|
Urinalysis Microscopic
|
Facility
|
IP
|
$188.00
|
|
|
Service Code
|
CPT 81001
|
| Hospital Charge Code |
1605260
|
|
Hospital Revenue Code
|
307
|
| Rate for Payer: Cash Price |
$165.44
|
|
|
Urinalysis Microscopic
|
Facility
|
OP
|
$188.00
|
|
|
Service Code
|
CPT 81001
|
| Hospital Charge Code |
1605260
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$1.24 |
| Max. Negotiated Rate |
$122.20 |
| Rate for Payer: Aetna Commercial |
$3.32
|
| Rate for Payer: Aetna Medicare |
$4.76
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1.24
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3.17
|
| Rate for Payer: Amerigroup Medicare |
$3.17
|
| Rate for Payer: BCBS of TX Blue Advantage |
$5.23
|
| Rate for Payer: BCBS of TX Blue Essentials |
$6.28
|
| Rate for Payer: BCBS of TX Medicare |
$3.17
|
| Rate for Payer: BCBS of TX PPO |
$7.01
|
| Rate for Payer: Cash Price |
$165.44
|
| Rate for Payer: Cash Price |
$165.44
|
| Rate for Payer: Cigna Medicaid |
$3.17
|
| Rate for Payer: Cigna Medicare |
$3.17
|
| Rate for Payer: Employer Direct Commercial |
$3.17
|
| Rate for Payer: Humana Medicare/TRICARE |
$3.17
|
| Rate for Payer: Molina CHIP/Medicaid |
$3.17
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3.17
|
| Rate for Payer: Molina Medicare |
$3.17
|
| Rate for Payer: Multiplan Auto |
$122.20
|
| Rate for Payer: Multiplan Commercial |
$122.20
|
| Rate for Payer: Multiplan Workers Comp |
$122.20
|
| Rate for Payer: Parkland Medicaid |
$3.17
|
| Rate for Payer: Scott and White EPO/PPO |
$3.96
|
| Rate for Payer: Scott and White Medicare |
$3.17
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$3.17
|
| Rate for Payer: Superior Health Plan EPO |
$3.17
|
| Rate for Payer: Superior Health Plan Medicare |
$3.17
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3.17
|
| Rate for Payer: Universal American Medicare |
$3.17
|
| Rate for Payer: Wellcare Medicare |
$3.17
|
| Rate for Payer: Wellmed Medicare |
$3.17
|
|
|
.Urinalysis (POCT)
|
Facility
|
OP
|
$122.00
|
|
|
Service Code
|
CPT 81003
|
| Hospital Charge Code |
1605211
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$0.88 |
| Max. Negotiated Rate |
$79.30 |
| Rate for Payer: Aetna Commercial |
$2.36
|
| Rate for Payer: Aetna Medicare |
$3.38
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$0.88
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$2.25
|
| Rate for Payer: Amerigroup Medicare |
$2.25
|
| Rate for Payer: BCBS of TX Blue Advantage |
$3.71
|
| Rate for Payer: BCBS of TX Blue Essentials |
$4.46
|
| Rate for Payer: BCBS of TX Medicare |
$2.25
|
| Rate for Payer: BCBS of TX PPO |
$4.97
|
| Rate for Payer: Cash Price |
$107.36
|
| Rate for Payer: Cash Price |
$107.36
|
| Rate for Payer: Cigna Medicaid |
$2.25
|
| Rate for Payer: Cigna Medicare |
$2.25
|
| Rate for Payer: Employer Direct Commercial |
$2.25
|
| Rate for Payer: Humana Medicare/TRICARE |
$2.25
|
| Rate for Payer: Molina CHIP/Medicaid |
$2.25
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$2.25
|
| Rate for Payer: Molina Medicare |
$2.25
|
| Rate for Payer: Multiplan Auto |
$79.30
|
| Rate for Payer: Multiplan Commercial |
$79.30
|
| Rate for Payer: Multiplan Workers Comp |
$79.30
|
| Rate for Payer: Parkland Medicaid |
$2.25
|
| Rate for Payer: Scott and White EPO/PPO |
$2.81
|
| Rate for Payer: Scott and White Medicare |
$2.25
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$2.25
|
| Rate for Payer: Superior Health Plan EPO |
$2.25
|
| Rate for Payer: Superior Health Plan Medicare |
$2.25
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$2.25
|
| Rate for Payer: Universal American Medicare |
$2.25
|
| Rate for Payer: Wellcare Medicare |
$2.25
