|
CT Biopsy Renal Right
|
Facility
|
OP
|
$1,821.00
|
|
|
Service Code
|
HCPCS 50200 RT
|
| Hospital Charge Code |
3801008
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$247.66 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$486.45
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,292.24
|
| Rate for Payer: BCBS of TX Blue Essentials |
$2,745.20
|
| Rate for Payer: BCBS of TX PPO |
$3,458.95
|
| Rate for Payer: Cash Price |
$1,238.28
|
| Rate for Payer: Cash Price |
$1,238.28
|
| Rate for Payer: Cash Price |
$1,238.28
|
| Rate for Payer: Cigna Commercial |
$3,507.10
|
| Rate for Payer: Cigna Medicaid |
$1,311.12
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,311.12
|
| 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 |
$1,311.12
|
| Rate for Payer: Scott and White EPO/PPO |
$910.50
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,311.12
|
| Rate for Payer: Superior Health Plan EPO |
$247.66
|
|
|
CT Biopsy Retroperitoneal Abdomen
|
Facility
|
OP
|
$2,714.00
|
|
|
Service Code
|
HCPCS 49180
|
| Hospital Charge Code |
3802162
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$486.45 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$486.45
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,659.12
|
| Rate for Payer: Amerigroup Medicare |
$1,659.12
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,292.24
|
| Rate for Payer: BCBS of TX Blue Essentials |
$2,745.20
|
| Rate for Payer: BCBS of TX Medicare |
$1,659.12
|
| Rate for Payer: BCBS of TX PPO |
$3,458.95
|
| Rate for Payer: Cash Price |
$1,845.52
|
| Rate for Payer: Cash Price |
$1,845.52
|
| Rate for Payer: Cash Price |
$1,845.52
|
| Rate for Payer: Cigna Commercial |
$3,507.10
|
| Rate for Payer: Cigna Medicaid |
$1,954.08
|
| Rate for Payer: Cigna Medicare |
$1,659.12
|
| Rate for Payer: Employer Direct Commercial |
$1,659.12
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,659.12
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,954.08
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,659.12
|
| Rate for Payer: Molina Medicare |
$1,659.12
|
| 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 |
$1,954.08
|
| Rate for Payer: Scott and White EPO/PPO |
$3,069.37
|
| Rate for Payer: Scott and White Medicare |
$1,659.12
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,954.08
|
| Rate for Payer: Superior Health Plan EPO |
$1,659.12
|
| Rate for Payer: Superior Health Plan Medicare |
$1,659.12
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,659.12
|
| Rate for Payer: Universal American Medicare |
$1,659.12
|
| Rate for Payer: Wellcare Medicare |
$1,659.12
|
| Rate for Payer: Wellmed Medicare |
$1,659.12
|
|
|
CT Biopsy Retroperitoneal Abdomen
|
Facility
|
IP
|
$2,714.00
|
|
|
Service Code
|
HCPCS 49180
|
| Hospital Charge Code |
3802162
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$1,845.52
|
|
|
CT Brain/Head w/ Contrast
|
Facility
|
IP
|
$6,082.00
|
|
|
Service Code
|
HCPCS 70460
|
| Hospital Charge Code |
3800018
|
|
Hospital Revenue Code
|
351
|
| Rate for Payer: Cash Price |
$4,135.76
|
|
|
CT Brain/Head w/ Contrast
|
Facility
|
OP
|
$6,082.00
|
|
|
Service Code
|
HCPCS 70460
|
| Hospital Charge Code |
3800018
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$152.36 |
| Max. Negotiated Rate |
$4,379.04 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$152.36
