Inpatient Ratio of Cost to Charges Effective 01/1/2018...357216601 1073901476 chg hospital conroe...

12
TPI NPI Provider Combined Name Provider Street Address City, State and Zip County Rate Effective Date Inpatient Rate (December) 112705203 1851344162 ABILENE REGIONAL MEDICAL CENTER 6250 US HIGHWAY 83 # 84 ABILENE, TX 79606-5215 TAYLOR 08/01/2017 28% 203965301 1235392192 ACUITY HOSPITAL OF SOUTH TEXAS LLC 718 LEXINGTON AVE SAN ANTONIO, TX 78212-476 BEXAR 05/24/2008 63% 365048301 1669732178 AD HOSPITAL EAST LLC- 12950 EAST FWY HOUSTON, TX 77015-5710 HARRIS 01/21/2016 50% 121789503 1821009242 ADVENTIST HEALTH SYSTEM SUNBELT INC-CENTRAL TEX 1301 WONDER WORLD DR SAN MARCOS, TX 78666-7533 HAYS 01/01/2018 41% 282322101 1407169196 AMH CATH LABS, LLC-TEXAS HEALTH HEART & VASCULAR 811 WRIGHT ST ARLINGTON, TX 76012-4708 TARRANT 01/01/2018 25% 127298107 1174563779 ANDREWS COUNTY HOSPITAL DISTRICT 720 HOSPITAL DR ANDREWS, TX 79714-3617 ANDREWS 10/01/2017 100% 364187001 1457393571 ANSON HOSPITAL DISTRICT- 101 AVENUE J ANSON, TX 79501 JONES 04/01/2017 69% 334284201 1295173664 ARISE HEALTHCARE SYSTEM, LLC- 3003 BEE CAVES RD AUSTIN, TX 78746-5542 TRAVIS 03/01/2016 24% 365612601 1114340080 ASPIRE HOSPITAL LLC 2006 S LOOP 336 W STE 500 CONROE, TX 77304-3315 MONTGOMERY 03/31/2015 50% 282268601 1386882488 ATRIUM MEDICAL CENTER LP- 11929 W AIRPORT BLVD STE 11 STAFFORD, TX 77477-2454 FORT BEND 07/01/2016 45% 348183001 1144625153 AUSTIN BEHAVIORAL HOSPITAL, LLC-CROSS CREEK HOS 8402 CROSS PARK DR AUSTIN, TX 78754-4595 TRAVIS 04/22/2015 50% 094215302 1245292630 AUSTIN CENTER FOR OUTPATIENT SURGERY LP-NORTH 6818 AUSTIN CTR BLVD #100 AUSTIN, TX 78731-3199 TRAVIS 01/01/2018 47% 130089906 1225038938 BALLINGER MEMORIAL HOSPITAL 608 AVENUE B BALLINGER, TX 76821-2406 RUNNELS 10/01/2016 96% 094148602 1093744187 BAPTIST HOSPITALS OF SOUTHEAST TEXAS-MEMORIAL H 3080 COLLEGE BEAUMONT, TX 77704-4606 JEFFERSON 01/01/2018 24% 020973601 1508810573 BAY AREA HEALTHCARE GROUP, LTD-CORPUS CHRISTI M 7101 S PADRE ISLAND DR CORPUS CHRISTI, TX 78412- NUECES 08/01/2017 15% 341698401 1336574904 BAY AREA REGIONAL MEDICAL CENTER LLC- 200 BLOSSOM ST WEBSTER, TX 77598-4204 HARRIS 06/01/2017 45% 135036506 1669472387 BAYLOR ALL SAINTS MEDICAL CENTER-BAYLOR SCOTT & 1400 8TH AVE FORT WORTH, TX 76104-4110 TARRANT 10/01/2017 44% 138353107 1194893263 BAYLOR COUNTY HOSPITAL DISTRICT-SEYMOUR HOSPIT 200 STADIUM DRIVE SEYMOUR, TX 76380-2344 BAYLOR 06/01/2017 100% 151691601 1609855139 BAYLOR HEART AND VASCULAR HOSPITAL 621 N HALL STREET DALLAS, TX 75226-2017 DALLAS 06/01/2017 32% 288563403 1285930891 BAYLOR INSTITUTE FOR REHABILITATION AT FRISCO- 500 BROAD ST WICHITA FALLS, TX 76301-31 WICHITA 04/01/2011 50% 127262703 1073511762 BAYLOR MED CTR AT GRAPEVINE-BAYLOR SCOTT AND W 1650 W COLLEGE ST GRAPEVINE, TX 76051-3565 TARRANT 07/01/2017 35% 344925801 1952509465 BAYLOR MEDICAL CENTER AT CARROLLTON-BAYLOR SCO 4343 N JOSEY LN CARROLLTON, TX 75010-460 DENTON 08/01/2017 55% 121776205 1992700983 BAYLOR MEDICAL CENTER AT IRVING- 1901 N MACARTHUR BLVD IRVING, TX 75061 DALLAS 06/01/2017 38% 135223905 1265430177 BAYLOR MEDICAL CENTER AT WAXAHACHIE 2400 N INTERSTATE HIGHWAY WAXAHACHIE, TX 75165-5240 ELLIS 07/01/2017 46% 314161601 1124305065 BAYLOR MEDICAL CENTERS AT GARLAND AND MCKINNEY 5252 W UNIVERSITY DR MCKINNEY, TX 75071-7822 COLLIN 07/01/2017 43% 171848805 1649273434 BAYLOR REGIONAL MEDICAL CENTER AT PLANO- 4700 ALLIANCE BLVD PLANO, TX 75093-5323 COLLIN 01/01/2018 31% 139485012 1447250253 BAYLOR UNIVERSITY MEDICAL CENTER 3600 GASTON AVE DALLAS, TX 75246-1800 DALLAS 12/01/2017 35% 020993401 1174522494 BAYSIDE COMMUNITY HOSPITAL- 200 HOSPITAL DRIVE ANAHUAC, TX 77514-0398 CHAMBERS 11/01/2015 100% 336658501 1396184180 BEHAVIORAL HEALTH CENTER OF THE PERMIAN BASIN LL 3300 S FM 1788 MIDLAND, TX 79706-2601 MIDLAND 12/20/2012 50% 217547301 1093021719 BEHAVIORAL HEALTH MANAGEMENT, LLC- 5314 DASHWOOD DR STE 200 HOUSTON, TX 77081-4603 HARRIS 08/18/2010 80% 083290905 1477857332 BELLVILLE ST JOSEPH HEALTH CENTER-BELLVILLE GENE 44 N CUMMINGS ST BELLVILLE, TX 77418-1347 AUSTIN 07/01/2017 100% 136141205 1821011248 BEXAR COUNTY HOSPITAL DISTRICT-UNIVERSITY HEALTH 4502 MEDICAL DR SAN ANTONIO, TX 78229-449 BEXAR 01/01/2018 35% 094224503 1356312243 BIG BEND REGIONAL MEDICAL CENTER 2600 N HIGHWAY 118 ALPINE, TX 79830-2002 BREWSTER 09/01/2017 34% 112721903 1538465901 BIR JV LLP-BAYLOR INSTITUTE FOR REHABILITATION 909 N WASHINGTON AVE DALLAS, TX 75246-1520 DALLAS 07/01/2014 78% 094226002 1801817135 BRAZOS VALLEY PHYSICIANS ORGANIZATION MSO LLC-TH 3131 UNIVERSITY DRIVE EAST BRYAN, TX 77802-3473 BRAZOS 12/01/2014 56% 207311601 1114903523 BRIM HEALTHCARE OF TEXAS LLC-WADLEY REGIONAL ME 1000 PINE ST TEXARKANA, TX 75501-5100 BOWIE 01/01/2018 28% 020930601 1679526982 BROWNWOOD REGIONAL MEDICAL CENTER 1501 BURNET RD BROWNWOOD, TX 76801-852 BROWN 09/01/2017 24% 322879301 1407191984 BSA HOSPITAL LLC DBA BAPTIST ST ANTHONYS HOSPITA 1600 WALLACE BLVD AMARILLO, TX 79106-1799 POTTER 01/01/2018 29% 364710901 1598138919 BT EAST DALLAS JV LLP-BAYLOR SCOTT & WHITE MEDICA 9440 POPPY DRIVE DALLAS, TX 75218-3652 DALLAS 08/01/2017 18% 362293801 1134127749 BT GARLAND JV LLP-BAYLOR SCOTT & WHITE MEDICAL C 2300 MARIE CURIE DR GARLAND, TX 75042-5706 DALLAS 01/01/2018 29% 112725003 1750377289 BURLESON ST JOSEPH HEALTH CENTER-BURLESON ST. J 1101 WOODSON DRIVE CALDWELL, TX 77836-1052 BURLESON 01/01/2015 41% 212060201 1205164928 CAHRMC LLC-RICE MEDICAL CENTER 600 S AUSTIN RD EAGLE LAKE, TX 77434-3202 COLORADO 01/01/2018 100% 312666601 1295097624 CAMBRIDGE HOSPITAL, LLC- 7601 FANNIN ST HOUSTON, TX 77054-1905 HARRIS 11/26/2012 50% 314300001 1134401466 CARROLLTON SPRINGS LLC 2225 PARKER RD CARROLLTON, TX 75010-471 DENTON 04/24/2012 50% 211970301 1013142553 CBSH,LLC- 6130 PARKWAY CORPUS CHRISTI, TX 78414- NUECES 01/01/2018 40% 192622201 1376662296 CEDAR PARK REGIONAL MEDICAL CENTER 1401 MEDICAL PARKWAY CEDAR PARK, TX 78613-7464WILLIAMSON 01/01/2018 21% 190809701 1609091693 CENTRAL TEXAS REHABILITATION HOSPITAL LLC-CENTRA 700 W 45TH ST AUSTIN, TX 78751-2800 TRAVIS 01/01/2016 100% 020817501 1174576698 CHCA BAYSHORE LP-BAYSHORE MEDICAL CENTER 4000 SPENCER HWY PASADENA, TX 77504-1202 HARRIS 01/01/2018 16% Inpatient Ratio of Cost to Charges Effective 01/1/2018 Prepared by HHSC Hospital Rate Analysis Department 1 of 12 1/24/2018

Transcript of Inpatient Ratio of Cost to Charges Effective 01/1/2018...357216601 1073901476 chg hospital conroe...

Page 1: Inpatient Ratio of Cost to Charges Effective 01/1/2018...357216601 1073901476 chg hospital conroe llc-chg hospital conroe, llc 1500 grand lake dr conroe, tx 77304-2891 montgomery 09/01/2010

TPI NPI Provider Combined Name Provider Street Address City, State and Zip County

Rate Effective

Date

Inpatient Rate

(December)

112705203 1851344162 ABILENE REGIONAL MEDICAL CENTER 6250 US HIGHWAY 83 # 84 ABILENE, TX 79606-5215 TAYLOR 08/01/2017 28%

203965301 1235392192 ACUITY HOSPITAL OF SOUTH TEXAS LLC 718 LEXINGTON AVE SAN ANTONIO, TX 78212-4768BEXAR 05/24/2008 63%

365048301 1669732178 AD HOSPITAL EAST LLC- 12950 EAST FWY HOUSTON, TX 77015-5710 HARRIS 01/21/2016 50%

121789503 1821009242 ADVENTIST HEALTH SYSTEM SUNBELT INC-CENTRAL TEXASMEDICAL CENTER 1301 WONDER WORLD DR SAN MARCOS, TX 78666-7533HAYS 01/01/2018 41%

282322101 1407169196 AMH CATH LABS, LLC-TEXAS HEALTH HEART & VASCULAR HOSPITAL ARLINGTON 811 WRIGHT ST ARLINGTON, TX 76012-4708 TARRANT 01/01/2018 25%

127298107 1174563779 ANDREWS COUNTY HOSPITAL DISTRICT 720 HOSPITAL DR ANDREWS, TX 79714-3617 ANDREWS 10/01/2017 100%

364187001 1457393571 ANSON HOSPITAL DISTRICT- 101 AVENUE J ANSON, TX 79501 JONES 04/01/2017 69%

334284201 1295173664 ARISE HEALTHCARE SYSTEM, LLC- 3003 BEE CAVES RD AUSTIN, TX 78746-5542 TRAVIS 03/01/2016 24%

365612601 1114340080 ASPIRE HOSPITAL LLC 2006 S LOOP 336 W STE 500 CONROE, TX 77304-3315 MONTGOMERY 03/31/2015 50%

282268601 1386882488 ATRIUM MEDICAL CENTER LP- 11929 W AIRPORT BLVD STE 110 STAFFORD, TX 77477-2454 FORT BEND 07/01/2016 45%

348183001 1144625153 AUSTIN BEHAVIORAL HOSPITAL, LLC-CROSS CREEK HOSPITAL 8402 CROSS PARK DR AUSTIN, TX 78754-4595 TRAVIS 04/22/2015 50%

094215302 1245292630 AUSTIN CENTER FOR OUTPATIENT SURGERY LP-NORTHWEST HILLS SURGICAL HOSPITAL 6818 AUSTIN CTR BLVD #100 AUSTIN, TX 78731-3199 TRAVIS 01/01/2018 47%

130089906 1225038938 BALLINGER MEMORIAL HOSPITAL 608 AVENUE B BALLINGER, TX 76821-2406 RUNNELS 10/01/2016 96%

094148602 1093744187 BAPTIST HOSPITALS OF SOUTHEAST TEXAS-MEMORIAL HERMANN BAPTIST BEAUMONT HOSPITAL 3080 COLLEGE BEAUMONT, TX 77704-4606 JEFFERSON 01/01/2018 24%

020973601 1508810573 BAY AREA HEALTHCARE GROUP, LTD-CORPUS CHRISTI MEDICAL CENTER 7101 S PADRE ISLAND DR CORPUS CHRISTI, TX 78412-4913NUECES 08/01/2017 15%

341698401 1336574904 BAY AREA REGIONAL MEDICAL CENTER LLC- 200 BLOSSOM ST WEBSTER, TX 77598-4204 HARRIS 06/01/2017 45%

135036506 1669472387 BAYLOR ALL SAINTS MEDICAL CENTER-BAYLOR SCOTT & WHITE ALL SAINTS MEDICAL CENTER FOR1400 8TH AVE FORT WORTH, TX 76104-4110TARRANT 10/01/2017 44%

138353107 1194893263 BAYLOR COUNTY HOSPITAL DISTRICT-SEYMOUR HOSPITAL 200 STADIUM DRIVE SEYMOUR, TX 76380-2344 BAYLOR 06/01/2017 100%

151691601 1609855139 BAYLOR HEART AND VASCULAR HOSPITAL 621 N HALL STREET DALLAS, TX 75226-2017 DALLAS 06/01/2017 32%

288563403 1285930891 BAYLOR INSTITUTE FOR REHABILITATION AT FRISCO- 500 BROAD ST WICHITA FALLS, TX 76301-3109WICHITA 04/01/2011 50%

127262703 1073511762 BAYLOR MED CTR AT GRAPEVINE-BAYLOR SCOTT AND WHITE MEDICAL CENTER-GRAPEVINE 1650 W COLLEGE ST GRAPEVINE, TX 76051-3565 TARRANT 07/01/2017 35%

344925801 1952509465 BAYLOR MEDICAL CENTER AT CARROLLTON-BAYLOR SCOTT & WHITE MEDICAL CENTER -CARROLLTON 4343 N JOSEY LN CARROLLTON, TX 75010-4603DENTON 08/01/2017 55%

121776205 1992700983 BAYLOR MEDICAL CENTER AT IRVING- 1901 N MACARTHUR BLVD IRVING, TX 75061 DALLAS 06/01/2017 38%

135223905 1265430177 BAYLOR MEDICAL CENTER AT WAXAHACHIE 2400 N INTERSTATE HIGHWAY 35 E WAXAHACHIE, TX 75165-5240ELLIS 07/01/2017 46%

314161601 1124305065 BAYLOR MEDICAL CENTERS AT GARLAND AND MCKINNEY-BAYLOR SCOTT AND WHITE MEDICAL CENTER - MCKINNEY 5252 W UNIVERSITY DR MCKINNEY, TX 75071-7822 COLLIN 07/01/2017 43%

171848805 1649273434 BAYLOR REGIONAL MEDICAL CENTER AT PLANO- 4700 ALLIANCE BLVD PLANO, TX 75093-5323 COLLIN 01/01/2018 31%

139485012 1447250253 BAYLOR UNIVERSITY MEDICAL CENTER 3600 GASTON AVE DALLAS, TX 75246-1800 DALLAS 12/01/2017 35%

020993401 1174522494 BAYSIDE COMMUNITY HOSPITAL- 200 HOSPITAL DRIVE ANAHUAC, TX 77514-0398 CHAMBERS 11/01/2015 100%

336658501 1396184180 BEHAVIORAL HEALTH CENTER OF THE PERMIAN BASIN LLC-OCEANS BEHAVIORAL HOSPITAL OF THE PERMIAN BASIN 3300 S FM 1788 MIDLAND, TX 79706-2601 MIDLAND 12/20/2012 50%

217547301 1093021719 BEHAVIORAL HEALTH MANAGEMENT, LLC- 5314 DASHWOOD DR STE 200 HOUSTON, TX 77081-4603 HARRIS 08/18/2010 80%

083290905 1477857332 BELLVILLE ST JOSEPH HEALTH CENTER-BELLVILLE GENERAL HOSPITAL 44 N CUMMINGS ST BELLVILLE, TX 77418-1347 AUSTIN 07/01/2017 100%

136141205 1821011248 BEXAR COUNTY HOSPITAL DISTRICT-UNIVERSITY HEALTH SYSTEM 4502 MEDICAL DR SAN ANTONIO, TX 78229-4493BEXAR 01/01/2018 35%

