|
CT Urogram
|
Facility
|
IP
|
$9,419.00
|
|
|
Service Code
|
CPT 74178
|
| Hospital Charge Code |
3890212
|
|
Hospital Revenue Code
|
352
|
| Rate for Payer: Cash Price |
$8,288.72
|
|
|
CT Urogram
|
Facility
|
OP
|
$9,419.00
|
|
|
Service Code
|
CPT 74178
|
| Hospital Charge Code |
3890212
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$6.29 |
| Max. Negotiated Rate |
$6,122.35 |
| Rate for Payer: Aetna Commercial |
$395.22
|
| Rate for Payer: Aetna Medicare |
$527.56
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$356.19
|
| 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 |
$8,288.72
|
| Rate for Payer: Cash Price |
$8,288.72
|
| Rate for Payer: Cash Price |
$8,288.72
|
| Rate for Payer: Cigna Commercial |
$796.73
|
| Rate for Payer: Cigna Medicaid |
$356.19
|
| 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 |
$356.19
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$351.71
|
| Rate for Payer: Molina Medicare |
$351.71
|
| Rate for Payer: Multiplan Auto |
$6,122.35
|
| Rate for Payer: Multiplan Commercial |
$6,122.35
|
| Rate for Payer: Multiplan Workers Comp |
$6,122.35
|
| Rate for Payer: Parkland Medicaid |
$356.19
|
| 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 |
$356.19
|
| 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 Wrist 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 Wrist w/ Contrast Left
|
Facility
|
IP
|
$3,312.00
|
|
|
Service Code
|
CPT 73201 LT
|
| Hospital Charge Code |
3800281
|
|
Hospital Revenue Code
|
352
|
| Rate for Payer: Cash Price |
$2,914.56
|
|
|
CT Wrist w/ Contrast Right
|
Facility
|
IP
|
$3,312.00
|
|
|
Service Code
|
CPT 73201 RT
|
| Hospital Charge Code |
3801842
|
|
Hospital Revenue Code
|
352
|
| Rate for Payer: Cash Price |
$2,914.56
|
|
|
CT Wrist 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 Wrist w/o Contrast Left
|
Facility
|
IP
|
$1,788.00
|
|
|
Service Code
|
CPT 73200 LT
|
| Hospital Charge Code |
3800943
|
|
Hospital Revenue Code
|
352
|
| Rate for Payer: Cash Price |
$1,573.44
|
|
|
CT Wrist 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 Wrist 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 Wrist w/o Contrast Right
|
Facility
|
IP
|
$1,788.00
|
|
|
Service Code
|
CPT 73200 RT
|
| Hospital Charge Code |
3801834
|
|
Hospital Revenue Code
|
352
|
| Rate for Payer: Cash Price |
$1,573.44
|
|
|
CUFF TOURNIQUET DPSB
|
Facility
|
IP
|
$133.48
|
|
| Hospital Charge Code |
8490526
|
|
Hospital Revenue Code
|
270
|
| Rate for Payer: Cash Price |
$117.46
|
|
|
CUFF TOURNIQUET DPSB
|
Facility
|
OP
|
$133.48
|
|
| Hospital Charge Code |
8490526
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.01 |
| Max. Negotiated Rate |
$86.76 |
| Rate for Payer: Aetna Commercial |
$73.41
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$12.01
|
| Rate for Payer: BCBS of TX Blue Advantage |
$40.04
|
| Rate for Payer: BCBS of TX Blue Essentials |
$48.05
|
| Rate for Payer: BCBS of TX PPO |
$53.39
|
| Rate for Payer: Cash Price |
$117.46
|
| Rate for Payer: Multiplan Auto |
$86.76
|
| Rate for Payer: Multiplan Commercial |
$86.76
|
| Rate for Payer: Multiplan Workers Comp |
$86.76
|
| Rate for Payer: Scott and White EPO/PPO |
$66.74
|
| Rate for Payer: Superior Health Plan EPO |
$18.15
