|
MRI Face Neck Orbit w/o Contrast BCE
|
Facility
|
OP
|
$3,625.00
|
|
|
Service Code
|
CPT 70540
|
| Hospital Charge Code |
3700085
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$4.01 |
| Max. Negotiated Rate |
$2,356.25 |
| Rate for Payer: Aetna Commercial |
$256.76
|
| Rate for Payer: Aetna Medicare |
$336.15
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$233.52
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$224.10
|
| Rate for Payer: Amerigroup Medicare |
$224.10
|
| Rate for Payer: BCBS of TX Blue Advantage |
$384.52
|
| Rate for Payer: BCBS of TX Blue Essentials |
$461.42
|
| Rate for Payer: BCBS of TX Medicare |
$224.10
|
| Rate for Payer: BCBS of TX PPO |
$515.02
|
| Rate for Payer: Cash Price |
$3,190.00
|
| Rate for Payer: Cash Price |
$3,190.00
|
| Rate for Payer: Cash Price |
$3,190.00
|
| Rate for Payer: Cigna Commercial |
$507.64
|
| Rate for Payer: Cigna Medicaid |
$233.52
|
| Rate for Payer: Cigna Medicare |
$224.10
|
| Rate for Payer: Employer Direct Commercial |
$224.10
|
| Rate for Payer: Humana Medicare/TRICARE |
$224.10
|
| Rate for Payer: Molina CHIP/Medicaid |
$233.52
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$224.10
|
| Rate for Payer: Molina Medicare |
$224.10
|
| Rate for Payer: Multiplan Auto |
$2,356.25
|
| Rate for Payer: Multiplan Commercial |
$2,356.25
|
| Rate for Payer: Multiplan Workers Comp |
$2,356.25
|
| Rate for Payer: Parkland Medicaid |
$233.52
|
| Rate for Payer: Scott and White EPO/PPO |
$4.01
|
| Rate for Payer: Scott and White Medicare |
$224.10
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$233.52
|
| Rate for Payer: Superior Health Plan EPO |
$224.10
|
| Rate for Payer: Superior Health Plan Medicare |
$224.10
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$224.10
|
| Rate for Payer: Universal American Medicare |
$224.10
|
| Rate for Payer: Wellcare Medicare |
$224.10
|
| Rate for Payer: Wellmed Medicare |
$224.10
|
|
|
MRI Face Neck Orbit w/ + w/o Contrast
|
Facility
|
OP
|
$7,561.00
|
|
|
Service Code
|
CPT 70543
|
| Hospital Charge Code |
3750460
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$6.29 |
| Max. Negotiated Rate |
$4,914.65 |
| Rate for Payer: Aetna Commercial |
$376.56
|
| Rate for Payer: Aetna Medicare |
$527.56
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$354.85
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$351.71
|
| Rate for Payer: Amerigroup Medicare |
$351.71
|
| Rate for Payer: BCBS of TX Blue Advantage |
$630.05
|
| Rate for Payer: BCBS of TX Blue Essentials |
$756.06
|
| Rate for Payer: BCBS of TX Medicare |
$351.71
|
| Rate for Payer: BCBS of TX PPO |
$843.89
|
| Rate for Payer: Cash Price |
$6,653.68
|
| Rate for Payer: Cash Price |
$6,653.68
|
| Rate for Payer: Cash Price |
$6,653.68
|
| Rate for Payer: Cigna Commercial |
$796.73
|
| Rate for Payer: Cigna Medicaid |
$354.85
|
| Rate for Payer: Cigna Medicare |
$351.71
|
| Rate for Payer: Employer Direct Commercial |
$351.71
|
| Rate for Payer: Humana Medicare/TRICARE |
$351.71
|
| Rate for Payer: Molina CHIP/Medicaid |
$354.85
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$351.71
|
| Rate for Payer: Molina Medicare |
$351.71
|
| Rate for Payer: Multiplan Auto |
$4,914.65
|
| Rate for Payer: Multiplan Commercial |
$4,914.65
|
| Rate for Payer: Multiplan Workers Comp |
$4,914.65
|
| Rate for Payer: Parkland Medicaid |
$354.85
|
| Rate for Payer: Scott and White EPO/PPO |
$6.29
|
| Rate for Payer: Scott and White Medicare |
$351.71
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$354.85
|
| Rate for Payer: Superior Health Plan EPO |
$351.71
|
| Rate for Payer: Superior Health Plan Medicare |
$351.71
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$351.71
|
| Rate for Payer: Universal American Medicare |
$351.71
|
| Rate for Payer: Wellcare Medicare |
$351.71
|
| Rate for Payer: Wellmed Medicare |
$351.71
|
|
|
MRI Face Neck Orbit w/ + w/o Contrast BCE
|
Facility
|
OP
|
$7,561.00
|
|
|
Service Code
|
CPT 70543
|
| Hospital Charge Code |
3750460
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$6.29 |
| Max. Negotiated Rate |
$4,914.65 |
| Rate for Payer: Aetna Commercial |
$376.56
|
| Rate for Payer: Aetna Medicare |
$527.56
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$354.85
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$351.71
|
| Rate for Payer: Amerigroup Medicare |
$351.71
|
| Rate for Payer: BCBS of TX Blue Advantage |
$630.05
|
| Rate for Payer: BCBS of TX Blue Essentials |
$756.06
|
| Rate for Payer: BCBS of TX Medicare |
$351.71
|
| Rate for Payer: BCBS of TX PPO |
$843.89
|
| Rate for Payer: Cash Price |
$6,653.68
|
| Rate for Payer: Cash Price |
$6,653.68
|
| Rate for Payer: Cash Price |
$6,653.68
|
| Rate for Payer: Cigna Commercial |
$796.73
|
| Rate for Payer: Cigna Medicaid |
$354.85
|
| Rate for Payer: Cigna Medicare |
$351.71
|
| Rate for Payer: Employer Direct Commercial |
$351.71
|
| Rate for Payer: Humana Medicare/TRICARE |
$351.71
|
| Rate for Payer: Molina CHIP/Medicaid |
$354.85
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$351.71
|
| Rate for Payer: Molina Medicare |
$351.71
|
| Rate for Payer: Multiplan Auto |
$4,914.65
|
| Rate for Payer: Multiplan Commercial |
$4,914.65
|
| Rate for Payer: Multiplan Workers Comp |
$4,914.65
|
| Rate for Payer: Parkland Medicaid |
$354.85
|
| Rate for Payer: Scott and White EPO/PPO |
$6.29
|
| Rate for Payer: Scott and White Medicare |
$351.71
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$354.85
|
| Rate for Payer: Superior Health Plan EPO |
$351.71
|
| Rate for Payer: Superior Health Plan Medicare |
$351.71
