|
CT Forearm 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 |
$1.80 |
| 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: 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 |
$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: 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 |
$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 |
$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 Forearm 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 |
$1.80 |
| 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: 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 |
$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: 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 |
$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 |
$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 Forearm w/ + w/o Contrast Left
|
Facility
|
OP
|
$3,348.00
|
|
|
Service Code
|
CPT 73202 LT
|
| Hospital Charge Code |
3800950
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$3.01 |
| Max. Negotiated Rate |
$2,176.20 |
| 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 |
$2,946.24
|
| Rate for Payer: Cash Price |
$2,946.24
|
| Rate for Payer: Cash Price |
$2,946.24
|
| 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 |
$2,176.20
|
| Rate for Payer: Multiplan Commercial |
$2,176.20
|
| Rate for Payer: Multiplan Workers Comp |
$2,176.20
|
| 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 Forearm w/ + w/o Contrast Right
|
Facility
|
OP
|
$3,348.00
|
|
|
Service Code
|
CPT 73202 RT
|
| Hospital Charge Code |
3801859
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$3.01 |
| Max. Negotiated Rate |
$2,176.20 |
| 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 |
$2,946.24
|
| Rate for Payer: Cash Price |
$2,946.24
|
| Rate for Payer: Cash Price |
$2,946.24
|
| 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 |
$2,176.20
|
| Rate for Payer: Multiplan Commercial |
$2,176.20
|
| Rate for Payer: Multiplan Workers Comp |
$2,176.20
|
| 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 Guidance for Needle Placement
|
Facility
|
OP
|
$4,508.00
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
3820024
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$108.13 |
| Max. Negotiated Rate |
$2,930.20 |
| Rate for Payer: Aetna Commercial |
$108.13
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$405.72
|
| Rate for Payer: BCBS of TX Blue Advantage |
$129.03
|
| Rate for Payer: BCBS of TX Blue Essentials |
$154.84
|
| Rate for Payer: BCBS of TX PPO |
$172.82
|
| Rate for Payer: Cash Price |
$3,967.04
|
| Rate for Payer: Cash Price |
$3,967.04
|
| Rate for Payer: Multiplan Auto |
$2,930.20
|
| Rate for Payer: Multiplan Commercial |
$2,930.20
|
| Rate for Payer: Multiplan Workers Comp |
$2,930.20
|
| Rate for Payer: Scott and White EPO/PPO |
$2,254.00
|
| Rate for Payer: Superior Health Plan EPO |
$613.09
|
|
|
CT Guidance for Needle Placement BCE
|
Facility
|
OP
|
$4,508.00
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
3820024
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$108.13 |
| Max. Negotiated Rate |
$2,930.20 |
| Rate for Payer: Aetna Commercial |
$108.13
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$405.72
|
| Rate for Payer: BCBS of TX Blue Advantage |
$129.03
|
| Rate for Payer: BCBS of TX Blue Essentials |
$154.84
|
| Rate for Payer: BCBS of TX PPO |
$172.82
|
| Rate for Payer: Cash Price |
$3,967.04
|
| Rate for Payer: Cash Price |
$3,967.04
|
| Rate for Payer: Multiplan Auto |
$2,930.20
|
| Rate for Payer: Multiplan Commercial |
$2,930.20
|
| Rate for Payer: Multiplan Workers Comp |
$2,930.20
|
| Rate for Payer: Scott and White EPO/PPO |
$2,254.00
|
| Rate for Payer: Superior Health Plan EPO |
$613.09
|
|
|
CT Guidance for Needle Placement BCE
|
Facility
|
IP
|
$4,508.00
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
3820024
|
|
Hospital Revenue Code
|
350
|
| Rate for Payer: Cash Price |
$3,967.04
|
|
|
CT Guided FNA Biopsy, First Lesion
|
Facility
|
OP
|
$2,851.00
|
|
|
Service Code
|
CPT 10009
|
| Hospital Charge Code |
3800245
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$14.19 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$1,400.00
|
| Rate for Payer: Aetna Medicare |
$965.18
|
| 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 |
$514.74
|
| Rate for Payer: BCBS of TX Blue Essentials |
$616.46
|
| Rate for Payer: BCBS of TX Medicare |
$643.45
|
| Rate for Payer: BCBS of TX PPO |
$776.74
|
| Rate for Payer: Cash Price |
$2,508.88
|
| Rate for Payer: Cash Price |
$2,508.88
|
| 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 |
$14.19
|
| 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 Guided FNA Biopsy, First Lesion BCE
|
Facility
|
IP
|
$2,851.00
|
|
|
Service Code
|
CPT 10009
|
| Hospital Charge Code |
3800245
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$2,508.88
|
|
|
CT Guided FNA Biopsy, First Lesion BCE
|
Facility
|
OP
|
$2,851.00
|
|
|
Service Code
|
CPT 10009
|
| Hospital Charge Code |
3800245
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$14.19 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$1,400.00
|
| Rate for Payer: Aetna Medicare |
$965.18
|
| 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 |
$514.74
|
| Rate for Payer: BCBS of TX Blue Essentials |
$616.46
|
| Rate for Payer: BCBS of TX Medicare |
$643.45
|
| Rate for Payer: BCBS of TX PPO |
$776.74
|
| Rate for Payer: Cash Price |
$2,508.88
|
| Rate for Payer: Cash Price |
$2,508.88
|
| 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 |
$14.19
|
| 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 Hand w/ Contrast Left
|
Facility
|
OP
|
$3,312.00
|
|
|
Service Code
|
CPT 73201 LT
|
