|
NM Myocardial SPECT Rest and Stress
|
Facility
|
OP
|
$7,373.00
|
|
|
Service Code
|
CPT 78452
|
| Hospital Charge Code |
3406824
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$23.22 |
| Max. Negotiated Rate |
$4,792.45 |
| Rate for Payer: Aetna Commercial |
$428.87
|
| Rate for Payer: Aetna Medicare |
$1,947.93
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$438.05
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,298.62
|
| Rate for Payer: Amerigroup Medicare |
$1,298.62
|
| Rate for Payer: BCBS of TX Blue Advantage |
$675.51
|
| Rate for Payer: BCBS of TX Blue Essentials |
$810.61
|
| Rate for Payer: BCBS of TX Medicare |
$1,298.62
|
| Rate for Payer: BCBS of TX PPO |
$904.77
|
| Rate for Payer: Cash Price |
$6,488.24
|
| Rate for Payer: Cash Price |
$6,488.24
|
| Rate for Payer: Cash Price |
$6,488.24
|
| Rate for Payer: Cigna Commercial |
$2,941.75
|
| Rate for Payer: Cigna Medicaid |
$438.05
|
| Rate for Payer: Cigna Medicare |
$1,298.62
|
| Rate for Payer: Employer Direct Commercial |
$1,298.62
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,298.62
|
| Rate for Payer: Molina CHIP/Medicaid |
$438.05
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,298.62
|
| Rate for Payer: Molina Medicare |
$1,298.62
|
| Rate for Payer: Multiplan Auto |
$4,792.45
|
| Rate for Payer: Multiplan Commercial |
$4,792.45
|
| Rate for Payer: Multiplan Workers Comp |
$4,792.45
|
| Rate for Payer: Parkland Medicaid |
$438.05
|
| Rate for Payer: Scott and White EPO/PPO |
$23.22
|
| Rate for Payer: Scott and White Medicare |
$1,298.62
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$438.05
|
| Rate for Payer: Superior Health Plan EPO |
$1,298.62
|
| Rate for Payer: Superior Health Plan Medicare |
$1,298.62
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,298.62
|
| Rate for Payer: Universal American Medicare |
$1,298.62
|
| Rate for Payer: Wellcare Medicare |
$1,298.62
|
| Rate for Payer: Wellmed Medicare |
$1,298.62
|
|
|
NM Myocardial SPECT Rest and Stress BCE
|
Facility
|
OP
|
$7,373.00
|
|
|
Service Code
|
CPT 78452
|
| Hospital Charge Code |
3406824
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$23.22 |
| Max. Negotiated Rate |
$4,792.45 |
| Rate for Payer: Aetna Commercial |
$428.87
|
| Rate for Payer: Aetna Medicare |
$1,947.93
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$438.05
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,298.62
|
| Rate for Payer: Amerigroup Medicare |
$1,298.62
|
| Rate for Payer: BCBS of TX Blue Advantage |
$675.51
|
| Rate for Payer: BCBS of TX Blue Essentials |
$810.61
|
| Rate for Payer: BCBS of TX Medicare |
$1,298.62
|
| Rate for Payer: BCBS of TX PPO |
$904.77
|
| Rate for Payer: Cash Price |
$6,488.24
|
| Rate for Payer: Cash Price |
$6,488.24
|
| Rate for Payer: Cash Price |
$6,488.24
|
| Rate for Payer: Cigna Commercial |
$2,941.75
|
| Rate for Payer: Cigna Medicaid |
$438.05
|
| Rate for Payer: Cigna Medicare |
$1,298.62
|
| Rate for Payer: Employer Direct Commercial |
$1,298.62
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,298.62
|
| Rate for Payer: Molina CHIP/Medicaid |
$438.05
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,298.62
|
| Rate for Payer: Molina Medicare |
$1,298.62
|
| Rate for Payer: Multiplan Auto |
$4,792.45
|
| Rate for Payer: Multiplan Commercial |
$4,792.45
|
| Rate for Payer: Multiplan Workers Comp |
$4,792.45
|
| Rate for Payer: Parkland Medicaid |
$438.05
|
| Rate for Payer: Scott and White EPO/PPO |
