|
MRI Hip w/ Contrast Left
|
Facility
|
OP
|
$4,425.00
|
|
|
Service Code
|
CPT 73722 LT
|
| Hospital Charge Code |
3740044
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$13.10 |
| Max. Negotiated Rate |
$2,876.25 |
| Rate for Payer: Aetna Commercial |
$376.53
|
| Rate for Payer: Aetna Medicare |
$1,098.39
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$328.79
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$732.26
|
| Rate for Payer: Amerigroup Medicare |
$732.26
|
| Rate for Payer: BCBS of TX Blue Advantage |
$1,123.35
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,348.02
|
| Rate for Payer: BCBS of TX Medicare |
$732.26
|
| Rate for Payer: BCBS of TX PPO |
$1,504.61
|
| Rate for Payer: Cash Price |
$3,894.00
|
| Rate for Payer: Cash Price |
$3,894.00
|
| Rate for Payer: Cash Price |
$3,894.00
|
| Rate for Payer: Cigna Commercial |
$1,658.78
|
| Rate for Payer: Cigna Medicaid |
$328.79
|
| Rate for Payer: Cigna Medicare |
$732.26
|
| Rate for Payer: Employer Direct Commercial |
$732.26
|
| Rate for Payer: Humana Medicare/TRICARE |
$732.26
|
| Rate for Payer: Molina CHIP/Medicaid |
$328.79
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$732.26
|
| Rate for Payer: Molina Medicare |
$732.26
|
| Rate for Payer: Multiplan Auto |
$2,876.25
|
| Rate for Payer: Multiplan Commercial |
$2,876.25
|
| Rate for Payer: Multiplan Workers Comp |
$2,876.25
|
| Rate for Payer: Parkland Medicaid |
$328.79
|
| Rate for Payer: Scott and White EPO/PPO |
$13.10
|
| Rate for Payer: Scott and White Medicare |
$732.26
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$328.79
|
| Rate for Payer: Superior Health Plan EPO |
$732.26
|
| Rate for Payer: Superior Health Plan Medicare |
$732.26
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$732.26
|
| Rate for Payer: Universal American Medicare |
$732.26
|
| Rate for Payer: Wellcare Medicare |
$732.26
|
| Rate for Payer: Wellmed Medicare |
$732.26
|
|
|
MRI Hip w/ Contrast Right
|
Facility
|
OP
|
$4,425.00
|
|
|
Service Code
|
CPT 73722 RT
|
| Hospital Charge Code |
3740045
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$13.10 |
| Max. Negotiated Rate |
$2,876.25 |
| Rate for Payer: Aetna Commercial |
$376.53
|
| Rate for Payer: Aetna Medicare |
$1,098.39
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$328.79
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$732.26
|
| Rate for Payer: Amerigroup Medicare |
$732.26
|
| Rate for Payer: BCBS of TX Blue Advantage |
$1,123.35
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,348.02
|
| Rate for Payer: BCBS of TX Medicare |
$732.26
|
| Rate for Payer: BCBS of TX PPO |
$1,504.61
|
| Rate for Payer: Cash Price |
$3,894.00
|
| Rate for Payer: Cash Price |
$3,894.00
|
| Rate for Payer: Cash Price |
$3,894.00
|
| Rate for Payer: Cigna Commercial |
$1,658.78
|
| Rate for Payer: Cigna Medicaid |
$328.79
|
| Rate for Payer: Cigna Medicare |
$732.26
|
| Rate for Payer: Employer Direct Commercial |
$732.26
|
| Rate for Payer: Humana Medicare/TRICARE |
$732.26
|
| Rate for Payer: Molina CHIP/Medicaid |
$328.79
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$732.26
|
| Rate for Payer: Molina Medicare |
$732.26
|
| Rate for Payer: Multiplan Auto |
$2,876.25
|
| Rate for Payer: Multiplan Commercial |
$2,876.25
|
| Rate for Payer: Multiplan Workers Comp |
$2,876.25
|
| Rate for Payer: Parkland Medicaid |
$328.79
|
| Rate for Payer: Scott and White EPO/PPO |
$13.10
|
| Rate for Payer: Scott and White Medicare |
$732.26
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$328.79
|
| Rate for Payer: Superior Health Plan EPO |
$732.26
|
| Rate for Payer: Superior Health Plan Medicare |
$732.26
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$732.26
|
