|
US Biopsy Prostate BCE
|
Facility
|
IP
|
$1,833.00
|
|
|
Service Code
|
CPT 55700
|
| Hospital Charge Code |
3500741
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$1,613.04
|
|
|
US Biopsy Renal Left
|
Facility
|
OP
|
$1,821.00
|
|
|
Service Code
|
CPT 50200 LT
|
| Hospital Charge Code |
3520020
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$32.70 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$2,200.00
|
| Rate for Payer: Aetna Medicare |
$2,224.11
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$486.45
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,482.74
|
| Rate for Payer: Amerigroup Medicare |
$1,482.74
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,292.24
|
| Rate for Payer: BCBS of TX Blue Essentials |
$2,745.20
|
| Rate for Payer: BCBS of TX Medicare |
$1,482.74
|
| Rate for Payer: BCBS of TX PPO |
$3,458.95
|
| Rate for Payer: Cash Price |
$1,602.48
|
| Rate for Payer: Cash Price |
$1,602.48
|
| Rate for Payer: Cigna Commercial |
$3,358.84
|
| Rate for Payer: Cigna Medicaid |
$486.45
|
| Rate for Payer: Cigna Medicare |
$1,482.74
|
| Rate for Payer: Employer Direct Commercial |
$1,482.74
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,482.74
|
| Rate for Payer: Molina CHIP/Medicaid |
$486.45
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,482.74
|
| Rate for Payer: Molina Medicare |
$1,482.74
|
| Rate for Payer: Multiplan Auto |
$10,000.00
|
| Rate for Payer: Multiplan Commercial |
$10,000.00
|
| Rate for Payer: Multiplan Workers Comp |
$10,000.00
|
| Rate for Payer: Parkland Medicaid |
$486.45
|
| Rate for Payer: Scott and White EPO/PPO |
$32.70
|
| Rate for Payer: Scott and White Medicare |
$1,482.74
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$486.45
|
| Rate for Payer: Superior Health Plan EPO |
$1,482.74
|
| Rate for Payer: Superior Health Plan Medicare |
$1,482.74
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,482.74
|
| Rate for Payer: Universal American Medicare |
$1,482.74
|
| Rate for Payer: Wellcare Medicare |
$1,482.74
|
| Rate for Payer: Wellmed Medicare |
$1,482.74
|
|
|
US Biopsy Renal Left BCE
|
Facility
|
OP
|
$1,821.00
|
|
|
Service Code
|
CPT 50200 LT
|
| Hospital Charge Code |
3520020
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$32.70 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$2,200.00
|
| Rate for Payer: Aetna Medicare |
$2,224.11
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$486.45
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,482.74
|
| Rate for Payer: Amerigroup Medicare |
$1,482.74
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,292.24
|
| Rate for Payer: BCBS of TX Blue Essentials |
$2,745.20
|
| Rate for Payer: BCBS of TX Medicare |
$1,482.74
|
| Rate for Payer: BCBS of TX PPO |
$3,458.95
|
| Rate for Payer: Cash Price |
$1,602.48
|
| Rate for Payer: Cash Price |
$1,602.48
|
| Rate for Payer: Cigna Commercial |
$3,358.84
|
| Rate for Payer: Cigna Medicaid |
$486.45
|
| Rate for Payer: Cigna Medicare |
$1,482.74
|
| Rate for Payer: Employer Direct Commercial |
$1,482.74
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,482.74
|
| Rate for Payer: Molina CHIP/Medicaid |
$486.45
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,482.74
|
| Rate for Payer: Molina Medicare |
$1,482.74
|
| Rate for Payer: Multiplan Auto |
$10,000.00
|
| Rate for Payer: Multiplan Commercial |
$10,000.00
|
| Rate for Payer: Multiplan Workers Comp |
$10,000.00
|
| Rate for Payer: Parkland Medicaid |
$486.45
|
| Rate for Payer: Scott and White EPO/PPO |
$32.70
|
| Rate for Payer: Scott and White Medicare |
$1,482.74
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$486.45
|
| Rate for Payer: Superior Health Plan EPO |
$1,482.74
|
| Rate for Payer: Superior Health Plan Medicare |
$1,482.74
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,482.74
|
| Rate for Payer: Universal American Medicare |
$1,482.74
|
| Rate for Payer: Wellcare Medicare |
$1,482.74
|
| Rate for Payer: Wellmed Medicare |
$1,482.74
|
|
|
US Biopsy Renal Right
|
Facility
|
OP
|
$1,821.00
|
|
|
Service Code
|
CPT 50200 RT
|
| Hospital Charge Code |
3520020