094224503 1356312243 BIG BEND REGIONAL MEDICAL CENTER 2600 N HIGHWAY 118 ALPINE, TX 79830-2002 BREWSTER 09/01/2017 34%

112721903 1538465901 BIR JV LLP-BAYLOR INSTITUTE FOR REHABILITATION 909 N WASHINGTON AVE DALLAS, TX 75246-1520 DALLAS 07/01/2014 78%

094226002 1801817135 BRAZOS VALLEY PHYSICIANS ORGANIZATION MSO LLC-THE PHYSICIANS CENTRE HOSPITAL 3131 UNIVERSITY DRIVE EAST BRYAN, TX 77802-3473 BRAZOS 12/01/2014 56%

207311601 1114903523 BRIM HEALTHCARE OF TEXAS LLC-WADLEY REGIONAL MEDICAL CENTER 1000 PINE ST TEXARKANA, TX 75501-5100 BOWIE 01/01/2018 28%

020930601 1679526982 BROWNWOOD REGIONAL MEDICAL CENTER 1501 BURNET RD BROWNWOOD, TX 76801-8520BROWN 09/01/2017 24%

322879301 1407191984 BSA HOSPITAL LLC DBA BAPTIST ST ANTHONYS HOSPITAL- 1600 WALLACE BLVD AMARILLO, TX 79106-1799 POTTER 01/01/2018 29%

364710901 1598138919 BT EAST DALLAS JV LLP-BAYLOR SCOTT & WHITE MEDICAL CENTER - WHITE ROCK 9440 POPPY DRIVE DALLAS, TX 75218-3652 DALLAS 08/01/2017 18%

362293801 1134127749 BT GARLAND JV LLP-BAYLOR SCOTT & WHITE MEDICAL CENTER - GARLAND 2300 MARIE CURIE DR GARLAND, TX 75042-5706 DALLAS 01/01/2018 29%

112725003 1750377289 BURLESON ST JOSEPH HEALTH CENTER-BURLESON ST. JOSEPH HEALTH CENTER 1101 WOODSON DRIVE CALDWELL, TX 77836-1052 BURLESON 01/01/2015 41%

212060201 1205164928 CAHRMC LLC-RICE MEDICAL CENTER 600 S AUSTIN RD EAGLE LAKE, TX 77434-3202 COLORADO 01/01/2018 100%

312666601 1295097624 CAMBRIDGE HOSPITAL, LLC- 7601 FANNIN ST HOUSTON, TX 77054-1905 HARRIS 11/26/2012 50%

314300001 1134401466 CARROLLTON SPRINGS LLC 2225 PARKER RD CARROLLTON, TX 75010-4711DENTON 04/24/2012 50%

211970301 1013142553 CBSH,LLC- 6130 PARKWAY CORPUS CHRISTI, TX 78414-2455NUECES 01/01/2018 40%

192622201 1376662296 CEDAR PARK REGIONAL MEDICAL CENTER 1401 MEDICAL PARKWAY CEDAR PARK, TX 78613-7464WILLIAMSON 01/01/2018 21%

190809701 1609091693 CENTRAL TEXAS REHABILITATION HOSPITAL LLC-CENTRAL TEXAS REHABILITATION HOSPITAL 700 W 45TH ST AUSTIN, TX 78751-2800 TRAVIS 01/01/2016 100%

020817501 1174576698 CHCA BAYSHORE LP-BAYSHORE MEDICAL CENTER 4000 SPENCER HWY PASADENA, TX 77504-1202 HARRIS 01/01/2018 16%

Inpatient Ratio of Cost to Charges Effective 01/1/2018

Prepared by HHSC Hospital Rate Analysis Department 1 of 12 1/24/2018

Page 2: Inpatient Ratio of Cost to Charges Effective 01/1/2018...357216601 1073901476 chg hospital conroe llc-chg hospital conroe, llc 1500 grand lake dr conroe, tx 77304-2891 montgomery 09/01/2010

TPI NPI Provider Combined Name Provider Street Address City, State and Zip County

Rate Effective

Date

Inpatient Rate

(December)

121807504 1063466035 CHCA CLEAR LAKE LP-CLEAR LAKE REGIONAL MEDICAL CENTER 500 W MEDICAL CENTER BLVD WEBSTER, TX 77598-4220 HARRIS 01/01/2018 11%

020841501 1962455816 CHCA CONROE LP-CONROE REGIONAL MEDICAL CENTER 504 MEDICAL CENTER BLVD CONROE, TX 77305-2808 MONTGOMERY 01/01/2018 16%

349366001 1609275585 CHCA PEARLAND, LP-PEARLAND MEDICAL CENTER 11100 SHADOW CREEK PKWY PEARLAND, TX 77584-7285 BRAZORIA 02/01/2017 41%

094187402 1275580938 CHCA WEST HOUSTON LP-WEST HOUSTON MEDICAL CENTER 12141 RICHMOND AVE HOUSTON, TX 77082-2408 HARRIS 01/01/2018 21%

112712802 1023065794 CHCA WOMANS HOSPITAL LP-THE WOMANS HOSPITAL OF TEXAS 7600 FANNIN ST HOUSTON, TX 77054-1906 HARRIS 03/01/2017 10%

356438701 1912395203 CHG HOSPITAL AUSTIN LLC-CORNERSTONE HOSPITAL AUSTIN 4207 BURNET RD AUSTIN, TX 78756-3316 TRAVIS 07/15/2005 50%

357216601 1073901476 CHG HOSPITAL CONROE LLC-CHG HOSPITAL CONROE, LLC 1500 GRAND LAKE DR CONROE, TX 77304-2891 MONTGOMERY 09/01/2010 35%

358588701 1457730426 CHG HOSPITAL HOUSTON LLC-CORNERSTONE HOSPITAL HOUSTON-BELLAIRE 5314 DASHWOOD DR HOUSTON, TX 77081-0000 HARRIS 07/01/2017 21%

355796901 1760870166 CHG HOSPITAL MCALLEN LLC-SOLARA HOSPITAL MCALLEN 301 W EXPRESSWAY 83 FL 8 MCALLEN, TX 78503 HIDALGO 05/01/2011 23%

357053301 1659761815 CHG HOSPITAL MEDICAL CENTER LLC- 2001 HERMANN DR HOUSTON, TX 77004-7643 HARRIS 01/12/2012 50%

127300503 1184622847 CHI ST LUKES HEALTH BAYLOR COLLEGE OF MEDICINE MED6720 BERTNER AVE HOUSTON, TX 77030-2604 HARRIS 07/01/2017 19%

138910807 1194743013 CHILDRENS MEDICAL CENTER OF DALLAS-CHILDRENS MEDICAL CENTER 1935 MEDICAL DISTRICT DR DALLAS, TX 75235-7701 DALLAS 10/01/2017 27%

354178101 1720480627 CHILDRENS MEDICAL CENTER OF DALLAS-CHILDREN'S MEDICAL CENTER PLANO 7601 PRESTON RD PLANO, TX 75024-3214 COLLIN 01/01/2018 35%

133250406 1326079534 CHILDRESS COUNTY HOSPITAL DISTRICT-CHILDRESS REGIONAL MEDICAL CENTER 901 US HIGHWAY 83 N CHILDRESS, TX 79201-2320 CHILDRESS 09/01/2017 62%

154632701 1548269590 CHILLICOTHE HOSPITAL DISTRICT 303 AVENUE I CHILLICOTHE, TX 79225-0370HARDEMAN 10/01/2011 100%

211454803 1548495740 CHRISTUS CONTINUING CARE- 820 CLARKSVILLE ST PARIS, TX 75460-6027 LAMAR 01/01/2015 50%

211468803 1932334125 CHRISTUS CONTINUING CARE- 2830 CALDER ST BEAUMONT, TX 77702-1809 JEFFERSON 07/01/2009 56%

094353202 1467453902 CHRISTUS HEALTH ARK LA TEX-CHRISTUS ST MICHAEL REHABILITATION HOSPITAL 2400 ST MICHAEL DR TEXARKANA, TX 75503-2374 BOWIE 08/01/2015 31%

020976902 1295736734 CHRISTUS HEALTH ARK LATEX- 2600 SAINT MICHAEL DR TEXARKANA, TX 75503-5220 BOWIE 06/01/2017 29%

138296208 1679557888 CHRISTUS HEALTH SOUTHEAST TEXAS-CHRISTUS HOSPITAL 2830 CALDER ST BEAUMONT, TX 77702-1809 JEFFERSON 07/01/2017 18%

366812101 1033568621 CHRISTUS HOPKINS HEALTH ALLIANCE-CHRISTUS MOTHER FRANCES HOSPITAL - SULPHUR SPRINGS115 AIRPORT RD SULPHUR SPRINGS, TX 75482-2105HOPKINS 11/01/2017 100%

112706003 1598749707 CHRISTUS JASPER MEMORIAL HOSPITAL- 1275 MARVIN HANCOCK DR JASPER, TX 75951-4935 JASPER 07/01/2017 59%

020844903 1821004151 CHRISTUS SANTA ROSA HEALTH CARE CORPORATION-CHILDRENS HOSPITAL OF SAN ANTONIO 333 N SANTA ROSA ST SAN ANTONIO, TX 78207-3108BEXAR 06/01/2017 34%

020844901 1194787218 CHRISTUS SANTA ROSA HEALTH CARE CORPORATION-CHRISTUS SANTA ROSA HOSPITAL 2827 BABCOCK RD SAN ANTONIO, TX 78229 BEXAR 07/01/2017 38%

094222903 1003885641 CHRISTUS SPOHN HEALTH SYSTEM CORPORATION- 2500 E MAIN ST ALICE, TX 78332-4261 JIM WELLS 06/01/2017 25%

020811801 1447228747 CHRISTUS SPOHN HEALTH SYSTEM CORPORATION-CHRISTUS SPOHN HOSPITAL BEEVILLE 1500 E HOUSTON ST BEEVILLE, TX 78102-5312 BEE 07/01/2017 38%

121775403 1689641680 CHRISTUS SPOHN HEALTH SYSTEM CORPORATION-CHRISTUS SPOHN HOSPITAL CORPUS CHRISTI 600 ELIZABETH ST CORPUS CHRISTI, TX 78404-2235NUECES 07/01/2017 21%

136436606 1093783391 CHRISTUS SPOHN HEALTH SYSTEM CORPORATION-CHRISTUS SPOHN HOSPITAL KLEBERG 1311 GENERAL CAVAZOS BLVD KINGSVILLE, TX 78363-7150 KLEBERG 07/01/2017 33%

363070901 1992172019 CISH OPERATIONS LLC- 1017 S TRAVIS AVE CLEVELAND, TX 77327 LIBERTY 06/16/2016 50%

137907508 1124052162 CITIZENS MEDICAL CENTER COUNTY OF VICTORIA-CITIZENS MEDICAL CENTER 2701 HOSPITAL DRIVE VICTORIA, TX 77901-5748 VICTORIA 06/01/2017 36%

112742503 1326015595 CLARITY CHILD GUIDANCE CENTER-SOUTHWEST MENTAL HEALTH 8535 TOM SLICK SAN ANTONIO, TX 78229-3367BEXAR 09/01/2017 60%

094138703 1437156361 CLAY COUNTY MEMORIAL HOSPITAL 310 W SOUTH ST HENRIETTA, TX 76365 CLAY 09/01/2016 100%

354076701 1861882532 CLEAR LAKE INSTITUTE FOR REHABILITATION, LLC-PAM REHABILITATION HOSPITAL OF CLEAR LAKE 110 E MEDICAL CENTER BLVD WEBSTER, TX 77598-4301 HARRIS 08/20/2015 50%

179322602 1972540417 CLEAR LAKE REHABILITATION HOSPITAL LLC-KINDRED REHABILIT HOSPITAL CLEAR LAKE 655 E MEDICAL CENTER BLVD WEBSTER, TX 77598-4328 HARRIS 08/01/2005 80%

094349003 1689648339 CMS REHAB OF WF LP-HEALTHSOUTH REHABILITATION HOSPITAL OF WICHITA FAL3901 ARMORY RD WICHITA FALLS, TX 76302-2204WICHITA 07/01/2015 50%

094152803 1942314448 COCHRAN MEMORIAL HOSPITAL 201 E GRANT AVE MORTON, TX 79346-3444 COCHRAN 09/01/2008 90%

020860501 1467403477 COLLEGE STATION MEDICAL CENTER 1604 ROCK PRAIRIE RD COLLEGE STATION, TX 77845-8395BRAZOS 09/01/2017 21%

020943901 1689628984 COLUMBIA HOSPITAL MEDICAL CITY DALLAS, SUBSIDIARY-MEDICAL CITY DALLAS HOSPITAL 7777 FOREST LN DALLAS, TX 75230-2505 DALLAS 07/01/2016 12%

020950401 1134172406 COLUMBIA MEDICAL CENTER OF ARLINGTON SUBSIDIARY LP-MEDICAL CENTER OF ARLINGTON 3301 MATLOCK RD ARLINGTON, TX 76015-2998 TARRANT 05/01/2017 15%

111905902 1306897277 COLUMBIA MEDICAL CENTER OF DENTON SUBSIDIARY LP-DENTON REGIONAL MEDICAL CENTER 3535 S I-35 E DENTON, TX 76210-6850 DENTON 01/01/2018 12%

020979302 1902857766 COLUMBIA MEDICAL CENTER OF LAS COLINAS, INC-LAS COLINAS MEDICAL CENTER 6800 N MACARTHUR BLVD IRVING, TX 75039-2422 DALLAS 01/01/2018 18%

112698903 1437102639 COLUMBIA MEDICAL CENTER OF MCKINNEY SUBSIDIARY LP-MEDICAL CENTER OF MCKINNEY 4500 MEDICAL CENTER DR MCKINNEY, TX 75069-1650 COLLIN 07/01/2017 16%

127311205 1699726406 COLUMBIA MEDICAL CENTER OF PLANO LP-MEDICAL CENTER OF PLANO 3901 W 15TH ST PLANO, TX 75075-7738 COLLIN 04/01/2017 15%

094105602 1518911833 COLUMBIA NORTH HILLS HOSPITAL-COLUMBIA NORTH HILLS HOSPITA 4401 BOOTH CALLOWAY RD NORTH RICHLAND HILLS, TX 76180-7371TARRANT 05/01/2017 15%

094193202 1659323772 COLUMBIA PLAZA MED CTR OF FT WORTH SUBSIDIARY LP-PLAZA MEDICAL CENTER OF FORT WORTH 900 8TH AVE FORT WORTH, TX 76104-3902TARRANT 02/01/2017 15%

112716902 1619924719 COLUMBIA RIO GRANDE HEALTHCARE LP-RIO GRANDE REGIONAL HOSPITAL 101 E RIDGE RD MCALLEN, TX 78503-1847 HIDALGO 08/01/2017 12%

020947001 1043267701 COLUMBIA VALLEY HEALTHCARE SYSTEMS LP-VALLEY REGIONAL MEDICAL CENTER 100A E ALTON GLOOR BLVD BROWNSVILLE, TX 78526-3346CAMERON 04/01/2017 11%

135033210 1740238641 COLUMBUS COMMUNITY HOSPITAL- 110 SHULT DR COLUMBUS, TX 78934-3016 COLORADO 04/01/2017 100%

281406304 1346544616 COMANCHE COUNTY MEDICAL CENTER COMPANY-COMANCHE COUNTY MEDICAL CENTER 10201 HIGHWAY 16 COMANCHE, TX 76442-4462 COMANCHE 01/01/2018 95%

112671602 1972581940 COMMUNITY HOSPITAL OF BRAZOSPORT-BRAZOSPORT REGIONAL HEALTH SYSTEM 100 MEDICAL DRIVE LAKE JACKSON, TX 77566-5674BRAZORIA 01/01/2018 38%

178396101 1174524466 CONTINUE CARE HOSPITAL OF TYLER INC-TYLER CONTINUE CARE HOSPITAL AT MOTHER FRANCES HOS800 EAST DAWSON 4TH FLOOR TYLER, TX 75701 SMITH 09/01/2011 10%

Prepared by HHSC Hospital Rate Analysis Department 2 of 12 1/24/2018

Page 3: Inpatient Ratio of Cost to Charges Effective 01/1/2018...357216601 1073901476 chg hospital conroe llc-chg hospital conroe, llc 1500 grand lake dr conroe, tx 77304-2891 montgomery 09/01/2010

TPI NPI Provider Combined Name Provider Street Address City, State and Zip County

Rate Effective

Date

Inpatient Rate

(December)

364396701 1992709661 CONTINUECARE HOSPITAL AT HENDRICK MEDICAL CENTER-CONTINUE CARE HOSPITAL AT HENDRICK MEDICAL CENTER 1900 PINE ST ABILENE, TX 79601 TAYLOR 07/01/2008 28%

352064501 1588005888 CONTINUECARE HOSPITAL OF MIDLAND INC- 4214 ANDREWS HWY FL 3 MIDLAND, TX 79703-4822 MIDLAND 05/01/2014 50%

021184901 1891765178 COOK CHILDREN'S MEDICAL CENTER- 801 7TH AVE FORT WORTH, TX 76104-2733TARRANT 11/01/2017 35%

196882804 1235299132 COOK CHILDRENS NORTHEAST HOSPITAL, LLC- 6316 PRECINCT LINE RD HURST, TX 76054-2766 TARRANT 01/01/2017 100%

130826407 1639176456 COON MEMORIAL HOSPITAL 1411 DENVER AVE DALHART, TX 79022-4809 DALLAM 07/01/2017 100%

094221102 1386652527 CORNERSTONE REGIONAL HOSPITAL 2302 CORNERSTONE BLVD EDINBURG, TX 78539-8471 HIDALGO 01/01/2017 13%

344945603 1821439183 CORPUS CHRISTI REHABILITATION HOSPITAL LLC 5726 ESPLANADE DR CORPUS CHRISTI, TX 78414-4165NUECES 07/19/2013 50%

