|
NM Kidney Imaging Multiple w/+w/o Pharm BCE
|
Facility
|
IP
|
$1,774.00
|
|
|
Service Code
|
CPT 78709
|
| Hospital Charge Code |
5208709
|
|
Hospital Revenue Code
|
341
|
| Rate for Payer: Cash Price |
$1,561.12
|
|
|
NM Kidney Imaging Single w/o Pharm
|
Facility
|
OP
|
$1,199.00
|
|
|
Service Code
|
CPT 78707
|
| Hospital Charge Code |
3400165
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$8.84 |
| Max. Negotiated Rate |
$1,119.78 |
| Rate for Payer: Aetna Commercial |
$202.68
|
| Rate for Payer: Aetna Medicare |
$741.48
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$218.53
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$494.32
|
| Rate for Payer: Amerigroup Medicare |
$494.32
|
| Rate for Payer: BCBS of TX Blue Advantage |
$319.32
|
| Rate for Payer: BCBS of TX Blue Essentials |
$383.19
|
| Rate for Payer: BCBS of TX Medicare |
$494.32
|
| Rate for Payer: BCBS of TX PPO |
$427.70
|
| Rate for Payer: Cash Price |
$1,055.12
|
| Rate for Payer: Cash Price |
$1,055.12
|
| Rate for Payer: Cash Price |
$1,055.12
|
| Rate for Payer: Cigna Commercial |
$1,119.78
|
| Rate for Payer: Cigna Medicaid |
$218.53
|
| Rate for Payer: Cigna Medicare |
$494.32
|
| Rate for Payer: Employer Direct Commercial |
$494.32
|
| Rate for Payer: Humana Medicare/TRICARE |
$494.32
|
| Rate for Payer: Molina CHIP/Medicaid |
$218.53
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$494.32
|
| Rate for Payer: Molina Medicare |
$494.32
|
| Rate for Payer: Multiplan Auto |
$779.35
|
| Rate for Payer: Multiplan Commercial |
$779.35
|
| Rate for Payer: Multiplan Workers Comp |
$779.35
|
| Rate for Payer: Parkland Medicaid |
$218.53
|
| Rate for Payer: Scott and White EPO/PPO |
$8.84
|
| Rate for Payer: Scott and White Medicare |
$494.32
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$218.53
|
| Rate for Payer: Superior Health Plan EPO |
$494.32
|
| Rate for Payer: Superior Health Plan Medicare |
$494.32
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$494.32
|
| Rate for Payer: Universal American Medicare |
$494.32
|
| Rate for Payer: Wellcare Medicare |
$494.32
|
| Rate for Payer: Wellmed Medicare |
$494.32
|
|
|
NM Kidney Imaging Single w/o Pharm BCE
|
Facility
|
IP
|
$1,199.00
|
|
|
Service Code
|
CPT 78707
|
| Hospital Charge Code |
3400165
|
|
Hospital Revenue Code
|
341
|
| Rate for Payer: Cash Price |
$1,055.12
|
|
|
NM Kidney Imaging Single w/o Pharm BCE
|
Facility
|
OP
|
$1,199.00
|
|
|
Service Code
|
CPT 78707
|
| Hospital Charge Code |
3400165
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$8.84 |
| Max. Negotiated Rate |
$1,119.78 |
| Rate for Payer: Aetna Commercial |
$202.68
|
| Rate for Payer: Aetna Medicare |
$741.48
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$218.53
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$494.32
|
| Rate for Payer: Amerigroup Medicare |
$494.32
|
| Rate for Payer: BCBS of TX Blue Advantage |
$319.32
|
| Rate for Payer: BCBS of TX Blue Essentials |
$383.19
|
| Rate for Payer: BCBS of TX Medicare |
$494.32
|
| Rate for Payer: BCBS of TX PPO |
$427.70
|
| Rate for Payer: Cash Price |
$1,055.12
|
| Rate for Payer: Cash Price |
$1,055.12
|
| Rate for Payer: Cash Price |
$1,055.12
|
| Rate for Payer: Cigna Commercial |
$1,119.78
|
| Rate for Payer: Cigna Medicaid |
$218.53
|
| Rate for Payer: Cigna Medicare |
$494.32
|
| Rate for Payer: Employer Direct Commercial |
$494.32
|
| Rate for Payer: Humana Medicare/TRICARE |
$494.32
|
| Rate for Payer: Molina CHIP/Medicaid |
$218.53
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$494.32
|
| Rate for Payer: Molina Medicare |
$494.32
|
| Rate for Payer: Multiplan Auto |
$779.35
|
| Rate for Payer: Multiplan Commercial |
$779.35
|