|
| Rate for Payer: Wellmed Medicare |
$2.25
|
|
|
Urinalysis without Microscopic
|
Facility
|
OP
|
$122.00
|
|
|
Service Code
|
CPT 81003
|
| Hospital Charge Code |
1605211
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$0.88 |
| Max. Negotiated Rate |
$79.30 |
| Rate for Payer: Aetna Commercial |
$2.36
|
| Rate for Payer: Aetna Medicare |
$3.38
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$0.88
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$2.25
|
| Rate for Payer: Amerigroup Medicare |
$2.25
|
| Rate for Payer: BCBS of TX Blue Advantage |
$3.71
|
| Rate for Payer: BCBS of TX Blue Essentials |
$4.46
|
| Rate for Payer: BCBS of TX Medicare |
$2.25
|
| Rate for Payer: BCBS of TX PPO |
$4.97
|
| Rate for Payer: Cash Price |
$107.36
|
| Rate for Payer: Cash Price |
$107.36
|
| Rate for Payer: Cigna Medicaid |
$2.25
|
| Rate for Payer: Cigna Medicare |
$2.25
|
| Rate for Payer: Employer Direct Commercial |
$2.25
|
| Rate for Payer: Humana Medicare/TRICARE |
$2.25
|
| Rate for Payer: Molina CHIP/Medicaid |
$2.25
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$2.25
|
| Rate for Payer: Molina Medicare |
$2.25
|
| Rate for Payer: Multiplan Auto |
$79.30
|
| Rate for Payer: Multiplan Commercial |
$79.30
|
| Rate for Payer: Multiplan Workers Comp |
$79.30
|
| Rate for Payer: Parkland Medicaid |
$2.25
|
| Rate for Payer: Scott and White EPO/PPO |
$2.81
|
| Rate for Payer: Scott and White Medicare |
$2.25
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$2.25
|
| Rate for Payer: Superior Health Plan EPO |
$2.25
|
| Rate for Payer: Superior Health Plan Medicare |
$2.25
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$2.25
|
| Rate for Payer: Universal American Medicare |
$2.25
|
| Rate for Payer: Wellcare Medicare |
$2.25
|
| Rate for Payer: Wellmed Medicare |
$2.25
|
|
|
Urinalysis without Microscopic
|
Facility
|
IP
|
$122.00
|
|
|
Service Code
|
CPT 81003
|
| Hospital Charge Code |
1605211
|
|
Hospital Revenue Code
|
307
|
| Rate for Payer: Cash Price |
$107.36
|
|
|
URINARY LEG BAG/EXT TUBE/STRAP S/M/L
|
Facility
|
OP
|
$31.60
|
|
| Hospital Charge Code |
145059
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.84 |
| Max. Negotiated Rate |
$20.54 |
| Rate for Payer: Aetna Commercial |
$17.38
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2.84
|
| Rate for Payer: BCBS of TX Blue Advantage |
$9.48
|
| Rate for Payer: BCBS of TX Blue Essentials |
$11.38
|
| Rate for Payer: BCBS of TX PPO |
$12.64
|
| Rate for Payer: Cash Price |
$27.81
|
| Rate for Payer: Multiplan Auto |
$20.54
|
| Rate for Payer: Multiplan Commercial |
$20.54
|
| Rate for Payer: Multiplan Workers Comp |
$20.54
|
| Rate for Payer: Scott and White EPO/PPO |
$15.80
|
| Rate for Payer: Superior Health Plan EPO |
$4.30
|
|
|
URINARY LEG BAG/EXT TUBE/STRAP S/M/L
|
Facility
|
IP
|
$31.60
|
|
| Hospital Charge Code |
145059
|
|
Hospital Revenue Code
|
270
|
| Rate for Payer: Cash Price |
$27.81
|
|
|
URINARY STONES WITH MCC
|
Facility
|
IP
|
$26,909.70
|
|
|
Service Code
|
MSDRG 693
|
| Min. Negotiated Rate |
$11,390.70 |
| Max. Negotiated Rate |
$26,909.70 |
| Rate for Payer: Aetna Commercial |
$15,933.38
|
| Rate for Payer: Aetna Medicare |
$19,442.37
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$12,961.58
|
| Rate for Payer: Amerigroup Medicare |
$12,961.58
|
| Rate for Payer: BCBS of TX Blue Advantage |
$11,390.70
|
| Rate for Payer: BCBS of TX Blue Essentials |
$13,658.23
|
| Rate for Payer: BCBS of TX Medicare |
$12,961.58
|
| Rate for Payer: BCBS of TX PPO |
$15,176.40
|
| Rate for Payer: Cigna Commercial |
$18,241.94
|
| Rate for Payer: Cigna Medicare |
$12,961.58
|
| Rate for Payer: Employer Direct Commercial |
