|
US Carotid Duplex Left BCE
|
Facility
|
OP
|
$1,338.00
|
|
|
Service Code
|
CPT 93882 LT
|
| Hospital Charge Code |
5036540
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$869.70 |
| Rate for Payer: Aetna Commercial |
$206.12
|
| Rate for Payer: Aetna Medicare |
$150.82
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$120.42
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$100.55
|
| Rate for Payer: Amerigroup Medicare |
$100.55
|
| Rate for Payer: BCBS of TX Blue Advantage |
$183.73
|
| Rate for Payer: BCBS of TX Blue Essentials |
$219.63
|
| Rate for Payer: BCBS of TX Medicare |
$100.55
|
| Rate for Payer: BCBS of TX PPO |
$244.97
|
| Rate for Payer: Cash Price |
$1,177.44
|
| Rate for Payer: Cash Price |
$1,177.44
|
| Rate for Payer: Cash Price |
$1,177.44
|
| 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 |
$869.70
|
| Rate for Payer: Multiplan Commercial |
$869.70
|
| Rate for Payer: Multiplan Workers Comp |
$869.70
|
| 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 Carotid Duplex Right
|
Facility
|
OP
|
$1,338.00
|
|
|
Service Code
|
CPT 93882 RT
|
| Hospital Charge Code |
5036540
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$869.70 |
| Rate for Payer: Aetna Commercial |
$206.12
|
| Rate for Payer: Aetna Medicare |
$150.82
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$120.42
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$100.55
|
| Rate for Payer: Amerigroup Medicare |
$100.55
|
| Rate for Payer: BCBS of TX Blue Advantage |
$183.73
|
| Rate for Payer: BCBS of TX Blue Essentials |
$219.63
|
| Rate for Payer: BCBS of TX Medicare |
$100.55
|
| Rate for Payer: BCBS of TX PPO |
$244.97
|
| Rate for Payer: Cash Price |
$1,177.44
|
| Rate for Payer: Cash Price |
$1,177.44
|
| Rate for Payer: Cash Price |
$1,177.44
|
| 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 |
$869.70
|
| Rate for Payer: Multiplan Commercial |
$869.70
|
| Rate for Payer: Multiplan Workers Comp |
$869.70
|
| 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 Carotid Duplex Right BCE
|
Facility
|
IP
|
$1,338.00
|
|
|
Service Code
|
CPT 93882 RT
|
| Hospital Charge Code |
5036540
|
|
Hospital Revenue Code
|
921
|
| Rate for Payer: Cash Price |
$1,177.44
|
|
|
US Carotid Duplex Right BCE
|
Facility
|
OP
|
$1,338.00
|
|
|
Service Code
|
CPT 93882 RT
|
| Hospital Charge Code |
5036540
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$869.70 |
| Rate for Payer: Aetna Commercial |
$206.12
|
| Rate for Payer: Aetna Medicare |
$150.82
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$120.42
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$100.55
|
| Rate for Payer: Amerigroup Medicare |
$100.55
|
| Rate for Payer: BCBS of TX Blue Advantage |
$183.73
|
| Rate for Payer: BCBS of TX Blue Essentials |
$219.63
|
| Rate for Payer: BCBS of TX Medicare |
$100.55
|
| Rate for Payer: BCBS of TX PPO |
$244.97
|
| Rate for Payer: Cash Price |
$1,177.44
|
| Rate for Payer: Cash Price |
$1,177.44
|
| Rate for Payer: Cash Price |
$1,177.44
|
| 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 |
$869.70
|
| Rate for Payer: Multiplan Commercial |
$869.70
|
| Rate for Payer: Multiplan Workers Comp |
$869.70
|
| 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 Chest
|
Facility
|
OP
|
$471.00
|
|
|
Service Code
|
CPT 76604
|
| Hospital Charge Code |
3500030
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$306.15 |
| Rate for Payer: Aetna Commercial |
$35.26
|
| Rate for Payer: Aetna Medicare |
$150.82
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$56.80
|
| 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 |