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$351.71
|
| Rate for Payer: Universal American Medicare |
$351.71
|
| Rate for Payer: Wellcare Medicare |
$351.71
|
| Rate for Payer: Wellmed Medicare |
$351.71
|
|
|
MRI Face Neck Orbit w/ + w/o Contrast BCE
|
Facility
|
IP
|
$7,561.00
|
|
|
Service Code
|
CPT 70543
|
| Hospital Charge Code |
3750460
|
|
Hospital Revenue Code
|
610
|
| Rate for Payer: Cash Price |
$6,653.68
|
|
|
MRI Femur w/o Contrast Left
|
Facility
|
OP
|
$3,635.00
|
|
|
Service Code
|
CPT 73718 LT
|
| Hospital Charge Code |
3750601
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$4.01 |
| Max. Negotiated Rate |
$2,362.75 |
| Rate for Payer: Aetna Commercial |
$252.33
|
| Rate for Payer: Aetna Medicare |
$336.15
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$233.52
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$224.10
|
| Rate for Payer: Amerigroup Medicare |
$224.10
|
| Rate for Payer: BCBS of TX Blue Advantage |
$384.52
|
| Rate for Payer: BCBS of TX Blue Essentials |
$461.42
|
| Rate for Payer: BCBS of TX Medicare |
$224.10
|
| Rate for Payer: BCBS of TX PPO |
$515.02
|
| Rate for Payer: Cash Price |
$3,198.80
|
| Rate for Payer: Cash Price |
$3,198.80
|
| Rate for Payer: Cash Price |
$3,198.80
|
| Rate for Payer: Cigna Commercial |
$507.64
|
| Rate for Payer: Cigna Medicaid |
$233.52
|
| Rate for Payer: Cigna Medicare |
$224.10
|
| Rate for Payer: Employer Direct Commercial |
$224.10
|
| Rate for Payer: Humana Medicare/TRICARE |
$224.10
|
| Rate for Payer: Molina CHIP/Medicaid |
$233.52
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$224.10
|
| Rate for Payer: Molina Medicare |
$224.10
|
| Rate for Payer: Multiplan Auto |
$2,362.75
|
| Rate for Payer: Multiplan Commercial |
$2,362.75
|
| Rate for Payer: Multiplan Workers Comp |
$2,362.75
|
| Rate for Payer: Parkland Medicaid |
$233.52
|
| Rate for Payer: Scott and White EPO/PPO |
$4.01
|
| Rate for Payer: Scott and White Medicare |
$224.10
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$233.52
|
| Rate for Payer: Superior Health Plan EPO |
$224.10
|
| Rate for Payer: Superior Health Plan Medicare |
$224.10
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$224.10
|
| Rate for Payer: Universal American Medicare |
$224.10
|
| Rate for Payer: Wellcare Medicare |
$224.10
|
| Rate for Payer: Wellmed Medicare |
$224.10
|
|
|
MRI Femur w/o Contrast Right
|
Facility
|
OP
|
$3,635.00
|
|
|
Service Code
|
CPT 73718 RT
|
| Hospital Charge Code |
3750619
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$4.01 |
| Max. Negotiated Rate |
$2,362.75 |
| Rate for Payer: Aetna Commercial |
$252.33
|
| Rate for Payer: Aetna Medicare |
$336.15
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$233.52
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$224.10
|
| Rate for Payer: Amerigroup Medicare |
$224.10
|
| Rate for Payer: BCBS of TX Blue Advantage |
$384.52
|
| Rate for Payer: BCBS of TX Blue Essentials |
$461.42
|
| Rate for Payer: BCBS of TX Medicare |
$224.10
|
| Rate for Payer: BCBS of TX PPO |
$515.02
|
| Rate for Payer: Cash Price |
$3,198.80
|
| Rate for Payer: Cash Price |
$3,198.80
|
| Rate for Payer: Cash Price |
$3,198.80
|
| Rate for Payer: Cigna Commercial |
$507.64
|
| Rate for Payer: Cigna Medicaid |
$233.52
|
| Rate for Payer: Cigna Medicare |
$224.10
|
| Rate for Payer: Employer Direct Commercial |
$224.10
|
| Rate for Payer: Humana Medicare/TRICARE |
$224.10
|
| Rate for Payer: Molina CHIP/Medicaid |
$233.52
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$224.10
|
| Rate for Payer: Molina Medicare |
$224.10
|
| Rate for Payer: Multiplan Auto |
$2,362.75
|
| Rate for Payer: Multiplan Commercial |
$2,362.75
|
| Rate for Payer: Multiplan Workers Comp |
$2,362.75
|
| Rate for Payer: Parkland Medicaid |
$233.52
|
| Rate for Payer: Scott and White EPO/PPO |
$4.01
|
| Rate for Payer: Scott and White Medicare |
$224.10
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$233.52
|
| Rate for Payer: Superior Health Plan EPO |
$224.10
|
| Rate for Payer: Superior Health Plan Medicare |
$224.10
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$224.10
|
| Rate for Payer: Universal American Medicare |
$224.10
|
| Rate for Payer: Wellcare Medicare |
$224.10
|
| Rate for Payer: Wellmed Medicare |
$224.10
|
|
|
MRI Femur w/ + w/o Contrast Left
|
Facility
|
OP
|
$4,568.00
|
|
|
Service Code
|
CPT 73720 LT
|
| Hospital Charge Code |
3700028
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$6.29 |
| Max. Negotiated Rate |
$2,969.20 |
| Rate for Payer: Aetna Commercial |
$375.10
|
| Rate for Payer: Aetna Medicare |
$527.56
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$353.51
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$351.71
|
| Rate for Payer: Amerigroup Medicare |
$351.71
|
| Rate for Payer: BCBS of TX Blue Advantage |
$630.05
|
| Rate for Payer: BCBS of TX Blue Essentials |
$756.06
|
| Rate for Payer: BCBS of TX Medicare |
$351.71
|
| Rate for Payer: BCBS of TX PPO |
$843.89
|
| Rate for Payer: Cash Price |
$4,019.84
|
| Rate for Payer: Cash Price |
$4,019.84
|
| Rate for Payer: Cash Price |
$4,019.84
|
| Rate for Payer: Cigna Commercial |
$796.73
|
| Rate for Payer: Cigna Medicaid |
$353.51
|
| Rate for Payer: Cigna Medicare |
$351.71
|
| Rate for Payer: Employer Direct Commercial |
$351.71
|
| Rate for Payer: Humana Medicare/TRICARE |
$351.71
|
| Rate for Payer: Molina CHIP/Medicaid |
$353.51
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$351.71
|
| Rate for Payer: Molina Medicare |
$351.71
|
| Rate for Payer: Multiplan Auto |
$2,969.20
|
| Rate for Payer: Multiplan Commercial |
$2,969.20
