|
CT Drain Pleura w Cath Left
|
Facility
|
OP
|
$2,334.00
|
|
|
Service Code
|
CPT 32557 LT
|
| Hospital Charge Code |
3800001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$317.42 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$1,400.00
|
| Rate for Payer: Aetna Medicare |
$2,197.02
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$446.27
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,723.99
|
| Rate for Payer: BCBS of TX Blue Essentials |
$3,262.26
|
| Rate for Payer: BCBS of TX PPO |
$4,110.45
|
| Rate for Payer: Cash Price |
$2,053.92
|
| Rate for Payer: Cash Price |
$2,053.92
|
| Rate for Payer: Cash Price |
$2,053.92
|
| Rate for Payer: Cigna Commercial |
$3,317.93
|
| Rate for Payer: Cigna Medicaid |
$446.27
|
| Rate for Payer: Molina CHIP/Medicaid |
$446.27
|
| Rate for Payer: Multiplan Auto |
$10,000.00
|
| Rate for Payer: Multiplan Commercial |
$10,000.00
|
| Rate for Payer: Multiplan Workers Comp |
$10,000.00
|
| Rate for Payer: Parkland Medicaid |
$446.27
|
| Rate for Payer: Scott and White EPO/PPO |
$1,167.00
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$446.27
|
| Rate for Payer: Superior Health Plan EPO |
$317.42
|
|
|
CT Drain Pleura w Cath Left BCE
|
Facility
|
OP
|
$2,334.00
|
|
|
Service Code
|
CPT 32557 LT
|
| Hospital Charge Code |
3800001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$317.42 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$1,400.00
|
| Rate for Payer: Aetna Medicare |
$2,197.02
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$446.27
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,723.99
|
| Rate for Payer: BCBS of TX Blue Essentials |
$3,262.26
|
| Rate for Payer: BCBS of TX PPO |
$4,110.45
|
| Rate for Payer: Cash Price |
$2,053.92
|
| Rate for Payer: Cash Price |
$2,053.92
|
| Rate for Payer: Cash Price |
$2,053.92
|
| Rate for Payer: Cigna Commercial |
$3,317.93
|
| Rate for Payer: Cigna Medicaid |
$446.27
|
| Rate for Payer: Molina CHIP/Medicaid |
$446.27
|
| Rate for Payer: Multiplan Auto |
$10,000.00
|
| Rate for Payer: Multiplan Commercial |
$10,000.00
|
| Rate for Payer: Multiplan Workers Comp |
$10,000.00
|
| Rate for Payer: Parkland Medicaid |
$446.27
|
| Rate for Payer: Scott and White EPO/PPO |
$1,167.00
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$446.27
|
| Rate for Payer: Superior Health Plan EPO |
$317.42
|
|
|
CT Drain Pleura w Cath Right
|
Facility
|
OP
|
$2,334.00
|
|
|
Service Code
|
CPT 32557 RT
|
| Hospital Charge Code |
3800001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$317.42 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$1,400.00
|
| Rate for Payer: Aetna Medicare |
$2,197.02
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$446.27
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,723.99
|
| Rate for Payer: BCBS of TX Blue Essentials |
$3,262.26
|
| Rate for Payer: BCBS of TX PPO |
$4,110.45
|
| Rate for Payer: Cash Price |
$2,053.92
|
| Rate for Payer: Cash Price |
$2,053.92
|
| Rate for Payer: Cash Price |
$2,053.92
|
| Rate for Payer: Cigna Commercial |
$3,317.93
|
| Rate for Payer: Cigna Medicaid |
$446.27
|
| Rate for Payer: Molina CHIP/Medicaid |
$446.27
|
| Rate for Payer: Multiplan Auto |
$10,000.00
|
| Rate for Payer: Multiplan Commercial |
$10,000.00
|
| Rate for Payer: Multiplan Workers Comp |
$10,000.00
|
| Rate for Payer: Parkland Medicaid |
$446.27
|
| Rate for Payer: Scott and White EPO/PPO |
$1,167.00
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$446.27
|