$12,961.58
|
| Rate for Payer: Humana Medicare/TRICARE |
$12,961.58
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$12,961.58
|
| Rate for Payer: Molina Medicare |
$12,961.58
|
| Rate for Payer: Multiplan Auto |
$26,909.70
|
| Rate for Payer: Multiplan Commercial |
$26,909.70
|
| Rate for Payer: Multiplan Workers Comp |
$26,909.70
|
| Rate for Payer: Scott and White EPO/PPO |
$12,392.62
|
| Rate for Payer: Scott and White Medicare |
$12,961.58
|
| Rate for Payer: Superior Health Plan EPO |
$12,961.58
|
| Rate for Payer: Superior Health Plan Medicare |
$12,961.58
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$12,961.58
|
| Rate for Payer: Universal American Medicare |
$12,961.58
|
| Rate for Payer: Wellcare Medicare |
$12,961.58
|
| Rate for Payer: Wellmed Medicare |
$12,961.58
|
|
|
URINARY STONES WITHOUT MCC
|
Facility
|
IP
|
$14,871.30
|
|
|
Service Code
|
MSDRG 694
|
| Min. Negotiated Rate |
$6,354.54 |
| Max. Negotiated Rate |
$14,871.30 |
| Rate for Payer: Aetna Commercial |
$8,805.38
|
| Rate for Payer: Aetna Medicare |
$12,660.28
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$8,440.19
|
| Rate for Payer: Amerigroup Medicare |
$8,440.19
|
| Rate for Payer: BCBS of TX Blue Advantage |
$6,354.54
|
| Rate for Payer: BCBS of TX Blue Essentials |
$7,244.97
|
| Rate for Payer: BCBS of TX Medicare |
$8,440.19
|
| Rate for Payer: BCBS of TX PPO |
$8,050.28
|
| Rate for Payer: Cigna Commercial |
$10,081.18
|
| Rate for Payer: Cigna Medicare |
$8,440.19
|
| Rate for Payer: Employer Direct Commercial |
$8,440.19
|
| Rate for Payer: Humana Medicare/TRICARE |
$8,440.19
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$8,440.19
|
| Rate for Payer: Molina Medicare |
$8,440.19
|
| Rate for Payer: Multiplan Auto |
$14,871.30
|
| Rate for Payer: Multiplan Commercial |
$14,871.30
|
| Rate for Payer: Multiplan Workers Comp |
$14,871.30
|
| Rate for Payer: Scott and White EPO/PPO |
$6,848.62
|
| Rate for Payer: Scott and White Medicare |
$8,440.19
|
| Rate for Payer: Superior Health Plan EPO |
$8,440.19
|
| Rate for Payer: Superior Health Plan Medicare |
$8,440.19
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$8,440.19
|
| Rate for Payer: Universal American Medicare |
$8,440.19
|
| Rate for Payer: Wellcare Medicare |
$8,440.19
|
| Rate for Payer: Wellmed Medicare |
$8,440.19
|
|
|
Urine Collection 24 Hour BCE
|
Facility
|
OP
|
$56.00
|
|
|
Service Code
|
CPT 81050
|
| Hospital Charge Code |
1704618
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$1.42 |
| Max. Negotiated Rate |
$36.40 |
| Rate for Payer: Aetna Commercial |
$3.82
|
| Rate for Payer: Aetna Medicare |
$5.46
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1.42
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3.64
|
| Rate for Payer: Amerigroup Medicare |
$3.64
|
| Rate for Payer: BCBS of TX Blue Advantage |
$6.01
|
| Rate for Payer: BCBS of TX Blue Essentials |
$7.21
|
| Rate for Payer: BCBS of TX Medicare |
$3.64
|
| Rate for Payer: BCBS of TX PPO |
$8.04
|
| Rate for Payer: Cash Price |
$49.28
|
| Rate for Payer: Cash Price |
$49.28
|
| Rate for Payer: Cigna Medicaid |
$3.64
|
| Rate for Payer: Cigna Medicare |
$3.64
|
| Rate for Payer: Employer Direct Commercial |
$3.64
|
| Rate for Payer: Humana Medicare/TRICARE |
$3.64
|
| Rate for Payer: Molina CHIP/Medicaid |
$3.64
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3.64
|
| Rate for Payer: Molina Medicare |
$3.64
|
| Rate for Payer: Multiplan Auto |
$36.40
|
| Rate for Payer: Multiplan Commercial |
$36.40
|
| Rate for Payer: Multiplan Workers Comp |
$36.40
|
| Rate for Payer: Parkland Medicaid |
$3.64
|
| Rate for Payer: Scott and White EPO/PPO |
