|
CT Neck Soft Tissue w/o Contrast BCE
|
Facility
|
IP
|
$5,958.00
|
|
|
Service Code
|
CPT 70490
|
| Hospital Charge Code |
3800075
|
|
Hospital Revenue Code
|
351
|
| Rate for Payer: Cash Price |
$5,243.04
|
|
|
CT Neck Soft Tissue w/ + w/o Contrast
|
Facility
|
OP
|
$8,364.00
|
|
|
Service Code
|
CPT 70492
|
| Hospital Charge Code |
3800158
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$3.01 |
| Max. Negotiated Rate |
$5,436.60 |
| Rate for Payer: Aetna Commercial |
$230.18
|
| 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 |
$7,360.32
|
| Rate for Payer: Cash Price |
$7,360.32
|
| Rate for Payer: Cash Price |
$7,360.32
|
| 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 |
$5,436.60
|
| Rate for Payer: Multiplan Commercial |
$5,436.60
|
| Rate for Payer: Multiplan Workers Comp |
$5,436.60
|
| 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 Neck Soft Tissue w/ + w/o Contrast BCE
|
Facility
|
IP
|
$8,364.00
|
|
|
Service Code
|
CPT 70492
|
| Hospital Charge Code |
3800158
|
|
Hospital Revenue Code
|
351
|
| Rate for Payer: Cash Price |
$7,360.32
|
|
|
CT Neck Soft Tissue w/ + w/o Contrast BCE
|
Facility
|
OP
|
$8,364.00
|
|
|
Service Code
|
CPT 70492
|
| Hospital Charge Code |
3800158
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$3.01 |
| Max. Negotiated Rate |
$5,436.60 |
| Rate for Payer: Aetna Commercial |
$230.18
|
| 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 |
$7,360.32
|
| Rate for Payer: Cash Price |
$7,360.32
|
| Rate for Payer: Cash Price |
$7,360.32
|
| 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 |
$5,436.60
|
| Rate for Payer: Multiplan Commercial |
$5,436.60
|
| Rate for Payer: Multiplan Workers Comp |
$5,436.60
|
| 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, Ng, Trich vag by NAA SO
|
Facility
|
OP
|
$298.00
|
|
|
Service Code
|
CPT 87491
|
| Hospital Charge Code |
1709682
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$13.69 |
| Max. Negotiated Rate |
$193.70 |
| Rate for Payer: Aetna Commercial |
$36.84
|
| Rate for Payer: Aetna Medicare |
$52.64
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$13.69
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$35.09
|
| Rate for Payer: Amerigroup Medicare |
$35.09
|
| Rate for Payer: BCBS of TX Blue Advantage |
$57.90
|
| Rate for Payer: BCBS of TX Blue Essentials |
$69.48
|
| Rate for Payer: BCBS of TX Medicare |
$35.09
|
| Rate for Payer: BCBS of TX PPO |
$77.55
|
| Rate for Payer: Cash Price |
$262.24
|
| Rate for Payer: Cash Price |
$262.24
|
| Rate for Payer: Cigna Medicaid |
$35.09
|
| Rate for Payer: Cigna Medicare |
$35.09
|
| Rate for Payer: Employer Direct Commercial |
$35.09
|
| Rate for Payer: Humana Medicare/TRICARE |
$35.09
|
| Rate for Payer: Molina CHIP/Medicaid |
$35.09
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$35.09
|
| Rate for Payer: Molina Medicare |
$35.09
|
| Rate for Payer: Multiplan Auto |
$193.70
|
| Rate for Payer: Multiplan Commercial |
$193.70
|
| Rate for Payer: Multiplan Workers Comp |
$193.70
|
| Rate for Payer: Parkland Medicaid |
$35.09
|
| Rate for Payer: Scott and White EPO/PPO |
$43.86
|
| Rate for Payer: Scott and White Medicare |
$35.09
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$35.09
|
| Rate for Payer: Superior Health Plan EPO |
$35.09
|
| Rate for Payer: Superior Health Plan Medicare |
$35.09
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$35.09
|
| Rate for Payer: Universal American Medicare |
$35.09
|
| Rate for Payer: Wellcare Medicare |
$35.09
|
| Rate for Payer: Wellmed Medicare |
$35.09
|
|
|
CT Orbits Sella w/ Contrast
|
Facility
|
OP
|
$4,332.00
|
|
|
Service Code
|
CPT 70481
|
| Hospital Charge Code |
3890027
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$3.01 |
| Max. Negotiated Rate |
$2,815.80 |
| Rate for Payer: Aetna Commercial |
$200.58
|
| 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 |
$3,812.16
|
| Rate for Payer: Cash Price |
$3,812.16
|
| Rate for Payer: Cash Price |