| Rate for Payer: Universal American Medicare |
$732.26
|
| Rate for Payer: Wellcare Medicare |
$732.26
|
| Rate for Payer: Wellmed Medicare |
$732.26
|
|
|
MRI Hip w/o Contrast Left
|
Facility
|
OP
|
$3,907.00
|
|
|
Service Code
|
CPT 73721 LT
|
| Hospital Charge Code |
3700036
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$4.01 |
| Max. Negotiated Rate |
$2,539.55 |
| Rate for Payer: Aetna Commercial |
$215.53
|
| Rate for Payer: Aetna Medicare |
$336.15
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$210.84
|
| 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 |
$3,438.16
|
| Rate for Payer: Cash Price |
$3,438.16
|
| Rate for Payer: Cash Price |
$3,438.16
|
| Rate for Payer: Cigna Commercial |
$507.64
|
| Rate for Payer: Cigna Medicaid |
$210.84
|
| 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 |
$210.84
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$224.10
|
| Rate for Payer: Molina Medicare |
$224.10
|
| Rate for Payer: Multiplan Auto |
$2,539.55
|
| Rate for Payer: Multiplan Commercial |
$2,539.55
|
| Rate for Payer: Multiplan Workers Comp |
$2,539.55
|
| Rate for Payer: Parkland Medicaid |
$210.84
|
| 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 |
$210.84
|
| 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 Hip w/o Contrast Right
|
Facility
|
OP
|
$3,907.00
|
|
|
Service Code
|
CPT 73721 RT
|
| Hospital Charge Code |
3700283
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$4.01 |
| Max. Negotiated Rate |
$2,539.55 |
| Rate for Payer: Aetna Commercial |
$215.53
|
| Rate for Payer: Aetna Medicare |
$336.15
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$210.84
|
| 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 |
$3,438.16
|
| Rate for Payer: Cash Price |
$3,438.16
|
| Rate for Payer: Cash Price |
$3,438.16
|
| Rate for Payer: Cigna Commercial |
$507.64
|
| Rate for Payer: Cigna Medicaid |
$210.84
|
| 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 |
$210.84
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$224.10
|
| Rate for Payer: Molina Medicare |
$224.10
|
| Rate for Payer: Multiplan Auto |
$2,539.55
|
| Rate for Payer: Multiplan Commercial |
$2,539.55
|
| Rate for Payer: Multiplan Workers Comp |
$2,539.55
|
| Rate for Payer: Parkland Medicaid |
$210.84
|
| 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 |
$210.84
|
| 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 Hip w/ + w/o Contrast Left
|
Facility
|
OP
|
$5,347.00
|
|
|
Service Code
|
CPT 73723 LT
|
| Hospital Charge Code |
3750643
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$6.29 |
| Max. Negotiated Rate |
$3,475.55 |
| Rate for Payer: Aetna Commercial |
$454.62
|
| 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 |
$4,705.36
|
| Rate for Payer: Cash Price |
$4,705.36
|
| Rate for Payer: Cash Price |
$4,705.36
|
| 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 |
$3,475.55
|
| Rate for Payer: Multiplan Commercial |
$3,475.55
|
| Rate for Payer: Multiplan Workers Comp |
$3,475.55
|
| 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 Hip w/ + w/o Contrast Right
|
Facility
|
OP
|
$5,347.00
|
|
|
Service Code
|
CPT 73723 RT
|
| Hospital Charge Code |
3750833
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$6.29 |
| Max. Negotiated Rate |
$3,475.55 |
| Rate for Payer: Aetna Commercial |
$454.62
|
| 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 |
$4,705.36
|
| Rate for Payer: Cash Price |
$4,705.36
|
| Rate for Payer: Cash Price |
$4,705.36
|
| 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 |
$3,475.55
|
| Rate for Payer: Multiplan Commercial |
$3,475.55
|
| Rate for Payer: Multiplan Workers Comp |
$3,475.55
|
