|
MRI Spine Cervical w/ + w/o Contrast
|
Facility
|
OP
|
$10,611.00
|
|
|
Service Code
|
CPT 72156
|
| Hospital Charge Code |
3700218
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$6.29 |
| Max. Negotiated Rate |
$6,897.15 |
| Rate for Payer: Aetna Commercial |
$335.79
|
| Rate for Payer: Aetna Medicare |
$527.56
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$334.46
|
| 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 |
$9,337.68
|
| Rate for Payer: Cash Price |
$9,337.68
|
| Rate for Payer: Cash Price |
$9,337.68
|
| Rate for Payer: Cigna Commercial |
$796.73
|
| Rate for Payer: Cigna Medicaid |
$334.46
|
| 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 |
$334.46
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$351.71
|
| Rate for Payer: Molina Medicare |
$351.71
|
| Rate for Payer: Multiplan Auto |
$6,897.15
|
| Rate for Payer: Multiplan Commercial |
$6,897.15
|
| Rate for Payer: Multiplan Workers Comp |
$6,897.15
|
| Rate for Payer: Parkland Medicaid |
$334.46
|
| 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 |
$334.46
|
| 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 Spine Cervical w/ + w/o Contrast BCE
|
Facility
|
IP
|
$10,611.00
|
|
|
Service Code
|
CPT 72156
|
| Hospital Charge Code |
3700218
|
|
Hospital Revenue Code
|
612
|
| Rate for Payer: Cash Price |
$9,337.68
|
|
|
MRI Spine Cervical w/ + w/o Contrast BCE
|
Facility
|
OP
|
$10,611.00
|
|
|
Service Code
|
CPT 72156
|
| Hospital Charge Code |
3700218
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$6.29 |
| Max. Negotiated Rate |
$6,897.15 |
| Rate for Payer: Aetna Commercial |
$335.79
|
| Rate for Payer: Aetna Medicare |
$527.56
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$334.46
|
| 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 |
$9,337.68
|
| Rate for Payer: Cash Price |
$9,337.68
|
| Rate for Payer: Cash Price |
$9,337.68
|
| Rate for Payer: Cigna Commercial |
$796.73
|
| Rate for Payer: Cigna Medicaid |
$334.46
|
| 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 |
$334.46
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$351.71
|
| Rate for Payer: Molina Medicare |
$351.71
|
| Rate for Payer: Multiplan Auto |
$6,897.15
|
| Rate for Payer: Multiplan Commercial |
$6,897.15
|
| Rate for Payer: Multiplan Workers Comp |
$6,897.15
|
| Rate for Payer: Parkland Medicaid |
$334.46
|
| 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 |
$334.46
|
| 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 Spine Lumbar w/o Contrast
|
Facility
|
OP
|
$6,239.00
|
|
|
Service Code
|
CPT 72148
|
| Hospital Charge Code |
3700234
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$4.01 |
| Max. Negotiated Rate |
$4,055.35 |
| Rate for Payer: Aetna Commercial |
$190.98
|
| Rate for Payer: Aetna Medicare |
$336.15
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$199.14
|
| 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 |
$5,490.32
|
| Rate for Payer: Cash Price |
$5,490.32
|
| Rate for Payer: Cash Price |
$5,490.32
|
| Rate for Payer: Cigna Commercial |
$507.64
|
| Rate for Payer: Cigna Medicaid |
$199.14
|
| 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 |
$199.14
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$224.10
|
| Rate for Payer: Molina Medicare |
$224.10
|
| Rate for Payer: Multiplan Auto |
$4,055.35
|
| Rate for Payer: Multiplan Commercial |
$4,055.35
|
| Rate for Payer: Multiplan Workers Comp |
$4,055.35
|
| Rate for Payer: Parkland Medicaid |
$199.14
|
| 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 |
$199.14
|