$3,812.16
|
| 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 |
$2,815.80
|
| Rate for Payer: Multiplan Commercial |
$2,815.80
|
| Rate for Payer: Multiplan Workers Comp |
$2,815.80
|
| 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 Orbits Sella w/ Contrast BCE
|
Facility
|
IP
|
$4,332.00
|
|
|
Service Code
|
CPT 70481
|
| Hospital Charge Code |
3890027
|
|
Hospital Revenue Code
|
351
|
| Rate for Payer: Cash Price |
$3,812.16
|
|
|
CT Orbits Sella w/ Contrast BCE
|
Facility
|
OP
|
$4,332.00
|
|
|
Service Code
|
CPT 70481
|
| Hospital Charge Code |
3890027
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$3.01 |
| Max. Negotiated Rate |
$2,815.80 |
| Rate for Payer: Aetna Commercial |
$200.58
|
| 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 |
$3,812.16
|
| Rate for Payer: Cash Price |
$3,812.16
|
| Rate for Payer: Cash Price |
$3,812.16
|
| 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 |
$2,815.80
|
| Rate for Payer: Multiplan Commercial |
$2,815.80
|
| Rate for Payer: Multiplan Workers Comp |
$2,815.80
|
| 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 Orbits Sella w/o Contrast
|
Facility
|
OP
|
$3,273.00
|
|
|
Service Code
|
CPT 70480
|
| Hospital Charge Code |
3800331
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$2,127.45 |
| Rate for Payer: Aetna Commercial |
$154.37
|
| 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 |
$2,880.24
|
| Rate for Payer: Cash Price |
$2,880.24
|
| Rate for Payer: Cash Price |
$2,880.24
|
| 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 |
$2,127.45
|
| Rate for Payer: Multiplan Commercial |
$2,127.45
|
| Rate for Payer: Multiplan Workers Comp |
$2,127.45
|
| 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 Orbits Sella w/o Contrast BCE
|
Facility
|
OP
|
$3,273.00
|
|
|
Service Code
|
CPT 70480
|
| Hospital Charge Code |
3800331
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$2,127.45 |
| Rate for Payer: Aetna Commercial |
$154.37
|
| 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 |
$2,880.24
|
| Rate for Payer: Cash Price |
$2,880.24
|
| Rate for Payer: Cash Price |
$2,880.24
|
| 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 |
$2,127.45
|
| Rate for Payer: Multiplan Commercial |
$2,127.45
|
| Rate for Payer: Multiplan Workers Comp |
$2,127.45
|
| 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 Orbits Sella w/o Contrast BCE
|
Facility
|
IP
|
$3,273.00
|
|
|
Service Code
|
CPT 70480
|
| Hospital Charge Code |
3800331
|
|
Hospital Revenue Code
|
351
|
| Rate for Payer: Cash Price |
$2,880.24
|
|
|
CT Orbits Sella w/ + w/o Contrast
|
Facility
|
OP
|
$5,435.00
|
|
|
Service Code
|
CPT 70482
|
| Hospital Charge Code |
3800372
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$3.01 |
| Max. Negotiated Rate |
$3,532.75 |
| Rate for Payer: Aetna Commercial |
$239.14
|
| 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 |
$4,782.80
|
| Rate for Payer: Cash Price |
$4,782.80
|
| Rate for Payer: Cash Price |
$4,782.80
|
| 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 |
$3,532.75
|
| Rate for Payer: Multiplan Commercial |
$3,532.75
|
| Rate for Payer: Multiplan Workers Comp |
$3,532.75
|
| 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 Orbits Sella w/ + w/o Contrast BCE
|
Facility
|
IP
|
$5,435.00
|
|
|
Service Code
|
CPT 70482
|
| Hospital Charge Code |
3800372
|
|
Hospital Revenue Code
|
351
|
| Rate for Payer: Cash Price |
$4,782.80
|
|
|
CT Orbits Sella w/ + w/o Contrast BCE
|
Facility
|
OP
|
$5,435.00
|
|
|
Service Code
|
CPT 70482
|
| Hospital Charge Code |
3800372
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$3.01 |
| Max. Negotiated Rate |
$3,532.75 |
| Rate for Payer: Aetna Commercial |
$239.14
|
| 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 |
$4,782.80
|
| Rate for Payer: Cash Price |
$4,782.80
|
| Rate for Payer: Cash Price |
$4,782.80
|
| 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 |
$3,532.75
|
| Rate for Payer: Multiplan Commercial |