134772611 1780823021 CORYELL COUNTY MEMORIAL HOSPITAL AUTHORITY- 1507 W MAIN ST GATESVILLE, TX 76528-1024 CORYELL 07/01/2017 100%

136331910 1720096019 COUNTY OF WARD-WARD MEMORIAL HOSPITAL 406 S GARY MONAHANS, TX 79756-4799 WARD 01/01/2017 47%

137227806 1790702371 COUNTY OF YOAKUM-YOAKUM COUNTY HOSPITAL 412 MUSTANG AVE DENVER CITY, TX 79323-2750YOAKUM 01/01/2018 100%

139461107 1972517365 COVENANT HEALTH SYSTEM-COVENANT MEDICAL CENTER 3615 19TH ST LUBBOCK, TX 79410 LUBBOCK 06/01/2017 14%

319209801 1013941780 COVENANT LONG TERM CARE LP-COVENANT SPECIALTY HOSPITAL 3815 20TH ST LUBBOCK, TX 79410-1235 LUBBOCK 06/01/2017 22%

358006001 1518348747 COVENANT REHABILITATION HOSPITAL OF LUBBOCK LLC-TRUSTPOINT REHABILITATION HOSPITAL OF LUBBOCK 4302 PRINCETON ST LUBBOCK, TX 79415-1304 LUBBOCK 01/01/2016 41%

358006003 1952784985 COVENANT REHABILITATION HOSPITAL OF LUBBOCK LLC-TRUSTPOINT REHABILITATION HOSPITAL OF LUBBOCK 4302 PRINCETON ST LUBBOCK, TX 79415-1304 LUBBOCK 08/01/2015 50%

303478701 1407010622 CR EMERGENCY ROOM LLC-BAYLOR EMERGENCY MEDICAL CENTER 26791 HIGHWAY 380 AUBREY, TX 76227-7654 DENTON 10/17/2009 50%

199602701 1316197767 CRANE COUNTY HOSPITAL DISTRICT-CRANE MEMORIAL HOSPITAL 1310 SOUTH ALFORD STREET CRANE, TX 79731-3809 CRANE 10/01/2016 100%

094141105 1063500270 CROSBYTON CLINIC HOSPITAL 710 W MAIN ST CROSBYTON, TX 79322-2143 CROSBY 01/01/2016 83%

138911619 1437148020 CUERO COMMUNITY HOSPITAL 2550 N ESPLANADE ST CUERO, TX 77954-4736 DEWITT 08/01/2017 75%

361949601 1568848059 CUMBERLAND SURGICAL HOSPITAL OF SAN ANTONIO LLC- 5330 N LOOP 1604 W SAN ANTONIO, TX 78249 BEXAR 01/23/2016 50%

378029801 1164952685 CY-FAIR MEDICAL CENTER HOSPITAL, LLC-CYPRESS FAIRBANKS MEDICAL CENTER HOSPITAL 10655 STEEPLETOP DR HOUSTON, TX 77065 HARRIS 08/01/2017 50%

021203701 1730187568 CYPRESS CREEK HOSPITAL INC 17750 CALI DR HOUSTON, TX 77090-2705 HARRIS 09/01/2006 51%

320384603 1356559991 DALLAS LTACH LLC-KINDRED HOSPITAL DALLAS CENTRAL 8050 MEADOW RD DALLAS, TX 75231-3406 DALLAS 09/01/2013 50%

219336901 1861690364 DALLAS MEDICAL CENTER LLC- 7 MEDICAL PKWY DALLAS, TX 75234-7823 DALLAS 08/01/2017 18%

189947801 1134108053 DAWSON COUNTY HOSPITAL DISTRICT-MEDICAL ARTS HOSPITAL 2000 N BRYAN AVE LAMESA, TX 79331 DAWSON 04/01/2017 85%

160709501 1053317362 DAY SURGERY AT RENAISSANCE LLC-DOCTORS HOSPITAL AT RENAISSANCE LTD 5501 S MCCOLL RD EDINBURG, TX 78539-9152 HIDALGO 01/01/2018 20%

133544006 1568454403 DEAF SMITH COUNTY HOSPITAL DISTRICT-HEREFORD REGIONAL MEDICAL CENTER 540 W 15TH ST HEREFORD, TX 79045-2820 DEAF SMITH 08/01/2017 98%

364597001 1407229529 DECATUR HOSPITAL AUTHORITY-WISE HEALTH SYSTEM 3200 N TARRANT PKWY FORT WORTH, TX 76177-8611TARRANT 07/26/2016 50%

343108201 1033204342 DENTON TRANSITIONAL LTCH LP-INTEGRITY TRANSITIONAL HOSPITAL 2813 S MAYHILL RD DENTON, TX 76208 DENTON 06/01/2008 50%

094118902 1851343909 DETAR HOSPITAL-DETAR HOSPITAL NAVARRO 506 E SAN ANTONIO ST VICTORIA, TX 77901-6060 VICTORIA 09/01/2017 17%

217884001 1326134255 DIMMIT REGIONAL HOSPITAL 704 HOSPITAL DR CARRIZO SPRINGS, TX 78834-3836DIMMIT 08/01/2017 71%

112727605 1891741468 DOCTORS HOSPITAL 1997 LP-UNITED MEMORIAL MEDICAL CENTER 510 W TIDWELL RD HOUSTON, TX 77091-4339 HARRIS 02/01/2017 33%

132812205 1548286172 DRISCOLL CHILDRENS HOSPITAL 3533 S ALAMEDA ST CORPUS CHRISTI, TX 78411-1721NUECES 09/01/2017 29%

199210901 1669655601 EAST EL PASO PHYSICIANS MEDICAL CENTER LLC-FOUNDATION SURGICAL HOSPITAL OF EL PASO 1416 GEORGE DIETER DR EL PASO, TX 79936-7601 EL PASO 01/01/2018 23%

020812601 1235256884 EAST TEXAS MEDICAL CENTER 1000 S BECKHAM AVE TYLER, TX 75701-1908 SMITH 11/01/2017 13%

020812603 1619092780 EAST TEXAS MEDICAL CENTER 1000 S BECKHAM 5TH FLOOR TYLER, TX 75701-1908 SMITH 09/01/2006 31%

139173209 1356320873 EAST TEXAS MEDICAL CENTER ATHENS 2000 S PALESTINE ATHENS, TX 75751-5610 HENDERSON 04/01/2017 17%

094127002 1801975107 EAST TEXAS MEDICAL CENTER CARTHAGE 409 COTTAGE RD CARTHAGE, TX 75633-1466 PANOLA 07/01/2017 39%

208843701 1770717167 EAST TEXAS MEDICAL CENTER HENDERSON- 300 WILSON ST HENDERSON, TX 75652-5956 RUSK 09/01/2017 30%

130612806 1285689133 EAST TEXAS MEDICAL CENTER JACKSONVILLE 501 S RAGSDALE ST JACKSONVILLE, TX 75766-2434CHEROKEE 11/01/2017 17%

138374715 1720037559 EAST TEXAS MEDICAL CENTER PITTSBURG- 2701 US HWY 271 N PITTSBURG, TX 75686-4289 CAMP 12/01/2017 33%

017624011 1396748430 EAST TEXAS MEDICAL CENTER QUITMAN- 117 N WINNSBORO ST QUITMAN, TX 75783-2144 WOOD 05/01/2017 27%

021177301 1700901873 EAST TEXAS MEDICAL CENTER RE 701 OLYMPIC PLAZA CIR TYLER, TX 75701-1950 SMITH 08/10/1995 80%

121817401 1821063553 EAST TEXAS MEDICAL CENTER TRINITY 317 PROSPECT DRIVE TRINITY, TX 75862-0317 TRINITY 03/01/2017 37%

137074409 1689650921 EASTLAND MEMORIAL HOSPITAL DISTRICT-EASTLAND MEMORIAL HOSPITAL 304 S DAUGHERTY AVE EASTLAND, TX 76448-2609 EASTLAND 06/01/2017 50%

348928801 1679903967 EBD BEMC BURLESON, LLC-BAYLOR EMERGENCY MEDICAL CENTER 12500 SOUTH FWY STE 100 BURLESON, TX 76028 JOHNSON 03/19/2015 50%

343799801 1952732653 EBD BEMC ROCKWALL, LLC-BAYLOR EMERGENCY MEDICAL CENTER 1975 ALPHA DR STE 100 ROCKWALL, TX 75087 ROCKWALL 10/01/2014 50%

135235306 1740273994 ECTOR COUNTY HOSPITAL DISTRICT-MEDICAL CENTER HOSPITAL 500 W 4TH ST ODESSA, TX 79761 ECTOR 09/01/2017 35%

169893802 1780677971 ECTOR COUNTY HOSPITAL DISTRICT-MEDICAL CENTER HOSPITAL 500 W 4TH ST ODESSA, TX 79761-5001 ECTOR 06/01/2011 37%

311054601 1003192311 EL CAMPO MEMORIAL HOSPITAL- 303 SANDY CORNER RD EL CAMPO, TX 77437-9535 WHARTON 04/01/2017 94%

291854201 1558659714 EL PASO CHILDRENS HOSPITAL- 4845 ALAMEDA AVE EL PASO, TX 79905-2705 EL PASO 11/01/2017 44%

138951211 1316936990 EL PASO COUNTY HOSPITAL DISTRICT-UNIVERSITY MEDICAL CENTER OF EL PASO 4815 ALAMEDA AVENUE EL PASO, TX 79905-2703 EL PASO 10/01/2017 37%

Prepared by HHSC Hospital Rate Analysis Department 3 of 12 1/24/2018

Page 4: Inpatient Ratio of Cost to Charges Effective 01/1/2018...357216601 1073901476 chg hospital conroe llc-chg hospital conroe, llc 1500 grand lake dr conroe, tx 77304-2891 montgomery 09/01/2010

TPI NPI Provider Combined Name Provider Street Address City, State and Zip County

Rate Effective

Date

Inpatient Rate

(December)

094109802 1770536120 EL PASO HEALTHCARE SYSTEM LTD-LAS PALMAS MEDICAL CENTER 1801 N OREGON ST EL PASO, TX 79902-3524 EL PASO 07/01/2017 11%

190248801 1194890103 EL PASO LTAC HOSPITAL 1221 N COTTON ST 3RD FLOOR EL PASO, TX 79902-3015 EL PASO 02/04/2007 50%

148322401 1366427130 EL PASO SPECIALTY HOSPITAL LTD-SURGICAL INSTITUTE OF EL PASO 1755 CURIE DR STE A EL PASO, TX 79902-2920 EL PASO 01/01/2017 43%

135034009 1871583153 ELECTRA HOSPITAL DISTRICT-ELECTRA MEMORIAL HOSPITAL 1207 S BAILEY ST ELECTRA, TX 76360-3221 WICHITA 08/01/2017 53%

309798201 1669752234 EMERUS BHS SA THOUSAND OAKS LLC-BAPTIST EMERGENCY HOSPITAL HAUSMAN 16088 SAN PEDRO AVENUE SAN ANTONIO, TX 78232-2249BEXAR 01/01/2018 39%

163111101 1063411767 ESSENT PRMC LP-PARIS REGIONAL MEDICAL CENTER 1128 CLARKSVILLE ST STE 50 PARIS, TX 75460-6089 LAMAR 07/01/2017 29%

325449201 1144566316 ESWCT CEDAR PARK, LLC-BAYLOR SCOTT & WHITE EMERGENCY MEDICAL CTR AT CEDA900 E WHITESTONE BLVD CEDAR PARK, TX 78613-9093WILLIAMSON 09/01/2013 50%

376537201 1235685892 FAIRFIELD HOSPITAL DISTRICT-FREESTONE MEDICAL CENTER 125 NEWMAN ST FAIRFIELD, TX 75840-1419 FREESTONE 08/01/2017 31%

133367602 1841294246 FALLS COMMUNITY HOSPITAL AND CLINIC 322 COLEMAN ST MARLIN, TX 76661-2358 FALLS 07/01/2017 37%

330811601 1760417646 FANNIN COUNTY HOSPITAL AUTHORITY-TMC BONHAM HOSPITAL 504 LIPSCOMB ST BONHAM, TX 75418-4028 FANNIN 01/01/2018 45%

354160901 1336533595 FIRST TEXAS HOSPITAL CARROLLTON LLC- 1401 E TRINITY MILLS RD CARROLLTON, TX 75006-1442DALLAS 11/03/2015 50%

365480801 1821450255 FIRST TEXAS HOSPITAL CY-FAIR, LLC-FIRST TEXAS HOSPITAL 9922 LOUETTA RD HOUSTON, TX 77070 HARRIS 10/11/2016 50%

112692202 1598746703 FISHER COUNTY HOSPITAL 774 STATE HWY 70 NORTH ROTAN, TX 79546-6918 FISHER 02/01/2016 100%

217744601 1902047376 FLOWER MOUND HOSPITAL PARTNERS LLC-TEXAS HEALTH PRESBYTERIAN HOSPITAL FLOWER MOUND 4400 LONG PRAIRIE RD FLOWER MOUND, TX 75028-1892DENTON 04/01/2017 43%

110803703 1770579591 FORT DUNCAN REGIONAL MEDICAL CENTER LP-FORT DUNCAN REGIONAL MEDICAL CENTER 3333 N FOSTER MALDONADO BLVD EAGLE PASS, TX 78852-5893 MAVERICK 01/01/2018 23%

112688002 1952308132 FRIO HOSPITAL 200 S I H 35 PEARSALL, TX 78061-6601 FRIO 01/01/2017 61%

157144001 1922002674 FRISCO MEDICAL CENTER-BAYLOR SCOTT & WHITE MEDICAL CENTER - FRISCO 5601 WARREN PKWY FRISCO, TX 75034 DENTON 01/01/2018 46%

167364201 1871599183 FT WORTH SURGICARE PARTNERS, LTD-BAYLOR SURGICAL HOSPITAL AT FT WORTH 1800 PARK PLACE AVE FORT WORTH, TX 76110-1302TARRANT 01/01/2016 44%

121777003 1922009331 GAINESVILLE HOSPITAL DISTRICT-NORTH TEXAS MEDICAL CENTER 1900 HOSPITAL BLVD GAINESVILLE, TX 76240-2002COOKE 08/01/2017 48%

359590201 1649646415 GARLAND BEHAVIORAL HOSPITAL 2300 MARIE CURIE DR GARLAND, TX 75042-5706 DALLAS 03/09/2016 50%

112728403 1083619712 GENERAL HOSPITAL-IRAAN GENERAL HOSPITAL 600 HWY 349 NORTH IRAAN, TX 79744-0665 PECOS 01/01/2018 100%

345305201 1275956807 GEORGETOWN BEHAVIORAL HEALTH INSTITUTE, LLC- 3101 S AUSTIN AVE GEORGETOWN, TX 78626-7541WILLIAMSON 10/28/2014 50%

312476002 1396902540 GLOBALREHAB FORT WORTH, LP- 6601 HARRIS PKWY FORT WORTH, TX 76132-6108TARRANT 11/19/2008 50%

310164401 1306011929 GLOBALREHAB LP- 1340 EMPIRE CENTRAL DR DALLAS, TX 75247-4022 DALLAS 11/19/2008 50%

349912101 1568695146 GLOBALREHAB SAN ANTONIO LP-SELECT REHABILITATION HOSPITAL OF SAN ANTONIO 19126 STONEHUE SAN ANTONIO, TX 78258-3490BEXAR 04/06/2010 80%

121785303 1932108214 GONZALES HEALTHCARE SYSTEMS-MEMORIAL HOSPITAL 1110 N SARAH DEWITT DR GONZALES, TX 78629-3311 GONZALES 05/01/2017 96%

094095902 1689663007 GOOD SHEPHERD MEDICAL CTR-GOOD SHEPHERD MEDICAL CENTER 700 E MARSHALL AVE LONGVIEW, TX 75601-5580 GREGG 09/01/2017 20%

137075116 1962455832 GOODALL WITCHER HOSPITAL FOUNDATION- 101 POSEY AVE CLIFTON, TX 76634 BOSQUE 11/01/2016 79%

197063401 1841497153 GPCH LLC-GOLDEN PLAINS COMMUNITY HOSPITAL 100 MEDICAL DR BORGER, TX 79007-7579 HUTCHINSON 01/01/2018 61%

346945401 1881691061 GRAHAM HOSPITAL DISTRICT- 1301 MONTGOMERY RD GRAHAM, TX 76450 YOUNG 11/01/2017 74%

147918003 1154317774 GRIMES ST JOSEPH HEALTH CENTER 210 S. JUDSON NAVASOTA, TX 77868-3704 GRIMES 01/01/2016 65%

138411709 1720088123 GUADALUPE COUNTY HOSPITAL BOARD-GUADALUPE REGIONAL MEDICAL CENTER 1215 EAST COURT SEGUIN, TX 78155-5129 GUADALUPE 08/01/2017 52%

121792903 1326037607 HAMILTON GENERAL HOSPITAL 400 N BROWN HAMILTON, TX 76531-1518 HAMILTON 08/01/2017 54%

110856504 1134137466 HAMILTON HOSPITAL 901 WEST HAMILTON ST OLNEY, TX 76374-1745 YOUNG 03/01/2017 65%

094131202 1396739710 HAMLIN MEMORIAL HOSPITAL 632 NW SECOND HAMLIN, TX 79520-3808 JONES 09/01/2015 100%

094117105 1992707780 HANSFORD COUNTY HOSPITAL DISTRICT-HANSFORD COUNTY HOSPITAL 707 SOUTH ROLAND ST SPEARMAN, TX 79081-3441 HANSFORD 10/01/2015 100%

