|
NM Liver/Spleen Imaging Injection/Scan
|
Facility
|
OP
|
$2,293.00
|
|
|
Service Code
|
HCPCS 78215
|
| Hospital Charge Code |
5208215
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$180.10 |
| Max. Negotiated Rate |
$1,650.96 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$180.10
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$401.59
|
| Rate for Payer: Amerigroup Medicare |
$401.59
|
| Rate for Payer: BCBS of TX Blue Advantage |
$292.56
|
| Rate for Payer: BCBS of TX Blue Essentials |
$351.07
|
| Rate for Payer: BCBS of TX Medicare |
$401.59
|
| Rate for Payer: BCBS of TX PPO |
$391.86
|
| Rate for Payer: Cash Price |
$1,559.24
|
| Rate for Payer: Cash Price |
$1,559.24
|
| Rate for Payer: Cash Price |
$1,559.24
|
| Rate for Payer: Cigna Commercial |
$848.90
|
| Rate for Payer: Cigna Medicaid |
$1,650.96
|
| Rate for Payer: Cigna Medicare |
$401.59
|
| Rate for Payer: Employer Direct Commercial |
$401.59
|
| Rate for Payer: Humana Medicare/TRICARE |
$401.59
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,650.96
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$401.59
|
| Rate for Payer: Molina Medicare |
$401.59
|
| Rate for Payer: Multiplan Auto |
$1,490.45
|
| Rate for Payer: Multiplan Commercial |
$1,490.45
|
| Rate for Payer: Multiplan Workers Comp |
$1,490.45
|
| Rate for Payer: Parkland Medicaid |
$1,650.96
|
| Rate for Payer: Scott and White EPO/PPO |
$224.80
|
| Rate for Payer: Scott and White Medicare |
$401.59
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,650.96
|
| Rate for Payer: Superior Health Plan EPO |
$401.59
|
| Rate for Payer: Superior Health Plan Medicare |
$401.59
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$401.59
|
| Rate for Payer: Universal American Medicare |
$401.59
|
| Rate for Payer: Wellcare Medicare |
$401.59
|
| Rate for Payer: Wellmed Medicare |
$401.59
|
|
|
NM Liver/Spleen Imaging Injection/Scan
|
Facility
|
IP
|
$2,293.00
|
|
|
Service Code
|
HCPCS 78215
|
| Hospital Charge Code |
5208215
|
|
Hospital Revenue Code
|
341
|
| Rate for Payer: Cash Price |
$1,559.24
|
|
|
NM Liver Vascular Flow Delay 1
|
Facility
|
IP
|
$2,485.00
|
|
|
Service Code
|
HCPCS 78202
|
| Hospital Charge Code |
5208202
|
|
Hospital Revenue Code
|
341
|
| Rate for Payer: Cash Price |
$1,689.80
|
|
|
NM Liver Vascular Flow Delay 1
|
Facility
|
OP
|
$2,485.00
|
|
|
Service Code
|
HCPCS 78202
|
| Hospital Charge Code |
5208202
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$194.80 |
| Max. Negotiated Rate |
$1,789.20 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$194.80
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$545.44
|
| Rate for Payer: Amerigroup Medicare |
$545.44
|
| Rate for Payer: BCBS of TX Blue Advantage |
$306.24
|
| Rate for Payer: BCBS of TX Blue Essentials |
$367.49
|
| Rate for Payer: BCBS of TX Medicare |
$545.44
|
| Rate for Payer: BCBS of TX PPO |
$410.18
|
| Rate for Payer: Cash Price |
$1,689.80
|
| Rate for Payer: Cash Price |
$1,689.80
|
| Rate for Payer: Cash Price |
$1,689.80
|
| Rate for Payer: Cigna Commercial |
$1,152.98
|
| Rate for Payer: Cigna Medicaid |
$1,789.20
|
| Rate for Payer: Cigna Medicare |
$545.44
|
| Rate for Payer: Employer Direct Commercial |
$545.44
|
| Rate for Payer: Humana Medicare/TRICARE |
$545.44
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,789.20
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$545.44
|
| Rate for Payer: Molina Medicare |
$545.44
|
| Rate for Payer: Multiplan Auto |
$1,615.25
|
| Rate for Payer: Multiplan Commercial |
$1,615.25
|
| Rate for Payer: Multiplan Workers Comp |