$414.48
|
| Rate for Payer: Cash Price |
$414.48
|
| Rate for Payer: Cash Price |
$414.48
|
| Rate for Payer: Cigna Commercial |
$227.77
|
| Rate for Payer: Cigna Medicaid |
$56.80
|
| 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 |
$56.80
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$100.55
|
| Rate for Payer: Molina Medicare |
$100.55
|
| Rate for Payer: Multiplan Auto |
$306.15
|
| Rate for Payer: Multiplan Commercial |
$306.15
|
| Rate for Payer: Multiplan Workers Comp |
$306.15
|
| Rate for Payer: Parkland Medicaid |
$56.80
|
| 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 |
$56.80
|
| 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 Chest BCE
|
Facility
|
OP
|
$471.00
|
|
|
Service Code
|
CPT 76604
|
| Hospital Charge Code |
3500030
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$306.15 |
| Rate for Payer: Aetna Commercial |
$35.26
|
| Rate for Payer: Aetna Medicare |
$150.82
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$56.80
|
| 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 |
$414.48
|
| Rate for Payer: Cash Price |
$414.48
|
| Rate for Payer: Cash Price |
$414.48
|
| Rate for Payer: Cigna Commercial |
$227.77
|
| Rate for Payer: Cigna Medicaid |
$56.80
|
| 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 |
$56.80
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$100.55
|
| Rate for Payer: Molina Medicare |
$100.55
|
| Rate for Payer: Multiplan Auto |
$306.15
|
| Rate for Payer: Multiplan Commercial |
$306.15
|
| Rate for Payer: Multiplan Workers Comp |
$306.15
|
| Rate for Payer: Parkland Medicaid |
$56.80
|
| 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 |
$56.80
|
| 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 Chest BCE
|
Facility
|
IP
|
$471.00
|
|
|
Service Code
|
CPT 76604
|
| Hospital Charge Code |
3500030
|
|
Hospital Revenue Code
|
402
|
| Rate for Payer: Cash Price |
$414.48
|
|
|
US Cholecystostomy Percutaneous
|
Facility
|
OP
|
$7,171.00
|
|
|
Service Code
|
CPT 47490
|
| Hospital Charge Code |
5067490
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$69.79 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$4,635.00
|
| Rate for Payer: Aetna Medicare |
$4,746.03
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$645.39
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3,164.02
|
| Rate for Payer: Amerigroup Medicare |
$3,164.02
|
| Rate for Payer: BCBS of TX Blue Advantage |
$5,192.60
|
| Rate for Payer: BCBS of TX Blue Essentials |
$6,218.68
|
| Rate for Payer: BCBS of TX Medicare |
$3,164.02
|
| Rate for Payer: BCBS of TX PPO |
$7,835.54
|
| Rate for Payer: Cash Price |
$6,310.48
|
| Rate for Payer: Cash Price |
$6,310.48
|
| Rate for Payer: Cash Price |
$6,310.48
|
| Rate for Payer: Cigna Commercial |
$7,167.43
|
| Rate for Payer: Cigna Medicare |
$3,164.02
|
| Rate for Payer: Employer Direct Commercial |
$3,164.02
|
| Rate for Payer: Humana Medicare/TRICARE |
$3,164.02
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3,164.02
|
| Rate for Payer: Molina Medicare |
$3,164.02
|
| 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: Scott and White EPO/PPO |
$69.79
|
| Rate for Payer: Scott and White Medicare |
$3,164.02
|
| Rate for Payer: Superior Health Plan EPO |
$3,164.02
|
| Rate for Payer: Superior Health Plan Medicare |
$3,164.02
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3,164.02
|
| Rate for Payer: Universal American Medicare |
$3,164.02
|
| Rate for Payer: Wellcare Medicare |
$3,164.02
|
| Rate for Payer: Wellmed Medicare |
$3,164.02
|
|
|
US Cholecystostomy Percutaneous BCE
