|
ANGIO FOLLOW UP EXISTING CATHETER
|
Facility
|
OP
|
$2,387.00
|
|
|
Service Code
|
CPT 75898
|
| Hospital Charge Code |
2320398
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$52.13 |
| Max. Negotiated Rate |
$6,603.56 |
| Rate for Payer: Aetna Commercial |
$3,254.32
|
| Rate for Payer: Aetna Medicare |
$4,372.65
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$133.71
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$2,915.10
|
| Rate for Payer: Amerigroup Medicare |
$2,915.10
|
| Rate for Payer: BCBS of TX Blue Advantage |
$1,804.75
|
| Rate for Payer: BCBS of TX Blue Essentials |
$2,165.70
|
| Rate for Payer: BCBS of TX Medicare |
$2,915.10
|
| Rate for Payer: BCBS of TX PPO |
$2,417.28
|
| Rate for Payer: Cash Price |
$2,100.56
|
| Rate for Payer: Cash Price |
$2,100.56
|
| Rate for Payer: Cash Price |
$2,100.56
|
| Rate for Payer: Cigna Commercial |
$6,603.56
|
| Rate for Payer: Cigna Medicaid |
$133.71
|
| Rate for Payer: Cigna Medicare |
$2,915.10
|
| Rate for Payer: Employer Direct Commercial |
$2,915.10
|
| Rate for Payer: Humana Medicare/TRICARE |
$2,915.10
|
| Rate for Payer: Molina CHIP/Medicaid |
$133.71
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$2,915.10
|
| Rate for Payer: Molina Medicare |
$2,915.10
|
| Rate for Payer: Multiplan Auto |
$1,551.55
|
| Rate for Payer: Multiplan Commercial |
$1,551.55
|
| Rate for Payer: Multiplan Workers Comp |
$1,551.55
|
| Rate for Payer: Parkland Medicaid |
$133.71
|
| Rate for Payer: Scott and White EPO/PPO |
$52.13
|
| Rate for Payer: Scott and White Medicare |
$2,915.10
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$133.71
|
| Rate for Payer: Superior Health Plan EPO |
$2,915.10
|
| Rate for Payer: Superior Health Plan Medicare |
$2,915.10
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$2,915.10
|
| Rate for Payer: Universal American Medicare |
$2,915.10
|
| Rate for Payer: Wellcare Medicare |
$2,915.10
|
| Rate for Payer: Wellmed Medicare |
$2,915.10
|
|
|
ANGIOGRAPHY EXTREMITY BILATERAL
|
Facility
|
IP
|
$5,813.00
|
|
|
Service Code
|
CPT 75716
|
| Hospital Charge Code |
2303402
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$5,115.44
|
|
|
ANGIOGRAPHY EXTREMITY BILATERAL
|
Facility
|
OP
|
$5,813.00
|
|
|
Service Code
|
CPT 75716
|
| Hospital Charge Code |
2303402
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$52.13 |
| Max. Negotiated Rate |
$6,603.56 |
| Rate for Payer: Aetna Commercial |
$82.46
|
| Rate for Payer: Aetna Medicare |
$4,372.65
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$162.39
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$2,915.10
|
| Rate for Payer: Amerigroup Medicare |
$2,915.10
|
| Rate for Payer: BCBS of TX Blue Advantage |
$4,572.61
|
| Rate for Payer: BCBS of TX Blue Essentials |
$5,487.13
|
| Rate for Payer: BCBS of TX Medicare |
$2,915.10
|
| Rate for Payer: BCBS of TX PPO |
$6,124.53
|
| Rate for Payer: Cash Price |
$5,115.44
|
| Rate for Payer: Cash Price |
$5,115.44
|
| Rate for Payer: Cash Price |
$5,115.44
|
| Rate for Payer: Cigna Commercial |
$6,603.56
|
| Rate for Payer: Cigna Medicaid |
$162.39
|
| Rate for Payer: Cigna Medicare |
$2,915.10
|