$1,615.25
|
| Rate for Payer: Parkland Medicaid |
$1,789.20
|
| Rate for Payer: Scott and White EPO/PPO |
$240.06
|
| Rate for Payer: Scott and White Medicare |
$545.44
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,789.20
|
| Rate for Payer: Superior Health Plan EPO |
$545.44
|
| Rate for Payer: Superior Health Plan Medicare |
$545.44
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$545.44
|
| Rate for Payer: Universal American Medicare |
$545.44
|
| Rate for Payer: Wellcare Medicare |
$545.44
|
| Rate for Payer: Wellmed Medicare |
$545.44
|
|
|
NM Lung Perfusion Imaging
|
Facility
|
IP
|
$2,252.00
|
|
|
Service Code
|
HCPCS 78580
|
| Hospital Charge Code |
3400090
|
|
Hospital Revenue Code
|
341
|
| Rate for Payer: Cash Price |
$1,531.36
|
|
|
NM Lung Perfusion Imaging
|
Facility
|
OP
|
$2,252.00
|
|
|
Service Code
|
HCPCS 78580
|
| Hospital Charge Code |
3400090
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$213.51 |
| Max. Negotiated Rate |
$1,621.44 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$213.51
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$401.59
|
| Rate for Payer: Amerigroup Medicare |
$401.59
|
| Rate for Payer: BCBS of TX Blue Advantage |
$346.68
|
| Rate for Payer: BCBS of TX Blue Essentials |
$416.02
|
| Rate for Payer: BCBS of TX Medicare |
$401.59
|
| Rate for Payer: BCBS of TX PPO |
$464.34
|
| Rate for Payer: Cash Price |
$1,531.36
|
| Rate for Payer: Cash Price |
$1,531.36
|
| Rate for Payer: Cash Price |
$1,531.36
|
| Rate for Payer: Cigna Commercial |
$848.90
|
| Rate for Payer: Cigna Medicaid |
$1,621.44
|
| Rate for Payer: Cigna Medicare |
$401.59
|
| Rate for Payer: Employer Direct Commercial |
$401.59
|
| Rate for Payer: Humana Medicare/TRICARE |
$401.59
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,621.44
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$401.59
|
| Rate for Payer: Molina Medicare |
$401.59
|
| Rate for Payer: Multiplan Auto |
$1,463.80
|
| Rate for Payer: Multiplan Commercial |
$1,463.80
|
| Rate for Payer: Multiplan Workers Comp |
$1,463.80
|
| Rate for Payer: Parkland Medicaid |
$1,621.44
|
| Rate for Payer: Scott and White EPO/PPO |
$267.60
|
| Rate for Payer: Scott and White Medicare |
$401.59
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,621.44
|
| Rate for Payer: Superior Health Plan EPO |
$401.59
|
| Rate for Payer: Superior Health Plan Medicare |
$401.59
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$401.59
|
| Rate for Payer: Universal American Medicare |
$401.59
|
| Rate for Payer: Wellcare Medicare |
$401.59
|
| Rate for Payer: Wellmed Medicare |
$401.59
|
|
|
NM Lung Ventilation Imaging
|
Facility
|
IP
|
$2,102.00
|
|
|
Service Code
|
HCPCS 78579
|
| Hospital Charge Code |
5208579
|
|
Hospital Revenue Code
|
341
|
| Rate for Payer: Cash Price |
$1,429.36
|
|
|
NM Lung Ventilation Imaging
|
Facility
|
OP
|
$2,102.00
|
|
|
Service Code
|
HCPCS 78579
|
| Hospital Charge Code |
5208579
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$169.08 |
| Max. Negotiated Rate |
$1,513.44 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$169.08
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$401.59
|
| Rate for Payer: Amerigroup Medicare |
$401.59
|
| Rate for Payer: BCBS of TX Blue Advantage |
$278.29
|
| Rate for Payer: BCBS of TX Blue Essentials |
$333.95
|
| Rate for Payer: BCBS of TX Medicare |
$401.59
|
| Rate for Payer: BCBS of TX PPO |
$372.74
|
| Rate for Payer: Cash Price |
$1,429.36
|
| Rate for Payer: Cash Price |
$1,429.36
|
| Rate for Payer: Cash Price |
$1,429.36
|
| Rate for Payer: Cigna Commercial |
