|
CT Angio Abdomen BCE
|
Facility
|
IP
|
$6,558.00
|
|
|
Service Code
|
CPT 74175
|
| Hospital Charge Code |
3890209
|
|
Hospital Revenue Code
|
352
|
| Rate for Payer: Cash Price |
$5,771.04
|
|
|
CT Angio Aorta Recon for Surgical Plan
|
Facility
|
OP
|
$855.00
|
|
|
Service Code
|
HCPCS G0288
|
| Hospital Charge Code |
5050288
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$60.06 |
| Max. Negotiated Rate |
$555.75 |
| Rate for Payer: Aetna Commercial |
$470.25
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$76.95
|
| Rate for Payer: BCBS of TX Blue Advantage |
$60.06
|
| Rate for Payer: BCBS of TX Blue Essentials |
$72.07
|
| Rate for Payer: BCBS of TX PPO |
$80.44
|
| Rate for Payer: Cash Price |
$752.40
|
| Rate for Payer: Cash Price |
$752.40
|
| Rate for Payer: Multiplan Auto |
$555.75
|
| Rate for Payer: Multiplan Commercial |
$555.75
|
| Rate for Payer: Multiplan Workers Comp |
$555.75
|
| Rate for Payer: Scott and White EPO/PPO |
$427.50
|
| Rate for Payer: Superior Health Plan EPO |
$116.28
|
|
|
CT Angio Aorta Recon for Surgical Plan BCE
|
Facility
|
OP
|
$855.00
|
|
|
Service Code
|
HCPCS G0288
|
| Hospital Charge Code |
5050288
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$60.06 |
| Max. Negotiated Rate |
$555.75 |
| Rate for Payer: Aetna Commercial |
$470.25
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$76.95
|
| Rate for Payer: BCBS of TX Blue Advantage |
$60.06
|
| Rate for Payer: BCBS of TX Blue Essentials |
$72.07
|
| Rate for Payer: BCBS of TX PPO |
$80.44
|
| Rate for Payer: Cash Price |
$752.40
|
| Rate for Payer: Cash Price |
$752.40
|
| Rate for Payer: Multiplan Auto |
$555.75
|
| Rate for Payer: Multiplan Commercial |
$555.75
|
| Rate for Payer: Multiplan Workers Comp |
$555.75
|
| Rate for Payer: Scott and White EPO/PPO |
$427.50
|
| Rate for Payer: Superior Health Plan EPO |
$116.28
|
|
|
CT Angio Aorta Recon for Surgical Plan BCE
|
Facility
|
IP
|
$855.00
|
|
|
Service Code
|
HCPCS G0288
|
| Hospital Charge Code |
5050288
|
|
Hospital Revenue Code
|
350
|
| Rate for Payer: Cash Price |
$752.40
|
|
|
CT Angio Brain/Head
|
Facility
|
OP
|
$6,952.00
|
|
|
Service Code
|
CPT 70496
|
| Hospital Charge Code |
3890167
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$3.01 |
| Max. Negotiated Rate |
$4,518.80 |
| Rate for Payer: Aetna Commercial |
$261.26
|
| 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 |
$6,117.76
|
| Rate for Payer: Cash Price |
$6,117.76
|
| Rate for Payer: Cash Price |
$6,117.76
|
| 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 |
$4,518.80
|
| Rate for Payer: Multiplan Commercial |
$4,518.80
|
| Rate for Payer: Multiplan Workers Comp |
$4,518.80
|
| 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 Angio Brain/Head BCE
|
Facility
|
OP
|
$6,952.00
|
|
|
Service Code
|
CPT 70496
|
| Hospital Charge Code |
3890167
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$3.01 |
| Max. Negotiated Rate |
$4,518.80 |
| Rate for Payer: Aetna Commercial |
$261.26
|
| 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 |
$6,117.76
|
| Rate for Payer: Cash Price |
$6,117.76
|
| Rate for Payer: Cash Price |
$6,117.76
|
| 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 |
$4,518.80
|
| Rate for Payer: Multiplan Commercial |
$4,518.80
|
| Rate for Payer: Multiplan Workers Comp |
$4,518.80
|
| 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 Angio Brain/Head BCE
|
Facility
|
IP
|
$6,952.00
|
|
|
Service Code
|
CPT 70496
|
| Hospital Charge Code |
3890167
|
|
Hospital Revenue Code
|
351
|
| Rate for Payer: Cash Price |