| Rate for Payer: Superior Health Plan EPO |
$317.42
|
|
|
CT Drain Pleura w Cath Right BCE
|
Facility
|
IP
|
$2,334.00
|
|
|
Service Code
|
CPT 32557 RT
|
| Hospital Charge Code |
3800001
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$2,053.92
|
|
|
CT Drain Pleura w Cath Right BCE
|
Facility
|
OP
|
$2,334.00
|
|
|
Service Code
|
CPT 32557 RT
|
| Hospital Charge Code |
3800001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$317.42 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$1,400.00
|
| Rate for Payer: Aetna Medicare |
$2,197.02
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$446.27
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,723.99
|
| Rate for Payer: BCBS of TX Blue Essentials |
$3,262.26
|
| Rate for Payer: BCBS of TX PPO |
$4,110.45
|
| Rate for Payer: Cash Price |
$2,053.92
|
| Rate for Payer: Cash Price |
$2,053.92
|
| Rate for Payer: Cash Price |
$2,053.92
|
| Rate for Payer: Cigna Commercial |
$3,317.93
|
| Rate for Payer: Cigna Medicaid |
$446.27
|
| Rate for Payer: Molina CHIP/Medicaid |
$446.27
|
| Rate for Payer: Multiplan Auto |
$10,000.00
|
| Rate for Payer: Multiplan Commercial |
$10,000.00
|
| Rate for Payer: Multiplan Workers Comp |
$10,000.00
|
| Rate for Payer: Parkland Medicaid |
$446.27
|
| Rate for Payer: Scott and White EPO/PPO |
$1,167.00
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$446.27
|
| Rate for Payer: Superior Health Plan EPO |
$317.42
|
|
|
CT Drain Soft Tissue Fluid w/Cath Perc
|
Facility
|
OP
|
$3,790.00
|
|
|
Service Code
|
CPT 10030
|
| Hospital Charge Code |
3890225
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$257.60 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$1,400.00
|
| Rate for Payer: Aetna Medicare |
$965.17
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$257.60
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$643.45
|
| Rate for Payer: Amerigroup Medicare |
$643.45
|
| Rate for Payer: BCBS of TX Blue Advantage |
$1,018.72
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,220.02
|
| Rate for Payer: BCBS of TX Medicare |
$643.45
|
| Rate for Payer: BCBS of TX PPO |
$1,537.23
|
| Rate for Payer: Cash Price |
$3,335.20
|
| Rate for Payer: Cash Price |
$3,335.20
|
| Rate for Payer: Cigna Commercial |
$1,457.60
|
| Rate for Payer: Cigna Medicaid |
$257.60
|
| Rate for Payer: Cigna Medicare |
$643.45
|
| Rate for Payer: Employer Direct Commercial |
$643.45
|
| Rate for Payer: Humana Medicare/TRICARE |
$643.45
|
| Rate for Payer: Molina CHIP/Medicaid |
$257.60
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$643.45
|
| Rate for Payer: Molina Medicare |
$643.45
|
| Rate for Payer: Multiplan Auto |
$10,000.00
|
| Rate for Payer: Multiplan Commercial |
$10,000.00
|
| Rate for Payer: Multiplan Workers Comp |
$10,000.00
|
| Rate for Payer: Parkland Medicaid |
$257.60
|
| Rate for Payer: Scott and White EPO/PPO |
$1,190.38
|
| Rate for Payer: Scott and White Medicare |
$643.45
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$257.60
|
| Rate for Payer: Superior Health Plan EPO |
$643.45
|
| Rate for Payer: Superior Health Plan Medicare |
$643.45
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$643.45
|
| Rate for Payer: Universal American Medicare |
$643.45
|
| Rate for Payer: Wellcare Medicare |
$643.45
|
| Rate for Payer: Wellmed Medicare |
$643.45
|
|
|
CT Drain Soft Tissue Fluid w/Cath Perc BCE
|
Facility
|
OP
|
$3,790.00
|
|
|
Service Code
|
CPT 10030
|
| Hospital Charge Code |
3890225
