|
Cryoglobulin, Ql, Serum, Rflx SO
|
Facility
|
IP
|
$47.00
|
|
|
Service Code
|
CPT 82595
|
| Hospital Charge Code |
1705482
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$41.36
|
|
|
Cryoglobulin, Ql, Serum, Rflx SO
|
Facility
|
OP
|
$47.00
|
|
|
Service Code
|
CPT 82595
|
| Hospital Charge Code |
1705482
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.52 |
| Max. Negotiated Rate |
$30.55 |
| Rate for Payer: Aetna Commercial |
$6.79
|
| Rate for Payer: Aetna Medicare |
$9.70
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2.52
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$6.47
|
| Rate for Payer: Amerigroup Medicare |
$6.47
|
| Rate for Payer: BCBS of TX Blue Advantage |
$10.68
|
| Rate for Payer: BCBS of TX Blue Essentials |
$12.81
|
| Rate for Payer: BCBS of TX Medicare |
$6.47
|
| Rate for Payer: BCBS of TX PPO |
$14.30
|
| Rate for Payer: Cash Price |
$41.36
|
| Rate for Payer: Cash Price |
$41.36
|
| Rate for Payer: Cigna Medicaid |
$6.47
|
| Rate for Payer: Cigna Medicare |
$6.47
|
| Rate for Payer: Employer Direct Commercial |
$6.47
|
| Rate for Payer: Humana Medicare/TRICARE |
$6.47
|
| Rate for Payer: Molina CHIP/Medicaid |
$6.47
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$6.47
|
| Rate for Payer: Molina Medicare |
$6.47
|
| Rate for Payer: Multiplan Auto |
$30.55
|
| Rate for Payer: Multiplan Commercial |
$30.55
|
| Rate for Payer: Multiplan Workers Comp |
$30.55
|
| Rate for Payer: Parkland Medicaid |
$6.47
|
| Rate for Payer: Scott and White EPO/PPO |
$8.09
|
| Rate for Payer: Scott and White Medicare |
$6.47
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$6.47
|
| Rate for Payer: Superior Health Plan EPO |
$6.47
|
| Rate for Payer: Superior Health Plan Medicare |
$6.47
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$6.47
|
| Rate for Payer: Universal American Medicare |
$6.47
|
| Rate for Payer: Wellcare Medicare |
$6.47
|
| Rate for Payer: Wellmed Medicare |
$6.47
|
|
|
.Cryptococcus Ag Titer 183036 SO
|
Facility
|
OP
|
$117.00
|
|
|
Service Code
|
CPT 87899
|
| Hospital Charge Code |
1605872
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$6.27 |
| Max. Negotiated Rate |
$76.05 |
| Rate for Payer: Aetna Commercial |
$16.87
|
| Rate for Payer: Aetna Medicare |
$24.10
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$6.27
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$16.07
|
| Rate for Payer: Amerigroup Medicare |
$16.07
|
| Rate for Payer: BCBS of TX Blue Advantage |
$26.52
|
| Rate for Payer: BCBS of TX Blue Essentials |
$31.82
|
| Rate for Payer: BCBS of TX Medicare |
$16.07
|
| Rate for Payer: BCBS of TX PPO |
$35.51
|
| Rate for Payer: Cash Price |
$102.96
|
| Rate for Payer: Cash Price |
$102.96
|
| Rate for Payer: Cigna Medicaid |
$16.07
|
| Rate for Payer: Cigna Medicare |
$16.07
|
| Rate for Payer: Employer Direct Commercial |
$16.07
|
| Rate for Payer: Humana Medicare/TRICARE |
$16.07
|
| Rate for Payer: Molina CHIP/Medicaid |
$16.07
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$16.07
|
| Rate for Payer: Molina Medicare |
$16.07
|
| Rate for Payer: Multiplan Auto |
$76.05
|
| Rate for Payer: Multiplan Commercial |
$76.05
|
| Rate for Payer: Multiplan Workers Comp |
$76.05
|
| Rate for Payer: Parkland Medicaid |
$16.07
|
| Rate for Payer: Scott and White EPO/PPO |
$20.09
|
| Rate for Payer: Scott and White Medicare |
$16.07
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$16.07
|
| Rate for Payer: Superior Health Plan EPO |
$16.07
|
| Rate for Payer: Superior Health Plan Medicare |
$16.07
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$16.07
|
| Rate for Payer: Universal American Medicare |
$16.07
|
| Rate for Payer: Wellcare Medicare |
$16.07
|
| Rate for Payer: Wellmed Medicare |
$16.07
|
|
|
.Cryptococcus Ag Titer CSF 183018 SO
|
Facility
|
OP
|
$117.00
|
|
|
Service Code
|
CPT 87899
|
| Hospital Charge Code |
1605872
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$6.27 |
| Max. Negotiated Rate |
$76.05 |
| Rate for Payer: Aetna Commercial |
$16.87
|
| Rate for Payer: Aetna Medicare |
$24.10
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$6.27
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$16.07
|
| Rate for Payer: Amerigroup Medicare |
$16.07
|
| Rate for Payer: BCBS of TX Blue Advantage |
$26.52
|
| Rate for Payer: BCBS of TX Blue Essentials |
$31.82
|
| Rate for Payer: BCBS of TX Medicare |
