|
EKG Charges - EKG -> Echocardiogram Doppler 93320
|
Facility
|
OP
|
$920.00
|
|
|
Service Code
|
HCPCS 93320
|
| Hospital Charge Code |
2800241
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$62.60 |
| Max. Negotiated Rate |
$662.40 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$82.80
|
| Rate for Payer: BCBS of TX Blue Advantage |
$276.00
|
| Rate for Payer: BCBS of TX Blue Essentials |
$331.20
|
| Rate for Payer: BCBS of TX PPO |
$368.00
|
| Rate for Payer: Cash Price |
$625.60
|
| Rate for Payer: Cash Price |
$625.60
|
| Rate for Payer: Cigna Medicaid |
$662.40
|
| Rate for Payer: Molina CHIP/Medicaid |
$662.40
|
| Rate for Payer: Multiplan Auto |
$598.00
|
| Rate for Payer: Multiplan Commercial |
$598.00
|
| Rate for Payer: Multiplan Workers Comp |
$598.00
|
| Rate for Payer: Parkland Medicaid |
$662.40
|
| Rate for Payer: Scott and White EPO/PPO |
$62.60
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$662.40
|
| Rate for Payer: Superior Health Plan EPO |
$125.12
|
|
|
EKG Charges - EKG -> Echocardiogram Doppler 93320
|
Facility
|
IP
|
$920.00
|
|
|
Service Code
|
HCPCS 93320
|
| Hospital Charge Code |
2800241
|
|
Hospital Revenue Code
|
480
|
| Rate for Payer: Cash Price |
$625.60
|
|
|
EKG Charges - EKG -> Echocardiogram Ex Stress 93350
|
Facility
|
IP
|
$2,782.00
|
|
|
Service Code
|
HCPCS 93350
|
| Hospital Charge Code |
2800704
|
|
Hospital Revenue Code
|
480
|
| Rate for Payer: Cash Price |
$1,891.76
|
|
|
EKG Charges - EKG -> Echocardiogram Ex Stress 93350
|
Facility
|
OP
|
$2,782.00
|
|
|
Service Code
|
HCPCS 93350
|
| Hospital Charge Code |
2800704
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$229.04 |
| Max. Negotiated Rate |
$2,003.04 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$250.38
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$548.90
|
| Rate for Payer: Amerigroup Medicare |
$548.90
|
| Rate for Payer: BCBS of TX Blue Advantage |
$834.60
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,001.52
|
| Rate for Payer: BCBS of TX Medicare |
$548.90
|
| Rate for Payer: BCBS of TX PPO |
$1,112.80
|
| Rate for Payer: Cash Price |
$1,891.76
|
| Rate for Payer: Cash Price |
$1,891.76
|
| Rate for Payer: Cash Price |
$1,891.76
|
| Rate for Payer: Cigna Commercial |
$1,160.29
|
| Rate for Payer: Cigna Medicaid |
$2,003.04
|
| Rate for Payer: Cigna Medicare |
$548.90
|
| Rate for Payer: Employer Direct Commercial |
$548.90
|
| Rate for Payer: Humana Medicare/TRICARE |
$548.90
|
| Rate for Payer: Molina CHIP/Medicaid |
$2,003.04
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$548.90
|
| Rate for Payer: Molina Medicare |
$548.90
|
| Rate for Payer: Multiplan Auto |
$1,808.30
|
| Rate for Payer: Multiplan Commercial |
$1,808.30
|
| Rate for Payer: Multiplan Workers Comp |
$1,808.30
|
| Rate for Payer: Parkland Medicaid |
$2,003.04
|
| Rate for Payer: Scott and White EPO/PPO |
$229.04
|
| Rate for Payer: Scott and White Medicare |
$548.90
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$2,003.04
|
| Rate for Payer: Superior Health Plan EPO |
$548.90
|
| Rate for Payer: Superior Health Plan Medicare |
$548.90
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$548.90
|
| Rate for Payer: Universal American Medicare |
$548.90
|
| Rate for Payer: Wellcare Medicare |
$548.90
|
| Rate for Payer: Wellmed Medicare |
$548.90
|
|
|
EKG Charges - EKG -> Echocardiogram w/ Contrast 99307
|
Facility
|
IP
|
$3,991.00
|
|
|
Service Code
|
HCPCS 93307
|
| Hospital Charge Code |
9230980
|
|
Hospital Revenue Code
|
