|
EA136 Aph Plt ACDA LR Bacti Mntr
|
Facility
|
OP
|
$1,136.02
|
|
|
Service Code
|
HCPCS P9035
|
| Hospital Charge Code |
2403863
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$102.24 |
| Max. Negotiated Rate |
$1,027.03 |
| Rate for Payer: Aetna Commercial |
$624.81
|
| Rate for Payer: Aetna Medicare |
$680.05
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$102.24
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$453.37
|
| Rate for Payer: Amerigroup Medicare |
$453.37
|
| Rate for Payer: BCBS of TX Blue Advantage |
$340.81
|
| Rate for Payer: BCBS of TX Blue Essentials |
$408.97
|
| Rate for Payer: BCBS of TX Medicare |
$453.37
|
| Rate for Payer: BCBS of TX PPO |
$454.41
|
| Rate for Payer: Cash Price |
$999.70
|
| Rate for Payer: Cash Price |
$999.70
|
| Rate for Payer: Cash Price |
$999.70
|
| Rate for Payer: Cigna Commercial |
$1,027.03
|
| Rate for Payer: Cigna Medicaid |
$480.75
|
| Rate for Payer: Cigna Medicare |
$453.37
|
| Rate for Payer: Employer Direct Commercial |
$453.37
|
| Rate for Payer: Humana Medicare/TRICARE |
$453.37
|
| Rate for Payer: Molina CHIP/Medicaid |
$480.75
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$453.37
|
| Rate for Payer: Molina Medicare |
$453.37
|
| Rate for Payer: Multiplan Auto |
$738.41
|
| Rate for Payer: Multiplan Commercial |
$738.41
|
| Rate for Payer: Multiplan Workers Comp |
$738.41
|
| Rate for Payer: Parkland Medicaid |
$480.75
|
| Rate for Payer: Scott and White EPO/PPO |
$568.01
|
| Rate for Payer: Scott and White Medicare |
$453.37
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$480.75
|
| Rate for Payer: Superior Health Plan EPO |
$453.37
|
| Rate for Payer: Superior Health Plan Medicare |
$453.37
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$453.37
|
| Rate for Payer: Universal American Medicare |
$453.37
|
| Rate for Payer: Wellcare Medicare |
$453.37
|
| Rate for Payer: Wellmed Medicare |
$453.37
|
|
|
EA137 Aph Plt ACDA LR 1 Bacti Mntr
|
Facility
|
OP
|
$1,136.00
|
|
|
Service Code
|
HCPCS P9035
|
| Hospital Charge Code |
2403863
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$102.24 |
| Max. Negotiated Rate |
$1,027.03 |
| Rate for Payer: Aetna Commercial |
$624.80
|
| Rate for Payer: Aetna Medicare |
$680.05
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$102.24
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$453.37
|
| Rate for Payer: Amerigroup Medicare |
$453.37
|
| Rate for Payer: BCBS of TX Blue Advantage |
$340.80
|
| Rate for Payer: BCBS of TX Blue Essentials |
$408.96
|
| Rate for Payer: BCBS of TX Medicare |
$453.37
|
| Rate for Payer: BCBS of TX PPO |
$454.40
|
| Rate for Payer: Cash Price |
$999.68
|
| Rate for Payer: Cash Price |
$999.68
|
| Rate for Payer: Cash Price |
$999.68
|
| Rate for Payer: Cigna Commercial |
$1,027.03
|
| Rate for Payer: Cigna Medicaid |
$480.75
|
| Rate for Payer: Cigna Medicare |
$453.37
|
| Rate for Payer: Employer Direct Commercial |
$453.37
|
| Rate for Payer: Humana Medicare/TRICARE |
$453.37
|
| Rate for Payer: Molina CHIP/Medicaid |
$480.75
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$453.37
|
| Rate for Payer: Molina Medicare |
$453.37
|
| Rate for Payer: Multiplan Auto |
$738.40
|
| Rate for Payer: Multiplan Commercial |
$738.40
|
| Rate for Payer: Multiplan Workers Comp |
$738.40
|
| Rate for Payer: Parkland Medicaid |
$480.75
|
| Rate for Payer: Scott and White EPO/PPO |
$568.00
|
| Rate for Payer: Scott and White Medicare |
$453.37
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$480.75
|
| Rate for Payer: Superior Health Plan EPO |
$453.37
|
| Rate for Payer: Superior Health Plan Medicare |
$453.37
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$453.37
|
| Rate for Payer: Universal American Medicare |
$453.37
|
| Rate for Payer: Wellcare Medicare |
$453.37
|
| Rate for Payer: Wellmed Medicare |
$453.37
|
|
|
EA137 Aph Plt ACDA LR 1 Bacti Mntr
|
Facility
|
IP
|
$1,136.00
|
|
|
Service Code
|
HCPCS P9035
|
| Hospital Charge Code |
2403863
|
|
Hospital Revenue Code
|
390
|
| Rate for Payer: Cash Price |
$999.68
|
|
|
EA138 Aph Plt ACDA LR 2 Bacti Mntr
|
Facility
|
OP
|
$1,136.02
|
|
|
Service Code
|
HCPCS P9035
|
| Hospital Charge Code |
2403863
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$102.24 |
| Max. Negotiated Rate |