$23.22
|
| Rate for Payer: Scott and White Medicare |
$1,298.62
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$438.05
|
| Rate for Payer: Superior Health Plan EPO |
$1,298.62
|
| Rate for Payer: Superior Health Plan Medicare |
$1,298.62
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,298.62
|
| Rate for Payer: Universal American Medicare |
$1,298.62
|
| Rate for Payer: Wellcare Medicare |
$1,298.62
|
| Rate for Payer: Wellmed Medicare |
$1,298.62
|
|
|
NM Myocardial SPECT Rest and Stress BCE
|
Facility
|
IP
|
$7,373.00
|
|
|
Service Code
|
CPT 78452
|
| Hospital Charge Code |
3406824
|
|
Hospital Revenue Code
|
341
|
| Rate for Payer: Cash Price |
$6,488.24
|
|
|
NM Myocardial SPECT Single Study
|
Facility
|
OP
|
$4,301.00
|
|
|
Service Code
|
CPT 78451
|
| Hospital Charge Code |
3406816
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$23.22 |
| Max. Negotiated Rate |
$2,941.75 |
| Rate for Payer: Aetna Commercial |
$296.89
|
| Rate for Payer: Aetna Medicare |
$1,947.93
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$315.75
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,298.62
|
| Rate for Payer: Amerigroup Medicare |
$1,298.62
|
| Rate for Payer: BCBS of TX Blue Advantage |
$467.40
|
| Rate for Payer: BCBS of TX Blue Essentials |
$560.87
|
| Rate for Payer: BCBS of TX Medicare |
$1,298.62
|
| Rate for Payer: BCBS of TX PPO |
$626.03
|
| Rate for Payer: Cash Price |
$3,784.88
|
| Rate for Payer: Cash Price |
$3,784.88
|
| Rate for Payer: Cash Price |
$3,784.88
|
| Rate for Payer: Cigna Commercial |
$2,941.75
|
| Rate for Payer: Cigna Medicaid |
$315.75
|
| Rate for Payer: Cigna Medicare |
$1,298.62
|
| Rate for Payer: Employer Direct Commercial |
$1,298.62
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,298.62
|
| Rate for Payer: Molina CHIP/Medicaid |
$315.75
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,298.62
|
| Rate for Payer: Molina Medicare |
$1,298.62
|
| Rate for Payer: Multiplan Auto |
$2,795.65
|
| Rate for Payer: Multiplan Commercial |
$2,795.65
|
| Rate for Payer: Multiplan Workers Comp |
$2,795.65
|
| Rate for Payer: Parkland Medicaid |
$315.75
|
| Rate for Payer: Scott and White EPO/PPO |
$23.22
|
| Rate for Payer: Scott and White Medicare |
$1,298.62
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$315.75
|
| Rate for Payer: Superior Health Plan EPO |
$1,298.62
|
| Rate for Payer: Superior Health Plan Medicare |
$1,298.62
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,298.62
|
| Rate for Payer: Universal American Medicare |
$1,298.62
|
| Rate for Payer: Wellcare Medicare |
$1,298.62
|
| Rate for Payer: Wellmed Medicare |
$1,298.62
|
|
|
NM Myocardial SPECT Single Study BCE
|
Facility
|
OP
|
$4,301.00
|
|
|
Service Code
|
CPT 78451
|
| Hospital Charge Code |
3406816
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$23.22 |
| Max. Negotiated Rate |
$2,941.75 |
| Rate for Payer: Aetna Commercial |
$296.89
|
| Rate for Payer: Aetna Medicare |
$1,947.93
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$315.75
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,298.62
|
| Rate for Payer: Amerigroup Medicare |
$1,298.62
|
| Rate for Payer: BCBS of TX Blue Advantage |
$467.40
|
| Rate for Payer: BCBS of TX Blue Essentials |
$560.87
|
| Rate for Payer: BCBS of TX Medicare |
$1,298.62
|
| Rate for Payer: BCBS of TX PPO |
$626.03
|
| Rate for Payer: Cash Price |
$3,784.88
|
| Rate for Payer: Cash Price |
$3,784.88
