Payer: Superior Health Plan EPO |
$14,595.75
|
| Rate for Payer: Superior Health Plan Medicare |
$14,595.75
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$14,595.75
|
| Rate for Payer: Universal American Medicare |
$14,595.75
|
| Rate for Payer: Wellcare Medicare |
$14,595.75
|
| Rate for Payer: Wellmed Medicare |
$14,595.75
|
|
|
Cardiac Rehab Counselling Smoking Cessatn 3-10Min BCE
|
Facility
|
OP
|
$53.00
|
|
|
Service Code
|
CPT 99406
|
| Hospital Charge Code |
6010375
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$0.47 |
| Max. Negotiated Rate |
$59.45 |
| Rate for Payer: Aetna Commercial |
$29.15
|
| Rate for Payer: Aetna Medicare |
$39.36
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$4.77
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$26.24
|
| Rate for Payer: Amerigroup Medicare |
$26.24
|
| 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 |
$26.24
|
| Rate for Payer: BCBS of TX PPO |
$29.26
|
| Rate for Payer: Cash Price |
$46.64
|
| Rate for Payer: Cash Price |
$46.64
|
| Rate for Payer: Cash Price |
$46.64
|
| Rate for Payer: Cigna Commercial |
$59.45
|
| Rate for Payer: Cigna Medicaid |
$10.29
|
| Rate for Payer: Cigna Medicare |
$26.24
|
| Rate for Payer: Employer Direct Commercial |
$26.24
|
| Rate for Payer: Humana Medicare/TRICARE |
$26.24
|
| Rate for Payer: Molina CHIP/Medicaid |
$10.29
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$26.24
|
| Rate for Payer: Molina Medicare |
$26.24
|
| Rate for Payer: Multiplan Auto |
$34.45
|
| Rate for Payer: Multiplan Commercial |
$34.45
|
| Rate for Payer: Multiplan Workers Comp |
$34.45
|
| Rate for Payer: Parkland Medicaid |
$10.29
|
| Rate for Payer: Scott and White EPO/PPO |
$0.47
|
| Rate for Payer: Scott and White Medicare |
$26.24
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$10.29
|
| Rate for Payer: Superior Health Plan EPO |
$26.24
|
| Rate for Payer: Superior Health Plan Medicare |
$26.24
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$26.24
|
| Rate for Payer: Universal American Medicare |
$26.24
|
| Rate for Payer: Wellcare Medicare |
$26.24
|
| Rate for Payer: Wellmed Medicare |
$26.24
|
|
|
Cardiac Rehab Counselling Smoking Cessatn 3-10Min BCE
|
Facility
|
IP
|
$53.00
|
|
|
Service Code
|
CPT 99406
|
| Hospital Charge Code |
6010375
|
|
Hospital Revenue Code
|
942
|
| Rate for Payer: Cash Price |
$46.64
|
|
|
Cardiac Rehab Phase I Units
|
Facility
|
OP
|
$186.00
|
|
|
Service Code
|
CPT 93799
|
| Hospital Charge Code |
1150309
|
|
Hospital Revenue Code
|
943
|
| Min. Negotiated Rate |
$2.55 |
| Max. Negotiated Rate |
$323.61 |
| Rate for Payer: Aetna Commercial |
$102.30
|
| Rate for Payer: Aetna Medicare |
$214.29
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$16.74
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$142.86
|
| Rate for Payer: Amerigroup Medicare |
$142.86
|
| Rate for Payer: BCBS of TX Blue Advantage |
$240.73
|
| Rate for Payer: BCBS of TX Blue Essentials |
$287.77
|
| Rate for Payer: BCBS of TX Medicare |
$142.86
|
| Rate for Payer: BCBS of TX PPO |
$320.97
|
| Rate for Payer: Cash Price |
$163.68
|
| Rate for Payer: Cash Price |
$163.68
|
| Rate for Payer: Cash Price |
$163.68
|
| Rate for Payer: Cigna Commercial |
$323.61
|
| Rate for Payer: Cigna Medicare |
$142.86
|
| Rate for Payer: Employer Direct Commercial |
$142.86
|
| Rate for Payer: Humana Medicare/TRICARE |
$142.86
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$142.86
|
| Rate for Payer: Molina Medicare |
$142.86
|
| Rate for Payer: Multiplan Auto |
$120.90
|
| Rate for Payer: Multiplan Commercial |
$120.90
|
| Rate for Payer: Multiplan Workers Comp |
$120.90
|
| Rate for Payer: Scott and White EPO/PPO |
$2.55
|
| Rate for Payer: Scott and White Medicare |
$142.86
|