| Rate for Payer: Multiplan Workers Comp |
$779.35
|
| Rate for Payer: Parkland Medicaid |
$218.53
|
| Rate for Payer: Scott and White EPO/PPO |
$8.84
|
| Rate for Payer: Scott and White Medicare |
$494.32
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$218.53
|
| Rate for Payer: Superior Health Plan EPO |
$494.32
|
| Rate for Payer: Superior Health Plan Medicare |
$494.32
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$494.32
|
| Rate for Payer: Universal American Medicare |
$494.32
|
| Rate for Payer: Wellcare Medicare |
$494.32
|
| Rate for Payer: Wellmed Medicare |
$494.32
|
|
|
NM Liver Imaging Static
|
Facility
|
OP
|
$2,255.00
|
|
|
Service Code
|
CPT 78201
|
| Hospital Charge Code |
5218201
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$8.84 |
| Max. Negotiated Rate |
$1,465.75 |
| Rate for Payer: Aetna Commercial |
$184.57
|
| Rate for Payer: Aetna Medicare |
$741.48
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$179.10
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$494.32
|
| Rate for Payer: Amerigroup Medicare |
$494.32
|
| Rate for Payer: BCBS of TX Blue Advantage |
$290.78
|
| Rate for Payer: BCBS of TX Blue Essentials |
$348.94
|
| Rate for Payer: BCBS of TX Medicare |
$494.32
|
| Rate for Payer: BCBS of TX PPO |
$389.47
|
| Rate for Payer: Cash Price |
$1,984.40
|
| Rate for Payer: Cash Price |
$1,984.40
|
| Rate for Payer: Cash Price |
$1,984.40
|
| Rate for Payer: Cigna Commercial |
$1,119.78
|
| Rate for Payer: Cigna Medicaid |
$179.10
|
| Rate for Payer: Cigna Medicare |
$494.32
|
| Rate for Payer: Employer Direct Commercial |
$494.32
|
| Rate for Payer: Humana Medicare/TRICARE |
$494.32
|
| Rate for Payer: Molina CHIP/Medicaid |
$179.10
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$494.32
|
| Rate for Payer: Molina Medicare |
$494.32
|
| Rate for Payer: Multiplan Auto |
$1,465.75
|
| Rate for Payer: Multiplan Commercial |
$1,465.75
|
| Rate for Payer: Multiplan Workers Comp |
$1,465.75
|
| Rate for Payer: Parkland Medicaid |
$179.10
|
| Rate for Payer: Scott and White EPO/PPO |
$8.84
|
| Rate for Payer: Scott and White Medicare |
$494.32
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$179.10
|
| Rate for Payer: Superior Health Plan EPO |
$494.32
|
| Rate for Payer: Superior Health Plan Medicare |
$494.32
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$494.32
|
| Rate for Payer: Universal American Medicare |
$494.32
|
| Rate for Payer: Wellcare Medicare |
$494.32
|
| Rate for Payer: Wellmed Medicare |
$494.32
|
|
|
NM Liver Imaging Static BCE
|
Facility
|
OP
|
$2,255.00
|
|
|
Service Code
|
CPT 78201
|
| Hospital Charge Code |
5218201
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$8.84 |
| Max. Negotiated Rate |
$1,465.75 |
| Rate for Payer: Aetna Commercial |
$184.57
|
| Rate for Payer: Aetna Medicare |
$741.48
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$179.10
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$494.32
|
| Rate for Payer: Amerigroup Medicare |
$494.32
|
| Rate for Payer: BCBS of TX Blue Advantage |
$290.78
|
| Rate for Payer: BCBS of TX Blue Essentials |
$348.94
|
| Rate for Payer: BCBS of TX Medicare |
$494.32
|
| Rate for Payer: BCBS of TX PPO |
$389.47
|
| Rate for Payer: Cash Price |
$1,984.40
|
| Rate for Payer: Cash Price |
$1,984.40
|
| Rate for Payer: Cash Price |
$1,984.40
|
| Rate for Payer: Cigna Commercial |
$1,119.78
|
| Rate for Payer: Cigna Medicaid |
$179.10
|
| Rate for Payer: Cigna Medicare |
$494.32
|
| Rate for Payer: Employer Direct Commercial |
$494.32
|
| Rate for Payer: Humana Medicare/TRICARE |
$494.32
|
| Rate for Payer: Molina CHIP/Medicaid |
$179.10
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$494.32
|
