|
US Lower Ext Venous Duplex Right
|
Facility
|
OP
|
$1,906.00
|
|
|
Service Code
|
CPT 93971 RT
|
| Hospital Charge Code |
3500279
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$1,238.90 |
| Rate for Payer: Aetna Commercial |
$200.03
|
| Rate for Payer: Aetna Medicare |
$150.82
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$171.54
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$100.55
|
| Rate for Payer: Amerigroup Medicare |
$100.55
|
| Rate for Payer: BCBS of TX Blue Advantage |
$174.33
|
| Rate for Payer: BCBS of TX Blue Essentials |
$208.40
|
| Rate for Payer: BCBS of TX Medicare |
$100.55
|
| Rate for Payer: BCBS of TX PPO |
$232.44
|
| Rate for Payer: Cash Price |
$1,677.28
|
| Rate for Payer: Cash Price |
$1,677.28
|
| Rate for Payer: Cash Price |
$1,677.28
|
| Rate for Payer: Cigna Commercial |
$227.77
|
| Rate for Payer: Cigna Medicaid |
$16.84
|
| 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 |
$16.84
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$100.55
|
| Rate for Payer: Molina Medicare |
$100.55
|
| Rate for Payer: Multiplan Auto |
$1,238.90
|
| Rate for Payer: Multiplan Commercial |
$1,238.90
|
| Rate for Payer: Multiplan Workers Comp |
$1,238.90
|
| Rate for Payer: Parkland Medicaid |
$16.84
|
| 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 |
$16.84
|
| 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 Lower Ext Venous Duplex Right BCE
|
Facility
|
OP
|
$1,906.00
|
|
|
Service Code
|
CPT 93971 RT
|
| Hospital Charge Code |
3500279
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$1,238.90 |
| Rate for Payer: Aetna Commercial |
$200.03
|
| Rate for Payer: Aetna Medicare |
$150.82
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$171.54
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$100.55
|
| Rate for Payer: Amerigroup Medicare |
$100.55
|
| Rate for Payer: BCBS of TX Blue Advantage |
$174.33
|
| Rate for Payer: BCBS of TX Blue Essentials |
$208.40
|
| Rate for Payer: BCBS of TX Medicare |
$100.55
|
| Rate for Payer: BCBS of TX PPO |
$232.44
|
| Rate for Payer: Cash Price |
$1,677.28
|
| Rate for Payer: Cash Price |
$1,677.28
|
| Rate for Payer: Cash Price |
$1,677.28
|
| Rate for Payer: Cigna Commercial |
$227.77
|
| Rate for Payer: Cigna Medicaid |
$16.84
|
| 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 |
$16.84
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$100.55
|
| Rate for Payer: Molina Medicare |
$100.55
|
| Rate for Payer: Multiplan Auto |
$1,238.90
|
| Rate for Payer: Multiplan Commercial |
$1,238.90
|
| Rate for Payer: Multiplan Workers Comp |
$1,238.90
|
| Rate for Payer: Parkland Medicaid |
$16.84
|
| 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 |
$16.84
|
| 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 OB < 14 weeks w/ TVS if indicated
|
Facility
|
OP
|
$1,606.00
|
|
|
Service Code
|
CPT 76801
|
| Hospital Charge Code |
3511128
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$1,043.90 |
| Rate for Payer: Aetna Commercial |
$81.88
|
| 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 |
$121.31
|
| Rate for Payer: BCBS of TX Blue Essentials |
$145.57
|
| Rate for Payer: BCBS of TX Medicare |
$100.55
|
| Rate for Payer: BCBS of TX PPO |
$162.48
|
| Rate for Payer: Cash Price |
$1,413.28
|
| Rate for Payer: Cash Price |
$1,413.28
|
| Rate for Payer: Cash Price |
$1,413.28
|
| Rate for Payer: Cigna Commercial |
$227.77
|
| Rate for Payer: Cigna Medicaid |