480
|
| Rate for Payer: Cash Price |
$2,713.88
|
|
|
EKG Charges - EKG -> Echocardiogram w/ Contrast 99307
|
Facility
|
OP
|
$3,991.00
|
|
|
Service Code
|
HCPCS 93307
|
| Hospital Charge Code |
9230980
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$168.46 |
| Max. Negotiated Rate |
$2,873.52 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$359.19
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$239.69
|
| Rate for Payer: Amerigroup Medicare |
$239.69
|
| Rate for Payer: BCBS of TX Blue Advantage |
$1,197.30
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,436.76
|
| Rate for Payer: BCBS of TX Medicare |
$239.69
|
| Rate for Payer: BCBS of TX PPO |
$1,596.40
|
| Rate for Payer: Cash Price |
$2,713.88
|
| Rate for Payer: Cash Price |
$2,713.88
|
| Rate for Payer: Cash Price |
$2,713.88
|
| Rate for Payer: Cigna Commercial |
$506.65
|
| Rate for Payer: Cigna Medicaid |
$2,873.52
|
| 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 |
$2,873.52
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$239.69
|
| Rate for Payer: Molina Medicare |
$239.69
|
| Rate for Payer: Multiplan Auto |
$2,594.15
|
| Rate for Payer: Multiplan Commercial |
$2,594.15
|
| Rate for Payer: Multiplan Workers Comp |
$2,594.15
|
| Rate for Payer: Parkland Medicaid |
$2,873.52
|
| Rate for Payer: Scott and White EPO/PPO |
$168.46
|
| Rate for Payer: Scott and White Medicare |
$239.69
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$2,873.52
|
| 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
|
|
|
EKG Charges - EKG -> Echocardiogram w/o Contrast 93307
|
Facility
|
IP
|
$3,991.00
|
|
|
Service Code
|
HCPCS 93307
|
| Hospital Charge Code |
2800159
|
|
Hospital Revenue Code
|
480
|
| Rate for Payer: Cash Price |
$2,713.88
|
|
|
EKG Charges - EKG -> Echocardiogram w/o Contrast 93307
|
Facility
|
OP
|
$3,991.00
|
|
|
Service Code
|
HCPCS 93307
|
| Hospital Charge Code |
2800159
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$168.46 |
| Max. Negotiated Rate |
$2,873.52 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$359.19
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$239.69
|
| Rate for Payer: Amerigroup Medicare |
$239.69
|
| Rate for Payer: BCBS of TX Blue Advantage |
$1,197.30
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,436.76
|
| Rate for Payer: BCBS of TX Medicare |
$239.69
|
| Rate for Payer: BCBS of TX PPO |
$1,596.40
|
| Rate for Payer: Cash Price |
$2,713.88
|
| Rate for Payer: Cash Price |
$2,713.88
|
| Rate for Payer: Cash Price |
$2,713.88
|
| Rate for Payer: Cigna Commercial |
$506.65
|
| Rate for Payer: Cigna Medicaid |
$2,873.52
|
| 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 |
$2,873.52
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$239.69
|
| Rate for Payer: Molina Medicare |
$239.69
|
| Rate for Payer: Multiplan Auto |
$2,594.15
|
| Rate for Payer: Multiplan Commercial |
$2,594.15
|
| Rate for Payer: Multiplan Workers Comp |
$2,594.15
|
| Rate for Payer: Parkland Medicaid |
$2,873.52
|
| Rate for Payer: Scott and White EPO/PPO |
$168.46
|
| Rate for Payer: Scott and White Medicare |
$239.69
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$2,873.52
|
| 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
|
|
|
EKG Charges - EKG -> Echo Doppler LTD or Follow Up 93321
|
Facility
|
IP
|
$697.00
|
|
|
Service Code
|
HCPCS 93321
|
| Hospital Charge Code |
2810002
|
|
Hospital Revenue Code
|
483
|
| Rate for Payer: Cash Price |
$473.96
|
|
|
EKG Charges - EKG -> Echo Doppler LTD or Follow Up 93321