$4.55
|
| Rate for Payer: Scott and White Medicare |
$3.64
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$3.64
|
| Rate for Payer: Superior Health Plan EPO |
$3.64
|
| Rate for Payer: Superior Health Plan Medicare |
$3.64
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3.64
|
| Rate for Payer: Universal American Medicare |
$3.64
|
| Rate for Payer: Wellcare Medicare |
$3.64
|
| Rate for Payer: Wellmed Medicare |
$3.64
|
|
|
Urine Collection 24 Hour BCE
|
Facility
|
IP
|
$56.00
|
|
|
Service Code
|
CPT 81050
|
| Hospital Charge Code |
1704618
|
|
Hospital Revenue Code
|
307
|
| Rate for Payer: Cash Price |
$49.28
|
|
|
Urine Creatinine
|
Facility
|
OP
|
$96.00
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
4102573
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.02 |
| Max. Negotiated Rate |
$62.40 |
| Rate for Payer: Aetna Commercial |
$5.44
|
| Rate for Payer: Aetna Medicare |
$7.77
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2.02
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$5.18
|
| Rate for Payer: Amerigroup Medicare |
$5.18
|
| Rate for Payer: BCBS of TX Blue Advantage |
$8.55
|
| Rate for Payer: BCBS of TX Blue Essentials |
$10.26
|
| Rate for Payer: BCBS of TX Medicare |
$5.18
|
| Rate for Payer: BCBS of TX PPO |
$11.45
|
| Rate for Payer: Cash Price |
$84.48
|
| Rate for Payer: Cash Price |
$84.48
|
| Rate for Payer: Cigna Medicaid |
$5.18
|
| Rate for Payer: Cigna Medicare |
$5.18
|
| Rate for Payer: Employer Direct Commercial |
$5.18
|
| Rate for Payer: Humana Medicare/TRICARE |
$5.18
|
| Rate for Payer: Molina CHIP/Medicaid |
$5.18
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$5.18
|
| Rate for Payer: Molina Medicare |
$5.18
|
| Rate for Payer: Multiplan Auto |
$62.40
|
| Rate for Payer: Multiplan Commercial |
$62.40
|
| Rate for Payer: Multiplan Workers Comp |
$62.40
|
| Rate for Payer: Parkland Medicaid |
$5.18
|
| Rate for Payer: Scott and White EPO/PPO |
$6.48
|
| Rate for Payer: Scott and White Medicare |
$5.18
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$5.18
|
| Rate for Payer: Superior Health Plan EPO |
$5.18
|
| Rate for Payer: Superior Health Plan Medicare |
$5.18
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$5.18
|
| Rate for Payer: Universal American Medicare |
$5.18
|
| Rate for Payer: Wellcare Medicare |
$5.18
|
| Rate for Payer: Wellmed Medicare |
$5.18
|
|
|
Urine Creatinine
|
Facility
|
IP
|
$96.00
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
4102573
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$84.48
|
|
|
Urine Culture
|
Facility
|
IP
|
$141.00
|
|
|
Service Code
|
CPT 87088
|
| Hospital Charge Code |
4107088
|
|
Hospital Revenue Code
|
306
|
| Rate for Payer: Cash Price |
$124.08
|
|
|
Urine Culture
|
Facility
|
OP
|
$141.00
|
|
|
Service Code
|
CPT 87088
|
| Hospital Charge Code |
4107088
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.16 |
| Max. Negotiated Rate |
$91.65 |
| Rate for Payer: Aetna Commercial |
$8.49
|
| Rate for Payer: Aetna Medicare |
$12.14
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$3.16
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$8.09
|
| Rate for Payer: Amerigroup Medicare |
$8.09
|
| Rate for Payer: BCBS of TX Blue Advantage |
$13.35
|
| Rate for Payer: BCBS of TX Blue Essentials |
$16.02
|
| Rate for Payer: BCBS of TX Medicare |
$8.09
|
| Rate for Payer: BCBS of TX PPO |
$17.88
|
| Rate for Payer: Cash Price |
$124.08
|
| Rate for Payer: Cash Price |
$124.08
|
| Rate for Payer: Cigna Medicaid |
$8.09
|
| Rate for Payer: Cigna Medicare |
$8.09
|
| Rate for Payer: Employer Direct Commercial |
$8.09
|
| Rate for Payer: Humana Medicare/TRICARE |
$8.09