$16.07
|
| Rate for Payer: BCBS of TX PPO |
$35.51
|
| Rate for Payer: Cash Price |
$102.96
|
| Rate for Payer: Cash Price |
$102.96
|
| Rate for Payer: Cigna Medicaid |
$16.07
|
| Rate for Payer: Cigna Medicare |
$16.07
|
| Rate for Payer: Employer Direct Commercial |
$16.07
|
| Rate for Payer: Humana Medicare/TRICARE |
$16.07
|
| Rate for Payer: Molina CHIP/Medicaid |
$16.07
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$16.07
|
| Rate for Payer: Molina Medicare |
$16.07
|
| Rate for Payer: Multiplan Auto |
$76.05
|
| Rate for Payer: Multiplan Commercial |
$76.05
|
| Rate for Payer: Multiplan Workers Comp |
$76.05
|
| Rate for Payer: Parkland Medicaid |
$16.07
|
| Rate for Payer: Scott and White EPO/PPO |
$20.09
|
| Rate for Payer: Scott and White Medicare |
$16.07
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$16.07
|
| Rate for Payer: Superior Health Plan EPO |
$16.07
|
| Rate for Payer: Superior Health Plan Medicare |
$16.07
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$16.07
|
| Rate for Payer: Universal American Medicare |
$16.07
|
| Rate for Payer: Wellcare Medicare |
$16.07
|
| Rate for Payer: Wellmed Medicare |
$16.07
|
|
|
Cryptococcus Antigen, CSF SO
|
Facility
|
OP
|
$117.00
|
|
|
Service Code
|
CPT 87899
|
| Hospital Charge Code |
1605872
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$6.27 |
| Max. Negotiated Rate |
$76.05 |
| Rate for Payer: Aetna Commercial |
$16.87
|
| Rate for Payer: Aetna Medicare |
$24.10
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$6.27
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$16.07
|
| Rate for Payer: Amerigroup Medicare |
$16.07
|
| Rate for Payer: BCBS of TX Blue Advantage |
$26.52
|
| Rate for Payer: BCBS of TX Blue Essentials |
$31.82
|
| Rate for Payer: BCBS of TX Medicare |
$16.07
|
| Rate for Payer: BCBS of TX PPO |
$35.51
|
| Rate for Payer: Cash Price |
$102.96
|
| Rate for Payer: Cash Price |
$102.96
|
| Rate for Payer: Cigna Medicaid |
$16.07
|
| Rate for Payer: Cigna Medicare |
$16.07
|
| Rate for Payer: Employer Direct Commercial |
$16.07
|
| Rate for Payer: Humana Medicare/TRICARE |
$16.07
|
| Rate for Payer: Molina CHIP/Medicaid |
$16.07
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$16.07
|
| Rate for Payer: Molina Medicare |
$16.07
|
| Rate for Payer: Multiplan Auto |
$76.05
|
| Rate for Payer: Multiplan Commercial |
$76.05
|
| Rate for Payer: Multiplan Workers Comp |
$76.05
|
| Rate for Payer: Parkland Medicaid |
$16.07
|
| Rate for Payer: Scott and White EPO/PPO |
$20.09
|
| Rate for Payer: Scott and White Medicare |
$16.07
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$16.07
|
| Rate for Payer: Superior Health Plan EPO |
$16.07
|
| Rate for Payer: Superior Health Plan Medicare |
$16.07
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$16.07
|
| Rate for Payer: Universal American Medicare |
$16.07
|
| Rate for Payer: Wellcare Medicare |
$16.07
|
| Rate for Payer: Wellmed Medicare |
$16.07
|
|
|
Cryptococcus Antigen, CSF SO
|
Facility
|
IP
|
$117.00
|
|
|
Service Code
|
CPT 87899
|
| Hospital Charge Code |
1605872
|
|
Hospital Revenue Code
|
306
|
| Rate for Payer: Cash Price |
$102.96
|
|
|
Cryptococcus Antigen, Serum SO
|
Facility
|
OP
|
$117.00
|
|
|
Service Code
|
CPT 87899
|
| Hospital Charge Code |
1605872
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$6.27 |
| Max. Negotiated Rate |
$76.05 |
| Rate for Payer: Aetna Commercial |
$16.87
|
| Rate for Payer: Aetna Medicare |
$24.10
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$6.27
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$16.07
|
| Rate for Payer: Amerigroup Medicare |
$16.07
|
| Rate for Payer: BCBS of TX Blue Advantage |
$26.52
|
| Rate for Payer: BCBS of TX Blue Essentials |
$31.82
|
| Rate for Payer: BCBS of TX Medicare |
$16.07
|
| Rate for Payer: BCBS of TX PPO |
$35.51
|
| Rate for Payer: Cash Price |
$102.96
|
| Rate for Payer: Cash Price |
$102.96
|
| Rate for Payer: Cigna Medicaid |
$16.07
|
| Rate for Payer: Cigna Medicare |
$16.07
|
| Rate for Payer: Employer Direct Commercial |
$16.07
|
| Rate for Payer: Humana Medicare/TRICARE |
$16.07
|
| Rate for Payer: Molina CHIP/Medicaid |
$16.07
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$16.07
|
| Rate for Payer: Molina Medicare |
$16.07
|
| Rate for Payer: Multiplan Auto |
$76.05
|
| Rate for Payer: Multiplan Commercial |
$76.05
|