$1,027.03 |
| Rate for Payer: Aetna Commercial |
$624.81
|
| Rate for Payer: Aetna Medicare |
$680.05
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$102.24
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$453.37
|
| Rate for Payer: Amerigroup Medicare |
$453.37
|
| Rate for Payer: BCBS of TX Blue Advantage |
$340.81
|
| Rate for Payer: BCBS of TX Blue Essentials |
$408.97
|
| Rate for Payer: BCBS of TX Medicare |
$453.37
|
| Rate for Payer: BCBS of TX PPO |
$454.41
|
| Rate for Payer: Cash Price |
$999.70
|
| Rate for Payer: Cash Price |
$999.70
|
| Rate for Payer: Cash Price |
$999.70
|
| Rate for Payer: Cigna Commercial |
$1,027.03
|
| Rate for Payer: Cigna Medicaid |
$480.75
|
| Rate for Payer: Cigna Medicare |
$453.37
|
| Rate for Payer: Employer Direct Commercial |
$453.37
|
| Rate for Payer: Humana Medicare/TRICARE |
$453.37
|
| Rate for Payer: Molina CHIP/Medicaid |
$480.75
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$453.37
|
| Rate for Payer: Molina Medicare |
$453.37
|
| Rate for Payer: Multiplan Auto |
$738.41
|
| Rate for Payer: Multiplan Commercial |
$738.41
|
| Rate for Payer: Multiplan Workers Comp |
$738.41
|
| Rate for Payer: Parkland Medicaid |
$480.75
|
| Rate for Payer: Scott and White EPO/PPO |
$568.01
|
| Rate for Payer: Scott and White Medicare |
$453.37
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$480.75
|
| Rate for Payer: Superior Health Plan EPO |
$453.37
|
| Rate for Payer: Superior Health Plan Medicare |
$453.37
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$453.37
|
| Rate for Payer: Universal American Medicare |
$453.37
|
| Rate for Payer: Wellcare Medicare |
$453.37
|
| Rate for Payer: Wellmed Medicare |
$453.37
|
|
|
EA139 Aph Plt ACDA LR 3 Bacti Mntr
|
Facility
|
OP
|
$1,136.02
|
|
|
Service Code
|
HCPCS P9035
|
| Hospital Charge Code |
2403863
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$102.24 |
| Max. Negotiated Rate |
$1,027.03 |
| Rate for Payer: Aetna Commercial |
$624.81
|
| Rate for Payer: Aetna Medicare |
$680.05
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$102.24
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$453.37
|
| Rate for Payer: Amerigroup Medicare |
$453.37
|
| Rate for Payer: BCBS of TX Blue Advantage |
$340.81
|
| Rate for Payer: BCBS of TX Blue Essentials |
$408.97
|
| Rate for Payer: BCBS of TX Medicare |
$453.37
|
| Rate for Payer: BCBS of TX PPO |
$454.41
|
| Rate for Payer: Cash Price |
$999.70
|
| Rate for Payer: Cash Price |
$999.70
|
| Rate for Payer: Cash Price |
$999.70
|
| Rate for Payer: Cigna Commercial |
$1,027.03
|
| Rate for Payer: Cigna Medicaid |
$480.75
|
| Rate for Payer: Cigna Medicare |
$453.37
|
| Rate for Payer: Employer Direct Commercial |
$453.37
|
| Rate for Payer: Humana Medicare/TRICARE |
$453.37
|
| Rate for Payer: Molina CHIP/Medicaid |
$480.75
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$453.37
|
| Rate for Payer: Molina Medicare |
$453.37
|
| Rate for Payer: Multiplan Auto |
$738.41
|
| Rate for Payer: Multiplan Commercial |
$738.41
|
| Rate for Payer: Multiplan Workers Comp |
$738.41
|
| Rate for Payer: Parkland Medicaid |
$480.75
|
| Rate for Payer: Scott and White EPO/PPO |
$568.01
|
| Rate for Payer: Scott and White Medicare |
$453.37
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$480.75
|
| Rate for Payer: Superior Health Plan EPO |
$453.37
|
| Rate for Payer: Superior Health Plan Medicare |
$453.37
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$453.37
|
| Rate for Payer: Universal American Medicare |
$453.37
|
| Rate for Payer: Wellcare Medicare |
$453.37
|
| Rate for Payer: Wellmed Medicare |
$453.37
|
|
|
EA140 Aph Plt ACDA LR Bacti Mntr
|
Facility
|
OP
|
$1,136.02
|
|
|
Service Code
|
HCPCS P9035
|
| Hospital Charge Code |
2403863
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$102.24 |
| Max. Negotiated Rate |
$1,027.03 |
| Rate for Payer: Aetna Commercial |
$624.81
|
| Rate for Payer: Aetna Medicare |
$680.05
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$102.24
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$453.37
|
| Rate for Payer: Amerigroup Medicare |
$453.37
|
| Rate for Payer: BCBS of TX Blue Advantage |
$340.81
|
| Rate for Payer: BCBS of TX Blue Essentials |
$408.97
|