|
| Rate for Payer: Molina CHIP/Medicaid |
$8.09
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$8.09
|
| Rate for Payer: Molina Medicare |
$8.09
|
| Rate for Payer: Multiplan Auto |
$91.65
|
| Rate for Payer: Multiplan Commercial |
$91.65
|
| Rate for Payer: Multiplan Workers Comp |
$91.65
|
| Rate for Payer: Parkland Medicaid |
$8.09
|
| Rate for Payer: Scott and White EPO/PPO |
$10.11
|
| Rate for Payer: Scott and White Medicare |
$8.09
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$8.09
|
| Rate for Payer: Superior Health Plan EPO |
$8.09
|
| Rate for Payer: Superior Health Plan Medicare |
$8.09
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$8.09
|
| Rate for Payer: Universal American Medicare |
$8.09
|
| Rate for Payer: Wellcare Medicare |
$8.09
|
| Rate for Payer: Wellmed Medicare |
$8.09
|
|
|
US Abdomen Complete
|
Facility
|
OP
|
$1,598.00
|
|
|
Service Code
|
CPT 76700
|
| Hospital Charge Code |
3500212
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$1,038.70 |
| Rate for Payer: Aetna Commercial |
$91.89
|
| Rate for Payer: Aetna Medicare |
$150.82
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$106.88
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$100.55
|
| Rate for Payer: Amerigroup Medicare |
$100.55
|
| Rate for Payer: BCBS of TX Blue Advantage |
$184.93
|
| Rate for Payer: BCBS of TX Blue Essentials |
$221.92
|
| Rate for Payer: BCBS of TX Medicare |
$100.55
|
| Rate for Payer: BCBS of TX PPO |
$247.70
|
| Rate for Payer: Cash Price |
$1,406.24
|
| Rate for Payer: Cash Price |
$1,406.24
|
| Rate for Payer: Cash Price |
$1,406.24
|
| Rate for Payer: Cigna Commercial |
$227.77
|
| Rate for Payer: Cigna Medicaid |
$106.88
|
| Rate for Payer: Cigna Medicare |
$100.55
|
| Rate for Payer: Employer Direct Commercial |
$100.55
|
| Rate for Payer: Humana Medicare/TRICARE |
$100.55
|
| Rate for Payer: Molina CHIP/Medicaid |
$106.88
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$100.55
|
| Rate for Payer: Molina Medicare |
$100.55
|
| Rate for Payer: Multiplan Auto |
$1,038.70
|
| Rate for Payer: Multiplan Commercial |
$1,038.70
|
| Rate for Payer: Multiplan Workers Comp |
$1,038.70
|
| Rate for Payer: Parkland Medicaid |
$106.88
|
| Rate for Payer: Scott and White EPO/PPO |
$1.80
|
| Rate for Payer: Scott and White Medicare |
$100.55
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$106.88
|
| Rate for Payer: Superior Health Plan EPO |
$100.55
|
| Rate for Payer: Superior Health Plan Medicare |
$100.55
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$100.55
|
| Rate for Payer: Universal American Medicare |
$100.55
|
| Rate for Payer: Wellcare Medicare |
$100.55
|
| Rate for Payer: Wellmed Medicare |
$100.55
|
|
|
US Abdomen Complete BCE
|
Facility
|
IP
|
$1,598.00
|
|
|
Service Code
|
CPT 76700
|
| Hospital Charge Code |
3500212
|
|
Hospital Revenue Code
|
402
|
| Rate for Payer: Cash Price |
$1,406.24
|
|
|
US Abdomen Complete BCE
|
Facility
|
OP
|
$1,598.00
|
|
|
Service Code
|
CPT 76700
|
| Hospital Charge Code |
3500212
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$1,038.70 |
| Rate for Payer: Aetna Commercial |
$91.89
|
| Rate for Payer: Aetna Medicare |
$150.82
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$106.88
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$100.55
|
| Rate for Payer: Amerigroup Medicare |
$100.55
|
| Rate for Payer: BCBS of TX Blue Advantage |
$184.93
|
| Rate for Payer: BCBS of TX Blue Essentials |
$221.92
|
| Rate for Payer: BCBS of TX Medicare |
$100.55
|
| Rate for Payer: BCBS of TX PPO |
$247.70
|
| Rate for Payer: Cash Price |
$1,406.24
|
| Rate for Payer: Cash Price |
$1,406.24
|