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$32.70 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$2,200.00
|
| Rate for Payer: Aetna Medicare |
$2,224.11
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$486.45
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,482.74
|
| Rate for Payer: Amerigroup Medicare |
$1,482.74
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,292.24
|
| Rate for Payer: BCBS of TX Blue Essentials |
$2,745.20
|
| Rate for Payer: BCBS of TX Medicare |
$1,482.74
|
| Rate for Payer: BCBS of TX PPO |
$3,458.95
|
| Rate for Payer: Cash Price |
$1,602.48
|
| Rate for Payer: Cash Price |
$1,602.48
|
| Rate for Payer: Cigna Commercial |
$3,358.84
|
| Rate for Payer: Cigna Medicaid |
$486.45
|
| Rate for Payer: Cigna Medicare |
$1,482.74
|
| Rate for Payer: Employer Direct Commercial |
$1,482.74
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,482.74
|
| Rate for Payer: Molina CHIP/Medicaid |
$486.45
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,482.74
|
| Rate for Payer: Molina Medicare |
$1,482.74
|
| Rate for Payer: Multiplan Auto |
$10,000.00
|
| Rate for Payer: Multiplan Commercial |
$10,000.00
|
| Rate for Payer: Multiplan Workers Comp |
$10,000.00
|
| Rate for Payer: Parkland Medicaid |
$486.45
|
| Rate for Payer: Scott and White EPO/PPO |
$32.70
|
| Rate for Payer: Scott and White Medicare |
$1,482.74
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$486.45
|
| Rate for Payer: Superior Health Plan EPO |
$1,482.74
|
| Rate for Payer: Superior Health Plan Medicare |
$1,482.74
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,482.74
|
| Rate for Payer: Universal American Medicare |
$1,482.74
|
| Rate for Payer: Wellcare Medicare |
$1,482.74
|
| Rate for Payer: Wellmed Medicare |
$1,482.74
|
|
|
US Biopsy Renal Right BCE
|
Facility
|
IP
|
$1,821.00
|
|
|
Service Code
|
CPT 50200 RT
|
| Hospital Charge Code |
3520020
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$1,602.48
|
|
|
US Biopsy Renal Right BCE
|
Facility
|
OP
|
$1,821.00
|
|
|
Service Code
|
CPT 50200 RT
|
| Hospital Charge Code |
3520020
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$32.70 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$2,200.00
|
| Rate for Payer: Aetna Medicare |
$2,224.11
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$486.45
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,482.74
|
| Rate for Payer: Amerigroup Medicare |
$1,482.74
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,292.24
|
| Rate for Payer: BCBS of TX Blue Essentials |
$2,745.20
|
| Rate for Payer: BCBS of TX Medicare |
$1,482.74
|
| Rate for Payer: BCBS of TX PPO |
$3,458.95
|
| Rate for Payer: Cash Price |
$1,602.48
|
| Rate for Payer: Cash Price |
$1,602.48
|
| Rate for Payer: Cigna Commercial |
$3,358.84
|
| Rate for Payer: Cigna Medicaid |
$486.45
|
| Rate for Payer: Cigna Medicare |
$1,482.74
|
| Rate for Payer: Employer Direct Commercial |
$1,482.74
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,482.74
|
| Rate for Payer: Molina CHIP/Medicaid |
$486.45
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,482.74
|
| Rate for Payer: Molina Medicare |
$1,482.74
|
| Rate for Payer: Multiplan Auto |
$10,000.00
|
| Rate for Payer: Multiplan Commercial |
$10,000.00
|
| Rate for Payer: Multiplan Workers Comp |
$10,000.00
|
| Rate for Payer: Parkland Medicaid |
$486.45
|
| Rate for Payer: Scott and White EPO/PPO |
$32.70
|
| Rate for Payer: Scott and White Medicare |
$1,482.74
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$486.45
|
| Rate for Payer: Superior Health Plan EPO |
$1,482.74
|
| Rate for Payer: Superior Health Plan Medicare |
$1,482.74
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,482.74
|
| Rate for Payer: Universal American Medicare |
$1,482.74
|
| Rate for Payer: Wellcare Medicare |
$1,482.74
|
| Rate for Payer: Wellmed Medicare |
$1,482.74
|
|
|
US Biopsy Soft Tissue Neck
|
Facility
|
OP
|
$4,329.00
|
|
|
Service Code
|
CPT 21550
|
| Hospital Charge Code |
5037507
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$32.70 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$2,200.00
|
| Rate for Payer: Aetna Medicare |
