|
CT Drain Soft Tissue Fluid w/Cath Perc
|
Facility
|
IP
|
$3,790.00
|
|
|
Service Code
|
HCPCS 10030
|
| Hospital Charge Code |
3890225
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$2,577.20
|
|
|
CT Drain Soft Tissue Fluid w/Cath Perc
|
Facility
|
OP
|
$3,790.00
|
|
|
Service Code
|
HCPCS 10030
|
| Hospital Charge Code |
3890225
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$257.60 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$257.60
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$711.36
|
| Rate for Payer: Amerigroup Medicare |
$711.36
|
| Rate for Payer: BCBS of TX Blue Advantage |
$1,018.72
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,220.02
|
| Rate for Payer: BCBS of TX Medicare |
$711.36
|
| Rate for Payer: BCBS of TX PPO |
$1,537.23
|
| Rate for Payer: Cash Price |
$2,577.20
|
| Rate for Payer: Cash Price |
$2,577.20
|
| Rate for Payer: Cash Price |
$2,577.20
|
| Rate for Payer: Cigna Commercial |
$1,503.68
|
| Rate for Payer: Cigna Medicaid |
$2,728.80
|
| Rate for Payer: Cigna Medicare |
$711.36
|
| Rate for Payer: Employer Direct Commercial |
$711.36
|
| Rate for Payer: Humana Medicare/TRICARE |
$711.36
|
| Rate for Payer: Molina CHIP/Medicaid |
$2,728.80
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$711.36
|
| Rate for Payer: Molina Medicare |
$711.36
|
| 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 |
$2,728.80
|
| Rate for Payer: Scott and White EPO/PPO |
$1,316.02
|
| Rate for Payer: Scott and White Medicare |
$711.36
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$2,728.80
|
| Rate for Payer: Superior Health Plan EPO |
$711.36
|
| Rate for Payer: Superior Health Plan Medicare |
$711.36
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$711.36
|
| Rate for Payer: Universal American Medicare |
$711.36
|
| Rate for Payer: Wellcare Medicare |
$711.36
|
| Rate for Payer: Wellmed Medicare |
$711.36
|
|
|
CT Drain Visceral Fluid w/Cath Perc
|
Facility
|
IP
|
$6,667.00
|
|
|
Service Code
|
HCPCS 49405
|
| Hospital Charge Code |
3890226
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$4,533.56
|
|
|
CT Drain Visceral Fluid w/Cath Perc
|
Facility
|
OP
|
$6,667.00
|
|
|
Service Code
|
HCPCS 49405
|
| Hospital Charge Code |
3890226
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$600.03 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$600.03
|
| 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 |
$4,533.56
|
| Rate for Payer: Cash Price |
$4,533.56
|
| Rate for Payer: Cash Price |
$4,533.56
|
| Rate for Payer: Cigna Commercial |
$3,507.10
|
| Rate for Payer: Cigna Medicaid |
$4,800.24
|
| 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 |
$4,800.24
|
| 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 |
$4,800.24
|
| 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 |
$4,800.24
|
| 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
|
|
|
C-Telopeptide, Serum SO
|
Facility
|
OP
|
$226.00
|
|
|
Service Code
|
HCPCS 82523 QW
|
| Hospital Charge Code |
1709161
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.29 |
| Max. Negotiated Rate |
$162.72 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$7.29
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$18.68
|
| Rate for Payer: Amerigroup Medicare |
$18.68
|
| Rate for Payer: BCBS of TX Blue Advantage |
$67.80
|
| Rate for Payer: BCBS of TX Blue Essentials |
$81.36
|
| Rate for Payer: BCBS of TX Medicare |