| Rate for Payer: Multiplan Workers Comp |
$76.05
|
| Rate for Payer: Parkland Medicaid |
$16.07
|
| Rate for Payer: Scott and White EPO/PPO |
$20.09
|
| Rate for Payer: Scott and White Medicare |
$16.07
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$16.07
|
| Rate for Payer: Superior Health Plan EPO |
$16.07
|
| Rate for Payer: Superior Health Plan Medicare |
$16.07
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$16.07
|
| Rate for Payer: Universal American Medicare |
$16.07
|
| Rate for Payer: Wellcare Medicare |
$16.07
|
| Rate for Payer: Wellmed Medicare |
$16.07
|
|
|
Crystal Examination Body Fluid
|
Facility
|
IP
|
$145.00
|
|
|
Service Code
|
CPT 89060
|
| Hospital Charge Code |
1600303
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$127.60
|
|
|
Crystal Examination Body Fluid
|
Facility
|
OP
|
$145.00
|
|
|
Service Code
|
CPT 89060
|
| Hospital Charge Code |
1600303
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.86 |
| Max. Negotiated Rate |
$94.25 |
| Rate for Payer: Aetna Commercial |
$7.70
|
| Rate for Payer: Aetna Medicare |
$11.00
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2.86
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$7.33
|
| Rate for Payer: Amerigroup Medicare |
$7.33
|
| Rate for Payer: BCBS of TX Blue Advantage |
$12.09
|
| Rate for Payer: BCBS of TX Blue Essentials |
$14.51
|
| Rate for Payer: BCBS of TX Medicare |
$7.33
|
| Rate for Payer: BCBS of TX PPO |
$16.20
|
| Rate for Payer: Cash Price |
$127.60
|
| Rate for Payer: Cash Price |
$127.60
|
| Rate for Payer: Cigna Medicaid |
$7.33
|
| Rate for Payer: Cigna Medicare |
$7.33
|
| Rate for Payer: Employer Direct Commercial |
$7.33
|
| Rate for Payer: Humana Medicare/TRICARE |
$7.33
|
| Rate for Payer: Molina CHIP/Medicaid |
$7.33
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$7.33
|
| Rate for Payer: Molina Medicare |
$7.33
|
| Rate for Payer: Multiplan Auto |
$94.25
|
| Rate for Payer: Multiplan Commercial |
$94.25
|
| Rate for Payer: Multiplan Workers Comp |
$94.25
|
| Rate for Payer: Parkland Medicaid |
$7.33
|
| Rate for Payer: Scott and White EPO/PPO |
$9.16
|
| Rate for Payer: Scott and White Medicare |
$7.33
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$7.33
|
| Rate for Payer: Superior Health Plan EPO |
$7.33
|
| Rate for Payer: Superior Health Plan Medicare |
$7.33
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$7.33
|
| Rate for Payer: Universal American Medicare |
$7.33
|
| Rate for Payer: Wellcare Medicare |
$7.33
|
| Rate for Payer: Wellmed Medicare |
$7.33
|
|
|
.CSF Differential
|
Facility
|
IP
|
$242.00
|
|
|
Service Code
|
CPT 89051
|
| Hospital Charge Code |
1600295
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$212.96
|
|
|
.CSF Differential
|
Facility
|
OP
|
$242.00
|
|
|
Service Code
|
CPT 89051
|
| Hospital Charge Code |
1600295
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.18 |
| Max. Negotiated Rate |
$157.30 |
| Rate for Payer: Aetna Commercial |
$5.88
|
| Rate for Payer: Aetna Medicare |
$8.40
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2.18
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$5.60
|
| Rate for Payer: Amerigroup Medicare |
$5.60
|
| Rate for Payer: BCBS of TX Blue Advantage |
$9.24
|
| Rate for Payer: BCBS of TX Blue Essentials |
$11.09
|
| Rate for Payer: BCBS of TX Medicare |
$5.60
|
| Rate for Payer: BCBS of TX PPO |
$12.38
|
| Rate for Payer: Cash Price |
$212.96
|
| Rate for Payer: Cash Price |
$212.96
|
| Rate for Payer: Cigna Medicaid |
$5.60
|
| Rate for Payer: Cigna Medicare |
$5.60
|
| Rate for Payer: Employer Direct Commercial |
$5.60
|
| Rate for Payer: Humana Medicare/TRICARE |
$5.60
|
| Rate for Payer: Molina CHIP/Medicaid |
$5.60
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$5.60
|
| Rate for Payer: Molina Medicare |
$5.60
|
| Rate for Payer: Multiplan Auto |
$157.30
|
| Rate for Payer: Multiplan Commercial |
$157.30
|
| Rate for Payer: Multiplan Workers Comp |
$157.30
|
| Rate for Payer: Parkland Medicaid |
$5.60
|
| Rate for Payer: Scott and White EPO/PPO |
$7.00
|
| Rate for Payer: Scott and White Medicare |
$5.60
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$5.60
|
| Rate for Payer: Superior Health Plan EPO |
$5.60
|
| Rate for Payer: Superior Health Plan Medicare |
$5.60
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$5.60
|
| Rate for Payer: Universal American Medicare |