|
| Rate for Payer: Cash Price |
$3,784.88
|
| Rate for Payer: Cigna Commercial |
$2,941.75
|
| Rate for Payer: Cigna Medicaid |
$315.75
|
| Rate for Payer: Cigna Medicare |
$1,298.62
|
| Rate for Payer: Employer Direct Commercial |
$1,298.62
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,298.62
|
| Rate for Payer: Molina CHIP/Medicaid |
$315.75
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,298.62
|
| Rate for Payer: Molina Medicare |
$1,298.62
|
| Rate for Payer: Multiplan Auto |
$2,795.65
|
| Rate for Payer: Multiplan Commercial |
$2,795.65
|
| Rate for Payer: Multiplan Workers Comp |
$2,795.65
|
| Rate for Payer: Parkland Medicaid |
$315.75
|
| Rate for Payer: Scott and White EPO/PPO |
$23.22
|
| Rate for Payer: Scott and White Medicare |
$1,298.62
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$315.75
|
| Rate for Payer: Superior Health Plan EPO |
$1,298.62
|
| Rate for Payer: Superior Health Plan Medicare |
$1,298.62
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,298.62
|
| Rate for Payer: Universal American Medicare |
$1,298.62
|
| Rate for Payer: Wellcare Medicare |
$1,298.62
|
| Rate for Payer: Wellmed Medicare |
$1,298.62
|
|
|
NM Myocardial SPECT Single Study BCE
|
Facility
|
IP
|
$4,301.00
|
|
|
Service Code
|
CPT 78451
|
| Hospital Charge Code |
3406816
|
|
Hospital Revenue Code
|
341
|
| Rate for Payer: Cash Price |
$3,784.88
|
|
|
NMO IgG Autoantibodies SO
|
Facility
|
IP
|
$431.00
|
|
|
Service Code
|
CPT 86051
|
| Hospital Charge Code |
1706332
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$379.28
|
|
|
NMO IgG Autoantibodies SO
|
Facility
|
OP
|
$431.00
|
|
|
Service Code
|
CPT 86051
|
| Hospital Charge Code |
1706332
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.50 |
| Max. Negotiated Rate |
$280.15 |
| Rate for Payer: Aetna Commercial |
$12.11
|
| Rate for Payer: Aetna Medicare |
$17.30
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$4.50
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$11.53
|
| Rate for Payer: Amerigroup Medicare |
$11.53
|
| Rate for Payer: BCBS of TX Blue Advantage |
$19.02
|
| Rate for Payer: BCBS of TX Blue Essentials |
$22.83
|
| Rate for Payer: BCBS of TX Medicare |
$11.53
|
| Rate for Payer: BCBS of TX PPO |
$25.48
|
| Rate for Payer: Cash Price |
$379.28
|
| Rate for Payer: Cash Price |
$379.28
|
| Rate for Payer: Cigna Medicaid |
$11.53
|
| Rate for Payer: Cigna Medicare |
$11.53
|
| Rate for Payer: Employer Direct Commercial |
$11.53
|
| Rate for Payer: Humana Medicare/TRICARE |
$11.53
|
| Rate for Payer: Molina CHIP/Medicaid |
$11.53
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$11.53
|
| Rate for Payer: Molina Medicare |
$11.53
|
| Rate for Payer: Multiplan Auto |
$280.15
|
| Rate for Payer: Multiplan Commercial |
$280.15
|
| Rate for Payer: Multiplan Workers Comp |
$280.15
|
| Rate for Payer: Parkland Medicaid |
$11.53
|
| Rate for Payer: Scott and White EPO/PPO |
$14.41
|
| Rate for Payer: Scott and White Medicare |
$11.53
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$11.53
|
| Rate for Payer: Superior Health Plan EPO |
$11.53
|
| Rate for Payer: Superior Health Plan Medicare |
$11.53
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$11.53
|
| Rate for Payer: Universal American Medicare |
$11.53
|
| Rate for Payer: Wellcare Medicare |
$11.53
|
| Rate for Payer: Wellmed Medicare |
$11.53
|
|
|
NM Parathyroid Imaging
|
Facility
|
OP
|
$1,822.00
|
|
|
Service Code
|
CPT 78070
|