$2,224.11
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$486.45
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,482.74
|
| Rate for Payer: Amerigroup Medicare |
$1,482.74
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,292.24
|
| Rate for Payer: BCBS of TX Blue Essentials |
$2,745.20
|
| Rate for Payer: BCBS of TX Medicare |
$1,482.74
|
| Rate for Payer: BCBS of TX PPO |
$3,458.95
|
| Rate for Payer: Cash Price |
$3,809.52
|
| Rate for Payer: Cash Price |
$3,809.52
|
| Rate for Payer: Cigna Commercial |
$3,358.84
|
| Rate for Payer: Cigna Medicaid |
$486.45
|
| Rate for Payer: Cigna Medicare |
$1,482.74
|
| Rate for Payer: Employer Direct Commercial |
$1,482.74
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,482.74
|
| Rate for Payer: Molina CHIP/Medicaid |
$486.45
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,482.74
|
| Rate for Payer: Molina Medicare |
$1,482.74
|
| Rate for Payer: Multiplan Auto |
$10,000.00
|
| Rate for Payer: Multiplan Commercial |
$10,000.00
|
| Rate for Payer: Multiplan Workers Comp |
$10,000.00
|
| Rate for Payer: Parkland Medicaid |
$486.45
|
| Rate for Payer: Scott and White EPO/PPO |
$32.70
|
| Rate for Payer: Scott and White Medicare |
$1,482.74
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$486.45
|
| Rate for Payer: Superior Health Plan EPO |
$1,482.74
|
| Rate for Payer: Superior Health Plan Medicare |
$1,482.74
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,482.74
|
| Rate for Payer: Universal American Medicare |
$1,482.74
|
| Rate for Payer: Wellcare Medicare |
$1,482.74
|
| Rate for Payer: Wellmed Medicare |
$1,482.74
|
|
|
US Biopsy Soft Tissue Neck BCE
|
Facility
|
IP
|
$4,329.00
|
|
|
Service Code
|
CPT 21550
|
| Hospital Charge Code |
5037507
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$3,809.52
|
|
|
US Biopsy Soft Tissue Neck BCE
|
Facility
|
OP
|
$4,329.00
|
|
|
Service Code
|
CPT 21550
|
| Hospital Charge Code |
5037507
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$32.70 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$2,200.00
|
| Rate for Payer: Aetna Medicare |
$2,224.11
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$486.45
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,482.74
|
| Rate for Payer: Amerigroup Medicare |
$1,482.74
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,292.24
|
| Rate for Payer: BCBS of TX Blue Essentials |
$2,745.20
|
| Rate for Payer: BCBS of TX Medicare |
$1,482.74
|
| Rate for Payer: BCBS of TX PPO |
$3,458.95
|
| Rate for Payer: Cash Price |
$3,809.52
|
| Rate for Payer: Cash Price |
$3,809.52
|
| Rate for Payer: Cigna Commercial |
$3,358.84
|
| Rate for Payer: Cigna Medicaid |
$486.45
|
| Rate for Payer: Cigna Medicare |
$1,482.74
|
| Rate for Payer: Employer Direct Commercial |
$1,482.74
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,482.74
|
| Rate for Payer: Molina CHIP/Medicaid |
$486.45
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,482.74
|
| Rate for Payer: Molina Medicare |
$1,482.74
|
| Rate for Payer: Multiplan Auto |
$10,000.00
|
| Rate for Payer: Multiplan Commercial |
$10,000.00
|
| Rate for Payer: Multiplan Workers Comp |
$10,000.00
|
| Rate for Payer: Parkland Medicaid |
$486.45
|
| Rate for Payer: Scott and White EPO/PPO |
$32.70
|
| Rate for Payer: Scott and White Medicare |
$1,482.74
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$486.45
|
| Rate for Payer: Superior Health Plan EPO |
$1,482.74
|
| Rate for Payer: Superior Health Plan Medicare |
$1,482.74
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,482.74
|
| Rate for Payer: Universal American Medicare |
$1,482.74
|
| Rate for Payer: Wellcare Medicare |
$1,482.74
|
| Rate for Payer: Wellmed Medicare |
$1,482.74
|
|
|
US Biopsy Thyroid Perc Core Needle
|
Facility
|
OP
|
$1,175.00
|
|
|
Service Code
|
CPT 60100
|
| Hospital Charge Code |
2117729
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$14.19 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$1,400.00
|
| Rate for Payer: Aetna Medicare |
$965.18
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$42.63
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$643.45