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$176.20
|
| Rate for Payer: Amerigroup Medicare |
$176.20
|
| 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 |
$176.20
|
| Rate for Payer: BCBS of TX PPO |
$402.71
|
| Rate for Payer: Cash Price |
$4,135.76
|
| Rate for Payer: Cash Price |
$4,135.76
|
| Rate for Payer: Cash Price |
$4,135.76
|
| Rate for Payer: Cigna Commercial |
$372.46
|
| Rate for Payer: Cigna Medicaid |
$4,379.04
|
| Rate for Payer: Cigna Medicare |
$176.20
|
| Rate for Payer: Employer Direct Commercial |
$176.20
|
| Rate for Payer: Humana Medicare/TRICARE |
$176.20
|
| Rate for Payer: Molina CHIP/Medicaid |
$4,379.04
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$176.20
|
| Rate for Payer: Molina Medicare |
$176.20
|
| Rate for Payer: Multiplan Auto |
$3,953.30
|
| Rate for Payer: Multiplan Commercial |
$3,953.30
|
| Rate for Payer: Multiplan Workers Comp |
$3,953.30
|
| Rate for Payer: Parkland Medicaid |
$4,379.04
|
| Rate for Payer: Scott and White EPO/PPO |
$3,041.00
|
| Rate for Payer: Scott and White Medicare |
$176.20
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$4,379.04
|
| Rate for Payer: Superior Health Plan EPO |
$176.20
|
| Rate for Payer: Superior Health Plan Medicare |
$176.20
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$176.20
|
| Rate for Payer: Universal American Medicare |
$176.20
|
| Rate for Payer: Wellcare Medicare |
$176.20
|
| Rate for Payer: Wellmed Medicare |
$176.20
|
|
|
CT Brain/Head w/ + w/o Contrast
|
Facility
|
IP
|
$8,702.00
|
|
|
Service Code
|
HCPCS 70470
|
| Hospital Charge Code |
3800026
|
|
Hospital Revenue Code
|
351
|
| Rate for Payer: Cash Price |
$5,917.36
|
|
|
CT Brain/Head w/ + w/o Contrast
|
Facility
|
OP
|
$8,702.00
|
|
|
Service Code
|
HCPCS 70470
|
| Hospital Charge Code |
3800026
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$175.06 |
| Max. Negotiated Rate |
$6,265.44 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$175.06
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$176.20
|
| Rate for Payer: Amerigroup Medicare |
$176.20
|
| 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 |
$176.20
|
| Rate for Payer: BCBS of TX PPO |
$402.71
|
| Rate for Payer: Cash Price |
$5,917.36
|
| Rate for Payer: Cash Price |
$5,917.36
|
| Rate for Payer: Cash Price |
$5,917.36
|
| Rate for Payer: Cigna Commercial |
$372.46
|
| Rate for Payer: Cigna Medicaid |
$6,265.44
|
| Rate for Payer: Cigna Medicare |
$176.20
|
| Rate for Payer: Employer Direct Commercial |
$176.20
|
| Rate for Payer: Humana Medicare/TRICARE |
$176.20
|
| Rate for Payer: Molina CHIP/Medicaid |
$6,265.44
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$176.20
|
| Rate for Payer: Molina Medicare |
$176.20
|
| Rate for Payer: Multiplan Auto |
$5,656.30
|
| Rate for Payer: Multiplan Commercial |
$5,656.30
|
| Rate for Payer: Multiplan Workers Comp |
$5,656.30
|
| Rate for Payer: Parkland Medicaid |
$6,265.44
|
| Rate for Payer: Scott and White EPO/PPO |
$4,351.00
|
| Rate for Payer: Scott and White Medicare |
$176.20
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$6,265.44
|
| Rate for Payer: Superior Health Plan EPO |
$176.20
|
| Rate for Payer: Superior Health Plan Medicare |
$176.20
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$176.20
|
| Rate for Payer: Universal American Medicare |
$176.20
|
| Rate for Payer: Wellcare Medicare |