| Hospital Charge Code |
3400322
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$6.75 |
| Max. Negotiated Rate |
$1,184.30 |
| Rate for Payer: Aetna Commercial |
$276.27
|
| Rate for Payer: Aetna Medicare |
$565.80
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$273.65
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$377.20
|
| Rate for Payer: Amerigroup Medicare |
$377.20
|
| Rate for Payer: BCBS of TX Blue Advantage |
$445.98
|
| Rate for Payer: BCBS of TX Blue Essentials |
$535.17
|
| Rate for Payer: BCBS of TX Medicare |
$377.20
|
| Rate for Payer: BCBS of TX PPO |
$597.34
|
| Rate for Payer: Cash Price |
$1,603.36
|
| Rate for Payer: Cash Price |
$1,603.36
|
| Rate for Payer: Cash Price |
$1,603.36
|
| Rate for Payer: Cigna Commercial |
$854.47
|
| Rate for Payer: Cigna Medicaid |
$273.65
|
| 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 |
$273.65
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$377.20
|
| Rate for Payer: Molina Medicare |
$377.20
|
| Rate for Payer: Multiplan Auto |
$1,184.30
|
| Rate for Payer: Multiplan Commercial |
$1,184.30
|
| Rate for Payer: Multiplan Workers Comp |
$1,184.30
|
| Rate for Payer: Parkland Medicaid |
$273.65
|
| 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 |
$273.65
|
| 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 Parathyroid Imaging Injection/Scan BCE
|
Facility
|
OP
|
$1,822.00
|
|
|
Service Code
|
CPT 78070
|
| Hospital Charge Code |
3400322
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$6.75 |
| Max. Negotiated Rate |
$1,184.30 |
| Rate for Payer: Aetna Commercial |
$276.27
|
| Rate for Payer: Aetna Medicare |
$565.80
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$273.65
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$377.20
|
| Rate for Payer: Amerigroup Medicare |
$377.20
|
| Rate for Payer: BCBS of TX Blue Advantage |
$445.98
|
| Rate for Payer: BCBS of TX Blue Essentials |
$535.17
|
| Rate for Payer: BCBS of TX Medicare |
$377.20
|
| Rate for Payer: BCBS of TX PPO |
$597.34
|
| Rate for Payer: Cash Price |
$1,603.36
|
| Rate for Payer: Cash Price |
$1,603.36
|
| Rate for Payer: Cash Price |
$1,603.36
|
| Rate for Payer: Cigna Commercial |
$854.47
|
| Rate for Payer: Cigna Medicaid |
$273.65
|
| 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 |
$273.65
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$377.20
|
| Rate for Payer: Molina Medicare |
$377.20
|
| Rate for Payer: Multiplan Auto |
$1,184.30
|
| Rate for Payer: Multiplan Commercial |
$1,184.30
|
| Rate for Payer: Multiplan Workers Comp |
$1,184.30
|
| Rate for Payer: Parkland Medicaid |
$273.65
|
| 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 |
$273.65
|
| 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 Parathyroid Imaging Injection/Scan BCE
|
Facility
|
IP
|
$1,822.00
|
|
|
Service Code
|
CPT 78070
|
| Hospital Charge Code |
3400322
|
|
Hospital Revenue Code
|
341
|
| Rate for Payer: Cash Price |
$1,603.36
|
|
|
NM Parathyroid Imaging w/ Spect
|
Facility
|
OP
|
$2,048.00
|
|
|
Service Code
|
CPT 78071
|
| Hospital Charge Code |
3450004
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$6.75 |
| Max. Negotiated Rate |
$1,331.20 |
| Rate for Payer: Aetna Commercial |
$317.31
|
| Rate for Payer: Aetna Medicare |
$565.80
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$326.78
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$377.20
|
| Rate for Payer: Amerigroup Medicare |
$377.20
|