| Rate for Payer: Employer Direct Commercial |
$2,915.10
|
| Rate for Payer: Humana Medicare/TRICARE |
$2,915.10
|
| Rate for Payer: Molina CHIP/Medicaid |
$162.39
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$2,915.10
|
| Rate for Payer: Molina Medicare |
$2,915.10
|
| Rate for Payer: Multiplan Auto |
$3,778.45
|
| Rate for Payer: Multiplan Commercial |
$3,778.45
|
| Rate for Payer: Multiplan Workers Comp |
$3,778.45
|
| Rate for Payer: Parkland Medicaid |
$162.39
|
| Rate for Payer: Scott and White EPO/PPO |
$52.13
|
| Rate for Payer: Scott and White Medicare |
$2,915.10
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$162.39
|
| Rate for Payer: Superior Health Plan EPO |
$2,915.10
|
| Rate for Payer: Superior Health Plan Medicare |
$2,915.10
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$2,915.10
|
| Rate for Payer: Universal American Medicare |
$2,915.10
|
| Rate for Payer: Wellcare Medicare |
$2,915.10
|
| Rate for Payer: Wellmed Medicare |
$2,915.10
|
|
|
ANGIOGRAPHY EXTREMITY UNILAT
|
Facility
|
OP
|
$4,768.00
|
|
|
Service Code
|
CPT 75710
|
| Hospital Charge Code |
2312502
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$52.13 |
| Max. Negotiated Rate |
$6,603.56 |
| Rate for Payer: Aetna Commercial |
$79.96
|
| Rate for Payer: Aetna Medicare |
$4,372.65
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$150.36
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$2,915.10
|
| Rate for Payer: Amerigroup Medicare |
$2,915.10
|
| Rate for Payer: BCBS of TX Blue Advantage |
$4,572.61
|
| Rate for Payer: BCBS of TX Blue Essentials |
$5,487.13
|
| Rate for Payer: BCBS of TX Medicare |
$2,915.10
|
| Rate for Payer: BCBS of TX PPO |
$6,124.53
|
| Rate for Payer: Cash Price |
$4,195.84
|
| Rate for Payer: Cash Price |
$4,195.84
|
| Rate for Payer: Cash Price |
$4,195.84
|
| Rate for Payer: Cigna Commercial |
$6,603.56
|
| Rate for Payer: Cigna Medicaid |
$150.36
|
| Rate for Payer: Cigna Medicare |
$2,915.10
|
| Rate for Payer: Employer Direct Commercial |
$2,915.10
|
| Rate for Payer: Humana Medicare/TRICARE |
$2,915.10
|
| Rate for Payer: Molina CHIP/Medicaid |
$150.36
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$2,915.10
|
| Rate for Payer: Molina Medicare |
$2,915.10
|
| Rate for Payer: Multiplan Auto |
$3,099.20
|
| Rate for Payer: Multiplan Commercial |
$3,099.20
|
| Rate for Payer: Multiplan Workers Comp |
$3,099.20
|
| Rate for Payer: Parkland Medicaid |
$150.36
|
| Rate for Payer: Scott and White EPO/PPO |
$52.13
|
| Rate for Payer: Scott and White Medicare |
$2,915.10
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$150.36
|
| Rate for Payer: Superior Health Plan EPO |
$2,915.10
|
| Rate for Payer: Superior Health Plan Medicare |
$2,915.10
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$2,915.10
|
| Rate for Payer: Universal American Medicare |
$2,915.10
|
| Rate for Payer: Wellcare Medicare |
$2,915.10
|
| Rate for Payer: Wellmed Medicare |
$2,915.10
|
|
|
ANGIOGRAPHY EXTREMITY UNILAT
|
Facility
|
IP
|
$4,768.00
|
|
|
Service Code
|
CPT 75710
|
| Hospital Charge Code |
2312502
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$4,195.84
|
|
|
ANGIO INTERNAL MAMMARY
|
Facility