| 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 Humerus 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 Humerus 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 Humerus 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 Humerus 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 Knee w/ Contrast Left
|
Facility
|
OP
|
$4,425.00
|
|
|
Service Code
|
CPT 73722 LT
|
| Hospital Charge Code |
3740044
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$13.10 |
| Max. Negotiated Rate |
$2,876.25 |
| Rate for Payer: Aetna Commercial |
$376.53
|
| Rate for Payer: Aetna Medicare |
$1,098.39
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$328.79
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$732.26
|
| Rate for Payer: Amerigroup Medicare |
$732.26
|
| Rate for Payer: BCBS of TX Blue Advantage |
$1,123.35
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,348.02
|
| Rate for Payer: BCBS of TX Medicare |
$732.26
|
| Rate for Payer: BCBS of TX PPO |
$1,504.61
|
| Rate for Payer: Cash Price |
$3,894.00
|
| Rate for Payer: Cash Price |
$3,894.00
|
| Rate for Payer: Cash Price |
$3,894.00
|
| Rate for Payer: Cigna Commercial |
$1,658.78
|
| Rate for Payer: Cigna Medicaid |
$328.79
|
| Rate for Payer: Cigna Medicare |
$732.26
|
| Rate for Payer: Employer Direct Commercial |
$732.26
|
| Rate for Payer: Humana Medicare/TRICARE |
$732.26
|
| Rate for Payer: Molina CHIP/Medicaid |
$328.79
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$732.26
|
| Rate for Payer: Molina Medicare |
$732.26
|
| Rate for Payer: Multiplan Auto |
$2,876.25
|
| Rate for Payer: Multiplan Commercial |
$2,876.25
|
| Rate for Payer: Multiplan Workers Comp |
$2,876.25
|
| Rate for Payer: Parkland Medicaid |
$328.79
|
| Rate for Payer: Scott and White EPO/PPO |
$13.10
|
| Rate for Payer: Scott and White Medicare |
$732.26
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$328.79
|
| Rate for Payer: Superior Health Plan EPO |
$732.26
|
| Rate for Payer: Superior Health Plan Medicare |
$732.26
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$732.26
|
| Rate for Payer: Universal American Medicare |
$732.26
|
| Rate for Payer: Wellcare Medicare |
$732.26
|
| Rate for Payer: Wellmed Medicare |
$732.26
|
|
|
MRI Knee w/ Contrast Right
|
Facility
|
OP
|
$4,425.00
|
|
|
Service Code
|
CPT 73722 RT
|
| Hospital Charge Code |
3740045
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$13.10 |
| Max. Negotiated Rate |
$2,876.25 |
| Rate for Payer: Aetna Commercial |
$376.53
|
| Rate for Payer: Aetna Medicare |
$1,098.39
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$328.79
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$732.26
|
| Rate for Payer: Amerigroup Medicare |
$732.26
|
| Rate for Payer: BCBS of TX Blue Advantage |
$1,123.35
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,348.02
|
| Rate for Payer: BCBS of TX Medicare |
$732.26
|
| Rate for Payer: BCBS of TX PPO |
$1,504.61
|
| Rate for Payer: Cash Price |
$3,894.00
|
| Rate for Payer: Cash Price |
$3,894.00
|
| Rate for Payer: Cash Price |
$3,894.00
|
| Rate for Payer: Cigna Commercial |
$1,658.78
|
| Rate for Payer: Cigna Medicaid |
$328.79
|
| Rate for Payer: Cigna Medicare |
$732.26
|
| Rate for Payer: Employer Direct Commercial |
$732.26
|
| Rate for Payer: Humana Medicare/TRICARE |
$732.26
|
| Rate for Payer: Molina CHIP/Medicaid |
$328.79
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$732.26
|
| Rate for Payer: Molina Medicare |
$732.26
|
| Rate for Payer: Multiplan Auto |
$2,876.25
|
| Rate for Payer: Multiplan Commercial |
$2,876.25
|
| Rate for Payer: Multiplan Workers Comp |
$2,876.25
|
| Rate for Payer: Parkland Medicaid |
$328.79
|
| Rate for Payer: Scott and White EPO/PPO |
$13.10
|
| Rate for Payer: Scott and White Medicare |
$732.26
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$328.79