|
| Rate for Payer: Multiplan Workers Comp |
$2,969.20
|
| Rate for Payer: Parkland Medicaid |
$353.51
|
| Rate for Payer: Scott and White EPO/PPO |
$6.29
|
| Rate for Payer: Scott and White Medicare |
$351.71
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$353.51
|
| Rate for Payer: Superior Health Plan EPO |
$351.71
|
| Rate for Payer: Superior Health Plan Medicare |
$351.71
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$351.71
|
| Rate for Payer: Universal American Medicare |
$351.71
|
| Rate for Payer: Wellcare Medicare |
$351.71
|
| Rate for Payer: Wellmed Medicare |
$351.71
|
|
|
MRI Femur w/ + w/o Contrast Right
|
Facility
|
OP
|
$4,568.00
|
|
|
Service Code
|
CPT 73720 RT
|
| Hospital Charge Code |
3700275
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$6.29 |
| Max. Negotiated Rate |
$2,969.20 |
| Rate for Payer: Aetna Commercial |
$375.10
|
| Rate for Payer: Aetna Medicare |
$527.56
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$353.51
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$351.71
|
| Rate for Payer: Amerigroup Medicare |
$351.71
|
| Rate for Payer: BCBS of TX Blue Advantage |
$630.05
|
| Rate for Payer: BCBS of TX Blue Essentials |
$756.06
|
| Rate for Payer: BCBS of TX Medicare |
$351.71
|
| Rate for Payer: BCBS of TX PPO |
$843.89
|
| Rate for Payer: Cash Price |
$4,019.84
|
| Rate for Payer: Cash Price |
$4,019.84
|
| Rate for Payer: Cash Price |
$4,019.84
|
| Rate for Payer: Cigna Commercial |
$796.73
|
| Rate for Payer: Cigna Medicaid |
$353.51
|
| Rate for Payer: Cigna Medicare |
$351.71
|
| Rate for Payer: Employer Direct Commercial |
$351.71
|
| Rate for Payer: Humana Medicare/TRICARE |
$351.71
|
| Rate for Payer: Molina CHIP/Medicaid |
$353.51
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$351.71
|
| Rate for Payer: Molina Medicare |
$351.71
|
| Rate for Payer: Multiplan Auto |
$2,969.20
|
| Rate for Payer: Multiplan Commercial |
$2,969.20
|
| Rate for Payer: Multiplan Workers Comp |
$2,969.20
|
| Rate for Payer: Parkland Medicaid |
$353.51
|
| Rate for Payer: Scott and White EPO/PPO |
$6.29
|
| Rate for Payer: Scott and White Medicare |
$351.71
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$353.51
|
| Rate for Payer: Superior Health Plan EPO |
$351.71
|
| Rate for Payer: Superior Health Plan Medicare |
$351.71
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$351.71
|
| Rate for Payer: Universal American Medicare |
$351.71
|
| Rate for Payer: Wellcare Medicare |
$351.71
|
| Rate for Payer: Wellmed Medicare |
$351.71
|
|
|
MRI Foot w/o Contrast Left
|
Facility
|
OP
|
$3,635.00
|
|
|
Service Code
|
CPT 73718 LT
|
| Hospital Charge Code |
3750601
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$4.01 |
| Max. Negotiated Rate |
$2,362.75 |
| Rate for Payer: Aetna Commercial |
$252.33
|
| Rate for Payer: Aetna Medicare |
$336.15
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$233.52
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$224.10
|
| Rate for Payer: Amerigroup Medicare |
$224.10
|
| Rate for Payer: BCBS of TX Blue Advantage |
$384.52
|
| Rate for Payer: BCBS of TX Blue Essentials |
$461.42
|
| Rate for Payer: BCBS of TX Medicare |
$224.10
|
| Rate for Payer: BCBS of TX PPO |
$515.02
|
| Rate for Payer: Cash Price |
$3,198.80
|
| Rate for Payer: Cash Price |
$3,198.80
|
| Rate for Payer: Cash Price |
$3,198.80
|
| Rate for Payer: Cigna Commercial |
$507.64
|
| Rate for Payer: Cigna Medicaid |
$233.52
|
| Rate for Payer: Cigna Medicare |
$224.10
|
| Rate for Payer: Employer Direct Commercial |
$224.10
|
| Rate for Payer: Humana Medicare/TRICARE |
$224.10
|
| Rate for Payer: Molina CHIP/Medicaid |
$233.52
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$224.10
|
| Rate for Payer: Molina Medicare |
$224.10
|
| Rate for Payer: Multiplan Auto |
$2,362.75
|
| Rate for Payer: Multiplan Commercial |
$2,362.75
|
| Rate for Payer: Multiplan Workers Comp |
$2,362.75
|
| Rate for Payer: Parkland Medicaid |
$233.52
|
| Rate for Payer: Scott and White EPO/PPO |
$4.01
|
| Rate for Payer: Scott and White Medicare |
$224.10
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$233.52
|
| Rate for Payer: Superior Health Plan EPO |
$224.10
|
| Rate for Payer: Superior Health Plan Medicare |
$224.10
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$224.10
|
| Rate for Payer: Universal American Medicare |
$224.10
|
| Rate for Payer: Wellcare Medicare |
$224.10
|
| Rate for Payer: Wellmed Medicare |
$224.10
|
|
|
MRI Foot w/o Contrast Right
|
Facility
|
OP
|
$3,635.00
|
|
|
Service Code
|
CPT 73718 RT
|
| Hospital Charge Code |
3750619
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$4.01 |
| Max. Negotiated Rate |
$2,362.75 |
| Rate for Payer: Aetna Commercial |
$252.33
|
| Rate for Payer: Aetna Medicare |
$336.15
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$233.52
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$224.10
|
| Rate for Payer: Amerigroup Medicare |
$224.10
|
| Rate for Payer: BCBS of TX Blue Advantage |
$384.52
|
| Rate for Payer: BCBS of TX Blue Essentials |
$461.42
|
| Rate for Payer: BCBS of TX Medicare |
$224.10
|
| Rate for Payer: BCBS of TX PPO |
$515.02
|
| Rate for Payer: Cash Price |
$3,198.80
|
| Rate for Payer: Cash Price |
$3,198.80
|
| Rate for Payer: Cash Price |
$3,198.80
|
| Rate for Payer: Cigna Commercial |
$507.64
|
| Rate for Payer: Cigna Medicaid |
$233.52
|
| Rate for Payer: Cigna Medicare |
$224.10
|
| Rate for Payer: Employer Direct Commercial |
$224.10
|
| Rate for Payer: Humana Medicare/TRICARE |
$224.10
|
| Rate for Payer: Molina CHIP/Medicaid |
$233.52