| Rate for Payer: BCBS of TX Blue Advantage |
$511.40
|
| Rate for Payer: BCBS of TX Blue Essentials |
$613.68
|
| Rate for Payer: BCBS of TX Medicare |
$377.20
|
| Rate for Payer: BCBS of TX PPO |
$684.97
|
| Rate for Payer: Cash Price |
$1,802.24
|
| Rate for Payer: Cash Price |
$1,802.24
|
| Rate for Payer: Cash Price |
$1,802.24
|
| Rate for Payer: Cigna Commercial |
$854.47
|
| Rate for Payer: Cigna Medicaid |
$326.78
|
| 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 |
$326.78
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$377.20
|
| Rate for Payer: Molina Medicare |
$377.20
|
| Rate for Payer: Multiplan Auto |
$1,331.20
|
| Rate for Payer: Multiplan Commercial |
$1,331.20
|
| Rate for Payer: Multiplan Workers Comp |
$1,331.20
|
| Rate for Payer: Parkland Medicaid |
$326.78
|
| 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 |
$326.78
|
| 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 Parathyroid Imaging w/ Spect Inj/Scan BCE
|
Facility
|
OP
|
$2,048.00
|
|
|
Service Code
|
CPT 78071
|
| Hospital Charge Code |
3450004
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$6.75 |
| Max. Negotiated Rate |
$1,331.20 |
| Rate for Payer: Aetna Commercial |
$317.31
|
| Rate for Payer: Aetna Medicare |
$565.80
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$326.78
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$377.20
|
| Rate for Payer: Amerigroup Medicare |
$377.20
|
| Rate for Payer: BCBS of TX Blue Advantage |
$511.40
|
| Rate for Payer: BCBS of TX Blue Essentials |
$613.68
|
| Rate for Payer: BCBS of TX Medicare |
$377.20
|
| Rate for Payer: BCBS of TX PPO |
$684.97
|
| Rate for Payer: Cash Price |
$1,802.24
|
| Rate for Payer: Cash Price |
$1,802.24
|
| Rate for Payer: Cash Price |
$1,802.24
|
| Rate for Payer: Cigna Commercial |
$854.47
|
| Rate for Payer: Cigna Medicaid |
$326.78
|
| 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 |
$326.78
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$377.20
|
| Rate for Payer: Molina Medicare |
$377.20
|
| Rate for Payer: Multiplan Auto |
$1,331.20
|
| Rate for Payer: Multiplan Commercial |
$1,331.20
|
| Rate for Payer: Multiplan Workers Comp |
$1,331.20
|
| Rate for Payer: Parkland Medicaid |
$326.78
|
| 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 |
$326.78
|
| 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 Parathyroid Imaging w/ Spect Inj/Scan BCE
|
Facility
|
IP
|
$2,048.00
|
|
|
Service Code
|
CPT 78071
|
| Hospital Charge Code |
3450004
|
|
Hospital Revenue Code
|
341
|
| Rate for Payer: Cash Price |
$1,802.24
|
|
|
NM Radiopharm Therapy Oral Admin
|
Facility
|
OP
|
$1,760.00
|
|
|
Service Code
|
CPT 79005
|
| Hospital Charge Code |
3402187
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$4.07 |
| Max. Negotiated Rate |
$1,144.00 |
| Rate for Payer: Aetna Commercial |
$57.80
|
| Rate for Payer: Aetna Medicare |
$341.30
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$134.33
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$227.53
|
| Rate for Payer: Amerigroup Medicare |
$227.53
|
| Rate for Payer: BCBS of TX Blue Advantage |
$83.85
|
| Rate for Payer: BCBS of TX Blue Essentials |
$100.62
|
| Rate for Payer: BCBS of TX Medicare |
$227.53
|
| Rate for Payer: BCBS of TX PPO |
$112.31
|
| Rate for Payer: Cash Price |
$1,548.80
|
| Rate for Payer: Cash Price |
$1,548.80
|
| Rate for Payer: Cash Price |
$1,548.80
|
| Rate for Payer: Cigna Commercial |
$515.41
|
| Rate for Payer: Cigna Medicaid |