| Rate for Payer: BCBS of TX Medicare |
$453.37
|
| Rate for Payer: BCBS of TX PPO |
$454.41
|
| Rate for Payer: Cash Price |
$999.70
|
| Rate for Payer: Cash Price |
$999.70
|
| Rate for Payer: Cash Price |
$999.70
|
| Rate for Payer: Cigna Commercial |
$1,027.03
|
| Rate for Payer: Cigna Medicaid |
$480.75
|
| Rate for Payer: Cigna Medicare |
$453.37
|
| Rate for Payer: Employer Direct Commercial |
$453.37
|
| Rate for Payer: Humana Medicare/TRICARE |
$453.37
|
| Rate for Payer: Molina CHIP/Medicaid |
$480.75
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$453.37
|
| Rate for Payer: Molina Medicare |
$453.37
|
| Rate for Payer: Multiplan Auto |
$738.41
|
| Rate for Payer: Multiplan Commercial |
$738.41
|
| Rate for Payer: Multiplan Workers Comp |
$738.41
|
| Rate for Payer: Parkland Medicaid |
$480.75
|
| Rate for Payer: Scott and White EPO/PPO |
$568.01
|
| Rate for Payer: Scott and White Medicare |
$453.37
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$480.75
|
| Rate for Payer: Superior Health Plan EPO |
$453.37
|
| Rate for Payer: Superior Health Plan Medicare |
$453.37
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$453.37
|
| Rate for Payer: Universal American Medicare |
$453.37
|
| Rate for Payer: Wellcare Medicare |
$453.37
|
| Rate for Payer: Wellmed Medicare |
$453.37
|
|
|
EA141 Aph Plt ACDA LR 1 Bacti Mntr
|
Facility
|
OP
|
$1,136.02
|
|
|
Service Code
|
HCPCS P9035
|
| Hospital Charge Code |
2403863
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$102.24 |
| Max. Negotiated Rate |
$1,027.03 |
| Rate for Payer: Aetna Commercial |
$624.81
|
| Rate for Payer: Aetna Medicare |
$680.05
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$102.24
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$453.37
|
| Rate for Payer: Amerigroup Medicare |
$453.37
|
| Rate for Payer: BCBS of TX Blue Advantage |
$340.81
|
| Rate for Payer: BCBS of TX Blue Essentials |
$408.97
|
| Rate for Payer: BCBS of TX Medicare |
$453.37
|
| Rate for Payer: BCBS of TX PPO |
$454.41
|
| Rate for Payer: Cash Price |
$999.70
|
| Rate for Payer: Cash Price |
$999.70
|
| Rate for Payer: Cash Price |
$999.70
|
| Rate for Payer: Cigna Commercial |
$1,027.03
|
| Rate for Payer: Cigna Medicaid |
$480.75
|
| Rate for Payer: Cigna Medicare |
$453.37
|
| Rate for Payer: Employer Direct Commercial |
$453.37
|
| Rate for Payer: Humana Medicare/TRICARE |
$453.37
|
| Rate for Payer: Molina CHIP/Medicaid |
$480.75
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$453.37
|
| Rate for Payer: Molina Medicare |
$453.37
|
| Rate for Payer: Multiplan Auto |
$738.41
|
| Rate for Payer: Multiplan Commercial |
$738.41
|
| Rate for Payer: Multiplan Workers Comp |
$738.41
|
| Rate for Payer: Parkland Medicaid |
$480.75
|
| Rate for Payer: Scott and White EPO/PPO |
$568.01
|
| Rate for Payer: Scott and White Medicare |
$453.37
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$480.75
|
| Rate for Payer: Superior Health Plan EPO |
$453.37
|
| Rate for Payer: Superior Health Plan Medicare |
$453.37
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$453.37
|
| Rate for Payer: Universal American Medicare |
$453.37
|
| Rate for Payer: Wellcare Medicare |
$453.37
|
| Rate for Payer: Wellmed Medicare |
$453.37
|
|
|
EA142 Aph Plt ACDA LR 2 Bacti Mntr
|
Facility
|
OP
|
$1,136.02
|
|
|
Service Code
|
HCPCS P9035
|
| Hospital Charge Code |
2403863
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$102.24 |
| Max. Negotiated Rate |
$1,027.03 |
| Rate for Payer: Aetna Commercial |
$624.81
|
| Rate for Payer: Aetna Medicare |
$680.05
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$102.24
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$453.37
|
| Rate for Payer: Amerigroup Medicare |
$453.37
|
| Rate for Payer: BCBS of TX Blue Advantage |
$340.81
|
| Rate for Payer: BCBS of TX Blue Essentials |
$408.97
|
| Rate for Payer: BCBS of TX Medicare |
$453.37
|
| Rate for Payer: BCBS of TX PPO |
$454.41
|
| Rate for Payer: Cash Price |
$999.70
|
| Rate for Payer: Cash Price |
$999.70
|
| Rate for Payer: Cash Price |
$999.70
|
| Rate for Payer: Cigna Commercial |
$1,027.03
|
| Rate for Payer: Cigna Medicaid |
$480.75
|
| Rate for Payer: Cigna Medicare |
$453.37
|
| Rate for Payer: Employer Direct Commercial |
$453.37
|
| Rate for Payer: Humana Medicare/TRICARE |