| Rate for Payer: Superior Health Plan EPO |
$142.86
|
| Rate for Payer: Superior Health Plan Medicare |
$142.86
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$142.86
|
| Rate for Payer: Universal American Medicare |
$142.86
|
| Rate for Payer: Wellcare Medicare |
$142.86
|
| Rate for Payer: Wellmed Medicare |
$142.86
|
|
|
Cardiac Rehab Phase I Units BCE
|
Facility
|
OP
|
$186.00
|
|
|
Service Code
|
CPT 93799
|
| Hospital Charge Code |
1150309
|
|
Hospital Revenue Code
|
943
|
| Min. Negotiated Rate |
$2.55 |
| Max. Negotiated Rate |
$323.61 |
| Rate for Payer: Aetna Commercial |
$102.30
|
| Rate for Payer: Aetna Medicare |
$214.29
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$16.74
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$142.86
|
| Rate for Payer: Amerigroup Medicare |
$142.86
|
| Rate for Payer: BCBS of TX Blue Advantage |
$240.73
|
| Rate for Payer: BCBS of TX Blue Essentials |
$287.77
|
| Rate for Payer: BCBS of TX Medicare |
$142.86
|
| Rate for Payer: BCBS of TX PPO |
$320.97
|
| Rate for Payer: Cash Price |
$163.68
|
| Rate for Payer: Cash Price |
$163.68
|
| Rate for Payer: Cash Price |
$163.68
|
| Rate for Payer: Cigna Commercial |
$323.61
|
| Rate for Payer: Cigna Medicare |
$142.86
|
| Rate for Payer: Employer Direct Commercial |
$142.86
|
| Rate for Payer: Humana Medicare/TRICARE |
$142.86
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$142.86
|
| Rate for Payer: Molina Medicare |
$142.86
|
| Rate for Payer: Multiplan Auto |
$120.90
|
| Rate for Payer: Multiplan Commercial |
$120.90
|
| Rate for Payer: Multiplan Workers Comp |
$120.90
|
| Rate for Payer: Scott and White EPO/PPO |
$2.55
|
| Rate for Payer: Scott and White Medicare |
$142.86
|
| Rate for Payer: Superior Health Plan EPO |
$142.86
|
| Rate for Payer: Superior Health Plan Medicare |
$142.86
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$142.86
|
| Rate for Payer: Universal American Medicare |
$142.86
|
| Rate for Payer: Wellcare Medicare |
$142.86
|
| Rate for Payer: Wellmed Medicare |
$142.86
|
|
|
Cardiac Rehab Phase I Units BCE
|
Facility
|
IP
|
$186.00
|
|
|
Service Code
|
CPT 93799
|
| Hospital Charge Code |
1150309
|
|
Hospital Revenue Code
|
943
|
| Rate for Payer: Cash Price |
$163.68
|
|
|
CARDIAC REHAB PII W/ECG MNTR Units
|
Facility
|
OP
|
$349.00
|
|
|
Service Code
|
CPT 93798
|
| Hospital Charge Code |
1100098
|
|
Hospital Revenue Code
|
943
|
| Min. Negotiated Rate |
$2.16 |
| Max. Negotiated Rate |
$273.75 |
| Rate for Payer: Aetna Commercial |
$191.95
|
| Rate for Payer: Aetna Medicare |
$181.28
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$31.41
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$120.85
|
| Rate for Payer: Amerigroup Medicare |
$120.85
|
| 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 Medicare |
$120.85
|
| Rate for Payer: BCBS of TX PPO |
$33.45
|
| Rate for Payer: Cash Price |
$307.12
|
| Rate for Payer: Cash Price |
$307.12
|
| Rate for Payer: Cash Price |
$307.12
|
| Rate for Payer: Cigna Commercial |
$273.75
|
| Rate for Payer: Cigna Medicare |
$120.85
|
| Rate for Payer: Employer Direct Commercial |
$120.85
|
| Rate for Payer: Humana Medicare/TRICARE |
$120.85
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$120.85
|
| Rate for Payer: Molina Medicare |
$120.85
|
| Rate for Payer: Multiplan Auto |
$226.85
|
| Rate for Payer: Multiplan Commercial |
$226.85
|
| Rate for Payer: Multiplan Workers Comp |
$226.85
|
| Rate for Payer: Scott and White EPO/PPO |
$2.16
|
| Rate for Payer: Scott and White Medicare |
$120.85
|
| Rate for Payer: Superior Health Plan EPO |
$120.85
|
| Rate for Payer: Superior Health Plan Medicare |
$120.85
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$120.85
|
| Rate for Payer: Universal American Medicare |