|
OP
|
$2,911.00
|
|
|
Service Code
|
CPT 75756
|
| Hospital Charge Code |
4615757
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$52.13 |
| Max. Negotiated Rate |
$6,603.56 |
| Rate for Payer: Aetna Commercial |
$119.07
|
| Rate for Payer: Aetna Medicare |
$4,372.65
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$161.73
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$2,915.10
|
| Rate for Payer: Amerigroup Medicare |
$2,915.10
|
| Rate for Payer: BCBS of TX Blue Advantage |
$4,572.61
|
| Rate for Payer: BCBS of TX Blue Essentials |
$5,487.13
|
| Rate for Payer: BCBS of TX Medicare |
$2,915.10
|
| Rate for Payer: BCBS of TX PPO |
$6,124.53
|
| Rate for Payer: Cash Price |
$2,561.68
|
| Rate for Payer: Cash Price |
$2,561.68
|
| Rate for Payer: Cash Price |
$2,561.68
|
| Rate for Payer: Cigna Commercial |
$6,603.56
|
| Rate for Payer: Cigna Medicaid |
$161.73
|
| Rate for Payer: Cigna Medicare |
$2,915.10
|
| Rate for Payer: Employer Direct Commercial |
$2,915.10
|
| Rate for Payer: Humana Medicare/TRICARE |
$2,915.10
|
| Rate for Payer: Molina CHIP/Medicaid |
$161.73
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$2,915.10
|
| Rate for Payer: Molina Medicare |
$2,915.10
|
| Rate for Payer: Multiplan Auto |
$1,892.15
|
| Rate for Payer: Multiplan Commercial |
$1,892.15
|
| Rate for Payer: Multiplan Workers Comp |
$1,892.15
|
| Rate for Payer: Parkland Medicaid |
$161.73
|
| Rate for Payer: Scott and White EPO/PPO |
$52.13
|
| Rate for Payer: Scott and White Medicare |
$2,915.10
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$161.73
|
| Rate for Payer: Superior Health Plan EPO |
$2,915.10
|
| Rate for Payer: Superior Health Plan Medicare |
$2,915.10
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$2,915.10
|
| Rate for Payer: Universal American Medicare |
$2,915.10
|
| Rate for Payer: Wellcare Medicare |
$2,915.10
|
| Rate for Payer: Wellmed Medicare |
$2,915.10
|
|
|
ANGIO PELVIC ART SELECT
|
Facility
|
OP
|
$7,951.00
|
|
|
Service Code
|
CPT 75736
|
| Hospital Charge Code |
2303378
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$89.88 |
| Max. Negotiated Rate |
$11,384.78 |
| Rate for Payer: Aetna Commercial |
$102.11
|
| Rate for Payer: Aetna Medicare |
$7,538.62
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$143.01
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$5,025.75
|
| Rate for Payer: Amerigroup Medicare |
$5,025.75
|
| Rate for Payer: BCBS of TX Blue Advantage |
$7,583.71
|
| Rate for Payer: BCBS of TX Blue Essentials |
$9,100.46
|
| Rate for Payer: BCBS of TX Medicare |
$5,025.75
|
| Rate for Payer: BCBS of TX PPO |
$10,157.58
|
| Rate for Payer: Cash Price |
$6,996.88
|
| Rate for Payer: Cash Price |
$6,996.88
|
| Rate for Payer: Cash Price |
$6,996.88
|
| Rate for Payer: Cigna Commercial |
$11,384.78
|
| Rate for Payer: Cigna Medicaid |
$143.01
|
| Rate for Payer: Cigna Medicare |
$5,025.75
|
| Rate for Payer: Employer Direct Commercial |
$5,025.75
|
| Rate for Payer: Humana Medicare/TRICARE |
$5,025.75
|
| Rate for Payer: Molina CHIP/Medicaid |
$143.01
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$5,025.75
|
| Rate for Payer: Molina Medicare |