|
| Rate for Payer: Superior Health Plan EPO |
$732.26
|
| Rate for Payer: Superior Health Plan Medicare |
$732.26
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$732.26
|
| Rate for Payer: Universal American Medicare |
$732.26
|
| Rate for Payer: Wellcare Medicare |
$732.26
|
| Rate for Payer: Wellmed Medicare |
$732.26
|
|
|
MRI Knee w/o Contrast Left
|
Facility
|
OP
|
$3,907.00
|
|
|
Service Code
|
CPT 73721 LT
|
| Hospital Charge Code |
3700036
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$4.01 |
| Max. Negotiated Rate |
$2,539.55 |
| Rate for Payer: Aetna Commercial |
$215.53
|
| Rate for Payer: Aetna Medicare |
$336.15
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$210.84
|
| 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 |
$3,438.16
|
| Rate for Payer: Cash Price |
$3,438.16
|
| Rate for Payer: Cash Price |
$3,438.16
|
| Rate for Payer: Cigna Commercial |
$507.64
|
| Rate for Payer: Cigna Medicaid |
$210.84
|
| 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 |
$210.84
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$224.10
|
| Rate for Payer: Molina Medicare |
$224.10
|
| Rate for Payer: Multiplan Auto |
$2,539.55
|
| Rate for Payer: Multiplan Commercial |
$2,539.55
|
| Rate for Payer: Multiplan Workers Comp |
$2,539.55
|
| Rate for Payer: Parkland Medicaid |
$210.84
|
| 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 |
$210.84
|
| 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 Knee w/o Contrast Right
|
Facility
|
OP
|
$3,907.00
|
|
|
Service Code
|
CPT 73721 RT
|
| Hospital Charge Code |
3700283
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$4.01 |
| Max. Negotiated Rate |
$2,539.55 |
| Rate for Payer: Aetna Commercial |
$215.53
|
| Rate for Payer: Aetna Medicare |
$336.15
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$210.84
|
| 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 |
$3,438.16
|
| Rate for Payer: Cash Price |
$3,438.16
|
| Rate for Payer: Cash Price |
$3,438.16
|
| Rate for Payer: Cigna Commercial |
$507.64
|
| Rate for Payer: Cigna Medicaid |
$210.84
|
| 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 |
$210.84
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$224.10
|
| Rate for Payer: Molina Medicare |
$224.10
|
| Rate for Payer: Multiplan Auto |
$2,539.55
|
| Rate for Payer: Multiplan Commercial |
$2,539.55
|
| Rate for Payer: Multiplan Workers Comp |
$2,539.55
|
| Rate for Payer: Parkland Medicaid |
$210.84
|
| 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 |
$210.84
|
| 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 Knee w/ + w/o Contrast Left
|
Facility
|
OP
|
$5,347.00
|
|
|
Service Code
|
CPT 73723 LT
|
| Hospital Charge Code |
3750643
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$6.29 |
| Max. Negotiated Rate |
$3,475.55 |
| Rate for Payer: Aetna Commercial |
$454.62
|
| 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 |
$4,705.36
|
| Rate for Payer: Cash Price |
$4,705.36
|
| Rate for Payer: Cash Price |
$4,705.36
|
| 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 |
$3,475.55
|
| Rate for Payer: Multiplan Commercial |
$3,475.55
|
| Rate for Payer: Multiplan Workers Comp |
$3,475.55
|
| 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 Knee w/ + w/o Contrast Right
|
Facility
|
OP
|
$5,347.00
|
|
|
Service Code
|
CPT 73723 RT
|
| Hospital Charge Code |
3750833
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$6.29 |
| Max. Negotiated Rate |
$3,475.55 |
| Rate for Payer: Aetna Commercial |
$454.62
|
| 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 |
$4,705.36
|
| Rate for Payer: Cash Price |
$4,705.36
|
| Rate for Payer: Cash Price |
$4,705.36
|
| 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 |
$3,475.55
|