|
Facility
|
OP
|
$697.00
|
|
|
Service Code
|
HCPCS 93321
|
| Hospital Charge Code |
2810002
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$30.89 |
| Max. Negotiated Rate |
$501.84 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$62.73
|
| Rate for Payer: BCBS of TX Blue Advantage |
$209.10
|
| Rate for Payer: BCBS of TX Blue Essentials |
$250.92
|
| Rate for Payer: BCBS of TX PPO |
$278.80
|
| Rate for Payer: Cash Price |
$473.96
|
| Rate for Payer: Cash Price |
$473.96
|
| Rate for Payer: Cigna Medicaid |
$501.84
|
| Rate for Payer: Molina CHIP/Medicaid |
$501.84
|
| Rate for Payer: Multiplan Auto |
$453.05
|
| Rate for Payer: Multiplan Commercial |
$453.05
|
| Rate for Payer: Multiplan Workers Comp |
$453.05
|
| Rate for Payer: Parkland Medicaid |
$501.84
|
| Rate for Payer: Scott and White EPO/PPO |
$30.89
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$501.84
|
| Rate for Payer: Superior Health Plan EPO |
$94.79
|
|
|
EKG Charges - EKG -> Echo Trans ESO w/ Probe w/ Contrast 93312
|
Facility
|
IP
|
$3,210.00
|
|
|
Service Code
|
HCPCS 93312
|
| Hospital Charge Code |
2800696
|
|
Hospital Revenue Code
|
480
|
| Rate for Payer: Cash Price |
$2,182.80
|
|
|
EKG Charges - EKG -> Echo Trans ESO w/ Probe w/ Contrast 93312
|
Facility
|
OP
|
$3,210.00
|
|
|
Service Code
|
HCPCS 93312
|
| Hospital Charge Code |
2800696
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$288.90 |
| Max. Negotiated Rate |
$2,311.20 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$288.90
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$548.90
|
| Rate for Payer: Amerigroup Medicare |
$548.90
|
| Rate for Payer: BCBS of TX Blue Advantage |
$963.00
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,155.60
|
| Rate for Payer: BCBS of TX Medicare |
$548.90
|
| Rate for Payer: BCBS of TX PPO |
$1,284.00
|
| Rate for Payer: Cash Price |
$2,182.80
|
| Rate for Payer: Cash Price |
$2,182.80
|
| Rate for Payer: Cash Price |
$2,182.80
|
| Rate for Payer: Cigna Commercial |
$1,160.29
|
| Rate for Payer: Cigna Medicaid |
$2,311.20
|
| Rate for Payer: Cigna Medicare |
$548.90
|
| Rate for Payer: Employer Direct Commercial |
$548.90
|
| Rate for Payer: Humana Medicare/TRICARE |
$548.90
|
| Rate for Payer: Molina CHIP/Medicaid |
$2,311.20
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$548.90
|
| Rate for Payer: Molina Medicare |
$548.90
|
| Rate for Payer: Multiplan Auto |
$2,086.50
|
| Rate for Payer: Multiplan Commercial |
$2,086.50
|
| Rate for Payer: Multiplan Workers Comp |
$2,086.50
|
| Rate for Payer: Parkland Medicaid |
$2,311.20
|
| Rate for Payer: Scott and White EPO/PPO |
$290.79
|
| Rate for Payer: Scott and White Medicare |
$548.90
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$2,311.20
|
| Rate for Payer: Superior Health Plan EPO |
$548.90
|
| Rate for Payer: Superior Health Plan Medicare |
$548.90
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$548.90
|
| Rate for Payer: Universal American Medicare |
$548.90
|
| Rate for Payer: Wellcare Medicare |
$548.90
|
| Rate for Payer: Wellmed Medicare |
$548.90
|
|
|
EKG Charges - EKG -> Echo Transthoracic LTD 93304
|
Facility
|
OP
|
$1,683.00
|
|
|
Service Code
|
HCPCS 93304
|
| Hospital Charge Code |
4606608
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$151.47 |
| Max. Negotiated Rate |
$1,211.76 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$151.47
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$548.90
|
| Rate for Payer: Amerigroup Medicare |
$548.90
|