$106.88
|
| Rate for Payer: Cigna Medicare |
$100.55
|
| Rate for Payer: Employer Direct Commercial |
$100.55
|
| Rate for Payer: Humana Medicare/TRICARE |
$100.55
|
| Rate for Payer: Molina CHIP/Medicaid |
$106.88
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$100.55
|
| Rate for Payer: Molina Medicare |
$100.55
|
| Rate for Payer: Multiplan Auto |
$1,043.90
|
| Rate for Payer: Multiplan Commercial |
$1,043.90
|
| Rate for Payer: Multiplan Workers Comp |
$1,043.90
|
| Rate for Payer: Parkland Medicaid |
$106.88
|
| Rate for Payer: Scott and White EPO/PPO |
$1.80
|
| Rate for Payer: Scott and White Medicare |
$100.55
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$106.88
|
| Rate for Payer: Superior Health Plan EPO |
$100.55
|
| Rate for Payer: Superior Health Plan Medicare |
$100.55
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$100.55
|
| Rate for Payer: Universal American Medicare |
$100.55
|
| Rate for Payer: Wellcare Medicare |
$100.55
|
| Rate for Payer: Wellmed Medicare |
$100.55
|
|
|
US OB < 14 weeks w/ TVS if indicated BCE
|
Facility
|
IP
|
$1,606.00
|
|
|
Service Code
|
CPT 76801
|
| Hospital Charge Code |
3511128
|
|
Hospital Revenue Code
|
402
|
| Rate for Payer: Cash Price |
$1,413.28
|
|
|
US OB < 14 weeks w/ TVS if indicated BCE
|
Facility
|
OP
|
$1,606.00
|
|
|
Service Code
|
CPT 76801
|
| Hospital Charge Code |
3511128
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$1,043.90 |
| Rate for Payer: Aetna Commercial |
$81.88
|
| 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 |
$121.31
|
| Rate for Payer: BCBS of TX Blue Essentials |
$145.57
|
| Rate for Payer: BCBS of TX Medicare |
$100.55
|
| Rate for Payer: BCBS of TX PPO |
$162.48
|
| Rate for Payer: Cash Price |
$1,413.28
|
| Rate for Payer: Cash Price |
$1,413.28
|
| Rate for Payer: Cash Price |
$1,413.28
|
| Rate for Payer: Cigna Commercial |
$227.77
|
| Rate for Payer: Cigna Medicaid |
$106.88
|
| Rate for Payer: Cigna Medicare |
$100.55
|
| Rate for Payer: Employer Direct Commercial |
$100.55
|
| Rate for Payer: Humana Medicare/TRICARE |
$100.55
|
| Rate for Payer: Molina CHIP/Medicaid |
$106.88
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$100.55
|
| Rate for Payer: Molina Medicare |
$100.55
|
| Rate for Payer: Multiplan Auto |
$1,043.90
|
| Rate for Payer: Multiplan Commercial |
$1,043.90
|
| Rate for Payer: Multiplan Workers Comp |
$1,043.90
|
| Rate for Payer: Parkland Medicaid |
$106.88
|
| Rate for Payer: Scott and White EPO/PPO |
$1.80
|
| Rate for Payer: Scott and White Medicare |
$100.55
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$106.88
|
| Rate for Payer: Superior Health Plan EPO |
$100.55
|
| Rate for Payer: Superior Health Plan Medicare |
$100.55
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$100.55
|
| Rate for Payer: Universal American Medicare |
$100.55
|
| Rate for Payer: Wellcare Medicare |
$100.55
|
| Rate for Payer: Wellmed Medicare |
$100.55
|
|
|
US OB Follow Up
|
Facility
|
OP
|
$761.00
|
|
|
Service Code
|
CPT 76816
|
| Hospital Charge Code |
3500188
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$494.65 |
| Rate for Payer: Aetna Commercial |
$79.96
|
| 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 |
$669.68
|
| Rate for Payer: Cash Price |
$669.68
|
| Rate for Payer: Cash Price |
$669.68
|
| 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 |
$494.65
|
| Rate for Payer: Multiplan Commercial |