$5.60
|
| Rate for Payer: Wellcare Medicare |
$5.60
|
| Rate for Payer: Wellmed Medicare |
$5.60
|
|
|
CT Abdomen w/ IV Contrast Only
|
Facility
|
OP
|
$5,161.00
|
|
|
Service Code
|
CPT 74160
|
| Hospital Charge Code |
3800257
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$3.01 |
| Max. Negotiated Rate |
$3,354.65 |
| Rate for Payer: Aetna Commercial |
$261.73
|
| Rate for Payer: Aetna Medicare |
$252.04
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$180.34
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$168.03
|
| Rate for Payer: Amerigroup Medicare |
$168.03
|
| Rate for Payer: BCBS of TX Blue Advantage |
$300.66
|
| Rate for Payer: BCBS of TX Blue Essentials |
$360.80
|
| Rate for Payer: BCBS of TX Medicare |
$168.03
|
| Rate for Payer: BCBS of TX PPO |
$402.71
|
| Rate for Payer: Cash Price |
$4,541.68
|
| Rate for Payer: Cash Price |
$4,541.68
|
| Rate for Payer: Cash Price |
$4,541.68
|
| Rate for Payer: Cigna Commercial |
$380.65
|
| Rate for Payer: Cigna Medicaid |
$180.34
|
| Rate for Payer: Cigna Medicare |
$168.03
|
| Rate for Payer: Employer Direct Commercial |
$168.03
|
| Rate for Payer: Humana Medicare/TRICARE |
$168.03
|
| Rate for Payer: Molina CHIP/Medicaid |
$180.34
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$168.03
|
| Rate for Payer: Molina Medicare |
$168.03
|
| Rate for Payer: Multiplan Auto |
$3,354.65
|
| Rate for Payer: Multiplan Commercial |
$3,354.65
|
| Rate for Payer: Multiplan Workers Comp |
$3,354.65
|
| Rate for Payer: Parkland Medicaid |
$180.34
|
| Rate for Payer: Scott and White EPO/PPO |
$3.01
|
| Rate for Payer: Scott and White Medicare |
$168.03
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$180.34
|
| Rate for Payer: Superior Health Plan EPO |
$168.03
|
| Rate for Payer: Superior Health Plan Medicare |
$168.03
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$168.03
|
| Rate for Payer: Universal American Medicare |
$168.03
|
| Rate for Payer: Wellcare Medicare |
$168.03
|
| Rate for Payer: Wellmed Medicare |
$168.03
|
|
|
CT Abdomen w/ IV & Oral Contrast
|
Facility
|
OP
|
$5,161.00
|
|
|
Service Code
|
CPT 74160
|
| Hospital Charge Code |
3800257
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$3.01 |
| Max. Negotiated Rate |
$3,354.65 |
| Rate for Payer: Aetna Commercial |
$261.73
|
| Rate for Payer: Aetna Medicare |
$252.04
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$180.34
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$168.03
|
| Rate for Payer: Amerigroup Medicare |
$168.03
|
| Rate for Payer: BCBS of TX Blue Advantage |
$300.66
|
| Rate for Payer: BCBS of TX Blue Essentials |
$360.80
|
| Rate for Payer: BCBS of TX Medicare |
$168.03
|
| Rate for Payer: BCBS of TX PPO |
$402.71
|
| Rate for Payer: Cash Price |
$4,541.68
|
| Rate for Payer: Cash Price |
$4,541.68
|
| Rate for Payer: Cash Price |
$4,541.68
|
| Rate for Payer: Cigna Commercial |
$380.65
|
| Rate for Payer: Cigna Medicaid |
$180.34
|
| Rate for Payer: Cigna Medicare |
$168.03
|
| Rate for Payer: Employer Direct Commercial |
$168.03
|
| Rate for Payer: Humana Medicare/TRICARE |
$168.03
|
| Rate for Payer: Molina CHIP/Medicaid |
$180.34
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$168.03
|
| Rate for Payer: Molina Medicare |
$168.03
|
| Rate for Payer: Multiplan Auto |
$3,354.65
|
| Rate for Payer: Multiplan Commercial |
$3,354.65
|
| Rate for Payer: Multiplan Workers Comp |
$3,354.65
|
| Rate for Payer: Parkland Medicaid |
$180.34
|
| Rate for Payer: Scott and White EPO/PPO |
$3.01
|
| Rate for Payer: Scott and White Medicare |
$168.03
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$180.34
|
| Rate for Payer: Superior Health Plan EPO |
$168.03
|
| Rate for Payer: Superior Health Plan Medicare |
$168.03
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$168.03
|
| Rate for Payer: Universal American Medicare |
$168.03
|
| Rate for Payer: Wellcare Medicare |
$168.03
|
| Rate for Payer: Wellmed Medicare |
$168.03
|
|
|
CT Abdomen w/ IV & Oral Contrast BCE
|
Facility
|
OP
|
$5,161.00
|
|
|
Service Code
|
CPT 74160
|
| Hospital Charge Code |
3800257
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$3.01 |
| Max. Negotiated Rate |
$3,354.65 |
| Rate for Payer: Aetna Commercial |
$261.73
|
| Rate for Payer: Aetna Medicare |
$252.04
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$180.34
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$168.03