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$257.60 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$1,400.00
|
| Rate for Payer: Aetna Medicare |
$965.17
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$257.60
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$643.45
|
| Rate for Payer: Amerigroup Medicare |
$643.45
|
| Rate for Payer: BCBS of TX Blue Advantage |
$1,018.72
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,220.02
|
| Rate for Payer: BCBS of TX Medicare |
$643.45
|
| Rate for Payer: BCBS of TX PPO |
$1,537.23
|
| Rate for Payer: Cash Price |
$3,335.20
|
| Rate for Payer: Cash Price |
$3,335.20
|
| Rate for Payer: Cigna Commercial |
$1,457.60
|
| Rate for Payer: Cigna Medicaid |
$257.60
|
| Rate for Payer: Cigna Medicare |
$643.45
|
| Rate for Payer: Employer Direct Commercial |
$643.45
|
| Rate for Payer: Humana Medicare/TRICARE |
$643.45
|
| Rate for Payer: Molina CHIP/Medicaid |
$257.60
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$643.45
|
| Rate for Payer: Molina Medicare |
$643.45
|
| Rate for Payer: Multiplan Auto |
$10,000.00
|
| Rate for Payer: Multiplan Commercial |
$10,000.00
|
| Rate for Payer: Multiplan Workers Comp |
$10,000.00
|
| Rate for Payer: Parkland Medicaid |
$257.60
|
| Rate for Payer: Scott and White EPO/PPO |
$1,190.38
|
| Rate for Payer: Scott and White Medicare |
$643.45
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$257.60
|
| Rate for Payer: Superior Health Plan EPO |
$643.45
|
| Rate for Payer: Superior Health Plan Medicare |
$643.45
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$643.45
|
| Rate for Payer: Universal American Medicare |
$643.45
|
| Rate for Payer: Wellcare Medicare |
$643.45
|
| Rate for Payer: Wellmed Medicare |
$643.45
|
|
|
CT Drain Soft Tissue Fluid w/Cath Perc BCE
|
Facility
|
IP
|
$3,790.00
|
|
|
Service Code
|
CPT 10030
|
| Hospital Charge Code |
3890225
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$3,335.20
|
|
|
CT Drain Visceral Fluid w/Cath Perc
|
Facility
|
OP
|
$6,667.00
|
|
|
Service Code
|
CPT 49405
|
| Hospital Charge Code |
3890226
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$600.03 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$2,200.00
|
| Rate for Payer: Aetna Medicare |
$2,224.11
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$600.03
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,482.74
|
| Rate for Payer: Amerigroup Medicare |
$1,482.74
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,292.24
|
| Rate for Payer: BCBS of TX Blue Essentials |
$2,745.20
|
| Rate for Payer: BCBS of TX Medicare |
$1,482.74
|
| Rate for Payer: BCBS of TX PPO |
$3,458.95
|
| Rate for Payer: Cash Price |
$5,866.96
|
| Rate for Payer: Cash Price |
$5,866.96
|
| Rate for Payer: Cash Price |
$5,866.96
|
| Rate for Payer: Cigna Commercial |
$3,358.84
|
| Rate for Payer: Cigna Medicare |
$1,482.74
|
| Rate for Payer: Employer Direct Commercial |
$1,482.74
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,482.74
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,482.74
|
| Rate for Payer: Molina Medicare |
$1,482.74
|
| Rate for Payer: Multiplan Auto |
$10,000.00
|
| Rate for Payer: Multiplan Commercial |
$10,000.00
|
| Rate for Payer: Multiplan Workers Comp |
$10,000.00
|
| Rate for Payer: Scott and White EPO/PPO |
$2,743.07
|
| Rate for Payer: Scott and White Medicare |
$1,482.74
|
| Rate for Payer: Superior Health Plan EPO |
$1,482.74
|
| Rate for Payer: Superior Health Plan Medicare |
$1,482.74
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,482.74