|
Facility
|
OP
|
$7,171.00
|
|
|
Service Code
|
CPT 47490
|
| Hospital Charge Code |
5067490
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$69.79 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$4,635.00
|
| Rate for Payer: Aetna Medicare |
$4,746.03
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$645.39
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3,164.02
|
| Rate for Payer: Amerigroup Medicare |
$3,164.02
|
| Rate for Payer: BCBS of TX Blue Advantage |
$5,192.60
|
| Rate for Payer: BCBS of TX Blue Essentials |
$6,218.68
|
| Rate for Payer: BCBS of TX Medicare |
$3,164.02
|
| Rate for Payer: BCBS of TX PPO |
$7,835.54
|
| Rate for Payer: Cash Price |
$6,310.48
|
| Rate for Payer: Cash Price |
$6,310.48
|
| Rate for Payer: Cash Price |
$6,310.48
|
| Rate for Payer: Cigna Commercial |
$7,167.43
|
| Rate for Payer: Cigna Medicare |
$3,164.02
|
| Rate for Payer: Employer Direct Commercial |
$3,164.02
|
| Rate for Payer: Humana Medicare/TRICARE |
$3,164.02
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3,164.02
|
| Rate for Payer: Molina Medicare |
$3,164.02
|
| 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: Scott and White EPO/PPO |
$69.79
|
| Rate for Payer: Scott and White Medicare |
$3,164.02
|
| Rate for Payer: Superior Health Plan EPO |
$3,164.02
|
| Rate for Payer: Superior Health Plan Medicare |
$3,164.02
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3,164.02
|
| Rate for Payer: Universal American Medicare |
$3,164.02
|
| Rate for Payer: Wellcare Medicare |
$3,164.02
|
| Rate for Payer: Wellmed Medicare |
$3,164.02
|
|
|
US Cholecystostomy Percutaneous BCE
|
Facility
|
IP
|
$7,171.00
|
|
|
Service Code
|
CPT 47490
|
| Hospital Charge Code |
5067490
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$6,310.48
|
|
|
US Drain Soft Tissue Fluid w/Cath Perc
|
Facility
|
OP
|
$3,790.00
|
|
|
Service Code
|
CPT 10030
|
| Hospital Charge Code |
3500005
|
|
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 |
$257.60
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$643.45
|
| Rate for Payer: Amerigroup Medicare |
$643.45
|
| Rate for Payer: BCBS of TX Blue Advantage |
$1,018.72
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,220.02
|
| Rate for Payer: BCBS of TX Medicare |
$643.45
|
| Rate for Payer: BCBS of TX PPO |
$1,537.23
|
| Rate for Payer: Cash Price |
$3,335.20
|
| Rate for Payer: Cash Price |
$3,335.20
|
| Rate for Payer: Cigna Commercial |
$1,457.60
|
| Rate for Payer: Cigna Medicaid |
$257.60
|
| 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 |
$257.60
|
| 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 |
$257.60
|
| 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 |
$257.60
|
| 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 Drain Soft Tissue Fluid w/Cath Perc BCE
|
Facility
|
OP
|
$3,790.00
|
|
|
Service Code
|
CPT 10030
|
| Hospital Charge Code |
3500005
|
|
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 |
$257.60
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$643.45
|
| Rate for Payer: Amerigroup Medicare |
$643.45
|
| Rate for Payer: BCBS of TX Blue Advantage |
$1,018.72
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,220.02
|
| Rate for Payer: BCBS of TX Medicare |
$643.45
|
| Rate for Payer: BCBS of TX PPO |
$1,537.23
|
| Rate for Payer: Cash Price |
$3,335.20
|
| Rate for Payer: Cash Price |
$3,335.20
|
| Rate for Payer: Cigna Commercial |
$1,457.60
|
| Rate for Payer: Cigna Medicaid |
$257.60
|
| 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 |
$257.60
|
| 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 |