$176.20
|
| Rate for Payer: Wellmed Medicare |
$176.20
|
|
|
CT brain perfusion
|
Facility
|
IP
|
$716.80
|
|
|
Service Code
|
HCPCS 70473
|
| Hospital Charge Code |
994183
|
|
Hospital Revenue Code
|
359
|
| Rate for Payer: Cash Price |
$487.42
|
|
|
CT brain perfusion
|
Facility
|
OP
|
$716.80
|
|
|
Service Code
|
HCPCS 70473
|
| Hospital Charge Code |
994183
|
|
Hospital Revenue Code
|
359
|
| Min. Negotiated Rate |
$176.20 |
| Max. Negotiated Rate |
$516.10 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$179.20
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$176.20
|
| Rate for Payer: Amerigroup Medicare |
$176.20
|
| Rate for Payer: BCBS of TX Blue Advantage |
$215.04
|
| Rate for Payer: BCBS of TX Blue Essentials |
$258.05
|
| Rate for Payer: BCBS of TX Medicare |
$176.20
|
| Rate for Payer: BCBS of TX PPO |
$286.72
|
| Rate for Payer: Cash Price |
$487.42
|
| Rate for Payer: Cash Price |
$487.42
|
| Rate for Payer: Cash Price |
$487.42
|
| Rate for Payer: Cigna Commercial |
$372.46
|
| Rate for Payer: Cigna Medicaid |
$516.10
|
| Rate for Payer: Cigna Medicare |
$176.20
|
| Rate for Payer: Employer Direct Commercial |
$176.20
|
| Rate for Payer: Humana Medicare/TRICARE |
$176.20
|
| Rate for Payer: Molina CHIP/Medicaid |
$516.10
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$176.20
|
| Rate for Payer: Molina Medicare |
$176.20
|
| Rate for Payer: Multiplan Auto |
$465.92
|
| Rate for Payer: Multiplan Commercial |
$465.92
|
| Rate for Payer: Multiplan Workers Comp |
$465.92
|
| Rate for Payer: Parkland Medicaid |
$516.10
|
| Rate for Payer: Scott and White EPO/PPO |
$358.40
|
| Rate for Payer: Scott and White Medicare |
$176.20
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$516.10
|
| Rate for Payer: Superior Health Plan EPO |
$176.20
|
| Rate for Payer: Superior Health Plan Medicare |
$176.20
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$176.20
|
| Rate for Payer: Universal American Medicare |
$176.20
|
| Rate for Payer: Wellcare Medicare |
$176.20
|
| Rate for Payer: Wellmed Medicare |
$176.20
|
|
|
CT Brain Stroke Protocol w/o Contrast
|
Facility
|
OP
|
$4,495.00
|
|
|
Service Code
|
HCPCS 70450
|
| Hospital Charge Code |
3800034
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$104.75 |
| Max. Negotiated Rate |
$3,236.40 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$104.75
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$105.02
|
| Rate for Payer: Amerigroup Medicare |
$105.02
|
| 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 |
$105.02
|
| Rate for Payer: BCBS of TX PPO |
$247.70
|
| Rate for Payer: Cash Price |
$3,056.60
|
| Rate for Payer: Cash Price |
$3,056.60
|
| Rate for Payer: Cash Price |
$3,056.60
|
| Rate for Payer: Cigna Commercial |
$222.00
|
| Rate for Payer: Cigna Medicaid |
$3,236.40
|
| Rate for Payer: Cigna Medicare |
$105.02
|
| Rate for Payer: Employer Direct Commercial |
$105.02
|
| Rate for Payer: Humana Medicare/TRICARE |
$105.02
|
| Rate for Payer: Molina CHIP/Medicaid |
$3,236.40
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$105.02
|
| Rate for Payer: Molina Medicare |
$105.02
|
| Rate for Payer: Multiplan Auto |
$2,921.75
|
| Rate for Payer: Multiplan Commercial |
$2,921.75
|
| Rate for Payer: Multiplan Workers Comp |
$2,921.75
|
| Rate for Payer: Parkland Medicaid |
$3,236.40
|