|
| Rate for Payer: Universal American Medicare |
$1,482.74
|
| Rate for Payer: Wellcare Medicare |
$1,482.74
|
| Rate for Payer: Wellmed Medicare |
$1,482.74
|
|
|
CT Drain Visceral Fluid w/Cath Perc BCE
|
Facility
|
OP
|
$6,667.00
|
|
|
Service Code
|
CPT 49405
|
| Hospital Charge Code |
3890226
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$600.03 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$2,200.00
|
| Rate for Payer: Aetna Medicare |
$2,224.11
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$600.03
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,482.74
|
| Rate for Payer: Amerigroup Medicare |
$1,482.74
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,292.24
|
| Rate for Payer: BCBS of TX Blue Essentials |
$2,745.20
|
| Rate for Payer: BCBS of TX Medicare |
$1,482.74
|
| Rate for Payer: BCBS of TX PPO |
$3,458.95
|
| Rate for Payer: Cash Price |
$5,866.96
|
| Rate for Payer: Cash Price |
$5,866.96
|
| Rate for Payer: Cash Price |
$5,866.96
|
| Rate for Payer: Cigna Commercial |
$3,358.84
|
| Rate for Payer: Cigna Medicare |
$1,482.74
|
| Rate for Payer: Employer Direct Commercial |
$1,482.74
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,482.74
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,482.74
|
| Rate for Payer: Molina Medicare |
$1,482.74
|
| Rate for Payer: Multiplan Auto |
$10,000.00
|
| Rate for Payer: Multiplan Commercial |
$10,000.00
|
| Rate for Payer: Multiplan Workers Comp |
$10,000.00
|
| Rate for Payer: Scott and White EPO/PPO |
$2,743.07
|
| Rate for Payer: Scott and White Medicare |
$1,482.74
|
| Rate for Payer: Superior Health Plan EPO |
$1,482.74
|
| Rate for Payer: Superior Health Plan Medicare |
$1,482.74
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,482.74
|
| Rate for Payer: Universal American Medicare |
$1,482.74
|
| Rate for Payer: Wellcare Medicare |
$1,482.74
|
| Rate for Payer: Wellmed Medicare |
$1,482.74
|
|
|
CT Drain Visceral Fluid w/Cath Perc BCE
|
Facility
|
IP
|
$6,667.00
|
|
|
Service Code
|
CPT 49405
|
| Hospital Charge Code |
3890226
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$5,866.96
|
|
|
CT Elbow w/ Contrast Left
|
Facility
|
OP
|
$3,312.00
|
|
|
Service Code
|
CPT 73201 LT
|
| Hospital Charge Code |
3800281
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$209.84 |
| Max. Negotiated Rate |
$2,152.80 |
| Rate for Payer: Aetna Commercial |
$231.91
|
| Rate for Payer: Aetna Medicare |
$527.57
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$209.84
|
| 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 PPO |
$843.89
|
| Rate for Payer: Cash Price |
$2,914.56
|
| Rate for Payer: Cash Price |
$2,914.56
|
| Rate for Payer: Cash Price |
$2,914.56
|
| Rate for Payer: Cigna Commercial |
$796.73
|
| Rate for Payer: Cigna Medicaid |
$209.84
|
| Rate for Payer: Molina CHIP/Medicaid |
$209.84
|
| Rate for Payer: Multiplan Auto |
$2,152.80
|
| Rate for Payer: Multiplan Commercial |
$2,152.80
|
| Rate for Payer: Multiplan Workers Comp |
$2,152.80
|
| Rate for Payer: Parkland Medicaid |
$209.84
|
| Rate for Payer: Scott and White EPO/PPO |
$1,656.00
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$209.84
|
| Rate for Payer: Superior Health Plan EPO |
$450.43
|
|
|
CT Elbow w/ Contrast Right
|
Facility
|
OP
|
$3,312.00
|
|
|
Service Code
|
CPT 73201 RT
|
| Hospital Charge Code |
3801842
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$209.84 |
| Max. Negotiated Rate |
$2,152.80 |
| Rate for Payer: Aetna Commercial |