|
|
|
CULTURE NON URINE,BLOOD OR STOOL
|
Facility
|
OP
|
$309.00
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
1604719
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.36 |
| Max. Negotiated Rate |
$200.85 |
| Rate for Payer: Aetna Commercial |
$9.05
|
| Rate for Payer: Aetna Medicare |
$12.93
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$3.36
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$8.62
|
| Rate for Payer: Amerigroup Medicare |
$8.62
|
| Rate for Payer: BCBS of TX Blue Advantage |
$14.22
|
| Rate for Payer: BCBS of TX Blue Essentials |
$17.07
|
| Rate for Payer: BCBS of TX Medicare |
$8.62
|
| Rate for Payer: BCBS of TX PPO |
$19.05
|
| Rate for Payer: Cash Price |
$271.92
|
| Rate for Payer: Cash Price |
$271.92
|
| Rate for Payer: Cigna Medicaid |
$8.62
|
| Rate for Payer: Cigna Medicare |
$8.62
|
| Rate for Payer: Employer Direct Commercial |
$8.62
|
| Rate for Payer: Humana Medicare/TRICARE |
$8.62
|
| Rate for Payer: Molina CHIP/Medicaid |
$8.62
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$8.62
|
| Rate for Payer: Molina Medicare |
$8.62
|
| Rate for Payer: Multiplan Auto |
$200.85
|
| Rate for Payer: Multiplan Commercial |
$200.85
|
| Rate for Payer: Multiplan Workers Comp |
$200.85
|
| Rate for Payer: Parkland Medicaid |
$8.62
|
| Rate for Payer: Scott and White EPO/PPO |
$10.78
|
| Rate for Payer: Scott and White Medicare |
$8.62
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$8.62
|
| Rate for Payer: Superior Health Plan EPO |
$8.62
|
| Rate for Payer: Superior Health Plan Medicare |
$8.62
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$8.62
|
| Rate for Payer: Universal American Medicare |
$8.62
|
| Rate for Payer: Wellcare Medicare |
$8.62
|
| Rate for Payer: Wellmed Medicare |
$8.62
|
|
|
CULTURE NON URINE,BLOOD OR STOOL
|
Facility
|
IP
|
$309.00
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
1604719
|
|
Hospital Revenue Code
|
306
|
| Rate for Payer: Cash Price |
$271.92
|
|
|
Culture Urine Colony BCE
|
Facility
|
OP
|
$299.00
|
|
|
Service Code
|
CPT 87086
|
| Hospital Charge Code |
4107086
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.15 |
| Max. Negotiated Rate |
$194.35 |
| Rate for Payer: Aetna Commercial |
$8.47
|
| Rate for Payer: Aetna Medicare |
$12.10
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$3.15
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$8.07
|
| Rate for Payer: Amerigroup Medicare |
$8.07
|
| Rate for Payer: BCBS of TX Blue Advantage |
$13.32
|
| Rate for Payer: BCBS of TX Blue Essentials |
$15.98
|
| Rate for Payer: BCBS of TX Medicare |
$8.07
|
| Rate for Payer: BCBS of TX PPO |
$17.83
|
| Rate for Payer: Cash Price |
$263.12
|
| Rate for Payer: Cash Price |
$263.12
|
| Rate for Payer: Cigna Medicaid |
$8.07
|
| Rate for Payer: Cigna Medicare |
$8.07
|
| Rate for Payer: Employer Direct Commercial |
$8.07
|
| Rate for Payer: Humana Medicare/TRICARE |
$8.07
|
| Rate for Payer: Molina CHIP/Medicaid |
$8.07
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$8.07
|
| Rate for Payer: Molina Medicare |
$8.07
|
| Rate for Payer: Multiplan Auto |
$194.35
|
| Rate for Payer: Multiplan Commercial |
$194.35
|
| Rate for Payer: Multiplan Workers Comp |
$194.35
|