| Rate for Payer: Scott and White EPO/PPO |
$2,247.50
|
| Rate for Payer: Scott and White Medicare |
$105.02
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$3,236.40
|
| Rate for Payer: Superior Health Plan EPO |
$105.02
|
| Rate for Payer: Superior Health Plan Medicare |
$105.02
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$105.02
|
| Rate for Payer: Universal American Medicare |
$105.02
|
| Rate for Payer: Wellcare Medicare |
$105.02
|
| Rate for Payer: Wellmed Medicare |
$105.02
|
|
|
CT Brain Stroke Protocol w/o Contrast
|
Facility
|
IP
|
$4,495.00
|
|
|
Service Code
|
HCPCS 70450
|
| Hospital Charge Code |
3800034
|
|
Hospital Revenue Code
|
351
|
| Rate for Payer: Cash Price |
$3,056.60
|
|
|
CT Catheter Exchange
|
Facility
|
IP
|
$815.00
|
|
|
Service Code
|
HCPCS 75984
|
| Hospital Charge Code |
4615985
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$554.20
|
|
|
CT Catheter Exchange
|
Facility
|
OP
|
$815.00
|
|
|
Service Code
|
HCPCS 75984
|
| Hospital Charge Code |
4615985
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$73.35 |
| Max. Negotiated Rate |
$586.80 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$73.35
|
| Rate for Payer: BCBS of TX Blue Advantage |
$112.98
|
| Rate for Payer: BCBS of TX Blue Essentials |
$135.57
|
| Rate for Payer: BCBS of TX PPO |
$151.32
|
| Rate for Payer: Cash Price |
$554.20
|
| Rate for Payer: Cash Price |
$554.20
|
| Rate for Payer: Cigna Medicaid |
$586.80
|
| Rate for Payer: Molina CHIP/Medicaid |
$586.80
|
| Rate for Payer: Multiplan Auto |
$529.75
|
| Rate for Payer: Multiplan Commercial |
$529.75
|
| Rate for Payer: Multiplan Workers Comp |
$529.75
|
| Rate for Payer: Parkland Medicaid |
$586.80
|
| Rate for Payer: Scott and White EPO/PPO |
$407.50
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$586.80
|
| Rate for Payer: Superior Health Plan EPO |
$110.84
|
|
|
CT Cervical spine with & W/out contrast
|
Facility
|
IP
|
$712.08
|
|
|
Service Code
|
HCPCS 72127
|
| Hospital Charge Code |
994146
|
|
Hospital Revenue Code
|
352
|
| Rate for Payer: Cash Price |
$484.21
|
|
|
CT Cervical spine with & W/out contrast
|
Facility
|
OP
|
$712.08
|
|
|
Service Code
|
HCPCS 72127
|
| Hospital Charge Code |
994146
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$175.06 |
| Max. Negotiated Rate |
$512.70 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$175.06
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$176.20
|
| Rate for Payer: Amerigroup Medicare |
$176.20
|
| 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 |
$176.20
|
| Rate for Payer: BCBS of TX PPO |
$402.71
|
| Rate for Payer: Cash Price |
$484.21
|
| Rate for Payer: Cash Price |
$484.21
|
| Rate for Payer: Cash Price |
$484.21
|
| Rate for Payer: Cigna Commercial |
$372.46
|
| Rate for Payer: Cigna Medicaid |
$512.70
|
| Rate for Payer: Cigna Medicare |
$176.20
|
| Rate for Payer: Employer Direct Commercial |
$176.20
|
| Rate for Payer: Humana Medicare/TRICARE |
$176.20
|
| Rate for Payer: Molina CHIP/Medicaid |
$512.70
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$176.20
|
| Rate for Payer: Molina Medicare |
$176.20
|
| Rate for Payer: Multiplan Auto |
$462.85
|
| Rate for Payer: Multiplan Commercial |
$462.85
|
| Rate for Payer: Multiplan Workers Comp |
$462.85
|
| Rate for Payer: Parkland Medicaid |
$512.70
|
| Rate for Payer: Scott and White EPO/PPO |
$356.04