$848.90
|
| Rate for Payer: Cigna Medicaid |
$1,513.44
|
| Rate for Payer: Cigna Medicare |
$401.59
|
| Rate for Payer: Employer Direct Commercial |
$401.59
|
| Rate for Payer: Humana Medicare/TRICARE |
$401.59
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,513.44
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$401.59
|
| Rate for Payer: Molina Medicare |
$401.59
|
| Rate for Payer: Multiplan Auto |
$1,366.30
|
| Rate for Payer: Multiplan Commercial |
$1,366.30
|
| Rate for Payer: Multiplan Workers Comp |
$1,366.30
|
| Rate for Payer: Parkland Medicaid |
$1,513.44
|
| Rate for Payer: Scott and White EPO/PPO |
$212.90
|
| Rate for Payer: Scott and White Medicare |
$401.59
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,513.44
|
| Rate for Payer: Superior Health Plan EPO |
$401.59
|
| Rate for Payer: Superior Health Plan Medicare |
$401.59
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$401.59
|
| Rate for Payer: Universal American Medicare |
$401.59
|
| Rate for Payer: Wellcare Medicare |
$401.59
|
| Rate for Payer: Wellmed Medicare |
$401.59
|
|
|
NM Lung Vent/Perf Imaging
|
Facility
|
OP
|
$2,346.00
|
|
|
Service Code
|
HCPCS 78582
|
| Hospital Charge Code |
3400012
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$297.04 |
| Max. Negotiated Rate |
$1,689.12 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$297.04
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$545.44
|
| Rate for Payer: Amerigroup Medicare |
$545.44
|
| Rate for Payer: BCBS of TX Blue Advantage |
$484.04
|
| Rate for Payer: BCBS of TX Blue Essentials |
$580.85
|
| Rate for Payer: BCBS of TX Medicare |
$545.44
|
| Rate for Payer: BCBS of TX PPO |
$648.33
|
| Rate for Payer: Cash Price |
$1,595.28
|
| Rate for Payer: Cash Price |
$1,595.28
|
| Rate for Payer: Cash Price |
$1,595.28
|
| Rate for Payer: Cigna Commercial |
$1,152.98
|
| Rate for Payer: Cigna Medicaid |
$1,689.12
|
| Rate for Payer: Cigna Medicare |
$545.44
|
| Rate for Payer: Employer Direct Commercial |
$545.44
|
| Rate for Payer: Humana Medicare/TRICARE |
$545.44
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,689.12
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$545.44
|
| Rate for Payer: Molina Medicare |
$545.44
|
| Rate for Payer: Multiplan Auto |
$1,524.90
|
| Rate for Payer: Multiplan Commercial |
$1,524.90
|
| Rate for Payer: Multiplan Workers Comp |
$1,524.90
|
| Rate for Payer: Parkland Medicaid |
$1,689.12
|
| Rate for Payer: Scott and White EPO/PPO |
$374.71
|
| Rate for Payer: Scott and White Medicare |
$545.44
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,689.12
|
| Rate for Payer: Superior Health Plan EPO |
$545.44
|
| Rate for Payer: Superior Health Plan Medicare |
$545.44
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$545.44
|
| Rate for Payer: Universal American Medicare |
$545.44
|
| Rate for Payer: Wellcare Medicare |
$545.44
|
| Rate for Payer: Wellmed Medicare |
$545.44
|
|
|
NM Lung Vent/Perf Imaging
|
Facility
|
IP
|
$2,346.00
|
|
|
Service Code
|
HCPCS 78582
|
| Hospital Charge Code |
3400012
|
|
Hospital Revenue Code
|
341
|
| Rate for Payer: Cash Price |
$1,595.28
|
|
|
NM Lymphoscintigraphy Injection/Scan
|
Facility
|
OP
|
$2,114.00
|
|
|
Service Code
|
HCPCS 78195
|
| Hospital Charge Code |
3400652
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$317.76 |
| Max. Negotiated Rate |
$1,522.08 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$317.76
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$545.44
|
| Rate for Payer: Amerigroup Medicare |
$545.44
|
| Rate for Payer: BCBS of TX Blue Advantage |