| 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 Spine Lumbar w/o Contrast BCE
|
Facility
|
IP
|
$6,239.00
|
|
|
Service Code
|
CPT 72148
|
| Hospital Charge Code |
3700234
|
|
Hospital Revenue Code
|
612
|
| Rate for Payer: Cash Price |
$5,490.32
|
|
|
MRI Spine Lumbar w/o Contrast BCE
|
Facility
|
OP
|
$6,239.00
|
|
|
Service Code
|
CPT 72148
|
| Hospital Charge Code |
3700234
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$4.01 |
| Max. Negotiated Rate |
$4,055.35 |
| Rate for Payer: Aetna Commercial |
$190.98
|
| Rate for Payer: Aetna Medicare |
$336.15
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$199.14
|
| 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 |
$5,490.32
|
| Rate for Payer: Cash Price |
$5,490.32
|
| Rate for Payer: Cash Price |
$5,490.32
|
| Rate for Payer: Cigna Commercial |
$507.64
|
| Rate for Payer: Cigna Medicaid |
$199.14
|
| 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 |
$199.14
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$224.10
|
| Rate for Payer: Molina Medicare |
$224.10
|
| Rate for Payer: Multiplan Auto |
$4,055.35
|
| Rate for Payer: Multiplan Commercial |
$4,055.35
|
| Rate for Payer: Multiplan Workers Comp |
$4,055.35
|
| Rate for Payer: Parkland Medicaid |
$199.14
|
| 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 |
$199.14
|
| 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 Spine Lumbar w/ + w/o Contrast
|
Facility
|
OP
|
$10,113.00
|
|
|
Service Code
|
CPT 72158
|
| Hospital Charge Code |
3700127
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$6.29 |
| Max. Negotiated Rate |
$6,573.45 |
| Rate for Payer: Aetna Commercial |
$334.32
|
| Rate for Payer: Aetna Medicare |
$527.56
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$333.80
|
| 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 |
$8,899.44
|
| Rate for Payer: Cash Price |
$8,899.44
|
| Rate for Payer: Cash Price |
$8,899.44
|
| Rate for Payer: Cigna Commercial |
$796.73
|
| Rate for Payer: Cigna Medicaid |
$333.80
|
| 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 |
$333.80
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$351.71
|
| Rate for Payer: Molina Medicare |
$351.71
|
| Rate for Payer: Multiplan Auto |
$6,573.45
|
| Rate for Payer: Multiplan Commercial |
$6,573.45
|
| Rate for Payer: Multiplan Workers Comp |
$6,573.45
|
| Rate for Payer: Parkland Medicaid |
$333.80
|
| 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 |
$333.80
|
| 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 Spine Lumbar w/ + w/o Contrast BCE
|
Facility
|
OP
|
$10,113.00
|
|
|
Service Code
|
CPT 72158
|
| Hospital Charge Code |
3700127
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$6.29 |
| Max. Negotiated Rate |
$6,573.45 |
| Rate for Payer: Aetna Commercial |
$334.32
|
| Rate for Payer: Aetna Medicare |
$527.56
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$333.80
|
| 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 |
$8,899.44
|
| Rate for Payer: Cash Price |
$8,899.44
|
| Rate for Payer: Cash Price |
$8,899.44
|
| Rate for Payer: Cigna Commercial |
$796.73
|
| Rate for Payer: Cigna Medicaid |
$333.80
|
| 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 |
$333.80
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$351.71
|
| Rate for Payer: Molina Medicare |
$351.71
|
| Rate for Payer: Multiplan Auto |
$6,573.45
|
| Rate for Payer: Multiplan Commercial |
$6,573.45
|
| Rate for Payer: Multiplan Workers Comp |
$6,573.45
|
| Rate for Payer: Parkland Medicaid |
$333.80
|
| 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 |
$333.80
|
