|
nitroglycerin 0.4 mg SL Tab
|
Facility
|
IP
|
$8.00
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
77727642
|
|
Hospital Revenue Code
|
250
|
| Rate for Payer: Cash Price |
$5.44
|
|
|
nitroglycerin 0.4 mg SL Tab
|
Facility
|
OP
|
$8.00
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
77727642
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.72 |
| Max. Negotiated Rate |
$5.20 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$0.72
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2.40
|
| Rate for Payer: BCBS of TX Blue Essentials |
$2.88
|
| Rate for Payer: BCBS of TX PPO |
$3.20
|
| Rate for Payer: Cash Price |
$5.44
|
| Rate for Payer: Multiplan Auto |
$5.20
|
| Rate for Payer: Multiplan Commercial |
$5.20
|
| Rate for Payer: Multiplan Workers Comp |
$5.20
|
| Rate for Payer: Scott and White EPO/PPO |
$4.00
|
| Rate for Payer: Superior Health Plan EPO |
$1.09
|
|
|
nitroglycerin 2% TD Oint 1 g
|
Facility
|
OP
|
$8.00
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
77728168
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.72 |
| Max. Negotiated Rate |
$5.20 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$0.72
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2.40
|
| Rate for Payer: BCBS of TX Blue Essentials |
$2.88
|
| Rate for Payer: BCBS of TX PPO |
$3.20
|
| Rate for Payer: Cash Price |
$5.44
|
| Rate for Payer: Multiplan Auto |
$5.20
|
| Rate for Payer: Multiplan Commercial |
$5.20
|
| Rate for Payer: Multiplan Workers Comp |
$5.20
|
| Rate for Payer: Scott and White EPO/PPO |
$4.00
|
| Rate for Payer: Superior Health Plan EPO |
$1.09
|
|
|
nitroglycerin 2% TD Oint 1 g
|
Facility
|
IP
|
$8.00
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
77728168
|
|
Hospital Revenue Code
|
250
|
| Rate for Payer: Cash Price |
$5.44
|
|
|
NM Bone Imaging Limited
|
Facility
|
OP
|
$1,134.00
|
|
|
Service Code
|
CPT 78300
|
| Hospital Charge Code |
3402153
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$6.75 |
| Max. Negotiated Rate |
$854.47 |
| Rate for Payer: Aetna Commercial |
$214.62
|
| Rate for Payer: Aetna Medicare |
$565.80
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$212.18
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$377.20
|
| Rate for Payer: Amerigroup Medicare |
$377.20
|
| Rate for Payer: BCBS of TX Blue Advantage |
$341.91
|
| Rate for Payer: BCBS of TX Blue Essentials |
$410.30
|
| Rate for Payer: BCBS of TX Medicare |
$377.20
|
| Rate for Payer: BCBS of TX PPO |
$457.96
|
| Rate for Payer: Cash Price |
$997.92
|
| Rate for Payer: Cash Price |
$997.92
|
| Rate for Payer: Cash Price |
$997.92
|
| Rate for Payer: Cigna Commercial |
$854.47
|
| Rate for Payer: Cigna Medicaid |
$212.18
|
| Rate for Payer: Cigna Medicare |
$377.20
|
| Rate for Payer: Employer Direct Commercial |
$377.20
|
| Rate for Payer: Humana Medicare/TRICARE |
$377.20
|
| Rate for Payer: Molina CHIP/Medicaid |
$212.18
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$377.20
|
| Rate for Payer: Molina Medicare |
$377.20
|
| Rate for Payer: Multiplan Auto |
$737.10
|
| Rate for Payer: Multiplan Commercial |
$737.10
|
| Rate for Payer: Multiplan Workers Comp |
$737.10
|
| Rate for Payer: Parkland Medicaid |
$212.18
|
| Rate for Payer: Scott and White EPO/PPO |
$6.75
|
| Rate for Payer: Scott and White Medicare |
$377.20
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$212.18
|
| Rate for Payer: Superior Health Plan EPO |
$377.20
|
| Rate for Payer: Superior Health Plan Medicare |
$377.20
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$377.20
|
| Rate for Payer: Universal American Medicare |
$377.20
|
| Rate for Payer: Wellcare Medicare |
$377.20
|
| Rate for Payer: Wellmed Medicare |
$377.20
|
|
|
NM Bone Imaging Limited Delay 1 BCE
|
Facility
|
IP
|
$1,134.00