$134.33
|
| Rate for Payer: Cigna Medicare |
$227.53
|
| Rate for Payer: Employer Direct Commercial |
$227.53
|
| Rate for Payer: Humana Medicare/TRICARE |
$227.53
|
| Rate for Payer: Molina CHIP/Medicaid |
$134.33
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$227.53
|
| Rate for Payer: Molina Medicare |
$227.53
|
| Rate for Payer: Multiplan Auto |
$1,144.00
|
| Rate for Payer: Multiplan Commercial |
$1,144.00
|
| Rate for Payer: Multiplan Workers Comp |
$1,144.00
|
| Rate for Payer: Parkland Medicaid |
$134.33
|
| Rate for Payer: Scott and White EPO/PPO |
$4.07
|
| Rate for Payer: Scott and White Medicare |
$227.53
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$134.33
|
| Rate for Payer: Superior Health Plan EPO |
$227.53
|
| Rate for Payer: Superior Health Plan Medicare |
$227.53
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$227.53
|
| Rate for Payer: Universal American Medicare |
$227.53
|
| Rate for Payer: Wellcare Medicare |
$227.53
|
| Rate for Payer: Wellmed Medicare |
$227.53
|
|
|
NM Radiopharm Therapy Oral Admin BCE
|
Facility
|
OP
|
$1,760.00
|
|
|
Service Code
|
CPT 79005
|
| Hospital Charge Code |
3402187
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$4.07 |
| Max. Negotiated Rate |
$1,144.00 |
| Rate for Payer: Aetna Commercial |
$57.80
|
| Rate for Payer: Aetna Medicare |
$341.30
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$134.33
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$227.53
|
| Rate for Payer: Amerigroup Medicare |
$227.53
|
| Rate for Payer: BCBS of TX Blue Advantage |
$83.85
|
| Rate for Payer: BCBS of TX Blue Essentials |
$100.62
|
| Rate for Payer: BCBS of TX Medicare |
$227.53
|
| Rate for Payer: BCBS of TX PPO |
$112.31
|
| Rate for Payer: Cash Price |
$1,548.80
|
| Rate for Payer: Cash Price |
$1,548.80
|
| Rate for Payer: Cash Price |
$1,548.80
|
| Rate for Payer: Cigna Commercial |
$515.41
|
| Rate for Payer: Cigna Medicaid |
$134.33
|
| Rate for Payer: Cigna Medicare |
$227.53
|
| Rate for Payer: Employer Direct Commercial |
$227.53
|
| Rate for Payer: Humana Medicare/TRICARE |
$227.53
|
| Rate for Payer: Molina CHIP/Medicaid |
$134.33
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$227.53
|
| Rate for Payer: Molina Medicare |
$227.53
|
| Rate for Payer: Multiplan Auto |
$1,144.00
|
| Rate for Payer: Multiplan Commercial |
$1,144.00
|
| Rate for Payer: Multiplan Workers Comp |
$1,144.00
|
| Rate for Payer: Parkland Medicaid |
$134.33
|
| Rate for Payer: Scott and White EPO/PPO |
$4.07
|
| Rate for Payer: Scott and White Medicare |
$227.53
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$134.33
|
| Rate for Payer: Superior Health Plan EPO |
$227.53
|
| Rate for Payer: Superior Health Plan Medicare |
$227.53
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$227.53
|
| Rate for Payer: Universal American Medicare |
$227.53
|
| Rate for Payer: Wellcare Medicare |
$227.53
|
| Rate for Payer: Wellmed Medicare |
$227.53
|
|
|
NM Radiopharm Therapy Oral Admin BCE
|
Facility
|
IP
|
$1,760.00
|
|
|
Service Code
|
CPT 79005
|
| Hospital Charge Code |
3402187
|
|
Hospital Revenue Code
|
342
|
| Rate for Payer: Cash Price |
$1,548.80
|
|
|
NM Thyroid Cancer Imaging Limited
|
Facility
|
OP
|
$2,011.00
|
|
|
Service Code
|
CPT 78015
|
| Hospital Charge Code |
5218015
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$6.75 |
| Max. Negotiated Rate |
$1,307.15 |
| Rate for Payer: Aetna Commercial |
$213.46
|