$453.37
|
| Rate for Payer: Molina CHIP/Medicaid |
$480.75
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$453.37
|
| Rate for Payer: Molina Medicare |
$453.37
|
| Rate for Payer: Multiplan Auto |
$738.41
|
| Rate for Payer: Multiplan Commercial |
$738.41
|
| Rate for Payer: Multiplan Workers Comp |
$738.41
|
| Rate for Payer: Parkland Medicaid |
$480.75
|
| Rate for Payer: Scott and White EPO/PPO |
$568.01
|
| Rate for Payer: Scott and White Medicare |
$453.37
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$480.75
|
| Rate for Payer: Superior Health Plan EPO |
$453.37
|
| Rate for Payer: Superior Health Plan Medicare |
$453.37
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$453.37
|
| Rate for Payer: Universal American Medicare |
$453.37
|
| Rate for Payer: Wellcare Medicare |
$453.37
|
| Rate for Payer: Wellmed Medicare |
$453.37
|
|
|
EA143 Aph Plt ACDA LR 3 Bacti Mntr
|
Facility
|
OP
|
$1,136.02
|
|
|
Service Code
|
HCPCS P9035
|
| Hospital Charge Code |
2403863
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$102.24 |
| Max. Negotiated Rate |
$1,027.03 |
| Rate for Payer: Aetna Commercial |
$624.81
|
| Rate for Payer: Aetna Medicare |
$680.05
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$102.24
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$453.37
|
| Rate for Payer: Amerigroup Medicare |
$453.37
|
| Rate for Payer: BCBS of TX Blue Advantage |
$340.81
|
| Rate for Payer: BCBS of TX Blue Essentials |
$408.97
|
| Rate for Payer: BCBS of TX Medicare |
$453.37
|
| Rate for Payer: BCBS of TX PPO |
$454.41
|
| Rate for Payer: Cash Price |
$999.70
|
| Rate for Payer: Cash Price |
$999.70
|
| Rate for Payer: Cash Price |
$999.70
|
| Rate for Payer: Cigna Commercial |
$1,027.03
|
| Rate for Payer: Cigna Medicaid |
$480.75
|
| Rate for Payer: Cigna Medicare |
$453.37
|
| Rate for Payer: Employer Direct Commercial |
$453.37
|
| Rate for Payer: Humana Medicare/TRICARE |
$453.37
|
| Rate for Payer: Molina CHIP/Medicaid |
$480.75
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$453.37
|
| Rate for Payer: Molina Medicare |
$453.37
|
| Rate for Payer: Multiplan Auto |
$738.41
|
| Rate for Payer: Multiplan Commercial |
$738.41
|
| Rate for Payer: Multiplan Workers Comp |
$738.41
|
| Rate for Payer: Parkland Medicaid |
$480.75
|
| Rate for Payer: Scott and White EPO/PPO |
$568.01
|
| Rate for Payer: Scott and White Medicare |
$453.37
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$480.75
|
| Rate for Payer: Superior Health Plan EPO |
$453.37
|
| Rate for Payer: Superior Health Plan Medicare |
$453.37
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$453.37
|
| Rate for Payer: Universal American Medicare |
$453.37
|
| Rate for Payer: Wellcare Medicare |
$453.37
|
| Rate for Payer: Wellmed Medicare |
$453.37
|
|
|
EA143 Aph Plt ACDA LR 3 Bacti Mntr
|
Facility
|
IP
|
$1,136.02
|
|
|
Service Code
|
HCPCS P9035
|
| Hospital Charge Code |
2403863
|
|
Hospital Revenue Code
|
390
|
| Rate for Payer: Cash Price |
$999.70
|
|
|
EA152 Aph Plt ACDA LR Irr Bacti Mntr
|
Facility
|
OP
|
$1,241.61
|
|
|
Service Code
|
HCPCS P9037
|
| Hospital Charge Code |
2403871
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$111.74 |
| Max. Negotiated Rate |
$1,462.22 |
| Rate for Payer: Aetna Commercial |
$682.89
|
| Rate for Payer: Aetna Medicare |
$968.24
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$111.74
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$645.49
|
| Rate for Payer: Amerigroup Medicare |
$645.49
|
| Rate for Payer: BCBS of TX Blue Advantage |
$372.48
|
| Rate for Payer: BCBS of TX Blue Essentials |
$446.98
|
| Rate for Payer: BCBS of TX Medicare |
$645.49
|
| Rate for Payer: BCBS of TX PPO |
$496.64
|
| Rate for Payer: Cash Price |
$1,092.62
|
| Rate for Payer: Cash Price |
$1,092.62
|
| Rate for Payer: Cash Price |
$1,092.62
|
| Rate for Payer: Cigna Commercial |
$1,462.22
|
| Rate for Payer: Cigna Medicaid |
$483.98
|
| Rate for Payer: Cigna Medicare |
$645.49
|
| Rate for Payer: Employer Direct Commercial |
$645.49
|
| Rate for Payer: Humana Medicare/TRICARE |
$645.49
|
| Rate for Payer: Molina CHIP/Medicaid |
$483.98
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$645.49
|
| Rate for Payer: Molina Medicare |
$645.49
|