$494.65
|
| Rate for Payer: Multiplan Workers Comp |
$494.65
|
| 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 OB Follow Up BCE
|
Facility
|
IP
|
$761.00
|
|
|
Service Code
|
CPT 76816
|
| Hospital Charge Code |
3500188
|
|
Hospital Revenue Code
|
402
|
| Rate for Payer: Cash Price |
$669.68
|
|
|
US OB Follow Up BCE
|
Facility
|
OP
|
$761.00
|
|
|
Service Code
|
CPT 76816
|
| Hospital Charge Code |
3500188
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$494.65 |
| Rate for Payer: Aetna Commercial |
$79.96
|
| 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 |
$669.68
|
| Rate for Payer: Cash Price |
$669.68
|
| Rate for Payer: Cash Price |
$669.68
|
| 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 |
$494.65
|
| Rate for Payer: Multiplan Commercial |
$494.65
|
| Rate for Payer: Multiplan Workers Comp |
$494.65
|
| 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 OB Greater Than 14 Weeks
|
Facility
|
OP
|
$1,654.00
|
|
|
Service Code
|
CPT 76805
|
| Hospital Charge Code |
3500170
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$1,075.10 |
| Rate for Payer: Aetna Commercial |
$101.90
|
| 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 |
$151.04
|
| Rate for Payer: BCBS of TX Blue Essentials |
$181.25
|
| Rate for Payer: BCBS of TX Medicare |
$100.55
|
| Rate for Payer: BCBS of TX PPO |
$202.30
|
| Rate for Payer: Cash Price |
$1,455.52
|
| Rate for Payer: Cash Price |
$1,455.52
|
| Rate for Payer: Cash Price |
$1,455.52
|
| Rate for Payer: Cigna Commercial |
$227.77
|
| Rate for Payer: Cigna Medicaid |
$106.88
|
| Rate for Payer: Cigna Medicare |
$100.55
|
| Rate for Payer: Employer Direct Commercial |
$100.55
|
| Rate for Payer: Humana Medicare/TRICARE |
$100.55
|
| Rate for Payer: Molina CHIP/Medicaid |
$106.88
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$100.55
|
| Rate for Payer: Molina Medicare |
$100.55
|
| Rate for Payer: Multiplan Auto |
$1,075.10
|
| Rate for Payer: Multiplan Commercial |
$1,075.10
|
| Rate for Payer: Multiplan Workers Comp |
$1,075.10
|
| 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 OB Greater Than 14 Weeks BCE
|
Facility
|
IP
|
$1,654.00
|
|
|
Service Code
|
CPT 76805
|
| Hospital Charge Code |
3500170
|
|
Hospital Revenue Code
|
402
|
| Rate for Payer: Cash Price |
$1,455.52
|
|
|
US OB Greater Than 14 Weeks BCE
|
Facility
|
OP
|
$1,654.00
|
|
|
Service Code
|
CPT 76805
|
| Hospital Charge Code |
3500170
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$1,075.10 |
| Rate for Payer: Aetna Commercial |
$101.90
|
| 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 |
$151.04
|
| Rate for Payer: BCBS of TX Blue Essentials |
$181.25
|
| Rate for Payer: BCBS of TX Medicare |
$100.55
|
| Rate for Payer: BCBS of TX PPO |
$202.30
|
| Rate for Payer: Cash Price |
$1,455.52
|
| Rate for Payer: Cash Price |
$1,455.52
|
| Rate for Payer: Cash Price |
$1,455.52
|
| Rate for Payer: Cigna Commercial |
$227.77
|
| Rate for Payer: Cigna Medicaid |
$106.88
|
| Rate for Payer: Cigna Medicare |
$100.55
|
| Rate for Payer: Employer Direct Commercial |
$100.55
|
| Rate for Payer: Humana Medicare/TRICARE |
$100.55
|
| Rate for Payer: Molina CHIP/Medicaid |
$106.88
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$100.55
|
| Rate for Payer: Molina Medicare |
$100.55
|
| Rate for Payer: Multiplan Auto |
$1,075.10
|
| Rate for Payer: Multiplan Commercial |
$1,075.10
|