|
| Rate for Payer: Scott and White Medicare |
$176.20
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$512.70
|
| Rate for Payer: Superior Health Plan EPO |
$176.20
|
| Rate for Payer: Superior Health Plan Medicare |
$176.20
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$176.20
|
| Rate for Payer: Universal American Medicare |
$176.20
|
| Rate for Payer: Wellcare Medicare |
$176.20
|
| Rate for Payer: Wellmed Medicare |
$176.20
|
|
|
CT colonography diagnostic
|
Facility
|
OP
|
$427.24
|
|
|
Service Code
|
HCPCS 74261
|
| Hospital Charge Code |
994184
|
|
Hospital Revenue Code
|
359
|
| Min. Negotiated Rate |
$104.75 |
| Max. Negotiated Rate |
$307.61 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$104.75
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$105.02
|
| Rate for Payer: Amerigroup Medicare |
$105.02
|
| 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 |
$105.02
|
| Rate for Payer: BCBS of TX PPO |
$247.70
|
| Rate for Payer: Cash Price |
$290.52
|
| Rate for Payer: Cash Price |
$290.52
|
| Rate for Payer: Cash Price |
$290.52
|
| Rate for Payer: Cigna Commercial |
$222.00
|
| Rate for Payer: Cigna Medicaid |
$307.61
|
| Rate for Payer: Cigna Medicare |
$105.02
|
| Rate for Payer: Employer Direct Commercial |
$105.02
|
| Rate for Payer: Humana Medicare/TRICARE |
$105.02
|
| Rate for Payer: Molina CHIP/Medicaid |
$307.61
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$105.02
|
| Rate for Payer: Molina Medicare |
$105.02
|
| Rate for Payer: Multiplan Auto |
$277.71
|
| Rate for Payer: Multiplan Commercial |
$277.71
|
| Rate for Payer: Multiplan Workers Comp |
$277.71
|
| Rate for Payer: Parkland Medicaid |
$307.61
|
| Rate for Payer: Scott and White EPO/PPO |
$213.62
|
| Rate for Payer: Scott and White Medicare |
$105.02
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$307.61
|
| Rate for Payer: Superior Health Plan EPO |
$105.02
|
| Rate for Payer: Superior Health Plan Medicare |
$105.02
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$105.02
|
| Rate for Payer: Universal American Medicare |
$105.02
|
| Rate for Payer: Wellcare Medicare |
$105.02
|
| Rate for Payer: Wellmed Medicare |
$105.02
|
|
|
CT colonography diagnostic
|
Facility
|
IP
|
$716.80
|
|
|
Service Code
|
HCPCS 74262
|
| Hospital Charge Code |
994185
|
|
Hospital Revenue Code
|
359
|
| Rate for Payer: Cash Price |
$487.42
|
|
|
CT colonography diagnostic
|
Facility
|
OP
|
$716.80
|
|
|
Service Code
|
HCPCS 74262
|
| Hospital Charge Code |
994185
|
|
Hospital Revenue Code
|
359
|
| Min. Negotiated Rate |
$175.06 |
| Max. Negotiated Rate |
$516.10 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$175.06
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$176.20
|
| Rate for Payer: Amerigroup Medicare |
$176.20
|
| 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 |
$176.20
|
| Rate for Payer: BCBS of TX PPO |
$402.71
|
| Rate for Payer: Cash Price |
$487.42
|
| Rate for Payer: Cash Price |
$487.42
|
| Rate for Payer: Cash Price |
$487.42
|
| Rate for Payer: Cigna Commercial |
$372.46
|
| Rate for Payer: Cigna Medicaid |
$516.10
|
| Rate for Payer: Cigna Medicare |
$176.20
|
| Rate for Payer: Employer Direct Commercial |
$176.20
|
| Rate for Payer: Humana Medicare/TRICARE |
$176.20
|
| Rate for Payer: Molina CHIP/Medicaid |
$516.10
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$176.20