$5,025.75
|
| Rate for Payer: Multiplan Auto |
$5,168.15
|
| Rate for Payer: Multiplan Commercial |
$5,168.15
|
| Rate for Payer: Multiplan Workers Comp |
$5,168.15
|
| Rate for Payer: Parkland Medicaid |
$143.01
|
| Rate for Payer: Scott and White EPO/PPO |
$89.88
|
| Rate for Payer: Scott and White Medicare |
$5,025.75
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$143.01
|
| Rate for Payer: Superior Health Plan EPO |
$5,025.75
|
| Rate for Payer: Superior Health Plan Medicare |
$5,025.75
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$5,025.75
|
| Rate for Payer: Universal American Medicare |
$5,025.75
|
| Rate for Payer: Wellcare Medicare |
$5,025.75
|
| Rate for Payer: Wellmed Medicare |
$5,025.75
|
|
|
ANGIO PELVIC ART SELECT
|
Facility
|
IP
|
$7,951.00
|
|
|
Service Code
|
CPT 75736
|
| Hospital Charge Code |
2303378
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$6,996.88
|
|
|
ANGIOPLASTY+ATHRECTOMY FEMO/POPLTL
|
Facility
|
OP
|
$25,421.00
|
|
|
Service Code
|
CPT 37225
|
| Hospital Charge Code |
2320537
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$353.72 |
| Max. Negotiated Rate |
$36,327.72 |
| Rate for Payer: Aetna Commercial |
$8,755.00
|
| Rate for Payer: Aetna Medicare |
$24,055.02
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$5,520.66
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$16,036.68
|
| Rate for Payer: Amerigroup Medicare |
$16,036.68
|
| Rate for Payer: BCBS of TX Blue Advantage |
$16,547.16
|
| Rate for Payer: BCBS of TX Blue Essentials |
$19,816.96
|
| Rate for Payer: BCBS of TX Medicare |
$16,036.68
|
| Rate for Payer: BCBS of TX PPO |
$24,969.37
|
| Rate for Payer: Cash Price |
$22,370.48
|
| Rate for Payer: Cash Price |
$22,370.48
|
| Rate for Payer: Cigna Commercial |
$36,327.72
|
| Rate for Payer: Cigna Medicaid |
$5,520.66
|
| Rate for Payer: Cigna Medicare |
$16,036.68
|
| Rate for Payer: Employer Direct Commercial |
$16,036.68
|
| Rate for Payer: Humana Medicare/TRICARE |
$16,036.68
|
| Rate for Payer: Molina CHIP/Medicaid |
$5,520.66
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$16,036.68
|
| Rate for Payer: Molina Medicare |
$16,036.68
|
| Rate for Payer: Multiplan Auto |
$10,000.00
|
| Rate for Payer: Multiplan Commercial |
$10,000.00
|
| Rate for Payer: Multiplan Workers Comp |
$10,000.00
|
| Rate for Payer: Parkland Medicaid |
$5,520.66
|
| Rate for Payer: Scott and White EPO/PPO |
$353.72
|
| Rate for Payer: Scott and White Medicare |
$16,036.68
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$5,520.66
|
| Rate for Payer: Superior Health Plan EPO |
$16,036.68
|
| Rate for Payer: Superior Health Plan Medicare |
$16,036.68
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$16,036.68
|
| Rate for Payer: Universal American Medicare |
$16,036.68
|
| Rate for Payer: Wellcare Medicare |
$16,036.68
|
| Rate for Payer: Wellmed Medicare |
$16,036.68
|
|
|
ANGIOPLASTY+ATHRECTOMY FEMO/POPLTL
|
Facility
|
IP
|
$25,421.00
|
|
|
Service Code
|
CPT 37225
|
| Hospital Charge Code |
2320537
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$22,370.48
|
|
|
ANGIOPLASTY+ATHRECTOMY+STENT FE/POP
|
Facility
|
OP
|
$37,778.00
|
|
|