|
|
|
Service Code
|
CPT 78300
|
| Hospital Charge Code |
3402153
|
|
Hospital Revenue Code
|
341
|
| Rate for Payer: Cash Price |
$997.92
|
|
|
NM Bone Imaging Limited Delay 1 BCE
|
Facility
|
OP
|
$1,134.00
|
|
|
Service Code
|
CPT 78300
|
| Hospital Charge Code |
3402153
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$6.75 |
| Max. Negotiated Rate |
$854.47 |
| Rate for Payer: Aetna Commercial |
$214.62
|
| Rate for Payer: Aetna Medicare |
$565.80
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$212.18
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$377.20
|
| Rate for Payer: Amerigroup Medicare |
$377.20
|
| Rate for Payer: BCBS of TX Blue Advantage |
$341.91
|
| Rate for Payer: BCBS of TX Blue Essentials |
$410.30
|
| Rate for Payer: BCBS of TX Medicare |
$377.20
|
| Rate for Payer: BCBS of TX PPO |
$457.96
|
| Rate for Payer: Cash Price |
$997.92
|
| Rate for Payer: Cash Price |
$997.92
|
| Rate for Payer: Cash Price |
$997.92
|
| Rate for Payer: Cigna Commercial |
$854.47
|
| Rate for Payer: Cigna Medicaid |
$212.18
|
| Rate for Payer: Cigna Medicare |
$377.20
|
| Rate for Payer: Employer Direct Commercial |
$377.20
|
| Rate for Payer: Humana Medicare/TRICARE |
$377.20
|
| Rate for Payer: Molina CHIP/Medicaid |
$212.18
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$377.20
|
| Rate for Payer: Molina Medicare |
$377.20
|
| Rate for Payer: Multiplan Auto |
$737.10
|
| Rate for Payer: Multiplan Commercial |
$737.10
|
| Rate for Payer: Multiplan Workers Comp |
$737.10
|
| Rate for Payer: Parkland Medicaid |
$212.18
|
| Rate for Payer: Scott and White EPO/PPO |
$6.75
|
| Rate for Payer: Scott and White Medicare |
$377.20
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$212.18
|
| Rate for Payer: Superior Health Plan EPO |
$377.20
|
| Rate for Payer: Superior Health Plan Medicare |
$377.20
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$377.20
|
| Rate for Payer: Universal American Medicare |
$377.20
|
| Rate for Payer: Wellcare Medicare |
$377.20
|
| Rate for Payer: Wellmed Medicare |
$377.20
|
|
|
NM Bone Imaging Whole Body
|
Facility
|
OP
|
$2,212.00
|
|
|
Service Code
|
CPT 78306
|
| Hospital Charge Code |
3400025
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$6.75 |
| Max. Negotiated Rate |
$1,437.80 |
| Rate for Payer: Aetna Commercial |
$277.04
|
| Rate for Payer: Aetna Medicare |
$565.80
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$275.66
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$377.20
|
| Rate for Payer: Amerigroup Medicare |
$377.20
|
| Rate for Payer: BCBS of TX Blue Advantage |
$446.57
|
| Rate for Payer: BCBS of TX Blue Essentials |
$535.89
|
| Rate for Payer: BCBS of TX Medicare |
$377.20
|
| Rate for Payer: BCBS of TX PPO |
$598.14
|
| Rate for Payer: Cash Price |
$1,946.56
|
| Rate for Payer: Cash Price |
$1,946.56
|
| Rate for Payer: Cash Price |
$1,946.56
|
| Rate for Payer: Cigna Commercial |
$854.47
|
| Rate for Payer: Cigna Medicaid |
$275.66
|
| Rate for Payer: Cigna Medicare |
$377.20
|
| Rate for Payer: Employer Direct Commercial |
$377.20
|
| Rate for Payer: Humana Medicare/TRICARE |
$377.20
|
| Rate for Payer: Molina CHIP/Medicaid |
$275.66
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$377.20
|
| Rate for Payer: Molina Medicare |
$377.20
|
| Rate for Payer: Multiplan Auto |
$1,437.80
|
| Rate for Payer: Multiplan Commercial |
$1,437.80
|
| Rate for Payer: Multiplan Workers Comp |
$1,437.80
|
| Rate for Payer: Parkland Medicaid |
$275.66
|
| Rate for Payer: Scott and White EPO/PPO |
$6.75
|
| Rate for Payer: Scott and White Medicare |
$377.20
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$275.66
|
| Rate for Payer: Superior Health Plan EPO |
$377.20
|
| Rate for Payer: Superior Health Plan Medicare |
$377.20