$120.85
|
| Rate for Payer: Wellcare Medicare |
$120.85
|
| Rate for Payer: Wellmed Medicare |
$120.85
|
|
|
Cardiac Rehab Pii W/Ecg Mntr Units BCE
|
Facility
|
IP
|
$349.00
|
|
|
Service Code
|
CPT 93798
|
| Hospital Charge Code |
1100098
|
|
Hospital Revenue Code
|
943
|
| Rate for Payer: Cash Price |
$307.12
|
|
|
Cardiac Rehab Pii W/Ecg Mntr Units BCE
|
Facility
|
OP
|
$349.00
|
|
|
Service Code
|
CPT 93798
|
| Hospital Charge Code |
1100098
|
|
Hospital Revenue Code
|
943
|
| Min. Negotiated Rate |
$2.16 |
| Max. Negotiated Rate |
$273.75 |
| Rate for Payer: Aetna Commercial |
$191.95
|
| Rate for Payer: Aetna Medicare |
$181.28
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$31.41
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$120.85
|
| Rate for Payer: Amerigroup Medicare |
$120.85
|
| 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 Medicare |
$120.85
|
| Rate for Payer: BCBS of TX PPO |
$33.45
|
| Rate for Payer: Cash Price |
$307.12
|
| Rate for Payer: Cash Price |
$307.12
|
| Rate for Payer: Cash Price |
$307.12
|
| Rate for Payer: Cigna Commercial |
$273.75
|
| Rate for Payer: Cigna Medicare |
$120.85
|
| Rate for Payer: Employer Direct Commercial |
$120.85
|
| Rate for Payer: Humana Medicare/TRICARE |
$120.85
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$120.85
|
| Rate for Payer: Molina Medicare |
$120.85
|
| Rate for Payer: Multiplan Auto |
$226.85
|
| Rate for Payer: Multiplan Commercial |
$226.85
|
| Rate for Payer: Multiplan Workers Comp |
$226.85
|
| Rate for Payer: Scott and White EPO/PPO |
$2.16
|
| Rate for Payer: Scott and White Medicare |
$120.85
|
| Rate for Payer: Superior Health Plan EPO |
$120.85
|
| Rate for Payer: Superior Health Plan Medicare |
$120.85
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$120.85
|
| Rate for Payer: Universal American Medicare |
$120.85
|
| Rate for Payer: Wellcare Medicare |
$120.85
|
| Rate for Payer: Wellmed Medicare |
$120.85
|
|
|
CARDIAC REHAB PII W/O ECG MTR Units
|
Facility
|
OP
|
$291.00
|
|
|
Service Code
|
CPT 93797
|
| Hospital Charge Code |
1100114
|
|
Hospital Revenue Code
|
943
|
| Min. Negotiated Rate |
$2.16 |
| Max. Negotiated Rate |
$273.75 |
| Rate for Payer: Aetna Commercial |
$160.05
|
| Rate for Payer: Aetna Medicare |
$181.28
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$26.19
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$120.85
|
| Rate for Payer: Amerigroup Medicare |
$120.85
|
| Rate for Payer: BCBS of TX Blue Advantage |
$15.68
|
| Rate for Payer: BCBS of TX Blue Essentials |
$18.74
|
| Rate for Payer: BCBS of TX Medicare |
$120.85
|
| Rate for Payer: BCBS of TX PPO |
$20.90
|
| Rate for Payer: Cash Price |
$256.08
|
| Rate for Payer: Cash Price |
$256.08
|
| Rate for Payer: Cash Price |
$256.08
|
| Rate for Payer: Cigna Commercial |
$273.75
|
| Rate for Payer: Cigna Medicare |
$120.85
|
| Rate for Payer: Employer Direct Commercial |
$120.85
|
| Rate for Payer: Humana Medicare/TRICARE |
$120.85
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$120.85
|
| Rate for Payer: Molina Medicare |
$120.85
|
| Rate for Payer: Multiplan Auto |
$189.15
|
| Rate for Payer: Multiplan Commercial |
$189.15
|
| Rate for Payer: Multiplan Workers Comp |
$189.15
|
| Rate for Payer: Scott and White EPO/PPO |
$2.16
|
| Rate for Payer: Scott and White Medicare |
$120.85
|
| Rate for Payer: Superior Health Plan EPO |
$120.85
|
| Rate for Payer: Superior Health Plan Medicare |
$120.85
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$120.85
|
| Rate for Payer: Universal American Medicare |
$120.85
|
| Rate for Payer: Wellcare Medicare |
$120.85
|
| Rate for Payer: Wellmed Medicare |
$120.85
|
|
|
Cardiac Rehab Pii W/O Ecg Mtr Units BCE
|
Facility
|
IP
|
$291.00
|