$231.91
|
| Rate for Payer: Aetna Medicare |
$527.57
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$209.84
|
| 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 PPO |
$843.89
|
| Rate for Payer: Cash Price |
$2,914.56
|
| Rate for Payer: Cash Price |
$2,914.56
|
| Rate for Payer: Cash Price |
$2,914.56
|
| Rate for Payer: Cigna Commercial |
$796.73
|
| Rate for Payer: Cigna Medicaid |
$209.84
|
| Rate for Payer: Molina CHIP/Medicaid |
$209.84
|
| Rate for Payer: Multiplan Auto |
$2,152.80
|
| Rate for Payer: Multiplan Commercial |
$2,152.80
|
| Rate for Payer: Multiplan Workers Comp |
$2,152.80
|
| Rate for Payer: Parkland Medicaid |
$209.84
|
| Rate for Payer: Scott and White EPO/PPO |
$1,656.00
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$209.84
|
| Rate for Payer: Superior Health Plan EPO |
$450.43
|
|
|
CT Elbow w/o Contrast Left
|
Facility
|
OP
|
$1,788.00
|
|
|
Service Code
|
CPT 73200 LT
|
| Hospital Charge Code |
3800943
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$106.88 |
| Max. Negotiated Rate |
$1,162.20 |
| Rate for Payer: Aetna Commercial |
$159.34
|
| Rate for Payer: Aetna Medicare |
$150.82
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$106.88
|
| 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 PPO |
$247.70
|
| Rate for Payer: Cash Price |
$1,573.44
|
| Rate for Payer: Cash Price |
$1,573.44
|
| Rate for Payer: Cash Price |
$1,573.44
|
| Rate for Payer: Cigna Commercial |
$227.77
|
| Rate for Payer: Cigna Medicaid |
$106.88
|
| Rate for Payer: Molina CHIP/Medicaid |
$106.88
|
| Rate for Payer: Multiplan Auto |
$1,162.20
|
| Rate for Payer: Multiplan Commercial |
$1,162.20
|
| Rate for Payer: Multiplan Workers Comp |
$1,162.20
|
| Rate for Payer: Parkland Medicaid |
$106.88
|
| Rate for Payer: Scott and White EPO/PPO |
$894.00
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$106.88
|
| Rate for Payer: Superior Health Plan EPO |
$243.17
|
|
|
CT Elbow w/o Contrast Right
|
Facility
|
OP
|
$1,788.00
|
|
|
Service Code
|
CPT 73200 RT
|
| Hospital Charge Code |
3801834
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$106.88 |
| Max. Negotiated Rate |
$1,162.20 |
| Rate for Payer: Aetna Commercial |
$159.34
|
| Rate for Payer: Aetna Medicare |
$150.82
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$106.88
|
| 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 PPO |
$247.70
|
| Rate for Payer: Cash Price |
$1,573.44
|
| Rate for Payer: Cash Price |
$1,573.44
|
| Rate for Payer: Cash Price |
$1,573.44
|
| Rate for Payer: Cigna Commercial |
$227.77
|
| Rate for Payer: Cigna Medicaid |
$106.88
|
| Rate for Payer: Molina CHIP/Medicaid |
$106.88
|
| Rate for Payer: Multiplan Auto |
$1,162.20
|
| Rate for Payer: Multiplan Commercial |
$1,162.20
|
| Rate for Payer: Multiplan Workers Comp |
$1,162.20
|
| Rate for Payer: Parkland Medicaid |
$106.88
|
| Rate for Payer: Scott and White EPO/PPO |
$894.00
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$106.88
|
| Rate for Payer: Superior Health Plan EPO |
$243.17
|
|
|
CT Femur w/ Contrast Left
|
Facility
|
OP
|
$3,797.00
|
|
|
Service Code
|
CPT 73701 LT
|
| Hospital Charge Code |
3800968
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$173.08 |
| Max. Negotiated Rate |
$2,468.05 |
| Rate for Payer: Aetna Commercial |
$176.22
|
| Rate for Payer: Aetna Medicare |
$252.04
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$173.08
|
| 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 PPO |
$402.71
|
| Rate for Payer: Cash Price |