$6,117.76
|
|
|
CT Angio Chest
|
Facility
|
OP
|
$7,351.00
|
|
|
Service Code
|
CPT 71275
|
| Hospital Charge Code |
3801636
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$3.01 |
| Max. Negotiated Rate |
$4,778.15 |
| Rate for Payer: Aetna Commercial |
$261.26
|
| 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 |
$6,468.88
|
| Rate for Payer: Cash Price |
$6,468.88
|
| Rate for Payer: Cash Price |
$6,468.88
|
| 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 |
$4,778.15
|
| Rate for Payer: Multiplan Commercial |
$4,778.15
|
| Rate for Payer: Multiplan Workers Comp |
$4,778.15
|
| 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 Angio Chest BCE
|
Facility
|
OP
|
$7,351.00
|
|
|
Service Code
|
CPT 71275
|
| Hospital Charge Code |
3801636
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$3.01 |
| Max. Negotiated Rate |
$4,778.15 |
| Rate for Payer: Aetna Commercial |
$261.26
|
| 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 |
$6,468.88
|
| Rate for Payer: Cash Price |
$6,468.88
|
| Rate for Payer: Cash Price |
$6,468.88
|
| 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 |
$4,778.15
|
| Rate for Payer: Multiplan Commercial |
$4,778.15
|
| Rate for Payer: Multiplan Workers Comp |
$4,778.15
|
| 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 Angio Chest BCE
|
Facility
|
IP
|
$7,351.00
|
|
|
Service Code
|
CPT 71275
|
| Hospital Charge Code |
3801636
|
|
Hospital Revenue Code
|
350
|
| Rate for Payer: Cash Price |
$6,468.88
|
|
|
CT Angio Coronary Artery Str/Mph/Fnt Cnt BCE
|
Facility
|
IP
|
$1,385.00
|
|
|
Service Code
|
CPT 75574
|
| Hospital Charge Code |
3800004
|
|
Hospital Revenue Code
|
350
|
| Rate for Payer: Cash Price |
$1,218.80
|
|
|
CT Angio Coronary Artery Str/Mph/Fnt Cnt BCE
|
Facility
|
OP
|
$1,385.00
|
|
|
Service Code
|
CPT 75574
|
| Hospital Charge Code |
3800004
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$3.01 |
| Max. Negotiated Rate |
$900.25 |
| Rate for Payer: Aetna Commercial |
$261.26
|
| 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 |
$333.00
|
| Rate for Payer: BCBS of TX Blue Essentials |
$399.60
|
| Rate for Payer: BCBS of TX Medicare |
$168.03
|
| Rate for Payer: BCBS of TX PPO |
$446.02
|
| Rate for Payer: Cash Price |
$1,218.80
|
| Rate for Payer: Cash Price |
$1,218.80
|
| Rate for Payer: Cash Price |
$1,218.80
|
| 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 |
$900.25
|
| Rate for Payer: Multiplan Commercial |
$900.25
|
| Rate for Payer: Multiplan Workers Comp |
$900.25
|
| 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 Angio Lower Extremity Left
|
Facility
|
OP
|
$6,112.00
|
|
|
Service Code
|
CPT 73706 LT
|
| Hospital Charge Code |
3890134
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$3.01 |
| Max. Negotiated Rate |
$3,972.80 |
| Rate for Payer: Aetna Commercial |
$261.26
|
| 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 |
$5,378.56
|
| Rate for Payer: Cash Price |
$5,378.56
|
| Rate for Payer: Cash Price |
$5,378.56
|
| Rate for Payer: Cigna Commercial |
$380.65
|
| Rate for Payer: Cigna Medicaid |
$198.34
|
| 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 |
$198.34
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$168.03
|
| Rate for Payer: Molina Medicare |
$168.03
|
| Rate for Payer: Multiplan Auto |
$3,972.80
|
| Rate for Payer: Multiplan Commercial |
$3,972.80
|
| Rate for Payer: Multiplan Workers Comp |
$3,972.80
|
| Rate for Payer: Parkland Medicaid |
$198.34
|
| 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 |
$198.34
|
