|
MRI TMJ BCE
|
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 Upper Extremity Joint w/ contrast Left BCE
|
Facility
|
OP
|
$3,722.00
|
|
|
Service Code
|
CPT 73222 LT
|
| Hospital Charge Code |
3740071
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$13.10 |
| Max. Negotiated Rate |
$2,419.30 |
| Rate for Payer: Aetna Commercial |
$375.55
|
| Rate for Payer: Aetna Medicare |
$1,098.39
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$328.45
|
| 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 |
$3,275.36
|
| Rate for Payer: Cash Price |
$3,275.36
|
| Rate for Payer: Cash Price |
$3,275.36
|
| Rate for Payer: Cigna Commercial |
$1,658.78
|
| Rate for Payer: Cigna Medicaid |
$328.45
|
| 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 |
$328.45
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$732.26
|
| Rate for Payer: Molina Medicare |
$732.26
|
| 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 |
$328.45
|
| 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 |
$328.45
|
| 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 Upper Extremity Joint w/ contrast Right BCE
|
Facility
|
OP
|
$3,722.00
|
|
|
Service Code
|
CPT 73222 RT
|
| Hospital Charge Code |
3740072
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$13.10 |
| Max. Negotiated Rate |
$2,419.30 |
| Rate for Payer: Aetna Commercial |
$375.55
|
| Rate for Payer: Aetna Medicare |
$1,098.39
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$328.45
|
| 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 |
$3,275.36
|
| Rate for Payer: Cash Price |
$3,275.36
|
| Rate for Payer: Cash Price |
$3,275.36
|
| Rate for Payer: Cigna Commercial |
$1,658.78
|
| Rate for Payer: Cigna Medicaid |
$328.45
|
| 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 |
$328.45
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$732.26
|
| Rate for Payer: Molina Medicare |
$732.26
|
| 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 |
$328.45
|
| 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 |
$328.45
|
| 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 Upper Extremity Joint w/o Contrast Left BCE
|
Facility
|
OP
|
$3,350.00
|
|
|
Service Code
|
CPT 73221 LT
|
| Hospital Charge Code |
3700051
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$4.01 |
| Max. Negotiated Rate |
$2,177.50 |
| Rate for Payer: Aetna Commercial |
$216.02
|
| Rate for Payer: Aetna Medicare |
$336.15
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$211.18
|
| 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 |
$2,948.00
|
| Rate for Payer: Cash Price |
$2,948.00
|
| Rate for Payer: Cash Price |
$2,948.00
|
| Rate for Payer: Cigna Commercial |
$507.64
|
| Rate for Payer: Cigna Medicaid |
$211.18
|
| 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 |
$211.18
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$224.10
|
| Rate for Payer: Molina Medicare |
$224.10
|
| Rate for Payer: Multiplan Auto |
$2,177.50
|
| Rate for Payer: Multiplan Commercial |
$2,177.50
|
| Rate for Payer: Multiplan Workers Comp |
$2,177.50
|
| Rate for Payer: Parkland Medicaid |
$211.18
|
| 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 |
$211.18
|
| 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 Upper Extremity Joint w/o Contrast Right BCE
|
Facility
|
OP
|
$3,350.00
|
|
|
Service Code
|
CPT 73221 RT
|
| Hospital Charge Code |
3700267
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$4.01 |
| Max. Negotiated Rate |
$2,177.50 |
| Rate for Payer: Aetna Commercial |
$216.02
|
| Rate for Payer: Aetna Medicare |
$336.15
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$211.18
|
| 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 |
$2,948.00
|
| Rate for Payer: Cash Price |
$2,948.00
|
| Rate for Payer: Cash Price |
$2,948.00
|
| Rate for Payer: Cigna Commercial |
$507.64
|
| Rate for Payer: Cigna Medicaid |
$211.18
|
| 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 |
$211.18
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$224.10
|
| Rate for Payer: Molina Medicare |
$224.10
|
| Rate for Payer: Multiplan Auto |
$2,177.50
|
| Rate for Payer: Multiplan Commercial |
$2,177.50
|