|
|
Service Code
|
CPT 93797
|
| Hospital Charge Code |
1100114
|
|
Hospital Revenue Code
|
943
|
| Rate for Payer: Cash Price |
$256.08
|
|
|
Cardiac Rehab Pii W/O Ecg Mtr Units BCE
|
Facility
|
OP
|
$291.00
|
|
|
Service Code
|
CPT 93797
|
| Hospital Charge Code |
1100114
|
|
Hospital Revenue Code
|
943
|
| Min. Negotiated Rate |
$2.16 |
| Max. Negotiated Rate |
$273.75 |
| Rate for Payer: Aetna Commercial |
$160.05
|
| Rate for Payer: Aetna Medicare |
$181.28
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$26.19
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$120.85
|
| Rate for Payer: Amerigroup Medicare |
$120.85
|
| Rate for Payer: BCBS of TX Blue Advantage |
$15.68
|
| Rate for Payer: BCBS of TX Blue Essentials |
$18.74
|
| Rate for Payer: BCBS of TX Medicare |
$120.85
|
| Rate for Payer: BCBS of TX PPO |
$20.90
|
| Rate for Payer: Cash Price |
$256.08
|
| Rate for Payer: Cash Price |
$256.08
|
| Rate for Payer: Cash Price |
$256.08
|
| Rate for Payer: Cigna Commercial |
$273.75
|
| Rate for Payer: Cigna Medicare |
$120.85
|
| Rate for Payer: Employer Direct Commercial |
$120.85
|
| Rate for Payer: Humana Medicare/TRICARE |
$120.85
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$120.85
|
| Rate for Payer: Molina Medicare |
$120.85
|
| Rate for Payer: Multiplan Auto |
$189.15
|
| Rate for Payer: Multiplan Commercial |
$189.15
|
| Rate for Payer: Multiplan Workers Comp |
$189.15
|
| Rate for Payer: Scott and White EPO/PPO |
$2.16
|
| Rate for Payer: Scott and White Medicare |
$120.85
|
| Rate for Payer: Superior Health Plan EPO |
$120.85
|
| Rate for Payer: Superior Health Plan Medicare |
$120.85
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$120.85
|
| Rate for Payer: Universal American Medicare |
$120.85
|
| Rate for Payer: Wellcare Medicare |
$120.85
|
| Rate for Payer: Wellmed Medicare |
$120.85
|
|
|
Cardiac Rehab Tobacco Counsel >10Min Symtomatic BCE
|
Facility
|
OP
|
$97.00
|
|
|
Service Code
|
CPT 99407
|
| Hospital Charge Code |
6010376
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$0.47 |
| Max. Negotiated Rate |
$63.05 |
| Rate for Payer: Aetna Commercial |
$53.35
|
| Rate for Payer: Aetna Medicare |
$39.36
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$8.73
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$26.24
|
| Rate for Payer: Amerigroup Medicare |
$26.24
|
| Rate for Payer: BCBS of TX Blue Advantage |
$45.78
|
| Rate for Payer: BCBS of TX Blue Essentials |
$54.72
|
| Rate for Payer: BCBS of TX Medicare |
$26.24
|
| Rate for Payer: BCBS of TX PPO |
$61.04
|
| Rate for Payer: Cash Price |
$85.36
|
| Rate for Payer: Cash Price |
$85.36
|
| Rate for Payer: Cash Price |
$85.36
|
| Rate for Payer: Cigna Commercial |
$59.45
|
| Rate for Payer: Cigna Medicaid |
$20.07
|
| Rate for Payer: Cigna Medicare |
$26.24
|
| Rate for Payer: Employer Direct Commercial |
$26.24
|
| Rate for Payer: Humana Medicare/TRICARE |
$26.24
|
| Rate for Payer: Molina CHIP/Medicaid |
$20.07
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$26.24
|
| Rate for Payer: Molina Medicare |
$26.24
|
| Rate for Payer: Multiplan Auto |
$63.05
|
| Rate for Payer: Multiplan Commercial |
$63.05
|
| Rate for Payer: Multiplan Workers Comp |
$63.05
|
| Rate for Payer: Parkland Medicaid |
$20.07
|
| Rate for Payer: Scott and White EPO/PPO |
$0.47
|
| Rate for Payer: Scott and White Medicare |
$26.24
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$20.07
|
| Rate for Payer: Superior Health Plan EPO |
$26.24
|
| Rate for Payer: Superior Health Plan Medicare |
$26.24
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$26.24
|
| Rate for Payer: Universal American Medicare |
$26.24
|
| Rate for Payer: Wellcare Medicare |
$26.24
|
| Rate for Payer: Wellmed Medicare |
$26.24