|
| Rate for Payer: Amerigroup Medicare |
$643.45
|
| Rate for Payer: BCBS of TX Blue Advantage |
$89.80
|
| Rate for Payer: BCBS of TX Blue Essentials |
$107.54
|
| Rate for Payer: BCBS of TX Medicare |
$643.45
|
| Rate for Payer: BCBS of TX PPO |
$135.50
|
| Rate for Payer: Cash Price |
$1,034.00
|
| Rate for Payer: Cash Price |
$1,034.00
|
| Rate for Payer: Cigna Commercial |
$1,457.60
|
| Rate for Payer: Cigna Medicaid |
$42.63
|
| Rate for Payer: Cigna Medicare |
$643.45
|
| Rate for Payer: Employer Direct Commercial |
$643.45
|
| Rate for Payer: Humana Medicare/TRICARE |
$643.45
|
| Rate for Payer: Molina CHIP/Medicaid |
$42.63
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$643.45
|
| Rate for Payer: Molina Medicare |
$643.45
|
| Rate for Payer: Multiplan Auto |
$10,000.00
|
| Rate for Payer: Multiplan Commercial |
$10,000.00
|
| Rate for Payer: Multiplan Workers Comp |
$10,000.00
|
| Rate for Payer: Parkland Medicaid |
$42.63
|
| Rate for Payer: Scott and White EPO/PPO |
$14.19
|
| Rate for Payer: Scott and White Medicare |
$643.45
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$42.63
|
| Rate for Payer: Superior Health Plan EPO |
$643.45
|
| Rate for Payer: Superior Health Plan Medicare |
$643.45
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$643.45
|
| Rate for Payer: Universal American Medicare |
$643.45
|
| Rate for Payer: Wellcare Medicare |
$643.45
|
| Rate for Payer: Wellmed Medicare |
$643.45
|
|
|
US Biopsy Thyroid Perc Core Needle BCE
|
Facility
|
IP
|
$1,175.00
|
|
|
Service Code
|
CPT 60100
|
| Hospital Charge Code |
2117729
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$1,034.00
|
|
|
US Biopsy Thyroid Perc Core Needle BCE
|
Facility
|
OP
|
$1,175.00
|
|
|
Service Code
|
CPT 60100
|
| Hospital Charge Code |
2117729
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$14.19 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$1,400.00
|
| Rate for Payer: Aetna Medicare |
$965.18
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$42.63
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$643.45
|
| Rate for Payer: Amerigroup Medicare |
$643.45
|
| Rate for Payer: BCBS of TX Blue Advantage |
$89.80
|
| Rate for Payer: BCBS of TX Blue Essentials |
$107.54
|
| Rate for Payer: BCBS of TX Medicare |
$643.45
|
| Rate for Payer: BCBS of TX PPO |
$135.50
|
| Rate for Payer: Cash Price |
$1,034.00
|
| Rate for Payer: Cash Price |
$1,034.00
|
| Rate for Payer: Cigna Commercial |
$1,457.60
|
| Rate for Payer: Cigna Medicaid |
$42.63
|
| Rate for Payer: Cigna Medicare |
$643.45
|
| Rate for Payer: Employer Direct Commercial |
$643.45
|
| Rate for Payer: Humana Medicare/TRICARE |
$643.45
|
| Rate for Payer: Molina CHIP/Medicaid |
$42.63
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$643.45
|
| Rate for Payer: Molina Medicare |
$643.45
|
| Rate for Payer: Multiplan Auto |
$10,000.00
|
| Rate for Payer: Multiplan Commercial |
$10,000.00
|
| Rate for Payer: Multiplan Workers Comp |
$10,000.00
|
| Rate for Payer: Parkland Medicaid |
$42.63
|
| Rate for Payer: Scott and White EPO/PPO |
$14.19
|
| Rate for Payer: Scott and White Medicare |
$643.45
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$42.63
|
| Rate for Payer: Superior Health Plan EPO |
$643.45
|
| Rate for Payer: Superior Health Plan Medicare |
$643.45
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$643.45
|
| Rate for Payer: Universal American Medicare |
$643.45
|
| Rate for Payer: Wellcare Medicare |
$643.45
|
| Rate for Payer: Wellmed Medicare |
$643.45
|
|
|
US Breast Asp Subcutaneous Fluid Lt
|
Facility
|
OP
|
$895.00
|
|
|
Service Code
|
CPT 10160 LT
|
| Hospital Charge Code |
5061160
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$8.04 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$492.25
|
| Rate for Payer: Aetna Medicare |
$547.00
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$67.83
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$364.67
|
| Rate for Payer: Amerigroup Medicare |
$364.67
|
| Rate for Payer: BCBS of TX Blue Advantage |
$139.23
|
| Rate for Payer: BCBS of TX Blue Essentials |
$166.74
|
| Rate for Payer: BCBS of TX Medicare |