$257.60
|
| 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 |
$257.60
|
| 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 Drain Soft Tissue Fluid w/Cath Perc BCE
|
Facility
|
IP
|
$3,790.00
|
|
|
Service Code
|
CPT 10030
|
| Hospital Charge Code |
3500005
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$3,335.20
|
|
|
US Duplex Hemodialysis Access Flow
|
Facility
|
OP
|
$793.00
|
|
|
Service Code
|
CPT 93990
|
| Hospital Charge Code |
3501061
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$515.45 |
| Rate for Payer: Aetna Commercial |
$217.65
|
| Rate for Payer: Aetna Medicare |
$150.82
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$71.37
|
| 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 |
$697.84
|
| Rate for Payer: Cash Price |
$697.84
|
| Rate for Payer: Cash Price |
$697.84
|
| 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 |
$515.45
|
| Rate for Payer: Multiplan Commercial |
$515.45
|
| Rate for Payer: Multiplan Workers Comp |
$515.45
|
| 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 Duplex Hemodialysis Access Flow BCE
|
Facility
|
OP
|
$793.00
|
|
|
Service Code
|
CPT 93990
|
| Hospital Charge Code |
3501061
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$515.45 |
| Rate for Payer: Aetna Commercial |
$217.65
|
| Rate for Payer: Aetna Medicare |
$150.82
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$71.37
|
| 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 |
$697.84
|
| Rate for Payer: Cash Price |
$697.84
|
| Rate for Payer: Cash Price |
$697.84
|
| 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 |
$515.45
|
| Rate for Payer: Multiplan Commercial |
$515.45
|
| Rate for Payer: Multiplan Workers Comp |
$515.45
|
| 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 Duplex Hemodialysis Access Flow BCE
|
Facility
|
IP
|
$793.00
|
|
|
Service Code
|
CPT 93990
|
| Hospital Charge Code |
3501061
|
|
Hospital Revenue Code
|
921
|
| Rate for Payer: Cash Price |
$697.84
|
|
|
US ECHOENCEPHALOGRAPHY
|
Facility
|
OP
|
$622.00
|
|
|
Service Code
|
CPT 76506
|
| Hospital Charge Code |
3500063
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$404.30 |
| Rate for Payer: Aetna Commercial |
$98.44
|
| 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 |
$547.36
|
| Rate for Payer: Cash Price |
$547.36
|
| Rate for Payer: Cash Price |
$547.36
|
| 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 |
$404.30
|
| Rate for Payer: Multiplan Commercial |
$404.30
|
| Rate for Payer: Multiplan Workers Comp |
$404.30
|
| 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 ECHOENCEPHALOGRAPHY BCE
|
Facility
|
IP
|
$622.00
|
|
|
Service Code
|
CPT 76506
|
| Hospital Charge Code |
3500063
|
|
Hospital Revenue Code
|
402
|
| Rate for Payer: Cash Price |
$547.36
|
|
|
US ECHOENCEPHALOGRAPHY BCE
|
Facility
|
OP
|
$622.00
|
|
|
Service Code
|
CPT 76506
|
| Hospital Charge Code |
3500063
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$404.30 |
| Rate for Payer: Aetna Commercial |
$98.44
|
| 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 |
$547.36
|
| Rate for Payer: Cash Price |
$547.36
|
| Rate for Payer: Cash Price |
$547.36
|
| 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 |
$404.30
|
| Rate for Payer: Multiplan Commercial |
$404.30
|
| Rate for Payer: Multiplan Workers Comp |
$404.30
|
| 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 Echo Fetal CV
|
Facility
|
OP
|
$1,124.00
|
|
|
Service Code
|
CPT 76825
|
| Hospital Charge Code |
5066870
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$9.02 |
| Max. Negotiated Rate |