$18.68
|
| Rate for Payer: BCBS of TX PPO |
$90.40
|
| Rate for Payer: Cash Price |
$153.68
|
| Rate for Payer: Cash Price |
$153.68
|
| Rate for Payer: Cigna Medicaid |
$162.72
|
| Rate for Payer: Cigna Medicare |
$18.68
|
| Rate for Payer: Employer Direct Commercial |
$18.68
|
| Rate for Payer: Humana Medicare/TRICARE |
$18.68
|
| Rate for Payer: Molina CHIP/Medicaid |
$162.72
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$18.68
|
| Rate for Payer: Molina Medicare |
$18.68
|
| Rate for Payer: Multiplan Auto |
$146.90
|
| Rate for Payer: Multiplan Commercial |
$146.90
|
| Rate for Payer: Multiplan Workers Comp |
$146.90
|
| Rate for Payer: Parkland Medicaid |
$162.72
|
| Rate for Payer: Scott and White EPO/PPO |
$23.35
|
| Rate for Payer: Scott and White Medicare |
$18.68
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$162.72
|
| Rate for Payer: Superior Health Plan EPO |
$18.68
|
| Rate for Payer: Superior Health Plan Medicare |
$18.68
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$18.68
|
| Rate for Payer: Universal American Medicare |
$18.68
|
| Rate for Payer: Wellcare Medicare |
$18.68
|
| Rate for Payer: Wellmed Medicare |
$18.68
|
|
|
C-Telopeptide, Serum SO
|
Facility
|
IP
|
$226.00
|
|
|
Service Code
|
HCPCS 82523 QW
|
| Hospital Charge Code |
1709161
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$153.68
|
|
|
CT gated chest without IV Contrast
|
Facility
|
IP
|
$4,075.00
|
|
|
Service Code
|
HCPCS 71250
|
| Hospital Charge Code |
994190
|
|
Hospital Revenue Code
|
352
|
| Rate for Payer: Cash Price |
$2,771.00
|
|
|
CT gated chest without IV Contrast
|
Facility
|
OP
|
$4,075.00
|
|
|
Service Code
|
HCPCS 71250
|
| Hospital Charge Code |
994190
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$104.75 |
| Max. Negotiated Rate |
$2,934.00 |
| 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 |
$2,771.00
|
| Rate for Payer: Cash Price |
$2,771.00
|
| Rate for Payer: Cash Price |
$2,771.00
|
| Rate for Payer: Cigna Commercial |
$222.00
|
| Rate for Payer: Cigna Medicaid |
$2,934.00
|
| 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 |
$2,934.00
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$105.02
|
| Rate for Payer: Molina Medicare |
$105.02
|
| 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 |
$2,934.00
|
| Rate for Payer: Scott and White EPO/PPO |
$2,037.50
|
| Rate for Payer: Scott and White Medicare |
$105.02
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$2,934.00
|
| 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 Guidance for Needle Placement
|
Facility
|
IP
|
$4,508.00
|
|
|
Service Code
|
HCPCS 77012
|
| Hospital Charge Code |
3820024
|
|
Hospital Revenue Code
|
350
|
| Rate for Payer: Cash Price |
$3,065.44
|
|
|
CT Guidance for Needle Placement
|
Facility
|
OP
|
$4,508.00
|
|
|
Service Code
|
HCPCS 77012
|
| Hospital Charge Code |
3820024
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$129.03 |
| Max. Negotiated Rate |
$3,245.76 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$405.72
|
| Rate for Payer: BCBS of TX Blue Advantage |
$129.03
|
| Rate for Payer: BCBS of TX Blue Essentials |
$154.84
|
| Rate for Payer: BCBS of TX PPO |
$172.82
|
| Rate for Payer: Cash Price |
$3,065.44
|
| Rate for Payer: Cash Price |
$3,065.44
|
| Rate for Payer: Cigna Medicaid |
$3,245.76
|
| Rate for Payer: Molina CHIP/Medicaid |
$3,245.76
|
| Rate for Payer: Multiplan Auto |
$2,930.20
|
