|
CT Thoracentesis w/ CT Guidance Right
|
Facility
|
OP
|
$1,959.00
|
|
|
Service Code
|
CPT 32555 RT
|
| Hospital Charge Code |
3800000
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$12.67 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$1,400.00
|
| Rate for Payer: Aetna Medicare |
$861.78
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$223.75
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$574.52
|
| Rate for Payer: Amerigroup Medicare |
$574.52
|
| Rate for Payer: BCBS of TX Blue Advantage |
$1,052.95
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,261.02
|
| Rate for Payer: BCBS of TX Medicare |
$574.52
|
| Rate for Payer: BCBS of TX PPO |
$1,588.89
|
| Rate for Payer: Cash Price |
$1,723.92
|
| Rate for Payer: Cash Price |
$1,723.92
|
| Rate for Payer: Cigna Commercial |
$1,301.46
|
| Rate for Payer: Cigna Medicaid |
$223.75
|
| Rate for Payer: Cigna Medicare |
$574.52
|
| Rate for Payer: Employer Direct Commercial |
$574.52
|
| Rate for Payer: Humana Medicare/TRICARE |
$574.52
|
| Rate for Payer: Molina CHIP/Medicaid |
$223.75
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$574.52
|
| Rate for Payer: Molina Medicare |
$574.52
|
| 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 |
$223.75
|
| Rate for Payer: Scott and White EPO/PPO |
$12.67
|
| Rate for Payer: Scott and White Medicare |
$574.52
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$223.75
|
| Rate for Payer: Superior Health Plan EPO |
$574.52
|
| Rate for Payer: Superior Health Plan Medicare |
$574.52
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$574.52
|
| Rate for Payer: Universal American Medicare |
$574.52
|
| Rate for Payer: Wellcare Medicare |
$574.52
|
| Rate for Payer: Wellmed Medicare |
$574.52
|
|
|
CT Thoracentesis w/ CT Guidance Right BCE
|
Facility
|
OP
|
$1,959.00
|
|
|
Service Code
|
CPT 32555 RT
|
| Hospital Charge Code |
3800000
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$12.67 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$1,400.00
|
| Rate for Payer: Aetna Medicare |
$861.78
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$223.75
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$574.52
|
| Rate for Payer: Amerigroup Medicare |
$574.52
|
| Rate for Payer: BCBS of TX Blue Advantage |
$1,052.95
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,261.02
|
| Rate for Payer: BCBS of TX Medicare |
$574.52
|
| Rate for Payer: BCBS of TX PPO |
$1,588.89
|
| Rate for Payer: Cash Price |
$1,723.92
|
| Rate for Payer: Cash Price |
$1,723.92
|
| Rate for Payer: Cigna Commercial |
$1,301.46
|
| Rate for Payer: Cigna Medicaid |
$223.75
|
| Rate for Payer: Cigna Medicare |
$574.52
|
| Rate for Payer: Employer Direct Commercial |
$574.52
|
| Rate for Payer: Humana Medicare/TRICARE |
$574.52
|
| Rate for Payer: Molina CHIP/Medicaid |
$223.75
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$574.52
|
| Rate for Payer: Molina Medicare |
$574.52
|
| 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 |
$223.75
|
| Rate for Payer: Scott and White EPO/PPO |
$12.67
|
| Rate for Payer: Scott and White Medicare |
$574.52
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$223.75
|
| Rate for Payer: Superior Health Plan EPO |
$574.52
|
| Rate for Payer: Superior Health Plan Medicare |
$574.52
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$574.52
|
| Rate for Payer: Universal American Medicare |
$574.52
|
| Rate for Payer: Wellcare Medicare |
$574.52
|
| Rate for Payer: Wellmed Medicare |
$574.52
|
|
|
CT Thoracentesis w/ CT Guidance Right BCE
|
Facility
|
IP
|
$1,959.00
|
|
|
Service Code
|
CPT 32555 RT
|
| Hospital Charge Code |
3800000
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$1,723.92
|
|
|
CT Thoracostomy w/ Drainage Left
|
Facility
|
OP
|
$819.00
|
|
|
Service Code
|
CPT 32551 LT
|
| Hospital Charge Code |
3851086
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$32.31 |
| 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 |
$73.71
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,464.68
|
| Rate for Payer: Amerigroup Medicare |
$1,464.68
|
| 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 Medicare |
$1,464.68
|
| Rate for Payer: BCBS of TX PPO |
$4,110.45
|
| Rate for Payer: Cash Price |
$720.72
|
| Rate for Payer: Cash Price |
$720.72
|