| Rate for Payer: Multiplan Commercial |
$3,475.55
|
| Rate for Payer: Multiplan Workers Comp |
$3,475.55
|
| 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 Lower Extremity Joint w/ contrast Left BCE
|
Facility
|
IP
|
$4,425.00
|
|
|
Service Code
|
CPT 73722 LT
|
| Hospital Charge Code |
3740044
|
|
Hospital Revenue Code
|
610
|
| Rate for Payer: Cash Price |
$3,894.00
|
|
|
MRI Lower Extremity Joint w/ contrast Left BCE
|
Facility
|
OP
|
$4,425.00
|
|
|
Service Code
|
CPT 73722 LT
|
| Hospital Charge Code |
3740044
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$13.10 |
| Max. Negotiated Rate |
$2,876.25 |
| Rate for Payer: Aetna Commercial |
$376.53
|
| Rate for Payer: Aetna Medicare |
$1,098.39
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$328.79
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$732.26
|
| Rate for Payer: Amerigroup Medicare |
$732.26
|
| Rate for Payer: BCBS of TX Blue Advantage |
$1,123.35
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,348.02
|
| Rate for Payer: BCBS of TX Medicare |
$732.26
|
| Rate for Payer: BCBS of TX PPO |
$1,504.61
|
| Rate for Payer: Cash Price |
$3,894.00
|
| Rate for Payer: Cash Price |
$3,894.00
|
| Rate for Payer: Cash Price |
$3,894.00
|
| Rate for Payer: Cigna Commercial |
$1,658.78
|
| Rate for Payer: Cigna Medicaid |
$328.79
|
| Rate for Payer: Cigna Medicare |
$732.26
|
| Rate for Payer: Employer Direct Commercial |
$732.26
|
| Rate for Payer: Humana Medicare/TRICARE |
$732.26
|
| Rate for Payer: Molina CHIP/Medicaid |
$328.79
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$732.26
|
| Rate for Payer: Molina Medicare |
$732.26
|
| Rate for Payer: Multiplan Auto |
$2,876.25
|
| Rate for Payer: Multiplan Commercial |
$2,876.25
|
| Rate for Payer: Multiplan Workers Comp |
$2,876.25
|
| Rate for Payer: Parkland Medicaid |
$328.79
|
| Rate for Payer: Scott and White EPO/PPO |
$13.10
|
| Rate for Payer: Scott and White Medicare |
$732.26
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$328.79
|
| Rate for Payer: Superior Health Plan EPO |
$732.26
|
| Rate for Payer: Superior Health Plan Medicare |
$732.26
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$732.26
|
| Rate for Payer: Universal American Medicare |
$732.26
|
| Rate for Payer: Wellcare Medicare |
$732.26
|
| Rate for Payer: Wellmed Medicare |
$732.26
|
|
|
MRI Lower Extremity Joint w/ contrast Right BCE
|
Facility
|
IP
|
$4,425.00
|
|
|
Service Code
|
CPT 73722 RT
|
| Hospital Charge Code |
3740045
|
|
Hospital Revenue Code
|
610
|
| Rate for Payer: Cash Price |
$3,894.00
|
|
|
MRI Lower Extremity Joint w/ contrast Right BCE
|
Facility
|
OP
|
$4,425.00
|
|
|
Service Code
|
CPT 73722 RT
|
| Hospital Charge Code |
3740045
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$13.10 |
| Max. Negotiated Rate |
$2,876.25 |
| Rate for Payer: Aetna Commercial |
$376.53
|
| Rate for Payer: Aetna Medicare |
$1,098.39
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$328.79
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$732.26
|
| Rate for Payer: Amerigroup Medicare |
$732.26
|
| Rate for Payer: BCBS of TX Blue Advantage |
$1,123.35
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,348.02
|
| Rate for Payer: BCBS of TX Medicare |
$732.26
|
| Rate for Payer: BCBS of TX PPO |
$1,504.61
|
| Rate for Payer: Cash Price |
$3,894.00
|
| Rate for Payer: Cash Price |
$3,894.00
|
| Rate for Payer: Cash Price |
$3,894.00
|
| Rate for Payer: Cigna Commercial |
$1,658.78
|
| Rate for Payer: Cigna Medicaid |
$328.79
|
| Rate for Payer: Cigna Medicare |
$732.26
|
| Rate for Payer: Employer Direct Commercial |
$732.26
|
| Rate for Payer: Humana Medicare/TRICARE |
$732.26
|
| Rate for Payer: Molina CHIP/Medicaid |
$328.79