| Hospital Charge Code |
3800281
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$6.29 |
| Max. Negotiated Rate |
$2,152.80 |
| Rate for Payer: Aetna Commercial |
$231.91
|
| Rate for Payer: Aetna Medicare |
$527.56
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$209.84
|
| 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 |
$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: 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 |
$209.84
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$351.71
|
| Rate for Payer: Molina Medicare |
$351.71
|
| 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 |
$6.29
|
| Rate for Payer: Scott and White Medicare |
$351.71
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$209.84
|
| 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 Hand w/ Contrast Right
|
Facility
|
OP
|
$3,312.00
|
|
|
Service Code
|
CPT 73201 RT
|
| Hospital Charge Code |
3801842
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$6.29 |
| Max. Negotiated Rate |
$2,152.80 |
| Rate for Payer: Aetna Commercial |
$231.91
|
| Rate for Payer: Aetna Medicare |
$527.56
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$209.84
|
| 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 |
$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: 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 |
$209.84
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$351.71
|
| Rate for Payer: Molina Medicare |
$351.71
|
| 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 |
$6.29
|
| Rate for Payer: Scott and White Medicare |
$351.71
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$209.84
|
| 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 Hand 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 |
$1.80 |
| 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: 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 |
$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: 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 |
$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 |
$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 Hand 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 |
$1.80 |
| 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: 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 |
$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: 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 |
$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 |
$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 Heart Calcium Scoring
|
Facility
|
OP
|
$151.00
|
|
|
Service Code
|
CPT 75571
|
| Hospital Charge Code |
3860005
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$188.25 |
| Rate for Payer: Aetna Commercial |
$111.11
|
| Rate for Payer: Aetna Medicare |
$124.65
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$86.88
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$83.10
|
| Rate for Payer: Amerigroup Medicare |
$83.10
|
| Rate for Payer: BCBS of TX Blue Advantage |
$131.69
|
| Rate for Payer: BCBS of TX Blue Essentials |
$158.02
|
| Rate for Payer: BCBS of TX Medicare |
$83.10
|
| Rate for Payer: BCBS of TX PPO |
$176.38
|
| Rate for Payer: Cash Price |
$132.88
|
| Rate for Payer: Cash Price |
$132.88
|
| Rate for Payer: Cash Price |
$132.88
|
| Rate for Payer: Cigna Commercial |
$188.25
|
| Rate for Payer: Cigna Medicaid |
$86.88
|
| Rate for Payer: Cigna Medicare |
$83.10
|
| Rate for Payer: Employer Direct Commercial |
$83.10
|
| Rate for Payer: Humana Medicare/TRICARE |
$83.10
|
| Rate for Payer: Molina CHIP/Medicaid |
$86.88
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$83.10
|
| Rate for Payer: Molina Medicare |
$83.10
|
| Rate for Payer: Multiplan Auto |
$98.15
|
| Rate for Payer: Multiplan Commercial |
$98.15
|
| Rate for Payer: Multiplan Workers Comp |
$98.15
|
| Rate for Payer: Parkland Medicaid |
$86.88
|
| Rate for Payer: Scott and White EPO/PPO |
$1.49
|
| Rate for Payer: Scott and White Medicare |
$83.10
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$86.88
|
| Rate for Payer: Superior Health Plan EPO |
$83.10
|
| Rate for Payer: Superior Health Plan Medicare |
$83.10
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$83.10
|
| Rate for Payer: Universal American Medicare |
$83.10
|
| Rate for Payer: Wellcare Medicare |
$83.10
|
| Rate for Payer: Wellmed Medicare |
$83.10
|
|
|
CT Heart Calcium Scoring BCE
|
Facility
|
OP
|
$151.00
|
|
|
Service Code
|
CPT 75571
|
| Hospital Charge Code |
3860005
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$188.25 |
| Rate for Payer: Aetna Commercial |
$111.11
|
| Rate for Payer: Aetna Medicare |
$124.65
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$86.88
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$83.10
|
| Rate for Payer: Amerigroup Medicare |
$83.10
|
| Rate for Payer: BCBS of TX Blue Advantage |
$131.69
|
| Rate for Payer: BCBS of TX Blue Essentials |
$158.02
|
| Rate for Payer: BCBS of TX Medicare |
$83.10
|
| Rate for Payer: BCBS of TX PPO |
$176.38
|
| Rate for Payer: Cash Price |
$132.88
|
| Rate for Payer: Cash Price |
$132.88
|
| Rate for Payer: Cash Price |
$132.88
|
| Rate for Payer: Cigna Commercial |
$188.25
|
| Rate for Payer: Cigna Medicaid |
$86.88
|
| Rate for Payer: Cigna Medicare |
$83.10
|
| Rate for Payer: Employer Direct Commercial |
$83.10
|
| Rate for Payer: Humana Medicare/TRICARE |
$83.10
|
| Rate for Payer: Molina CHIP/Medicaid |
$86.88
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$83.10
|
| Rate for Payer: Molina Medicare |
$83.10
|
| Rate for Payer: Multiplan Auto |
$98.15
|
| Rate for Payer: Multiplan Commercial |
$98.15
|
| Rate for Payer: Multiplan Workers Comp |
$98.15
|
| Rate for Payer: Parkland Medicaid |