121692107 1861510521 HARDEMAN COUNTY MEMORIAL HOSPITAL 402 MERCER ST QUANAH, TX 79252 HARDEMAN 10/01/2012 100%

154504801 1881688976 HARLINGEN MEDICAL CENTER LP- 5501 S EXPRESSWAY 77 HARLINGEN, TX 78550-3213 CAMERON 01/01/2018 27%

133355104 1205900370 HARRIS COUNTY HOSPITAL DISTRICT 1504 TAUB LOOP HOUSTON, TX 77030-1608 HARRIS 06/01/2017 55%

112667403 1124092036 HARRISON COUNTY HOSPITAL ASSOCIATION-GOOD SHEPHERD MEDICAL CENTER MARSHALL 811 S WASHINGTON AVE MARSHALL, TX 75670-5336 HARRISON 10/01/2017 38%

112702904 1184607897 HASKELL MEMORIAL HOSPITAL 1 NORTH AVENUE N HASKELL, TX 79521-5499 HASKELL 05/01/2016 100%

355497401 1780025148 HAVEN BEHAVIORAL SERVICES OF FRISCO LLC-HAVEN BEHAVIORAL HOSPITAL OF FRISCO 5680 FRISCO SQUARE BLVD STE 3000 FRISCO, TX 75034-3300 DENTON 01/09/2015 50%

021195501 1477669208 HEALTH AND HUMAN SERVICES COMMISSION-NORTH TEXAS STATE HOSPITAL 6515 KEMP BLVD WICHITA FALLS, TX 76308-5419WICHITA 05/01/2006 77%

021196301 1245344472 HEALTH AND HUMAN SERVICES COMMISSION-NORTH TEXAS STATE HOSPITAL 4730 COLLEGE DR VERNON, TX 76384-2231 WILBARGER 05/01/2006 84%

021219301 1821161167 HEALTH AND HUMAN SERVICES COMMISSION-RIO GRANDE STATE CENTER 1401 S RANGERVILLE RD HARLINGEN, TX 78552-7638 CAMERON 10/01/2006 100%

112751605 1720094550 HEALTH AND HUMAN SERVICES COMMISSION-TDMHMR-EL PASO PSYCHIATRIC CENTER 4615 ALAMEDA AVE EL PASO, TX 79905-2702 EL PASO 01/01/2006 41%

199329702 1699749341 HEALTH SOUTH CITY VIEW REHABILITATION HOSPITAL-HEALTHSOUTH CITY VIEW REHABILITATION HOSPITAL 6701 OAKMONT BLVD FORT WORTH, TX 76132-2957TARRANT 09/01/2006 50%

337018101 1366871600 HEALTH SOUTH REHABILITATION HOSPITAL OF HUMBLE- 19002 MCKAY DR HUMBLE, TX 77338-5701 HARRIS 01/01/2014 83%

021185601 1013968726 HEALTHBRIDGE CHILDRENS HOSPITAL- HOUSTON LTD-HEALTHBRIDGE CHILDRENS HOSPITAL 2929 WOODLAND PARK DR HOUSTON, TX 77082-2687 HARRIS 01/01/2018 37%

094347402 1144294893 HEALTHSOUTH PLANO REHABILITATION HOSPITAL LLC-HEALTHSOUTH PLANO REHABILITATION HOSPITAL 2800 W 15TH ST PLANO, TX 75075-7526 COLLIN 09/01/2006 80%

309446801 1548546088 HEALTHSOUTH REHAB HOSPITAL OF SOUTH AUSTIN LLC-HEALTHSOUTH REHABILITATION HOSPITAL OF AUSTIN 330 W BEN WHITE BLVD AUSTIN, TX 78704-8095 TRAVIS 06/29/2012 50%

Prepared by HHSC Hospital Rate Analysis Department 4 of 12 1/24/2018

Page 5: Inpatient Ratio of Cost to Charges Effective 01/1/2018...357216601 1073901476 chg hospital conroe llc-chg hospital conroe, llc 1500 grand lake dr conroe, tx 77304-2891 montgomery 09/01/2010

TPI NPI Provider Combined Name Provider Street Address City, State and Zip County

Rate Effective

Date

Inpatient Rate

(December)

288662403 1427374222 HEALTHSOUTH REHAB HOSPITAL OF THE MID-CITIES LLC-RELIANT REHABILITATION HOSPITAL MID CITIES 2304 HIGHWAY 121 BEDFORD, TX 76021-5985 TARRANT 11/05/2010 80%

021168201 1548233265 HEALTHSOUTH REHAB INSTITUTUE OF SAN ANTONIO (RIOSA-HEALTHSOUTH REHAB INSTITUTUE OF SAN ANTONIO 9119 CINNAMON HL SAN ANTONIO, TX 78240-5401BEXAR 09/01/2006 40%

021173202 1821062050 HEALTHSOUTH REHABILIATION HOSPITAL OF ARLINGTON 3200 MATLOCK RD ARLINGTON, TX 76015-2911 TARRANT 08/01/2009 58%

094352403 1194798801 HEALTHSOUTH REHABILITATION HOSPITAL THE WOODLANDS-HEALTHSOUTH REHAB HOSPITAL THE WOODLANDS 18550 INTERSTATE 45 S SHENANDOAH, TX 77384-4119MONTGOMERY 09/01/2004 50%

209804801 1477731156 HEALTHSOUTH REHABILITATION HOSPITAL NORTH HOUSTON-HEALTHSOUTH REHABILITATION HOSPITAL VISION PARK 117 VISION PARK BLVD SHENANDOAH, TX 77384-3001MONTGOMERY 07/01/2015 80%

313188001 1659539567 HEALTHSOUTH REHABILITATION HOSPITAL OF ABILENE LLC-HEALTHSOUTH REHABILITATION HOSPITAL OF ABILENE 6401 DIRECTORS PKWY ABILENE, TX 79606-5881 TAYLOR 10/30/2009 50%

301006801 1275813610 HEALTHSOUTH REHABILITATION HOSPITAL OF CYPRESS LLC- 13031 WORTHAM CENTER DR HOUSTON, TX 77065-5662 HARRIS 09/01/2012 50%

314562501 1982920773 HEALTHSOUTH REHABILITATION HOSPITAL OF DALLAS LLC-HEALTHSOUTH REHABILITATION HOSPITAL OF DALLAS 7930 NORTHAVEN RD DALLAS, TX 75230-3331 DALLAS 10/07/2010 50%

094343303 1851364558 HEALTHSOUTH REHABILITATION HOSPITAL OF FORT WORTH- 1212 W LANCASTER AVE # 1212 FORT WORTH, TX 76102-4510TARRANT 01/01/2011 100%

199238002 1720279342 HEALTHSOUTH REHABILITATION HOSPITAL OF RICHARDSON 3351 WATERVIEW PKWY RICHARDSON, TX 75080-1449DALLAS 02/01/2016 56%

209190201 1245422567 HEALTHSOUTH REHABILITATION HOSPITAL OF ROUND ROCK 1400 HESTERS CROSSING RD ROUND ROCK, TX 78681-8025WILLIAMSON 07/09/2008 50%

219907701 1518287721 HEALTHSOUTH REHABILITATION HOSPITAL OF SUGAR LAND-HEALTHSOUTH SUGAR LAND REHABILITATION HOSPITAL 1325 HIGHWAY 6 SUGAR LAND, TX 77478-4906FORT BEND 10/05/2010 50%

315341301 1376829812 HEALTHSOUTH REHABILITATION HOSPITAL OF VINTAGE PAR-HEALTHSOUTH REHABILITATION HOSPITAL THE VINTAGE 20180 CHASEWOOD PARK DR HOUSTON, TX 77070-1436 HARRIS 05/14/2012 50%

021175701 1649243353 HEALTHSOUTH REHABILITATION OF TEXARKANA INC 515 W 12TH ST TEXARKANA, TX 75501-4416 BOWIE 09/01/2006 29%

094351601 1821061532 HEALTHSOUTH REHABILITATION-HEALTHSOUTH REHABILITATION HOSPITAL OF MIDLAND/ODE1800 HERITAGE BLVD MIDLAND, TX 79707-9750 MIDLAND 09/01/2006 52%

322916301 1558349399 HEART OF TEXAS HEALTHCARE SYSTEM- 2008 NINE RD BRADY, TX 76825-7210 MCCULLOCH 04/01/2017 86%

109588703 1558354241 HEMPHILL COUNTY HOSPITAL 1020 S 4TH ST CANADIAN, TX 79014 HEMPHILL 10/01/2016 100%

138644310 1528064649 HENDRICK MEDICAL CENTER 1900 PINE ABILENE, TX 79601-2432 TAYLOR 08/01/2017 22%

361699701 1235510090 HERITAGE PARK SURGICAL HOSPITAL, LLC-BAYLOR SCOTT & WHITE SURGICAL HOSPITAL AT SHERMAN 3601 N CALAIS ST SHERMAN, TX 75090-1785 GRAYSON 12/22/2010 50%

312239201 1841562709 HH KILLEEN HEALTH SYSTEM LLC- 850 W CENTRAL TEXAS EXPY HARKER HEIGHTS, TX 76548-1890BELL 05/01/2017 32%

184076101 1205999232 HICKORY TRAIL HOSPITAL LP 2000 OLD HICKORY TRL DESOTO, TX 75115-2242 DALLAS 07/01/2006 73%

136430906 1497726343 HILL COUNTRY MEMORIAL HOSPITAL-HILL COUNTRY MEMORIAL HOSP 1020 S STATE HIGHWAY 16 FREDERICKSBURG, TX 78624-0835GILLESPIE 01/01/2018 45%

138962907 1891882833 HILLCREST BAPTIST MEDICAL CENTER-BAYLOR SCOTT & WHITE MEDICAL CENTER-HILLCREST 100 HILLCREST MEDICAL BLVD WACO, TX 76712-8897 MCLENNAN 10/01/2017 35%

021215104 1689692402 HMIH CEDAR CREST LLC-CEDAR CREST HOSPITAL 3500 S IH 35 BELTON, TX 76513-9426 BELL 12/23/2015 50%

365213301 1265808232 HOPEBRIDGE HOSPITAL HOUSTON, LLC-HOPEBRIDGE HOSPITAL 5556 GASMER DR HOUSTON, TX 77035 HARRIS 07/01/2017 36%

192996002 1962614834 HORIZON HEALTH AUSTIN INC-AUSTIN LAKES HOSPITAL 1025 E 32ND STREET AUSTIN, TX 78705-2714 TRAVIS 12/12/2007 80%

348990801 1689098790 HOUSTON BEHAVIORAL HEALTHCARE HOSPITAL, LLC- 2801 GESSNER RD HOUSTON, TX 77080-2503 HARRIS 03/25/2015 50%

360991901 1306223458 HOUSTON COUNTY HOSPITAL DISTRICT- 1100 E LOOP 304 CROCKETT, TX 75835-1810 HOUSTON 01/01/2018 56%

342897103 1306268321 HOUSTON METHODIST ST CATHERINE HOSPITAL-HOUSTON METHODIST ST CATHERINE HOSPITAL. 701 S FRY RD KATY, TX 77450-2237 HARRIS 07/01/2017 57%

336478801 1952723967 HOUSTON METHODIST ST JOHN HOSPITAL- 18300 SAINT JOHN DR HOUSTON, TX 77058-6302 HARRIS 01/01/2018 27%

193867201 1740450121 HOUSTON NORTHWEST OPERATING COMPANY LLC-HOUSTON NORTHWEST MEDICAL CENTER 710 CYPRESS CREEK PKWY HOUSTON, TX 77090-3402 HARRIS 05/01/2017 18%

131038504 1598750721 HUNT MEMORIAL HOSPITAL DISTRICT-HUNT REGIONAL MEDICAL CENTER 4215 JOE RAMSEY BLVD GREENVILLE, TX 75401-7852 HUNT 10/01/2017 41%

163936101 1669569984 IRVING COPPELL SURGICAL HOSPITAL LLP-IRVING-COPPELL SURGICAL HOSPITAL LLP 400 W INTERSTATE 635 STE 101 IRVING, TX 75063-1158 DALLAS 01/01/2017 35%

119874904 1790777696 JACK COUNTY HOSPITAL DISTRICT-FAITH COMMUNITY HOSPITAL 215 CHISHOLM TRL JACKSBORO, TX 76458-1403 JACK 06/01/2017 100%

121808305 1124061882 JACKSON COUNTY HOSPITAL DISTRICT-JACKSON HEALTHCARE CENTER 1013 S WELLS ST EDNA, TX 77957-4045 JACKSON 08/01/2017 100%

136412710 1699772541 KARNES COUNTY HOSPITAL DISTRICT-OTTO KAISER MEMORIAL HOSPITAL 3349 S HWY 181 KENEDY, TX 78119-5240 KARNES 06/01/2017 90%

168648701 1669480323 KELL WEST REGIONAL HOSPITAL LLC-KELL WEST REGIONAL HOSPITAL 5420 KELL WEST BOULEVARD WICHITA FALLS, TX 76310-2542WICHITA 12/01/2017 68%

021004901 1922177997 KINDRED HOSPITALS LIMITED PARTNERSHIP-KINDRED HOSPITAL - MANSFIELD 1802 HIGHWAY 157 N MANSFIELD, TX 76063-3923 TARRANT 12/01/2006 26%

021001501 1699844654 KINDRED HOSPITALS LIMITED PARTNERSHIP-KINDRED HOSPITAL- DALLAS 9525 GREENVILLE AVE DALLAS, TX 75243-4116 DALLAS 12/01/2006 25%

164466801 1598834566 KINDRED HOSPITALS LIMITED PARTNERSHIP-KINDRED HOSPITAL-FORT WORTH 815 EIGHTH AVENUE FORT WORTH, TX 76104-2609TARRANT 11/01/2016 25%

021002301 1558430520 KINDRED HOSPITALS LIMITED PARTNERSHIP-KINDRED HOSPITALS SAN ANTONIO 3636 MEDICAL DRIVE SAN ANTONIO, TX 78229-2183BEXAR 05/01/2014 42%

149633301 1821167818 KINDRED HOSPITALS LIMITED PARTNERSHIP-KINDRED HOSPITAL-WHITE ROCK 9440 POPPY DR -5TH FLOOR SOUTH DALLAS, TX 75218-3652 DALLAS 09/01/2004 50%

021008001 1942379912 KINDRED HOSPITALS LIMITED PARTNERSHIP-KINDRED HOSPTIAL HOUSTON MEDICAL CENTER 6441 MAIN STREET HOUSTON, TX 77030-1502 HARRIS 09/01/2010 50%

112724302 1811942238 KINGWOOD PLAZA HOSPITAL-KINGWOOD MEDICAL CENTER 22999 HIGHWAY 59 N KINGWOOD, TX 77339-4438 HARRIS 08/01/2017 13%

135035706 1861488579 KNAPP MEDICAL CENTER 1401 E 8TH ST WESLACO, TX 78596-6640 HIDALGO 01/01/2018 30%

366222301 1558721365 KND DEVELOPMENT 68, LLC-KINDRED HOSPITAL - SAN ANTONIO CENTRAL 111 DALLAS ST FL 4 SAN ANTONIO, TX 78205-1201BEXAR 06/28/2016 50%

094178302 1114998911 LAKE GRANBURY MEDICAL CENTER 1310 PALUXY RD GRANBURY, TX 76048-5655 HOOD 12/01/2017 23%

020966001 1205018439 LAKE POINTE MEDICAL CENTER 6800 SCENIC DR ROWLETT, TX 75088-4552 DALLAS 05/01/2017 18%

310443201 1831471291 LAKEWAY REGIONAL MEDICAL CENTER LLC- 100 MEDICAL PKWY LAKEWAY, TX 78738-5621 TRAVIS 09/01/2017 43%

127313803 1700854288 LAMB HEALTHCARE CENTER 1500 S SUNSET LITTLEFIELD, TX 79339-4899 LAMB 08/01/2017 100%

331242301 1851632616 LANCASTER REGIONAL HOSPITAL LP- 2600 W PLEASANT RUN RD LANCASTER, TX 75146-1114 DALLAS 01/01/2018 46%

Prepared by HHSC Hospital Rate Analysis Department 5 of 12 1/24/2018

Page 6: Inpatient Ratio of Cost to Charges Effective 01/1/2018...357216601 1073901476 chg hospital conroe llc-chg hospital conroe, llc 1500 grand lake dr conroe, tx 77304-2891 montgomery 09/01/2010

TPI NPI Provider Combined Name Provider Street Address City, State and Zip County

Rate Effective

Date

Inpatient Rate

(December)

162033801 1548232044 LAREDO MEDICAL CENTER 1700 E SAUNDERS STREET LAREDO, TX 78041-5401 WEBB 08/01/2017 14%

094186602 1396731105 LAREDO REGIONAL MEDICAL CENTER LP-DOCTORS HOSPITAL OF LAREDO 10700 MCPHERSON RD LAREDO, TX 78045-6268 WEBB 01/01/2018 21%

350658601 1710389929 LAREDO REHABILITATION HOSPITAL LLC- 2005A E BUSTAMANTE ST LAREDO, TX 78041-5470 WEBB 02/26/2015 50%

185051301 1316992878 LAREDO SPECIALTY HOSPITAL 2005 BUSTAMANIE LAREDO, TX 78041-5470 WEBB 07/07/2006 50%

135233809 1992767511 LAVACA MEDICAL CENTER HBP-LAVACA MEDICAL CENTER 1400 N TEXANA ST HALLETTSVILLE, TX 77964-2021LAVACA 01/01/2018 94%

284333604 1154324952 LIBERTY COUNTY HOSPITAL DISTRICT NO 1-LIBERTY DAYTON REGIONAL MEDICAL CENTER 1353 N TRAVIS ST LIBERTY, TX 77575-3549 LIBERTY 10/01/2016 97%

121781205 1831140979 LILLIAN M HUDSPETH MEMORIAL ER PHYS-LILLIAN M HUDSPETH MEMORIAL HOSPITAL 308 HUDSPETH ST SONORA, TX 76950-8003 SUTTON 01/01/2018 100%