Service Code
|
CPT 37227
|
| Hospital Charge Code |
2320539
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$353.72 |
| Max. Negotiated Rate |
$40,168.72 |
| Rate for Payer: Aetna Commercial |
$13,390.00
|
| Rate for Payer: Aetna Medicare |
$24,055.02
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$9,226.90
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$16,036.68
|
| Rate for Payer: Amerigroup Medicare |
$16,036.68
|
| Rate for Payer: BCBS of TX Blue Advantage |
$26,619.75
|
| Rate for Payer: BCBS of TX Blue Essentials |
$31,879.94
|
| Rate for Payer: BCBS of TX Medicare |
$16,036.68
|
| Rate for Payer: BCBS of TX PPO |
$40,168.72
|
| Rate for Payer: Cash Price |
$33,244.64
|
| Rate for Payer: Cash Price |
$33,244.64
|
| Rate for Payer: Cigna Commercial |
$36,327.72
|
| Rate for Payer: Cigna Medicaid |
$9,226.90
|
| Rate for Payer: Cigna Medicare |
$16,036.68
|
| Rate for Payer: Employer Direct Commercial |
$16,036.68
|
| Rate for Payer: Humana Medicare/TRICARE |
$16,036.68
|
| Rate for Payer: Molina CHIP/Medicaid |
$9,226.90
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$16,036.68
|
| Rate for Payer: Molina Medicare |
$16,036.68
|
| Rate for Payer: Multiplan Auto |
$10,000.00
|
| Rate for Payer: Multiplan Commercial |
$10,000.00
|
| Rate for Payer: Multiplan Workers Comp |
$10,000.00
|
| Rate for Payer: Parkland Medicaid |
$9,226.90
|
| Rate for Payer: Scott and White EPO/PPO |
$353.72
|
| Rate for Payer: Scott and White Medicare |
$16,036.68
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$9,226.90
|
| Rate for Payer: Superior Health Plan EPO |
$16,036.68
|
| Rate for Payer: Superior Health Plan Medicare |
$16,036.68
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$16,036.68
|
| Rate for Payer: Universal American Medicare |
$16,036.68
|
| Rate for Payer: Wellcare Medicare |
$16,036.68
|
| Rate for Payer: Wellmed Medicare |
$16,036.68
|
|
|
ANGIOPLASTY+ATHRECTOMY+STENT FE/POP
|
Facility
|
IP
|
$37,778.00
|
|
|
Service Code
|
CPT 37227
|
| Hospital Charge Code |
2320539
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$33,244.64
|
|
|
ANGIOPLASTY EA ADD TIBIAL/PERONEAL
|
Facility
|
OP
|
$9,499.00
|
|
|
Service Code
|
CPT 37232
|
| Hospital Charge Code |
2320544
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$854.91 |
| Max. Negotiated Rate |
$7,210.00 |
| Rate for Payer: Aetna Commercial |
$7,210.00
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$854.91
|
| Rate for Payer: Cash Price |
$8,359.12
|
| Rate for Payer: Cash Price |
$8,359.12
|
| Rate for Payer: Multiplan Auto |
$6,174.35
|
| Rate for Payer: Multiplan Commercial |
$6,174.35
|
| Rate for Payer: Multiplan Workers Comp |
$6,174.35
|
| Rate for Payer: Scott and White EPO/PPO |
$4,749.50
|
| Rate for Payer: Superior Health Plan EPO |
$1,291.86
|
|
|
ANGIOPLASTY EA ADD TIBIAL/PERONEAL
|
Facility
|
IP
|
$9,499.00
|
|
|
Service Code
|
CPT 37232
|
| Hospital Charge Code |
2320544
|
|
Hospital Revenue Code
|
480
|
| Rate for Payer: Cash Price |
$8,359.12
|
|
|
ANGIOPLASTY FEMO/POPLTL W STENT
|
Facility
|
IP
|
$24,258.00
|
|
|
Service Code
|
CPT 37226
|
| Hospital Charge Code |
2320538
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$21,347.04