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$377.20
|
| Rate for Payer: Universal American Medicare |
$377.20
|
| Rate for Payer: Wellcare Medicare |
$377.20
|
| Rate for Payer: Wellmed Medicare |
$377.20
|
|
|
NM Bone Imaging Whole Body Delay 1 BCE
|
Facility
|
OP
|
$2,212.00
|
|
|
Service Code
|
CPT 78306
|
| Hospital Charge Code |
3400025
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$6.75 |
| Max. Negotiated Rate |
$1,437.80 |
| Rate for Payer: Aetna Commercial |
$277.04
|
| Rate for Payer: Aetna Medicare |
$565.80
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$275.66
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$377.20
|
| Rate for Payer: Amerigroup Medicare |
$377.20
|
| Rate for Payer: BCBS of TX Blue Advantage |
$446.57
|
| Rate for Payer: BCBS of TX Blue Essentials |
$535.89
|
| Rate for Payer: BCBS of TX Medicare |
$377.20
|
| Rate for Payer: BCBS of TX PPO |
$598.14
|
| Rate for Payer: Cash Price |
$1,946.56
|
| Rate for Payer: Cash Price |
$1,946.56
|
| Rate for Payer: Cash Price |
$1,946.56
|
| Rate for Payer: Cigna Commercial |
$854.47
|
| Rate for Payer: Cigna Medicaid |
$275.66
|
| Rate for Payer: Cigna Medicare |
$377.20
|
| Rate for Payer: Employer Direct Commercial |
$377.20
|
| Rate for Payer: Humana Medicare/TRICARE |
$377.20
|
| Rate for Payer: Molina CHIP/Medicaid |
$275.66
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$377.20
|
| Rate for Payer: Molina Medicare |
$377.20
|
| Rate for Payer: Multiplan Auto |
$1,437.80
|
| Rate for Payer: Multiplan Commercial |
$1,437.80
|
| Rate for Payer: Multiplan Workers Comp |
$1,437.80
|
| Rate for Payer: Parkland Medicaid |
$275.66
|
| Rate for Payer: Scott and White EPO/PPO |
$6.75
|
| Rate for Payer: Scott and White Medicare |
$377.20
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$275.66
|
| Rate for Payer: Superior Health Plan EPO |
$377.20
|
| Rate for Payer: Superior Health Plan Medicare |
$377.20
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$377.20
|
| Rate for Payer: Universal American Medicare |
$377.20
|
| Rate for Payer: Wellcare Medicare |
$377.20
|
| Rate for Payer: Wellmed Medicare |
$377.20
|
|
|
NM Bone Imaging Whole Body Delay 1 BCE
|
Facility
|
IP
|
$2,212.00
|
|
|
Service Code
|
CPT 78306
|
| Hospital Charge Code |
3400025
|
|
Hospital Revenue Code
|
341
|
| Rate for Payer: Cash Price |
$1,946.56
|
|
|
NM Bone Marrow Imaging Limited
|
Facility
|
OP
|
$1,764.00
|
|
|
Service Code
|
CPT 78102
|
| Hospital Charge Code |
5208102
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$6.75 |
| Max. Negotiated Rate |
$1,146.60 |
| Rate for Payer: Aetna Commercial |
$159.14
|
| Rate for Payer: Aetna Medicare |
$565.80
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$162.39
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$377.20
|
| Rate for Payer: Amerigroup Medicare |
$377.20
|
| Rate for Payer: BCBS of TX Blue Advantage |
$246.18
|
| Rate for Payer: BCBS of TX Blue Essentials |
$295.42
|
| Rate for Payer: BCBS of TX Medicare |
$377.20
|
| Rate for Payer: BCBS of TX PPO |
$329.73
|
| Rate for Payer: Cash Price |
$1,552.32
|
| Rate for Payer: Cash Price |
$1,552.32
|
| Rate for Payer: Cash Price |
$1,552.32
|
| Rate for Payer: Cigna Commercial |
$854.47
|
| Rate for Payer: Cigna Medicaid |
$162.39
|
| Rate for Payer: Cigna Medicare |
$377.20
|
| Rate for Payer: Employer Direct Commercial |
$377.20
|
| Rate for Payer: Humana Medicare/TRICARE |
$377.20
|
| Rate for Payer: Molina CHIP/Medicaid |
$162.39
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$377.20
|
| Rate for Payer: Molina Medicare |
$377.20
|
| Rate for Payer: Multiplan Auto |
$1,146.60
|
| Rate for Payer: Multiplan Commercial |
$1,146.60
|
| Rate for Payer: Multiplan Workers Comp |
$1,146.60
|
| Rate for Payer: Parkland Medicaid |