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$224.10
|
| Rate for Payer: Molina Medicare |
$224.10
|
| Rate for Payer: Multiplan Auto |
$2,362.75
|
| Rate for Payer: Multiplan Commercial |
$2,362.75
|
| Rate for Payer: Multiplan Workers Comp |
$2,362.75
|
| Rate for Payer: Parkland Medicaid |
$233.52
|
| Rate for Payer: Scott and White EPO/PPO |
$4.01
|
| Rate for Payer: Scott and White Medicare |
$224.10
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$233.52
|
| Rate for Payer: Superior Health Plan EPO |
$224.10
|
| Rate for Payer: Superior Health Plan Medicare |
$224.10
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$224.10
|
| Rate for Payer: Universal American Medicare |
$224.10
|
| Rate for Payer: Wellcare Medicare |
$224.10
|
| Rate for Payer: Wellmed Medicare |
$224.10
|
|
|
MRI Foot w/ + w/o Contrast Left
|
Facility
|
OP
|
$4,568.00
|
|
|
Service Code
|
CPT 73720 LT
|
| Hospital Charge Code |
3700028
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$6.29 |
| Max. Negotiated Rate |
$2,969.20 |
| Rate for Payer: Aetna Commercial |
$375.10
|
| Rate for Payer: Aetna Medicare |
$527.56
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$353.51
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$351.71
|
| Rate for Payer: Amerigroup Medicare |
$351.71
|
| Rate for Payer: BCBS of TX Blue Advantage |
$630.05
|
| Rate for Payer: BCBS of TX Blue Essentials |
$756.06
|
| Rate for Payer: BCBS of TX Medicare |
$351.71
|
| Rate for Payer: BCBS of TX PPO |
$843.89
|
| Rate for Payer: Cash Price |
$4,019.84
|
| Rate for Payer: Cash Price |
$4,019.84
|
| Rate for Payer: Cash Price |
$4,019.84
|
| Rate for Payer: Cigna Commercial |
$796.73
|
| Rate for Payer: Cigna Medicaid |
$353.51
|
| Rate for Payer: Cigna Medicare |
$351.71
|
| Rate for Payer: Employer Direct Commercial |
$351.71
|
| Rate for Payer: Humana Medicare/TRICARE |
$351.71
|
| Rate for Payer: Molina CHIP/Medicaid |
$353.51
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$351.71
|
| Rate for Payer: Molina Medicare |
$351.71
|
| Rate for Payer: Multiplan Auto |
$2,969.20
|
| Rate for Payer: Multiplan Commercial |
$2,969.20
|
| Rate for Payer: Multiplan Workers Comp |
$2,969.20
|
| Rate for Payer: Parkland Medicaid |
$353.51
|
| Rate for Payer: Scott and White EPO/PPO |
$6.29
|
| Rate for Payer: Scott and White Medicare |
$351.71
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$353.51
|
| Rate for Payer: Superior Health Plan EPO |
$351.71
|
| Rate for Payer: Superior Health Plan Medicare |
$351.71
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$351.71
|
| Rate for Payer: Universal American Medicare |
$351.71
|
| Rate for Payer: Wellcare Medicare |
$351.71
|
| Rate for Payer: Wellmed Medicare |
$351.71
|
|
|
MRI Foot w/ + w/o Contrast Right
|
Facility
|
OP
|
$4,568.00
|
|
|
Service Code
|
CPT 73720 RT
|
| Hospital Charge Code |
3700275
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$6.29 |
| Max. Negotiated Rate |
$2,969.20 |
| Rate for Payer: Aetna Commercial |
$375.10
|
| Rate for Payer: Aetna Medicare |
$527.56
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$353.51
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$351.71
|
| Rate for Payer: Amerigroup Medicare |
$351.71
|
| Rate for Payer: BCBS of TX Blue Advantage |
$630.05
|
| Rate for Payer: BCBS of TX Blue Essentials |
$756.06
|
| Rate for Payer: BCBS of TX Medicare |
$351.71
|
| Rate for Payer: BCBS of TX PPO |
$843.89
|
| Rate for Payer: Cash Price |
$4,019.84
|
| Rate for Payer: Cash Price |
$4,019.84
|
| Rate for Payer: Cash Price |
$4,019.84
|
| Rate for Payer: Cigna Commercial |
$796.73
|
| Rate for Payer: Cigna Medicaid |
$353.51
|
| Rate for Payer: Cigna Medicare |
$351.71
|
| Rate for Payer: Employer Direct Commercial |
$351.71
|
| Rate for Payer: Humana Medicare/TRICARE |
$351.71
|
| Rate for Payer: Molina CHIP/Medicaid |
$353.51
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$351.71
|
| Rate for Payer: Molina Medicare |
$351.71
|
| Rate for Payer: Multiplan Auto |
$2,969.20
|
| Rate for Payer: Multiplan Commercial |
$2,969.20
|
| Rate for Payer: Multiplan Workers Comp |
$2,969.20
|
| Rate for Payer: Parkland Medicaid |
$353.51
|
| Rate for Payer: Scott and White EPO/PPO |
$6.29
|
| Rate for Payer: Scott and White Medicare |
$351.71
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$353.51
|
| Rate for Payer: Superior Health Plan EPO |
$351.71
|
| Rate for Payer: Superior Health Plan Medicare |
$351.71
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$351.71
|
| Rate for Payer: Universal American Medicare |
$351.71
|
| Rate for Payer: Wellcare Medicare |
$351.71
|
| Rate for Payer: Wellmed Medicare |
$351.71
|
|
|
MRI Forearm w/ Contrast Left
|
Facility
|
OP
|
$3,958.00
|
|
|
Service Code
|
CPT 73219 LT
|
| Hospital Charge Code |
5250842
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$6.29 |
| Max. Negotiated Rate |
$2,572.70 |
| Rate for Payer: Aetna Commercial |
$403.04
|
| Rate for Payer: Aetna Medicare |
$527.56
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$348.50
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$351.71
|
| Rate for Payer: Amerigroup Medicare |
$351.71
|
| Rate for Payer: BCBS of TX Blue Advantage |
$630.05
|
| Rate for Payer: BCBS of TX Blue Essentials |
$756.06
|
| Rate for Payer: BCBS of TX Medicare |
$351.71
|
| Rate for Payer: BCBS of TX PPO |
$843.89
|
| Rate for Payer: Cash Price |
$3,483.04
|
| Rate for Payer: Cash Price |
$3,483.04
|
| Rate for Payer: Cash Price |
$3,483.04
|
| Rate for Payer: Cigna Commercial |
$796.73
|
| Rate for Payer: Cigna Medicaid |
$348.50
|
| Rate for Payer: Cigna Medicare |