$511.40
|
| Rate for Payer: BCBS of TX Blue Essentials |
$613.68
|
| Rate for Payer: BCBS of TX Medicare |
$545.44
|
| Rate for Payer: BCBS of TX PPO |
$684.97
|
| Rate for Payer: Cash Price |
$1,437.52
|
| Rate for Payer: Cash Price |
$1,437.52
|
| Rate for Payer: Cash Price |
$1,437.52
|
| Rate for Payer: Cigna Commercial |
$1,152.98
|
| Rate for Payer: Cigna Medicaid |
$1,522.08
|
| Rate for Payer: Cigna Medicare |
$545.44
|
| Rate for Payer: Employer Direct Commercial |
$545.44
|
| Rate for Payer: Humana Medicare/TRICARE |
$545.44
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,522.08
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$545.44
|
| Rate for Payer: Molina Medicare |
$545.44
|
| Rate for Payer: Multiplan Auto |
$1,374.10
|
| Rate for Payer: Multiplan Commercial |
$1,374.10
|
| Rate for Payer: Multiplan Workers Comp |
$1,374.10
|
| Rate for Payer: Parkland Medicaid |
$1,522.08
|
| Rate for Payer: Scott and White EPO/PPO |
$399.77
|
| Rate for Payer: Scott and White Medicare |
$545.44
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,522.08
|
| Rate for Payer: Superior Health Plan EPO |
$545.44
|
| Rate for Payer: Superior Health Plan Medicare |
$545.44
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$545.44
|
| Rate for Payer: Universal American Medicare |
$545.44
|
| Rate for Payer: Wellcare Medicare |
$545.44
|
| Rate for Payer: Wellmed Medicare |
$545.44
|
|
|
NM Lymphoscintigraphy Injection/Scan
|
Facility
|
IP
|
$2,114.00
|
|
|
Service Code
|
HCPCS 78195
|
| Hospital Charge Code |
3400652
|
|
Hospital Revenue Code
|
341
|
| Rate for Payer: Cash Price |
$1,437.52
|
|
|
NM Myocardial SPECT Rest and Stress
|
Facility
|
IP
|
$7,373.00
|
|
|
Service Code
|
HCPCS 78452
|
| Hospital Charge Code |
3406824
|
|
Hospital Revenue Code
|
341
|
| Rate for Payer: Cash Price |
$5,013.64
|
|
|
NM Myocardial SPECT Rest and Stress
|
Facility
|
OP
|
$7,373.00
|
|
|
Service Code
|
HCPCS 78452
|
| Hospital Charge Code |
3406824
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$422.34 |
| Max. Negotiated Rate |
$5,308.56 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$422.34
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,300.55
|
| Rate for Payer: Amerigroup Medicare |
$1,300.55
|
| Rate for Payer: BCBS of TX Blue Advantage |
$675.51
|
| Rate for Payer: BCBS of TX Blue Essentials |
$810.61
|
| Rate for Payer: BCBS of TX Medicare |
$1,300.55
|
| Rate for Payer: BCBS of TX PPO |
$904.77
|
| Rate for Payer: Cash Price |
$5,013.64
|
| Rate for Payer: Cash Price |
$5,013.64
|
| Rate for Payer: Cash Price |
$5,013.64
|
| Rate for Payer: Cigna Commercial |
$2,749.13
|
| Rate for Payer: Cigna Medicaid |
$5,308.56
|
| Rate for Payer: Cigna Medicare |
$1,300.55
|
| Rate for Payer: Employer Direct Commercial |
$1,300.55
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,300.55
|
| Rate for Payer: Molina CHIP/Medicaid |
$5,308.56
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,300.55
|
| Rate for Payer: Molina Medicare |
$1,300.55
|
| Rate for Payer: Multiplan Auto |
$4,792.45
|
| Rate for Payer: Multiplan Commercial |
$4,792.45
|
| Rate for Payer: Multiplan Workers Comp |
$4,792.45
|
| Rate for Payer: Parkland Medicaid |
$5,308.56
|
| Rate for Payer: Scott and White EPO/PPO |
$534.92
|
| Rate for Payer: Scott and White Medicare |
$1,300.55
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$5,308.56
|
| Rate for Payer: Superior Health Plan EPO |
$1,300.55
|
| Rate for Payer: Superior Health Plan Medicare |
$1,300.55
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,300.55
|