| Rate for Payer: Multiplan Commercial |
$2,930.20
|
| Rate for Payer: Multiplan Workers Comp |
$2,930.20
|
| Rate for Payer: Parkland Medicaid |
$3,245.76
|
| Rate for Payer: Scott and White EPO/PPO |
$2,254.00
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$3,245.76
|
| Rate for Payer: Superior Health Plan EPO |
$613.09
|
|
|
CT Guided FNA Biopsy, First Lesion
|
Facility
|
OP
|
$2,851.00
|
|
|
Service Code
|
HCPCS 10009
|
| Hospital Charge Code |
3800245
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$257.60 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$257.60
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$711.36
|
| Rate for Payer: Amerigroup Medicare |
$711.36
|
| Rate for Payer: BCBS of TX Blue Advantage |
$514.74
|
| Rate for Payer: BCBS of TX Blue Essentials |
$616.46
|
| Rate for Payer: BCBS of TX Medicare |
$711.36
|
| Rate for Payer: BCBS of TX PPO |
$776.74
|
| Rate for Payer: Cash Price |
$1,938.68
|
| Rate for Payer: Cash Price |
$1,938.68
|
| Rate for Payer: Cash Price |
$1,938.68
|
| Rate for Payer: Cigna Commercial |
$1,503.68
|
| Rate for Payer: Cigna Medicaid |
$2,052.72
|
| Rate for Payer: Cigna Medicare |
$711.36
|
| Rate for Payer: Employer Direct Commercial |
$711.36
|
| Rate for Payer: Humana Medicare/TRICARE |
$711.36
|
| Rate for Payer: Molina CHIP/Medicaid |
$2,052.72
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$711.36
|
| Rate for Payer: Molina Medicare |
$711.36
|
| 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 |
$2,052.72
|
| Rate for Payer: Scott and White EPO/PPO |
$1,316.02
|
| Rate for Payer: Scott and White Medicare |
$711.36
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$2,052.72
|
| Rate for Payer: Superior Health Plan EPO |
$711.36
|
| Rate for Payer: Superior Health Plan Medicare |
$711.36
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$711.36
|
| Rate for Payer: Universal American Medicare |
$711.36
|
| Rate for Payer: Wellcare Medicare |
$711.36
|
| Rate for Payer: Wellmed Medicare |
$711.36
|
|
|
CT Guided FNA Biopsy, First Lesion
|
Facility
|
IP
|
$2,851.00
|
|
|
Service Code
|
HCPCS 10009
|
| Hospital Charge Code |
3800245
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$1,938.68
|
|
|
CT Heart Calcium Scoring
|
Facility
|
IP
|
$151.00
|
|
|
Service Code
|
HCPCS 75571
|
| Hospital Charge Code |
3860005
|
|
Hospital Revenue Code
|
350
|
| Rate for Payer: Cash Price |
$102.68
|
|
|
CT Heart Calcium Scoring
|
Facility
|
OP
|
$151.00
|
|
|
Service Code
|
HCPCS 75571
|
| Hospital Charge Code |
3860005
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$75.50 |
| Max. Negotiated Rate |
$184.79 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$86.58
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$87.42
|
| Rate for Payer: Amerigroup Medicare |
$87.42
|
| Rate for Payer: BCBS of TX Blue Advantage |
$131.69
|
| Rate for Payer: BCBS of TX Blue Essentials |
$158.02
|
| Rate for Payer: BCBS of TX Medicare |
$87.42
|
| Rate for Payer: BCBS of TX PPO |
$176.38
|
| Rate for Payer: Cash Price |
$102.68
|
| Rate for Payer: Cash Price |
$102.68
|
| Rate for Payer: Cash Price |
$102.68
|
| Rate for Payer: Cigna Commercial |
$184.79
|
| Rate for Payer: Cigna Medicaid |
$108.72
|
| Rate for Payer: Cigna Medicare |
$87.42
|
| Rate for Payer: Employer Direct Commercial |
$87.42
|
| Rate for Payer: Humana Medicare/TRICARE |
$87.42
|
| Rate for Payer: Molina CHIP/Medicaid |