$351.71
|
| Rate for Payer: Employer Direct Commercial |
$351.71
|
| Rate for Payer: Humana Medicare/TRICARE |
$351.71
|
| Rate for Payer: Molina CHIP/Medicaid |
$348.50
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$351.71
|
| Rate for Payer: Molina Medicare |
$351.71
|
| Rate for Payer: Multiplan Auto |
$2,572.70
|
| Rate for Payer: Multiplan Commercial |
$2,572.70
|
| Rate for Payer: Multiplan Workers Comp |
$2,572.70
|
| Rate for Payer: Parkland Medicaid |
$348.50
|
| Rate for Payer: Scott and White EPO/PPO |
$6.29
|
| Rate for Payer: Scott and White Medicare |
$351.71
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$348.50
|
| Rate for Payer: Superior Health Plan EPO |
$351.71
|
| Rate for Payer: Superior Health Plan Medicare |
$351.71
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$351.71
|
| Rate for Payer: Universal American Medicare |
$351.71
|
| Rate for Payer: Wellcare Medicare |
$351.71
|
| Rate for Payer: Wellmed Medicare |
$351.71
|
|
|
MRI Forearm w/ Contrast Right
|
Facility
|
OP
|
$3,958.00
|
|
|
Service Code
|
CPT 73219 RT
|
| Hospital Charge Code |
3750866
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$6.29 |
| Max. Negotiated Rate |
$2,572.70 |
| Rate for Payer: Aetna Commercial |
$403.04
|
| Rate for Payer: Aetna Medicare |
$527.56
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$348.50
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$351.71
|
| Rate for Payer: Amerigroup Medicare |
$351.71
|
| Rate for Payer: BCBS of TX Blue Advantage |
$630.05
|
| Rate for Payer: BCBS of TX Blue Essentials |
$756.06
|
| Rate for Payer: BCBS of TX Medicare |
$351.71
|
| Rate for Payer: BCBS of TX PPO |
$843.89
|
| Rate for Payer: Cash Price |
$3,483.04
|
| Rate for Payer: Cash Price |
$3,483.04
|
| Rate for Payer: Cash Price |
$3,483.04
|
| Rate for Payer: Cigna Commercial |
$796.73
|
| Rate for Payer: Cigna Medicaid |
$348.50
|
| Rate for Payer: Cigna Medicare |
$351.71
|
| Rate for Payer: Employer Direct Commercial |
$351.71
|
| Rate for Payer: Humana Medicare/TRICARE |
$351.71
|
| Rate for Payer: Molina CHIP/Medicaid |
$348.50
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$351.71
|
| Rate for Payer: Molina Medicare |
$351.71
|
| Rate for Payer: Multiplan Auto |
$2,572.70
|
| Rate for Payer: Multiplan Commercial |
$2,572.70
|
| Rate for Payer: Multiplan Workers Comp |
$2,572.70
|
| Rate for Payer: Parkland Medicaid |
$348.50
|
| Rate for Payer: Scott and White EPO/PPO |
$6.29
|
| Rate for Payer: Scott and White Medicare |
$351.71
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$348.50
|
| Rate for Payer: Superior Health Plan EPO |
$351.71
|
| Rate for Payer: Superior Health Plan Medicare |
$351.71
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$351.71
|
| Rate for Payer: Universal American Medicare |
$351.71
|
| Rate for Payer: Wellcare Medicare |
$351.71
|
| Rate for Payer: Wellmed Medicare |
$351.71
|
|
|
MRI Forearm w/o Contrast Left
|
Facility
|
OP
|
$3,722.00
|
|
|
Service Code
|
CPT 73218 LT
|
| Hospital Charge Code |
3750536
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$4.01 |
| Max. Negotiated Rate |
$2,419.30 |
| Rate for Payer: Aetna Commercial |
$332.85
|
| Rate for Payer: Aetna Medicare |
$336.15
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$233.52
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$224.10
|
| Rate for Payer: Amerigroup Medicare |
$224.10
|
| Rate for Payer: BCBS of TX Blue Advantage |
$384.52
|
| Rate for Payer: BCBS of TX Blue Essentials |
$461.42
|
| Rate for Payer: BCBS of TX Medicare |
$224.10
|
| Rate for Payer: BCBS of TX PPO |
$515.02
|
| Rate for Payer: Cash Price |
$3,275.36
|
| Rate for Payer: Cash Price |
$3,275.36
|
| Rate for Payer: Cash Price |
$3,275.36
|
| Rate for Payer: Cigna Commercial |
$507.64
|
| Rate for Payer: Cigna Medicaid |
$233.52
|
| Rate for Payer: Cigna Medicare |
$224.10
|
| Rate for Payer: Employer Direct Commercial |
$224.10
|
| Rate for Payer: Humana Medicare/TRICARE |
$224.10
|
| Rate for Payer: Molina CHIP/Medicaid |
$233.52
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$224.10
|
| Rate for Payer: Molina Medicare |
$224.10
|
| Rate for Payer: Multiplan Auto |
$2,419.30
|
| Rate for Payer: Multiplan Commercial |
$2,419.30
|
| Rate for Payer: Multiplan Workers Comp |
$2,419.30
|
| Rate for Payer: Parkland Medicaid |
$233.52
|
| Rate for Payer: Scott and White EPO/PPO |
$4.01
|
| Rate for Payer: Scott and White Medicare |
$224.10
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$233.52
|
| Rate for Payer: Superior Health Plan EPO |
$224.10
|
| Rate for Payer: Superior Health Plan Medicare |
$224.10
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$224.10
|
| Rate for Payer: Universal American Medicare |
$224.10
|
| Rate for Payer: Wellcare Medicare |
$224.10
|
| Rate for Payer: Wellmed Medicare |
$224.10
|
|
|
MRI Forearm w/o Contrast Right
|
Facility
|
OP
|
$3,722.00
|
|
|
Service Code
|
CPT 73218 RT
|
| Hospital Charge Code |
3750551
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$4.01 |
| Max. Negotiated Rate |
$2,419.30 |
| Rate for Payer: Aetna Commercial |
$332.85
|
| Rate for Payer: Aetna Medicare |
$336.15
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$233.52
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$224.10
|
| Rate for Payer: Amerigroup Medicare |
$224.10
|
| Rate for Payer: BCBS of TX Blue Advantage |
$384.52
|
| Rate for Payer: BCBS of TX Blue Essentials |
$461.42
|
| Rate for Payer: BCBS of TX Medicare |
$224.10
|
| Rate for Payer: BCBS of TX PPO |
$515.02
|
| Rate for Payer: Cash Price |
$3,275.36
|
| Rate for Payer: Cash Price |