|
|
|
CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH CC
|
Facility
|
IP
|
$120,940.70
|
|
|
Service Code
|
MSDRG 217
|
| Min. Negotiated Rate |
$48,277.94 |
| Max. Negotiated Rate |
$120,940.70 |
| Rate for Payer: Aetna Commercial |
$71,609.62
|
| Rate for Payer: Aetna Medicare |
$72,416.91
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$48,277.94
|
| Rate for Payer: Amerigroup Medicare |
$48,277.94
|
| Rate for Payer: BCBS of TX Blue Advantage |
$54,350.28
|
| Rate for Payer: BCBS of TX Blue Essentials |
$65,657.73
|
| Rate for Payer: BCBS of TX Medicare |
$48,277.94
|
| Rate for Payer: BCBS of TX PPO |
$72,955.86
|
| Rate for Payer: Cigna Commercial |
$81,985.06
|
| Rate for Payer: Cigna Medicare |
$48,277.94
|
| Rate for Payer: Employer Direct Commercial |
$48,277.94
|
| Rate for Payer: Humana Medicare/TRICARE |
$48,277.94
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$48,277.94
|
| Rate for Payer: Molina Medicare |
$48,277.94
|
| Rate for Payer: Multiplan Auto |
$120,940.70
|
| Rate for Payer: Multiplan Commercial |
$120,940.70
|
| Rate for Payer: Multiplan Workers Comp |
$120,940.70
|
| Rate for Payer: Scott and White EPO/PPO |
$55,696.38
|
| Rate for Payer: Scott and White Medicare |
$48,277.94
|
| Rate for Payer: Superior Health Plan EPO |
$48,277.94
|
| Rate for Payer: Superior Health Plan Medicare |
$48,277.94
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$48,277.94
|
| Rate for Payer: Universal American Medicare |
$48,277.94
|
| Rate for Payer: Wellcare Medicare |
$48,277.94
|
| Rate for Payer: Wellmed Medicare |
$48,277.94
|
|
|
CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH MCC
|
Facility
|
IP
|
$184,400.70
|
|
|
Service Code
|
MSDRG 216
|
| Min. Negotiated Rate |
$72,112.39 |
| Max. Negotiated Rate |
$184,400.70 |
| Rate for Payer: Aetna Commercial |
$109,184.62
|
| Rate for Payer: Aetna Medicare |
$108,168.58
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$72,112.39
|
| Rate for Payer: Amerigroup Medicare |
$72,112.39
|
| Rate for Payer: BCBS of TX Blue Advantage |
$82,938.40
|
| Rate for Payer: BCBS of TX Blue Essentials |
$101,341.87
|
| Rate for Payer: BCBS of TX Medicare |
$72,112.39
|
| Rate for Payer: BCBS of TX PPO |
$112,606.44
|
| Rate for Payer: Cigna Commercial |
$125,004.26
|
| Rate for Payer: Cigna Medicare |
$72,112.39
|
| Rate for Payer: Employer Direct Commercial |
$72,112.39
|
| Rate for Payer: Humana Medicare/TRICARE |
$72,112.39
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$72,112.39
|
| Rate for Payer: Molina Medicare |
$72,112.39
|
| Rate for Payer: Multiplan Auto |
$184,400.70
|
| Rate for Payer: Multiplan Commercial |
$184,400.70
|
| Rate for Payer: Multiplan Workers Comp |
$184,400.70
|
| Rate for Payer: Scott and White EPO/PPO |
$84,921.38
|
| Rate for Payer: Scott and White Medicare |
$72,112.39
|
| Rate for Payer: Superior Health Plan EPO |
$72,112.39
|
| Rate for Payer: Superior Health Plan Medicare |
$72,112.39
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$72,112.39
|
| Rate for Payer: Universal American Medicare |
$72,112.39
|
| Rate for Payer: Wellcare Medicare |
$72,112.39
|
| Rate for Payer: Wellmed Medicare |
$72,112.39
|
|
|
CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITHOUT CC/MCC
|
Facility
|
IP
|
$108,237.30
|
|
|
Service Code
|
MSDRG 218
|
| Min. Negotiated Rate |
$43,506.77 |
| Max. Negotiated Rate |
$108,237.30 |
| Rate for Payer: Aetna Commercial |
$64,087.88
|
| Rate for Payer: Aetna Medicare |
$65,260.16
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$43,506.77
|
| Rate for Payer: Amerigroup Medicare |
$43,506.77
|
| Rate for Payer: BCBS of TX Blue Advantage |
$48,743.94
|
| Rate for Payer: BCBS of TX Blue Essentials |
$60,936.79
|
| Rate for Payer: BCBS of TX Medicare |