| 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 Angio Lower Extremity Left BCE
|
Facility
|
OP
|
$6,112.00
|
|
|
Service Code
|
CPT 73706 LT
|
| Hospital Charge Code |
3890134
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$3.01 |
| Max. Negotiated Rate |
$3,972.80 |
| Rate for Payer: Aetna Commercial |
$261.26
|
| 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 |
$5,378.56
|
| Rate for Payer: Cash Price |
$5,378.56
|
| Rate for Payer: Cash Price |
$5,378.56
|
| Rate for Payer: Cigna Commercial |
$380.65
|
| Rate for Payer: Cigna Medicaid |
$198.34
|
| 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 |
$198.34
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$168.03
|
| Rate for Payer: Molina Medicare |
$168.03
|
| Rate for Payer: Multiplan Auto |
$3,972.80
|
| Rate for Payer: Multiplan Commercial |
$3,972.80
|
| Rate for Payer: Multiplan Workers Comp |
$3,972.80
|
| Rate for Payer: Parkland Medicaid |
$198.34
|
| 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 |
$198.34
|
| 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 Angio Lower Extremity Right
|
Facility
|
OP
|
$6,112.00
|
|
|
Service Code
|
CPT 73706 RT
|
| Hospital Charge Code |
3890134
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$3.01 |
| Max. Negotiated Rate |
$3,972.80 |
| Rate for Payer: Aetna Commercial |
$261.26
|
| 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 |
$5,378.56
|
| Rate for Payer: Cash Price |
$5,378.56
|
| Rate for Payer: Cash Price |
$5,378.56
|
| Rate for Payer: Cigna Commercial |
$380.65
|
| Rate for Payer: Cigna Medicaid |
$198.34
|
| 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 |
$198.34
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$168.03
|
| Rate for Payer: Molina Medicare |
$168.03
|
| Rate for Payer: Multiplan Auto |
$3,972.80
|
| Rate for Payer: Multiplan Commercial |
$3,972.80
|
| Rate for Payer: Multiplan Workers Comp |
$3,972.80
|
| Rate for Payer: Parkland Medicaid |
$198.34
|
| 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 |
$198.34
|
| 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 Angio Lower Extremity Right BCE
|
Facility
|
OP
|
$6,112.00
|
|
|
Service Code
|
CPT 73706 RT
|
| Hospital Charge Code |
3890134
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$3.01 |
| Max. Negotiated Rate |
$3,972.80 |
| Rate for Payer: Aetna Commercial |
$261.26
|
| 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 |
$5,378.56
|
| Rate for Payer: Cash Price |
$5,378.56
|
| Rate for Payer: Cash Price |
$5,378.56
|
| Rate for Payer: Cigna Commercial |
$380.65
|
| Rate for Payer: Cigna Medicaid |
$198.34
|
| 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 |
$198.34
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$168.03
|
| Rate for Payer: Molina Medicare |
$168.03
|
| Rate for Payer: Multiplan Auto |
$3,972.80
|
| Rate for Payer: Multiplan Commercial |
$3,972.80
|
| Rate for Payer: Multiplan Workers Comp |
$3,972.80
|
| Rate for Payer: Parkland Medicaid |
$198.34
|
| 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 |
$198.34
|
| 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 Angio Lower Extremity Right BCE
|
Facility
|
IP
|
$6,112.00
|
|
|
Service Code
|
CPT 73706 RT
|
| Hospital Charge Code |
3890134
|
|
Hospital Revenue Code
|
352
|
| Rate for Payer: Cash Price |
$5,378.56
|
|
|
CT Angio Neck
|
Facility
|
OP
|
$8,782.00
|
|
|
Service Code
|
CPT 70498
|
| Hospital Charge Code |
3890175
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$3.01 |
| Max. Negotiated Rate |
$5,708.30 |
| Rate for Payer: Aetna Commercial |
$261.26
|