$108.72
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$87.42
|
| Rate for Payer: Molina Medicare |
$87.42
|
| Rate for Payer: Multiplan Auto |
$98.15
|
| Rate for Payer: Multiplan Commercial |
$98.15
|
| Rate for Payer: Multiplan Workers Comp |
$98.15
|
| Rate for Payer: Parkland Medicaid |
$108.72
|
| Rate for Payer: Scott and White EPO/PPO |
$75.50
|
| Rate for Payer: Scott and White Medicare |
$87.42
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$108.72
|
| Rate for Payer: Superior Health Plan EPO |
$87.42
|
| Rate for Payer: Superior Health Plan Medicare |
$87.42
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$87.42
|
| Rate for Payer: Universal American Medicare |
$87.42
|
| Rate for Payer: Wellcare Medicare |
$87.42
|
| Rate for Payer: Wellmed Medicare |
$87.42
|
|
|
CT, heart, w/out contrast material, with quan evaluation of coronary calcium
|
Facility
|
IP
|
$355.64
|
|
|
Service Code
|
HCPCS 75571
|
| Hospital Charge Code |
994180
|
|
Hospital Revenue Code
|
359
|
| Rate for Payer: Cash Price |
$241.84
|
|
|
CT, heart, w/out contrast material, with quan evaluation of coronary calcium
|
Facility
|
OP
|
$355.64
|
|
|
Service Code
|
HCPCS 75571
|
| Hospital Charge Code |
994180
|
|
Hospital Revenue Code
|
359
|
| Min. Negotiated Rate |
$86.58 |
| Max. Negotiated Rate |
$256.06 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$86.58
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$87.42
|
| Rate for Payer: Amerigroup Medicare |
$87.42
|
| Rate for Payer: BCBS of TX Blue Advantage |
$131.69
|
| Rate for Payer: BCBS of TX Blue Essentials |
$158.02
|
| Rate for Payer: BCBS of TX Medicare |
$87.42
|
| Rate for Payer: BCBS of TX PPO |
$176.38
|
| Rate for Payer: Cash Price |
$241.84
|
| Rate for Payer: Cash Price |
$241.84
|
| Rate for Payer: Cash Price |
$241.84
|
| Rate for Payer: Cigna Commercial |
$184.79
|
| Rate for Payer: Cigna Medicaid |
$256.06
|
| Rate for Payer: Cigna Medicare |
$87.42
|
| Rate for Payer: Employer Direct Commercial |
$87.42
|
| Rate for Payer: Humana Medicare/TRICARE |
$87.42
|
| Rate for Payer: Molina CHIP/Medicaid |
$256.06
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$87.42
|
| Rate for Payer: Molina Medicare |
$87.42
|
| Rate for Payer: Multiplan Auto |
$231.17
|
| Rate for Payer: Multiplan Commercial |
$231.17
|
| Rate for Payer: Multiplan Workers Comp |
$231.17
|
| Rate for Payer: Parkland Medicaid |
$256.06
|
| Rate for Payer: Scott and White EPO/PPO |
$177.82
|
| Rate for Payer: Scott and White Medicare |
$87.42
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$256.06
|
| Rate for Payer: Superior Health Plan EPO |
$87.42
|
| Rate for Payer: Superior Health Plan Medicare |
$87.42
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$87.42
|
| Rate for Payer: Universal American Medicare |
$87.42
|
| Rate for Payer: Wellcare Medicare |
$87.42
|
| Rate for Payer: Wellmed Medicare |
$87.42
|
|
|
CT Humerus w/ + w/o Contrast Left
|
Facility
|
OP
|
$3,348.00
|
|
|
Service Code
|
HCPCS 73202 LT
|
| Hospital Charge Code |
3800950
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$175.06 |
| Max. Negotiated Rate |
$2,410.56 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$175.06
|
| 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 PPO |
$402.71
|
| Rate for Payer: Cash Price |
$2,276.64
|
| Rate for Payer: Cash Price |
$2,276.64
|
| Rate for Payer: Cash Price |
$2,276.64
|