$43,506.77
|
| Rate for Payer: BCBS of TX PPO |
$67,710.17
|
| Rate for Payer: Cigna Commercial |
$73,373.50
|
| Rate for Payer: Cigna Medicare |
$43,506.77
|
| Rate for Payer: Employer Direct Commercial |
$43,506.77
|
| Rate for Payer: Humana Medicare/TRICARE |
$43,506.77
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$43,506.77
|
| Rate for Payer: Molina Medicare |
$43,506.77
|
| Rate for Payer: Multiplan Auto |
$108,237.30
|
| Rate for Payer: Multiplan Commercial |
$108,237.30
|
| Rate for Payer: Multiplan Workers Comp |
$108,237.30
|
| Rate for Payer: Scott and White EPO/PPO |
$49,846.12
|
| Rate for Payer: Scott and White Medicare |
$43,506.77
|
| Rate for Payer: Superior Health Plan EPO |
$43,506.77
|
| Rate for Payer: Superior Health Plan Medicare |
$43,506.77
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$43,506.77
|
| Rate for Payer: Universal American Medicare |
$43,506.77
|
| Rate for Payer: Wellcare Medicare |
$43,506.77
|
| Rate for Payer: Wellmed Medicare |
$43,506.77
|
|
|
CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH CC
|
Facility
|
IP
|
$99,647.40
|
|
|
Service Code
|
MSDRG 220
|
| Min. Negotiated Rate |
$40,280.55 |
| Max. Negotiated Rate |
$99,647.40 |
| Rate for Payer: Aetna Commercial |
$59,001.75
|
| Rate for Payer: Aetna Medicare |
$60,420.82
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$40,280.55
|
| Rate for Payer: Amerigroup Medicare |
$40,280.55
|
| Rate for Payer: BCBS of TX Blue Advantage |
$44,336.44
|
| Rate for Payer: BCBS of TX Blue Essentials |
$53,713.49
|
| Rate for Payer: BCBS of TX Medicare |
$40,280.55
|
| Rate for Payer: BCBS of TX PPO |
$59,683.97
|
| Rate for Payer: Cigna Commercial |
$67,550.45
|
| Rate for Payer: Cigna Medicare |
$40,280.55
|
| Rate for Payer: Employer Direct Commercial |
$40,280.55
|
| Rate for Payer: Humana Medicare/TRICARE |
$40,280.55
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$40,280.55
|
| Rate for Payer: Molina Medicare |
$40,280.55
|
| Rate for Payer: Multiplan Auto |
$99,647.40
|
| Rate for Payer: Multiplan Commercial |
$99,647.40
|
| Rate for Payer: Multiplan Workers Comp |
$99,647.40
|
| Rate for Payer: Scott and White EPO/PPO |
$45,890.25
|
| Rate for Payer: Scott and White Medicare |
$40,280.55
|
| Rate for Payer: Superior Health Plan EPO |
$40,280.55
|
| Rate for Payer: Superior Health Plan Medicare |
$40,280.55
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$40,280.55
|
| Rate for Payer: Universal American Medicare |
$40,280.55
|
| Rate for Payer: Wellcare Medicare |
$40,280.55
|
| Rate for Payer: Wellmed Medicare |
$40,280.55
|
|
|
CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH MCC
|
Facility
|
IP
|
$146,512.80
|
|
|
Service Code
|
MSDRG 219
|
| Min. Negotiated Rate |
$57,882.36 |
| Max. Negotiated Rate |
$146,512.80 |
| Rate for Payer: Aetna Commercial |
$86,751.00
|
| Rate for Payer: Aetna Medicare |
$86,823.54
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$57,882.36
|
| Rate for Payer: Amerigroup Medicare |
$57,882.36
|
| Rate for Payer: BCBS of TX Blue Advantage |
$66,316.32
|
| Rate for Payer: BCBS of TX Blue Essentials |
$79,369.62
|
| Rate for Payer: BCBS of TX Medicare |
$57,882.36
|
| Rate for Payer: BCBS of TX PPO |
$88,191.89
|
| Rate for Payer: Cigna Commercial |
$99,320.26
|
| Rate for Payer: Cigna Medicare |
$57,882.36
|
| Rate for Payer: Employer Direct Commercial |
$57,882.36
|
| Rate for Payer: Humana Medicare/TRICARE |
$57,882.36
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$57,882.36
|
| Rate for Payer: Molina Medicare |
$57,882.36
|
| Rate for Payer: Multiplan Auto |
$146,512.80
|
| Rate for Payer: Multiplan Commercial |
$146,512.80
|
| Rate for Payer: Multiplan Workers Comp |
$146,512.80
|
| Rate for Payer: Scott and White EPO/PPO |