| Rate for Payer: Multiplan Auto |
$807.05
|
| Rate for Payer: Multiplan Commercial |
$807.05
|
| Rate for Payer: Multiplan Workers Comp |
$807.05
|
| Rate for Payer: Parkland Medicaid |
$483.98
|
| Rate for Payer: Scott and White EPO/PPO |
$620.80
|
| Rate for Payer: Scott and White Medicare |
$645.49
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$483.98
|
| Rate for Payer: Superior Health Plan EPO |
$645.49
|
| Rate for Payer: Superior Health Plan Medicare |
$645.49
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$645.49
|
| Rate for Payer: Universal American Medicare |
$645.49
|
| Rate for Payer: Wellcare Medicare |
$645.49
|
| Rate for Payer: Wellmed Medicare |
$645.49
|
|
|
EA153 Aph Plt ACDA LR Irr 1 Bacti Mntr
|
Facility
|
OP
|
$1,241.61
|
|
|
Service Code
|
HCPCS P9037
|
| Hospital Charge Code |
2403871
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$111.74 |
| Max. Negotiated Rate |
$1,462.22 |
| Rate for Payer: Aetna Commercial |
$682.89
|
| Rate for Payer: Aetna Medicare |
$968.24
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$111.74
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$645.49
|
| Rate for Payer: Amerigroup Medicare |
$645.49
|
| Rate for Payer: BCBS of TX Blue Advantage |
$372.48
|
| Rate for Payer: BCBS of TX Blue Essentials |
$446.98
|
| Rate for Payer: BCBS of TX Medicare |
$645.49
|
| Rate for Payer: BCBS of TX PPO |
$496.64
|
| Rate for Payer: Cash Price |
$1,092.62
|
| Rate for Payer: Cash Price |
$1,092.62
|
| Rate for Payer: Cash Price |
$1,092.62
|
| Rate for Payer: Cigna Commercial |
$1,462.22
|
| Rate for Payer: Cigna Medicaid |
$483.98
|
| Rate for Payer: Cigna Medicare |
$645.49
|
| Rate for Payer: Employer Direct Commercial |
$645.49
|
| Rate for Payer: Humana Medicare/TRICARE |
$645.49
|
| Rate for Payer: Molina CHIP/Medicaid |
$483.98
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$645.49
|
| Rate for Payer: Molina Medicare |
$645.49
|
| Rate for Payer: Multiplan Auto |
$807.05
|
| Rate for Payer: Multiplan Commercial |
$807.05
|
| Rate for Payer: Multiplan Workers Comp |
$807.05
|
| Rate for Payer: Parkland Medicaid |
$483.98
|
| Rate for Payer: Scott and White EPO/PPO |
$620.80
|
| Rate for Payer: Scott and White Medicare |
$645.49
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$483.98
|
| Rate for Payer: Superior Health Plan EPO |
$645.49
|
| Rate for Payer: Superior Health Plan Medicare |
$645.49
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$645.49
|
| Rate for Payer: Universal American Medicare |
$645.49
|
| Rate for Payer: Wellcare Medicare |
$645.49
|
| Rate for Payer: Wellmed Medicare |
$645.49
|
|
|
EA154 Aph Plt ACDA LR Irr 2 Bacti Mntr
|
Facility
|
OP
|
$1,241.61
|
|
|
Service Code
|
HCPCS P9037
|
| Hospital Charge Code |
2403871
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$111.74 |
| Max. Negotiated Rate |
$1,462.22 |
| Rate for Payer: Aetna Commercial |
$682.89
|
| Rate for Payer: Aetna Medicare |
$968.24
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$111.74
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$645.49
|
| Rate for Payer: Amerigroup Medicare |
$645.49
|
| Rate for Payer: BCBS of TX Blue Advantage |
$372.48
|
| Rate for Payer: BCBS of TX Blue Essentials |
$446.98
|
| Rate for Payer: BCBS of TX Medicare |
$645.49
|
| Rate for Payer: BCBS of TX PPO |
$496.64
|
| Rate for Payer: Cash Price |
$1,092.62
|
| Rate for Payer: Cash Price |
$1,092.62
|
| Rate for Payer: Cash Price |
$1,092.62
|
| Rate for Payer: Cigna Commercial |
$1,462.22
|
| Rate for Payer: Cigna Medicaid |
$483.98
|
| Rate for Payer: Cigna Medicare |
$645.49
|
| Rate for Payer: Employer Direct Commercial |
$645.49
|
| Rate for Payer: Humana Medicare/TRICARE |
$645.49
|
| Rate for Payer: Molina CHIP/Medicaid |
$483.98
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$645.49
|
| Rate for Payer: Molina Medicare |
$645.49
|
| Rate for Payer: Multiplan Auto |
$807.05
|
| Rate for Payer: Multiplan Commercial |
$807.05
|
| Rate for Payer: Multiplan Workers Comp |
$807.05
|
| Rate for Payer: Parkland Medicaid |
$483.98
|
| Rate for Payer: Scott and White EPO/PPO |
$620.80
|
| Rate for Payer: Scott and White Medicare |
$645.49
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$483.98
|
| Rate for Payer: Superior Health Plan EPO |