| Rate for Payer: Universal American Medicare |
$1,300.55
|
| Rate for Payer: Wellcare Medicare |
$1,300.55
|
| Rate for Payer: Wellmed Medicare |
$1,300.55
|
|
|
NM Myocardial SPECT Single Study
|
Facility
|
IP
|
$4,301.00
|
|
|
Service Code
|
HCPCS 78451
|
| Hospital Charge Code |
3406816
|
|
Hospital Revenue Code
|
341
|
| Rate for Payer: Cash Price |
$2,924.68
|
|
|
NM Myocardial SPECT Single Study
|
Facility
|
OP
|
$4,301.00
|
|
|
Service Code
|
HCPCS 78451
|
| Hospital Charge Code |
3406816
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$306.74 |
| Max. Negotiated Rate |
$3,096.72 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$306.74
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,300.55
|
| Rate for Payer: Amerigroup Medicare |
$1,300.55
|
| Rate for Payer: BCBS of TX Blue Advantage |
$467.40
|
| Rate for Payer: BCBS of TX Blue Essentials |
$560.87
|
| Rate for Payer: BCBS of TX Medicare |
$1,300.55
|
| Rate for Payer: BCBS of TX PPO |
$626.03
|
| Rate for Payer: Cash Price |
$2,924.68
|
| Rate for Payer: Cash Price |
$2,924.68
|
| Rate for Payer: Cash Price |
$2,924.68
|
| Rate for Payer: Cigna Commercial |
$2,749.13
|
| Rate for Payer: Cigna Medicaid |
$3,096.72
|
| Rate for Payer: Cigna Medicare |
$1,300.55
|
| Rate for Payer: Employer Direct Commercial |
$1,300.55
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,300.55
|
| Rate for Payer: Molina CHIP/Medicaid |
$3,096.72
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,300.55
|
| Rate for Payer: Molina Medicare |
$1,300.55
|
| Rate for Payer: Multiplan Auto |
$2,795.65
|
| Rate for Payer: Multiplan Commercial |
$2,795.65
|
| Rate for Payer: Multiplan Workers Comp |
$2,795.65
|
| Rate for Payer: Parkland Medicaid |
$3,096.72
|
| Rate for Payer: Scott and White EPO/PPO |
$386.73
|
| Rate for Payer: Scott and White Medicare |
$1,300.55
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$3,096.72
|
| Rate for Payer: Superior Health Plan EPO |
$1,300.55
|
| Rate for Payer: Superior Health Plan Medicare |
$1,300.55
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,300.55
|
| Rate for Payer: Universal American Medicare |
$1,300.55
|
| Rate for Payer: Wellcare Medicare |
$1,300.55
|
| Rate for Payer: Wellmed Medicare |
$1,300.55
|
|
|
NM Parathyroid Imaging Injection/Scan
|
Facility
|
IP
|
$1,822.00
|
|
|
Service Code
|
HCPCS 78070
|
| Hospital Charge Code |
3400322
|
|
Hospital Revenue Code
|
341
|
| Rate for Payer: Cash Price |
$1,238.96
|
|
|
NM Parathyroid Imaging Injection/Scan
|
Facility
|
OP
|
$1,822.00
|
|
|
Service Code
|
HCPCS 78070
|
| Hospital Charge Code |
3400322
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$265.30 |
| Max. Negotiated Rate |
$1,311.84 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$265.30
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$401.59
|
| Rate for Payer: Amerigroup Medicare |
$401.59
|
| Rate for Payer: BCBS of TX Blue Advantage |
$445.98
|
| Rate for Payer: BCBS of TX Blue Essentials |
$535.17
|
| Rate for Payer: BCBS of TX Medicare |
$401.59
|
| Rate for Payer: BCBS of TX PPO |
$597.34
|
| Rate for Payer: Cash Price |
$1,238.96
|
| Rate for Payer: Cash Price |
$1,238.96
|
| Rate for Payer: Cash Price |
$1,238.96
|
| Rate for Payer: Cigna Commercial |
$848.90
|
| Rate for Payer: Cigna Medicaid |
$1,311.84
|
| Rate for Payer: Cigna Medicare |
$401.59
|
| Rate for Payer: Employer Direct Commercial |
$401.59
|
| Rate for Payer: Humana Medicare/TRICARE |
$401.59
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,311.84
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$401.59
|