$67,473.00
|
| Rate for Payer: Scott and White Medicare |
$57,882.36
|
| Rate for Payer: Superior Health Plan EPO |
$57,882.36
|
| Rate for Payer: Superior Health Plan Medicare |
$57,882.36
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$57,882.36
|
| Rate for Payer: Universal American Medicare |
$57,882.36
|
| Rate for Payer: Wellcare Medicare |
$57,882.36
|
| Rate for Payer: Wellmed Medicare |
$57,882.36
|
|
|
CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITHOUT CC/MCC
|
Facility
|
IP
|
$88,323.40
|
|
|
Service Code
|
MSDRG 221
|
| Min. Negotiated Rate |
$36,027.46 |
| Max. Negotiated Rate |
$88,323.40 |
| Rate for Payer: Aetna Commercial |
$52,296.75
|
| Rate for Payer: Aetna Medicare |
$54,041.19
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$36,027.46
|
| Rate for Payer: Amerigroup Medicare |
$36,027.46
|
| Rate for Payer: BCBS of TX Blue Advantage |
$39,650.30
|
| Rate for Payer: BCBS of TX Blue Essentials |
$47,543.76
|
| Rate for Payer: BCBS of TX Medicare |
$36,027.46
|
| Rate for Payer: BCBS of TX PPO |
$52,828.45
|
| Rate for Payer: Cigna Commercial |
$59,873.97
|
| Rate for Payer: Cigna Medicare |
$36,027.46
|
| Rate for Payer: Employer Direct Commercial |
$36,027.46
|
| Rate for Payer: Humana Medicare/TRICARE |
$36,027.46
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$36,027.46
|
| Rate for Payer: Molina Medicare |
$36,027.46
|
| Rate for Payer: Multiplan Auto |
$88,323.40
|
| Rate for Payer: Multiplan Commercial |
$88,323.40
|
| Rate for Payer: Multiplan Workers Comp |
$88,323.40
|
| Rate for Payer: Scott and White EPO/PPO |
$40,675.25
|
| Rate for Payer: Scott and White Medicare |
$36,027.46
|
| Rate for Payer: Superior Health Plan EPO |
$36,027.46
|
| Rate for Payer: Superior Health Plan Medicare |
$36,027.46
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$36,027.46
|
| Rate for Payer: Universal American Medicare |
$36,027.46
|
| Rate for Payer: Wellcare Medicare |
$36,027.46
|
| Rate for Payer: Wellmed Medicare |
$36,027.46
|
|
|
CARDIOLIPIN (PHOSPHOLIPID) AB EA LG
|
Facility
|
OP
|
$84.00
|
|
|
Service Code
|
CPT 86147
|
| Hospital Charge Code |
1702406
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.93 |
| Max. Negotiated Rate |
$56.24 |
| Rate for Payer: Aetna Commercial |
$26.72
|
| Rate for Payer: Aetna Medicare |
$38.18
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$9.93
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$25.45
|
| Rate for Payer: Amerigroup Medicare |
$25.45
|
| Rate for Payer: BCBS of TX Blue Advantage |
$41.99
|
| Rate for Payer: BCBS of TX Blue Essentials |
$50.39
|
| Rate for Payer: BCBS of TX Medicare |
$25.45
|
| Rate for Payer: BCBS of TX PPO |
$56.24
|
| Rate for Payer: Cash Price |
$73.92
|
| Rate for Payer: Cash Price |
$73.92
|
| Rate for Payer: Cigna Medicaid |
$25.45
|
| Rate for Payer: Cigna Medicare |
$25.45
|
| Rate for Payer: Employer Direct Commercial |
$25.45
|
| Rate for Payer: Humana Medicare/TRICARE |
$25.45
|
| Rate for Payer: Molina CHIP/Medicaid |
$25.45
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$25.45
|
| Rate for Payer: Molina Medicare |
$25.45
|
| Rate for Payer: Multiplan Auto |
$54.60
|
| Rate for Payer: Multiplan Commercial |
$54.60
|
| Rate for Payer: Multiplan Workers Comp |
$54.60
|
| Rate for Payer: Parkland Medicaid |
$25.45
|
| Rate for Payer: Scott and White EPO/PPO |
$31.81
|
| Rate for Payer: Scott and White Medicare |
$25.45
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$25.45
|
| Rate for Payer: Superior Health Plan EPO |
$25.45
|
| Rate for Payer: Superior Health Plan Medicare |
$25.45
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$25.45
|
| Rate for Payer: Universal American Medicare |
$25.45
|
| Rate for Payer: Wellcare Medicare |