| Rate for Payer: Cigna Commercial |
$372.46
|
| Rate for Payer: Cigna Medicaid |
$2,410.56
|
| Rate for Payer: Molina CHIP/Medicaid |
$2,410.56
|
| Rate for Payer: Multiplan Auto |
$2,176.20
|
| Rate for Payer: Multiplan Commercial |
$2,176.20
|
| Rate for Payer: Multiplan Workers Comp |
$2,176.20
|
| Rate for Payer: Parkland Medicaid |
$2,410.56
|
| Rate for Payer: Scott and White EPO/PPO |
$1,674.00
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$2,410.56
|
| Rate for Payer: Superior Health Plan EPO |
$455.33
|
|
|
CT Humerus w/ + w/o Contrast Left
|
Facility
|
IP
|
$3,348.00
|
|
|
Service Code
|
HCPCS 73202 LT
|
| Hospital Charge Code |
3800950
|
|
Hospital Revenue Code
|
352
|
| Rate for Payer: Cash Price |
$2,276.64
|
|
|
CT Humerus w/ + w/o Contrast Right
|
Facility
|
IP
|
$3,348.00
|
|
|
Service Code
|
HCPCS 73202 RT
|
| Hospital Charge Code |
3801859
|
|
Hospital Revenue Code
|
352
|
| Rate for Payer: Cash Price |
$2,276.64
|
|
|
CT Humerus w/ + w/o Contrast Right
|
Facility
|
OP
|
$3,348.00
|
|
|
Service Code
|
HCPCS 73202 RT
|
| Hospital Charge Code |
3801859
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$175.06 |
| Max. Negotiated Rate |
$2,410.56 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$175.06
|
| 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 PPO |
$402.71
|
| Rate for Payer: Cash Price |
$2,276.64
|
| Rate for Payer: Cash Price |
$2,276.64
|
| Rate for Payer: Cash Price |
$2,276.64
|
| Rate for Payer: Cigna Commercial |
$372.46
|
| Rate for Payer: Cigna Medicaid |
$2,410.56
|
| Rate for Payer: Molina CHIP/Medicaid |
$2,410.56
|
| Rate for Payer: Multiplan Auto |
$2,176.20
|
| Rate for Payer: Multiplan Commercial |
$2,176.20
|
| Rate for Payer: Multiplan Workers Comp |
$2,176.20
|
| Rate for Payer: Parkland Medicaid |
$2,410.56
|
| Rate for Payer: Scott and White EPO/PPO |
$1,674.00
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$2,410.56
|
| Rate for Payer: Superior Health Plan EPO |
$455.33
|
|
|
CT Incis/Drain Hema/Seroma/Fluid
|
Facility
|
IP
|
$6,773.30
|
|
|
Service Code
|
HCPCS 10140
|
| Hospital Charge Code |
8912548
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$4,605.84
|
|
|
CT Incis/Drain Hema/Seroma/Fluid
|
Facility
|
OP
|
$6,773.30
|
|
|
Service Code
|
HCPCS 10140
|
| Hospital Charge Code |
8912548
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$90.81 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$90.81
|
| 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 |
$183.82
|
| Rate for Payer: BCBS of TX Blue Essentials |
$220.14
|
| Rate for Payer: BCBS of TX Medicare |
$1,659.12
|
| Rate for Payer: BCBS of TX PPO |
$277.38
|
| Rate for Payer: Cash Price |
$4,605.84
|
| Rate for Payer: Cash Price |
$4,605.84
|
| Rate for Payer: Cash Price |
$4,605.84
|
| Rate for Payer: Cigna Commercial |
$3,507.10
|
| Rate for Payer: Cigna Medicaid |
$4,876.78
|
| 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 |
$4,876.78
|
| 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 |
$4,876.78
|
| 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 |
$4,876.78
|
| 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 Joint/Bursa Major Arthr/Asp/Inj Right BCE
|
Facility
|
OP
|
$1,676.00
|
|
|
Service Code
|
HCPCS 20610
|
| Hospital Charge Code |
3860001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$27.96 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$27.96
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$308.35