| Rate for Payer: Molina Medicare |
$494.32
|
| Rate for Payer: Multiplan Auto |
$1,465.75
|
| Rate for Payer: Multiplan Commercial |
$1,465.75
|
| Rate for Payer: Multiplan Workers Comp |
$1,465.75
|
| Rate for Payer: Parkland Medicaid |
$179.10
|
| Rate for Payer: Scott and White EPO/PPO |
$8.84
|
| Rate for Payer: Scott and White Medicare |
$494.32
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$179.10
|
| Rate for Payer: Superior Health Plan EPO |
$494.32
|
| Rate for Payer: Superior Health Plan Medicare |
$494.32
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$494.32
|
| Rate for Payer: Universal American Medicare |
$494.32
|
| Rate for Payer: Wellcare Medicare |
$494.32
|
| Rate for Payer: Wellmed Medicare |
$494.32
|
|
|
NM Liver Imaging Static BCE
|
Facility
|
IP
|
$2,255.00
|
|
|
Service Code
|
CPT 78201
|
| Hospital Charge Code |
5218201
|
|
Hospital Revenue Code
|
341
|
| Rate for Payer: Cash Price |
$1,984.40
|
|
|
NM Liver Imaging w/ Vascular Flow
|
Facility
|
OP
|
$2,485.00
|
|
|
Service Code
|
CPT 78202
|
| Hospital Charge Code |
5208202
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$8.84 |
| Max. Negotiated Rate |
$1,615.25 |
| Rate for Payer: Aetna Commercial |
$203.46
|
| Rate for Payer: Aetna Medicare |
$741.48
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$195.46
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$494.32
|
| Rate for Payer: Amerigroup Medicare |
$494.32
|
| Rate for Payer: BCBS of TX Blue Advantage |
$306.24
|
| Rate for Payer: BCBS of TX Blue Essentials |
$367.49
|
| Rate for Payer: BCBS of TX Medicare |
$494.32
|
| Rate for Payer: BCBS of TX PPO |
$410.18
|
| Rate for Payer: Cash Price |
$2,186.80
|
| Rate for Payer: Cash Price |
$2,186.80
|
| Rate for Payer: Cash Price |
$2,186.80
|
| Rate for Payer: Cigna Commercial |
$1,119.78
|
| Rate for Payer: Cigna Medicaid |
$195.46
|
| Rate for Payer: Cigna Medicare |
$494.32
|
| Rate for Payer: Employer Direct Commercial |
$494.32
|
| Rate for Payer: Humana Medicare/TRICARE |
$494.32
|
| Rate for Payer: Molina CHIP/Medicaid |
$195.46
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$494.32
|
| Rate for Payer: Molina Medicare |
$494.32
|
| Rate for Payer: Multiplan Auto |
$1,615.25
|
| Rate for Payer: Multiplan Commercial |
$1,615.25
|
| Rate for Payer: Multiplan Workers Comp |
$1,615.25
|
| Rate for Payer: Parkland Medicaid |
$195.46
|
| Rate for Payer: Scott and White EPO/PPO |
$8.84
|
| Rate for Payer: Scott and White Medicare |
$494.32
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$195.46
|
| Rate for Payer: Superior Health Plan EPO |
$494.32
|
| Rate for Payer: Superior Health Plan Medicare |
$494.32
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$494.32
|
| Rate for Payer: Universal American Medicare |
$494.32
|
| Rate for Payer: Wellcare Medicare |
$494.32
|
| Rate for Payer: Wellmed Medicare |
$494.32
|
|
|
NM Liver/Spleen Imaging
|
Facility
|
OP
|
$2,293.00
|
|
|
Service Code
|
CPT 78215
|
| Hospital Charge Code |
5208215
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$6.75 |
| Max. Negotiated Rate |
$1,490.45 |
| Rate for Payer: Aetna Commercial |
$187.67
|
| Rate for Payer: Aetna Medicare |
$565.80
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$184.44
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$377.20
|
| Rate for Payer: Amerigroup Medicare |
$377.20
|
| Rate for Payer: BCBS of TX Blue Advantage |
$292.56
|
| Rate for Payer: BCBS of TX Blue Essentials |
$351.07
|
| Rate for Payer: BCBS of TX Medicare |
$377.20
|
| Rate for Payer: BCBS of TX PPO |
$391.86
|
| Rate for Payer: Cash Price |
$2,017.84
|
| Rate for Payer: Cash Price |
$2,017.84
|
| Rate for Payer: Cash Price |
$2,017.84
|
| Rate for Payer: Cigna Commercial |