$3,341.36
|
| Rate for Payer: Cash Price |
$3,341.36
|
| Rate for Payer: Cash Price |
$3,341.36
|
| Rate for Payer: Cigna Commercial |
$380.65
|
| Rate for Payer: Cigna Medicaid |
$173.08
|
| Rate for Payer: Molina CHIP/Medicaid |
$173.08
|
| Rate for Payer: Multiplan Auto |
$2,468.05
|
| Rate for Payer: Multiplan Commercial |
$2,468.05
|
| Rate for Payer: Multiplan Workers Comp |
$2,468.05
|
| Rate for Payer: Parkland Medicaid |
$173.08
|
| Rate for Payer: Scott and White EPO/PPO |
$1,898.50
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$173.08
|
| Rate for Payer: Superior Health Plan EPO |
$516.39
|
|
|
CT Femur w/ Contrast Right
|
Facility
|
OP
|
$3,797.00
|
|
|
Service Code
|
CPT 73701 RT
|
| Hospital Charge Code |
3801875
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$173.08 |
| Max. Negotiated Rate |
$2,468.05 |
| Rate for Payer: Aetna Commercial |
$176.22
|
| Rate for Payer: Aetna Medicare |
$252.04
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$173.08
|
| 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 PPO |
$402.71
|
| Rate for Payer: Cash Price |
$3,341.36
|
| Rate for Payer: Cash Price |
$3,341.36
|
| Rate for Payer: Cash Price |
$3,341.36
|
| Rate for Payer: Cigna Commercial |
$380.65
|
| Rate for Payer: Cigna Medicaid |
$173.08
|
| Rate for Payer: Molina CHIP/Medicaid |
$173.08
|
| Rate for Payer: Multiplan Auto |
$2,468.05
|
| Rate for Payer: Multiplan Commercial |
$2,468.05
|
| Rate for Payer: Multiplan Workers Comp |
$2,468.05
|
| Rate for Payer: Parkland Medicaid |
$173.08
|
| Rate for Payer: Scott and White EPO/PPO |
$1,898.50
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$173.08
|
| Rate for Payer: Superior Health Plan EPO |
$516.39
|
|
|
CT Femur w/o Contrast Left
|
Facility
|
OP
|
$3,266.00
|
|
|
Service Code
|
CPT 73700 LT
|
| Hospital Charge Code |
3800141
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$106.88 |
| Max. Negotiated Rate |
$2,122.90 |
| Rate for Payer: Aetna Commercial |
$129.01
|
| Rate for Payer: Aetna Medicare |
$150.82
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$106.88
|
| 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 PPO |
$247.70
|
| Rate for Payer: Cash Price |
$2,874.08
|
| Rate for Payer: Cash Price |
$2,874.08
|
| Rate for Payer: Cash Price |
$2,874.08
|
| Rate for Payer: Cigna Commercial |
$227.77
|
| Rate for Payer: Cigna Medicaid |
$106.88
|
| Rate for Payer: Molina CHIP/Medicaid |
$106.88
|
| Rate for Payer: Multiplan Auto |
$2,122.90
|
| Rate for Payer: Multiplan Commercial |
$2,122.90
|
| Rate for Payer: Multiplan Workers Comp |
$2,122.90
|
| Rate for Payer: Parkland Medicaid |
$106.88
|
| Rate for Payer: Scott and White EPO/PPO |
$1,633.00
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$106.88
|
| Rate for Payer: Superior Health Plan EPO |
$444.18
|
|
|
CT Femur w/o Contrast Right
|
Facility
|
OP
|
$3,266.00
|
|
|
Service Code
|
CPT 73700 RT
|
| Hospital Charge Code |
3801867
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$106.88 |
| Max. Negotiated Rate |
$2,122.90 |
| Rate for Payer: Aetna Commercial |
$129.01
|
| Rate for Payer: Aetna Medicare |
$150.82
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$106.88
|
| 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 PPO |
$247.70
|
| Rate for Payer: Cash Price |
$2,874.08
|
| Rate for Payer: Cash Price |
$2,874.08
|
| Rate for Payer: Cash Price |
$2,874.08
|
| Rate for Payer: Cigna Commercial |
$227.77
|
| Rate for Payer: Cigna Medicaid |
$106.88
|