| Rate for Payer: Multiplan Workers Comp |
$1,075.10
|
| 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 OB Level II
|
Facility
|
OP
|
$1,380.00
|
|
|
Service Code
|
CPT 76811
|
| Hospital Charge Code |
5066811
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$4.01 |
| Max. Negotiated Rate |
$897.00 |
| Rate for Payer: Aetna Commercial |
$95.58
|
| Rate for Payer: Aetna Medicare |
$336.15
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$176.09
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$224.10
|
| Rate for Payer: Amerigroup Medicare |
$224.10
|
| Rate for Payer: BCBS of TX Blue Advantage |
$139.74
|
| Rate for Payer: BCBS of TX Blue Essentials |
$167.69
|
| Rate for Payer: BCBS of TX Medicare |
$224.10
|
| Rate for Payer: BCBS of TX PPO |
$187.16
|
| Rate for Payer: Cash Price |
$1,214.40
|
| Rate for Payer: Cash Price |
$1,214.40
|
| Rate for Payer: Cash Price |
$1,214.40
|
| Rate for Payer: Cigna Commercial |
$507.64
|
| Rate for Payer: Cigna Medicaid |
$176.09
|
| Rate for Payer: Cigna Medicare |
$224.10
|
| Rate for Payer: Employer Direct Commercial |
$224.10
|
| Rate for Payer: Humana Medicare/TRICARE |
$224.10
|
| Rate for Payer: Molina CHIP/Medicaid |
$176.09
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$224.10
|
| Rate for Payer: Molina Medicare |
$224.10
|
| Rate for Payer: Multiplan Auto |
$897.00
|
| Rate for Payer: Multiplan Commercial |
$897.00
|
| Rate for Payer: Multiplan Workers Comp |
$897.00
|
| Rate for Payer: Parkland Medicaid |
$176.09
|
| Rate for Payer: Scott and White EPO/PPO |
$4.01
|
| Rate for Payer: Scott and White Medicare |
$224.10
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$176.09
|
| Rate for Payer: Superior Health Plan EPO |
$224.10
|
| Rate for Payer: Superior Health Plan Medicare |
$224.10
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$224.10
|
| Rate for Payer: Universal American Medicare |
$224.10
|
| Rate for Payer: Wellcare Medicare |
$224.10
|
| Rate for Payer: Wellmed Medicare |
$224.10
|
|
|
US OB Level II BCE
|
Facility
|
OP
|
$1,380.00
|
|
|
Service Code
|
CPT 76811
|
| Hospital Charge Code |
5066811
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$4.01 |
| Max. Negotiated Rate |
$897.00 |
| Rate for Payer: Aetna Commercial |
$95.58
|
| Rate for Payer: Aetna Medicare |
$336.15
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$176.09
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$224.10
|
| Rate for Payer: Amerigroup Medicare |
$224.10
|
| Rate for Payer: BCBS of TX Blue Advantage |
$139.74
|
| Rate for Payer: BCBS of TX Blue Essentials |
$167.69
|
| Rate for Payer: BCBS of TX Medicare |
$224.10
|
| Rate for Payer: BCBS of TX PPO |
$187.16
|
| Rate for Payer: Cash Price |
$1,214.40
|
| Rate for Payer: Cash Price |
$1,214.40
|
| Rate for Payer: Cash Price |
$1,214.40
|
| Rate for Payer: Cigna Commercial |
$507.64
|
| Rate for Payer: Cigna Medicaid |
$176.09
|
| Rate for Payer: Cigna Medicare |
$224.10
|
| Rate for Payer: Employer Direct Commercial |
$224.10
|
| Rate for Payer: Humana Medicare/TRICARE |
$224.10
|
| Rate for Payer: Molina CHIP/Medicaid |
$176.09
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$224.10
|
| Rate for Payer: Molina Medicare |
$224.10
|
| Rate for Payer: Multiplan Auto |
$897.00
|
| Rate for Payer: Multiplan Commercial |
$897.00
|
| Rate for Payer: Multiplan Workers Comp |
$897.00
|
| Rate for Payer: Parkland Medicaid |
$176.09
|