| Rate for Payer: BCBS of TX Blue Advantage |
$504.90
|
| Rate for Payer: BCBS of TX Blue Essentials |
$605.88
|
| Rate for Payer: BCBS of TX Medicare |
$548.90
|
| Rate for Payer: BCBS of TX PPO |
$673.20
|
| Rate for Payer: Cash Price |
$1,144.44
|
| Rate for Payer: Cash Price |
$1,144.44
|
| Rate for Payer: Cash Price |
$1,144.44
|
| Rate for Payer: Cigna Commercial |
$1,160.29
|
| Rate for Payer: Cigna Medicaid |
$1,211.76
|
| Rate for Payer: Cigna Medicare |
$548.90
|
| Rate for Payer: Employer Direct Commercial |
$548.90
|
| Rate for Payer: Humana Medicare/TRICARE |
$548.90
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,211.76
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$548.90
|
| Rate for Payer: Molina Medicare |
$548.90
|
| Rate for Payer: Multiplan Auto |
$1,093.95
|
| Rate for Payer: Multiplan Commercial |
$1,093.95
|
| Rate for Payer: Multiplan Workers Comp |
$1,093.95
|
| Rate for Payer: Parkland Medicaid |
$1,211.76
|
| Rate for Payer: Scott and White EPO/PPO |
$191.93
|
| Rate for Payer: Scott and White Medicare |
$548.90
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,211.76
|
| Rate for Payer: Superior Health Plan EPO |
$548.90
|
| Rate for Payer: Superior Health Plan Medicare |
$548.90
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$548.90
|
| Rate for Payer: Universal American Medicare |
$548.90
|
| Rate for Payer: Wellcare Medicare |
$548.90
|
| Rate for Payer: Wellmed Medicare |
$548.90
|
|
|
EKG Charges - EKG -> Echo Transthoracic LTD 93304
|
Facility
|
IP
|
$1,683.00
|
|
|
Service Code
|
HCPCS 93304
|
| Hospital Charge Code |
4606608
|
|
Hospital Revenue Code
|
480
|
| Rate for Payer: Cash Price |
$1,144.44
|
|
|
EKG Charges - EKG -> Holter scanning analysis w/ report 12-48 hrs 93226
|
Facility
|
IP
|
$1,031.00
|
|
|
Service Code
|
HCPCS 93226
|
| Hospital Charge Code |
2800863
|
|
Hospital Revenue Code
|
731
|
| Rate for Payer: Cash Price |
$701.08
|
|
|
EKG Charges - EKG -> Holter scanning analysis w/ report 12-48 hrs 93226
|
Facility
|
OP
|
$1,031.00
|
|
|
Service Code
|
HCPCS 93226
|
| Hospital Charge Code |
2800863
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$44.05 |
| Max. Negotiated Rate |
$742.32 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$92.79
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$59.26
|
| Rate for Payer: Amerigroup Medicare |
$59.26
|
| Rate for Payer: BCBS of TX Blue Advantage |
$309.30
|
| Rate for Payer: BCBS of TX Blue Essentials |
$371.16
|
| Rate for Payer: BCBS of TX Medicare |
$59.26
|
| Rate for Payer: BCBS of TX PPO |
$412.40
|
| Rate for Payer: Cash Price |
$701.08
|
| Rate for Payer: Cash Price |
$701.08
|
| Rate for Payer: Cash Price |
$701.08
|
| Rate for Payer: Cigna Commercial |
$125.27
|
| Rate for Payer: Cigna Medicaid |
$742.32
|
| Rate for Payer: Cigna Medicare |
$59.26
|
| Rate for Payer: Employer Direct Commercial |
$59.26
|
| Rate for Payer: Humana Medicare/TRICARE |
$59.26
|
| Rate for Payer: Molina CHIP/Medicaid |
$742.32
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$59.26
|
| Rate for Payer: Molina Medicare |
$59.26
|
| Rate for Payer: Multiplan Auto |
$670.15
|
| Rate for Payer: Multiplan Commercial |
$670.15
|
| Rate for Payer: Multiplan Workers Comp |
$670.15
|
| Rate for Payer: Parkland Medicaid |
$742.32
|
| Rate for Payer: Scott and White EPO/PPO |
$44.05
|
| Rate for Payer: Scott and White Medicare |
$59.26
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$742.32
|
| Rate for Payer: Superior Health Plan EPO |
$59.26
|