|
| Rate for Payer: Amerigroup Medicare |
$168.03
|
| Rate for Payer: BCBS of TX Blue Advantage |
$300.66
|
| Rate for Payer: BCBS of TX Blue Essentials |
$360.80
|
| Rate for Payer: BCBS of TX Medicare |
$168.03
|
| Rate for Payer: BCBS of TX PPO |
$402.71
|
| Rate for Payer: Cash Price |
$4,541.68
|
| Rate for Payer: Cash Price |
$4,541.68
|
| Rate for Payer: Cash Price |
$4,541.68
|
| Rate for Payer: Cigna Commercial |
$380.65
|
| Rate for Payer: Cigna Medicaid |
$180.34
|
| Rate for Payer: Cigna Medicare |
$168.03
|
| Rate for Payer: Employer Direct Commercial |
$168.03
|
| Rate for Payer: Humana Medicare/TRICARE |
$168.03
|
| Rate for Payer: Molina CHIP/Medicaid |
$180.34
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$168.03
|
| Rate for Payer: Molina Medicare |
$168.03
|
| Rate for Payer: Multiplan Auto |
$3,354.65
|
| Rate for Payer: Multiplan Commercial |
$3,354.65
|
| Rate for Payer: Multiplan Workers Comp |
$3,354.65
|
| Rate for Payer: Parkland Medicaid |
$180.34
|
| Rate for Payer: Scott and White EPO/PPO |
$3.01
|
| Rate for Payer: Scott and White Medicare |
$168.03
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$180.34
|
| Rate for Payer: Superior Health Plan EPO |
$168.03
|
| Rate for Payer: Superior Health Plan Medicare |
$168.03
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$168.03
|
| Rate for Payer: Universal American Medicare |
$168.03
|
| Rate for Payer: Wellcare Medicare |
$168.03
|
| Rate for Payer: Wellmed Medicare |
$168.03
|
|
|
CT Abdomen w/ IV & Oral Contrast BCE
|
Facility
|
IP
|
$5,161.00
|
|
|
Service Code
|
CPT 74160
|
| Hospital Charge Code |
3800257
|
|
Hospital Revenue Code
|
352
|
| Rate for Payer: Cash Price |
$4,541.68
|
|
|
CT Abdomen w/o IV and Oral Contrast
|
Facility
|
OP
|
$4,150.00
|
|
|
Service Code
|
CPT 74150
|
| Hospital Charge Code |
3800117
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$2,697.50 |
| Rate for Payer: Aetna Commercial |
$127.02
|
| Rate for Payer: Aetna Medicare |
$150.82
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$106.88
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$100.55
|
| Rate for Payer: Amerigroup Medicare |
$100.55
|
| Rate for Payer: BCBS of TX Blue Advantage |
$184.93
|
| Rate for Payer: BCBS of TX Blue Essentials |
$221.92
|
| Rate for Payer: BCBS of TX Medicare |
$100.55
|
| Rate for Payer: BCBS of TX PPO |
$247.70
|
| Rate for Payer: Cash Price |
$3,652.00
|
| Rate for Payer: Cash Price |
$3,652.00
|
| Rate for Payer: Cash Price |
$3,652.00
|
| Rate for Payer: Cigna Commercial |
$227.77
|
| Rate for Payer: Cigna Medicaid |
$106.88
|
| Rate for Payer: Cigna Medicare |
$100.55
|
| Rate for Payer: Employer Direct Commercial |
$100.55
|
| Rate for Payer: Humana Medicare/TRICARE |
$100.55
|
| Rate for Payer: Molina CHIP/Medicaid |
$106.88
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$100.55
|
| Rate for Payer: Molina Medicare |
$100.55
|
| Rate for Payer: Multiplan Auto |
$2,697.50
|
| Rate for Payer: Multiplan Commercial |
$2,697.50
|
| Rate for Payer: Multiplan Workers Comp |
$2,697.50
|
| Rate for Payer: Parkland Medicaid |
$106.88
|
| Rate for Payer: Scott and White EPO/PPO |
$1.80
|
| Rate for Payer: Scott and White Medicare |
$100.55
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$106.88
|
| Rate for Payer: Superior Health Plan EPO |
$100.55
|
| Rate for Payer: Superior Health Plan Medicare |
$100.55
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$100.55
|
| Rate for Payer: Universal American Medicare |
$100.55
|
| Rate for Payer: Wellcare Medicare |
$100.55
|
| Rate for Payer: Wellmed Medicare |
$100.55
|
|
|
CT Abdomen w/o IV Contrast w/ Oral
|
Facility
|
OP
|
$4,150.00
|
|
|
Service Code
|
CPT 74150
|
| Hospital Charge Code |
3800117
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$2,697.50 |
| Rate for Payer: Aetna Commercial |
$127.02
|
| Rate for Payer: Aetna Medicare |
$150.82
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$106.88
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$100.55
|
| Rate for Payer: Amerigroup Medicare |
$100.55
|
| Rate for Payer: BCBS of TX Blue Advantage |
$184.93
|
| Rate for Payer: BCBS of TX Blue Essentials |
$221.92
|
| Rate for Payer: BCBS of TX Medicare |
$100.55
|
| Rate for Payer: BCBS of TX PPO |
$247.70
|
| Rate for Payer: Cash Price |
$3,652.00
|
| Rate for Payer: Cash Price |
$3,652.00
|