| Rate for Payer: Molina CHIP/Medicaid |
$106.88
|
| Rate for Payer: Multiplan Auto |
$2,122.90
|
| Rate for Payer: Multiplan Commercial |
$2,122.90
|
| Rate for Payer: Multiplan Workers Comp |
$2,122.90
|
| Rate for Payer: Parkland Medicaid |
$106.88
|
| Rate for Payer: Scott and White EPO/PPO |
$1,633.00
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$106.88
|
| Rate for Payer: Superior Health Plan EPO |
$444.18
|
|
|
CT Foot w/ Contrast Left
|
Facility
|
OP
|
$3,797.00
|
|
|
Service Code
|
CPT 73701 LT
|
| Hospital Charge Code |
3800968
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$173.08 |
| Max. Negotiated Rate |
$2,468.05 |
| Rate for Payer: Aetna Commercial |
$176.22
|
| Rate for Payer: Aetna Medicare |
$252.04
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$173.08
|
| 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 PPO |
$402.71
|
| Rate for Payer: Cash Price |
$3,341.36
|
| Rate for Payer: Cash Price |
$3,341.36
|
| Rate for Payer: Cash Price |
$3,341.36
|
| Rate for Payer: Cigna Commercial |
$380.65
|
| Rate for Payer: Cigna Medicaid |
$173.08
|
| Rate for Payer: Molina CHIP/Medicaid |
$173.08
|
| Rate for Payer: Multiplan Auto |
$2,468.05
|
| Rate for Payer: Multiplan Commercial |
$2,468.05
|
| Rate for Payer: Multiplan Workers Comp |
$2,468.05
|
| Rate for Payer: Parkland Medicaid |
$173.08
|
| Rate for Payer: Scott and White EPO/PPO |
$1,898.50
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$173.08
|
| Rate for Payer: Superior Health Plan EPO |
$516.39
|
|
|
CT Foot w/ Contrast Right
|
Facility
|
OP
|
$3,797.00
|
|
|
Service Code
|
CPT 73701 RT
|
| Hospital Charge Code |
3801875
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$173.08 |
| Max. Negotiated Rate |
$2,468.05 |
| Rate for Payer: Aetna Commercial |
$176.22
|
| Rate for Payer: Aetna Medicare |
$252.04
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$173.08
|
| 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 PPO |
$402.71
|
| Rate for Payer: Cash Price |
$3,341.36
|
| Rate for Payer: Cash Price |
$3,341.36
|
| Rate for Payer: Cash Price |
$3,341.36
|
| Rate for Payer: Cigna Commercial |
$380.65
|
| Rate for Payer: Cigna Medicaid |
$173.08
|
| Rate for Payer: Molina CHIP/Medicaid |
$173.08
|
| Rate for Payer: Multiplan Auto |
$2,468.05
|
| Rate for Payer: Multiplan Commercial |
$2,468.05
|
| Rate for Payer: Multiplan Workers Comp |
$2,468.05
|
| Rate for Payer: Parkland Medicaid |
$173.08
|
| Rate for Payer: Scott and White EPO/PPO |
$1,898.50
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$173.08
|
| Rate for Payer: Superior Health Plan EPO |
$516.39
|
|
|
CT Foot w/o Contrast Left
|
Facility
|
OP
|
$3,266.00
|
|
|
Service Code
|
CPT 73700 LT
|
| Hospital Charge Code |
3800141
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$106.88 |
| Max. Negotiated Rate |
$2,122.90 |
| Rate for Payer: Aetna Commercial |
$129.01
|
| Rate for Payer: Aetna Medicare |
$150.82
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$106.88
|
| 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 PPO |
$247.70
|
| Rate for Payer: Cash Price |
$2,874.08
|
| Rate for Payer: Cash Price |
$2,874.08
|
| Rate for Payer: Cash Price |
$2,874.08
|
| Rate for Payer: Cigna Commercial |
$227.77
|
| Rate for Payer: Cigna Medicaid |
$106.88
|
| Rate for Payer: Molina CHIP/Medicaid |
$106.88
|
| Rate for Payer: Multiplan Auto |
$2,122.90
|
| Rate for Payer: Multiplan Commercial |
$2,122.90
|
| Rate for Payer: Multiplan Workers Comp |
$2,122.90
|