$854.47
|
| Rate for Payer: Cigna Medicaid |
$184.44
|
| 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 |
$184.44
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$377.20
|
| Rate for Payer: Molina Medicare |
$377.20
|
| Rate for Payer: Multiplan Auto |
$1,490.45
|
| Rate for Payer: Multiplan Commercial |
$1,490.45
|
| Rate for Payer: Multiplan Workers Comp |
$1,490.45
|
| Rate for Payer: Parkland Medicaid |
$184.44
|
| 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 |
$184.44
|
| 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 Liver/Spleen Imaging Injection/Scan BCE
|
Facility
|
IP
|
$2,293.00
|
|
|
Service Code
|
CPT 78215
|
| Hospital Charge Code |
5208215
|
|
Hospital Revenue Code
|
341
|
| Rate for Payer: Cash Price |
$2,017.84
|
|
|
NM Liver/Spleen Imaging Injection/Scan BCE
|
Facility
|
OP
|
$2,293.00
|
|
|
Service Code
|
CPT 78215
|
| Hospital Charge Code |
5208215
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$6.75 |
| Max. Negotiated Rate |
$1,490.45 |
| Rate for Payer: Aetna Commercial |
$187.67
|
| Rate for Payer: Aetna Medicare |
$565.80
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$184.44
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$377.20
|
| Rate for Payer: Amerigroup Medicare |
$377.20
|
| Rate for Payer: BCBS of TX Blue Advantage |
$292.56
|
| Rate for Payer: BCBS of TX Blue Essentials |
$351.07
|
| Rate for Payer: BCBS of TX Medicare |
$377.20
|
| Rate for Payer: BCBS of TX PPO |
$391.86
|
| Rate for Payer: Cash Price |
$2,017.84
|
| Rate for Payer: Cash Price |
$2,017.84
|
| Rate for Payer: Cash Price |
$2,017.84
|
| Rate for Payer: Cigna Commercial |
$854.47
|
| Rate for Payer: Cigna Medicaid |
$184.44
|
| 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 |
$184.44
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$377.20
|
| Rate for Payer: Molina Medicare |
$377.20
|
| Rate for Payer: Multiplan Auto |
$1,490.45
|
| Rate for Payer: Multiplan Commercial |
$1,490.45
|
| Rate for Payer: Multiplan Workers Comp |
$1,490.45
|
| Rate for Payer: Parkland Medicaid |
$184.44
|
| 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 |
$184.44
|
| 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 Liver Vascular Flow Delay 1 BCE
|
Facility
|
OP
|
$2,485.00
|
|
|
Service Code
|
CPT 78202
|
| Hospital Charge Code |
5208202
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$8.84 |
| Max. Negotiated Rate |
$1,615.25 |
| Rate for Payer: Aetna Commercial |
$203.46
|
| Rate for Payer: Aetna Medicare |
$741.48
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$195.46
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$494.32
|
| Rate for Payer: Amerigroup Medicare |
$494.32
|
| Rate for Payer: BCBS of TX Blue Advantage |
$306.24
|
| Rate for Payer: BCBS of TX Blue Essentials |
$367.49
|
| Rate for Payer: BCBS of TX Medicare |
$494.32
|
| Rate for Payer: BCBS of TX PPO |
$410.18
|
| Rate for Payer: Cash Price |
$2,186.80
|
| Rate for Payer: Cash Price |
$2,186.80
|
| Rate for Payer: Cash Price |
$2,186.80
|
| Rate for Payer: Cigna Commercial |
$1,119.78
|
| Rate for Payer: Cigna Medicaid |
$195.46
|
| Rate for Payer: Cigna Medicare |
$494.32
|
| Rate for Payer: Employer Direct Commercial |
$494.32
|
| Rate for Payer: Humana Medicare/TRICARE |
$494.32
|
| Rate for Payer: Molina CHIP/Medicaid |
$195.46
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$494.32
|
| Rate for Payer: Molina Medicare |
$494.32
|
| Rate for Payer: Multiplan Auto |
$1,615.25
|
| Rate for Payer: Multiplan Commercial |
$1,615.25
|
| Rate for Payer: Multiplan Workers Comp |
$1,615.25
|
| Rate for Payer: Parkland Medicaid |
$195.46
|
| Rate for Payer: Scott and White EPO/PPO |
$8.84
|