| 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 |
$7,728.16
|
| Rate for Payer: Cash Price |
$7,728.16
|
| Rate for Payer: Cash Price |
$7,728.16
|
| 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 |
$5,708.30
|
| Rate for Payer: Multiplan Commercial |
$5,708.30
|
| Rate for Payer: Multiplan Workers Comp |
$5,708.30
|
| 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 Angio Neck BCE
|
Facility
|
IP
|
$8,782.00
|
|
|
Service Code
|
CPT 70498
|
| Hospital Charge Code |
3890175
|
|
Hospital Revenue Code
|
350
|
| Rate for Payer: Cash Price |
$7,728.16
|
|
|
CT Angio Neck BCE
|
Facility
|
OP
|
$8,782.00
|
|
|
Service Code
|
CPT 70498
|
| Hospital Charge Code |
3890175
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$3.01 |
| Max. Negotiated Rate |
$5,708.30 |
| Rate for Payer: Aetna Commercial |
$261.26
|
| 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 |
$7,728.16
|
| Rate for Payer: Cash Price |
$7,728.16
|
| Rate for Payer: Cash Price |
$7,728.16
|
| 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 |
$5,708.30
|
| Rate for Payer: Multiplan Commercial |
$5,708.30
|
| Rate for Payer: Multiplan Workers Comp |
$5,708.30
|
| 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 Angio Pelvis
|
Facility
|
OP
|
$5,003.00
|
|
|
Service Code
|
CPT 72191
|
| Hospital Charge Code |
3890183
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$3.01 |
| Max. Negotiated Rate |
$3,251.95 |
| Rate for Payer: Aetna Commercial |
$261.99
|
| 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 |
$4,402.64
|
| Rate for Payer: Cash Price |
$4,402.64
|
| Rate for Payer: Cash Price |
$4,402.64
|
| 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 |
$3,251.95
|
| Rate for Payer: Multiplan Commercial |
$3,251.95
|
| Rate for Payer: Multiplan Workers Comp |
$3,251.95
|
| 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 Angio Pelvis BCE
|
Facility
|
OP
|
$5,003.00
|
|
|
Service Code
|
CPT 72191
|
| Hospital Charge Code |
3890183
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$3.01 |
| Max. Negotiated Rate |
$3,251.95 |
| Rate for Payer: Aetna Commercial |
$261.99
|
| 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 |
$4,402.64
|
| Rate for Payer: Cash Price |
$4,402.64
|
| Rate for Payer: Cash Price |
$4,402.64
|
| 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 |
$3,251.95
|
| Rate for Payer: Multiplan Commercial |
$3,251.95
|
| Rate for Payer: Multiplan Workers Comp |
$3,251.95
|
| 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 Angio Pelvis BCE
|
Facility
|
IP
|
$5,003.00
|
|
|
Service Code
|
CPT 72191
|
| Hospital Charge Code |
3890183
|
|
Hospital Revenue Code
|
352
|
| Rate for Payer: Cash Price |
$4,402.64
|
|
|
CT Angio Upper Extremity Left
|
Facility
|
OP
|
$5,854.00
|
|
|
Service Code
|
CPT 73206 LT
|
| Hospital Charge Code |
3890191
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$3.01 |
| Max. Negotiated Rate |
$3,805.10 |
| Rate for Payer: Aetna Commercial |
$261.26
|
| 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 |
$5,151.52
|
| Rate for Payer: Cash Price |
$5,151.52
|
| Rate for Payer: Cash Price |
$5,151.52
|
| 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 |
$3,805.10
|
| Rate for Payer: Multiplan Commercial |
$3,805.10
|
| Rate for Payer: Multiplan Workers Comp |
$3,805.10
|
| 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 Angio Upper Extremity Left BCE
|
Facility
|
IP
|
$5,854.00
|
|
|
Service Code
|
CPT 73206 LT
|
| Hospital Charge Code |
3890191
|
|
Hospital Revenue Code
|
352
|
| Rate for Payer: Cash Price |
$5,151.52
|
|