$364.67
|
| Rate for Payer: BCBS of TX PPO |
$210.09
|
| Rate for Payer: Cash Price |
$787.60
|
| Rate for Payer: Cash Price |
$787.60
|
| Rate for Payer: Cash Price |
$787.60
|
| Rate for Payer: Cigna Commercial |
$826.08
|
| Rate for Payer: Cigna Medicaid |
$67.83
|
| Rate for Payer: Cigna Medicare |
$364.67
|
| Rate for Payer: Employer Direct Commercial |
$364.67
|
| Rate for Payer: Humana Medicare/TRICARE |
$364.67
|
| Rate for Payer: Molina CHIP/Medicaid |
$67.83
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$364.67
|
| Rate for Payer: Molina Medicare |
$364.67
|
| Rate for Payer: Multiplan Auto |
$10,000.00
|
| Rate for Payer: Multiplan Commercial |
$10,000.00
|
| Rate for Payer: Multiplan Workers Comp |
$10,000.00
|
| Rate for Payer: Parkland Medicaid |
$67.83
|
| Rate for Payer: Scott and White EPO/PPO |
$8.04
|
| Rate for Payer: Scott and White Medicare |
$364.67
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$67.83
|
| Rate for Payer: Superior Health Plan EPO |
$364.67
|
| Rate for Payer: Superior Health Plan Medicare |
$364.67
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$364.67
|
| Rate for Payer: Universal American Medicare |
$364.67
|
| Rate for Payer: Wellcare Medicare |
$364.67
|
| Rate for Payer: Wellmed Medicare |
$364.67
|
|
|
US Breast Asp Subcutaneous Fluid Lt BCE
|
Facility
|
OP
|
$895.00
|
|
|
Service Code
|
CPT 10160 LT
|
| Hospital Charge Code |
5061160
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$8.04 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$492.25
|
| Rate for Payer: Aetna Medicare |
$547.00
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$67.83
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$364.67
|
| Rate for Payer: Amerigroup Medicare |
$364.67
|
| Rate for Payer: BCBS of TX Blue Advantage |
$139.23
|
| Rate for Payer: BCBS of TX Blue Essentials |
$166.74
|
| Rate for Payer: BCBS of TX Medicare |
$364.67
|
| Rate for Payer: BCBS of TX PPO |
$210.09
|
| Rate for Payer: Cash Price |
$787.60
|
| Rate for Payer: Cash Price |
$787.60
|
| Rate for Payer: Cash Price |
$787.60
|
| Rate for Payer: Cigna Commercial |
$826.08
|
| Rate for Payer: Cigna Medicaid |
$67.83
|
| Rate for Payer: Cigna Medicare |
$364.67
|
| Rate for Payer: Employer Direct Commercial |
$364.67
|
| Rate for Payer: Humana Medicare/TRICARE |
$364.67
|
| Rate for Payer: Molina CHIP/Medicaid |
$67.83
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$364.67
|
| Rate for Payer: Molina Medicare |
$364.67
|
| Rate for Payer: Multiplan Auto |
$10,000.00
|
| Rate for Payer: Multiplan Commercial |
$10,000.00
|
| Rate for Payer: Multiplan Workers Comp |
$10,000.00
|
| Rate for Payer: Parkland Medicaid |
$67.83
|
| Rate for Payer: Scott and White EPO/PPO |
$8.04
|
| Rate for Payer: Scott and White Medicare |
$364.67
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$67.83
|
| Rate for Payer: Superior Health Plan EPO |
$364.67
|
| Rate for Payer: Superior Health Plan Medicare |
$364.67
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$364.67
|
| Rate for Payer: Universal American Medicare |
$364.67
|
| Rate for Payer: Wellcare Medicare |
$364.67
|
| Rate for Payer: Wellmed Medicare |
$364.67
|
|
|
US Breast Asp Subcutaneous Fluid Rt
|
Facility
|
OP
|
$895.00
|
|
|
Service Code
|
CPT 10160 RT
|
| Hospital Charge Code |
5061160
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$8.04 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$492.25
|
| Rate for Payer: Aetna Medicare |
$547.00
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$67.83
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$364.67
|
| Rate for Payer: Amerigroup Medicare |
$364.67
|
| Rate for Payer: BCBS of TX Blue Advantage |
$139.23
|
| Rate for Payer: BCBS of TX Blue Essentials |
$166.74
|
| Rate for Payer: BCBS of TX Medicare |
$364.67
|
| Rate for Payer: BCBS of TX PPO |
$210.09
|
| Rate for Payer: Cash Price |
$787.60
|
| Rate for Payer: Cash Price |
$787.60
|
| Rate for Payer: Cash Price |
$787.60
|
| Rate for Payer: Cigna Commercial |
$826.08
|
| Rate for Payer: Cigna Medicaid |
$67.83
|
| Rate for Payer: Cigna Medicare |
$364.67
|