$3,275.36
|
| Rate for Payer: Cash Price |
$3,275.36
|
| Rate for Payer: Cigna Commercial |
$507.64
|
| Rate for Payer: Cigna Medicaid |
$233.52
|
| Rate for Payer: Cigna Medicare |
$224.10
|
| Rate for Payer: Employer Direct Commercial |
$224.10
|
| Rate for Payer: Humana Medicare/TRICARE |
$224.10
|
| Rate for Payer: Molina CHIP/Medicaid |
$233.52
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$224.10
|
| Rate for Payer: Molina Medicare |
$224.10
|
| Rate for Payer: Multiplan Auto |
$2,419.30
|
| Rate for Payer: Multiplan Commercial |
$2,419.30
|
| Rate for Payer: Multiplan Workers Comp |
$2,419.30
|
| Rate for Payer: Parkland Medicaid |
$233.52
|
| Rate for Payer: Scott and White EPO/PPO |
$4.01
|
| Rate for Payer: Scott and White Medicare |
$224.10
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$233.52
|
| Rate for Payer: Superior Health Plan EPO |
$224.10
|
| Rate for Payer: Superior Health Plan Medicare |
$224.10
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$224.10
|
| Rate for Payer: Universal American Medicare |
$224.10
|
| Rate for Payer: Wellcare Medicare |
$224.10
|
| Rate for Payer: Wellmed Medicare |
$224.10
|
|
|
MRI Forearm w/ + w/o Contrast Left
|
Facility
|
OP
|
$4,608.00
|
|
|
Service Code
|
CPT 73220 LT
|
| Hospital Charge Code |
3700044
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$6.29 |
| Max. Negotiated Rate |
$2,995.20 |
| Rate for Payer: Aetna Commercial |
$491.42
|
| Rate for Payer: Aetna Medicare |
$527.56
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$368.43
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$351.71
|
| Rate for Payer: Amerigroup Medicare |
$351.71
|
| Rate for Payer: BCBS of TX Blue Advantage |
$630.05
|
| Rate for Payer: BCBS of TX Blue Essentials |
$756.06
|
| Rate for Payer: BCBS of TX Medicare |
$351.71
|
| Rate for Payer: BCBS of TX PPO |
$843.89
|
| Rate for Payer: Cash Price |
$4,055.04
|
| Rate for Payer: Cash Price |
$4,055.04
|
| Rate for Payer: Cash Price |
$4,055.04
|
| Rate for Payer: Cigna Commercial |
$796.73
|
| Rate for Payer: Cigna Medicaid |
$368.43
|
| Rate for Payer: Cigna Medicare |
$351.71
|
| Rate for Payer: Employer Direct Commercial |
$351.71
|
| Rate for Payer: Humana Medicare/TRICARE |
$351.71
|
| Rate for Payer: Molina CHIP/Medicaid |
$368.43
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$351.71
|
| Rate for Payer: Molina Medicare |
$351.71
|
| Rate for Payer: Multiplan Auto |
$2,995.20
|
| Rate for Payer: Multiplan Commercial |
$2,995.20
|
| Rate for Payer: Multiplan Workers Comp |
$2,995.20
|
| Rate for Payer: Parkland Medicaid |
$368.43
|
| Rate for Payer: Scott and White EPO/PPO |
$6.29
|
| Rate for Payer: Scott and White Medicare |
$351.71
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$368.43
|
| Rate for Payer: Superior Health Plan EPO |
$351.71
|
| Rate for Payer: Superior Health Plan Medicare |
$351.71
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$351.71
|
| Rate for Payer: Universal American Medicare |
$351.71
|
| Rate for Payer: Wellcare Medicare |
$351.71
|
| Rate for Payer: Wellmed Medicare |
$351.71
|
|
|
MRI Forearm w/ + w/o Contrast Right
|
Facility
|
OP
|
$4,608.00
|
|
|
Service Code
|
CPT 73220 RT
|
| Hospital Charge Code |
3700259
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$6.29 |
| Max. Negotiated Rate |
$2,995.20 |
| Rate for Payer: Aetna Commercial |
$491.42
|
| Rate for Payer: Aetna Medicare |
$527.56
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$368.43
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$351.71
|
| Rate for Payer: Amerigroup Medicare |
$351.71
|
| Rate for Payer: BCBS of TX Blue Advantage |
$630.05
|
| Rate for Payer: BCBS of TX Blue Essentials |
$756.06
|
| Rate for Payer: BCBS of TX Medicare |
$351.71
|
| Rate for Payer: BCBS of TX PPO |
$843.89
|
| Rate for Payer: Cash Price |
$4,055.04
|
| Rate for Payer: Cash Price |
$4,055.04
|
| Rate for Payer: Cash Price |
$4,055.04
|
| Rate for Payer: Cigna Commercial |
$796.73
|
| Rate for Payer: Cigna Medicaid |
$368.43
|
| Rate for Payer: Cigna Medicare |
$351.71
|
| Rate for Payer: Employer Direct Commercial |
$351.71
|
| Rate for Payer: Humana Medicare/TRICARE |
$351.71
|
| Rate for Payer: Molina CHIP/Medicaid |
$368.43
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$351.71
|
| Rate for Payer: Molina Medicare |
$351.71
|
| Rate for Payer: Multiplan Auto |
$2,995.20
|
| Rate for Payer: Multiplan Commercial |
$2,995.20
|
| Rate for Payer: Multiplan Workers Comp |
$2,995.20
|
| Rate for Payer: Parkland Medicaid |
$368.43
|
| Rate for Payer: Scott and White EPO/PPO |
$6.29
|
| Rate for Payer: Scott and White Medicare |
$351.71
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$368.43
|
| Rate for Payer: Superior Health Plan EPO |
$351.71
|
| Rate for Payer: Superior Health Plan Medicare |
$351.71
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$351.71
|
| Rate for Payer: Universal American Medicare |
$351.71
|
| Rate for Payer: Wellcare Medicare |
$351.71
|
| Rate for Payer: Wellmed Medicare |
$351.71
|
|
|
MRI Hand w/ Contrast Left
|
Facility
|
OP
|
$3,958.00
|
|
|
Service Code
|
CPT 73219 LT
|
| Hospital Charge Code |
5250842
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$6.29 |
| Max. Negotiated Rate |
$2,572.70 |
| Rate for Payer: Aetna Commercial |
$403.04
|
| Rate for Payer: Aetna Medicare |
$527.56
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$348.50
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$351.71
|
| Rate for Payer: Amerigroup Medicare |
$351.71
|
| Rate for Payer: BCBS of TX Blue Advantage |
$630.05
|
| Rate for Payer: BCBS of TX Blue Essentials |