140714001 1861487779 LIMESTONE MEDICAL CENTER 701 MCCLINTIC GROESBECK, TX 76642-2128 LIMESTONE 07/01/2017 75%

342027501 1619303641 LITTLE RIVER HEALTHCARE CAMERON HOSPITAL- 806 N CROCKETT AVE CAMERON, TX 76520-2553 MILAM 07/19/2014 50%

110839103 1528026267 LONGVIEW MEDICAL CENTER LP-LONGVIEW REGIONAL MEDICAL CENTER 2901 N 4TH ST LONGVIEW, TX 75605-5128 GREGG 09/01/2017 17%

163219201 1922001775 LUBBOCK HEART HOSPITAL LLC-LUBBOCK HEART HOSPITAL 4810 N LOOP 289 LUBBOCK, TX 79416-3025 LUBBOCK 04/01/2017 44%

281514401 1225289499 LUBBOCK HERITAGE HOSPITAL LLC-GRACE MEDICAL CENTER 2412 50TH ST LUBBOCK, TX 79412-2504 LUBBOCK 01/01/2018 36%

136492909 1992708705 LUBBOCK REGIONAL MHMR CENTER 1602 10TH ST LUBBOCK, TX 79401-2607 LUBBOCK 09/01/2012 50%

094180903 1821066820 LYNN COUNTY HOSPITAL-LYNN COUNTY HOSPITAL DISTRICT 2600 LOCKWOOD TAHOKA, TX 79373 LYNN 09/01/2017 72%

020990001 1780731737 MADISON ST JOSEPH HEALTH CENTER 1101 WEST CROSS ST MADISONVILLE, TX 77864 MADISON 07/01/2017 33%

136145310 1679560866 MARTIN COUNTY HOSPITAL DISTRICT 600 EAST I 20 STANTON, TX 79782-0640 MARTIN 05/01/2015 100%

130959304 1679678767 MATAGORDA COUNTY HOSPITAL DISTRICT-MATAGORDA REGIONAL MEDICAL CENTER 104 7TH ST BAY CITY, TX 77414-4853 MATAGORDA 08/01/2017 54%

283280001 1871898478 MAYHILL BEHAVIORAL HEALTH LLC- 2809 S MAYHILL RD DENTON, TX 76208-5910 DENTON 01/01/2018 31%

094172602 1023013935 MCCAMEY HOSPITAL 2500 S HWY 305 MCCAMEY, TX 79752-1200 UPTON 09/01/2014 100%

094192402 1255384533 MEDICAL CENTER OF LEWISVILLE SUBSIDIARY LP-MEDICAL CENTER OF LEWISVILLE 500 WEST MAIN LEWISVILLE, TX 75057-3629 DENTON 05/01/2017 19%

212140201 1427048453 MEDINA COUNTY HOSPITAL DISTRICT- 3100 AVENUE E HONDO, TX 78861-3534 MEDINA 09/01/2017 87%

020834001 1730132234 MEMORIAL HERMANN HEALTH SYSTEM-MHHS THE WOODLANDS HOSPITAL 1635 NORTH LOOP W HOUSTON, TX 77008-1532 HARRIS 07/01/2017 33%

337433201 1710985098 MEMORIAL HERMANN HEALTH SYSTEM-TIRR MEMORIAL HERMANN 1333 MOURSUND ST HOUSTON, TX 77030-3405 HARRIS 01/01/2018 46%

137805107 1982666111 MEMORIAL HERMANN HOSPITAL SYSTEM-MHHS HERMANN HOSPITAL 6411 FANNIN ST HOUSTON, TX 77030-1501 HARRIS 07/01/2017 24%

146509801 1932152337 MEMORIAL HERMANN HOSPITAL SYSTEM-MHHS KATY HOSPITAL 23900 KATY FWY KATY, TX 77494-1323 FORT BEND 01/01/2017 31%

020934801 1740233782 MEMORIAL HERMANN HOSPITAL SYSTEM-MHHS MEMORIAL CITY HOSPITAL 921 GESSNER RD HOUSTON, TX 77024-2315 HARRIS 07/01/2017 37%

192751901 1295843787 MEMORIAL HERMANN HOSPITAL SYSTEM-MHHS NORTHEAST HOSPITAL 18951 MEMORIAL NORTH HUMBLE, TX 77338-4217 HARRIS 01/01/2018 29%

146021401 1295788735 MEMORIAL HERMANN HOSPITAL SYSTEM-MHHS SUGAR LAND HOSPITAL 17500 WEST GRAND PARKWAY SOUTH SUGAR LAND, TX 77479-2562FORT BEND 08/01/2017 34%

202351701 1366532228 MEMORIAL HERMANN SPECIALTY HOSPITAL KINGWOOD LLC 300 KINGWOOD MEDICAL DR KINGWOOD, TX 77339-6400 HARRIS 12/01/2014 41%

201645301 1033114608 MEMORIAL HERMANN SUGAR LAND SURGICAL HOSPITAL LLP-SUGAR LAND SURGICAL HOSPITAL 16906 SOUTHWEST FWY SUGAR LAND, TX 77479-2350FORT BEND 02/01/2012 36%

112697102 1689650616 MEMORIAL HOSP OF POLK COUNTY-MEMORIAL MEDICAL CENTER LIVINGSTON 1717 HIGHWAY 59 BYPASS LIVINGSTON, TX 77351-5703 POLK 06/01/2017 36%

094121303 1821025990 MEMORIAL HOSPITAL 209 NW 8TH ST SEMINOLE, TX 79360-3447 GAINES 09/01/2017 100%

137909111 1689630865 MEMORIAL MEDICAL CENTER 815 N VIRGINIA PORT LAVACA, TX 77979-0025CALHOUN 01/01/2018 56%

139172412 1396746129 MEMORIAL MEDICAL CENTER OF EAST TEXAS-MEMORIAL MED CTR OF EAST TX 1201 FRANK STREET LUFKIN, TX 75904-1447 ANGELINA 06/01/2017 29%

130734007 1578547345 MEMORIAL MEDICAL CENTER SAN AUGUSTINE 511 E HOSPITAL ST SAN AUGUSTINE, TX 75972-0658SAN AUGUSTINE 07/01/2017 72%

121821603 1497731426 MEMORIAL SPECIALTY HOSPITAL 1201 W FRANK AVE LUFKIN, TX 75904-0000 ANGELINA 07/01/2017 27%

353570001 1285028951 MESA HILLS SPECIALTY HOSPITAL OPERATOR, LLC-MESA HILLS SPECIALTY HOSPITAL 2311 N OREGON ST EL PASO, TX 79902 EL PASO 04/01/2015 32%

218319601 1831146331 MESQUITE SPECIALTY HOSPITAL LP 1024 N GALLOWAY AVE MESQUITE, TX 75149-2434 DALLAS 09/01/2009 50%

376837601 1184179194 METHODIST HEALTH CENTERS-HOUSTON METHODIST THE WOODLANDS HOSPITAL 17201 INTERSTATE 45 S SHENANDOAH, TX 77385-3311MONTGOMERY 07/24/2017 50%

281028501 1083937593 METHODIST HEALTH CENTERS-METHODIST WEST HOUSTON HOSPITAL 18500 KATY FWY HOUSTON, TX 77094-1110 HARRIS 01/01/2018 37%

121820803 1871560003 METHODIST HEALTHCARE SYSTEM OF SAN ANTONIO LTD LLP-METHODIST AMBULATORY SURGERY 9150 HUEBNER RD STE 100 SAN ANTONIO, TX 78240-1558BEXAR 01/01/2017 44%

204254101 1659525236 METHODIST HEALTHCARE SYSTEM OF SAN ANTONIO LTD LLP-METHODIST STONE OAK HOSPITAL 1139 E SONTERRA BLVD SAN ANTONIO, TX 78258-3999BEXAR 03/01/2017 18%

094154402 1124074273 METHODIST HOSPITAL 7700 FLOYD CURL DR SAN ANTONIO, TX 78229-3902BEXAR 07/01/2017 17%

133258705 1225146400 METHODIST HOSPITAL LEVELLAND-COVENANT HOSPITAL LEVELLAND 1900 COLLEGE AVENUE LEVELLAND, TX 79336 HOCKLEY 06/01/2017 54%

126679303 1275592131 METHODIST HOSPITAL OF DALLAS-METHODIST CHARLTON MEDICAL CENTER 3500 W WHEATLAND RD DALLAS, TX 75237-3460 DALLAS 06/01/2017 29%

186221101 1689629941 METHODIST HOSPITAL OF DALLAS-METHODIST MANSFIELD MEDICAL CENTER 2700 E BROAD ST MANSFIELD, TX 76063-5899 TARRANT 07/01/2017 26%

127263503 1073580726 METHODIST HOSPITAL PLAINVIEW-COVENANT HOSPITAL PLAINVIEW 2601 DIMMITT RD PLAINVIEW, TX 79072-1833 HALE 06/01/2017 38%

135032405 1528027786 METHODIST HOSPITALS OF DALLAS-METHODIST DALLAS MEDICAL CENTER 1441 N BECKLEY AVE DALLAS, TX 75203-1201 DALLAS 06/01/2017 28%

209345201 1033165501 METHODIST HOSPITALS OF DALLAS-METHODIST RICHARDSON MEDICAL CENTER 2831 E PRESIDENT GEORGE BUSH HWY RICHARDSON, TX 75082-3561DALLAS 06/01/2017 28%

328934001 1952538431 METHODIST MCKINNEY HOSPITAL LLC- 8000 ELDORADO PKWY MCKINNEY, TX 75070-5940 COLLIN 09/01/2013 50%

094219503 1497871628 METHODIST SUGAR LAND HOSPITAL-HOUSTON METHODIST SUGAR LAND HOSPITAL 16655 SOUTHWEST FWY SUGAR LAND, TX 77479-2329FORT BEND 01/01/2018 26%

Prepared by HHSC Hospital Rate Analysis Department 6 of 12 1/24/2018

Page 7: Inpatient Ratio of Cost to Charges Effective 01/1/2018...357216601 1073901476 chg hospital conroe llc-chg hospital conroe, llc 1500 grand lake dr conroe, tx 77304-2891 montgomery 09/01/2010

TPI NPI Provider Combined Name Provider Street Address City, State and Zip County

Rate Effective

Date

Inpatient Rate

(December)

140713201 1871619254 METHODIST WILLOWBROOK-HOUSTON METHODIST WILLOWBROOK HOSPITAL 18220 TOMBALL PKWY HOUSTON, TX 77070-4347 HARRIS 01/01/2018 25%

127319504 1437171568 METHODISTS CHILDRENS HOSPITAL-COVENANT CHILDRENS HOSPITAL 4015 22ND PL LUBBOCK, TX 79410-1119 LUBBOCK 09/01/2017 23%

094119702 1629089966 METROPLEX ADVENTIST HOSPITAL INC-METROPLEX HOSPITAL 2201 SOUTH CLEAR CREEK RD KILLEEN, TX 76549-4110 BELL 08/01/2017 36%

149073203 1750392916 METROPLEX ADVENTIST HOSPITAL INC-ROLLINS BROOK COMMUNITY HOSPITAL 608 N KEY AVE LAMPASAS, TX 76550-1106 LAMPASAS 08/01/2017 45%

357475801 1346630316 MID JEFFERSON EXTENDED CARE HOSPITAL- 2600 HIGHWAY 365 NEDERLAND, TX 77627 JEFFERSON 11/01/2011 67%

136143806 1255325817 MIDLAND COUNTY HOSPITAL DISTRCT-MIDLAND MEMORIAL HOSPITAL 400 ROSALIND REDFERN GROVER PKWY MIDLAND, TX 79701-5846 MIDLAND 09/01/2017 40%

021189801 1023015120 MILLWOOD HOSPITAL 1011 NORTH COOPER STREET ARLINGTON, TX 76011-5517 TARRANT 09/01/2006 21%

112679902 1205833985 MISSION HOSPITAL INC-MISSION REGIONAL MEDICAL CENTER 900 SOUTH BRYAN RD MISSION, TX 78572-6613 HIDALGO 09/01/2017 27%

136325111 1184631673 MITCHELL COUNTY HOSPITAL DISTRICT-MITCHELL COUNTY HOSPITAL 997 W INTERSTATE 20 COLORADO CITY, TX 79512 MITCHELL 08/01/2017 100%

094129604 1700991700 MOORE COUNTY HOSPITAL- 224 E 2ND ST DUMAS, TX 79029-3808 MOORE 07/01/2016 55%

141858401 1952306672 MOTHER FRANCES HOSPITAL JACKSONVILLE 2026 S JACKSON ST JACKSONVILLE, TX 75766-5822CHEROKEE 06/01/2017 42%

094108002 1679578439 MOTHER FRANCES HOSPITAL REGIONAL HEALTHCARE CENTER-MOTHER FRANCES HOSPITAL 800 E DAWSON ST TYLER, TX 75701-2036 SMITH 06/01/2017 21%

127301306 1659308948 MOTHER FRANCES HOSPITAL WINNSBORO 719 W COKE RD WINNSBORO, TX 75494-3011 WOOD 06/01/2017 37%

094159302 1386647717 MSH PARTNERS LLC-BAYLOR MEDICAL CENTER AT UPTOWN 2727 E LEMMON AVE DALLAS, TX 75204-2833 DALLAS 01/01/2016 47%

120745806 1699770149 MUENSTER HOSPITAL DISTRICT-MUENSTER MEMORIAL HOSPITAL 605 N MAPLE ST MUENSTER, TX 76252-2425 COOKE 07/01/2015 100%

131030209 1780612754 NACOGDOCHES COUNTY HOSPITAL DISTRICT- 1204 N MOUND ST NACOGDOCHES, TX 75961-4027NACOGDOCHES 04/01/2012 46%

131030203 1801831748 NACOGDOCHES COUNTY HOSPITAL DISTRICT-MEMORIAL HOSPITAL 1204 N MOUND ST NACOGDOCHES, TX 75961-4027NACOGDOCHES 06/01/2017 59%

130605205 1700885076 NACOGDOCHES MEDICAL CENTER 4920 NE STALLINGS DR NACOGDOCHES, TX 75965-1254NACOGDOCHES 01/01/2018 23%

112701102 1144274226 NAVARRO REGIONAL HOSPITAL 3201 W STATE HIGHWAY 22 CORSICANA, TX 75110-2450 NAVARRO 01/01/2017 22%

147227603 1760482939 NEURO INSTITUTE OF AUSTIN LP-TEXAS NEUROREHAB CENTER 1106 W DITTMAR RD AUSTIN, TX 78745-6328 TRAVIS 01/01/2016 42%

291429301 1801191853 NEW BRAUNFELS REG REHAB HOSP INC- 2041 SUNDANCE PKWY NEW BRAUNFELS, TX 78130-2779COMAL 08/26/2011 50%

331172201 1023451077 NEW LIFECARE HOSPITALS OF NORTH TEXAS LLC- 1950 RECORD CROSSING RD DALLAS, TX 75235-6223 DALLAS 07/01/2017 21%

330847001 1679916530 NEW LIFECARE HOSPITALS OF SOUTH TEXAS LLC- 2001 S M ST MCALLEN, TX 78503-1551 HIDALGO 05/31/2013 50%

112718503 1477583334 NEW MEDICAL HORIZONS II LTD-CYPRESS FAIRBANKS MED CTR 10655 STEEPLETOP DR HOUSTON, TX 77065-4222 HARRIS 02/01/2017 21%

329623801 1942643804 NEW SAN ANTONIO SPECIALTY HOSPITAL LLC-LIFE CARE HOSPITALS OF SAN ANTONIO 8902 FLOYD CURL DR SAN ANTONIO, TX 78240-1681BEXAR 05/31/2013 50%

133252005 1093786204 NHCI OF HILLSBORO INC-HILL REGIONAL HOSPITAL 101 CIRCLE DR HILLSBORO, TX 76645-0000 HILL 05/01/2017 50%

297342201 1801168190 NIX HOSPITALS SYSTEM LLC- 414 NAVARRO ST STE 600 SAN ANTONIO, TX 78205-2541BEXAR 01/01/2018 20%

127310404 1689655912 NOCONA HOSPITAL DISTRICT-NOCONA GENERAL HOSPITAL 100 PARK RD NOCONA, TX 76255-3616 MONTAGUE 05/01/2017 60%

121845505 1245315647 NORTH BAY GENERAL HOSPITAL INC 1711 W WHEELER AVE ARANSAS PASS, TX 78336-4536SAN PATRICIO 01/01/2018 31%

185964702 1548236524 NORTH CENTRAL SURGICAL CENTER LLP 9301 N CENTRAL EXPY STE 100 DALLAS, TX 75231-0802 DALLAS 09/01/2009 50%

189049301 1285681064 NORTH CYPRESS MEDICAL CENTER OPERATION COMPANY LTD-NORTH CYPRESS MEDICAL CENTER 21214 NORTHWEST FREEWAY CYPRESS, TX 77429-3373 HARRIS 01/01/2018 15%

020989201 1205837770 NORTH RUNNELS COUNTY HOSPITAL- 7821 STATE HIGHWAY 153 WINTERS, TX 79567-7345 RUNNELS 06/01/2017 100%

350857401 1871911016 NORTH TEXAS - MCA, LLC-MEDICAL CENTER OF ALLIANCE 3101 N TARRANT PKWY FORT WORTH, TX 76177-8601TARRANT 02/01/2017 43%

121787905 1396748471 NORTH WHEELER COUNTY HOSTPIAL DISTRICT-PARKVIEW HOSPITAL 901 SWEETWATER WHEELER, TX 79096-1030 WHEELER 01/01/2011 100%

137245009 1467442418 NORTHWEST TEXAS HEALTH CARE SYSTEM INC-NORTHWEST TEXAS HOSPITAL 1501 S COULTER ST AMARILLO, TX 79106-1770 POTTER 01/01/2018 20%

127303903 1700883196 OAK BEND MEDICAL CENTER-OAKBEND MEDICAL CENTER 1705 JACKSON ST RICHMOND, TX 77469-3246 FORT BEND 01/01/2018 41%