$162.39
|
| Rate for Payer: Scott and White EPO/PPO |
$6.75
|
| Rate for Payer: Scott and White Medicare |
$377.20
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$162.39
|
| Rate for Payer: Superior Health Plan EPO |
$377.20
|
| Rate for Payer: Superior Health Plan Medicare |
$377.20
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$377.20
|
| Rate for Payer: Universal American Medicare |
$377.20
|
| Rate for Payer: Wellcare Medicare |
$377.20
|
| Rate for Payer: Wellmed Medicare |
$377.20
|
|
|
NM Bone Marrow Imaging Limited BCE
|
Facility
|
IP
|
$1,764.00
|
|
|
Service Code
|
CPT 78102
|
| Hospital Charge Code |
5208102
|
|
Hospital Revenue Code
|
341
|
| Rate for Payer: Cash Price |
$1,552.32
|
|
|
NM Bone Marrow Imaging Limited BCE
|
Facility
|
OP
|
$1,764.00
|
|
|
Service Code
|
CPT 78102
|
| Hospital Charge Code |
5208102
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$6.75 |
| Max. Negotiated Rate |
$1,146.60 |
| Rate for Payer: Aetna Commercial |
$159.14
|
| Rate for Payer: Aetna Medicare |
$565.80
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$162.39
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$377.20
|
| Rate for Payer: Amerigroup Medicare |
$377.20
|
| Rate for Payer: BCBS of TX Blue Advantage |
$246.18
|
| Rate for Payer: BCBS of TX Blue Essentials |
$295.42
|
| Rate for Payer: BCBS of TX Medicare |
$377.20
|
| Rate for Payer: BCBS of TX PPO |
$329.73
|
| Rate for Payer: Cash Price |
$1,552.32
|
| Rate for Payer: Cash Price |
$1,552.32
|
| Rate for Payer: Cash Price |
$1,552.32
|
| Rate for Payer: Cigna Commercial |
$854.47
|
| Rate for Payer: Cigna Medicaid |
$162.39
|
| Rate for Payer: Cigna Medicare |
$377.20
|
| Rate for Payer: Employer Direct Commercial |
$377.20
|
| Rate for Payer: Humana Medicare/TRICARE |
$377.20
|
| Rate for Payer: Molina CHIP/Medicaid |
$162.39
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$377.20
|
| Rate for Payer: Molina Medicare |
$377.20
|
| Rate for Payer: Multiplan Auto |
$1,146.60
|
| Rate for Payer: Multiplan Commercial |
$1,146.60
|
| Rate for Payer: Multiplan Workers Comp |
$1,146.60
|
| Rate for Payer: Parkland Medicaid |
$162.39
|
| Rate for Payer: Scott and White EPO/PPO |
$6.75
|
| Rate for Payer: Scott and White Medicare |
$377.20
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$162.39
|
| Rate for Payer: Superior Health Plan EPO |
$377.20
|
| Rate for Payer: Superior Health Plan Medicare |
$377.20
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$377.20
|
| Rate for Payer: Universal American Medicare |
$377.20
|
| Rate for Payer: Wellcare Medicare |
$377.20
|
| Rate for Payer: Wellmed Medicare |
$377.20
|
|
|
NM Bone Marrow Imaging Whole Body
|
Facility
|
OP
|
$1,978.00
|
|
|
Service Code
|
CPT 78104
|
| Hospital Charge Code |
5208104
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$6.75 |
| Max. Negotiated Rate |
$1,285.70 |
| Rate for Payer: Aetna Commercial |
$230.04
|
| Rate for Payer: Aetna Medicare |
$565.80
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$234.56
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$377.20
|
| Rate for Payer: Amerigroup Medicare |
$377.20
|
| Rate for Payer: BCBS of TX Blue Advantage |
$359.77
|
| Rate for Payer: BCBS of TX Blue Essentials |
$431.72
|
| Rate for Payer: BCBS of TX Medicare |
$377.20
|
| Rate for Payer: BCBS of TX PPO |
$481.87
|
| Rate for Payer: Cash Price |
$1,740.64
|
| Rate for Payer: Cash Price |
$1,740.64
|
| Rate for Payer: Cash Price |
$1,740.64
|
| Rate for Payer: Cigna Commercial |
$854.47
|
| Rate for Payer: Cigna Medicaid |
$234.56
|
| Rate for Payer: Cigna Medicare |
$377.20
|
| Rate for Payer: Employer Direct Commercial |
$377.20
|
| Rate for Payer: Humana Medicare/TRICARE |
$377.20
|
| Rate for Payer: Molina CHIP/Medicaid |