$86.88
|
| Rate for Payer: Scott and White EPO/PPO |
$1.49
|
| Rate for Payer: Scott and White Medicare |
$83.10
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$86.88
|
| Rate for Payer: Superior Health Plan EPO |
$83.10
|
| Rate for Payer: Superior Health Plan Medicare |
$83.10
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$83.10
|
| Rate for Payer: Universal American Medicare |
$83.10
|
| Rate for Payer: Wellcare Medicare |
$83.10
|
| Rate for Payer: Wellmed Medicare |
$83.10
|
|
|
CT Heart Calcium Scoring BCE
|
Facility
|
IP
|
$151.00
|
|
|
Service Code
|
CPT 75571
|
| Hospital Charge Code |
3860005
|
|
Hospital Revenue Code
|
350
|
| Rate for Payer: Cash Price |
$132.88
|
|
|
CT Hip w/ Contrast Left
|
Facility
|
OP
|
$3,797.00
|
|
|
Service Code
|
CPT 73701 LT
|
| Hospital Charge Code |
3800968
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$3.01 |
| 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: 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 |
$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: 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 |
$173.08
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$168.03
|
| Rate for Payer: Molina Medicare |
$168.03
|
| 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 |
$3.01
|
| Rate for Payer: Scott and White Medicare |
$168.03
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$173.08
|
| 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 Hip w/ Contrast Right
|
Facility
|
OP
|
$3,797.00
|
|
|
Service Code
|
CPT 73701 RT
|
| Hospital Charge Code |
3801875
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$3.01 |
| 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: 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 |
$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: 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 |
$173.08
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$168.03
|
| Rate for Payer: Molina Medicare |
$168.03
|
| 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 |
$3.01
|
| Rate for Payer: Scott and White Medicare |
$168.03
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$173.08
|
| 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 Hip 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 |
$1.80 |
| 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: 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 |
$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: 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 |
$2,122.90
|
| 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 |
$1.80
|
| 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 Hip 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 |
$1.80 |
| 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: 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 |
$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: 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 |
$2,122.90
|
| 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 |
$1.80
|
| 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 Humerus w/ Contrast Left
|
Facility
|
OP
|
$3,312.00
|
|
|
Service Code
|
CPT 73201 LT
|
| Hospital Charge Code |
3800281
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$6.29 |
| Max. Negotiated Rate |
$2,152.80 |
| Rate for Payer: Aetna Commercial |
$231.91
|
| Rate for Payer: Aetna Medicare |
$527.56
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$209.84
|
| 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 |
$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: 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 |
$209.84
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$351.71
|
| Rate for Payer: Molina Medicare |
$351.71
|
| 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 |
$6.29
|
| Rate for Payer: Scott and White Medicare |
$351.71
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$209.84
|
| 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 Humerus w/ Contrast Right
|
Facility
|
OP
|
$3,312.00
|
|
|
Service Code
|
CPT 73201 RT
|
| Hospital Charge Code |
3801842
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$6.29 |
| Max. Negotiated Rate |
$2,152.80 |
| Rate for Payer: Aetna Commercial |
$231.91
|
| Rate for Payer: Aetna Medicare |
$527.56
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$209.84
|
| 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 |
$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: 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 |
$209.84
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$351.71
|
| Rate for Payer: Molina Medicare |
$351.71
|
| 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 |
$6.29
|
| Rate for Payer: Scott and White Medicare |
$351.71
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$209.84
|
| 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 Humerus 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 |
$1.80 |
| 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: 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 |
$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: 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 |
$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 |
$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 Humerus 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 |
$1.80 |
| 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: 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 |
$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: 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 |
$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 |
$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
|
|