| Rate for Payer: Employer Direct Commercial |
$364.67
|
| Rate for Payer: Humana Medicare/TRICARE |
$364.67
|
| Rate for Payer: Molina CHIP/Medicaid |
$67.83
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$364.67
|
| Rate for Payer: Molina Medicare |
$364.67
|
| Rate for Payer: Multiplan Auto |
$10,000.00
|
| Rate for Payer: Multiplan Commercial |
$10,000.00
|
| Rate for Payer: Multiplan Workers Comp |
$10,000.00
|
| Rate for Payer: Parkland Medicaid |
$67.83
|
| Rate for Payer: Scott and White EPO/PPO |
$8.04
|
| Rate for Payer: Scott and White Medicare |
$364.67
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$67.83
|
| Rate for Payer: Superior Health Plan EPO |
$364.67
|
| Rate for Payer: Superior Health Plan Medicare |
$364.67
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$364.67
|
| Rate for Payer: Universal American Medicare |
$364.67
|
| Rate for Payer: Wellcare Medicare |
$364.67
|
| Rate for Payer: Wellmed Medicare |
$364.67
|
|
|
US Breast Asp Subcutaneous Fluid Rt BCE
|
Facility
|
OP
|
$895.00
|
|
|
Service Code
|
CPT 10160 RT
|
| Hospital Charge Code |
5061160
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$8.04 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$492.25
|
| Rate for Payer: Aetna Medicare |
$547.00
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$67.83
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$364.67
|
| Rate for Payer: Amerigroup Medicare |
$364.67
|
| Rate for Payer: BCBS of TX Blue Advantage |
$139.23
|
| Rate for Payer: BCBS of TX Blue Essentials |
$166.74
|
| Rate for Payer: BCBS of TX Medicare |
$364.67
|
| Rate for Payer: BCBS of TX PPO |
$210.09
|
| Rate for Payer: Cash Price |
$787.60
|
| Rate for Payer: Cash Price |
$787.60
|
| Rate for Payer: Cash Price |
$787.60
|
| Rate for Payer: Cigna Commercial |
$826.08
|
| Rate for Payer: Cigna Medicaid |
$67.83
|
| Rate for Payer: Cigna Medicare |
$364.67
|
| Rate for Payer: Employer Direct Commercial |
$364.67
|
| Rate for Payer: Humana Medicare/TRICARE |
$364.67
|
| Rate for Payer: Molina CHIP/Medicaid |
$67.83
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$364.67
|
| Rate for Payer: Molina Medicare |
$364.67
|
| Rate for Payer: Multiplan Auto |
$10,000.00
|
| Rate for Payer: Multiplan Commercial |
$10,000.00
|
| Rate for Payer: Multiplan Workers Comp |
$10,000.00
|
| Rate for Payer: Parkland Medicaid |
$67.83
|
| Rate for Payer: Scott and White EPO/PPO |
$8.04
|
| Rate for Payer: Scott and White Medicare |
$364.67
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$67.83
|
| Rate for Payer: Superior Health Plan EPO |
$364.67
|
| Rate for Payer: Superior Health Plan Medicare |
$364.67
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$364.67
|
| Rate for Payer: Universal American Medicare |
$364.67
|
| Rate for Payer: Wellcare Medicare |
$364.67
|
| Rate for Payer: Wellmed Medicare |
$364.67
|
|
|
US Breast Asp Subcutaneous Fluid Rt BCE
|
Facility
|
IP
|
$895.00
|
|
|
Service Code
|
CPT 10160 RT
|
| Hospital Charge Code |
5061160
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$787.60
|
|
|
US Breast Biopsy w/ US Guide Left
|
Facility
|
OP
|
$5,178.00
|
|
|
Service Code
|
CPT 19083 LT
|
| Hospital Charge Code |
3530037
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$32.70 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$2,200.00
|
| Rate for Payer: Aetna Medicare |
$2,224.11
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$486.45
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,482.74
|
| Rate for Payer: Amerigroup Medicare |
$1,482.74
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,292.24
|
| Rate for Payer: BCBS of TX Blue Essentials |
$2,745.20
|
| Rate for Payer: BCBS of TX Medicare |
$1,482.74
|
| Rate for Payer: BCBS of TX PPO |
$3,458.95
|
| Rate for Payer: Cash Price |
$4,556.64
|
| Rate for Payer: Cash Price |
$4,556.64
|
| Rate for Payer: Cigna Commercial |
$3,358.84
|
| Rate for Payer: Cigna Medicaid |
$121.36
|
| Rate for Payer: Cigna Medicare |
$1,482.74
|
| Rate for Payer: Employer Direct Commercial |
$1,482.74
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,482.74
|
| Rate for Payer: Molina CHIP/Medicaid |