$756.06
|
| Rate for Payer: BCBS of TX Medicare |
$351.71
|
| Rate for Payer: BCBS of TX PPO |
$843.89
|
| Rate for Payer: Cash Price |
$3,483.04
|
| Rate for Payer: Cash Price |
$3,483.04
|
| Rate for Payer: Cash Price |
$3,483.04
|
| Rate for Payer: Cigna Commercial |
$796.73
|
| Rate for Payer: Cigna Medicaid |
$348.50
|
| Rate for Payer: Cigna Medicare |
$351.71
|
| Rate for Payer: Employer Direct Commercial |
$351.71
|
| Rate for Payer: Humana Medicare/TRICARE |
$351.71
|
| Rate for Payer: Molina CHIP/Medicaid |
$348.50
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$351.71
|
| Rate for Payer: Molina Medicare |
$351.71
|
| Rate for Payer: Multiplan Auto |
$2,572.70
|
| Rate for Payer: Multiplan Commercial |
$2,572.70
|
| Rate for Payer: Multiplan Workers Comp |
$2,572.70
|
| Rate for Payer: Parkland Medicaid |
$348.50
|
| Rate for Payer: Scott and White EPO/PPO |
$6.29
|
| Rate for Payer: Scott and White Medicare |
$351.71
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$348.50
|
| Rate for Payer: Superior Health Plan EPO |
$351.71
|
| Rate for Payer: Superior Health Plan Medicare |
$351.71
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$351.71
|
| Rate for Payer: Universal American Medicare |
$351.71
|
| Rate for Payer: Wellcare Medicare |
$351.71
|
| Rate for Payer: Wellmed Medicare |
$351.71
|
|
|
MRI Hand w/ Contrast Left
|
Facility
|
IP
|
$3,958.00
|
|
|
Service Code
|
CPT 73219 LT
|
| Hospital Charge Code |
5250842
|
|
Hospital Revenue Code
|
610
|
| Rate for Payer: Cash Price |
$3,483.04
|
|
|
MRI Hand w/ Contrast Right
|
Facility
|
OP
|
$3,958.00
|
|
|
Service Code
|
CPT 73219 RT
|
| Hospital Charge Code |
3750866
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$6.29 |
| Max. Negotiated Rate |
$2,572.70 |
| Rate for Payer: Aetna Commercial |
$403.04
|
| Rate for Payer: Aetna Medicare |
$527.56
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$348.50
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$351.71
|
| Rate for Payer: Amerigroup Medicare |
$351.71
|
| Rate for Payer: BCBS of TX Blue Advantage |
$630.05
|
| Rate for Payer: BCBS of TX Blue Essentials |
$756.06
|
| Rate for Payer: BCBS of TX Medicare |
$351.71
|
| Rate for Payer: BCBS of TX PPO |
$843.89
|
| Rate for Payer: Cash Price |
$3,483.04
|
| Rate for Payer: Cash Price |
$3,483.04
|
| Rate for Payer: Cash Price |
$3,483.04
|
| Rate for Payer: Cigna Commercial |
$796.73
|
| Rate for Payer: Cigna Medicaid |
$348.50
|
| Rate for Payer: Cigna Medicare |
$351.71
|
| Rate for Payer: Employer Direct Commercial |
$351.71
|
| Rate for Payer: Humana Medicare/TRICARE |
$351.71
|
| Rate for Payer: Molina CHIP/Medicaid |
$348.50
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$351.71
|
| Rate for Payer: Molina Medicare |
$351.71
|
| Rate for Payer: Multiplan Auto |
$2,572.70
|
| Rate for Payer: Multiplan Commercial |
$2,572.70
|
| Rate for Payer: Multiplan Workers Comp |
$2,572.70
|
| Rate for Payer: Parkland Medicaid |
$348.50
|
| Rate for Payer: Scott and White EPO/PPO |
$6.29
|
| Rate for Payer: Scott and White Medicare |
$351.71
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$348.50
|
| Rate for Payer: Superior Health Plan EPO |
$351.71
|
| Rate for Payer: Superior Health Plan Medicare |
$351.71
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$351.71
|
| Rate for Payer: Universal American Medicare |
$351.71
|
| Rate for Payer: Wellcare Medicare |
$351.71
|
| Rate for Payer: Wellmed Medicare |
$351.71
|
|
|
MRI Hand w/o Contrast Left
|
Facility
|
OP
|
$3,722.00
|
|
|
Service Code
|
CPT 73218 LT
|
| Hospital Charge Code |
3750536
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$4.01 |
| Max. Negotiated Rate |
$2,419.30 |
| Rate for Payer: Aetna Commercial |
$332.85
|
| Rate for Payer: Aetna Medicare |
$336.15
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$233.52
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$224.10
|
| Rate for Payer: Amerigroup Medicare |
$224.10
|
| Rate for Payer: BCBS of TX Blue Advantage |
$384.52
|
| Rate for Payer: BCBS of TX Blue Essentials |
$461.42
|
| Rate for Payer: BCBS of TX Medicare |
$224.10
|
| Rate for Payer: BCBS of TX PPO |
$515.02
|
| Rate for Payer: Cash Price |
$3,275.36
|
| Rate for Payer: Cash Price |
$3,275.36
|
| Rate for Payer: Cash Price |
$3,275.36
|
| Rate for Payer: Cigna Commercial |
$507.64
|
| Rate for Payer: Cigna Medicaid |
$233.52
|
| Rate for Payer: Cigna Medicare |
$224.10
|
| Rate for Payer: Employer Direct Commercial |
$224.10
|
| Rate for Payer: Humana Medicare/TRICARE |
$224.10
|
| Rate for Payer: Molina CHIP/Medicaid |
$233.52
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$224.10
|
| Rate for Payer: Molina Medicare |
$224.10
|
| Rate for Payer: Multiplan Auto |
$2,419.30
|
| Rate for Payer: Multiplan Commercial |
$2,419.30
|
| Rate for Payer: Multiplan Workers Comp |
$2,419.30
|
| Rate for Payer: Parkland Medicaid |
$233.52
|
| Rate for Payer: Scott and White EPO/PPO |
$4.01
|
| Rate for Payer: Scott and White Medicare |
$224.10
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$233.52
|
| Rate for Payer: Superior Health Plan EPO |
$224.10
|
| Rate for Payer: Superior Health Plan Medicare |
$224.10
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$224.10
|
| Rate for Payer: Universal American Medicare |
$224.10
|
| Rate for Payer: Wellcare Medicare |
$224.10
|
| Rate for Payer: Wellmed Medicare |
$224.10
|
|
|
MRI Hand w/o Contrast Right
|
Facility
|
OP
|
$3,722.00
|
|
|
Service Code
|
CPT 73218 RT
|
| Hospital Charge Code |
3750551
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$4.01 |