| 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 Spine Lumbar w/ + w/o Contrast BCE
|
Facility
|
IP
|
$10,113.00
|
|
|
Service Code
|
CPT 72158
|
| Hospital Charge Code |
3700127
|
|
Hospital Revenue Code
|
612
|
| Rate for Payer: Cash Price |
$8,899.44
|
|
|
MRI Spine Thoracic w/o Contrast
|
Facility
|
OP
|
$6,239.00
|
|
|
Service Code
|
CPT 72146
|
| Hospital Charge Code |
3700101
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$4.01 |
| Max. Negotiated Rate |
$4,055.35 |
| Rate for Payer: Aetna Commercial |
$190.49
|
| Rate for Payer: Aetna Medicare |
$336.15
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$198.48
|
| 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 |
$5,490.32
|
| Rate for Payer: Cash Price |
$5,490.32
|
| Rate for Payer: Cash Price |
$5,490.32
|
| Rate for Payer: Cigna Commercial |
$507.64
|
| Rate for Payer: Cigna Medicaid |
$198.48
|
| 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 |
$198.48
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$224.10
|
| Rate for Payer: Molina Medicare |
$224.10
|
| Rate for Payer: Multiplan Auto |
$4,055.35
|
| Rate for Payer: Multiplan Commercial |
$4,055.35
|
| Rate for Payer: Multiplan Workers Comp |
$4,055.35
|
| Rate for Payer: Parkland Medicaid |
$198.48
|
| 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 |
$198.48
|
| 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 Spine Thoracic w/o Contrast BCE
|
Facility
|
OP
|
$6,239.00
|
|
|
Service Code
|
CPT 72146
|
| Hospital Charge Code |
3700101
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$4.01 |
| Max. Negotiated Rate |
$4,055.35 |
| Rate for Payer: Aetna Commercial |
$190.49
|
| Rate for Payer: Aetna Medicare |
$336.15
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$198.48
|
| 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 |
$5,490.32
|
| Rate for Payer: Cash Price |
$5,490.32
|
| Rate for Payer: Cash Price |
$5,490.32
|
| Rate for Payer: Cigna Commercial |
$507.64
|
| Rate for Payer: Cigna Medicaid |
$198.48
|
| 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 |
$198.48
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$224.10
|
| Rate for Payer: Molina Medicare |
$224.10
|
| Rate for Payer: Multiplan Auto |
$4,055.35
|
| Rate for Payer: Multiplan Commercial |
$4,055.35
|
| Rate for Payer: Multiplan Workers Comp |
$4,055.35
|
| Rate for Payer: Parkland Medicaid |
$198.48
|
| 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 |
$198.48
|
| 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 Spine Thoracic w/o Contrast BCE
|
Facility
|
IP
|
$6,239.00
|
|
|
Service Code
|
CPT 72146
|
| Hospital Charge Code |
3700101
|
|
Hospital Revenue Code
|
612
|
| Rate for Payer: Cash Price |
$5,490.32
|
|
|
MRI Spine Thoracic w/ + w/o Contrast
|
Facility
|
OP
|
$10,113.00
|
|
|
Service Code
|
CPT 72157
|
| Hospital Charge Code |
3700093
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$6.29 |
| Max. Negotiated Rate |
$6,573.45 |
| Rate for Payer: Aetna Commercial |
$336.28
|
| Rate for Payer: Aetna Medicare |
$527.56
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$335.14
|
| 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 |
$8,899.44
|
| Rate for Payer: Cash Price |
$8,899.44
|
| Rate for Payer: Cash Price |
$8,899.44
|
| Rate for Payer: Cigna Commercial |
$796.73
|
| Rate for Payer: Cigna Medicaid |
$335.14
|
| 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 |
$335.14
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$351.71
|
| Rate for Payer: Molina Medicare |
$351.71
|
| Rate for Payer: Multiplan Auto |
$6,573.45
|