|
|
|
ANGIOPLASTY FEMO/POPLTL W STENT
|
Facility
|
OP
|
$24,258.00
|
|
|
Service Code
|
CPT 37226
|
| Hospital Charge Code |
2320538
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$221.91 |
| Max. Negotiated Rate |
$24,969.37 |
| Rate for Payer: Aetna Commercial |
$8,755.00
|
| Rate for Payer: Aetna Medicare |
$15,091.60
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$5,338.09
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$10,061.07
|
| Rate for Payer: Amerigroup Medicare |
$10,061.07
|
| Rate for Payer: BCBS of TX Blue Advantage |
$16,547.16
|
| Rate for Payer: BCBS of TX Blue Essentials |
$19,816.96
|
| Rate for Payer: BCBS of TX Medicare |
$10,061.07
|
| Rate for Payer: BCBS of TX PPO |
$24,969.37
|
| Rate for Payer: Cash Price |
$21,347.04
|
| Rate for Payer: Cash Price |
$21,347.04
|
| Rate for Payer: Cigna Commercial |
$22,791.24
|
| Rate for Payer: Cigna Medicaid |
$5,338.09
|
| Rate for Payer: Cigna Medicare |
$10,061.07
|
| Rate for Payer: Employer Direct Commercial |
$10,061.07
|
| Rate for Payer: Humana Medicare/TRICARE |
$10,061.07
|
| Rate for Payer: Molina CHIP/Medicaid |
$5,338.09
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$10,061.07
|
| Rate for Payer: Molina Medicare |
$10,061.07
|
| 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 |
$5,338.09
|
| Rate for Payer: Scott and White EPO/PPO |
$221.91
|
| Rate for Payer: Scott and White Medicare |
$10,061.07
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$5,338.09
|
| Rate for Payer: Superior Health Plan EPO |
$10,061.07
|
| Rate for Payer: Superior Health Plan Medicare |
$10,061.07
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$10,061.07
|
| Rate for Payer: Universal American Medicare |
$10,061.07
|
| Rate for Payer: Wellcare Medicare |
$10,061.07
|
| Rate for Payer: Wellmed Medicare |
$10,061.07
|
|
|
ANGIOPLASTY FEMORAL/POPLITEAL
|
Facility
|
OP
|
$15,930.00
|
|
|
Service Code
|
CPT 37224
|
| Hospital Charge Code |
2320536
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$115.30 |
| Max. Negotiated Rate |
$12,483.85 |
| Rate for Payer: Aetna Commercial |
$7,210.00
|
| Rate for Payer: Aetna Medicare |
$7,840.86
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2,512.98
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$5,227.24
|
| Rate for Payer: Amerigroup Medicare |
$5,227.24
|
| Rate for Payer: BCBS of TX Blue Advantage |
$8,273.03
|
| Rate for Payer: BCBS of TX Blue Essentials |
$9,907.82
|
| Rate for Payer: BCBS of TX Medicare |
$5,227.24
|
| Rate for Payer: BCBS of TX PPO |
$12,483.85
|
| Rate for Payer: Cash Price |
$14,018.40
|
| Rate for Payer: Cash Price |
$14,018.40
|
| Rate for Payer: Cigna Commercial |
$11,841.22
|
| Rate for Payer: Cigna Medicaid |
$2,512.98
|
| Rate for Payer: Cigna Medicare |
$5,227.24
|
| Rate for Payer: Employer Direct Commercial |
$5,227.24
|
| Rate for Payer: Humana Medicare/TRICARE |
$5,227.24
|
| Rate for Payer: Molina CHIP/Medicaid |
$2,512.98
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$5,227.24
|
| Rate for Payer: Molina Medicare |
$5,227.24
|
| 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 |
$2,512.98
|