| Rate for Payer: Multiplan Workers Comp |
$2,177.50
|
| Rate for Payer: Parkland Medicaid |
$211.18
|
| 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 |
$211.18
|
| 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 Upper Extremity Joint w + w/o Contrast Left BCE
|
Facility
|
OP
|
$3,908.00
|
|
|
Service Code
|
CPT 73223 LT
|
| Hospital Charge Code |
3750585
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$6.29 |
| Max. Negotiated Rate |
$2,540.20 |
| Rate for Payer: Aetna Commercial |
$456.08
|
| 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 |
$3,439.04
|
| Rate for Payer: Cash Price |
$3,439.04
|
| Rate for Payer: Cash Price |
$3,439.04
|
| 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 |
$2,540.20
|
| Rate for Payer: Multiplan Commercial |
$2,540.20
|
| Rate for Payer: Multiplan Workers Comp |
$2,540.20
|
| 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 Upper Extremity Joint w + w/o Contrast Right BCE
|
Facility
|
OP
|
$3,908.00
|
|
|
Service Code
|
CPT 73223 RT
|
| Hospital Charge Code |
3750593
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$6.29 |
| Max. Negotiated Rate |
$2,540.20 |
| Rate for Payer: Aetna Commercial |
$456.08
|
| 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 |
$3,439.04
|
| Rate for Payer: Cash Price |
$3,439.04
|
| Rate for Payer: Cash Price |
$3,439.04
|
| 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 |
$2,540.20
|
| Rate for Payer: Multiplan Commercial |
$2,540.20
|
| Rate for Payer: Multiplan Workers Comp |
$2,540.20
|
| 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 Upper Extremity Non Joint w/ Contast Right BCE
|
Facility
|
IP
|
$3,958.00
|
|
|
Service Code
|
CPT 73219 RT
|
| Hospital Charge Code |
3750866
|
|
Hospital Revenue Code
|
610
|
| Rate for Payer: Cash Price |
$3,483.04
|
|
|
MRI Upper Extremity Non Joint w/ Contast Right BCE
|
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 Upper Extremity Non Joint w/o Contrast Left BCE
|
Facility
|
IP
|
$3,722.00
|
|
|
Service Code
|
CPT 73218 LT
|
| Hospital Charge Code |
3750536
|
|
Hospital Revenue Code
|
610
|
| Rate for Payer: Cash Price |
$3,275.36
|
|
|
MRI Upper Extremity Non Joint w/o Contrast Left BCE
|
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 Upper Extremity Non Joint w/o Contrast Right BCE
|
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 Upper Extremity Non Joint w/o Contrast Right BCE
|
Facility
|
IP
|
$3,722.00
|
|
|
Service Code
|
CPT 73218 RT
|
| Hospital Charge Code |
3750551
|
|
Hospital Revenue Code
|
610
|
| Rate for Payer: Cash Price |
$3,275.36
|
|
|
MRI Upper Extremity Non Joint w/ + w/o Contrast Left BCE
|
Facility
|
IP
|
$4,608.00
|
|
|
Service Code
|
CPT 73220 LT
|
| Hospital Charge Code |
3700044
|
|
Hospital Revenue Code
|
610
|
| Rate for Payer: Cash Price |
$4,055.04
|
|
|
MRI Upper Extremity Non Joint w/ + w/o Contrast Left BCE
|
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 Upper Extremity Non Joint w/ +w/o Contrast Right BCE
|
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 Upper Extremity Non Joint w/ +w/o Contrast Right BCE
|
Facility
|
IP
|
$4,608.00
|
|
|
Service Code
|
CPT 73220 RT
|
| Hospital Charge Code |
3700259
|
|
Hospital Revenue Code
|
610
|
| Rate for Payer: Cash Price |
$4,055.04
|
|
|
MRI Wrist w/ Contrast Left
|
Facility
|
IP
|
$3,722.00
|
|
|
Service Code
|
CPT 73222 LT
|
| Hospital Charge Code |
3740071
|
|
Hospital Revenue Code
|
610
|
| Rate for Payer: Cash Price |
$3,275.36
|
|
|
MRI Wrist w/ Contrast Left
|
Facility
|
OP
|
$3,722.00
|
|
|
Service Code
|
CPT 73222 LT
|
| Hospital Charge Code |
3740071
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$13.10 |
| Max. Negotiated Rate |
$2,419.30 |
| Rate for Payer: Aetna Commercial |
$375.55
|
| Rate for Payer: Aetna Medicare |
$1,098.39
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$328.45
|
| 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 |
$3,275.36
|
| Rate for Payer: Cash Price |
$3,275.36
|
| Rate for Payer: Cash Price |
$3,275.36
|
| Rate for Payer: Cigna Commercial |
$1,658.78
|
| Rate for Payer: Cigna Medicaid |
$328.45
|
| 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 |