333366801 1750620456 OCEANS BEHAVIORAL HOSPITAL OF ABILENE LLC- 4225 WOODS PL ABILENE, TX 79602-7991 TAYLOR 11/07/2013 50%

352075101 1891193868 OCEANS BEHAVIORAL HOSPITAL OF KATY LLC- 455 PARK GROVE LN KATY, TX 77450-1572 HARRIS 05/21/2015 50%

341027602 1689004939 OCEANS BEHAVORIAL HOSPITAL OF LUFKIN LLC 302 GOBBLERS KNOB RD LUFKIN, TX 75904-5419 ANGELINA 03/19/2014 50%

358963201 1255708715 OCH HOLDINGS-OUR CHILDREN'S HOUSE 1340 EMPIRE CENTRAL DR DALLAS, TX 75247-4022 DALLAS 08/01/2017 39%

112704504 1245237593 OCHILTREE GENERAL HOSPITAL 3101 GARRETT DR PERRYTON, TX 79070-5323 OCHILTREE 08/01/2017 100%

112711003 1801852736 ODESSA REGIONAL HOSPITAL LP-ODESSA REGIONAL MEDICAL CENTER 520 EAST 6TH ST ODESSA, TX 79761-4527 ECTOR 09/01/2017 19%

285368102 1881915304 OPREX SURGERY BAYTOWN LP-ALTAS BAYTOWN HOSPICE 1455 MANOR DRIVE STE 200 BAYTOWN, TX 77521 HARRIS 06/23/2015 50%

020977701 1134166192 ORTHOPEDIC HOSPITAL LTD-TEXAS ORTHOPEDIC HOSPITAL 7401 MAIN ST HOUSTON, TX 77030-4509 HARRIS 01/01/2018 11%

158914501 1295890093 ORTHOPEDIC AND SPINE SURGICAL HOSPITAL OF S TX LP-SOUTH TEXAS SPINE AND SURGICAL HOSPITAL LP 18600 HARDY OAK BLVD SAN ANTONIO, TX 78258-4206BEXAR 01/01/2018 28%

152686501 1780786699 PALACIOS COMMUNITY MEDICAL CENTER 311 GREEN AVE PALACIOS, TX 77465-3213 MATAGORDA 01/01/2017 98%

121816602 1164510673 PALESTINE PRINCIPAL HEALTHCARE LIMITED PARTNERSHIP-PALESTINE REGIONAL MEDICAL CENTER 2900 S LOOP 256 PALESTINE, TX 75801-6958 ANDERSON 01/01/2018 17%

138950412 1972590602 PALO PINTO GENERAL HOSPITAL 400 SW 25TH AVE MINERAL WELLS, TX 76067-8246PALO PINTO 08/01/2017 59%

367514201 1831550680 PAM SQUARED AT BEAUMONT, LLC- 3340 PLAZA 10 DR BEAUMONT, TX 77707-2551 JEFFERSON 06/01/2016 50%

346300201 1467853051 PAM SQUARED AT CORPUS CHRISTI LLC-PAM SPECIALTY HOSPITAL AT CORPUS CHRISTI NORTH 600 ELIZABETH ST FL 3 CORPUS CHRISTI, TX 78404 NUECES 11/03/2014 47%

346138602 1225439821 PAM SQUARED AT TEXARKANA, LLC- 2400 SAINT MICHAEL DR FL 2 TEXARKANA, TX 75503 BOWIE 11/03/2014 34%

Prepared by HHSC Hospital Rate Analysis Department 7 of 12 1/24/2018

Page 8: Inpatient Ratio of Cost to Charges Effective 01/1/2018...357216601 1073901476 chg hospital conroe llc-chg hospital conroe, llc 1500 grand lake dr conroe, tx 77304-2891 montgomery 09/01/2010

TPI NPI Provider Combined Name Provider Street Address City, State and Zip County

Rate Effective

Date

Inpatient Rate

(December)

357622501 1942601547 PAM SQUARED AT TEXARKANA, LLC-PAM SPECIALTY HOSPITAL OF TEXARKANA SOUTH 1000 PINE ST TEXARKANA, TX 75501 BOWIE 11/03/2014 34%

121811703 1780615880 PARK PLAZA HOSPITAL 1313 HERMANN DR HOUSTON, TX 77004-7005 HARRIS 01/01/2018 16%

127295703 1932123247 PARKLAND MEMORIAL HOSPITAL 5200 HARRY HINES BLVD DALLAS, TX 75235-7709 DALLAS 08/01/2017 33%

111915801 1497708929 PARKVIEW REGIONAL HOSPITAL 600 SOUTH BONHAM STREET MEXIA, TX 76667-3603 LIMESTONE 04/01/2017 35%

137343308 1861475626 PARMER COUNTY COMMUNITY HOSPITAL 1307 CLEVELAND AVE FRIONA, TX 79035-1121 PARMER 09/01/2017 86%

130616909 1760598692 PECOS COUNTY MEMORIAL HOSPITAL- 387 INTERSTATE 10 W FORT STOCKTON, TX 79735-2700PECOS 01/01/2018 63%

174662001 1316933609 PHYSICIANS MEDICAL CENTER LLC-TEXAS HEALTH CENTER FOR DIAGNOSTICS AND SURGERY PL6020 WEST PARKER ROAD PLANO, TX 75093-8171 COLLIN 12/01/2013 40%

165305701 1912948845 PHYSICIANS SURGICAL HOSPITALS LLC-QUAIL CREEK SURGICAL HOSPITAL 6819 PLUM CREEK DR AMARILLO, TX 79124-1602 POTTER 01/01/2018 20%

343467201 1659374585 PINE CREEK MEDICAL CENTER, LLC- 9032 HARRY HINES BLVD DALLAS, TX 75235-1720 DALLAS 09/01/2012 50%

361849801 1184089054 PINE VALLEY SPECIALTY HOSPITAL OPERATOR, LLC-PINE VALLEY SPECIALTY HOSPITAL 6160 SOUTH LOOP E HOUSTON, TX 77087 HARRIS 01/01/2016 89%

136142011 1033118716 PLAINS MEMORIAL HOSPITAL DISTRICT-PLAINS MEMORIAL HOSPITAL 310 WEST HALSELL DIMMITT, TX 79027-1846 CASTRO 05/01/2016 67%

353871201 1689068355 PLANO SPECIALTY HOSPITAL OPERATOR LLC-PLANO SPECIALTY HOSPITAL 1621 COIT RD PLANO, TX 75075 COLLIN 04/01/2015 42%

352444901 1851785521 PLUM CREEK SPECIALTY HOSPITAL OPERATOR LLC-PLUM CREEK SPECIALTY HOSPITAL 5601 PLUM CREEK DR AMARILLO, TX 79124 POTTER 04/01/2015 56%

325177904 1043552177 POST ACUTE MEDICAL AT ALLEN LLC DBA WARM SPRINGS-WARM SPRINGS REHABILITATION HOSPITAL OF ALLEN 1001 RAINTREE CIR ALLEN, TX 75013-4912 COLLIN 04/08/2013 50%

199191101 1114962842 POST ACUTE MEDICAL AT LULING LLC-WARM SPRINGS SPECIALTY HOSPITAL OF LULING LLC 200 MEMORIAL DR LULING, TX 78648-3213 CALDWELL 12/01/2006 67%

199478201 1376588228 POST ACUTE MEDICAL AT SAN ANTONIO LLC-WARM SPRINGS REHABILITATION HOSPITAL OF SAN ANTONI5101 MEDICAL DR SAN ANTONIO, TX 78229-4801BEXAR 05/01/2017 32%

199183801 1659316115 POST ACUTE MEDICAL AT VICTORIA LLC-PAM SPECIALTY HOSPITAL OF VICTORIA NORTH 102 MEDICAL DR VICTORIA, TX 77904-3101 VICTORIA 08/01/2007 68%

317151401 1689795098 POST ACUTE MEDICAL OF NEW BRAUNFELS LLC-WARM SPRINGS SPECIALTY HOSPITAL OF NEW BRAUNFELS 1445 HANZ DR NEW BRAUNFELS, TX 78130-2567COMAL 09/01/2012 50%

329971101 1366874620 POST ACUTE SPECIALTY HOSPITAL OF CORPUS CHRISTI LL- 6226 SARATOGA BLVD CORPUS CHRISTI, TX 78414-3421NUECES 09/01/2013 25%

331384301 1417389784 POST ACUTE SPECIALTY HOSPITAL OF VICTORIA LLC DBA-PAM SPECIALTY HOSPITAL OF VICTORIA SOUTH 506 E SAN ANTONIO ST FL 3 VICTORIA, TX 77901-6060 VICTORIA 09/25/2013 50%

316360201 1407121189 PREFERRED HOSPITAL LEASING COLEMAN INC- 310 S PECOS ST COLEMAN, TX 76834-4159 COLEMAN 12/01/2017 74%

179272301 1295764553 PREFERRED HOSPITAL LEASING ELDORADO INC-SCHLEICHER COUNTY MEDICAL CENTER 102 N US HIGHWAY 277 ELDORADO, TX 76936-4010 SCHLEICHER 12/01/2014 100%

200683501 1932379856 PREFERRED HOSPITAL LEASING HEMPHILL INC-SABINE COUNTY HOSPITAL 2301 HIGHWAY 83 WEST HEMPHILL, TX 75948-4159 SABINE 12/01/2014 100%

126840107 1477594299 PREFERRED HOSPITAL LEASING INC-COLLINGSWORTH GENERAL HOSPITAL 1013 15TH ST WELLINGTON, TX 79095 COLLINGSWORTH 08/01/2017 100%

206083201 1164688495 PREFERRED HOSPITAL LEASING JUNCTION INC-KIMBLE HOSPITAL 349 REID RD JUNCTION, TX 76849-3049 KIMBLE 04/01/2016 100%

350190001 1619368339 PREFERRED HOSPITAL LEASING MULESHOE INC-MULESHOE AREA MEDICAL CENTER 708 S 1ST ST MULESHOE, TX 79347-3627 BAILEY 10/01/2016 100%

176354201 1013970862 PREFERRED HOSPITAL LEASING VAN HORN INC-CULBERSON HOSPITAL EISENHOWER AND FM 2185 VAN HORN, TX 79855-0609 CULBERSON 03/01/2013 100%

121822403 1700805678 PRHC ENNIS LP-ENNIS REGIONAL MEDICAL CENTER 2201 WEST LAMPASAS ENNIS, TX 75119-5644 ELLIS 05/01/2017 22%

354018901 1790174860 PRIME HEALTHCARE SERVICES MESQUITE LLC-DALLAS REGIONAL MEDICAL CENTER 1011 N GALLOWAY AVE MESQUITE, TX 75149 DALLAS 01/01/2017 13%

308032701 1386902138 PRIME HEALTHCARE SERVICES PAMPA LLC-PAMPA REGIONAL MEDICAL CENTER 1 MEDICAL PLAZA DR PAMPA, TX 79065 GRAY 08/01/2017 42%

340716501 1902237431 PROMISE HOSPITAL OF DALLAS INC- 7955 HARRY HINES BLVD BLD DALLAS, TX 75235-3305 DALLAS 03/18/2014 52%

339884401 1346671849 PROMISE HOSPITAL OF WICHITA FALLS INC- 1103 GRACE ST WICHITA FALLS, TX 76301-4414WICHITA 03/17/2014 80%

111829102 1093708679 PROVIDENCE HEALTH SERVICES OF WACO-PROVIDENCE HEALTHCARE NETWORK 6901 MEDICAL PARKWAY WACO, TX 76712-7910 MCLENNAN 07/01/2017 37%

370663201 1467836841 PROVIDENCE HOSPITAL OF NORTH HOUSTON LLC- 16750 RED OAK DR HOUSTON, TX 77090 HARRIS 12/14/2016 50%

121806703 1881697316 REAGAN HOSPITAL DISTRICT-REAGAN MEMORIAL HOSPITAL 1300 N MAIN AVE BIG LAKE, TX 76932-3938 REAGAN 03/01/2012 100%

210433301 1427048743 RED RIVER HOSPITAL LLC-RED RIVER HOSPITAL 1505 EIGHT STREET WICHITA FALLS, TX 76301-3106WICHITA 01/29/2010 38%

112684904 1831170273 REEVES COUNTY HOSPITAL DISTRICT 2323 TEXAS ST PECOS, TX 79772-7338 REEVES 01/01/2018 100%

020991801 1942240189 REFUGIO COUNTY MEMORIAL HOSPITAL DISTRICT 107 SWIFT ST REFUGIO, TX 78377-2425 REFUGIO 01/01/2017 100%

179884501 1518905025 REHABCARE GROUP OF ARLINGTON LP-KINDRED REHABILITATION HOSPITAL ARLINGTON 2601 WEST RANDOL MILL ROAD STE 101 ARLINGTON, TX 76012-4216 TARRANT 02/24/2006 50%

212203801 1770740359 REHABILIATION INSTITUTE OF DENTON LLC-SELELCT REHABILITATIOIN HOSPITAL OF DENTON 2620 SCRIPTURE ST DENTON, TX 76201-4315 DENTON 04/03/2009 50%

218868201 1922321447 REHABILITATION HOSPITAL OF MESQUITE LLC-MESQUITE REHABILITATION INSTITUTE 1023 N BELT LINE RD MESQUITE, TX 75149-1788 DALLAS 11/03/2010 50%

343723801 1427472463 RESOLUTE HOSPITAL COMPANY LLC- 555 CREEKSIDE XING NEW BRAUNFELS, TX 78130-2594COMAL 05/01/2017 43%

112745802 1518937218 RIVER CREST HOSPITAL 1636 HUNTERS GLEN RD SAN ANGELO, TX 76901-5016TOM GREEN 02/01/2006 25%

339869503 1184056954 ROCK SPRINGS, LLC- 700 SE INNER LOOP GEORGETOWN, TX 78626-7700WILLIAMSON 06/25/2014 50%

183086102 1306933692 ROCKDALE BLACKHAWK LLC-LITTLE RIVER HEALTHCARE 1700 BRAZOS AVE ROCKDALE, TX 76567-2517 MILAM 01/01/2018 56%

193399601 1629138029 ROCKWALL REGIONAL HOSPITAL LLC-TEXAS HEALTH PRESBYTERIAN HOSPITAL ROCKWALL 3150 HORIZON RD ROCKWALL, TX 75032-7805 ROCKWALL 01/01/2018 36%

133244705 1275581852 ROLLING PLAINS MEMORIAL HOSPITAL 200 E ARIZONA AVE SWEETWATER, TX 79556-7120NOLAN 09/01/2017 100%

020957901 1649223645 ROUND ROCK HOSPITAL-ROUND ROCK MEDICAL CENTER 2400 ROUND ROCK AVE ROUND ROCK, TX 78681-4004WILLIAMSON 08/01/2017 23%

127267603 1942294939 SAINT JOSEPH REGIONAL HEALTH CENTER 2801 FRANCISCAN DRIVE BRYAN, TX 77802-3867 BRAZOS 07/01/2017 23%

112693002 1194776104 SAN ANGELO COMMUNITY MEDICAL CENTER 3501 KNICKERBOCKER RD SAN ANGELO, TX 76904-7610TOM GREEN 07/01/2017 24%

349059101 1871917971 SAN ANTONIO BEHAVIORAL HEALTHCARE HOSPITAL, LLC- 8550 HUEBNER RD SAN ANTONIO, TX 78240 BEXAR 01/22/2015 50%

Prepared by HHSC Hospital Rate Analysis Department 8 of 12 1/24/2018

Page 9: Inpatient Ratio of Cost to Charges Effective 01/1/2018...357216601 1073901476 chg hospital conroe llc-chg hospital conroe, llc 1500 grand lake dr conroe, tx 77304-2891 montgomery 09/01/2010

TPI NPI Provider Combined Name Provider Street Address City, State and Zip County

Rate Effective

Date

Inpatient Rate

(December)

137962006 1891789772 SAN JACINTO METHODIST HOSPITAL-SAN JACINTO METHODIST HOSP 4401 GARTH RD BAYTOWN, TX 77521-2122 HARRIS 01/01/2018 27%

354215101 1720411713 SAS HEALTHCARE INC-SUNDANCE HOSPITAL DALLAS 2696 W WALNUT ST GARLAND, TX 75042 DALLAS 01/08/2015 80%

094212002 1538117452 SCA HOUSTON HOSPITAL FOR SPECIALIZED SURGERY LP-HOUSTON HOSPITAL FOR SPECIALIZED SURGERY 5445 LA BRANCH ST HOUSTON, TX 77004-6835 HARRIS 12/01/2005 100%

150967102 1013993559 SCCI HOSPITAL EL PASO INC-KINDRED HOSPITAL EL PASO 1740 CURIE DR EL PASO, TX 79902-2901 EL PASO 11/01/2016 21%

131043506 1831160423 SCENIC MOUNTAIN MEDICAL CENTER 1601 W 11TH PL BIG SPRING, TX 79720-4114 HOWARD 01/01/2018 26%

135226205 1154315307 SCOTT & WHITE HOSPITAL BRENHAM-BAYLOR SCOTT AND WHITE MEDICAL CENTER BRENHAM 700 MEDICAL PKWY BRENHAM, TX 77833-5413 WASHINGTON 01/01/2018 100%

353712801 1396138970 SCOTT & WHITE HOSPITAL-MARBLE FALLS-BAYLOR SCOTT & WHITE MEDICAL CENTER-MARBLE FALLS 810 W HIGHWAY 71 MARBLE FALLS, TX 78654-8602BURNET 05/01/2017 86%

220798701 1326349986 SCOTT AND WHITE HOSPITAL - LLANO-BAYLOR SCOTT AND WHITE MEDICAL CENTER - LLANO 200 W OLLIE ST LLANO, TX 78643-2628 LLANO 09/01/2016 56%