| Rate for Payer: Scott and White EPO/PPO |
$115.30
|
| Rate for Payer: Scott and White Medicare |
$5,227.24
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$2,512.98
|
| Rate for Payer: Superior Health Plan EPO |
$5,227.24
|
| Rate for Payer: Superior Health Plan Medicare |
$5,227.24
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$5,227.24
|
| Rate for Payer: Universal American Medicare |
$5,227.24
|
| Rate for Payer: Wellcare Medicare |
$5,227.24
|
| Rate for Payer: Wellmed Medicare |
$5,227.24
|
|
|
ANGIOPLASTY FEMORAL/POPLITEAL
|
Facility
|
IP
|
$15,930.00
|
|
|
Service Code
|
CPT 37224
|
| Hospital Charge Code |
2320536
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$14,018.40
|
|
|
ANGIOPLASTY ILIAC ART EA ADD IPSI L
|
Facility
|
OP
|
$17,715.00
|
|
|
Service Code
|
CPT 37222
|
| Hospital Charge Code |
2320534
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,594.35 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$7,210.00
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,594.35
|
| Rate for Payer: Cash Price |
$15,589.20
|
| Rate for Payer: Cash Price |
$15,589.20
|
| Rate for Payer: Multiplan Auto |
$10,000.00
|
| Rate for Payer: Multiplan Commercial |
$10,000.00
|
| Rate for Payer: Multiplan Workers Comp |
$10,000.00
|
| Rate for Payer: Scott and White EPO/PPO |
$8,857.50
|
| Rate for Payer: Superior Health Plan EPO |
$2,409.24
|
|
|
ANGIOPLASTY ILIAC ART EA ADD IPSI L
|
Facility
|
IP
|
$17,715.00
|
|
|
Service Code
|
CPT 37222
|
| Hospital Charge Code |
2320534
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$15,589.20
|
|
|
ANGIOPLASTY ILIAC ART EA AD W STENT
|
Facility
|
IP
|
$20,260.00
|
|
|
Service Code
|
CPT 37223
|
| Hospital Charge Code |
2320535
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$17,828.80
|
|
|
ANGIOPLASTY ILIAC ART EA AD W STENT
|
Facility
|
OP
|
$20,260.00
|
|
|
Service Code
|
CPT 37223
|
| Hospital Charge Code |
2320535
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,823.40 |
| Max. Negotiated Rate |
$10,130.00 |
| Rate for Payer: Aetna Commercial |
$7,210.00
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,823.40
|
| Rate for Payer: Cash Price |
$17,828.80
|
| Rate for Payer: Cash Price |
$17,828.80
|
| Rate for Payer: Multiplan Auto |
$10,000.00
|
| Rate for Payer: Multiplan Commercial |
$10,000.00
|
| Rate for Payer: Multiplan Workers Comp |
$10,000.00
|
| Rate for Payer: Scott and White EPO/PPO |
$10,130.00
|
| Rate for Payer: Superior Health Plan EPO |
$2,755.36
|
|
|
ANGIOPLASTY ILIAC ARTERY+STENT
|
Facility
|
IP
|
$23,790.00
|
|
|
Service Code
|
CPT 37221
|
| Hospital Charge Code |
2320533
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$20,935.20
|
|
|
ANGIOPLASTY ILIAC ARTERY+STENT
|
Facility
|
OP
|
$23,790.00
|
|
|
Service Code
|
CPT 37221
|
| Hospital Charge Code |
2320533
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$221.91 |
| Max. Negotiated Rate |
$24,969.37 |
| Rate for Payer: Aetna Commercial |
$8,755.00
|
| Rate for Payer: Aetna Medicare |
$15,091.60
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$5,097.38
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$10,061.07
|
| Rate for Payer: Amerigroup Medicare |