| Rate for Payer: Cash Price |
$3,652.00
|
| Rate for Payer: Cigna Commercial |
$227.77
|
| Rate for Payer: Cigna Medicaid |
$106.88
|
| Rate for Payer: Cigna Medicare |
$100.55
|
| Rate for Payer: Employer Direct Commercial |
$100.55
|
| Rate for Payer: Humana Medicare/TRICARE |
$100.55
|
| Rate for Payer: Molina CHIP/Medicaid |
$106.88
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$100.55
|
| Rate for Payer: Molina Medicare |
$100.55
|
| Rate for Payer: Multiplan Auto |
$2,697.50
|
| Rate for Payer: Multiplan Commercial |
$2,697.50
|
| Rate for Payer: Multiplan Workers Comp |
$2,697.50
|
| Rate for Payer: Parkland Medicaid |
$106.88
|
| Rate for Payer: Scott and White EPO/PPO |
$1.80
|
| Rate for Payer: Scott and White Medicare |
$100.55
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$106.88
|
| Rate for Payer: Superior Health Plan EPO |
$100.55
|
| Rate for Payer: Superior Health Plan Medicare |
$100.55
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$100.55
|
| Rate for Payer: Universal American Medicare |
$100.55
|
| Rate for Payer: Wellcare Medicare |
$100.55
|
| Rate for Payer: Wellmed Medicare |
$100.55
|
|
|
CT Abdomen w/o IV Contrast w/ Oral BCE
|
Facility
|
IP
|
$4,150.00
|
|
|
Service Code
|
CPT 74150
|
| Hospital Charge Code |
3800117
|
|
Hospital Revenue Code
|
352
|
| Rate for Payer: Cash Price |
$3,652.00
|
|
|
CT Abdomen w/o IV Contrast w/ Oral BCE
|
Facility
|
OP
|
$4,150.00
|
|
|
Service Code
|
CPT 74150
|
| Hospital Charge Code |
3800117
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$2,697.50 |
| Rate for Payer: Aetna Commercial |
$127.02
|
| Rate for Payer: Aetna Medicare |
$150.82
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$106.88
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$100.55
|
| Rate for Payer: Amerigroup Medicare |
$100.55
|
| Rate for Payer: BCBS of TX Blue Advantage |
$184.93
|
| Rate for Payer: BCBS of TX Blue Essentials |
$221.92
|
| Rate for Payer: BCBS of TX Medicare |
$100.55
|
| Rate for Payer: BCBS of TX PPO |
$247.70
|
| Rate for Payer: Cash Price |
$3,652.00
|
| Rate for Payer: Cash Price |
$3,652.00
|
| Rate for Payer: Cash Price |
$3,652.00
|
| Rate for Payer: Cigna Commercial |
$227.77
|
| Rate for Payer: Cigna Medicaid |
$106.88
|
| Rate for Payer: Cigna Medicare |
$100.55
|
| Rate for Payer: Employer Direct Commercial |
$100.55
|
| Rate for Payer: Humana Medicare/TRICARE |
$100.55
|
| Rate for Payer: Molina CHIP/Medicaid |
$106.88
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$100.55
|
| Rate for Payer: Molina Medicare |
$100.55
|
| Rate for Payer: Multiplan Auto |
$2,697.50
|
| Rate for Payer: Multiplan Commercial |
$2,697.50
|
| Rate for Payer: Multiplan Workers Comp |
$2,697.50
|
| Rate for Payer: Parkland Medicaid |
$106.88
|
| Rate for Payer: Scott and White EPO/PPO |
$1.80
|
| Rate for Payer: Scott and White Medicare |
$100.55
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$106.88
|
| Rate for Payer: Superior Health Plan EPO |
$100.55
|
| Rate for Payer: Superior Health Plan Medicare |
$100.55
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$100.55
|
| Rate for Payer: Universal American Medicare |
$100.55
|
| Rate for Payer: Wellcare Medicare |
$100.55
|
| Rate for Payer: Wellmed Medicare |
$100.55
|
|
|
CT Abdomen w/ + w/o IV Contrast Only
|
Facility
|
OP
|
$6,367.00
|
|
|
Service Code
|
CPT 74170
|
| Hospital Charge Code |
3800182
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$3.01 |
| Max. Negotiated Rate |
$4,138.55 |
| Rate for Payer: Aetna Commercial |
$261.50
|
| Rate for Payer: Aetna Medicare |
$252.04
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$180.34
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$168.03
|
| Rate for Payer: Amerigroup Medicare |
$168.03
|
| Rate for Payer: BCBS of TX Blue Advantage |
$300.66
|
| Rate for Payer: BCBS of TX Blue Essentials |
$360.80
|
| Rate for Payer: BCBS of TX Medicare |
$168.03
|
| Rate for Payer: BCBS of TX PPO |
$402.71
|
| Rate for Payer: Cash Price |
$5,602.96
|
| Rate for Payer: Cash Price |
$5,602.96
|
| Rate for Payer: Cash Price |
$5,602.96
|
| Rate for Payer: Cigna Commercial |
$380.65
|
| Rate for Payer: Cigna Medicaid |
$180.34
|
| Rate for Payer: Cigna Medicare |
$168.03
|
| Rate for Payer: Employer Direct Commercial |
$168.03
|
| Rate for Payer: Humana Medicare/TRICARE |
$168.03
|
| Rate for Payer: Molina CHIP/Medicaid |
$180.34