$234.56
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$377.20
|
| Rate for Payer: Molina Medicare |
$377.20
|
| Rate for Payer: Multiplan Auto |
$1,285.70
|
| Rate for Payer: Multiplan Commercial |
$1,285.70
|
| Rate for Payer: Multiplan Workers Comp |
$1,285.70
|
| Rate for Payer: Parkland Medicaid |
$234.56
|
| Rate for Payer: Scott and White EPO/PPO |
$6.75
|
| Rate for Payer: Scott and White Medicare |
$377.20
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$234.56
|
| Rate for Payer: Superior Health Plan EPO |
$377.20
|
| Rate for Payer: Superior Health Plan Medicare |
$377.20
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$377.20
|
| Rate for Payer: Universal American Medicare |
$377.20
|
| Rate for Payer: Wellcare Medicare |
$377.20
|
| Rate for Payer: Wellmed Medicare |
$377.20
|
|
|
NM Bone Marrow Imaging Whole Body BCE
|
Facility
|
OP
|
$1,978.00
|
|
|
Service Code
|
CPT 78104
|
| Hospital Charge Code |
5208104
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$6.75 |
| Max. Negotiated Rate |
$1,285.70 |
| Rate for Payer: Aetna Commercial |
$230.04
|
| Rate for Payer: Aetna Medicare |
$565.80
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$234.56
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$377.20
|
| Rate for Payer: Amerigroup Medicare |
$377.20
|
| Rate for Payer: BCBS of TX Blue Advantage |
$359.77
|
| Rate for Payer: BCBS of TX Blue Essentials |
$431.72
|
| Rate for Payer: BCBS of TX Medicare |
$377.20
|
| Rate for Payer: BCBS of TX PPO |
$481.87
|
| Rate for Payer: Cash Price |
$1,740.64
|
| Rate for Payer: Cash Price |
$1,740.64
|
| Rate for Payer: Cash Price |
$1,740.64
|
| Rate for Payer: Cigna Commercial |
$854.47
|
| Rate for Payer: Cigna Medicaid |
$234.56
|
| Rate for Payer: Cigna Medicare |
$377.20
|
| Rate for Payer: Employer Direct Commercial |
$377.20
|
| Rate for Payer: Humana Medicare/TRICARE |
$377.20
|
| Rate for Payer: Molina CHIP/Medicaid |
$234.56
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$377.20
|
| Rate for Payer: Molina Medicare |
$377.20
|
| Rate for Payer: Multiplan Auto |
$1,285.70
|
| Rate for Payer: Multiplan Commercial |
$1,285.70
|
| Rate for Payer: Multiplan Workers Comp |
$1,285.70
|
| Rate for Payer: Parkland Medicaid |
$234.56
|
| Rate for Payer: Scott and White EPO/PPO |
$6.75
|
| Rate for Payer: Scott and White Medicare |
$377.20
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$234.56
|
| Rate for Payer: Superior Health Plan EPO |
$377.20
|
| Rate for Payer: Superior Health Plan Medicare |
$377.20
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$377.20
|
| Rate for Payer: Universal American Medicare |
$377.20
|
| Rate for Payer: Wellcare Medicare |
$377.20
|
| Rate for Payer: Wellmed Medicare |
$377.20
|
|
|
NM Bone Marrow Imaging Whole Body BCE
|
Facility
|
IP
|
$1,978.00
|
|
|
Service Code
|
CPT 78104
|
| Hospital Charge Code |
5208104
|
|
Hospital Revenue Code
|
341
|
| Rate for Payer: Cash Price |
$1,740.64
|
|
|
NM Bone Three Phase Study
|
Facility
|
OP
|
$2,852.00
|
|
|
Service Code
|
CPT 78315
|
| Hospital Charge Code |
3400389
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$6.75 |
| Max. Negotiated Rate |
$1,853.80 |
| Rate for Payer: Aetna Commercial |
$322.32
|
| Rate for Payer: Aetna Medicare |
$565.80
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$322.78
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$377.20
|
| Rate for Payer: Amerigroup Medicare |
$377.20
|
| Rate for Payer: BCBS of TX Blue Advantage |
$509.01
|
| Rate for Payer: BCBS of TX Blue Essentials |
$610.81
|
| Rate for Payer: BCBS of TX Medicare |
$377.20
|
| Rate for Payer: BCBS of TX PPO |
$681.76
|
| Rate for Payer: Cash Price |
$2,509.76
|
| Rate for Payer: Cash Price |
$2,509.76
|
| Rate for Payer: Cash Price |
$2,509.76