$10,061.07
|
| Rate for Payer: BCBS of TX Blue Advantage |
$16,547.16
|
| Rate for Payer: BCBS of TX Blue Essentials |
$19,816.96
|
| Rate for Payer: BCBS of TX Medicare |
$10,061.07
|
| Rate for Payer: BCBS of TX PPO |
$24,969.37
|
| Rate for Payer: Cash Price |
$20,935.20
|
| Rate for Payer: Cash Price |
$20,935.20
|
| Rate for Payer: Cigna Commercial |
$22,791.24
|
| Rate for Payer: Cigna Medicaid |
$5,097.38
|
| Rate for Payer: Cigna Medicare |
$10,061.07
|
| Rate for Payer: Employer Direct Commercial |
$10,061.07
|
| Rate for Payer: Humana Medicare/TRICARE |
$10,061.07
|
| Rate for Payer: Molina CHIP/Medicaid |
$5,097.38
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$10,061.07
|
| Rate for Payer: Molina Medicare |
$10,061.07
|
| 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 |
$5,097.38
|
| Rate for Payer: Scott and White EPO/PPO |
$221.91
|
| Rate for Payer: Scott and White Medicare |
$10,061.07
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$5,097.38
|
| Rate for Payer: Superior Health Plan EPO |
$10,061.07
|
| Rate for Payer: Superior Health Plan Medicare |
$10,061.07
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$10,061.07
|
| Rate for Payer: Universal American Medicare |
$10,061.07
|
| Rate for Payer: Wellcare Medicare |
$10,061.07
|
| Rate for Payer: Wellmed Medicare |
$10,061.07
|
|
|
ANGIOPLASTY ILIAC ARTERY UNI LAT
|
Facility
|
OP
|
$11,511.00
|
|
|
Service Code
|
CPT 37220
|
| Hospital Charge Code |
2320532
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$115.30 |
| Max. Negotiated Rate |
$12,483.85 |
| Rate for Payer: Aetna Commercial |
$7,210.00
|
| Rate for Payer: Aetna Medicare |
$7,840.86
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2,337.18
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$5,227.24
|
| Rate for Payer: Amerigroup Medicare |
$5,227.24
|
| Rate for Payer: BCBS of TX Blue Advantage |
$8,273.03
|
| Rate for Payer: BCBS of TX Blue Essentials |
$9,907.82
|
| Rate for Payer: BCBS of TX Medicare |
$5,227.24
|
| Rate for Payer: BCBS of TX PPO |
$12,483.85
|
| Rate for Payer: Cash Price |
$10,129.68
|
| Rate for Payer: Cash Price |
$10,129.68
|
| Rate for Payer: Cigna Commercial |
$11,841.22
|
| Rate for Payer: Cigna Medicaid |
$2,337.18
|
| Rate for Payer: Cigna Medicare |
$5,227.24
|
| Rate for Payer: Employer Direct Commercial |
$5,227.24
|
| Rate for Payer: Humana Medicare/TRICARE |
$5,227.24
|
| Rate for Payer: Molina CHIP/Medicaid |
$2,337.18
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$5,227.24
|
| Rate for Payer: Molina Medicare |
$5,227.24
|
| 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 |
$2,337.18
|
| Rate for Payer: Scott and White EPO/PPO |
$115.30
|
| Rate for Payer: Scott and White Medicare |
$5,227.24
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$2,337.18
|
| Rate for Payer: Superior Health Plan EPO |
$5,227.24
|
| Rate for Payer: Superior Health Plan Medicare |
$5,227.24
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$5,227.24
|
| Rate for Payer: Universal American Medicare |
$5,227.24
|
| Rate for Payer: Wellcare Medicare |
$5,227.24
|
| Rate for Payer: Wellmed Medicare |
$5,227.24
|
|