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$168.03
|
| Rate for Payer: Molina Medicare |
$168.03
|
| Rate for Payer: Multiplan Auto |
$4,138.55
|
| Rate for Payer: Multiplan Commercial |
$4,138.55
|
| Rate for Payer: Multiplan Workers Comp |
$4,138.55
|
| Rate for Payer: Parkland Medicaid |
$180.34
|
| Rate for Payer: Scott and White EPO/PPO |
$3.01
|
| Rate for Payer: Scott and White Medicare |
$168.03
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$180.34
|
| Rate for Payer: Superior Health Plan EPO |
$168.03
|
| Rate for Payer: Superior Health Plan Medicare |
$168.03
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$168.03
|
| Rate for Payer: Universal American Medicare |
$168.03
|
| Rate for Payer: Wellcare Medicare |
$168.03
|
| Rate for Payer: Wellmed Medicare |
$168.03
|
|
|
CT Abdomen w/ + w/o IV&Oral Contrast
|
Facility
|
OP
|
$6,367.00
|
|
|
Service Code
|
CPT 74170
|
| Hospital Charge Code |
3800182
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$3.01 |
| Max. Negotiated Rate |
$4,138.55 |
| Rate for Payer: Aetna Commercial |
$261.50
|
| Rate for Payer: Aetna Medicare |
$252.04
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$180.34
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$168.03
|
| Rate for Payer: Amerigroup Medicare |
$168.03
|
| Rate for Payer: BCBS of TX Blue Advantage |
$300.66
|
| Rate for Payer: BCBS of TX Blue Essentials |
$360.80
|
| Rate for Payer: BCBS of TX Medicare |
$168.03
|
| Rate for Payer: BCBS of TX PPO |
$402.71
|
| Rate for Payer: Cash Price |
$5,602.96
|
| Rate for Payer: Cash Price |
$5,602.96
|
| Rate for Payer: Cash Price |
$5,602.96
|
| Rate for Payer: Cigna Commercial |
$380.65
|
| Rate for Payer: Cigna Medicaid |
$180.34
|
| Rate for Payer: Cigna Medicare |
$168.03
|
| Rate for Payer: Employer Direct Commercial |
$168.03
|
| Rate for Payer: Humana Medicare/TRICARE |
$168.03
|
| Rate for Payer: Molina CHIP/Medicaid |
$180.34
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$168.03
|
| Rate for Payer: Molina Medicare |
$168.03
|
| Rate for Payer: Multiplan Auto |
$4,138.55
|
| Rate for Payer: Multiplan Commercial |
$4,138.55
|
| Rate for Payer: Multiplan Workers Comp |
$4,138.55
|
| Rate for Payer: Parkland Medicaid |
$180.34
|
| Rate for Payer: Scott and White EPO/PPO |
$3.01
|
| Rate for Payer: Scott and White Medicare |
$168.03
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$180.34
|
| Rate for Payer: Superior Health Plan EPO |
$168.03
|
| Rate for Payer: Superior Health Plan Medicare |
$168.03
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$168.03
|
| Rate for Payer: Universal American Medicare |
$168.03
|
| Rate for Payer: Wellcare Medicare |
$168.03
|
| Rate for Payer: Wellmed Medicare |
$168.03
|
|
|
CT Abdomen w/ + w/o IV&Oral Contrast BCE
|
Facility
|
OP
|
$6,367.00
|
|
|
Service Code
|
CPT 74170
|
| Hospital Charge Code |
3800182
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$3.01 |
| Max. Negotiated Rate |
$4,138.55 |
| Rate for Payer: Aetna Commercial |
$261.50
|
| Rate for Payer: Aetna Medicare |
$252.04
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$180.34
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$168.03
|
| Rate for Payer: Amerigroup Medicare |
$168.03
|
| Rate for Payer: BCBS of TX Blue Advantage |
$300.66
|
| Rate for Payer: BCBS of TX Blue Essentials |
$360.80
|
| Rate for Payer: BCBS of TX Medicare |
$168.03
|
| Rate for Payer: BCBS of TX PPO |
$402.71
|
| Rate for Payer: Cash Price |
$5,602.96
|
| Rate for Payer: Cash Price |
$5,602.96
|
| Rate for Payer: Cash Price |
$5,602.96
|
| Rate for Payer: Cigna Commercial |
$380.65
|
| Rate for Payer: Cigna Medicaid |
$180.34
|
| Rate for Payer: Cigna Medicare |
$168.03
|
| Rate for Payer: Employer Direct Commercial |
$168.03
|
| Rate for Payer: Humana Medicare/TRICARE |
$168.03
|
| Rate for Payer: Molina CHIP/Medicaid |
$180.34
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$168.03
|
| Rate for Payer: Molina Medicare |
$168.03
|
| Rate for Payer: Multiplan Auto |
$4,138.55
|
| Rate for Payer: Multiplan Commercial |
$4,138.55
|
| Rate for Payer: Multiplan Workers Comp |
$4,138.55
|
| Rate for Payer: Parkland Medicaid |
$180.34
|
| Rate for Payer: Scott and White EPO/PPO |
$3.01
|
| Rate for Payer: Scott and White Medicare |
$168.03
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$180.34
|
| Rate for Payer: Superior Health Plan EPO |