| Max. Negotiated Rate |
$2,419.30 |
| Rate for Payer: Aetna Commercial |
$332.85
|
| Rate for Payer: Aetna Medicare |
$336.15
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$233.52
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$224.10
|
| Rate for Payer: Amerigroup Medicare |
$224.10
|
| Rate for Payer: BCBS of TX Blue Advantage |
$384.52
|
| Rate for Payer: BCBS of TX Blue Essentials |
$461.42
|
| Rate for Payer: BCBS of TX Medicare |
$224.10
|
| Rate for Payer: BCBS of TX PPO |
$515.02
|
| Rate for Payer: Cash Price |
$3,275.36
|
| Rate for Payer: Cash Price |
$3,275.36
|
| Rate for Payer: Cash Price |
$3,275.36
|
| Rate for Payer: Cigna Commercial |
$507.64
|
| Rate for Payer: Cigna Medicaid |
$233.52
|
| Rate for Payer: Cigna Medicare |
$224.10
|
| Rate for Payer: Employer Direct Commercial |
$224.10
|
| Rate for Payer: Humana Medicare/TRICARE |
$224.10
|
| Rate for Payer: Molina CHIP/Medicaid |
$233.52
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$224.10
|
| Rate for Payer: Molina Medicare |
$224.10
|
| Rate for Payer: Multiplan Auto |
$2,419.30
|
| Rate for Payer: Multiplan Commercial |
$2,419.30
|
| Rate for Payer: Multiplan Workers Comp |
$2,419.30
|
| Rate for Payer: Parkland Medicaid |
$233.52
|
| Rate for Payer: Scott and White EPO/PPO |
$4.01
|
| Rate for Payer: Scott and White Medicare |
$224.10
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$233.52
|
| Rate for Payer: Superior Health Plan EPO |
$224.10
|
| Rate for Payer: Superior Health Plan Medicare |
$224.10
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$224.10
|
| Rate for Payer: Universal American Medicare |
$224.10
|
| Rate for Payer: Wellcare Medicare |
$224.10
|
| Rate for Payer: Wellmed Medicare |
$224.10
|
|
|
MRI Hand w/ + w/o Contrast Left
|
Facility
|
OP
|
$4,608.00
|
|
|
Service Code
|
CPT 73220 LT
|
| Hospital Charge Code |
3700044
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$6.29 |
| Max. Negotiated Rate |
$2,995.20 |
| Rate for Payer: Aetna Commercial |
$491.42
|
| Rate for Payer: Aetna Medicare |
$527.56
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$368.43
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$351.71
|
| Rate for Payer: Amerigroup Medicare |
$351.71
|
| Rate for Payer: BCBS of TX Blue Advantage |
$630.05
|
| Rate for Payer: BCBS of TX Blue Essentials |
$756.06
|
| Rate for Payer: BCBS of TX Medicare |
$351.71
|
| Rate for Payer: BCBS of TX PPO |
$843.89
|
| Rate for Payer: Cash Price |
$4,055.04
|
| Rate for Payer: Cash Price |
$4,055.04
|
| Rate for Payer: Cash Price |
$4,055.04
|
| Rate for Payer: Cigna Commercial |
$796.73
|
| Rate for Payer: Cigna Medicaid |
$368.43
|
| Rate for Payer: Cigna Medicare |
$351.71
|
| Rate for Payer: Employer Direct Commercial |
$351.71
|
| Rate for Payer: Humana Medicare/TRICARE |
$351.71
|
| Rate for Payer: Molina CHIP/Medicaid |
$368.43
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$351.71
|
| Rate for Payer: Molina Medicare |
$351.71
|
| Rate for Payer: Multiplan Auto |
$2,995.20
|
| Rate for Payer: Multiplan Commercial |
$2,995.20
|
| Rate for Payer: Multiplan Workers Comp |
$2,995.20
|
| Rate for Payer: Parkland Medicaid |
$368.43
|
| Rate for Payer: Scott and White EPO/PPO |
$6.29
|
| Rate for Payer: Scott and White Medicare |
$351.71
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$368.43
|
| Rate for Payer: Superior Health Plan EPO |
$351.71
|
| Rate for Payer: Superior Health Plan Medicare |
$351.71
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$351.71
|
| Rate for Payer: Universal American Medicare |
$351.71
|
| Rate for Payer: Wellcare Medicare |
$351.71
|
| Rate for Payer: Wellmed Medicare |
$351.71
|
|
|
MRI Hand w/ + w/o Contrast Right
|
Facility
|
OP
|
$4,608.00
|
|
|
Service Code
|
CPT 73220 RT
|
| Hospital Charge Code |
3700259
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$6.29 |
| Max. Negotiated Rate |
$2,995.20 |
| Rate for Payer: Aetna Commercial |
$491.42
|
| Rate for Payer: Aetna Medicare |
$527.56
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$368.43
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$351.71
|
| Rate for Payer: Amerigroup Medicare |
$351.71
|
| Rate for Payer: BCBS of TX Blue Advantage |
$630.05
|
| Rate for Payer: BCBS of TX Blue Essentials |
$756.06
|
| Rate for Payer: BCBS of TX Medicare |
$351.71
|
| Rate for Payer: BCBS of TX PPO |
$843.89
|
| Rate for Payer: Cash Price |
$4,055.04
|
| Rate for Payer: Cash Price |
$4,055.04
|
| Rate for Payer: Cash Price |
$4,055.04
|
| Rate for Payer: Cigna Commercial |
$796.73
|
| Rate for Payer: Cigna Medicaid |
$368.43
|
| Rate for Payer: Cigna Medicare |
$351.71
|
| Rate for Payer: Employer Direct Commercial |
$351.71
|
| Rate for Payer: Humana Medicare/TRICARE |
$351.71
|
| Rate for Payer: Molina CHIP/Medicaid |
$368.43
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$351.71
|
| Rate for Payer: Molina Medicare |
$351.71
|
| Rate for Payer: Multiplan Auto |
$2,995.20
|
| Rate for Payer: Multiplan Commercial |
$2,995.20
|
| Rate for Payer: Multiplan Workers Comp |
$2,995.20
|
| Rate for Payer: Parkland Medicaid |
$368.43
|
| Rate for Payer: Scott and White EPO/PPO |
$6.29
|
| Rate for Payer: Scott and White Medicare |
$351.71
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$368.43
|
| Rate for Payer: Superior Health Plan EPO |
$351.71
|
| Rate for Payer: Superior Health Plan Medicare |
$351.71
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$351.71
|
| Rate for Payer: Universal American Medicare |
$351.71
|
| Rate for Payer: Wellcare Medicare |
$351.71
|
| Rate for Payer: Wellmed Medicare |
$351.71
|
|