| Rate for Payer: Superior Health Plan Medicare |
$59.26
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$59.26
|
| Rate for Payer: Universal American Medicare |
$59.26
|
| Rate for Payer: Wellcare Medicare |
$59.26
|
| Rate for Payer: Wellmed Medicare |
$59.26
|
|
|
EKG Charges - EKG -> Pediatric Echo Complete 93303
|
Facility
|
IP
|
$2,448.00
|
|
|
Service Code
|
HCPCS 93303
|
| Hospital Charge Code |
2810001
|
|
Hospital Revenue Code
|
480
|
| Rate for Payer: Cash Price |
$1,664.64
|
|
|
EKG Charges - EKG -> Pediatric Echo Complete 93303
|
Facility
|
OP
|
$2,448.00
|
|
|
Service Code
|
HCPCS 93303
|
| Hospital Charge Code |
2810001
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$220.32 |
| Max. Negotiated Rate |
$1,762.56 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$220.32
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$548.90
|
| Rate for Payer: Amerigroup Medicare |
$548.90
|
| Rate for Payer: BCBS of TX Blue Advantage |
$734.40
|
| Rate for Payer: BCBS of TX Blue Essentials |
$881.28
|
| Rate for Payer: BCBS of TX Medicare |
$548.90
|
| Rate for Payer: BCBS of TX PPO |
$979.20
|
| Rate for Payer: Cash Price |
$1,664.64
|
| Rate for Payer: Cash Price |
$1,664.64
|
| Rate for Payer: Cash Price |
$1,664.64
|
| Rate for Payer: Cigna Commercial |
$1,160.29
|
| Rate for Payer: Cigna Medicaid |
$1,762.56
|
| Rate for Payer: Cigna Medicare |
$548.90
|
| Rate for Payer: Employer Direct Commercial |
$548.90
|
| Rate for Payer: Humana Medicare/TRICARE |
$548.90
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,762.56
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$548.90
|
| Rate for Payer: Molina Medicare |
$548.90
|
| Rate for Payer: Multiplan Auto |
$1,591.20
|
| Rate for Payer: Multiplan Commercial |
$1,591.20
|
| Rate for Payer: Multiplan Workers Comp |
$1,591.20
|
| Rate for Payer: Parkland Medicaid |
$1,762.56
|
| Rate for Payer: Scott and White EPO/PPO |
$271.05
|
| Rate for Payer: Scott and White Medicare |
$548.90
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,762.56
|
| Rate for Payer: Superior Health Plan EPO |
$548.90
|
| Rate for Payer: Superior Health Plan Medicare |
$548.90
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$548.90
|
| Rate for Payer: Universal American Medicare |
$548.90
|
| Rate for Payer: Wellcare Medicare |
$548.90
|
| Rate for Payer: Wellmed Medicare |
$548.90
|
|
|
EKG Charges - EKG -> Routine ECG 12 lead/15 lead tracing only 93005
|
Facility
|
IP
|
$700.00
|
|
|
Service Code
|
HCPCS 93005
|
| Hospital Charge Code |
2800019
|
|
Hospital Revenue Code
|
730
|
| Rate for Payer: Cash Price |
$476.00
|
|
|
EKG Charges - EKG -> Routine ECG 12 lead/15 lead tracing only 93005
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
HCPCS 93005
|
| Hospital Charge Code |
2800019
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$7.78 |
| Max. Negotiated Rate |
$504.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$63.00
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$59.26
|
| Rate for Payer: Amerigroup Medicare |
$59.26
|
| Rate for Payer: BCBS of TX Blue Advantage |
$210.00
|
| Rate for Payer: BCBS of TX Blue Essentials |
$252.00
|
| Rate for Payer: BCBS of TX Medicare |
$59.26
|
| Rate for Payer: BCBS of TX PPO |
$280.00
|
| Rate for Payer: Cash Price |
$476.00
|
| Rate for Payer: Cash Price |
$476.00
|
| Rate for Payer: Cash Price |
$476.00
|
| Rate for Payer: Cigna Commercial |
$125.27
|
| Rate for Payer: Cigna Medicaid |
$504.00
|
| Rate for Payer: Cigna Medicare |
$59.26
|