|
| Rate for Payer: Cigna Commercial |
$854.47
|
| Rate for Payer: Cigna Medicaid |
$322.78
|
| Rate for Payer: Cigna Medicare |
$377.20
|
| Rate for Payer: Employer Direct Commercial |
$377.20
|
| Rate for Payer: Humana Medicare/TRICARE |
$377.20
|
| Rate for Payer: Molina CHIP/Medicaid |
$322.78
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$377.20
|
| Rate for Payer: Molina Medicare |
$377.20
|
| Rate for Payer: Multiplan Auto |
$1,853.80
|
| Rate for Payer: Multiplan Commercial |
$1,853.80
|
| Rate for Payer: Multiplan Workers Comp |
$1,853.80
|
| Rate for Payer: Parkland Medicaid |
$322.78
|
| Rate for Payer: Scott and White EPO/PPO |
$6.75
|
| Rate for Payer: Scott and White Medicare |
$377.20
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$322.78
|
| Rate for Payer: Superior Health Plan EPO |
$377.20
|
| Rate for Payer: Superior Health Plan Medicare |
$377.20
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$377.20
|
| Rate for Payer: Universal American Medicare |
$377.20
|
| Rate for Payer: Wellcare Medicare |
$377.20
|
| Rate for Payer: Wellmed Medicare |
$377.20
|
|
|
NM Bone Three Phase Study Injection/Scan BCE
|
Facility
|
IP
|
$2,852.00
|
|
|
Service Code
|
CPT 78315
|
| Hospital Charge Code |
3400389
|
|
Hospital Revenue Code
|
341
|
| Rate for Payer: Cash Price |
$2,509.76
|
|
|
NM Bone Three Phase Study Injection/Scan BCE
|
Facility
|
OP
|
$2,852.00
|
|
|
Service Code
|
CPT 78315
|
| Hospital Charge Code |
3400389
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$6.75 |
| Max. Negotiated Rate |
$1,853.80 |
| Rate for Payer: Aetna Commercial |
$322.32
|
| Rate for Payer: Aetna Medicare |
$565.80
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$322.78
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$377.20
|
| Rate for Payer: Amerigroup Medicare |
$377.20
|
| Rate for Payer: BCBS of TX Blue Advantage |
$509.01
|
| Rate for Payer: BCBS of TX Blue Essentials |
$610.81
|
| Rate for Payer: BCBS of TX Medicare |
$377.20
|
| Rate for Payer: BCBS of TX PPO |
$681.76
|
| Rate for Payer: Cash Price |
$2,509.76
|
| Rate for Payer: Cash Price |
$2,509.76
|
| Rate for Payer: Cash Price |
$2,509.76
|
| Rate for Payer: Cigna Commercial |
$854.47
|
| Rate for Payer: Cigna Medicaid |
$322.78
|
| Rate for Payer: Cigna Medicare |
$377.20
|
| Rate for Payer: Employer Direct Commercial |
$377.20
|
| Rate for Payer: Humana Medicare/TRICARE |
$377.20
|
| Rate for Payer: Molina CHIP/Medicaid |
$322.78
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$377.20
|
| Rate for Payer: Molina Medicare |
$377.20
|
| Rate for Payer: Multiplan Auto |
$1,853.80
|
| Rate for Payer: Multiplan Commercial |
$1,853.80
|
| Rate for Payer: Multiplan Workers Comp |
$1,853.80
|
| Rate for Payer: Parkland Medicaid |
$322.78
|
| Rate for Payer: Scott and White EPO/PPO |
$6.75
|
| Rate for Payer: Scott and White Medicare |
$377.20
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$322.78
|
| Rate for Payer: Superior Health Plan EPO |
$377.20
|
| Rate for Payer: Superior Health Plan Medicare |
$377.20
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$377.20
|
| Rate for Payer: Universal American Medicare |
$377.20
|
| Rate for Payer: Wellcare Medicare |
$377.20
|
| Rate for Payer: Wellmed Medicare |
$377.20
|
|
|
NM Brain Imaging <4 Delay 1
|
Facility
|
OP
|
$1,118.00
|
|
|
Service Code
|
CPT 78600
|
| Hospital Charge Code |
5208600
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$6.75 |
| Max. Negotiated Rate |
$854.47 |
| Rate for Payer: Aetna Commercial |
$176.49
|
| Rate for Payer: Aetna Medicare |
$565.80
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$170.41
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$377.20
|
| Rate for Payer: Amerigroup Medicare |
$377.20
|