| Rate for Payer: Cash Price |
$1,406.24
|
| Rate for Payer: Cigna Commercial |
$227.77
|
| Rate for Payer: Cigna Medicaid |
$106.88
|
| Rate for Payer: Cigna Medicare |
$100.55
|
| Rate for Payer: Employer Direct Commercial |
$100.55
|
| Rate for Payer: Humana Medicare/TRICARE |
$100.55
|
| Rate for Payer: Molina CHIP/Medicaid |
$106.88
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$100.55
|
| Rate for Payer: Molina Medicare |
$100.55
|
| Rate for Payer: Multiplan Auto |
$1,038.70
|
| Rate for Payer: Multiplan Commercial |
$1,038.70
|
| Rate for Payer: Multiplan Workers Comp |
$1,038.70
|
| Rate for Payer: Parkland Medicaid |
$106.88
|
| Rate for Payer: Scott and White EPO/PPO |
$1.80
|
| Rate for Payer: Scott and White Medicare |
$100.55
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$106.88
|
| Rate for Payer: Superior Health Plan EPO |
$100.55
|
| Rate for Payer: Superior Health Plan Medicare |
$100.55
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$100.55
|
| Rate for Payer: Universal American Medicare |
$100.55
|
| Rate for Payer: Wellcare Medicare |
$100.55
|
| Rate for Payer: Wellmed Medicare |
$100.55
|
|
|
US Abdomen Limited
|
Facility
|
OP
|
$1,236.00
|
|
|
Service Code
|
CPT 76705
|
| Hospital Charge Code |
3500055
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$803.40 |
| Rate for Payer: Aetna Commercial |
$69.16
|
| Rate for Payer: Aetna Medicare |
$150.82
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$88.55
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$100.55
|
| Rate for Payer: Amerigroup Medicare |
$100.55
|
| Rate for Payer: BCBS of TX Blue Advantage |
$184.93
|
| Rate for Payer: BCBS of TX Blue Essentials |
$221.92
|
| Rate for Payer: BCBS of TX Medicare |
$100.55
|
| Rate for Payer: BCBS of TX PPO |
$247.70
|
| Rate for Payer: Cash Price |
$1,087.68
|
| Rate for Payer: Cash Price |
$1,087.68
|
| Rate for Payer: Cash Price |
$1,087.68
|
| Rate for Payer: Cigna Commercial |
$227.77
|
| Rate for Payer: Cigna Medicaid |
$88.55
|
| Rate for Payer: Cigna Medicare |
$100.55
|
| Rate for Payer: Employer Direct Commercial |
$100.55
|
| Rate for Payer: Humana Medicare/TRICARE |
$100.55
|
| Rate for Payer: Molina CHIP/Medicaid |
$88.55
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$100.55
|
| Rate for Payer: Molina Medicare |
$100.55
|
| Rate for Payer: Multiplan Auto |
$803.40
|
| Rate for Payer: Multiplan Commercial |
$803.40
|
| Rate for Payer: Multiplan Workers Comp |
$803.40
|
| Rate for Payer: Parkland Medicaid |
$88.55
|
| Rate for Payer: Scott and White EPO/PPO |
$1.80
|
| Rate for Payer: Scott and White Medicare |
$100.55
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$88.55
|
| Rate for Payer: Superior Health Plan EPO |
$100.55
|
| Rate for Payer: Superior Health Plan Medicare |
$100.55
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$100.55
|
| Rate for Payer: Universal American Medicare |
$100.55
|
| Rate for Payer: Wellcare Medicare |
$100.55
|
| Rate for Payer: Wellmed Medicare |
$100.55
|
|
|
US Abdomen Limited BCE
|
Facility
|
IP
|
$1,236.00
|
|
|
Service Code
|
CPT 76705
|
| Hospital Charge Code |
3500055
|
|
Hospital Revenue Code
|
402
|
| Rate for Payer: Cash Price |
$1,087.68
|
|
|
US Abdomen Limited BCE
|
Facility
|
OP
|
$1,236.00
|
|
|
Service Code
|
CPT 76705
|
| Hospital Charge Code |
3500055
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$803.40 |
| Rate for Payer: Aetna Commercial |
$69.16
|
| Rate for Payer: Aetna Medicare |
$150.82
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$88.55
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$100.55
|
| Rate for Payer: Amerigroup Medicare |
$100.55
|
| Rate for Payer: BCBS of TX Blue Advantage |