| Rate for Payer: Employer Direct Commercial |
$59.26
|
| Rate for Payer: Humana Medicare/TRICARE |
$59.26
|
| Rate for Payer: Molina CHIP/Medicaid |
$504.00
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$59.26
|
| Rate for Payer: Molina Medicare |
$59.26
|
| Rate for Payer: Multiplan Auto |
$455.00
|
| Rate for Payer: Multiplan Commercial |
$455.00
|
| Rate for Payer: Multiplan Workers Comp |
$455.00
|
| Rate for Payer: Parkland Medicaid |
$504.00
|
| Rate for Payer: Scott and White EPO/PPO |
$7.78
|
| Rate for Payer: Scott and White Medicare |
$59.26
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$504.00
|
| Rate for Payer: Superior Health Plan EPO |
$59.26
|
| Rate for Payer: Superior Health Plan Medicare |
$59.26
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$59.26
|
| Rate for Payer: Universal American Medicare |
$59.26
|
| Rate for Payer: Wellcare Medicare |
$59.26
|
| Rate for Payer: Wellmed Medicare |
$59.26
|
|
|
EKG Charges - EKG -> Stress Echo w/ Dobutamine 93350
|
Facility
|
IP
|
$2,782.00
|
|
|
Service Code
|
HCPCS 93350
|
| Hospital Charge Code |
2800555
|
|
Hospital Revenue Code
|
480
|
| Rate for Payer: Cash Price |
$1,891.76
|
|
|
EKG Charges - EKG -> Stress Echo w/ Dobutamine 93350
|
Facility
|
OP
|
$2,782.00
|
|
|
Service Code
|
HCPCS 93350
|
| Hospital Charge Code |
2800555
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$229.04 |
| Max. Negotiated Rate |
$2,003.04 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$250.38
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$548.90
|
| Rate for Payer: Amerigroup Medicare |
$548.90
|
| Rate for Payer: BCBS of TX Blue Advantage |
$834.60
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,001.52
|
| Rate for Payer: BCBS of TX Medicare |
$548.90
|
| Rate for Payer: BCBS of TX PPO |
$1,112.80
|
| Rate for Payer: Cash Price |
$1,891.76
|
| Rate for Payer: Cash Price |
$1,891.76
|
| Rate for Payer: Cash Price |
$1,891.76
|
| Rate for Payer: Cigna Commercial |
$1,160.29
|
| Rate for Payer: Cigna Medicaid |
$2,003.04
|
| Rate for Payer: Cigna Medicare |
$548.90
|
| Rate for Payer: Employer Direct Commercial |
$548.90
|
| Rate for Payer: Humana Medicare/TRICARE |
$548.90
|
| Rate for Payer: Molina CHIP/Medicaid |
$2,003.04
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$548.90
|
| Rate for Payer: Molina Medicare |
$548.90
|
| Rate for Payer: Multiplan Auto |
$1,808.30
|
| Rate for Payer: Multiplan Commercial |
$1,808.30
|
| Rate for Payer: Multiplan Workers Comp |
$1,808.30
|
| Rate for Payer: Parkland Medicaid |
$2,003.04
|
| Rate for Payer: Scott and White EPO/PPO |
$229.04
|
| Rate for Payer: Scott and White Medicare |
$548.90
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$2,003.04
|
| Rate for Payer: Superior Health Plan EPO |
$548.90
|
| Rate for Payer: Superior Health Plan Medicare |
$548.90
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$548.90
|
| Rate for Payer: Universal American Medicare |
$548.90
|
| Rate for Payer: Wellcare Medicare |
$548.90
|
| Rate for Payer: Wellmed Medicare |
$548.90
|
|
|
EKG Charges - EKG -> Stresss TTE Complete 93351
|
Facility
|
IP
|
$2,991.00
|
|
|
Service Code
|
HCPCS 93351
|
| Hospital Charge Code |
2810003
|
|
Hospital Revenue Code
|
483
|
| Rate for Payer: Cash Price |
$2,033.88
|
|
|
EKG Charges - EKG -> Stresss TTE Complete 93351
|
Facility
|
OP
|
$2,991.00
|
|
|
Service Code
|
HCPCS 93351
|
| Hospital Charge Code |
2810003
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$269.19 |
| Max. Negotiated Rate |