| Rate for Payer: Aetna Medicare |
$565.80
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$216.19
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$377.20
|
| Rate for Payer: Amerigroup Medicare |
$377.20
|
| Rate for Payer: BCBS of TX Blue Advantage |
$328.25
|
| Rate for Payer: BCBS of TX Blue Essentials |
$393.90
|
| Rate for Payer: BCBS of TX Medicare |
$377.20
|
| Rate for Payer: BCBS of TX PPO |
$439.66
|
| Rate for Payer: Cash Price |
$1,769.68
|
| Rate for Payer: Cash Price |
$1,769.68
|
| Rate for Payer: Cash Price |
$1,769.68
|
| Rate for Payer: Cigna Commercial |
$854.47
|
| Rate for Payer: Cigna Medicaid |
$216.19
|
| 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 |
$216.19
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$377.20
|
| Rate for Payer: Molina Medicare |
$377.20
|
| Rate for Payer: Multiplan Auto |
$1,307.15
|
| Rate for Payer: Multiplan Commercial |
$1,307.15
|
| Rate for Payer: Multiplan Workers Comp |
$1,307.15
|
| Rate for Payer: Parkland Medicaid |
$216.19
|
| 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 |
$216.19
|
| 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 Thyroid Cancer Imaging Limited BCE
|
Facility
|
IP
|
$2,011.00
|
|
|
Service Code
|
CPT 78015
|
| Hospital Charge Code |
5218015
|
|
Hospital Revenue Code
|
341
|
| Rate for Payer: Cash Price |
$1,769.68
|
|
|
NM Thyroid Cancer Imaging Limited BCE
|
Facility
|
OP
|
$2,011.00
|
|
|
Service Code
|
CPT 78015
|
| Hospital Charge Code |
5218015
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$6.75 |
| Max. Negotiated Rate |
$1,307.15 |
| Rate for Payer: Aetna Commercial |
$213.46
|
| Rate for Payer: Aetna Medicare |
$565.80
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$216.19
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$377.20
|
| Rate for Payer: Amerigroup Medicare |
$377.20
|
| Rate for Payer: BCBS of TX Blue Advantage |
$328.25
|
| Rate for Payer: BCBS of TX Blue Essentials |
$393.90
|
| Rate for Payer: BCBS of TX Medicare |
$377.20
|
| Rate for Payer: BCBS of TX PPO |
$439.66
|
| Rate for Payer: Cash Price |
$1,769.68
|
| Rate for Payer: Cash Price |
$1,769.68
|
| Rate for Payer: Cash Price |
$1,769.68
|
| Rate for Payer: Cigna Commercial |
$854.47
|
| Rate for Payer: Cigna Medicaid |
$216.19
|
| 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 |
$216.19
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$377.20
|
| Rate for Payer: Molina Medicare |
$377.20
|
| Rate for Payer: Multiplan Auto |
$1,307.15
|
| Rate for Payer: Multiplan Commercial |
$1,307.15
|
| Rate for Payer: Multiplan Workers Comp |
$1,307.15
|
| Rate for Payer: Parkland Medicaid |
$216.19
|
| 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 |
$216.19
|
| 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 Thyroid Cancer Imaging WB Delay 1 BCE
|
Facility
|
IP
|
$2,212.00
|
|
|
Service Code
|
CPT 78018
|
| Hospital Charge Code |
3400272
|
|
Hospital Revenue Code
|
341
|
| Rate for Payer: Cash Price |
$1,946.56
|
|
|
NM Thyroid Cancer Imaging WB Delay 1 BCE
|
Facility
|
OP
|
$2,212.00
|
|
|
Service Code
|
CPT 78018
|
| Hospital Charge Code |
3400272
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$8.84 |
| Max. Negotiated Rate |
$1,437.80 |
| Rate for Payer: Aetna Commercial |
$296.12
|
| Rate for Payer: Aetna Medicare |
$741.48
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$290.70
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$494.32
|
| Rate for Payer: Amerigroup Medicare |