$3,532.75
|
| Rate for Payer: Multiplan Workers Comp |
$3,532.75
|
| 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 Pelvis w/ Contrast
|
Facility
|
OP
|
$4,538.00
|
|
|
Service Code
|
CPT 72193
|
| Hospital Charge Code |
3800265
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$3.01 |
| Max. Negotiated Rate |
$2,949.70 |
| Rate for Payer: Aetna Commercial |
$261.73
|
| Rate for Payer: Aetna Medicare |
$252.04
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$180.34
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$168.03
|
| Rate for Payer: Amerigroup Medicare |
$168.03
|
| Rate for Payer: BCBS of TX Blue Advantage |
$300.66
|
| Rate for Payer: BCBS of TX Blue Essentials |
$360.80
|
| Rate for Payer: BCBS of TX Medicare |
$168.03
|
| Rate for Payer: BCBS of TX PPO |
$402.71
|
| Rate for Payer: Cash Price |
$3,993.44
|
| Rate for Payer: Cash Price |
$3,993.44
|
| Rate for Payer: Cash Price |
$3,993.44
|
| 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 |
$2,949.70
|
| Rate for Payer: Multiplan Commercial |
$2,949.70
|
| Rate for Payer: Multiplan Workers Comp |
$2,949.70
|
| 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 Pelvis w/ Contrast BCE
|
Facility
|
IP
|
$4,538.00
|
|
|
Service Code
|
CPT 72193
|
| Hospital Charge Code |
3800265
|
|
Hospital Revenue Code
|
352
|
| Rate for Payer: Cash Price |
$3,993.44
|
|
|
CT Pelvis w/ Contrast BCE
|
Facility
|
OP
|
$4,538.00
|
|
|
Service Code
|
CPT 72193
|
| Hospital Charge Code |
3800265
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$3.01 |
| Max. Negotiated Rate |
$2,949.70 |
| Rate for Payer: Aetna Commercial |
$261.73
|
| Rate for Payer: Aetna Medicare |
$252.04
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$180.34
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$168.03
|
| Rate for Payer: Amerigroup Medicare |
$168.03
|
| Rate for Payer: BCBS of TX Blue Advantage |
$300.66
|
| Rate for Payer: BCBS of TX Blue Essentials |
$360.80
|
| Rate for Payer: BCBS of TX Medicare |
$168.03
|
| Rate for Payer: BCBS of TX PPO |
$402.71
|
| Rate for Payer: Cash Price |
$3,993.44
|
| Rate for Payer: Cash Price |
$3,993.44
|
| Rate for Payer: Cash Price |
$3,993.44
|
| 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 |
$2,949.70
|
| Rate for Payer: Multiplan Commercial |
$2,949.70
|
| Rate for Payer: Multiplan Workers Comp |
$2,949.70
|
| 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 Pelvis w/o Contrast
|
Facility
|
OP
|
$3,778.00
|
|
|
Service Code
|
CPT 72192
|
| Hospital Charge Code |
5052192
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$2,455.70 |
| Rate for Payer: Aetna Commercial |
$128.52
|
| Rate for Payer: Aetna Medicare |
$150.82
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$106.88
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$100.55
|
| Rate for Payer: Amerigroup Medicare |
$100.55
|
| Rate for Payer: BCBS of TX Blue Advantage |
$184.93
|
| Rate for Payer: BCBS of TX Blue Essentials |
$221.92
|
| Rate for Payer: BCBS of TX Medicare |
$100.55
|
| Rate for Payer: BCBS of TX PPO |
$247.70
|
| Rate for Payer: Cash Price |
$3,324.64
|
| Rate for Payer: Cash Price |
$3,324.64
|
| Rate for Payer: Cash Price |
$3,324.64
|
| 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 |
$2,455.70
|
| Rate for Payer: Multiplan Commercial |
$2,455.70
|
| Rate for Payer: Multiplan Workers Comp |
$2,455.70
|
| 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 Pelvis w/o Contrast BCE
|
Facility
|
OP
|
$3,778.00
|
|
|
Service Code
|
CPT 72192
|
| Hospital Charge Code |
5052192
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$2,455.70 |
| Rate for Payer: Aetna Commercial |
$128.52
|
| Rate for Payer: Aetna Medicare |
$150.82
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$106.88
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$100.55
|
| Rate for Payer: Amerigroup Medicare |
$100.55
|
| Rate for Payer: BCBS of TX Blue Advantage |
$184.93
|