$645.49
|
| Rate for Payer: Superior Health Plan Medicare |
$645.49
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$645.49
|
| Rate for Payer: Universal American Medicare |
$645.49
|
| Rate for Payer: Wellcare Medicare |
$645.49
|
| Rate for Payer: Wellmed Medicare |
$645.49
|
|
|
EA155 Aph Plt ACDA LR Irr 3 Bacti Mntr
|
Facility
|
OP
|
$1,241.61
|
|
|
Service Code
|
HCPCS P9037
|
| Hospital Charge Code |
2403871
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$111.74 |
| Max. Negotiated Rate |
$1,462.22 |
| Rate for Payer: Aetna Commercial |
$682.89
|
| Rate for Payer: Aetna Medicare |
$968.24
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$111.74
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$645.49
|
| Rate for Payer: Amerigroup Medicare |
$645.49
|
| Rate for Payer: BCBS of TX Blue Advantage |
$372.48
|
| Rate for Payer: BCBS of TX Blue Essentials |
$446.98
|
| Rate for Payer: BCBS of TX Medicare |
$645.49
|
| Rate for Payer: BCBS of TX PPO |
$496.64
|
| Rate for Payer: Cash Price |
$1,092.62
|
| Rate for Payer: Cash Price |
$1,092.62
|
| Rate for Payer: Cash Price |
$1,092.62
|
| Rate for Payer: Cigna Commercial |
$1,462.22
|
| Rate for Payer: Cigna Medicaid |
$483.98
|
| Rate for Payer: Cigna Medicare |
$645.49
|
| Rate for Payer: Employer Direct Commercial |
$645.49
|
| Rate for Payer: Humana Medicare/TRICARE |
$645.49
|
| Rate for Payer: Molina CHIP/Medicaid |
$483.98
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$645.49
|
| Rate for Payer: Molina Medicare |
$645.49
|
| Rate for Payer: Multiplan Auto |
$807.05
|
| Rate for Payer: Multiplan Commercial |
$807.05
|
| Rate for Payer: Multiplan Workers Comp |
$807.05
|
| Rate for Payer: Parkland Medicaid |
$483.98
|
| Rate for Payer: Scott and White EPO/PPO |
$620.80
|
| Rate for Payer: Scott and White Medicare |
$645.49
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$483.98
|
| Rate for Payer: Superior Health Plan EPO |
$645.49
|
| Rate for Payer: Superior Health Plan Medicare |
$645.49
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$645.49
|
| Rate for Payer: Universal American Medicare |
$645.49
|
| Rate for Payer: Wellcare Medicare |
$645.49
|
| Rate for Payer: Wellmed Medicare |
$645.49
|
|
|
EA156 Aph Plt ACDA LR Irr Bacti Mntr
|
Facility
|
OP
|
$1,241.61
|
|
|
Service Code
|
HCPCS P9037
|
| Hospital Charge Code |
2403871
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$111.74 |
| Max. Negotiated Rate |
$1,462.22 |
| Rate for Payer: Aetna Commercial |
$682.89
|
| Rate for Payer: Aetna Medicare |
$968.24
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$111.74
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$645.49
|
| Rate for Payer: Amerigroup Medicare |
$645.49
|
| Rate for Payer: BCBS of TX Blue Advantage |
$372.48
|
| Rate for Payer: BCBS of TX Blue Essentials |
$446.98
|
| Rate for Payer: BCBS of TX Medicare |
$645.49
|
| Rate for Payer: BCBS of TX PPO |
$496.64
|
| Rate for Payer: Cash Price |
$1,092.62
|
| Rate for Payer: Cash Price |
$1,092.62
|
| Rate for Payer: Cash Price |
$1,092.62
|
| Rate for Payer: Cigna Commercial |
$1,462.22
|
| Rate for Payer: Cigna Medicaid |
$483.98
|
| Rate for Payer: Cigna Medicare |
$645.49
|
| Rate for Payer: Employer Direct Commercial |
$645.49
|
| Rate for Payer: Humana Medicare/TRICARE |
$645.49
|
| Rate for Payer: Molina CHIP/Medicaid |
$483.98
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$645.49
|
| Rate for Payer: Molina Medicare |
$645.49
|
| Rate for Payer: Multiplan Auto |
$807.05
|
| Rate for Payer: Multiplan Commercial |
$807.05
|
| Rate for Payer: Multiplan Workers Comp |
$807.05
|
| Rate for Payer: Parkland Medicaid |
$483.98
|
| Rate for Payer: Scott and White EPO/PPO |
$620.80
|
| Rate for Payer: Scott and White Medicare |
$645.49
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$483.98
|
| Rate for Payer: Superior Health Plan EPO |
$645.49
|
| Rate for Payer: Superior Health Plan Medicare |
$645.49
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$645.49
|
| Rate for Payer: Universal American Medicare |
$645.49
|
| Rate for Payer: Wellcare Medicare |
$645.49
|
| Rate for Payer: Wellmed Medicare |
$645.49
|
|
|
EA157 Aph Plt ACDA LR Irr 1 Bacti Mntr
|
Facility
|
OP
|
$1,241.61
|
|
|
Service Code
|
HCPCS P9037
|