| Rate for Payer: Scott and White Medicare |
$494.32
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$195.46
|
| Rate for Payer: Superior Health Plan EPO |
$494.32
|
| Rate for Payer: Superior Health Plan Medicare |
$494.32
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$494.32
|
| Rate for Payer: Universal American Medicare |
$494.32
|
| Rate for Payer: Wellcare Medicare |
$494.32
|
| Rate for Payer: Wellmed Medicare |
$494.32
|
|
|
NM Liver Vascular Flow Delay 1 BCE
|
Facility
|
IP
|
$2,485.00
|
|
|
Service Code
|
CPT 78202
|
| Hospital Charge Code |
5208202
|
|
Hospital Revenue Code
|
341
|
| Rate for Payer: Cash Price |
$2,186.80
|
|
|
NM Lung Perfusion Imaging
|
Facility
|
OP
|
$2,252.00
|
|
|
Service Code
|
CPT 78580
|
| Hospital Charge Code |
3400090
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$6.75 |
| Max. Negotiated Rate |
$1,463.80 |
| Rate for Payer: Aetna Commercial |
$217.72
|
| Rate for Payer: Aetna Medicare |
$565.80
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$221.20
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$377.20
|
| Rate for Payer: Amerigroup Medicare |
$377.20
|
| Rate for Payer: BCBS of TX Blue Advantage |
$346.68
|
| Rate for Payer: BCBS of TX Blue Essentials |
$416.02
|
| Rate for Payer: BCBS of TX Medicare |
$377.20
|
| Rate for Payer: BCBS of TX PPO |
$464.34
|
| Rate for Payer: Cash Price |
$1,981.76
|
| Rate for Payer: Cash Price |
$1,981.76
|
| Rate for Payer: Cash Price |
$1,981.76
|
| Rate for Payer: Cigna Commercial |
$854.47
|
| Rate for Payer: Cigna Medicaid |
$221.20
|
| 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 |
$221.20
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$377.20
|
| Rate for Payer: Molina Medicare |
$377.20
|
| Rate for Payer: Multiplan Auto |
$1,463.80
|
| Rate for Payer: Multiplan Commercial |
$1,463.80
|
| Rate for Payer: Multiplan Workers Comp |
$1,463.80
|
| Rate for Payer: Parkland Medicaid |
$221.20
|
| 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 |
$221.20
|
| 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 Lung Perfusion Imaging BCE
|
Facility
|
OP
|
$2,252.00
|
|
|
Service Code
|
CPT 78580
|
| Hospital Charge Code |
3400090
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$6.75 |
| Max. Negotiated Rate |
$1,463.80 |
| Rate for Payer: Aetna Commercial |
$217.72
|
| Rate for Payer: Aetna Medicare |
$565.80
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$221.20
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$377.20
|
| Rate for Payer: Amerigroup Medicare |
$377.20
|
| Rate for Payer: BCBS of TX Blue Advantage |
$346.68
|
| Rate for Payer: BCBS of TX Blue Essentials |
$416.02
|
| Rate for Payer: BCBS of TX Medicare |
$377.20
|
| Rate for Payer: BCBS of TX PPO |
$464.34
|
| Rate for Payer: Cash Price |
$1,981.76
|
| Rate for Payer: Cash Price |
$1,981.76
|
| Rate for Payer: Cash Price |
$1,981.76
|
| Rate for Payer: Cigna Commercial |
$854.47
|
| Rate for Payer: Cigna Medicaid |
$221.20
|
| 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 |
$221.20
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$377.20
|
| Rate for Payer: Molina Medicare |
$377.20
|
| Rate for Payer: Multiplan Auto |
$1,463.80
|
| Rate for Payer: Multiplan Commercial |
$1,463.80
|
| Rate for Payer: Multiplan Workers Comp |
$1,463.80
|
| Rate for Payer: Parkland Medicaid |
$221.20
|
| 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 |
$221.20
|
| 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 Lung Perfusion Imaging BCE
|
Facility
|
IP
|
$2,252.00
|
|
|
Service Code
|
CPT 78580
|
| Hospital Charge Code |
3400090
|
|
Hospital Revenue Code
|
341
|
| Rate for Payer: Cash Price |
$1,981.76
|
|
|
NM Lung Ventilation Imaging
|
Facility
|