| Rate for Payer: Molina Medicare |
$401.59
|
| Rate for Payer: Multiplan Auto |
$1,184.30
|
| Rate for Payer: Multiplan Commercial |
$1,184.30
|
| Rate for Payer: Multiplan Workers Comp |
$1,184.30
|
| Rate for Payer: Parkland Medicaid |
$1,311.84
|
| Rate for Payer: Scott and White EPO/PPO |
$332.69
|
| Rate for Payer: Scott and White Medicare |
$401.59
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,311.84
|
| Rate for Payer: Superior Health Plan EPO |
$401.59
|
| Rate for Payer: Superior Health Plan Medicare |
$401.59
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$401.59
|
| Rate for Payer: Universal American Medicare |
$401.59
|
| Rate for Payer: Wellcare Medicare |
$401.59
|
| Rate for Payer: Wellmed Medicare |
$401.59
|
|
|
NM Parathyroid Imaging w/ Spect Inj/Scan
|
Facility
|
IP
|
$2,048.00
|
|
|
Service Code
|
HCPCS 78071
|
| Hospital Charge Code |
3450004
|
|
Hospital Revenue Code
|
341
|
| Rate for Payer: Cash Price |
$1,392.64
|
|
|
NM Parathyroid Imaging w/ Spect Inj/Scan
|
Facility
|
OP
|
$2,048.00
|
|
|
Service Code
|
HCPCS 78071
|
| Hospital Charge Code |
3450004
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$314.75 |
| Max. Negotiated Rate |
$1,474.56 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$314.75
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$401.59
|
| Rate for Payer: Amerigroup Medicare |
$401.59
|
| Rate for Payer: BCBS of TX Blue Advantage |
$511.40
|
| Rate for Payer: BCBS of TX Blue Essentials |
$613.68
|
| Rate for Payer: BCBS of TX Medicare |
$401.59
|
| Rate for Payer: BCBS of TX PPO |
$684.97
|
| Rate for Payer: Cash Price |
$1,392.64
|
| Rate for Payer: Cash Price |
$1,392.64
|
| Rate for Payer: Cash Price |
$1,392.64
|
| Rate for Payer: Cigna Commercial |
$848.90
|
| Rate for Payer: Cigna Medicaid |
$1,474.56
|
| Rate for Payer: Cigna Medicare |
$401.59
|
| Rate for Payer: Employer Direct Commercial |
$401.59
|
| Rate for Payer: Humana Medicare/TRICARE |
$401.59
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,474.56
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$401.59
|
| Rate for Payer: Molina Medicare |
$401.59
|
| Rate for Payer: Multiplan Auto |
$1,331.20
|
| Rate for Payer: Multiplan Commercial |
$1,331.20
|
| Rate for Payer: Multiplan Workers Comp |
$1,331.20
|
| Rate for Payer: Parkland Medicaid |
$1,474.56
|
| Rate for Payer: Scott and White EPO/PPO |
$395.70
|
| Rate for Payer: Scott and White Medicare |
$401.59
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,474.56
|
| Rate for Payer: Superior Health Plan EPO |
$401.59
|
| Rate for Payer: Superior Health Plan Medicare |
$401.59
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$401.59
|
| Rate for Payer: Universal American Medicare |
$401.59
|
| Rate for Payer: Wellcare Medicare |
$401.59
|
| Rate for Payer: Wellmed Medicare |
$401.59
|
|
|
NM Radiopharm Therapy Oral Admin
|
Facility
|
OP
|
$1,760.00
|
|
|
Service Code
|
HCPCS 79005
|
| Hospital Charge Code |
3402187
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$83.85 |
| Max. Negotiated Rate |
$1,267.20 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$134.99
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$234.40
|
| Rate for Payer: Amerigroup Medicare |
$234.40
|
| Rate for Payer: BCBS of TX Blue Advantage |
$83.85
|
| Rate for Payer: BCBS of TX Blue Essentials |
$100.62
|
| Rate for Payer: BCBS of TX Medicare |
$234.40
|
| Rate for Payer: BCBS of TX PPO |
$112.31
|
| Rate for Payer: Cash Price |
$1,196.80
|
| Rate for Payer: Cash Price |
$1,196.80
|
| Rate for Payer: Cash Price |
$1,196.80
|
| Rate for Payer: Cigna Commercial |