| Rate for Payer: BCBS of TX Blue Essentials |
$221.92
|
| Rate for Payer: BCBS of TX Medicare |
$100.55
|
| Rate for Payer: BCBS of TX PPO |
$247.70
|
| Rate for Payer: Cash Price |
$3,324.64
|
| Rate for Payer: Cash Price |
$3,324.64
|
| Rate for Payer: Cash Price |
$3,324.64
|
| 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 |
$2,455.70
|
| Rate for Payer: Multiplan Commercial |
$2,455.70
|
| Rate for Payer: Multiplan Workers Comp |
$2,455.70
|
| 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 Pelvis w/o Contrast BCE
|
Facility
|
IP
|
$3,778.00
|
|
|
Service Code
|
CPT 72192
|
| Hospital Charge Code |
5052192
|
|
Hospital Revenue Code
|
352
|
| Rate for Payer: Cash Price |
$3,324.64
|
|
|
CT Pelvis w/ + w/o Contrast
|
Facility
|
OP
|
$4,765.00
|
|
|
Service Code
|
CPT 72194
|
| Hospital Charge Code |
3800190
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$3.01 |
| Max. Negotiated Rate |
$3,097.25 |
| 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 |
$4,193.20
|
| Rate for Payer: Cash Price |
$4,193.20
|
| Rate for Payer: Cash Price |
$4,193.20
|
| 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 |
$3,097.25
|
| Rate for Payer: Multiplan Commercial |
$3,097.25
|
| Rate for Payer: Multiplan Workers Comp |
$3,097.25
|
| 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 Pelvis w/ + w/o Contrast BCE
|
Facility
|
OP
|
$4,765.00
|
|
|
Service Code
|
CPT 72194
|
| Hospital Charge Code |
3800190
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$3.01 |
| Max. Negotiated Rate |
$3,097.25 |
| 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 |
$4,193.20
|
| Rate for Payer: Cash Price |
$4,193.20
|
| Rate for Payer: Cash Price |
$4,193.20
|
| 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 |
$3,097.25
|
| Rate for Payer: Multiplan Commercial |
$3,097.25
|
| Rate for Payer: Multiplan Workers Comp |
$3,097.25
|
| 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 Pelvis w/ + w/o Contrast BCE
|
Facility
|
IP
|
$4,765.00
|
|
|
Service Code
|
CPT 72194
|
| Hospital Charge Code |
3800190
|
|
Hospital Revenue Code
|
352
|
| Rate for Payer: Cash Price |
$4,193.20
|
|
|
CT Sacroplasty Bilat 2 or more needles
|
Facility
|
OP
|
$21,024.00
|
|
|
Service Code
|
CPT 0201T
|
| Hospital Charge Code |
5052898
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$117.01 |
| Max. Negotiated Rate |
$15,074.51 |
| Rate for Payer: Aetna Commercial |
$4,635.00
|
| Rate for Payer: Aetna Medicare |
$9,814.08
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,892.16
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$6,542.72
|
| Rate for Payer: Amerigroup Medicare |
$6,542.72
|
| Rate for Payer: BCBS of TX Blue Advantage |
$9,989.86
|
| Rate for Payer: BCBS of TX Blue Essentials |
$11,963.90
|
| Rate for Payer: BCBS of TX Medicare |
$6,542.72
|
| Rate for Payer: BCBS of TX PPO |
$15,074.51
|
| Rate for Payer: Cash Price |
$18,501.12
|
| Rate for Payer: Cash Price |
$18,501.12
|
| Rate for Payer: Cash Price |
$18,501.12
|
| Rate for Payer: Cigna Commercial |
$14,821.16
|
| Rate for Payer: Cigna Medicare |
$6,542.72
|
| Rate for Payer: Employer Direct Commercial |
$6,542.72
|
| Rate for Payer: Humana Medicare/TRICARE |
$6,542.72
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$6,542.72
|
| Rate for Payer: Molina Medicare |
$6,542.72
|
| 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 |
$117.01
|
| Rate for Payer: Scott and White Medicare |
$6,542.72
|
| Rate for Payer: Superior Health Plan EPO |
$6,542.72
|
| Rate for Payer: Superior Health Plan Medicare |
$6,542.72
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$6,542.72
|
| Rate for Payer: Universal American Medicare |
$6,542.72
|
| Rate for Payer: Wellcare Medicare |
$6,542.72
|
| Rate for Payer: Wellmed Medicare |
$6,542.72
|
|
|
CT Sacroplasty Bilat 2 or more needles BCE
|
Facility
|
IP
|
$21,024.00
|
|
|
Service Code
|
CPT 0201T
|
| Hospital Charge Code |
5052898
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$18,501.12
|
|