326725404 1265772362 SCOTT AND WHITE HOSPITAL COLLEGE STATION-BAYLOR SCOTT & WHITE MEDICAL CENTER COLLEGE STATIO700 SCOTT AND WHITE DR COLLEGE STATION, TX 77845-6441BRAZOS 05/01/2017 39%

190123303 1265568638 SCOTT AND WHITE HOSPITAL ROUND ROCK-BAYLOR SCOTT & WHITE MEDICAL CENTER - ROUND ROCK 300 UNIVERSITY BLVD ROUND ROCK, TX 78665-1032WILLIAMSON 05/01/2017 39%

136327710 1962497800 SCOTT AND WHITE HOSPITAL TAYLOR-BAYLOR SCOTT AND WHITE MEDICAL CENTER TAYLOR 305 MALLARD LN TAYLOR, TX 76574-1208 WILLIAMSON 01/01/2017 51%

137249208 1477516466 SCOTT AND WHITE MEMORIAL HOSPITAL-SCOTT AND WHITE MEDICAL CENTER - TEMPLE 2401 S 31ST ST TEMPLE, TX 76508-0001 BELL 08/01/2017 33%

136330112 1578588463 SCURRY COUNTY HOSPITAL DISTRICT-D.M. COGDELL MEMORIAL HOSPITAL 1700 COGDELL BLVD SNYDER, TX 79549-6162 SCURRY 01/01/2018 72%

358597801 1184029811 SELECT SPECIALITY HOSPITAL-DALLAS, INC- 3500 GASTON AVE DALLAS, TX 75246-2017 DALLAS 07/01/2015 50%

194036301 1063411239 SELECT SPECIALTY HOSPITAL DALLAS INC-DALLAS SPECIALTY HOSPITAL DALLAS INC 2329 PARKER RD CARROLLTON, TX 75010-4713DENTON 09/01/2004 50%

197824901 1861492670 SELECT SPECIALTY HOSPITAL LONGVIEW INC-SELECT SPECIALTY HOSPITAL LONGVIEW 700 E MARSHALL AVE LONGVIEW, TX 75601-5580 GREGG 01/01/2004 50%

361697101 1790189942 SELECT SPECIALTY HOSPITAL-DALLAS, INC 2300 MARIE CURIE DR GARLAND, TX 75042 DALLAS 07/01/2015 50%

137265806 1093810327 SETON FAMILY OF HOSPITALS-DELL SETON MEDICAL CENTER AT THE UNIVERSITY OF TEX1500 RED RIVER ST AUSTIN, TX 78701-0000 TRAVIS 06/01/2017 31%

094153604 1356446686 SETON FAMILY OF HOSPITALS-SETON EDGAR B DAVIS HOSPITAL 130 HAYS ST LULING, TX 78648-3207 CALDWELL 07/01/2017 49%

094151004 1003833013 SETON FAMILY OF HOSPITALS-SETON HIGHLAND LAKES 3201 S WATER ST BURNET, TX 78611-4510 BURNET 07/01/2017 27%

135225404 1164526786 SETON FAMILY OF HOSPITALS-SETON MEDICAL CENTER AUSTIN 1201 W 38TH ST AUSTIN, TX 78705-1006 TRAVIS 07/01/2017 20%

208013701 1619115383 SETON FAMILY OF HOSPITALS-SETON MEDICAL CENTER HAYS 6001 KYLE PKWY KYLE, TX 78640-6112 HAYS 06/01/2017 23%

194106401 1578780870 SETON FAMILY OF HOSPITALS-SETON MEDICAL CENTER WILLIAMSON 201 SETON PKWY ROUND ROCK, TX 78665-8000WILLIAMSON 07/01/2017 21%

158980601 1124137054 SETON FAMILY OF HOSPITALS-SETON NORTHWEST HOSPITAL 11113 RESEARCH BLVD AUSTIN, TX 78759-5297 TRAVIS 06/01/2017 22%

286326801 1154612638 SETON FAMILY OF HOSPITALS-SETON SMITHVILLE REGIONAL HOSPITAL 1201 HILL RD SMITHVILLE, TX 78957-9533 BASTROP 07/01/2016 81%

158977201 1750499273 SETON FAMILY OF HOSPITALS-SETON SOUTHWEST HOSPITAL 7900 FM 1826 AUSTIN, TX 78737-1407 HAYS 06/01/2017 20%

186599001 1447355771 SETON HEALTHCARE-DELL CHILDRENS MEDICAL CENTER OF CENTRAL TEXAS 4900 MUELLER BLVD AUSTIN, TX 78723-3079 TRAVIS 07/01/2017 21%

121193005 1538150370 SHAMROCK GENERAL HOSPITAL 1000 S MAIN ST SHAMROCK, TX 79079-2820 WHEELER 10/01/2016 100%

137226005 1992707228 SHANNON MEDICAL CENTER 120 E HARRIS AVE SAN ANGELO, TX 76903-5904TOM GREEN 09/01/2017 46%

175965601 1861598633 SHC KPH LP-KINGWOOD PINES HOSPITAL 2001 LADBROOK, DR KINGWOOD, TX 77339-0000 HARRIS 10/01/2006 38%

220351501 1013957836 SHERMAN GRAYSON HOSPITAL LLC-WILSON N JONES REGIONAL MEMORIAL CENTER 500 N HIGHLAND AVE SHERMAN, TX 75092-7354 GRAYSON 04/01/2017 31%

298213401 1518000306 SHRINERS HOSPITAL FOR CHILDREN- 6977 MAIN ST HOUSTON, TX 77030-3701 HARRIS 01/01/2018 90%

293388901 1669513941 SHRINERS HOSPITALS FOR CHILDREN- 815 MARKET ST GALVESTON, TX 77550-2725 GALVESTON 01/01/2018 60%

127294003 1790782704 SID PETERSON MEMORIAL HOSPITAL-PETERSON REGIONAL MEDICAL CENTER 551 HILL COUNTRY DR KERRVILLE, TX 78028-6085 KERR 06/01/2017 44%

133245406 1215969787 SIERRA MEDICAL CENTER-THE HOSPITAL OF PROVIDENCE SIERRA CAMPUS 1625 MEDICAL CENTER DR EL PASO, TX 79902-5005 EL PASO 05/01/2017 15%

181706601 1154361475 SJ MEDICAL CENTER LLC-ST JOSEPH MEDICAL CENTER 1401 ST JOSEPH PKWY HOUSTON, TX 77002-8301 HARRIS 12/01/2017 18%

190895601 1598710592 SOLARA HOSPITAL HARLINGEN 508 VICTORIA LANE HARLINGEN, TX 78550-3225 CAMERON 01/04/2007 50%

216719901 1700826575 SOMERVELL COUNTY HOSPITAL DISTRICT-GLEN ROSE MEDICAL CENTER 1021 HOLDEN ST GLEN ROSE, TX 76043-4937 SOMERVELL 12/01/2016 69%

094113001 1770573586 SOUTH TEXAS HEALTH SYSTEM 1102 W TRENTON RD EDINBURG, TX 78539-9105 HIDALGO 01/01/2018 14%

121780403 1184695785 SOUTH TEXAS REGIONAL MEDICAL CENTER 1905 HIGHWAY 97 E JOURDANTON, TX 78026-1504ATASCOSA 06/01/2017 33%

173995503 1093712697 SOUTH TEXAS REHABILITATION HOSPITAL LP- 425 EAST ALTON GLOOR BROWNSVILLE, TX 78526-3361CAMERON 06/01/2014 60%

171461001 1629064928 SOUTHLAKE SPECIALTY HOSPITAL LLC-TEXAS HEALTH HARRIS METHODIST HOSPITAL SOUTHLAKE 1545 SOUTHLAKE BLVD SOUTHLAKE, TX 76092-6422 TARRANT 01/01/2018 48%

136491104 1912906298 SOUTHWEST GENERAL HOSPITAL LP-SOUTHWEST GENERAL HOSPITAL 7400 BARLITE BLVD SAN ANTONIO, TX 78224-1308BEXAR 09/01/2017 22%

352273201 1376954263 SRP BEHAVIORAL HOSPITAL OF PLANO LLC- 4301 MAPLESHADE PLANO, TX 75093 COLLIN 11/05/2014 50%

351415002 1447672910 SRP OCEANS HOSPITAL OF FORTWORTH LLC-WELLBRIDGE HEALTHCARE OF FORT WORTH 6200 OVERTON RIDGE BLVD FORT WORTH, TX 76132-3614TARRANT 09/18/2015 50%

362439701 1184014433 SRP OCEANS HOSPITAL OF SAN MARCOS LLC-OCEANS BEHAVIORAL HOSPITAL OF SAN MARCOS 1106 N INTERSTATE 35 SAN MARCOS, TX 78666 HAYS 10/23/2015 50%

094160103 1720033947 ST DAVIDS COMMUNITY HOSPITAL-ST DAVIDS MEDICAL CENTER 919 E 32ND ST AUSTIN, TX 78705-2703 TRAVIS 01/01/2018 20%

112717702 1679528889 ST DAVIDS HEALTHCARE PARTNERSHIP LP LLP-SOUTH AUSTIN HOSPITAL 901 W. BEN WHITE BLVD AUSTIN, TX 78704-6903 TRAVIS 11/01/2017 16%

094216103 1629021845 ST DAVID'S HEALTHCARE PARTNERSHIP LP LLP-ST DAVID'S NORTH AUSTIN MEDICAL CENTER 12221 N MO PAC EXPY AUSTIN, TX 78758-2401 TRAVIS 06/01/2017 16%

368423501 1932573417 ST JOSEPH HEALTHSOUTH REHABILITATION HOSPITAL LLC-CHI ST JOSEPEH REHABILITATION HOSPITAL WITH HEALTH1600 JOSEPH DR BRYAN, TX 77802 BRAZOS 09/01/2016 50%

160630301 1942208616 ST LUKES COMMUNITY HEALTH SERVICES-ST LUKES THE WOODLANDS HOSPITAL 17200 ST LUKE'S WAY THE WOODLANDS, TX 77384-8007MONTGOMERY 06/01/2017 28%

Prepared by HHSC Hospital Rate Analysis Department 9 of 12 1/24/2018

Page 10: Inpatient Ratio of Cost to Charges Effective 01/1/2018...357216601 1073901476 chg hospital conroe llc-chg hospital conroe, llc 1500 grand lake dr conroe, tx 77304-2891 montgomery 09/01/2010

TPI NPI Provider Combined Name Provider Street Address City, State and Zip County

Rate Effective

Date

Inpatient Rate

(December)

339153401 1710314141 ST LUKES HOSPITAL AT THE VINTAGE- 20171 CHASEWOOD PARK DR HOUSTON, TX 77070-1437 HARRIS 06/01/2017 50%

210274101 1184868879 ST LUKES LAKESIDE HOSPITAL LLC-ST LUKES LAKESIDE HOSPITAL 17400 ST LUKES WAY THE WOODLANDS, TX 77384-8036MONTGOMERY 07/01/2016 41%

281219001 1407990088 ST LUKES PATIENTS MEDICAL CENTER- 4600 E SAM HOUSTON PKWY S PASADENA, TX 77505-3948 HARRIS 07/01/2017 42%

176692501 1659362630 ST MARKS MEDICAL CENTER ONE ST MARK'S PLACE LA GRANGE, TX 78945-1250 FAYETTE 07/01/2017 100%

298019501 1659559573 ST. LUKE'S COMMUNITY DEVELOPMENT CORPORATION-SUGAR-ST. LUKE'S SUGAR LAND HOSPITAL 1317 LAKE POINTE PKWY SUGAR LAND, TX 77478-3997FORT BEND 07/01/2017 54%

126842708 1649224825 STAMFORD MEMORIAL HOSPITAL- 1601 COLUMBIA ST STAMFORD, TX 79553-6863 JONES 01/01/2018 100%

136332705 1760567085 STARR COUNTY MEMORIAL HOSPITAL 128 N FM 3167 RIO GRANDE CITY, TX 78582-6211STARR 09/01/2017 100%

337991901 1285065623 STEPHENS MEMORIAL HOSPITAL- 200 S GENEVA ST BRECKENRIDGE, TX 76424-4702STEPHENS 01/01/2017 78%

020992601 1083612121 STONEWALL MEMORIAL HOSPITAL DISTRICT-STONEWALL MEMORIAL HOSPITAL 821 N BROADWAY ASPERMONT, TX 79502-9023 STONEWALL 10/01/2016 100%

371439601 1154782548 STRATEGIC BH-BROWNSVILLE, LLC-PALMS BEHAVIORAL HEALTH 613 VICTORIA LN HARLINGEN, TX 78550 CAMERON 10/04/2016 50%

338014903 1568885549 STRATEGIC BH-ROCK PRAIRIE BEHAVIORAL HEALTH 3550 NOMAND DR COLLEGE STATION, TX 77845-6399BRAZOS 06/10/2014 50%

335255101 1164665899 SUGAR LAND 24 HOUR HOSPITAL, LLC-EMERUS EMERGENCY HOSPITAL SUGAR LAND 16000 SOUTHWEST FWY STE 100 SUGAR LAND, TX 77479-2674FORT BEND 01/01/2016 87%

361635101 1003282039 SUN HOUSTON, LLC- 7601 FANNIN ST HOUSTON, TX 77054-1905 HARRIS 04/19/2016 50%

283761901 1578878245 SUNDANCE HOSPITAL- 7000 US 287 HWY ARLINGTON, TX 76001-2805 TARRANT 07/23/2011 80%

020988401 1023011657 SWEENY COMMUNITY HOSPITAL 305 N MCKINNEY SWEENY, TX 77480-2801 BRAZORIA 08/01/2017 100%

316076401 1518253194 SWISHER MEMORIAL HEALTHCARE SYSTEM-SWISHER MEMORIAL HOSPITAL 539 SE 2ND ST TULIA, TX 79088-2400 SWISHER 01/01/2017 100%

126675104 1992753222 TARRANT COUNTY HOSPITAL DISTRICT-JPS HEALTH NETWORK 1500 S MAIN ST FORT WORTH, TX 76104-4917TARRANT 09/01/2017 36%

169553801 1801826839 TENET FRISCO LTD 12505 LEBANON RD FRISCO, TX 75035-8298 COLLIN 01/01/2018 29%

196829901 1972709970 TENET HOSPITALS LIMITED-THE HOSPITALS OF PROVIDENCE EAST CAMPUS 3280 JOE BATTLE BLVD EL PASO, TX 79938-2622 EL PASO 01/01/2018 12%

130601104 1700801909 TENET HOSPITALS LIMITED-THE HOSPITALS OF PROVIDENCE MEMORIAL CAMPUS 2001 NORTH OREGON EL PASO, TX 79902-3320 EL PASO 05/01/2017 13%

369162801 1538522412 TENET HOSPITALS LIMITED-THE HOSPITALS OF PROVIDENCE TRANSMOUNTAIN CAMPUS 2000 TRANS MOUNTAIN RD EL PASO, TX 79911-0000 EL PASO 02/06/2017 50%

130618504 1811916901 TERRY MEMORIAL HOSPITAL DISTRICT-BROWNFIELD REGIONAL MEDICAL CENTER 705 E FELT BROWNFIELD, TX 79316-3439TERRY 08/01/2017 73%

133257904 1841354677 TEXAS CENTER FOR INFECTIOUS 2303 SE MILITARY DR SAN ANTONIO, TX 78223-3542BEXAR 03/01/2017 90%

139135109 1477643690 TEXAS CHILDRENS HOSPITAL 6621 FANNIN ST HOUSTON, TX 77030-2358 HARRIS 12/01/2017 33%

318137201 1245523372 TEXAS GENERAL HOSPITAL- 2709 HOSPITAL BLVD GRAND PRAIRIE, TX 75051-1017DALLAS 01/01/2017 15%

371495801 1720474919 TEXAS GENERAL HOSPITAL - VZRMC LP- 707 N WALDRIP ST GRAND SALINE, TX 75140-1555VAN ZANDT 11/09/2016 50%

130614405 1174533343 TEXAS HEALTH ARLINGTON MEMORIAL HOSPITAL 800 W RANDOL MILL RD ARRLINGTON, TX 76012 TARRANT 1/1/2018 0.32

316296801 1215296884 TEXAS HEALTH HARRIS METHODIST HOSPITAL ALLIANCE- 10864 TEXAS HEALTH TRL FORT WORTH, TX 76244-4897TARRANT 07/01/2017 36%

127304703 1508899204 TEXAS HEALTH HARRIS METHODIST HOSPITAL AZLE- 108 DENVER TRL AZLE, TX 76020-3614 TARRANT 08/01/2017 35%

131036903 1396778064 TEXAS HEALTH HARRIS METHODIST HOSPITAL CLEBURNE- 201 WALLS DR CLEBURNE, TX 76033-4007 JOHNSON 09/01/2017 29%

112677302 1336172105 TEXAS HEALTH HARRIS METHODIST HOSPITAL FORT WORTH- 1301 PENNSYLVANIA AVE FORT WORTH, TX 76104-2122TARRANT 10/01/2017 27%

136326908 1104845015 TEXAS HEALTH HARRIS METHODIST HOSPITAL HURST EULES- 1600 HOSPITAL PARKWAY BEDFORD, TX 76021-6913 TARRANT 11/01/2017 35%

120726804 1417980202 TEXAS HEALTH HARRIS METHODIST HOSPITAL SOUTHWEST F- 6100 HARRIS PKWY FORT WORTH, TX 76132-4101TARRANT 09/01/2017 32%

121794503 1922031541 TEXAS HEALTH HARRIS METHODIST HOSPITAL STEPHENVILL- 411 N BELKNAP STEPHENVILLE, TX 76401-3415ERATH 11/01/2017 40%

314080801 1033120423 TEXAS HEALTH HUGULEY HOSPITAL-TEXAS HEALTH HUGLEY FORT WORTH SOUTH 11801 SOUTH FWY BURLESON, TX 76028-7021 JOHNSON 01/01/2018 31%