|
| Rate for Payer: Amerigroup Medicare |
$308.35
|
| Rate for Payer: BCBS of TX Blue Advantage |
$51.84
|
| Rate for Payer: BCBS of TX Blue Essentials |
$62.08
|
| Rate for Payer: BCBS of TX Medicare |
$308.35
|
| Rate for Payer: BCBS of TX PPO |
$78.22
|
| Rate for Payer: Cash Price |
$1,139.68
|
| Rate for Payer: Cash Price |
$1,139.68
|
| Rate for Payer: Cash Price |
$1,139.68
|
| Rate for Payer: Cigna Commercial |
$651.79
|
| Rate for Payer: Cigna Medicaid |
$1,206.72
|
| Rate for Payer: Cigna Medicare |
$308.35
|
| Rate for Payer: Employer Direct Commercial |
$308.35
|
| Rate for Payer: Humana Medicare/TRICARE |
$308.35
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,206.72
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$308.35
|
| Rate for Payer: Molina Medicare |
$308.35
|
| 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 |
$1,206.72
|
| Rate for Payer: Scott and White EPO/PPO |
$570.45
|
| Rate for Payer: Scott and White Medicare |
$308.35
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,206.72
|
| Rate for Payer: Superior Health Plan EPO |
$308.35
|
| Rate for Payer: Superior Health Plan Medicare |
$308.35
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$308.35
|
| Rate for Payer: Universal American Medicare |
$308.35
|
| Rate for Payer: Wellcare Medicare |
$308.35
|
| Rate for Payer: Wellmed Medicare |
$308.35
|
|
|
CT Joint/Bursa Major Arthr/Asp/Inj Right BCE
|
Facility
|
IP
|
$1,676.00
|
|
|
Service Code
|
HCPCS 20610
|
| Hospital Charge Code |
3860001
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$1,139.68
|
|
|
CT Limited Study/Follow Up Study
|
Facility
|
OP
|
$1,113.00
|
|
|
Service Code
|
HCPCS 76380
|
| Hospital Charge Code |
5056505
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$86.58 |
| Max. Negotiated Rate |
$801.36 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$86.58
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$87.42
|
| Rate for Payer: Amerigroup Medicare |
$87.42
|
| Rate for Payer: BCBS of TX Blue Advantage |
$131.69
|
| Rate for Payer: BCBS of TX Blue Essentials |
$158.02
|
| Rate for Payer: BCBS of TX Medicare |
$87.42
|
| Rate for Payer: BCBS of TX PPO |
$176.38
|
| Rate for Payer: Cash Price |
$756.84
|
| Rate for Payer: Cash Price |
$756.84
|
| Rate for Payer: Cash Price |
$756.84
|
| Rate for Payer: Cigna Commercial |
$184.79
|
| Rate for Payer: Cigna Medicaid |
$801.36
|
| Rate for Payer: Cigna Medicare |
$87.42
|
| Rate for Payer: Employer Direct Commercial |
$87.42
|
| Rate for Payer: Humana Medicare/TRICARE |
$87.42
|
| Rate for Payer: Molina CHIP/Medicaid |
$801.36
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$87.42
|
| Rate for Payer: Molina Medicare |
$87.42
|
| Rate for Payer: Multiplan Auto |
$723.45
|
| Rate for Payer: Multiplan Commercial |
$723.45
|
| Rate for Payer: Multiplan Workers Comp |
$723.45
|
| Rate for Payer: Parkland Medicaid |
$801.36
|
| Rate for Payer: Scott and White EPO/PPO |
$556.50
|
| Rate for Payer: Scott and White Medicare |
$87.42
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$801.36
|
| Rate for Payer: Superior Health Plan EPO |
$87.42
|
| Rate for Payer: Superior Health Plan Medicare |
$87.42
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$87.42
|
| Rate for Payer: Universal American Medicare |
$87.42
|
| Rate for Payer: Wellcare Medicare |
$87.42
|
| Rate for Payer: Wellmed Medicare |
$87.42
|
|