$2,153.52 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$269.19
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$548.90
|
| Rate for Payer: Amerigroup Medicare |
$548.90
|
| Rate for Payer: BCBS of TX Blue Advantage |
$897.30
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,076.76
|
| Rate for Payer: BCBS of TX Medicare |
$548.90
|
| Rate for Payer: BCBS of TX PPO |
$1,196.40
|
| Rate for Payer: Cash Price |
$2,033.88
|
| Rate for Payer: Cash Price |
$2,033.88
|
| Rate for Payer: Cash Price |
$2,033.88
|
| Rate for Payer: Cigna Commercial |
$1,160.29
|
| Rate for Payer: Cigna Medicaid |
$2,153.52
|
| Rate for Payer: Cigna Medicare |
$548.90
|
| Rate for Payer: Employer Direct Commercial |
$548.90
|
| Rate for Payer: Humana Medicare/TRICARE |
$548.90
|
| Rate for Payer: Molina CHIP/Medicaid |
$2,153.52
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$548.90
|
| Rate for Payer: Molina Medicare |
$548.90
|
| Rate for Payer: Multiplan Auto |
$1,944.15
|
| Rate for Payer: Multiplan Commercial |
$1,944.15
|
| Rate for Payer: Multiplan Workers Comp |
$1,944.15
|
| Rate for Payer: Parkland Medicaid |
$2,153.52
|
| Rate for Payer: Scott and White EPO/PPO |
$286.62
|
| Rate for Payer: Scott and White Medicare |
$548.90
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$2,153.52
|
| Rate for Payer: Superior Health Plan EPO |
$548.90
|
| Rate for Payer: Superior Health Plan Medicare |
$548.90
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$548.90
|
| Rate for Payer: Universal American Medicare |
$548.90
|
| Rate for Payer: Wellcare Medicare |
$548.90
|
| Rate for Payer: Wellmed Medicare |
$548.90
|
|
|
EKG Charges - EKG -> TEE w/ Probe w/o Contrast 93312
|
Facility
|
OP
|
$3,210.00
|
|
|
Service Code
|
HCPCS 93312
|
| Hospital Charge Code |
2800498
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$288.90 |
| Max. Negotiated Rate |
$2,311.20 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$288.90
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$548.90
|
| Rate for Payer: Amerigroup Medicare |
$548.90
|
| Rate for Payer: BCBS of TX Blue Advantage |
$963.00
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,155.60
|
| Rate for Payer: BCBS of TX Medicare |
$548.90
|
| Rate for Payer: BCBS of TX PPO |
$1,284.00
|
| Rate for Payer: Cash Price |
$2,182.80
|
| Rate for Payer: Cash Price |
$2,182.80
|
| Rate for Payer: Cash Price |
$2,182.80
|
| Rate for Payer: Cigna Commercial |
$1,160.29
|
| Rate for Payer: Cigna Medicaid |
$2,311.20
|
| Rate for Payer: Cigna Medicare |
$548.90
|
| Rate for Payer: Employer Direct Commercial |
$548.90
|
| Rate for Payer: Humana Medicare/TRICARE |
$548.90
|
| Rate for Payer: Molina CHIP/Medicaid |
$2,311.20
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$548.90
|
| Rate for Payer: Molina Medicare |
$548.90
|
| Rate for Payer: Multiplan Auto |
$2,086.50
|
| Rate for Payer: Multiplan Commercial |
$2,086.50
|
| Rate for Payer: Multiplan Workers Comp |
$2,086.50
|
| Rate for Payer: Parkland Medicaid |
$2,311.20
|
| Rate for Payer: Scott and White EPO/PPO |
$290.79
|
| Rate for Payer: Scott and White Medicare |
$548.90
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$2,311.20
|
| Rate for Payer: Superior Health Plan EPO |
$548.90
|
| Rate for Payer: Superior Health Plan Medicare |
$548.90
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$548.90
|
| Rate for Payer: Universal American Medicare |
$548.90
|
| Rate for Payer: Wellcare Medicare |
$548.90
|
| Rate for Payer: Wellmed Medicare |
$548.90
|
|