| Rate for Payer: Cash Price |
$720.72
|
| Rate for Payer: Cigna Commercial |
$3,317.93
|
| Rate for Payer: Cigna Medicare |
$1,464.68
|
| Rate for Payer: Employer Direct Commercial |
$1,464.68
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,464.68
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,464.68
|
| Rate for Payer: Molina Medicare |
$1,464.68
|
| 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 |
$32.31
|
| Rate for Payer: Scott and White Medicare |
$1,464.68
|
| Rate for Payer: Superior Health Plan EPO |
$1,464.68
|
| Rate for Payer: Superior Health Plan Medicare |
$1,464.68
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,464.68
|
| Rate for Payer: Universal American Medicare |
$1,464.68
|
| Rate for Payer: Wellcare Medicare |
$1,464.68
|
| Rate for Payer: Wellmed Medicare |
$1,464.68
|
|
|
CT Thoracostomy w/ Drainage Left BCE
|
Facility
|
OP
|
$819.00
|
|
|
Service Code
|
CPT 32551 LT
|
| Hospital Charge Code |
3851086
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$32.31 |
| 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 |
$73.71
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,464.68
|
| Rate for Payer: Amerigroup Medicare |
$1,464.68
|
| 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 Medicare |
$1,464.68
|
| Rate for Payer: BCBS of TX PPO |
$4,110.45
|
| Rate for Payer: Cash Price |
$720.72
|
| Rate for Payer: Cash Price |
$720.72
|
| Rate for Payer: Cash Price |
$720.72
|
| Rate for Payer: Cigna Commercial |
$3,317.93
|
| Rate for Payer: Cigna Medicare |
$1,464.68
|
| Rate for Payer: Employer Direct Commercial |
$1,464.68
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,464.68
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,464.68
|
| Rate for Payer: Molina Medicare |
$1,464.68
|
| 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 |
$32.31
|
| Rate for Payer: Scott and White Medicare |
$1,464.68
|
| Rate for Payer: Superior Health Plan EPO |
$1,464.68
|
| Rate for Payer: Superior Health Plan Medicare |
$1,464.68
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,464.68
|
| Rate for Payer: Universal American Medicare |
$1,464.68
|
| Rate for Payer: Wellcare Medicare |
$1,464.68
|
| Rate for Payer: Wellmed Medicare |
$1,464.68
|
|
|
CT Thoracostomy w/ Drainage Right
|
Facility
|
OP
|
$819.00
|
|
|
Service Code
|
CPT 32551 RT
|
| Hospital Charge Code |
3851086
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$32.31 |
| 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 |
$73.71
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,464.68
|
| Rate for Payer: Amerigroup Medicare |
$1,464.68
|
| 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 Medicare |
$1,464.68
|
| Rate for Payer: BCBS of TX PPO |
$4,110.45
|
| Rate for Payer: Cash Price |
$720.72
|
| Rate for Payer: Cash Price |
$720.72
|
| Rate for Payer: Cash Price |
$720.72
|
| Rate for Payer: Cigna Commercial |
$3,317.93
|
| Rate for Payer: Cigna Medicare |
$1,464.68
|
| Rate for Payer: Employer Direct Commercial |
$1,464.68
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,464.68
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,464.68
|
| Rate for Payer: Molina Medicare |
$1,464.68
|
| 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 |
$32.31
|
| Rate for Payer: Scott and White Medicare |
$1,464.68
|
| Rate for Payer: Superior Health Plan EPO |
$1,464.68
|
| Rate for Payer: Superior Health Plan Medicare |
$1,464.68
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,464.68
|
| Rate for Payer: Universal American Medicare |
$1,464.68
|
| Rate for Payer: Wellcare Medicare |
$1,464.68
|
| Rate for Payer: Wellmed Medicare |
$1,464.68
|
|
|
CT Thoracostomy w/ Drainage Right BCE
|
Facility
|
OP
|
$819.00
|
|
|
Service Code
|
CPT 32551 RT
|
| Hospital Charge Code |
3851086
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$32.31 |
| 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 |
$73.71
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,464.68
|
| Rate for Payer: Amerigroup Medicare |
$1,464.68
|
| 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 Medicare |
$1,464.68
|
| Rate for Payer: BCBS of TX PPO |
$4,110.45
|
| Rate for Payer: Cash Price |
$720.72
|
| Rate for Payer: Cash Price |
$720.72
|
| Rate for Payer: Cash Price |
$720.72
|
| Rate for Payer: Cigna Commercial |
$3,317.93
|