| Rate for Payer: Multiplan Commercial |
$6,573.45
|
| Rate for Payer: Multiplan Workers Comp |
$6,573.45
|
| Rate for Payer: Parkland Medicaid |
$335.14
|
| 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 |
$335.14
|
| 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 Spine Thoracic w/ + w/o Contrast BCE
|
Facility
|
IP
|
$10,113.00
|
|
|
Service Code
|
CPT 72157
|
| Hospital Charge Code |
3700093
|
|
Hospital Revenue Code
|
612
|
| Rate for Payer: Cash Price |
$8,899.44
|
|
|
MRI Spine Thoracic w/ + w/o Contrast BCE
|
Facility
|
OP
|
$10,113.00
|
|
|
Service Code
|
CPT 72157
|
| Hospital Charge Code |
3700093
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$6.29 |
| Max. Negotiated Rate |
$6,573.45 |
| Rate for Payer: Aetna Commercial |
$336.28
|
| Rate for Payer: Aetna Medicare |
$527.56
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$335.14
|
| 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 |
$8,899.44
|
| Rate for Payer: Cash Price |
$8,899.44
|
| Rate for Payer: Cash Price |
$8,899.44
|
| Rate for Payer: Cigna Commercial |
$796.73
|
| Rate for Payer: Cigna Medicaid |
$335.14
|
| 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 |
$335.14
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$351.71
|
| Rate for Payer: Molina Medicare |
$351.71
|
| Rate for Payer: Multiplan Auto |
$6,573.45
|
| Rate for Payer: Multiplan Commercial |
$6,573.45
|
| Rate for Payer: Multiplan Workers Comp |
$6,573.45
|
| Rate for Payer: Parkland Medicaid |
$335.14
|
| 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 |
$335.14
|
| 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 Tibia Fibula 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 Tibia Fibula w/o Contrast Left
|
Facility
|
IP
|
$3,635.00
|
|
|
Service Code
|
CPT 73718 LT
|
| Hospital Charge Code |
3750601
|
|
Hospital Revenue Code
|
610
|
| Rate for Payer: Cash Price |
$3,198.80
|
|
|
MRI Tibia Fibula w/o Contrast Right
|
Facility
|
IP
|
$3,635.00
|
|
|
Service Code
|
CPT 73718 RT
|
| Hospital Charge Code |
3750619
|
|
Hospital Revenue Code
|
610
|
| Rate for Payer: Cash Price |
$3,198.80
|
|
|
MRI Tibia Fibula 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 Tibia Fibula 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 Tibia Fibula w/ + w/o Contrast Left
|
Facility
|
IP
|
$4,568.00
|
|
|
Service Code
|
CPT 73720 LT
|
| Hospital Charge Code |
3700028
|
|
Hospital Revenue Code
|
610
|
| Rate for Payer: Cash Price |
$4,019.84
|
|
|
MRI Tibia Fibula 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 Tibia Fibula w/ + w/o Contrast Right
|
Facility
|
IP
|
$4,568.00
|
|
|
Service Code
|
CPT 73720 RT
|
| Hospital Charge Code |
3700275
|
|
Hospital Revenue Code
|
610
|
| Rate for Payer: Cash Price |
$4,019.84
|
|
|
MRI TMJ
|
Facility
|
OP
|
$2,866.00
|
|
|
Service Code
|
CPT 70336
|
| Hospital Charge Code |
3701018
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$4.01 |
| Max. Negotiated Rate |
$1,862.90 |
| Rate for Payer: Aetna Commercial |
$310.75
|
| 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 |
$2,522.08
|
| Rate for Payer: Cash Price |
$2,522.08
|
| Rate for Payer: Cash Price |
$2,522.08
|
| 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 |
$1,862.90
|
| Rate for Payer: Multiplan Commercial |
$1,862.90
|
| Rate for Payer: Multiplan Workers Comp |
$1,862.90
|
| 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 TMJ BCE
|
Facility
|
IP
|
$2,866.00
|
|
|
Service Code
|
CPT 70336
|
| Hospital Charge Code |
3701018
|
|
Hospital Revenue Code
|
610
|
| Rate for Payer: Cash Price |
$2,522.08
|
|