| Rate for Payer: BCBS of TX Blue Advantage |
$278.88
|
| Rate for Payer: BCBS of TX Blue Essentials |
$334.66
|
| Rate for Payer: BCBS of TX Medicare |
$377.20
|
| Rate for Payer: BCBS of TX PPO |
$373.53
|
| Rate for Payer: Cash Price |
$983.84
|
| Rate for Payer: Cash Price |
$983.84
|
| Rate for Payer: Cash Price |
$983.84
|
| Rate for Payer: Cigna Commercial |
$854.47
|
| Rate for Payer: Cigna Medicaid |
$170.41
|
| Rate for Payer: Cigna Medicare |
$377.20
|
| Rate for Payer: Employer Direct Commercial |
$377.20
|
| Rate for Payer: Humana Medicare/TRICARE |
$377.20
|
| Rate for Payer: Molina CHIP/Medicaid |
$170.41
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$377.20
|
| Rate for Payer: Molina Medicare |
$377.20
|
| Rate for Payer: Multiplan Auto |
$726.70
|
| Rate for Payer: Multiplan Commercial |
$726.70
|
| Rate for Payer: Multiplan Workers Comp |
$726.70
|
| Rate for Payer: Parkland Medicaid |
$170.41
|
| Rate for Payer: Scott and White EPO/PPO |
$6.75
|
| Rate for Payer: Scott and White Medicare |
$377.20
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$170.41
|
| Rate for Payer: Superior Health Plan EPO |
$377.20
|
| Rate for Payer: Superior Health Plan Medicare |
$377.20
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$377.20
|
| Rate for Payer: Universal American Medicare |
$377.20
|
| Rate for Payer: Wellcare Medicare |
$377.20
|
| Rate for Payer: Wellmed Medicare |
$377.20
|
|
|
NM Brain Imaging <4 Delay 1 BCE
|
Facility
|
OP
|
$1,118.00
|
|
|
Service Code
|
CPT 78600
|
| Hospital Charge Code |
5208600
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$6.75 |
| Max. Negotiated Rate |
$854.47 |
| Rate for Payer: Aetna Commercial |
$176.49
|
| Rate for Payer: Aetna Medicare |
$565.80
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$170.41
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$377.20
|
| Rate for Payer: Amerigroup Medicare |
$377.20
|
| Rate for Payer: BCBS of TX Blue Advantage |
$278.88
|
| Rate for Payer: BCBS of TX Blue Essentials |
$334.66
|
| Rate for Payer: BCBS of TX Medicare |
$377.20
|
| Rate for Payer: BCBS of TX PPO |
$373.53
|
| Rate for Payer: Cash Price |
$983.84
|
| Rate for Payer: Cash Price |
$983.84
|
| Rate for Payer: Cash Price |
$983.84
|
| Rate for Payer: Cigna Commercial |
$854.47
|
| Rate for Payer: Cigna Medicaid |
$170.41
|
| Rate for Payer: Cigna Medicare |
$377.20
|
| Rate for Payer: Employer Direct Commercial |
$377.20
|
| Rate for Payer: Humana Medicare/TRICARE |
$377.20
|
| Rate for Payer: Molina CHIP/Medicaid |
$170.41
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$377.20
|
| Rate for Payer: Molina Medicare |
$377.20
|
| Rate for Payer: Multiplan Auto |
$726.70
|
| Rate for Payer: Multiplan Commercial |
$726.70
|
| Rate for Payer: Multiplan Workers Comp |
$726.70
|
| Rate for Payer: Parkland Medicaid |
$170.41
|
| Rate for Payer: Scott and White EPO/PPO |
$6.75
|
| Rate for Payer: Scott and White Medicare |
$377.20
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$170.41
|
| Rate for Payer: Superior Health Plan EPO |
$377.20
|
| Rate for Payer: Superior Health Plan Medicare |
$377.20
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$377.20
|
| Rate for Payer: Universal American Medicare |
$377.20
|
| Rate for Payer: Wellcare Medicare |
$377.20
|
| Rate for Payer: Wellmed Medicare |
$377.20
|
|
|
NM Brain Imaging <4 Delay 1 BCE
|
Facility
|
IP
|
$1,118.00
|
|
|
Service Code
|
CPT 78600
|
| Hospital Charge Code |
5208600
|
|
Hospital Revenue Code
|
341
|
| Rate for Payer: Cash Price |
$983.84
|
|
|
NM Cardiac MUGA
|
Facility
|
OP
|
$1,751.00
|
|
|
Service Code
|
CPT 78472
|
| Hospital Charge Code |
3400033
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$6.75 |
| Max. Negotiated Rate |
$1,138.15 |
| Rate for Payer: Aetna Commercial |