$184.93
|
| Rate for Payer: BCBS of TX Blue Essentials |
$221.92
|
| Rate for Payer: BCBS of TX Medicare |
$100.55
|
| Rate for Payer: BCBS of TX PPO |
$247.70
|
| Rate for Payer: Cash Price |
$1,087.68
|
| Rate for Payer: Cash Price |
$1,087.68
|
| Rate for Payer: Cash Price |
$1,087.68
|
| Rate for Payer: Cigna Commercial |
$227.77
|
| Rate for Payer: Cigna Medicaid |
$88.55
|
| Rate for Payer: Cigna Medicare |
$100.55
|
| Rate for Payer: Employer Direct Commercial |
$100.55
|
| Rate for Payer: Humana Medicare/TRICARE |
$100.55
|
| Rate for Payer: Molina CHIP/Medicaid |
$88.55
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$100.55
|
| Rate for Payer: Molina Medicare |
$100.55
|
| Rate for Payer: Multiplan Auto |
$803.40
|
| Rate for Payer: Multiplan Commercial |
$803.40
|
| Rate for Payer: Multiplan Workers Comp |
$803.40
|
| Rate for Payer: Parkland Medicaid |
$88.55
|
| Rate for Payer: Scott and White EPO/PPO |
$1.80
|
| Rate for Payer: Scott and White Medicare |
$100.55
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$88.55
|
| Rate for Payer: Superior Health Plan EPO |
$100.55
|
| Rate for Payer: Superior Health Plan Medicare |
$100.55
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$100.55
|
| Rate for Payer: Universal American Medicare |
$100.55
|
| Rate for Payer: Wellcare Medicare |
$100.55
|
| Rate for Payer: Wellmed Medicare |
$100.55
|
|
|
US Aorta IVC Iliac Duplex Complete
|
Facility
|
OP
|
$974.00
|
|
|
Service Code
|
CPT 93978
|
| Hospital Charge Code |
3500352
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$4.01 |
| Max. Negotiated Rate |
$633.10 |
| Rate for Payer: Aetna Commercial |
$291.57
|
| Rate for Payer: Aetna Medicare |
$336.15
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$87.66
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$224.10
|
| Rate for Payer: Amerigroup Medicare |
$224.10
|
| Rate for Payer: BCBS of TX Blue Advantage |
$264.64
|
| Rate for Payer: BCBS of TX Blue Essentials |
$316.35
|
| Rate for Payer: BCBS of TX Medicare |
$224.10
|
| Rate for Payer: BCBS of TX PPO |
$352.85
|
| Rate for Payer: Cash Price |
$857.12
|
| Rate for Payer: Cash Price |
$857.12
|
| Rate for Payer: Cash Price |
$857.12
|
| Rate for Payer: Cigna Commercial |
$507.64
|
| Rate for Payer: Cigna Medicaid |
$180.76
|
| Rate for Payer: Cigna Medicare |
$224.10
|
| Rate for Payer: Employer Direct Commercial |
$224.10
|
| Rate for Payer: Humana Medicare/TRICARE |
$224.10
|
| Rate for Payer: Molina CHIP/Medicaid |
$180.76
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$224.10
|
| Rate for Payer: Molina Medicare |
$224.10
|
| Rate for Payer: Multiplan Auto |
$633.10
|
| Rate for Payer: Multiplan Commercial |
$633.10
|
| Rate for Payer: Multiplan Workers Comp |
$633.10
|
| Rate for Payer: Parkland Medicaid |
$180.76
|
| Rate for Payer: Scott and White EPO/PPO |
$4.01
|
| Rate for Payer: Scott and White Medicare |
$224.10
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$180.76
|
| Rate for Payer: Superior Health Plan EPO |
$224.10
|
| Rate for Payer: Superior Health Plan Medicare |
$224.10
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$224.10
|
| Rate for Payer: Universal American Medicare |
$224.10
|
| Rate for Payer: Wellcare Medicare |
$224.10
|
| Rate for Payer: Wellmed Medicare |
$224.10
|
|
|
US Aorta IVC Iliac Duplex Complete BCE
|
Facility
|
OP
|
$974.00
|
|
|
Service Code
|
CPT 93978
|
| Hospital Charge Code |
3500352
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$4.01 |
| Max. Negotiated Rate |
$633.10 |
| Rate for Payer: Aetna Commercial |
$291.57
|
| Rate for Payer: Aetna Medicare |
$336.15