$1,142.91 |
| Rate for Payer: Aetna Commercial |
$214.24
|
| Rate for Payer: Aetna Medicare |
$756.80
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$262.96
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$504.53
|
| Rate for Payer: Amerigroup Medicare |
$504.53
|
| Rate for Payer: BCBS of TX Blue Advantage |
$321.70
|
| Rate for Payer: BCBS of TX Blue Essentials |
$386.04
|
| Rate for Payer: BCBS of TX Medicare |
$504.53
|
| Rate for Payer: BCBS of TX PPO |
$430.88
|
| Rate for Payer: Cash Price |
$989.12
|
| Rate for Payer: Cash Price |
$989.12
|
| Rate for Payer: Cash Price |
$989.12
|
| Rate for Payer: Cigna Commercial |
$1,142.91
|
| Rate for Payer: Cigna Medicaid |
$262.96
|
| Rate for Payer: Cigna Medicare |
$504.53
|
| Rate for Payer: Employer Direct Commercial |
$504.53
|
| Rate for Payer: Humana Medicare/TRICARE |
$504.53
|
| Rate for Payer: Molina CHIP/Medicaid |
$262.96
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$504.53
|
| Rate for Payer: Molina Medicare |
$504.53
|
| Rate for Payer: Multiplan Auto |
$730.60
|
| Rate for Payer: Multiplan Commercial |
$730.60
|
| Rate for Payer: Multiplan Workers Comp |
$730.60
|
| Rate for Payer: Parkland Medicaid |
$262.96
|
| Rate for Payer: Scott and White EPO/PPO |
$9.02
|
| Rate for Payer: Scott and White Medicare |
$504.53
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$262.96
|
| Rate for Payer: Superior Health Plan EPO |
$504.53
|
| Rate for Payer: Superior Health Plan Medicare |
$504.53
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$504.53
|
| Rate for Payer: Universal American Medicare |
$504.53
|
| Rate for Payer: Wellcare Medicare |
$504.53
|
| Rate for Payer: Wellmed Medicare |
$504.53
|
|
|
US Echo Fetal CV BCE
|
Facility
|
OP
|
$1,124.00
|
|
|
Service Code
|
CPT 76825
|
| Hospital Charge Code |
5066870
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$9.02 |
| Max. Negotiated Rate |
$1,142.91 |
| Rate for Payer: Aetna Commercial |
$214.24
|
| Rate for Payer: Aetna Medicare |
$756.80
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$262.96
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$504.53
|
| Rate for Payer: Amerigroup Medicare |
$504.53
|
| Rate for Payer: BCBS of TX Blue Advantage |
$321.70
|
| Rate for Payer: BCBS of TX Blue Essentials |
$386.04
|
| Rate for Payer: BCBS of TX Medicare |
$504.53
|
| Rate for Payer: BCBS of TX PPO |
$430.88
|
| Rate for Payer: Cash Price |
$989.12
|
| Rate for Payer: Cash Price |
$989.12
|
| Rate for Payer: Cash Price |
$989.12
|
| Rate for Payer: Cigna Commercial |
$1,142.91
|
| Rate for Payer: Cigna Medicaid |
$262.96
|
| Rate for Payer: Cigna Medicare |
$504.53
|
| Rate for Payer: Employer Direct Commercial |
$504.53
|
| Rate for Payer: Humana Medicare/TRICARE |
$504.53
|
| Rate for Payer: Molina CHIP/Medicaid |
$262.96
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$504.53
|
| Rate for Payer: Molina Medicare |
$504.53
|
| Rate for Payer: Multiplan Auto |
$730.60
|
| Rate for Payer: Multiplan Commercial |
$730.60
|
| Rate for Payer: Multiplan Workers Comp |
$730.60
|
| Rate for Payer: Parkland Medicaid |
$262.96
|
| Rate for Payer: Scott and White EPO/PPO |
$9.02
|
| Rate for Payer: Scott and White Medicare |
$504.53
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$262.96
|
| Rate for Payer: Superior Health Plan EPO |
$504.53
|
| Rate for Payer: Superior Health Plan Medicare |
$504.53
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$504.53
|
| Rate for Payer: Universal American Medicare |
$504.53
|
| Rate for Payer: Wellcare Medicare |
$504.53
|