| Rate for Payer: Scott and White EPO/PPO |
$4.01
|
| Rate for Payer: Scott and White Medicare |
$224.10
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$176.09
|
| Rate for Payer: Superior Health Plan EPO |
$224.10
|
| Rate for Payer: Superior Health Plan Medicare |
$224.10
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$224.10
|
| Rate for Payer: Universal American Medicare |
$224.10
|
| Rate for Payer: Wellcare Medicare |
$224.10
|
| Rate for Payer: Wellmed Medicare |
$224.10
|
|
|
US OB Level II BCE
|
Facility
|
IP
|
$1,380.00
|
|
|
Service Code
|
CPT 76811
|
| Hospital Charge Code |
5066811
|
|
Hospital Revenue Code
|
402
|
| Rate for Payer: Cash Price |
$1,214.40
|
|
|
US OB Limited
|
Facility
|
OP
|
$596.00
|
|
|
Service Code
|
CPT 76815
|
| Hospital Charge Code |
3500196
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$387.40 |
| Rate for Payer: Aetna Commercial |
$58.38
|
| Rate for Payer: Aetna Medicare |
$150.82
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$81.86
|
| 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 |
$524.48
|
| Rate for Payer: Cash Price |
$524.48
|
| Rate for Payer: Cash Price |
$524.48
|
| Rate for Payer: Cigna Commercial |
$227.77
|
| Rate for Payer: Cigna Medicaid |
$81.86
|
| 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 |
$81.86
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$100.55
|
| Rate for Payer: Molina Medicare |
$100.55
|
| Rate for Payer: Multiplan Auto |
$387.40
|
| Rate for Payer: Multiplan Commercial |
$387.40
|
| Rate for Payer: Multiplan Workers Comp |
$387.40
|
| Rate for Payer: Parkland Medicaid |
$81.86
|
| 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 |
$81.86
|
| 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 OB Limited BCE
|
Facility
|
OP
|
$596.00
|
|
|
Service Code
|
CPT 76815
|
| Hospital Charge Code |
3500196
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$387.40 |
| Rate for Payer: Aetna Commercial |
$58.38
|
| Rate for Payer: Aetna Medicare |
$150.82
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$81.86
|
| 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 |
$524.48
|
| Rate for Payer: Cash Price |
$524.48
|
| Rate for Payer: Cash Price |
$524.48
|
| Rate for Payer: Cigna Commercial |
$227.77
|
| Rate for Payer: Cigna Medicaid |
$81.86
|
| 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 |
$81.86
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$100.55
|
| Rate for Payer: Molina Medicare |
$100.55
|
| Rate for Payer: Multiplan Auto |
$387.40
|
| Rate for Payer: Multiplan Commercial |
$387.40
|
| Rate for Payer: Multiplan Workers Comp |
$387.40
|
| Rate for Payer: Parkland Medicaid |
$81.86
|
| 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 |
$81.86
|
| 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 OB Limited BCE
|
Facility
|
IP
|
$596.00
|
|
|
Service Code
|
CPT 76815
|
| Hospital Charge Code |
3500196
|
|
Hospital Revenue Code
|
402
|
| Rate for Payer: Cash Price |
$524.48
|
|
|
US OB Transvaginal
|
Facility
|
OP
|
$303.00
|
|
|
Service Code
|
CPT 76817
|
| Hospital Charge Code |
3511169
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$247.70 |
| Rate for Payer: Aetna Commercial |
$66.08
|
| Rate for Payer: Aetna Medicare |
$150.82
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$93.23
|
| 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 |
$266.64
|
| Rate for Payer: Cash Price |
$266.64
|
| Rate for Payer: Cash Price |