$494.32
|
| Rate for Payer: BCBS of TX Blue Advantage |
$467.40
|
| Rate for Payer: BCBS of TX Blue Essentials |
$560.87
|
| Rate for Payer: BCBS of TX Medicare |
$494.32
|
| Rate for Payer: BCBS of TX PPO |
$626.03
|
| 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 |
$1,119.78
|
| Rate for Payer: Cigna Medicaid |
$290.70
|
| 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 |
$290.70
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$494.32
|
| Rate for Payer: Molina Medicare |
$494.32
|
| 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 |
$290.70
|
| 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 |
$290.70
|
| 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 Thyroid Cancer Imaging Whole Body
|
Facility
|
OP
|
$2,212.00
|
|
|
Service Code
|
CPT 78018
|
| Hospital Charge Code |
3400272
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$8.84 |
| Max. Negotiated Rate |
$1,437.80 |
| Rate for Payer: Aetna Commercial |
$296.12
|
| Rate for Payer: Aetna Medicare |
$741.48
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$290.70
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$494.32
|
| Rate for Payer: Amerigroup Medicare |
$494.32
|
| Rate for Payer: BCBS of TX Blue Advantage |
$467.40
|
| Rate for Payer: BCBS of TX Blue Essentials |
$560.87
|
| Rate for Payer: BCBS of TX Medicare |
$494.32
|
| Rate for Payer: BCBS of TX PPO |
$626.03
|
| 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 |
$1,119.78
|
| Rate for Payer: Cigna Medicaid |
$290.70
|
| 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 |
$290.70
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$494.32
|
| Rate for Payer: Molina Medicare |
$494.32
|
| 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 |
$290.70
|
| 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 |
$290.70
|
| 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 Thyroid Imaging
|
Facility
|
OP
|
$1,026.00
|
|
|
Service Code
|
CPT 78013
|
| Hospital Charge Code |
3450001
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$6.75 |
| Max. Negotiated Rate |
$854.47 |
| Rate for Payer: Aetna Commercial |
$191.52
|
| Rate for Payer: Aetna Medicare |
$565.80
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$178.43
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$377.20
|
| Rate for Payer: Amerigroup Medicare |
$377.20
|
| Rate for Payer: BCBS of TX Blue Advantage |
$298.52
|
| Rate for Payer: BCBS of TX Blue Essentials |
$358.22
|
| Rate for Payer: BCBS of TX Medicare |
$377.20
|
| Rate for Payer: BCBS of TX PPO |
$399.83
|
| Rate for Payer: Cash Price |
$902.88
|
| Rate for Payer: Cash Price |
$902.88
|
| Rate for Payer: Cash Price |
$902.88
|
| Rate for Payer: Cigna Commercial |
$854.47
|
| Rate for Payer: Cigna Medicaid |
$178.43
|
| 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 |
$178.43
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$377.20
|
| Rate for Payer: Molina Medicare |
$377.20
|
| Rate for Payer: Multiplan Auto |
$666.90
|
| Rate for Payer: Multiplan Commercial |
$666.90
|
| Rate for Payer: Multiplan Workers Comp |
$666.90
|
| Rate for Payer: Parkland Medicaid |
$178.43
|
| 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 |
$178.43
|
| 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 Thyroid Imaging BCE
|
Facility
|
IP
|
$1,026.00
|
|
|
Service Code
|
CPT 78013
|
| Hospital Charge Code |
3450001
|
|
Hospital Revenue Code
|
341
|
| Rate for Payer: Cash Price |
$902.88
|
|