$196.52
|
| Rate for Payer: Aetna Medicare |
$565.80
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$212.84
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$377.20
|
| Rate for Payer: Amerigroup Medicare |
$377.20
|
| Rate for Payer: BCBS of TX Blue Advantage |
$310.40
|
| Rate for Payer: BCBS of TX Blue Essentials |
$372.48
|
| Rate for Payer: BCBS of TX Medicare |
$377.20
|
| Rate for Payer: BCBS of TX PPO |
$415.75
|
| Rate for Payer: Cash Price |
$1,540.88
|
| Rate for Payer: Cash Price |
$1,540.88
|
| Rate for Payer: Cash Price |
$1,540.88
|
| Rate for Payer: Cigna Commercial |
$854.47
|
| Rate for Payer: Cigna Medicaid |
$212.84
|
| Rate for Payer: Cigna Medicare |
$377.20
|
| Rate for Payer: Employer Direct Commercial |
$377.20
|
| Rate for Payer: Humana Medicare/TRICARE |
$377.20
|
| Rate for Payer: Molina CHIP/Medicaid |
$212.84
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$377.20
|
| Rate for Payer: Molina Medicare |
$377.20
|
| Rate for Payer: Multiplan Auto |
$1,138.15
|
| Rate for Payer: Multiplan Commercial |
$1,138.15
|
| Rate for Payer: Multiplan Workers Comp |
$1,138.15
|
| Rate for Payer: Parkland Medicaid |
$212.84
|
| Rate for Payer: Scott and White EPO/PPO |
$6.75
|
| Rate for Payer: Scott and White Medicare |
$377.20
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$212.84
|
| Rate for Payer: Superior Health Plan EPO |
$377.20
|
| Rate for Payer: Superior Health Plan Medicare |
$377.20
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$377.20
|
| Rate for Payer: Universal American Medicare |
$377.20
|
| Rate for Payer: Wellcare Medicare |
$377.20
|
| Rate for Payer: Wellmed Medicare |
$377.20
|
|
|
NM Cardiac MUGA BCE
|
Facility
|
OP
|
$1,751.00
|
|
|
Service Code
|
CPT 78472
|
| Hospital Charge Code |
3400033
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$6.75 |
| Max. Negotiated Rate |
$1,138.15 |
| Rate for Payer: Aetna Commercial |
$196.52
|
| Rate for Payer: Aetna Medicare |
$565.80
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$212.84
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$377.20
|
| Rate for Payer: Amerigroup Medicare |
$377.20
|
| Rate for Payer: BCBS of TX Blue Advantage |
$310.40
|
| Rate for Payer: BCBS of TX Blue Essentials |
$372.48
|
| Rate for Payer: BCBS of TX Medicare |
$377.20
|
| Rate for Payer: BCBS of TX PPO |
$415.75
|
| Rate for Payer: Cash Price |
$1,540.88
|
| Rate for Payer: Cash Price |
$1,540.88
|
| Rate for Payer: Cash Price |
$1,540.88
|
| Rate for Payer: Cigna Commercial |
$854.47
|
| Rate for Payer: Cigna Medicaid |
$212.84
|
| Rate for Payer: Cigna Medicare |
$377.20
|
| Rate for Payer: Employer Direct Commercial |
$377.20
|
| Rate for Payer: Humana Medicare/TRICARE |
$377.20
|
| Rate for Payer: Molina CHIP/Medicaid |
$212.84
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$377.20
|
| Rate for Payer: Molina Medicare |
$377.20
|
| Rate for Payer: Multiplan Auto |
$1,138.15
|
| Rate for Payer: Multiplan Commercial |
$1,138.15
|
| Rate for Payer: Multiplan Workers Comp |
$1,138.15
|
| Rate for Payer: Parkland Medicaid |
$212.84
|
| Rate for Payer: Scott and White EPO/PPO |
$6.75
|
| Rate for Payer: Scott and White Medicare |
$377.20
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$212.84
|
| Rate for Payer: Superior Health Plan EPO |
$377.20
|
| Rate for Payer: Superior Health Plan Medicare |
$377.20
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$377.20
|
| Rate for Payer: Universal American Medicare |
$377.20
|
| Rate for Payer: Wellcare Medicare |
$377.20
|
| Rate for Payer: Wellmed Medicare |
$377.20
|
|
|
NM Cardiac MUGA BCE
|
Facility
|
IP
|
$1,751.00
|
|
|
Service Code
|
CPT 78472
|
| Hospital Charge Code |
3400033
|
|
Hospital Revenue Code
|
341
|
| Rate for Payer: Cash Price |
$1,540.88
|
|