| Rate for Payer: Wellmed Medicare |
$504.53
|
|
|
US Echo Fetal CV BCE
|
Facility
|
IP
|
$1,124.00
|
|
|
Service Code
|
CPT 76825
|
| Hospital Charge Code |
5066870
|
|
Hospital Revenue Code
|
402
|
| Rate for Payer: Cash Price |
$989.12
|
|
|
US Extremity Joint Complete Left BCE
|
Facility
|
OP
|
$974.00
|
|
|
Service Code
|
CPT 76881 LT
|
| Hospital Charge Code |
3530082
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$633.10 |
| Rate for Payer: Aetna Commercial |
$32.57
|
| Rate for Payer: Aetna Medicare |
$150.82
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$96.28
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$100.55
|
| Rate for Payer: Amerigroup Medicare |
$100.55
|
| Rate for Payer: BCBS of TX Blue Advantage |
$95.73
|
| Rate for Payer: BCBS of TX Blue Essentials |
$114.88
|
| Rate for Payer: BCBS of TX Medicare |
$100.55
|
| Rate for Payer: BCBS of TX PPO |
$128.22
|
| 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 |
$227.77
|
| Rate for Payer: Cigna Medicaid |
$24.06
|
| 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 |
$24.06
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$100.55
|
| Rate for Payer: Molina Medicare |
$100.55
|
| 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 |
$24.06
|
| 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 |
$24.06
|
| 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 Extremity Joint Complete Right BCE
|
Facility
|
OP
|
$974.00
|
|
|
Service Code
|
CPT 76881 RT
|
| Hospital Charge Code |
3530081
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$633.10 |
| Rate for Payer: Aetna Commercial |
$32.57
|
| Rate for Payer: Aetna Medicare |
$150.82
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$96.28
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$100.55
|
| Rate for Payer: Amerigroup Medicare |
$100.55
|
| Rate for Payer: BCBS of TX Blue Advantage |
$95.73
|
| Rate for Payer: BCBS of TX Blue Essentials |
$114.88
|
| Rate for Payer: BCBS of TX Medicare |
$100.55
|
| Rate for Payer: BCBS of TX PPO |
$128.22
|
| 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 |
$227.77
|
| Rate for Payer: Cigna Medicaid |
$24.06
|
| 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 |
$24.06
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$100.55
|
| Rate for Payer: Molina Medicare |
$100.55
|
| 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 |
$24.06
|
| 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 |
$24.06
|
| 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 Extremity Joint Limited Bilat BCE
|
Facility
|
OP
|
$844.00
|
|
|
Service Code
|
CPT 76882
|
| Hospital Charge Code |
3530083
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$548.60 |
| Rate for Payer: Aetna Commercial |
$37.96
|
| Rate for Payer: Aetna Medicare |
$150.82
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$30.35
|
| 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 |
$742.72
|
| Rate for Payer: Cash Price |
$742.72
|
| Rate for Payer: Cash Price |
$742.72
|
| Rate for Payer: Cigna Commercial |
$227.77
|
| Rate for Payer: Cigna Medicaid |
$30.35
|
| 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 |
$30.35
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$100.55
|
| Rate for Payer: Molina Medicare |
$100.55
|
| Rate for Payer: Multiplan Auto |
$548.60
|
| Rate for Payer: Multiplan Commercial |
$548.60
|
| Rate for Payer: Multiplan Workers Comp |
$548.60
|
| Rate for Payer: Parkland Medicaid |
$30.35
|
| 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 |
$30.35
|
| 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
|
|