| Hospital Charge Code |
2403871
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$111.74 |
| Max. Negotiated Rate |
$1,462.22 |
| Rate for Payer: Aetna Commercial |
$682.89
|
| Rate for Payer: Aetna Medicare |
$968.24
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$111.74
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$645.49
|
| Rate for Payer: Amerigroup Medicare |
$645.49
|
| Rate for Payer: BCBS of TX Blue Advantage |
$372.48
|
| Rate for Payer: BCBS of TX Blue Essentials |
$446.98
|
| Rate for Payer: BCBS of TX Medicare |
$645.49
|
| Rate for Payer: BCBS of TX PPO |
$496.64
|
| Rate for Payer: Cash Price |
$1,092.62
|
| Rate for Payer: Cash Price |
$1,092.62
|
| Rate for Payer: Cash Price |
$1,092.62
|
| Rate for Payer: Cigna Commercial |
$1,462.22
|
| Rate for Payer: Cigna Medicaid |
$483.98
|
| Rate for Payer: Cigna Medicare |
$645.49
|
| Rate for Payer: Employer Direct Commercial |
$645.49
|
| Rate for Payer: Humana Medicare/TRICARE |
$645.49
|
| Rate for Payer: Molina CHIP/Medicaid |
$483.98
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$645.49
|
| Rate for Payer: Molina Medicare |
$645.49
|
| Rate for Payer: Multiplan Auto |
$807.05
|
| Rate for Payer: Multiplan Commercial |
$807.05
|
| Rate for Payer: Multiplan Workers Comp |
$807.05
|
| Rate for Payer: Parkland Medicaid |
$483.98
|
| Rate for Payer: Scott and White EPO/PPO |
$620.80
|
| Rate for Payer: Scott and White Medicare |
$645.49
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$483.98
|
| Rate for Payer: Superior Health Plan EPO |
$645.49
|
| Rate for Payer: Superior Health Plan Medicare |
$645.49
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$645.49
|
| Rate for Payer: Universal American Medicare |
$645.49
|
| Rate for Payer: Wellcare Medicare |
$645.49
|
| Rate for Payer: Wellmed Medicare |
$645.49
|
|
|
EA158 Aph Plt ACDA LR Irr 2 Bacti Mntr
|
Facility
|
OP
|
$1,241.61
|
|
|
Service Code
|
HCPCS P9037
|
| Hospital Charge Code |
2403871
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$111.74 |
| Max. Negotiated Rate |
$1,462.22 |
| Rate for Payer: Aetna Commercial |
$682.89
|
| Rate for Payer: Aetna Medicare |
$968.24
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$111.74
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$645.49
|
| Rate for Payer: Amerigroup Medicare |
$645.49
|
| Rate for Payer: BCBS of TX Blue Advantage |
$372.48
|
| Rate for Payer: BCBS of TX Blue Essentials |
$446.98
|
| Rate for Payer: BCBS of TX Medicare |
$645.49
|
| Rate for Payer: BCBS of TX PPO |
$496.64
|
| Rate for Payer: Cash Price |
$1,092.62
|
| Rate for Payer: Cash Price |
$1,092.62
|
| Rate for Payer: Cash Price |
$1,092.62
|
| Rate for Payer: Cigna Commercial |
$1,462.22
|
| Rate for Payer: Cigna Medicaid |
$483.98
|
| Rate for Payer: Cigna Medicare |
$645.49
|
| Rate for Payer: Employer Direct Commercial |
$645.49
|
| Rate for Payer: Humana Medicare/TRICARE |
$645.49
|
| Rate for Payer: Molina CHIP/Medicaid |
$483.98
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$645.49
|
| Rate for Payer: Molina Medicare |
$645.49
|
| Rate for Payer: Multiplan Auto |
$807.05
|
| Rate for Payer: Multiplan Commercial |
$807.05
|
| Rate for Payer: Multiplan Workers Comp |
$807.05
|
| Rate for Payer: Parkland Medicaid |
$483.98
|
| Rate for Payer: Scott and White EPO/PPO |
$620.80
|
| Rate for Payer: Scott and White Medicare |
$645.49
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$483.98
|
| Rate for Payer: Superior Health Plan EPO |
$645.49
|
| Rate for Payer: Superior Health Plan Medicare |
$645.49
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$645.49
|
| Rate for Payer: Universal American Medicare |
$645.49
|
| Rate for Payer: Wellcare Medicare |
$645.49
|
| Rate for Payer: Wellmed Medicare |
$645.49
|
|
|
EA159 Aph Plt ACDA LR Irr 3 Bacti Mntr
|
Facility
|
OP
|
$1,241.61
|
|
|
Service Code
|
HCPCS P9037
|
| Hospital Charge Code |
2403871
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$111.74 |
| Max. Negotiated Rate |
$1,462.22 |
| Rate for Payer: Aetna Commercial |
$682.89
|
| Rate for Payer: Aetna Medicare |
$968.24
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$111.74
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$645.49
|
| Rate for Payer: Amerigroup Medicare |
$645.49
|