$495.48
|
| Rate for Payer: Cigna Medicaid |
$1,267.20
|
| Rate for Payer: Cigna Medicare |
$234.40
|
| Rate for Payer: Employer Direct Commercial |
$234.40
|
| Rate for Payer: Humana Medicare/TRICARE |
$234.40
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,267.20
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$234.40
|
| Rate for Payer: Molina Medicare |
$234.40
|
| Rate for Payer: Multiplan Auto |
$1,144.00
|
| Rate for Payer: Multiplan Commercial |
$1,144.00
|
| Rate for Payer: Multiplan Workers Comp |
$1,144.00
|
| Rate for Payer: Parkland Medicaid |
$1,267.20
|
| Rate for Payer: Scott and White EPO/PPO |
$165.10
|
| Rate for Payer: Scott and White Medicare |
$234.40
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,267.20
|
| Rate for Payer: Superior Health Plan EPO |
$234.40
|
| Rate for Payer: Superior Health Plan Medicare |
$234.40
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$234.40
|
| Rate for Payer: Universal American Medicare |
$234.40
|
| Rate for Payer: Wellcare Medicare |
$234.40
|
| Rate for Payer: Wellmed Medicare |
$234.40
|
|
|
NM Radiopharm Therapy Oral Admin
|
Facility
|
IP
|
$1,760.00
|
|
|
Service Code
|
HCPCS 79005
|
| Hospital Charge Code |
3402187
|
|
Hospital Revenue Code
|
342
|
| Rate for Payer: Cash Price |
$1,196.80
|
|
|
NM Thyroid Cancer Imaging Limited
|
Facility
|
IP
|
$2,011.00
|
|
|
Service Code
|
HCPCS 78015
|
| Hospital Charge Code |
5218015
|
|
Hospital Revenue Code
|
341
|
| Rate for Payer: Cash Price |
$1,367.48
|
|
|
NM Thyroid Cancer Imaging Limited
|
Facility
|
OP
|
$2,011.00
|
|
|
Service Code
|
HCPCS 78015
|
| Hospital Charge Code |
5218015
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$209.50 |
| Max. Negotiated Rate |
$1,447.92 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$209.50
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$401.59
|
| Rate for Payer: Amerigroup Medicare |
$401.59
|
| Rate for Payer: BCBS of TX Blue Advantage |
$328.25
|
| Rate for Payer: BCBS of TX Blue Essentials |
$393.90
|
| Rate for Payer: BCBS of TX Medicare |
$401.59
|
| Rate for Payer: BCBS of TX PPO |
$439.66
|
| Rate for Payer: Cash Price |
$1,367.48
|
| Rate for Payer: Cash Price |
$1,367.48
|
| Rate for Payer: Cash Price |
$1,367.48
|
| Rate for Payer: Cigna Commercial |
$848.90
|
| Rate for Payer: Cigna Medicaid |
$1,447.92
|
| Rate for Payer: Cigna Medicare |
$401.59
|
| Rate for Payer: Employer Direct Commercial |
$401.59
|
| Rate for Payer: Humana Medicare/TRICARE |
$401.59
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,447.92
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$401.59
|
| Rate for Payer: Molina Medicare |
$401.59
|
| Rate for Payer: Multiplan Auto |
$1,307.15
|
| Rate for Payer: Multiplan Commercial |
$1,307.15
|
| Rate for Payer: Multiplan Workers Comp |
$1,307.15
|
| Rate for Payer: Parkland Medicaid |
$1,447.92
|
| Rate for Payer: Scott and White EPO/PPO |
$261.88
|
| Rate for Payer: Scott and White Medicare |
$401.59
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,447.92
|
| Rate for Payer: Superior Health Plan EPO |
$401.59
|
| Rate for Payer: Superior Health Plan Medicare |
$401.59
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$401.59
|
| Rate for Payer: Universal American Medicare |
$401.59
|
| Rate for Payer: Wellcare Medicare |
$401.59
|
| Rate for Payer: Wellmed Medicare |
$401.59
|
|
|
NM Thyroid Cancer Imaging WB Delay 1
|
Facility
|
IP
|
$2,212.00
|
|
|
Service Code
|
HCPCS 78018
|
| Hospital Charge Code |
3400272
|
|
Hospital Revenue Code
|
341
|
| Rate for Payer: Cash Price |
$1,504.16
|
|