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$87.66
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$224.10
|
| Rate for Payer: Amerigroup Medicare |
$224.10
|
| Rate for Payer: BCBS of TX Blue Advantage |
$264.64
|
| Rate for Payer: BCBS of TX Blue Essentials |
$316.35
|
| Rate for Payer: BCBS of TX Medicare |
$224.10
|
| Rate for Payer: BCBS of TX PPO |
$352.85
|
| Rate for Payer: Cash Price |
$857.12
|
| Rate for Payer: Cash Price |
$857.12
|
| Rate for Payer: Cash Price |
$857.12
|
| Rate for Payer: Cigna Commercial |
$507.64
|
| Rate for Payer: Cigna Medicaid |
$180.76
|
| Rate for Payer: Cigna Medicare |
$224.10
|
| Rate for Payer: Employer Direct Commercial |
$224.10
|
| Rate for Payer: Humana Medicare/TRICARE |
$224.10
|
| Rate for Payer: Molina CHIP/Medicaid |
$180.76
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$224.10
|
| Rate for Payer: Molina Medicare |
$224.10
|
| Rate for Payer: Multiplan Auto |
$633.10
|
| Rate for Payer: Multiplan Commercial |
$633.10
|
| Rate for Payer: Multiplan Workers Comp |
$633.10
|
| Rate for Payer: Parkland Medicaid |
$180.76
|
| Rate for Payer: Scott and White EPO/PPO |
$4.01
|
| Rate for Payer: Scott and White Medicare |
$224.10
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$180.76
|
| Rate for Payer: Superior Health Plan EPO |
$224.10
|
| Rate for Payer: Superior Health Plan Medicare |
$224.10
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$224.10
|
| Rate for Payer: Universal American Medicare |
$224.10
|
| Rate for Payer: Wellcare Medicare |
$224.10
|
| Rate for Payer: Wellmed Medicare |
$224.10
|
|
|
US Aorta IVC Iliac Duplex Complete BCE
|
Facility
|
IP
|
$974.00
|
|
|
Service Code
|
CPT 93978
|
| Hospital Charge Code |
3500352
|
|
Hospital Revenue Code
|
921
|
| Rate for Payer: Cash Price |
$857.12
|
|
|
US Aorta IVC Iliac Duplex Limited
|
Facility
|
OP
|
$666.00
|
|
|
Service Code
|
CPT 93979
|
| Hospital Charge Code |
3500360
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$432.90 |
| Rate for Payer: Aetna Commercial |
$191.87
|
| Rate for Payer: Aetna Medicare |
$150.82
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$59.94
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$100.55
|
| Rate for Payer: Amerigroup Medicare |
$100.55
|
| Rate for Payer: BCBS of TX Blue Advantage |
$195.02
|
| Rate for Payer: BCBS of TX Blue Essentials |
$233.13
|
| Rate for Payer: BCBS of TX Medicare |
$100.55
|
| Rate for Payer: BCBS of TX PPO |
$260.03
|
| Rate for Payer: Cash Price |
$586.08
|
| Rate for Payer: Cash Price |
$586.08
|
| Rate for Payer: Cash Price |
$586.08
|
| Rate for Payer: Cigna Commercial |
$227.77
|
| Rate for Payer: Cigna Medicaid |
$106.88
|
| Rate for Payer: Cigna Medicare |
$100.55
|
| Rate for Payer: Employer Direct Commercial |
$100.55
|
| Rate for Payer: Humana Medicare/TRICARE |
$100.55
|
| Rate for Payer: Molina CHIP/Medicaid |
$106.88
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$100.55
|
| Rate for Payer: Molina Medicare |
$100.55
|
| Rate for Payer: Multiplan Auto |
$432.90
|
| Rate for Payer: Multiplan Commercial |
$432.90
|
| Rate for Payer: Multiplan Workers Comp |
$432.90
|
| Rate for Payer: Parkland Medicaid |
$106.88
|
| Rate for Payer: Scott and White EPO/PPO |
$1.80
|
| Rate for Payer: Scott and White Medicare |
$100.55
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$106.88
|
| Rate for Payer: Superior Health Plan EPO |
$100.55
|
| Rate for Payer: Superior Health Plan Medicare |
$100.55
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$100.55
|
| Rate for Payer: Universal American Medicare |
$100.55
|
| Rate for Payer: Wellcare Medicare |
$100.55
|
| Rate for Payer: Wellmed Medicare |
$100.55
|
|