$328.45
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$732.26
|
| Rate for Payer: Molina Medicare |
$732.26
|
| 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 |
$328.45
|
| 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 |
$328.45
|
| 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 Wrist w/ Contrast Right
|
Facility
|
IP
|
$3,722.00
|
|
|
Service Code
|
CPT 73222 RT
|
| Hospital Charge Code |
3740072
|
|
Hospital Revenue Code
|
610
|
| Rate for Payer: Cash Price |
$3,275.36
|
|
|
MRI Wrist w/ Contrast Right
|
Facility
|
OP
|
$3,722.00
|
|
|
Service Code
|
CPT 73222 RT
|
| Hospital Charge Code |
3740072
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$13.10 |
| Max. Negotiated Rate |
$2,419.30 |
| Rate for Payer: Aetna Commercial |
$375.55
|
| Rate for Payer: Aetna Medicare |
$1,098.39
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$328.45
|
| 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 |
$3,275.36
|
| Rate for Payer: Cash Price |
$3,275.36
|
| Rate for Payer: Cash Price |
$3,275.36
|
| Rate for Payer: Cigna Commercial |
$1,658.78
|
| Rate for Payer: Cigna Medicaid |
$328.45
|
| 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 |
$328.45
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$732.26
|
| Rate for Payer: Molina Medicare |
$732.26
|
| 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 |
$328.45
|
| 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 |
$328.45
|
| 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 Wrist w/o Contrast Left
|
Facility
|
OP
|
$3,350.00
|
|
|
Service Code
|
CPT 73221 LT
|
| Hospital Charge Code |
3700051
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$4.01 |
| Max. Negotiated Rate |
$2,177.50 |
| Rate for Payer: Aetna Commercial |
$216.02
|
| Rate for Payer: Aetna Medicare |
$336.15
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$211.18
|
| 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 |
$2,948.00
|
| Rate for Payer: Cash Price |
$2,948.00
|
| Rate for Payer: Cash Price |
$2,948.00
|
| Rate for Payer: Cigna Commercial |
$507.64
|
| Rate for Payer: Cigna Medicaid |
$211.18
|
| 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 |
$211.18
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$224.10
|
| Rate for Payer: Molina Medicare |
$224.10
|
| Rate for Payer: Multiplan Auto |
$2,177.50
|
| Rate for Payer: Multiplan Commercial |
$2,177.50
|
| Rate for Payer: Multiplan Workers Comp |
$2,177.50
|
| Rate for Payer: Parkland Medicaid |
$211.18
|
| 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 |
$211.18
|
| 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 Wrist w/o Contrast Left
|
Facility
|
IP
|
$3,350.00
|
|
|
Service Code
|
CPT 73221 LT
|
| Hospital Charge Code |
3700051
|
|
Hospital Revenue Code
|
610
|
| Rate for Payer: Cash Price |
$2,948.00
|
|
|
MRI Wrist w/o Contrast Right
|
Facility
|
OP
|
$3,350.00
|
|
|
Service Code
|
CPT 73221 RT
|
| Hospital Charge Code |
3700267
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$4.01 |
| Max. Negotiated Rate |
$2,177.50 |
| Rate for Payer: Aetna Commercial |
$216.02
|
| Rate for Payer: Aetna Medicare |
$336.15
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$211.18
|
| 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 |
$2,948.00
|
| Rate for Payer: Cash Price |
$2,948.00
|
| Rate for Payer: Cash Price |
$2,948.00
|
| Rate for Payer: Cigna Commercial |
$507.64
|
| Rate for Payer: Cigna Medicaid |
$211.18
|
| 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 |
$211.18
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$224.10
|
| Rate for Payer: Molina Medicare |
$224.10
|
| Rate for Payer: Multiplan Auto |
$2,177.50
|
| Rate for Payer: Multiplan Commercial |
$2,177.50
|
| Rate for Payer: Multiplan Workers Comp |
$2,177.50
|
| Rate for Payer: Parkland Medicaid |
$211.18
|
| 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 |
$211.18
|
| 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 Wrist w/o Contrast Right
|
Facility
|
IP
|
$3,350.00
|
|
|
Service Code
|
CPT 73221 RT
|
| Hospital Charge Code |
3700267
|
|
Hospital Revenue Code
|
610
|
| Rate for Payer: Cash Price |
$2,948.00
|
|