OP
|
$2,102.00
|
|
|
Service Code
|
CPT 78579
|
| Hospital Charge Code |
5208579
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$6.75 |
| Max. Negotiated Rate |
$1,366.30 |
| Rate for Payer: Aetna Commercial |
$177.64
|
| Rate for Payer: Aetna Medicare |
$565.80
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$176.43
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$377.20
|
| Rate for Payer: Amerigroup Medicare |
$377.20
|
| Rate for Payer: BCBS of TX Blue Advantage |
$278.29
|
| Rate for Payer: BCBS of TX Blue Essentials |
$333.95
|
| Rate for Payer: BCBS of TX Medicare |
$377.20
|
| Rate for Payer: BCBS of TX PPO |
$372.74
|
| Rate for Payer: Cash Price |
$1,849.76
|
| Rate for Payer: Cash Price |
$1,849.76
|
| Rate for Payer: Cash Price |
$1,849.76
|
| Rate for Payer: Cigna Commercial |
$854.47
|
| Rate for Payer: Cigna Medicaid |
$176.43
|
| 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 |
$176.43
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$377.20
|
| Rate for Payer: Molina Medicare |
$377.20
|
| Rate for Payer: Multiplan Auto |
$1,366.30
|
| Rate for Payer: Multiplan Commercial |
$1,366.30
|
| Rate for Payer: Multiplan Workers Comp |
$1,366.30
|
| Rate for Payer: Parkland Medicaid |
$176.43
|
| 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 |
$176.43
|
| 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 Lung Ventilation Imaging BCE
|
Facility
|
IP
|
$2,102.00
|
|
|
Service Code
|
CPT 78579
|
| Hospital Charge Code |
5208579
|
|
Hospital Revenue Code
|
341
|
| Rate for Payer: Cash Price |
$1,849.76
|
|
|
NM Lung Ventilation Imaging BCE
|
Facility
|
OP
|
$2,102.00
|
|
|
Service Code
|
CPT 78579
|
| Hospital Charge Code |
5208579
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$6.75 |
| Max. Negotiated Rate |
$1,366.30 |
| Rate for Payer: Aetna Commercial |
$177.64
|
| Rate for Payer: Aetna Medicare |
$565.80
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$176.43
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$377.20
|
| Rate for Payer: Amerigroup Medicare |
$377.20
|
| Rate for Payer: BCBS of TX Blue Advantage |
$278.29
|
| Rate for Payer: BCBS of TX Blue Essentials |
$333.95
|
| Rate for Payer: BCBS of TX Medicare |
$377.20
|
| Rate for Payer: BCBS of TX PPO |
$372.74
|
| Rate for Payer: Cash Price |
$1,849.76
|
| Rate for Payer: Cash Price |
$1,849.76
|
| Rate for Payer: Cash Price |
$1,849.76
|
| Rate for Payer: Cigna Commercial |
$854.47
|
| Rate for Payer: Cigna Medicaid |
$176.43
|
| 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 |
$176.43
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$377.20
|
| Rate for Payer: Molina Medicare |
$377.20
|
| Rate for Payer: Multiplan Auto |
$1,366.30
|
| Rate for Payer: Multiplan Commercial |
$1,366.30
|
| Rate for Payer: Multiplan Workers Comp |
$1,366.30
|
| Rate for Payer: Parkland Medicaid |
$176.43
|
| 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 |
$176.43
|
| 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 Lung Vent/Perf Imaging
|
Facility
|
OP
|
$2,346.00
|
|
|
Service Code
|
CPT 78582
|
| Hospital Charge Code |
3400012
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$8.84 |
| Max. Negotiated Rate |
$1,524.90 |
| Rate for Payer: Aetna Commercial |
$304.97
|
| Rate for Payer: Aetna Medicare |
$741.48
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$309.40
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$494.32
|
| Rate for Payer: Amerigroup Medicare |
$494.32
|
| Rate for Payer: BCBS of TX Blue Advantage |
$484.04
|
| Rate for Payer: BCBS of TX Blue Essentials |
$580.85
|
| Rate for Payer: BCBS of TX Medicare |
$494.32
|
| Rate for Payer: BCBS of TX PPO |
$648.33
|
| Rate for Payer: Cash Price |