$121.36
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,482.74
|
| Rate for Payer: Molina Medicare |
$1,482.74
|
| Rate for Payer: Multiplan Auto |
$10,000.00
|
| Rate for Payer: Multiplan Commercial |
$10,000.00
|
| Rate for Payer: Multiplan Workers Comp |
$10,000.00
|
| Rate for Payer: Parkland Medicaid |
$121.36
|
| Rate for Payer: Scott and White EPO/PPO |
$32.70
|
| Rate for Payer: Scott and White Medicare |
$1,482.74
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$486.45
|
| Rate for Payer: Superior Health Plan EPO |
$1,482.74
|
| Rate for Payer: Superior Health Plan Medicare |
$1,482.74
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,482.74
|
| Rate for Payer: Universal American Medicare |
$1,482.74
|
| Rate for Payer: Wellcare Medicare |
$1,482.74
|
| Rate for Payer: Wellmed Medicare |
$1,482.74
|
|
|
US Breast Biopsy w/ US Guide Left BCE
|
Facility
|
IP
|
$5,178.00
|
|
|
Service Code
|
CPT 19083 LT
|
| Hospital Charge Code |
3530037
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$4,556.64
|
|
|
US Breast Biopsy w/ US Guide Left BCE
|
Facility
|
OP
|
$5,178.00
|
|
|
Service Code
|
CPT 19083 LT
|
| Hospital Charge Code |
3530037
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$32.70 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$2,200.00
|
| Rate for Payer: Aetna Medicare |
$2,224.11
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$486.45
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,482.74
|
| Rate for Payer: Amerigroup Medicare |
$1,482.74
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,292.24
|
| Rate for Payer: BCBS of TX Blue Essentials |
$2,745.20
|
| Rate for Payer: BCBS of TX Medicare |
$1,482.74
|
| Rate for Payer: BCBS of TX PPO |
$3,458.95
|
| Rate for Payer: Cash Price |
$4,556.64
|
| Rate for Payer: Cash Price |
$4,556.64
|
| Rate for Payer: Cigna Commercial |
$3,358.84
|
| Rate for Payer: Cigna Medicaid |
$121.36
|
| Rate for Payer: Cigna Medicare |
$1,482.74
|
| Rate for Payer: Employer Direct Commercial |
$1,482.74
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,482.74
|
| Rate for Payer: Molina CHIP/Medicaid |
$121.36
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,482.74
|
| Rate for Payer: Molina Medicare |
$1,482.74
|
| Rate for Payer: Multiplan Auto |
$10,000.00
|
| Rate for Payer: Multiplan Commercial |
$10,000.00
|
| Rate for Payer: Multiplan Workers Comp |
$10,000.00
|
| Rate for Payer: Parkland Medicaid |
$121.36
|
| Rate for Payer: Scott and White EPO/PPO |
$32.70
|
| Rate for Payer: Scott and White Medicare |
$1,482.74
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$486.45
|
| Rate for Payer: Superior Health Plan EPO |
$1,482.74
|
| Rate for Payer: Superior Health Plan Medicare |
$1,482.74
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,482.74
|
| Rate for Payer: Universal American Medicare |
$1,482.74
|
| Rate for Payer: Wellcare Medicare |
$1,482.74
|
| Rate for Payer: Wellmed Medicare |
$1,482.74
|
|
|
US Breast Biopsy w/ US Guide Right
|
Facility
|
OP
|
$5,178.00
|
|
|
Service Code
|
CPT 19083 RT
|
| Hospital Charge Code |
3530035
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$32.70 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$2,200.00
|
| Rate for Payer: Aetna Medicare |
$2,224.11
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$486.45
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,482.74
|
| Rate for Payer: Amerigroup Medicare |
$1,482.74
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,292.24
|
| Rate for Payer: BCBS of TX Blue Essentials |
$2,745.20
|
| Rate for Payer: BCBS of TX Medicare |
$1,482.74
|
| Rate for Payer: BCBS of TX PPO |
$3,458.95
|
| Rate for Payer: Cash Price |
$4,556.64
|
| Rate for Payer: Cash Price |
$4,556.64
|
| Rate for Payer: Cigna Commercial |
$3,358.84
|
| Rate for Payer: Cigna Medicaid |
$121.36
|
| Rate for Payer: Cigna Medicare |
$1,482.74
|
| Rate for Payer: Employer Direct Commercial |
$1,482.74
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,482.74
|
| Rate for Payer: Molina CHIP/Medicaid |
$121.36
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,482.74
|