$266.64
|
| Rate for Payer: Cigna Commercial |
$227.77
|
| Rate for Payer: Cigna Medicaid |
$93.23
|
| 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 |
$93.23
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$100.55
|
| Rate for Payer: Molina Medicare |
$100.55
|
| Rate for Payer: Multiplan Auto |
$196.95
|
| Rate for Payer: Multiplan Commercial |
$196.95
|
| Rate for Payer: Multiplan Workers Comp |
$196.95
|
| Rate for Payer: Parkland Medicaid |
$93.23
|
| 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 |
$93.23
|
| 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 OB Transvaginal BCE
|
Facility
|
IP
|
$303.00
|
|
|
Service Code
|
CPT 76817
|
| Hospital Charge Code |
3511169
|
|
Hospital Revenue Code
|
402
|
| Rate for Payer: Cash Price |
$266.64
|
|
|
US OB Transvaginal BCE
|
Facility
|
OP
|
$303.00
|
|
|
Service Code
|
CPT 76817
|
| Hospital Charge Code |
3511169
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$247.70 |
| Rate for Payer: Aetna Commercial |
$66.08
|
| Rate for Payer: Aetna Medicare |
$150.82
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$93.23
|
| 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 |
$266.64
|
| Rate for Payer: Cash Price |
$266.64
|
| Rate for Payer: Cash Price |
$266.64
|
| Rate for Payer: Cigna Commercial |
$227.77
|
| Rate for Payer: Cigna Medicaid |
$93.23
|
| 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 |
$93.23
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$100.55
|
| Rate for Payer: Molina Medicare |
$100.55
|
| Rate for Payer: Multiplan Auto |
$196.95
|
| Rate for Payer: Multiplan Commercial |
$196.95
|
| Rate for Payer: Multiplan Workers Comp |
$196.95
|
| Rate for Payer: Parkland Medicaid |
$93.23
|
| 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 |
$93.23
|
| 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 Paracentesis
|
Facility
|
OP
|
$1,947.00
|
|
|
Service Code
|
CPT 49083
|
| Hospital Charge Code |
3520068
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$18.29 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$2,200.00
|
| Rate for Payer: Aetna Medicare |
$1,243.53
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$334.95
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$829.02
|
| Rate for Payer: Amerigroup Medicare |
$829.02
|
| Rate for Payer: BCBS of TX Blue Advantage |
$1,312.49
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,571.84
|
| Rate for Payer: BCBS of TX Medicare |
$829.02
|
| Rate for Payer: BCBS of TX PPO |
$1,980.52
|
| Rate for Payer: Cash Price |
$1,713.36
|
| Rate for Payer: Cash Price |
$1,713.36
|
| Rate for Payer: Cigna Commercial |
$1,877.98
|
| Rate for Payer: Cigna Medicaid |
$334.95
|
| Rate for Payer: Cigna Medicare |
$829.02
|
| Rate for Payer: Employer Direct Commercial |
$829.02
|
| Rate for Payer: Humana Medicare/TRICARE |
$829.02
|
| Rate for Payer: Molina CHIP/Medicaid |
$334.95
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$829.02
|
| Rate for Payer: Molina Medicare |
$829.02
|
| 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: Parkland Medicaid |
$334.95
|
| Rate for Payer: Scott and White EPO/PPO |
$18.29
|
| Rate for Payer: Scott and White Medicare |
$829.02
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$334.95
|
| Rate for Payer: Superior Health Plan EPO |
$829.02
|
| Rate for Payer: Superior Health Plan Medicare |
$829.02
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$829.02