$2,064.48
|
| Rate for Payer: Cash Price |
$2,064.48
|
| Rate for Payer: Cash Price |
$2,064.48
|
| Rate for Payer: Cigna Commercial |
$1,119.78
|
| Rate for Payer: Cigna Medicaid |
$309.40
|
| Rate for Payer: Cigna Medicare |
$494.32
|
| Rate for Payer: Employer Direct Commercial |
$494.32
|
| Rate for Payer: Humana Medicare/TRICARE |
$494.32
|
| Rate for Payer: Molina CHIP/Medicaid |
$309.40
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$494.32
|
| Rate for Payer: Molina Medicare |
$494.32
|
| Rate for Payer: Multiplan Auto |
$1,524.90
|
| Rate for Payer: Multiplan Commercial |
$1,524.90
|
| Rate for Payer: Multiplan Workers Comp |
$1,524.90
|
| Rate for Payer: Parkland Medicaid |
$309.40
|
| Rate for Payer: Scott and White EPO/PPO |
$8.84
|
| Rate for Payer: Scott and White Medicare |
$494.32
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$309.40
|
| Rate for Payer: Superior Health Plan EPO |
$494.32
|
| Rate for Payer: Superior Health Plan Medicare |
$494.32
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$494.32
|
| Rate for Payer: Universal American Medicare |
$494.32
|
| Rate for Payer: Wellcare Medicare |
$494.32
|
| Rate for Payer: Wellmed Medicare |
$494.32
|
|
|
NM Lung Vent/Perf Imaging BCE
|
Facility
|
IP
|
$2,346.00
|
|
|
Service Code
|
CPT 78582
|
| Hospital Charge Code |
3400012
|
|
Hospital Revenue Code
|
341
|
| Rate for Payer: Cash Price |
$2,064.48
|
|
|
NM Lung Vent/Perf Imaging BCE
|
Facility
|
OP
|
$2,346.00
|
|
|
Service Code
|
CPT 78582
|
| Hospital Charge Code |
3400012
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$8.84 |
| Max. Negotiated Rate |
$1,524.90 |
| Rate for Payer: Aetna Commercial |
$304.97
|
| Rate for Payer: Aetna Medicare |
$741.48
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$309.40
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$494.32
|
| Rate for Payer: Amerigroup Medicare |
$494.32
|
| Rate for Payer: BCBS of TX Blue Advantage |
$484.04
|
| Rate for Payer: BCBS of TX Blue Essentials |
$580.85
|
| Rate for Payer: BCBS of TX Medicare |
$494.32
|
| Rate for Payer: BCBS of TX PPO |
$648.33
|
| Rate for Payer: Cash Price |
$2,064.48
|
| Rate for Payer: Cash Price |
$2,064.48
|
| Rate for Payer: Cash Price |
$2,064.48
|
| Rate for Payer: Cigna Commercial |
$1,119.78
|
| Rate for Payer: Cigna Medicaid |
$309.40
|
| Rate for Payer: Cigna Medicare |
$494.32
|
| Rate for Payer: Employer Direct Commercial |
$494.32
|
| Rate for Payer: Humana Medicare/TRICARE |
$494.32
|
| Rate for Payer: Molina CHIP/Medicaid |
$309.40
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$494.32
|
| Rate for Payer: Molina Medicare |
$494.32
|
| Rate for Payer: Multiplan Auto |
$1,524.90
|
| Rate for Payer: Multiplan Commercial |
$1,524.90
|
| Rate for Payer: Multiplan Workers Comp |
$1,524.90
|
| Rate for Payer: Parkland Medicaid |
$309.40
|
| Rate for Payer: Scott and White EPO/PPO |
$8.84
|
| Rate for Payer: Scott and White Medicare |
$494.32
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$309.40
|
| Rate for Payer: Superior Health Plan EPO |
$494.32
|
| Rate for Payer: Superior Health Plan Medicare |
$494.32
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$494.32
|
| Rate for Payer: Universal American Medicare |
$494.32
|
| Rate for Payer: Wellcare Medicare |
$494.32
|
| Rate for Payer: Wellmed Medicare |
$494.32
|
|
|
NM Lymphoscintigraphy
|
Facility
|
OP
|
$2,114.00
|
|
|
Service Code
|
CPT 78195
|
| Hospital Charge Code |
3400652
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$8.84 |
| Max. Negotiated Rate |
$1,374.10 |
| Rate for Payer: Aetna Commercial |
$321.93
|
| Rate for Payer: Aetna Medicare |
$741.48
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$329.79