| Rate for Payer: Molina Medicare |
$1,482.74
|
| Rate for Payer: Multiplan Auto |
$10,000.00
|
| Rate for Payer: Multiplan Commercial |
$10,000.00
|
| Rate for Payer: Multiplan Workers Comp |
$10,000.00
|
| Rate for Payer: Parkland Medicaid |
$121.36
|
| Rate for Payer: Scott and White EPO/PPO |
$32.70
|
| Rate for Payer: Scott and White Medicare |
$1,482.74
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$486.45
|
| Rate for Payer: Superior Health Plan EPO |
$1,482.74
|
| Rate for Payer: Superior Health Plan Medicare |
$1,482.74
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,482.74
|
| Rate for Payer: Universal American Medicare |
$1,482.74
|
| Rate for Payer: Wellcare Medicare |
$1,482.74
|
| Rate for Payer: Wellmed Medicare |
$1,482.74
|
|
|
US Breast Biopsy w/ US Guide Right BCE
|
Facility
|
IP
|
$5,178.00
|
|
|
Service Code
|
CPT 19083 RT
|
| Hospital Charge Code |
3530035
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$4,556.64
|
|
|
US Breast Biopsy w/ US Guide Right BCE
|
Facility
|
OP
|
$5,178.00
|
|
|
Service Code
|
CPT 19083 RT
|
| Hospital Charge Code |
3530035
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$32.70 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$2,200.00
|
| Rate for Payer: Aetna Medicare |
$2,224.11
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$486.45
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,482.74
|
| Rate for Payer: Amerigroup Medicare |
$1,482.74
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,292.24
|
| Rate for Payer: BCBS of TX Blue Essentials |
$2,745.20
|
| Rate for Payer: BCBS of TX Medicare |
$1,482.74
|
| Rate for Payer: BCBS of TX PPO |
$3,458.95
|
| Rate for Payer: Cash Price |
$4,556.64
|
| Rate for Payer: Cash Price |
$4,556.64
|
| Rate for Payer: Cigna Commercial |
$3,358.84
|
| Rate for Payer: Cigna Medicaid |
$121.36
|
| Rate for Payer: Cigna Medicare |
$1,482.74
|
| Rate for Payer: Employer Direct Commercial |
$1,482.74
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,482.74
|
| Rate for Payer: Molina CHIP/Medicaid |
$121.36
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,482.74
|
| Rate for Payer: Molina Medicare |
$1,482.74
|
| Rate for Payer: Multiplan Auto |
$10,000.00
|
| Rate for Payer: Multiplan Commercial |
$10,000.00
|
| Rate for Payer: Multiplan Workers Comp |
$10,000.00
|
| Rate for Payer: Parkland Medicaid |
$121.36
|
| Rate for Payer: Scott and White EPO/PPO |
$32.70
|
| Rate for Payer: Scott and White Medicare |
$1,482.74
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$486.45
|
| Rate for Payer: Superior Health Plan EPO |
$1,482.74
|
| Rate for Payer: Superior Health Plan Medicare |
$1,482.74
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,482.74
|
| Rate for Payer: Universal American Medicare |
$1,482.74
|
| Rate for Payer: Wellcare Medicare |
$1,482.74
|
| Rate for Payer: Wellmed Medicare |
$1,482.74
|
|
|
US Breast Complete Left
|
Facility
|
OP
|
$589.00
|
|
|
Service Code
|
CPT 76641 LT
|
| Hospital Charge Code |
3530061
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$382.85 |
| Rate for Payer: Aetna Commercial |
$79.57
|
| Rate for Payer: Aetna Medicare |
$150.82
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$103.91
|
| 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 |
$518.32
|
| Rate for Payer: Cash Price |
$518.32
|
| Rate for Payer: Cash Price |
$518.32
|
| Rate for Payer: Cigna Commercial |
$227.77
|
| Rate for Payer: Cigna Medicaid |
$27.80
|
| 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 |
$27.80
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$100.55
|
| Rate for Payer: Molina Medicare |
$100.55
|
| Rate for Payer: Multiplan Auto |
$382.85
|
| Rate for Payer: Multiplan Commercial |
$382.85
|
| Rate for Payer: Multiplan Workers Comp |
$382.85
|
| Rate for Payer: Parkland Medicaid |
$27.80
|
| 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 |
$27.80
|
| 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 Breast Complete Left BCE
|
Facility
|
IP
|
$589.00
|
|
|
Service Code
|
CPT 76641 LT
|
| Hospital Charge Code |
3530061
|
|
Hospital Revenue Code
|
402
|
| Rate for Payer: Cash Price |
$518.32
|
|