020982701 1548291883 TEXAS HEALTH PRESBYTERIAN HOSPITAL ALLEN- 1105 CENTRAL EXPY N ALLEN, TX 75013-3103 COLLIN 01/01/2018 45%

020967802 1003883158 TEXAS HEALTH PRESBYTERIAN HOSPITAL DENTON- 3000 I 35 NORTH DENTON, TX 76201-5119 DENTON 05/01/2017 29%

094140302 1457382798 TEXAS HEALTH PRESBYTERIAN HOSPITAL KAUFMAN- 850 ED HALL DR KAUFMAN, TX 75142-1861 KAUFMAN 01/01/2018 48%

094207002 1770514077 TEXAS HEALTH PRESBYTERIAN HOSPTAL PLANO- 6200 W PARKER RD PLANO, TX 75093-7939 COLLIN 01/01/2018 31%

094205403 1730278417 TEXAS HEALTH SPECIALTY HOSPITAL FORT WORTH- 1301 PENNSYLVANIA AVE FORT WORTH, TX 76104-2122TARRANT 09/01/2006 30%

185556101 1962504340 TEXAS HEART HOSPITAL OF THE SOUTHWEST LLP-THE HEART HOSPITAL BAYLOR PLANO 1100 ALLIED DRIVE PLANO, TX 75093-5348 COLLIN 01/01/2018 30%

173574801 1245201656 TEXAS INSTITUTE FOR SURGERY LLP-TEXAS INSTITUTE FOR SURGERY AT TEXAS HEALTH PRESBY7115 GREENVILLE AVENUE STE 100 DALLAS, TX 75231-3623 DALLAS 05/01/2012 100%

333086201 1578809505 TEXAS OAKS PSYCHIATRIC HOSPITAL LP-AUSTIN OAKS HOSPITAL 1407 W STASSNEY LN AUSTIN, TX 78745-2947 TRAVIS 09/12/2013 50%

020908201 1396779948 TEXAS PRESBYTERIAN HOSPITAL OF DALLAS 8200 WALNUT HILL LN DALLAS, TX 75231-4426 DALLAS 01/01/2018 29%

209719801 1255579389 TEXAS REGIONAL MEDICAL CENTER LTD-TEXAS REGIONAL MEDICAL CENTER AT SUNNYVALE 231 S COLLINS RD SUNNYVALE, TX 75182-4624 DALLAS 12/01/2017 25%

315440301 1760628184 TEXAS SCOTTISH RITE HOSPITAL FOR CRIPPLED CHILDREN- 2222 WELBORN ST DALLAS, TX 75219-3924 DALLAS 10/01/2017 69%

162459501 1942292255 TEXAS SPINE AND JOINT HOSPITAL LTD 1814 ROSELAND BLVD TYLER, TX 75701-4262 SMITH 01/01/2018 15%

021017102 1700955796 THC HOUSTON INC- 4801 E SAM HOUSTON PKWY S PASADENA, TX 77505-3955 HARRIS 09/01/2012 20%

021017101 1043389034 THC HOUSTON INC-KINDRED HOSPITAL HOUSTON NORTHWEST 11297 FALLBROOK DR HOUSTON, TX 77065-4230 HARRIS 08/01/2008 20%

178795401 1043328198 THE HOSPITAL AT WESTLAKE MEDICAL CENTER 5656 BEE CAVES RD STE M302 WEST LAKE HILLS, TX 78746-5814TRAVIS 12/01/2014 52%

163925401 1861467573 THE MEDICAL CENTER OF SOUTHEAST TEXAS LP- 2555 JIMMY JOHNSON BLVD PORT ARTHUR, TX 77640-2007JEFFERSON 12/01/2017 20%

Prepared by HHSC Hospital Rate Analysis Department 10 of 12 1/24/2018

Page 11: Inpatient Ratio of Cost to Charges Effective 01/1/2018...357216601 1073901476 chg hospital conroe llc-chg hospital conroe, llc 1500 grand lake dr conroe, tx 77304-2891 montgomery 09/01/2010

TPI NPI Provider Combined Name Provider Street Address City, State and Zip County

Rate Effective

Date

Inpatient Rate

(December)

137949705 1548387418 THE METHODIST HOSPITAL 6565 FANNIN HOUSTON, TX 77030-2703 HARRIS 01/01/2018 23%

112672402 1174582050 THE UNIVERSITY OF TEXAS MD ANDERSON CANCER CENTER-MD ANDERSON HOSPITAL 1515 HOLCOMBE BLVD HOUSTON, TX 77030-4009 HARRIS 09/01/2017 48%

330388501 1194753590 THHBP MANAGEMENT COMPANY LLC-THE HEART HOSPITAL BAYLOR DENTON 2801 S MAYHILL RD DENTON, TX 76208-5910 DENTON 01/01/2017 83%

088189803 1356418974 THROCKMORTON COUNTY MEMORIAL HOSPITAL- 802 N MINTER AVE THROCKMORTON, TX 76483-5357THROCKMORTON 01/01/2017 100%

094379704 1871566018 TIMBERLAWN MENTAL HEALTH SYSTEM 4600 SAMUELL BLVD DALLAS, TX 75228-6827 DALLAS 06/01/2006 28%

138913209 1174526529 TITUS COUNTY MEM HOSP DIST-TITUS REGIONAL MEDICAL CENTER 2001 N JEFFERSON MT PLEASANT, TX 75455-2341TITUS 10/01/2017 64%

340639901 1144651514 TOMBALL EXPRESS MEDICAL CENTER, LLC-EMERUS COMMUNITY HOSPITAL 24429 STATE HIGHWAY 249 TOMBALL, TX 77375-7877 HARRIS 07/18/2014 50%

094208803 1144203662 TOPS SPECIALTY HOSPITAL, LTD- 17080 RED OAK DRIVE HOUSTON, TX 77090-2602 HARRIS 12/01/2013 38%

021011402 1174692156 TRANSITIONAL HOSPITALS CORPORATION OF TEXAS INC-KINDRED HOSPITAL - TARRANT COUNTY 1000 N COOPER ST ARLINGTON, TX 76011-5540 TARRANT 06/01/2008 43%

021011401 1659440634 TRANSITIONAL HOSPITALS CORPORATION OF TEXAS INC-KINDRED HOSPITAL- TARRANT COUNTY 1000 N COOPER ST ARLINGTON, TX 76011-5540 TARRANT 06/01/2008 43%

184505902 1316911068 TRINITY MOTHER FRANCES REHABILITATION HOSPITAL-CHRISTUS TRINITY MOTHER FRANCES REHABILATION HOSPI3131 TROUP HWY TYLER, TX 75701-8350 SMITH 03/01/2016 73%

149047601 1609876309 TRIUMPH HOSPITAL OF EAST HOUSTON LP-KINDRED HOSPITAL CLEAR LAKE 350 BLOSSOM ST WEBSTER, TX 77598-4206 HARRIS 11/01/2011 24%

094354003 1285626028 TRIUMPH HOSPITAL OF NORTH HOUSTON LP-KINDRED HOSPITAL TOMBALL 505 GRAHAM DR TOMBALL, TX 77375-3368 HARRIS 11/01/2011 39%

322878502 1417225434 TRIUMPH REHABILIATION HOSPITAL OF NORTHEAST HOUSTO-KINDRED REHABILITATION HOSPITAL NORTHEAST HOUSTON 18839 MCKAY DR HUMBLE, TX 77338-5721 HARRIS 09/01/2013 50%

157203401 1720088412 TRIUMPH SOUTHWEST LP-KINDRED HOSPITAL SUGAR LAND 1550 FIRST COLONY BLVD SUGAR LAND, TX 77479-4000FORT BEND 04/01/2017 13%

172620001 1982609558 TROPHY CLUB MEDICAL CENTER LP 2850 EAST STATE HWY 114 TROPHY CLUB, TX 76262-1168DENTON 01/01/2016 100%

136381405 1447259627 TYLER COUNTY HOSPITAL 1100 W BLUFF WOODVILLE, TX 75979-4738 TYLER 06/01/2017 59%

194997601 1851390967 UHS OF TEXOMA INC-TEXOMA MEDICAL CENTER 5016 S US HIGHWAY 75 DENISON, TX 75020-4584 GRAYSON 01/01/2018 29%

135237906 1023013448 UNITED REGIONAL HEALTHCARE 1600 11TH STREET WICHITA FALLS, TX 76301-4388WICHITA 01/01/2018 32%

191968002 1386779304 UNIVERSITY BEHAVIORAL HEALTH OF EL PASO LLC 1900 DENVER AVE EL PASO, TX 79902-3008 EL PASO 03/05/2008 80%

137999206 1821087164 UNIVERSITY MEDICAL CENTER 602 INDIANA AVE LUBBOCK, TX 79415-3364 LUBBOCK 01/01/2018 26%

021187203 1578547667 UNIVERSITY OF TEXAS HEALTH SCIENCE CENTER AT HOUST-HARRIS COUNTY PSYCHIATRIC CENTER 2800 S MACGREGOR WAY HOUSTON, TX 77021-1032 HARRIS 08/04/2013 50%

127278304 1417941295 UNIVERSITY OF TEXAS HEALTH SCIENCE CENTER AT TYLER-UT HEALTH CENTER-TYLER 11937 US HIGHWAY 271 TYLER, TX 75708-3154 SMITH 09/01/2017 30%

094092602 1548226988 UNIVERSITY OF TEXAS MEDICAL BRANCH AT GALVESTON-UNIVERSITY OF TEXAS MEDICAL BRANCH 301 UNIVERSITY BLVD RT 1076 GALVESTON, TX 77555-0001 GALVESTON 09/01/2017 37%

175287501 1285798918 UNIVERSITY OF TEXAS SOUTHWESTERN MEDICAL CENTER AT-UNIVERSITY OF TEXAS SOUTHWESTERN UNIVERSITY HOSPTI6201 HARRY HINES DALLAS, TX 75390-0001 DALLAS 09/01/2017 50%

175289101 1417010653 UNIVERSITY OF TEXAS SOUTHWESTERN MEDICAL CENTER AT-UTSOUTHWESTERN UNIVERSITY HOSPITAL ZALE LIPSHY 5151 HARRY HINES BLVD DALLAS, TX 75390-9200 DALLAS 09/01/2017 47%

162965101 1659352987 USMD HOSPITAL AT ARLINGTON LP 801 W INTERSTATE 20 ARLINGTON, TX 76017-5851 TARRANT 01/01/2018 36%

198248001 1568656502 USMD HOSPITAL AT FORT WORTH LP 5900 ALTAMESA BLVD FORT WORTH, TX 76132-5473TARRANT 01/01/2018 46%

121782006 1740288505 UVALDE COUNTY HOSPITAL AUTHORITY-UVALDE MEMORIAL HOSPITAL 1025 GARNER FIELD RD UVALDE, TX 78801-4809 UVALDE 12/01/2017 65%

119877204 1104830900 VAL VERDE HOSPITAL CORPORATION-VAL VERDE REGIONAL MEDICAL CENTER 801 N BEDELL AVE DEL RIO, TX 78840-4112 VAL VERDE 07/01/2017 52%

294543801 1184911877 VHS BROWNSVILLE HOSPITAL COMPANY LLC-VALLEY BAPTIST MEDICAL CENTER BROWNSVILLE 1040 W JEFFERSON ST BROWNSVILLE, TX 78520-6338CAMERON 05/01/2017 16%

292096901 1154618742 VHS HARLINGEN HOSPITAL COMPANY LLC- 2101 PEASE ST HARLINGEN, TX 78550-8307 CAMERON 07/01/2017 19%

159156201 1598744856 VHS SAN ANTONIO PARTNERS LLC-BAPTIST HEALTH SYSTEM 111 DALLAS ST SAN ANTONIO, TX 78205-1201BEXAR 07/01/2017 16%

334801301 1063844306 VIBRA HOSPITAL OF AMARILLO LLC-VIBRA HOSPITAL OF AMARILLO 7501 WALLACE BLVD AMARILLO, TX 79124-2150 POTTER 09/01/2013 24%

334224803 1750713012 VIBRA REHABILITATION HOSPITAL OF AMARILLO LLC-VIBRA REHABILITATION HOSPITAL OF AMARILLO 7200 SW 9TH AVE AMARILLO, TX 79106-1703 POTTER 01/01/2018 80%

357697701 1740693316 VIBRA REHABILITATION HOSPITAL OF EL PASO, LLC-HIGHLANDS REHABILITATION HOSPITAL 1395 GEORGE DIETER DR EL PASO, TX 79936-7499 EL PASO 06/01/2016 82%

347495902 1194137364 VIBRA REHABILITATION HOSPITAL OF LAKE TRAVIS- 2000 MEDICAL DR LAKEWAY, TX 78734-4200 TRAVIS 01/16/2015 50%

197976701 1477507432 VIBRA SPECIALTY HOSPITAL OF DALLAS LLC- 2700 WALKER WAY DESOTO, TX 75115-2088 DALLAS 08/01/2007 50%

197976703 1053778860 VIBRA SPECIALTY HOSPITAL OF DALLAS LLC-VIBRA HOSPITAL OF RICHARDSON 401 W CAMPBELL RD STE 300 RICHARDSON, TX 75080-3416DALLAS 07/06/2015 50%

020981901 1891718789 VISTA COMMUNITY MEDICAL CENTER HOSPITAL LLP-SURGERY SPECIALTY HOSPITAL OF AMERICA SE HOUSTON 4301 VISTA RD PASADENA, TX 77504-2117 HARRIS 05/01/2011 41%

126667806 1104842475 W J MANGOLD MEMORIAL HOSPITAL 320 N MAIN ST LOCKNEY, TX 79241-0037 FLOYD 08/01/2017 100%

189791001 1144225699 WALKER COUNTY HOSPITAL CORPORATION-HUNTSVILLE MEMORIAL HOSPITAL 110 MEMORIAL HOSPITAL DR HUNTSVILLE, TX 77342-4001 WALKER 07/01/2017 32%

341048201 1083056790 WALNUT HILL PHYSICIANS HOSPITAL LLC-WALNUT HILL MEDICAL CENTER 7502 GREENVILLE AVE DALLAS, TX 75231-3802 DALLAS 03/01/2017 52%

347731701 1861818809 WARM SPRINGS REHABILITATION HOSPITAL OF KYLE LLC- 5980 KYLE PKWY KYLE, TX 78640-2400 HAYS 09/08/2014 50%

350452401 1073952339 WARM SPRINGS REHABILITATION HOSPITAL OF VICTORIA L-PAM REHABILITATION HOSPITAL OF VICTORIA 101 JAMES COLEMAN DR VICTORIA, TX 77904-3147 VICTORIA 02/26/2015 50%

326690001 1629037163 WARM SPRINGS SPECIALTY HOSPITAL OF SAN ANTONIO 7400 BARLITE BLVD SAN ANTONIO, TX 78224-1308BEXAR 09/01/2013 50%

184409401 1982781852 WEATHERFORD TEXAS HOSPITAL COMPANY LLC-WEATHERFORD REGIONAL MEDICAL CENTER 713 E ANDERSON STREET WEATHERFORD, TX 76086-5705PARKER 12/01/2017 23%

359190101 1720407935 WEIMAR MEDICAL CENTER 400 YOUENS DR WEIMAR, TX 78962-3680 COLORADO 02/26/2016 50%

350453201 1538551791 WESLACO REGIONAL REHABILITATION HOSPITAL, LLC- 906 JAMES ST WESLACO, TX 78596-9840 HIDALGO 08/01/2016 100%

121829905 1598764359 WEST OAK HOSPITAL INC-TEXAS WEST OAKS HOSPITAL 6500 HORNWOOD DR HOUSTON, TX 77074-5008 HARRIS 10/01/2006 44%

344854001 1215354899 WESTPARK SPRINGS LLC- 6902 S PEEK RD RICHMOND, TX 77407-1741 FORT BEND 12/19/2014 50%

Prepared by HHSC Hospital Rate Analysis Department 11 of 12 1/24/2018

Page 12: Inpatient Ratio of Cost to Charges Effective 01/1/2018...357216601 1073901476 chg hospital conroe llc-chg hospital conroe, llc 1500 grand lake dr conroe, tx 77304-2891 montgomery 09/01/2010

TPI NPI Provider Combined Name Provider Street Address City, State and Zip County

Rate Effective

Date

Inpatient Rate

(December)

112707808 1316931835 WILBARGER COUNTY HOSPITAL DISTRICT-WILBARGER GENERAL HOSPITAL 920 HILLCREST DRIVE VERNON, TX 76384-3132 WILBARGER 08/01/2017 38%

135151206 1871599829 WILSON COUNTY MEMORIAL HOSPITAL DISTRICT-CONNALLY MEMORIAL MEDICAL CENTER 499 10TH STREET FLORESVILLE, TX 78114-3175WILSON 09/01/2017 36%

094204701 1730183658 WINKLER COUNTY MEMORIAL HOSP 821 JEFFEE DR KERMIT, TX 79745-4610 WINKLER 01/01/2018 100%

148698701 1295781227 WINNIE COMMUNITY HOSPITAL LLC 538 BROADWAY WINNIE, TX 77665 CHAMBERS 01/01/2017 55%

130606006 1124076401 WISE REGIONAL HEALTH SYSTEM-WISE HEALTH SYSTEM 2000 SOUTH FM 51 DECATUR, TX 76234-3702 WISE 01/01/2018 46%

094164302 1487607792 WOODLAND HEIGHTS MEDICAL CENTER 505 S JOHN REDDITT DR LUFKIN, TX 75904-3159 ANGELINA 01/01/2017 18%

112673204 1881697878 YOAKUM COMMUNITY HOSPITAL 1200 CARL RAMERT DR YOAKUM, TX 77995-4868 LAVACA 08/01/2017 99%

Prepared by HHSC Hospital Rate Analysis Department 12 of 12 1/24/2018