$168.03
|
| Rate for Payer: Superior Health Plan Medicare |
$168.03
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$168.03
|
| Rate for Payer: Universal American Medicare |
$168.03
|
| Rate for Payer: Wellcare Medicare |
$168.03
|
| Rate for Payer: Wellmed Medicare |
$168.03
|
|
|
CT Abdomen w/ + w/o IV&Oral Contrast BCE
|
Facility
|
IP
|
$6,367.00
|
|
|
Service Code
|
CPT 74170
|
| Hospital Charge Code |
3800182
|
|
Hospital Revenue Code
|
352
|
| Rate for Payer: Cash Price |
$5,602.96
|
|
|
CT Abd/Pelvis w/ IV Contrast Only
|
Facility
|
OP
|
$7,920.00
|
|
|
Service Code
|
CPT 74177
|
| Hospital Charge Code |
3890211
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$6.29 |
| Max. Negotiated Rate |
$5,148.00 |
| Rate for Payer: Aetna Commercial |
$350.47
|
| Rate for Payer: Aetna Medicare |
$527.56
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$318.09
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$351.71
|
| Rate for Payer: Amerigroup Medicare |
$351.71
|
| Rate for Payer: BCBS of TX Blue Advantage |
$630.05
|
| Rate for Payer: BCBS of TX Blue Essentials |
$756.06
|
| Rate for Payer: BCBS of TX Medicare |
$351.71
|
| Rate for Payer: BCBS of TX PPO |
$843.89
|
| Rate for Payer: Cash Price |
$6,969.60
|
| Rate for Payer: Cash Price |
$6,969.60
|
| Rate for Payer: Cash Price |
$6,969.60
|
| Rate for Payer: Cigna Commercial |
$796.73
|
| Rate for Payer: Cigna Medicaid |
$318.09
|
| Rate for Payer: Cigna Medicare |
$351.71
|
| Rate for Payer: Employer Direct Commercial |
$351.71
|
| Rate for Payer: Humana Medicare/TRICARE |
$351.71
|
| Rate for Payer: Molina CHIP/Medicaid |
$318.09
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$351.71
|
| Rate for Payer: Molina Medicare |
$351.71
|
| Rate for Payer: Multiplan Auto |
$5,148.00
|
| Rate for Payer: Multiplan Commercial |
$5,148.00
|
| Rate for Payer: Multiplan Workers Comp |
$5,148.00
|
| Rate for Payer: Parkland Medicaid |
$318.09
|
| Rate for Payer: Scott and White EPO/PPO |
$6.29
|
| Rate for Payer: Scott and White Medicare |
$351.71
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$318.09
|
| Rate for Payer: Superior Health Plan EPO |
$351.71
|
| Rate for Payer: Superior Health Plan Medicare |
$351.71
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$351.71
|
| Rate for Payer: Universal American Medicare |
$351.71
|
| Rate for Payer: Wellcare Medicare |
$351.71
|
| Rate for Payer: Wellmed Medicare |
$351.71
|
|
|
CT Abd/Pelvis w/ IV & Oral Contrast
|
Facility
|
OP
|
$7,920.00
|
|
|
Service Code
|
CPT 74177
|
| Hospital Charge Code |
3890211
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$6.29 |
| Max. Negotiated Rate |
$5,148.00 |
| Rate for Payer: Aetna Commercial |
$350.47
|
| Rate for Payer: Aetna Medicare |
$527.56
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$318.09
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$351.71
|
| Rate for Payer: Amerigroup Medicare |
$351.71
|
| Rate for Payer: BCBS of TX Blue Advantage |
$630.05
|
| Rate for Payer: BCBS of TX Blue Essentials |
$756.06
|
| Rate for Payer: BCBS of TX Medicare |
$351.71
|
| Rate for Payer: BCBS of TX PPO |
$843.89
|
| Rate for Payer: Cash Price |
$6,969.60
|
| Rate for Payer: Cash Price |
$6,969.60
|
| Rate for Payer: Cash Price |
$6,969.60
|
| Rate for Payer: Cigna Commercial |
$796.73
|
| Rate for Payer: Cigna Medicaid |
$318.09
|
| Rate for Payer: Cigna Medicare |
$351.71
|
| Rate for Payer: Employer Direct Commercial |
$351.71
|
| Rate for Payer: Humana Medicare/TRICARE |
$351.71
|
| Rate for Payer: Molina CHIP/Medicaid |
$318.09
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$351.71
|
| Rate for Payer: Molina Medicare |
$351.71
|
| Rate for Payer: Multiplan Auto |
$5,148.00
|
| Rate for Payer: Multiplan Commercial |
$5,148.00
|
| Rate for Payer: Multiplan Workers Comp |
$5,148.00
|
| Rate for Payer: Parkland Medicaid |
$318.09
|
| Rate for Payer: Scott and White EPO/PPO |
$6.29
|
| Rate for Payer: Scott and White Medicare |
$351.71
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$318.09
|
| Rate for Payer: Superior Health Plan EPO |
$351.71
|
| Rate for Payer: Superior Health Plan Medicare |
$351.71
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$351.71
|
| Rate for Payer: Universal American Medicare |
$351.71
|
| Rate for Payer: Wellcare Medicare |
$351.71
|
| Rate for Payer: Wellmed Medicare |
$351.71
|
|