| Rate for Payer: Parkland Medicaid |
$106.88
|
| Rate for Payer: Scott and White EPO/PPO |
$1,633.00
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$106.88
|
| Rate for Payer: Superior Health Plan EPO |
$444.18
|
|
|
CT Foot w/o Contrast Right
|
Facility
|
OP
|
$3,266.00
|
|
|
Service Code
|
CPT 73700 RT
|
| Hospital Charge Code |
3801867
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$106.88 |
| Max. Negotiated Rate |
$2,122.90 |
| Rate for Payer: Aetna Commercial |
$129.01
|
| Rate for Payer: Aetna Medicare |
$150.82
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$106.88
|
| 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 PPO |
$247.70
|
| Rate for Payer: Cash Price |
$2,874.08
|
| Rate for Payer: Cash Price |
$2,874.08
|
| Rate for Payer: Cash Price |
$2,874.08
|
| Rate for Payer: Cigna Commercial |
$227.77
|
| Rate for Payer: Cigna Medicaid |
$106.88
|
| Rate for Payer: Molina CHIP/Medicaid |
$106.88
|
| Rate for Payer: Multiplan Auto |
$2,122.90
|
| Rate for Payer: Multiplan Commercial |
$2,122.90
|
| Rate for Payer: Multiplan Workers Comp |
$2,122.90
|
| Rate for Payer: Parkland Medicaid |
$106.88
|
| Rate for Payer: Scott and White EPO/PPO |
$1,633.00
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$106.88
|
| Rate for Payer: Superior Health Plan EPO |
$444.18
|
|
|
CT Forearm w/ Contrast Left
|
Facility
|
OP
|
$3,312.00
|
|
|
Service Code
|
CPT 73201 LT
|
| Hospital Charge Code |
3800281
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$209.84 |
| Max. Negotiated Rate |
$2,152.80 |
| Rate for Payer: Aetna Commercial |
$231.91
|
| Rate for Payer: Aetna Medicare |
$527.57
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$209.84
|
| 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 PPO |
$843.89
|
| Rate for Payer: Cash Price |
$2,914.56
|
| Rate for Payer: Cash Price |
$2,914.56
|
| Rate for Payer: Cash Price |
$2,914.56
|
| Rate for Payer: Cigna Commercial |
$796.73
|
| Rate for Payer: Cigna Medicaid |
$209.84
|
| Rate for Payer: Molina CHIP/Medicaid |
$209.84
|
| Rate for Payer: Multiplan Auto |
$2,152.80
|
| Rate for Payer: Multiplan Commercial |
$2,152.80
|
| Rate for Payer: Multiplan Workers Comp |
$2,152.80
|
| Rate for Payer: Parkland Medicaid |
$209.84
|
| Rate for Payer: Scott and White EPO/PPO |
$1,656.00
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$209.84
|
| Rate for Payer: Superior Health Plan EPO |
$450.43
|
|
|
CT Forearm w/ Contrast Right
|
Facility
|
OP
|
$3,312.00
|
|
|
Service Code
|
CPT 73201 RT
|
| Hospital Charge Code |
3801842
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$209.84 |
| Max. Negotiated Rate |
$2,152.80 |
| Rate for Payer: Aetna Commercial |
$231.91
|
| Rate for Payer: Aetna Medicare |
$527.57
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$209.84
|
| 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 PPO |
$843.89
|
| Rate for Payer: Cash Price |
$2,914.56
|
| Rate for Payer: Cash Price |
$2,914.56
|
| Rate for Payer: Cash Price |
$2,914.56
|
| Rate for Payer: Cigna Commercial |
$796.73
|
| Rate for Payer: Cigna Medicaid |
$209.84
|
| Rate for Payer: Molina CHIP/Medicaid |
$209.84
|
| Rate for Payer: Multiplan Auto |
$2,152.80
|
| Rate for Payer: Multiplan Commercial |
$2,152.80
|
| Rate for Payer: Multiplan Workers Comp |
$2,152.80
|
| Rate for Payer: Parkland Medicaid |
$209.84
|
| Rate for Payer: Scott and White EPO/PPO |
$1,656.00
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$209.84
|
| Rate for Payer: Superior Health Plan EPO |
$450.43
|
|