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$494.32
|
| Rate for Payer: Amerigroup Medicare |
$494.32
|
| Rate for Payer: BCBS of TX Blue Advantage |
$511.40
|
| Rate for Payer: BCBS of TX Blue Essentials |
$613.68
|
| Rate for Payer: BCBS of TX Medicare |
$494.32
|
| Rate for Payer: BCBS of TX PPO |
$684.97
|
| Rate for Payer: Cash Price |
$1,860.32
|
| Rate for Payer: Cash Price |
$1,860.32
|
| Rate for Payer: Cash Price |
$1,860.32
|
| Rate for Payer: Cigna Commercial |
$1,119.78
|
| Rate for Payer: Cigna Medicaid |
$329.79
|
| Rate for Payer: Cigna Medicare |
$494.32
|
| Rate for Payer: Employer Direct Commercial |
$494.32
|
| Rate for Payer: Humana Medicare/TRICARE |
$494.32
|
| Rate for Payer: Molina CHIP/Medicaid |
$329.79
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$494.32
|
| Rate for Payer: Molina Medicare |
$494.32
|
| Rate for Payer: Multiplan Auto |
$1,374.10
|
| Rate for Payer: Multiplan Commercial |
$1,374.10
|
| Rate for Payer: Multiplan Workers Comp |
$1,374.10
|
| Rate for Payer: Parkland Medicaid |
$329.79
|
| Rate for Payer: Scott and White EPO/PPO |
$8.84
|
| Rate for Payer: Scott and White Medicare |
$494.32
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$329.79
|
| Rate for Payer: Superior Health Plan EPO |
$494.32
|
| Rate for Payer: Superior Health Plan Medicare |
$494.32
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$494.32
|
| Rate for Payer: Universal American Medicare |
$494.32
|
| Rate for Payer: Wellcare Medicare |
$494.32
|
| Rate for Payer: Wellmed Medicare |
$494.32
|
|
|
NM Lymphoscintigraphy Injection/Scan BCE
|
Facility
|
OP
|
$2,114.00
|
|
|
Service Code
|
CPT 78195
|
| Hospital Charge Code |
3400652
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$8.84 |
| Max. Negotiated Rate |
$1,374.10 |
| Rate for Payer: Aetna Commercial |
$321.93
|
| Rate for Payer: Aetna Medicare |
$741.48
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$329.79
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$494.32
|
| Rate for Payer: Amerigroup Medicare |
$494.32
|
| Rate for Payer: BCBS of TX Blue Advantage |
$511.40
|
| Rate for Payer: BCBS of TX Blue Essentials |
$613.68
|
| Rate for Payer: BCBS of TX Medicare |
$494.32
|
| Rate for Payer: BCBS of TX PPO |
$684.97
|
| Rate for Payer: Cash Price |
$1,860.32
|
| Rate for Payer: Cash Price |
$1,860.32
|
| Rate for Payer: Cash Price |
$1,860.32
|
| Rate for Payer: Cigna Commercial |
$1,119.78
|
| Rate for Payer: Cigna Medicaid |
$329.79
|
| Rate for Payer: Cigna Medicare |
$494.32
|
| Rate for Payer: Employer Direct Commercial |
$494.32
|
| Rate for Payer: Humana Medicare/TRICARE |
$494.32
|
| Rate for Payer: Molina CHIP/Medicaid |
$329.79
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$494.32
|
| Rate for Payer: Molina Medicare |
$494.32
|
| Rate for Payer: Multiplan Auto |
$1,374.10
|
| Rate for Payer: Multiplan Commercial |
$1,374.10
|
| Rate for Payer: Multiplan Workers Comp |
$1,374.10
|
| Rate for Payer: Parkland Medicaid |
$329.79
|
| Rate for Payer: Scott and White EPO/PPO |
$8.84
|
| Rate for Payer: Scott and White Medicare |
$494.32
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$329.79
|
| Rate for Payer: Superior Health Plan EPO |
$494.32
|
| Rate for Payer: Superior Health Plan Medicare |
$494.32
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$494.32
|
| Rate for Payer: Universal American Medicare |
$494.32
|
| Rate for Payer: Wellcare Medicare |
$494.32
|
| Rate for Payer: Wellmed Medicare |
$494.32
|
|
|
NM Lymphoscintigraphy Injection/Scan BCE
|
Facility
|
IP
|
$2,114.00
|
|
|
Service Code
|
CPT 78195
|
| Hospital Charge Code |
3400652
|
|
Hospital Revenue Code
|
341
|
| Rate for Payer: Cash Price |
$1,860.32
|
|