| Rate for Payer: Cigna Medicare |
$1,464.68
|
| Rate for Payer: Employer Direct Commercial |
$1,464.68
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,464.68
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,464.68
|
| Rate for Payer: Molina Medicare |
$1,464.68
|
| 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 |
$32.31
|
| Rate for Payer: Scott and White Medicare |
$1,464.68
|
| Rate for Payer: Superior Health Plan EPO |
$1,464.68
|
| Rate for Payer: Superior Health Plan Medicare |
$1,464.68
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,464.68
|
| Rate for Payer: Universal American Medicare |
$1,464.68
|
| Rate for Payer: Wellcare Medicare |
$1,464.68
|
| Rate for Payer: Wellmed Medicare |
$1,464.68
|
|
|
CT Thoracostomy w/ Drainage Right BCE
|
Facility
|
IP
|
$819.00
|
|
|
Service Code
|
CPT 32551 RT
|
| Hospital Charge Code |
3851086
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$720.72
|
|
|
CT Thorax w/ Contrast
|
Facility
|
OP
|
$5,138.00
|
|
|
Service Code
|
CPT 71260
|
| Hospital Charge Code |
3800240
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$3.01 |
| Max. Negotiated Rate |
$3,339.70 |
| Rate for Payer: Aetna Commercial |
$175.74
|
| 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 |
$4,521.44
|
| Rate for Payer: Cash Price |
$4,521.44
|
| Rate for Payer: Cash Price |
$4,521.44
|
| Rate for Payer: Cigna Commercial |
$380.65
|
| Rate for Payer: Cigna Medicaid |
$44.11
|
| 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 |
$44.11
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$168.03
|
| Rate for Payer: Molina Medicare |
$168.03
|
| Rate for Payer: Multiplan Auto |
$3,339.70
|
| Rate for Payer: Multiplan Commercial |
$3,339.70
|
| Rate for Payer: Multiplan Workers Comp |
$3,339.70
|
| Rate for Payer: Parkland Medicaid |
$44.11
|
| 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 |
$44.11
|
| 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 Thorax w/ Contrast BCE
|
Facility
|
IP
|
$5,138.00
|
|
|
Service Code
|
CPT 71260
|
| Hospital Charge Code |
3800240
|
|
Hospital Revenue Code
|
352
|
| Rate for Payer: Cash Price |
$4,521.44
|
|
|
CT Thorax w/ Contrast BCE
|
Facility
|
OP
|
$5,138.00
|
|
|
Service Code
|
CPT 71260
|
| Hospital Charge Code |
3800240
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$3.01 |
| Max. Negotiated Rate |
$3,339.70 |
| Rate for Payer: Aetna Commercial |
$175.74
|
| 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 |
$4,521.44
|
| Rate for Payer: Cash Price |
$4,521.44
|
| Rate for Payer: Cash Price |
$4,521.44
|
| Rate for Payer: Cigna Commercial |
$380.65
|
| Rate for Payer: Cigna Medicaid |
$44.11
|
| 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 |
$44.11
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$168.03
|
| Rate for Payer: Molina Medicare |
$168.03
|
| Rate for Payer: Multiplan Auto |
$3,339.70
|
| Rate for Payer: Multiplan Commercial |
$3,339.70
|
| Rate for Payer: Multiplan Workers Comp |
$3,339.70
|
| Rate for Payer: Parkland Medicaid |
$44.11
|
| 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 |
$44.11
|
| 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 Thorax w/o Contrast
|
Facility
|
OP
|
$4,075.00
|
|
|
Service Code
|
CPT 71250
|
| Hospital Charge Code |
3800091
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$2,648.75 |
| 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 |
$3,586.00
|
| Rate for Payer: Cash Price |
$3,586.00
|
| Rate for Payer: Cash Price |
$3,586.00
|
| Rate for Payer: Cigna Commercial |
$227.77
|
| Rate for Payer: Cigna Medicaid |
$40.90
|
| 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 |
$40.90
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$100.55
|
| Rate for Payer: Molina Medicare |
$100.55
|
| Rate for Payer: Multiplan Auto |
$2,648.75
|
| Rate for Payer: Multiplan Commercial |
$2,648.75
|
| Rate for Payer: Multiplan Workers Comp |
$2,648.75
|
| Rate for Payer: Parkland Medicaid |
$40.90
|
| 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 |
$40.90
|
| 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 Thorax w/o Contrast BCE
|
Facility
|
OP
|
$4,075.00
|
|
|
Service Code
|
CPT 71250
|
| Hospital Charge Code |
3800091
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$2,648.75 |
| 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 |