|
| Rate for Payer: Molina Medicare |
$176.20
|
| Rate for Payer: Multiplan Auto |
$465.92
|
| Rate for Payer: Multiplan Commercial |
$465.92
|
| Rate for Payer: Multiplan Workers Comp |
$465.92
|
| Rate for Payer: Parkland Medicaid |
$516.10
|
| Rate for Payer: Scott and White EPO/PPO |
$358.40
|
| Rate for Payer: Scott and White Medicare |
$176.20
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$516.10
|
| Rate for Payer: Superior Health Plan EPO |
$176.20
|
| Rate for Payer: Superior Health Plan Medicare |
$176.20
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$176.20
|
| Rate for Payer: Universal American Medicare |
$176.20
|
| Rate for Payer: Wellcare Medicare |
$176.20
|
| Rate for Payer: Wellmed Medicare |
$176.20
|
|
|
CT colonography diagnostic
|
Facility
|
IP
|
$427.24
|
|
|
Service Code
|
HCPCS 74261
|
| Hospital Charge Code |
994184
|
|
Hospital Revenue Code
|
359
|
| Rate for Payer: Cash Price |
$290.52
|
|
|
CT colonography screening
|
Facility
|
OP
|
$975.08
|
|
|
Service Code
|
HCPCS 74263
|
| Hospital Charge Code |
994186
|
|
Hospital Revenue Code
|
359
|
| Min. Negotiated Rate |
$87.76 |
| Max. Negotiated Rate |
$1,440.01 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$87.76
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$239.69
|
| Rate for Payer: Amerigroup Medicare |
$239.69
|
| Rate for Payer: BCBS of TX Blue Advantage |
$1,075.12
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,290.15
|
| Rate for Payer: BCBS of TX Medicare |
$239.69
|
| Rate for Payer: BCBS of TX PPO |
$1,440.01
|
| Rate for Payer: Cash Price |
$663.05
|
| Rate for Payer: Cash Price |
$663.05
|
| Rate for Payer: Cash Price |
$663.05
|
| Rate for Payer: Cigna Commercial |
$506.65
|
| Rate for Payer: Cigna Medicaid |
$702.06
|
| Rate for Payer: Cigna Medicare |
$239.69
|
| Rate for Payer: Employer Direct Commercial |
$239.69
|
| Rate for Payer: Humana Medicare/TRICARE |
$239.69
|
| Rate for Payer: Molina CHIP/Medicaid |
$702.06
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$239.69
|
| Rate for Payer: Molina Medicare |
$239.69
|
| Rate for Payer: Multiplan Auto |
$633.80
|
| Rate for Payer: Multiplan Commercial |
$633.80
|
| Rate for Payer: Multiplan Workers Comp |
$633.80
|
| Rate for Payer: Parkland Medicaid |
$702.06
|
| Rate for Payer: Scott and White EPO/PPO |
$487.54
|
| Rate for Payer: Scott and White Medicare |
$239.69
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$702.06
|
| Rate for Payer: Superior Health Plan EPO |
$239.69
|
| Rate for Payer: Superior Health Plan Medicare |
$239.69
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$239.69
|
| Rate for Payer: Universal American Medicare |
$239.69
|
| Rate for Payer: Wellcare Medicare |
$239.69
|
| Rate for Payer: Wellmed Medicare |
$239.69
|
|
|
CT colonography screening
|
Facility
|
IP
|
$975.08
|
|
|
Service Code
|
HCPCS 74263
|
| Hospital Charge Code |
994186
|
|
Hospital Revenue Code
|
359
|
| Rate for Payer: Cash Price |
$663.05
|
|
|
CT Drain Per/Retr Fld w/Cath Perc
|
Facility
|
OP
|
$6,783.00
|
|
|
Service Code
|
HCPCS 49406
|
| Hospital Charge Code |
3890227
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$486.45 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$486.45
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,659.12
|
| Rate for Payer: Amerigroup Medicare |
$1,659.12