| Rate for Payer: BCBS of TX Blue Advantage |
$372.48
|
| Rate for Payer: BCBS of TX Blue Essentials |
$446.98
|
| Rate for Payer: BCBS of TX Medicare |
$645.49
|
| Rate for Payer: BCBS of TX PPO |
$496.64
|
| Rate for Payer: Cash Price |
$1,092.62
|
| Rate for Payer: Cash Price |
$1,092.62
|
| Rate for Payer: Cash Price |
$1,092.62
|
| Rate for Payer: Cigna Commercial |
$1,462.22
|
| Rate for Payer: Cigna Medicaid |
$483.98
|
| Rate for Payer: Cigna Medicare |
$645.49
|
| Rate for Payer: Employer Direct Commercial |
$645.49
|
| Rate for Payer: Humana Medicare/TRICARE |
$645.49
|
| Rate for Payer: Molina CHIP/Medicaid |
$483.98
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$645.49
|
| Rate for Payer: Molina Medicare |
$645.49
|
| Rate for Payer: Multiplan Auto |
$807.05
|
| Rate for Payer: Multiplan Commercial |
$807.05
|
| Rate for Payer: Multiplan Workers Comp |
$807.05
|
| Rate for Payer: Parkland Medicaid |
$483.98
|
| Rate for Payer: Scott and White EPO/PPO |
$620.80
|
| Rate for Payer: Scott and White Medicare |
$645.49
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$483.98
|
| Rate for Payer: Superior Health Plan EPO |
$645.49
|
| Rate for Payer: Superior Health Plan Medicare |
$645.49
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$645.49
|
| Rate for Payer: Universal American Medicare |
$645.49
|
| Rate for Payer: Wellcare Medicare |
$645.49
|
| Rate for Payer: Wellmed Medicare |
$645.49
|
|
|
EA159 Aph Plt ACDA LR Irr 3 Bacti Mntr
|
Facility
|
IP
|
$1,241.61
|
|
|
Service Code
|
HCPCS P9037
|
| Hospital Charge Code |
2403871
|
|
Hospital Revenue Code
|
390
|
| Rate for Payer: Cash Price |
$1,092.62
|
|
|
Ear Culture
|
Facility
|
OP
|
$309.00
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
4107067
|
|
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
|
|
|
Ear Culture
|
Facility
|
IP
|
$309.00
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
4107067
|
|
Hospital Revenue Code
|
306
|
| Rate for Payer: Cash Price |
$271.92
|
|
|
EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH CC
|
Facility
|
IP
|
$17,510.29
|
|
|
Service Code
|
MSDRG 147
|
| Min. Negotiated Rate |
$11,290.94 |
| Max. Negotiated Rate |
$17,510.29 |
| Rate for Payer: Aetna Commercial |
$13,902.75
|
| Rate for Payer: Aetna Medicare |
$17,510.29
|
| Rate for Payer: BCBS of TX Blue Advantage |
$11,290.94
|
| Rate for Payer: BCBS of TX Blue Essentials |
$12,903.91
|
| Rate for Payer: BCBS of TX PPO |
$14,338.23
|
| Rate for Payer: Cigna Commercial |
$15,917.10
|
|
|
EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH MCC
|
Facility
|
IP
|
$27,189.68
|
|
|
Service Code
|
MSDRG 146
|
| Min. Negotiated Rate |
$17,684.18 |
| Max. Negotiated Rate |
$27,189.68 |
| Rate for Payer: Aetna Commercial |
$23,748.75
|
| Rate for Payer: Aetna Medicare |
$26,878.53
|
| Rate for Payer: BCBS of TX Blue Advantage |
$17,684.18
|
| Rate for Payer: BCBS of TX Blue Essentials |
$19,844.47
|
| Rate for Payer: BCBS of TX PPO |
$22,050.26
|
| Rate for Payer: Cigna Commercial |
$27,189.68
|
|
|
EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITHOUT CC/MCC
|
Facility
|
IP
|
$13,805.59
|
|
|
Service Code
|
MSDRG 148
|
| Min. Negotiated Rate |
$7,468.89 |
| Max. Negotiated Rate |
$13,805.59 |
| Rate for Payer: Aetna Commercial |
$10,009.12
|
| Rate for Payer: Aetna Medicare |
$13,805.59
|
| Rate for Payer: BCBS of TX Blue Advantage |
$7,844.92
|
| Rate for Payer: BCBS of TX Blue Essentials |
$7,468.89
|
| Rate for Payer: BCBS of TX PPO |
$8,299.09
|
| Rate for Payer: Cigna Commercial |
$11,459.34
|
|
|
EAR TUBE -- DHF
|
Facility
|
OP
|
$155.00
|
|
| Hospital Charge Code |
81210650
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13.95 |
| Max. Negotiated Rate |
$77.50 |
| Rate for Payer: Aetna Commercial |
$46.50
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$13.95
|
| Rate for Payer: BCBS of TX Blue Advantage |
$46.50
|
| Rate for Payer: BCBS of TX Blue Essentials |
$55.80
|
| Rate for Payer: BCBS of TX PPO |
$62.00
|
| Rate for Payer: Cash Price |
$136.40
|
| Rate for Payer: Multiplan Auto |
$77.50
|
| Rate for Payer: Multiplan Commercial |
$77.50
|
| Rate for Payer: Multiplan Workers Comp |
$77.50
|
| Rate for Payer: Scott and White EPO/PPO |
$77.50
|
| Rate for Payer: Superior Health Plan EPO |
$21.08
|
|