$3,586.00
|
| Rate for Payer: Cash Price |
$3,586.00
|
| Rate for Payer: Cash Price |
$3,586.00
|
| Rate for Payer: Cigna Commercial |
$227.77
|
| Rate for Payer: Cigna Medicaid |
$40.90
|
| 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 |
$40.90
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$100.55
|
| Rate for Payer: Molina Medicare |
$100.55
|
| Rate for Payer: Multiplan Auto |
$2,648.75
|
| Rate for Payer: Multiplan Commercial |
$2,648.75
|
| Rate for Payer: Multiplan Workers Comp |
$2,648.75
|
| Rate for Payer: Parkland Medicaid |
$40.90
|
| 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 |
$40.90
|
| 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 Thorax w/o Contrast BCE
|
Facility
|
IP
|
$4,075.00
|
|
|
Service Code
|
CPT 71250
|
| Hospital Charge Code |
3800091
|
|
Hospital Revenue Code
|
352
|
| Rate for Payer: Cash Price |
$3,586.00
|
|
|
CT Thorax w/ + w/o Contrast
|
Facility
|
OP
|
$6,165.00
|
|
|
Service Code
|
CPT 71270
|
| Hospital Charge Code |
3800174
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$3.01 |
| Max. Negotiated Rate |
$4,007.25 |
| Rate for Payer: Aetna Commercial |
$217.26
|
| Rate for Payer: Aetna Medicare |
$252.04
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$180.34
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$168.03
|
| Rate for Payer: Amerigroup Medicare |
$168.03
|
| Rate for Payer: BCBS of TX Blue Advantage |
$300.66
|
| Rate for Payer: BCBS of TX Blue Essentials |
$360.80
|
| Rate for Payer: BCBS of TX Medicare |
$168.03
|
| Rate for Payer: BCBS of TX PPO |
$402.71
|
| Rate for Payer: Cash Price |
$5,425.20
|
| Rate for Payer: Cash Price |
$5,425.20
|
| Rate for Payer: Cash Price |
$5,425.20
|
| 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 |
$4,007.25
|
| Rate for Payer: Multiplan Commercial |
$4,007.25
|
| Rate for Payer: Multiplan Workers Comp |
$4,007.25
|
| 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 Thorax w/ + w/o Contrast BCE
|
Facility
|
IP
|
$6,165.00
|
|
|
Service Code
|
CPT 71270
|
| Hospital Charge Code |
3800174
|
|
Hospital Revenue Code
|
352
|
| Rate for Payer: Cash Price |
$5,425.20
|
|
|
CT Thorax w/ + w/o Contrast BCE
|
Facility
|
OP
|
$6,165.00
|
|
|
Service Code
|
CPT 71270
|
| Hospital Charge Code |
3800174
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$3.01 |
| Max. Negotiated Rate |
$4,007.25 |
| Rate for Payer: Aetna Commercial |
$217.26
|
| Rate for Payer: Aetna Medicare |
$252.04
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$180.34
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$168.03
|
| Rate for Payer: Amerigroup Medicare |
$168.03
|
| Rate for Payer: BCBS of TX Blue Advantage |
$300.66
|
| Rate for Payer: BCBS of TX Blue Essentials |
$360.80
|
| Rate for Payer: BCBS of TX Medicare |
$168.03
|
| Rate for Payer: BCBS of TX PPO |
$402.71
|
| Rate for Payer: Cash Price |
$5,425.20
|
| Rate for Payer: Cash Price |
$5,425.20
|
| Rate for Payer: Cash Price |
$5,425.20
|
| 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 |
$4,007.25
|
| Rate for Payer: Multiplan Commercial |
$4,007.25
|
| Rate for Payer: Multiplan Workers Comp |
$4,007.25
|
| 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 Tibia Fibula w/ Contrast Left
|
Facility
|
IP
|
$3,797.00
|
|
|
Service Code
|
CPT 73701 LT
|
| Hospital Charge Code |
3800968
|
|
Hospital Revenue Code
|
352
|
| Rate for Payer: Cash Price |
$3,341.36
|
|
|
CT Tibia Fibula 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 Tibia Fibula w/ Contrast Right
|
Facility
|
IP
|
$3,797.00
|
|
|
Service Code
|
CPT 73701 RT
|
| Hospital Charge Code |
3801875
|
|
Hospital Revenue Code
|
352
|
| Rate for Payer: Cash Price |
$3,341.36
|
|
|
CT Tibia Fibula 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 Tibia Fibula 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 Tibia Fibula w/o Contrast Left
|
Facility
|
IP
|
$3,266.00
|
|
|
Service Code
|
CPT 73700 LT
|
| Hospital Charge Code |
3800141
|
|
Hospital Revenue Code
|
352
|
| Rate for Payer: Cash Price |
$2,874.08
|
|
|
CT Tibia Fibula 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 Tibia Fibula w/o Contrast Right
|
Facility
|
IP
|
$3,266.00
|
|
|
Service Code
|
CPT 73700 RT
|
| Hospital Charge Code |
3801867
|
|
Hospital Revenue Code
|
352
|
| Rate for Payer: Cash Price |
$2,874.08
|
|