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,292.24
|
| Rate for Payer: BCBS of TX Blue Essentials |
$2,745.20
|
| Rate for Payer: BCBS of TX Medicare |
$1,659.12
|
| Rate for Payer: BCBS of TX PPO |
$3,458.95
|
| Rate for Payer: Cash Price |
$4,612.44
|
| Rate for Payer: Cash Price |
$4,612.44
|
| Rate for Payer: Cash Price |
$4,612.44
|
| Rate for Payer: Cigna Commercial |
$3,507.10
|
| Rate for Payer: Cigna Medicaid |
$4,883.76
|
| Rate for Payer: Cigna Medicare |
$1,659.12
|
| Rate for Payer: Employer Direct Commercial |
$1,659.12
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,659.12
|
| Rate for Payer: Molina CHIP/Medicaid |
$4,883.76
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,659.12
|
| Rate for Payer: Molina Medicare |
$1,659.12
|
| 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 |
$4,883.76
|
| Rate for Payer: Scott and White EPO/PPO |
$3,069.37
|
| Rate for Payer: Scott and White Medicare |
$1,659.12
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$4,883.76
|
| Rate for Payer: Superior Health Plan EPO |
$1,659.12
|
| Rate for Payer: Superior Health Plan Medicare |
$1,659.12
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,659.12
|
| Rate for Payer: Universal American Medicare |
$1,659.12
|
| Rate for Payer: Wellcare Medicare |
$1,659.12
|
| Rate for Payer: Wellmed Medicare |
$1,659.12
|
|
|
CT Drain Per/Retr Fld w/Cath Perc
|
Facility
|
IP
|
$6,783.00
|
|
|
Service Code
|
HCPCS 49406
|
| Hospital Charge Code |
3890227
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$4,612.44
|
|
|
CT Drain Pleura w Cath Right
|
Facility
|
OP
|
$2,334.00
|
|
|
Service Code
|
HCPCS 32557
|
| Hospital Charge Code |
3800001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$446.27 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$446.27
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,581.33
|
| Rate for Payer: Amerigroup Medicare |
$1,581.33
|
| 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 |
$1,581.33
|
| Rate for Payer: BCBS of TX PPO |
$4,110.45
|
| Rate for Payer: Cash Price |
$1,587.12
|
| Rate for Payer: Cash Price |
$1,587.12
|
| Rate for Payer: Cash Price |
$1,587.12
|
| Rate for Payer: Cigna Commercial |
$3,342.63
|
| Rate for Payer: Cigna Medicaid |
$1,680.48
|
| Rate for Payer: Cigna Medicare |
$1,581.33
|
| Rate for Payer: Employer Direct Commercial |
$1,581.33
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,581.33
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,680.48
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,581.33
|
| Rate for Payer: Molina Medicare |
$1,581.33
|
| 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 |
$1,680.48
|
| Rate for Payer: Scott and White EPO/PPO |
$2,925.46
|
| Rate for Payer: Scott and White Medicare |
$1,581.33
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,680.48
|
| Rate for Payer: Superior Health Plan EPO |
$1,581.33
|
| Rate for Payer: Superior Health Plan Medicare |
$1,581.33
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,581.33
|
| Rate for Payer: Universal American Medicare |
$1,581.33
|
| Rate for Payer: Wellcare Medicare |
$1,581.33
|
| Rate for Payer: Wellmed Medicare |
$1,581.33
|
|
|
CT Drain Pleura w Cath Right
|
Facility
|
IP
|
$2,334.00
|
|
|
Service Code
|
HCPCS 32557
|
| Hospital Charge Code |
3800001
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$1,587.12
|
|