$25.45
|
| Rate for Payer: Wellmed Medicare |
$25.45
|
|
|
Cardiovascular stress test trace 93017
|
Facility
|
IP
|
$2,571.00
|
|
|
Service Code
|
CPT 93017
|
| Hospital Charge Code |
2800142
|
|
Hospital Revenue Code
|
482
|
| Rate for Payer: Cash Price |
$2,262.48
|
|
|
Cardiovascular stress test trace 93017
|
Facility
|
OP
|
$2,571.00
|
|
|
Service Code
|
CPT 93017
|
| Hospital Charge Code |
2800142
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$5.13 |
| Max. Negotiated Rate |
$1,671.15 |
| Rate for Payer: Aetna Commercial |
$59.47
|
| Rate for Payer: Aetna Medicare |
$430.59
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$231.39
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$287.06
|
| Rate for Payer: Amerigroup Medicare |
$287.06
|
| Rate for Payer: BCBS of TX Blue Advantage |
$440.39
|
| Rate for Payer: BCBS of TX Blue Essentials |
$526.45
|
| Rate for Payer: BCBS of TX Medicare |
$287.06
|
| Rate for Payer: BCBS of TX PPO |
$587.19
|
| Rate for Payer: Cash Price |
$2,262.48
|
| Rate for Payer: Cash Price |
$2,262.48
|
| Rate for Payer: Cash Price |
$2,262.48
|
| Rate for Payer: Cigna Commercial |
$650.28
|
| Rate for Payer: Cigna Medicare |
$287.06
|
| Rate for Payer: Employer Direct Commercial |
$287.06
|
| Rate for Payer: Humana Medicare/TRICARE |
$287.06
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$287.06
|
| Rate for Payer: Molina Medicare |
$287.06
|
| Rate for Payer: Multiplan Auto |
$1,671.15
|
| Rate for Payer: Multiplan Commercial |
$1,671.15
|
| Rate for Payer: Multiplan Workers Comp |
$1,671.15
|
| Rate for Payer: Scott and White EPO/PPO |
$5.13
|
| Rate for Payer: Scott and White Medicare |
$287.06
|
| Rate for Payer: Superior Health Plan EPO |
$287.06
|
| Rate for Payer: Superior Health Plan Medicare |
$287.06
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$287.06
|
| Rate for Payer: Universal American Medicare |
$287.06
|
| Rate for Payer: Wellcare Medicare |
$287.06
|
| Rate for Payer: Wellmed Medicare |
$287.06
|
|
|
Cardiovascular stress test trace 93017 BCE
|
Facility
|
OP
|
$2,571.00
|
|
|
Service Code
|
CPT 93017
|
| Hospital Charge Code |
2800142
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$5.13 |
| Max. Negotiated Rate |
$1,671.15 |
| Rate for Payer: Aetna Commercial |
$59.47
|
| Rate for Payer: Aetna Medicare |
$430.59
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$231.39
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$287.06
|
| Rate for Payer: Amerigroup Medicare |
$287.06
|
| Rate for Payer: BCBS of TX Blue Advantage |
$440.39
|
| Rate for Payer: BCBS of TX Blue Essentials |
$526.45
|
| Rate for Payer: BCBS of TX Medicare |
$287.06
|
| Rate for Payer: BCBS of TX PPO |
$587.19
|
| Rate for Payer: Cash Price |
$2,262.48
|
| Rate for Payer: Cash Price |
$2,262.48
|
| Rate for Payer: Cash Price |
$2,262.48
|
| Rate for Payer: Cigna Commercial |
$650.28
|
| Rate for Payer: Cigna Medicare |
$287.06
|
| Rate for Payer: Employer Direct Commercial |
$287.06
|
| Rate for Payer: Humana Medicare/TRICARE |
$287.06
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$287.06
|
| Rate for Payer: Molina Medicare |
$287.06
|
| Rate for Payer: Multiplan Auto |
$1,671.15
|
| Rate for Payer: Multiplan Commercial |
$1,671.15
|
| Rate for Payer: Multiplan Workers Comp |
$1,671.15
|
| Rate for Payer: Scott and White EPO/PPO |
$5.13
|
| Rate for Payer: Scott and White Medicare |
$287.06
|
| Rate for Payer: Superior Health Plan EPO |
$287.06
|
| Rate for Payer: Superior Health Plan Medicare |
$287.06
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$287.06
|
| Rate for Payer: Universal American Medicare |
$287.06
|
| Rate for Payer: Wellcare Medicare |
$287.06
|
| Rate for Payer: Wellmed Medicare |
$287.06
|
|