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$732.26
|
| Rate for Payer: Molina Medicare |
$732.26
|
| Rate for Payer: Multiplan Auto |
$2,876.25
|
| Rate for Payer: Multiplan Commercial |
$2,876.25
|
| Rate for Payer: Multiplan Workers Comp |
$2,876.25
|
| Rate for Payer: Parkland Medicaid |
$328.79
|
| Rate for Payer: Scott and White EPO/PPO |
$13.10
|
| Rate for Payer: Scott and White Medicare |
$732.26
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$328.79
|
| Rate for Payer: Superior Health Plan EPO |
$732.26
|
| Rate for Payer: Superior Health Plan Medicare |
$732.26
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$732.26
|
| Rate for Payer: Universal American Medicare |
$732.26
|
| Rate for Payer: Wellcare Medicare |
$732.26
|
| Rate for Payer: Wellmed Medicare |
$732.26
|
|
|
MRI Lower Extremity Joint w/o Contrast Left BCE
|
Facility
|
IP
|
$3,907.00
|
|
|
Service Code
|
CPT 73721 LT
|
| Hospital Charge Code |
3700036
|
|
Hospital Revenue Code
|
610
|
| Rate for Payer: Cash Price |
$3,438.16
|
|
|
MRI Lower Extremity Joint w/o Contrast Left BCE
|
Facility
|
OP
|
$3,907.00
|
|
|
Service Code
|
CPT 73721 LT
|
| Hospital Charge Code |
3700036
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$4.01 |
| Max. Negotiated Rate |
$2,539.55 |
| Rate for Payer: Aetna Commercial |
$215.53
|
| Rate for Payer: Aetna Medicare |
$336.15
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$210.84
|
| 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 |
$3,438.16
|
| Rate for Payer: Cash Price |
$3,438.16
|
| Rate for Payer: Cash Price |
$3,438.16
|
| Rate for Payer: Cigna Commercial |
$507.64
|
| Rate for Payer: Cigna Medicaid |
$210.84
|
| 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 |
$210.84
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$224.10
|
| Rate for Payer: Molina Medicare |
$224.10
|
| Rate for Payer: Multiplan Auto |
$2,539.55
|
| Rate for Payer: Multiplan Commercial |
$2,539.55
|
| Rate for Payer: Multiplan Workers Comp |
$2,539.55
|
| Rate for Payer: Parkland Medicaid |
$210.84
|
| 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 |
$210.84
|
| 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 Lower Extremity Joint w/o Contrast Right BCE
|
Facility
|
IP
|
$3,907.00
|
|
|
Service Code
|
CPT 73721 RT
|
| Hospital Charge Code |
3700283
|
|
Hospital Revenue Code
|
610
|
| Rate for Payer: Cash Price |
$3,438.16
|
|
|
MRI Lower Extremity Joint w/o Contrast Right BCE
|
Facility
|
OP
|
$3,907.00
|
|
|
Service Code
|
CPT 73721 RT
|
| Hospital Charge Code |
3700283
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$4.01 |
| Max. Negotiated Rate |
$2,539.55 |
| Rate for Payer: Aetna Commercial |
$215.53
|
| Rate for Payer: Aetna Medicare |
$336.15
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$210.84
|
| 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 |
$3,438.16
|
| Rate for Payer: Cash Price |
$3,438.16
|
| Rate for Payer: Cash Price |
$3,438.16
|
| Rate for Payer: Cigna Commercial |
$507.64
|
| Rate for Payer: Cigna Medicaid |
$210.84
|
| 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 |
$210.84
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$224.10
|
| Rate for Payer: Molina Medicare |
$224.10
|
| Rate for Payer: Multiplan Auto |
$2,539.55
|
| Rate for Payer: Multiplan Commercial |
$2,539.55
|
| Rate for Payer: Multiplan Workers Comp |
$2,539.55
|
| Rate for Payer: Parkland Medicaid |
$210.84
|
| 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 |
$210.84
|
| 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 Lower Extremity Joint w + w/o Conttast Left BCE
|
Facility
|
IP
|
$5,347.00
|
|
|
Service Code
|
CPT 73723 LT
|
| Hospital Charge Code |
3750643
|
|
Hospital Revenue Code
|
610
|
| Rate for Payer: Cash Price |
$4,705.36
|
|