| Rate for Payer: Parkland Medicaid |
$8.07
|
| Rate for Payer: Scott and White EPO/PPO |
$10.09
|
| Rate for Payer: Scott and White Medicare |
$8.07
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$8.07
|
| Rate for Payer: Superior Health Plan EPO |
$8.07
|
| Rate for Payer: Superior Health Plan Medicare |
$8.07
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$8.07
|
| Rate for Payer: Universal American Medicare |
$8.07
|
| Rate for Payer: Wellcare Medicare |
$8.07
|
| Rate for Payer: Wellmed Medicare |
$8.07
|
|
|
Culture Urine Colony BCE
|
Facility
|
IP
|
$299.00
|
|
|
Service Code
|
CPT 87086
|
| Hospital Charge Code |
4107086
|
|
Hospital Revenue Code
|
306
|
| Rate for Payer: Cash Price |
$263.12
|
|
|
CURETTE, RIGID CURVED W/REG TIP 7MM STERILE -- DHF
|
Facility
|
OP
|
$22.93
|
|
| Hospital Charge Code |
80343007
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.06 |
| Max. Negotiated Rate |
$14.90 |
| Rate for Payer: Aetna Commercial |
$12.61
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2.06
|
| Rate for Payer: BCBS of TX Blue Advantage |
$6.88
|
| Rate for Payer: BCBS of TX Blue Essentials |
$8.25
|
| Rate for Payer: BCBS of TX PPO |
$9.17
|
| Rate for Payer: Cash Price |
$20.18
|
| Rate for Payer: Multiplan Auto |
$14.90
|
| Rate for Payer: Multiplan Commercial |
$14.90
|
| Rate for Payer: Multiplan Workers Comp |
$14.90
|
| Rate for Payer: Scott and White EPO/PPO |
$11.46
|
| Rate for Payer: Superior Health Plan EPO |
$3.12
|
|
|
CURETTE, VACUUM CURVED ROUND TIP 10 MM STERILE -- DHF
|
Facility
|
OP
|
$22.93
|
|
| Hospital Charge Code |
80343007
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.06 |
| Max. Negotiated Rate |
$14.90 |
| Rate for Payer: Aetna Commercial |
$12.61
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2.06
|
| Rate for Payer: BCBS of TX Blue Advantage |
$6.88
|
| Rate for Payer: BCBS of TX Blue Essentials |
$8.25
|
| Rate for Payer: BCBS of TX PPO |
$9.17
|
| Rate for Payer: Cash Price |
$20.18
|
| Rate for Payer: Multiplan Auto |
$14.90
|
| Rate for Payer: Multiplan Commercial |
$14.90
|
| Rate for Payer: Multiplan Workers Comp |
$14.90
|
| Rate for Payer: Scott and White EPO/PPO |
$11.46
|
| Rate for Payer: Superior Health Plan EPO |
$3.12
|
|
|
CURETTE, VACUUM CURVED ROUND TIP, 11MM, STERILE -- DHF
|
Facility
|
OP
|
$22.93
|
|
| Hospital Charge Code |
80343007
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.06 |
| Max. Negotiated Rate |
$14.90 |
| Rate for Payer: Aetna Commercial |
$12.61
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2.06
|
| Rate for Payer: BCBS of TX Blue Advantage |
$6.88
|
| Rate for Payer: BCBS of TX Blue Essentials |
$8.25
|
| Rate for Payer: BCBS of TX PPO |
$9.17
|
| Rate for Payer: Cash Price |
$20.18
|
| Rate for Payer: Multiplan Auto |
$14.90
|
| Rate for Payer: Multiplan Commercial |
$14.90
|
| Rate for Payer: Multiplan Workers Comp |
$14.90
|
| Rate for Payer: Scott and White EPO/PPO |
$11.46
|
| Rate for Payer: Superior Health Plan EPO |
$3.12
|
|
|
CURETTE, VACUUM CURVED ROUND TIP, 12MM, STERILE -- DHF
|
Facility
|
OP
|
$22.93
|
|
| Hospital Charge Code |
80343007
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.06 |
| Max. Negotiated Rate |
$14.90 |
| Rate for Payer: Aetna Commercial |
$12.61
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2.06
|
| Rate for Payer: BCBS of TX Blue Advantage |
$6.88
|
| Rate for Payer: BCBS of TX Blue Essentials |
$8.25
|
| Rate for Payer: BCBS of TX PPO |
$9.17
|
| Rate for Payer: Cash Price |
$20.18
|
| Rate for Payer: Multiplan Auto |
$14.90
|
| Rate for Payer: Multiplan Commercial |
$14.90
|
| Rate for Payer: Multiplan Workers Comp |
$14.90
|
| Rate for Payer: Scott and White EPO/PPO |
$11.46
|
| Rate for Payer: Superior Health Plan EPO |
$3.12
|
|
|
CURETTE, VACUUM CURVED ROUND TIP, 8MM, STERILE -- DHF
|
Facility
|
OP
|
$22.93
|
|
| Hospital Charge Code |
80343007
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.06 |
| Max. Negotiated Rate |
$14.90 |
| Rate for Payer: Aetna Commercial |
$12.61
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2.06
|
| Rate for Payer: BCBS of TX Blue Advantage |
$6.88
|
| Rate for Payer: BCBS of TX Blue Essentials |
$8.25
|
| Rate for Payer: BCBS of TX PPO |
$9.17
|
| Rate for Payer: Cash Price |
$20.18
|
| Rate for Payer: Multiplan Auto |
$14.90
|
| Rate for Payer: Multiplan Commercial |
$14.90
|
| Rate for Payer: Multiplan Workers Comp |
$14.90
|
| Rate for Payer: Scott and White EPO/PPO |
$11.46
|
| Rate for Payer: Superior Health Plan EPO |
$3.12
|
|
|
CURETTE, VACUUM CURVED ROUND TIP, 8MM, STERILE -- DHF
|
Facility
|
IP
|
$22.93
|
|
| Hospital Charge Code |
80343007
|
|
Hospital Revenue Code
|
270
|
| Rate for Payer: Cash Price |
$20.18
|
|
|
CURETTE, VACUUM CURVED ROUND TIP 9 MM STERILE -- DHF
|
Facility
|
OP
|
$22.93
|
|
| Hospital Charge Code |
80343007
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.06 |
| Max. Negotiated Rate |
$14.90 |
| Rate for Payer: Aetna Commercial |
$12.61
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2.06
|
| Rate for Payer: BCBS of TX Blue Advantage |
$6.88
|
| Rate for Payer: BCBS of TX Blue Essentials |
$8.25
|
| Rate for Payer: BCBS of TX PPO |
$9.17
|
| Rate for Payer: Cash Price |
$20.18
|
| Rate for Payer: Multiplan Auto |
$14.90
|
| Rate for Payer: Multiplan Commercial |
$14.90
|
| Rate for Payer: Multiplan Workers Comp |
$14.90
|
| Rate for Payer: Scott and White EPO/PPO |
$11.46
|
| Rate for Payer: Superior Health Plan EPO |
$3.12
|
|
|
CUTTER, ENDOSCOPIC LINEAR ARTICULAT 45MM NO RELOAD -- DHF
|
Facility
|
IP
|
$1,581.16
|
|
| Hospital Charge Code |
81911851
|
|
Hospital Revenue Code
|
272
|
| Rate for Payer: Cash Price |
$1,391.42
|
|
|
CUTTER, ENDOSCOPIC LINEAR ARTICULAT 45MM NO RELOAD -- DHF
|
Facility
|
OP
|
$1,581.16
|
|
| Hospital Charge Code |
81911851
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$142.30 |
| Max. Negotiated Rate |
$1,027.75 |
| Rate for Payer: Aetna Commercial |
$869.64
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$142.30
|
| Rate for Payer: BCBS of TX Blue Advantage |
$474.35
|
| Rate for Payer: BCBS of TX Blue Essentials |
$569.22
|
| Rate for Payer: BCBS of TX PPO |
$632.46
|
| Rate for Payer: Cash Price |
$1,391.42
|
| Rate for Payer: Multiplan Auto |
$1,027.75
|
| Rate for Payer: Multiplan Commercial |
$1,027.75
|
| Rate for Payer: Multiplan Workers Comp |
$1,027.75
|
| Rate for Payer: Scott and White EPO/PPO |
$790.58
|
| Rate for Payer: Superior Health Plan EPO |
$215.04
|
|