|
| Rate for Payer: Universal American Medicare |
$829.02
|
| Rate for Payer: Wellcare Medicare |
$829.02
|
| Rate for Payer: Wellmed Medicare |
$829.02
|
|
|
US Paracentesis BCE
|
Facility
|
OP
|
$1,947.00
|
|
|
Service Code
|
CPT 49083
|
| Hospital Charge Code |
3520068
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$18.29 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$2,200.00
|
| Rate for Payer: Aetna Medicare |
$1,243.53
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$334.95
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$829.02
|
| Rate for Payer: Amerigroup Medicare |
$829.02
|
| Rate for Payer: BCBS of TX Blue Advantage |
$1,312.49
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,571.84
|
| Rate for Payer: BCBS of TX Medicare |
$829.02
|
| Rate for Payer: BCBS of TX PPO |
$1,980.52
|
| Rate for Payer: Cash Price |
$1,713.36
|
| Rate for Payer: Cash Price |
$1,713.36
|
| Rate for Payer: Cigna Commercial |
$1,877.98
|
| Rate for Payer: Cigna Medicaid |
$334.95
|
| Rate for Payer: Cigna Medicare |
$829.02
|
| Rate for Payer: Employer Direct Commercial |
$829.02
|
| Rate for Payer: Humana Medicare/TRICARE |
$829.02
|
| Rate for Payer: Molina CHIP/Medicaid |
$334.95
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$829.02
|
| Rate for Payer: Molina Medicare |
$829.02
|
| 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: Parkland Medicaid |
$334.95
|
| Rate for Payer: Scott and White EPO/PPO |
$18.29
|
| Rate for Payer: Scott and White Medicare |
$829.02
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$334.95
|
| Rate for Payer: Superior Health Plan EPO |
$829.02
|
| Rate for Payer: Superior Health Plan Medicare |
$829.02
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$829.02
|
| Rate for Payer: Universal American Medicare |
$829.02
|
| Rate for Payer: Wellcare Medicare |
$829.02
|
| Rate for Payer: Wellmed Medicare |
$829.02
|
|
|
US Paracentesis BCE
|
Facility
|
IP
|
$1,947.00
|
|
|
Service Code
|
CPT 49083
|
| Hospital Charge Code |
3520068
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$1,713.36
|
|
|
US Pelvis Comp w/Transvag if indicated
|
Facility
|
OP
|
$1,483.00
|
|
|
Service Code
|
CPT 76856
|
| Hospital Charge Code |
3500089
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$963.95 |
| Rate for Payer: Aetna Commercial |
$84.96
|
| 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 |
$184.93
|
| Rate for Payer: BCBS of TX Blue Essentials |
$221.92
|
| Rate for Payer: BCBS of TX Medicare |
$100.55
|
| Rate for Payer: BCBS of TX PPO |
$247.70
|
| Rate for Payer: Cash Price |
$1,305.04
|
| Rate for Payer: Cash Price |
$1,305.04
|
| Rate for Payer: Cash Price |
$1,305.04
|
| Rate for Payer: Cigna Commercial |
$227.77
|
| Rate for Payer: Cigna Medicaid |
$96.28
|
| 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 |
$96.28
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$100.55
|
| Rate for Payer: Molina Medicare |
$100.55
|
| Rate for Payer: Multiplan Auto |
$963.95
|
| Rate for Payer: Multiplan Commercial |
$963.95
|
| Rate for Payer: Multiplan Workers Comp |
$963.95
|
| Rate for Payer: Parkland Medicaid |
$96.28
|
| 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 |
$96.28
|
| 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 Pelvis Comp w/Transvag if indicated BCE
|
Facility
|
IP
|
$1,483.00
|
|
|
Service Code
|
CPT 76856
|
| Hospital Charge Code |
3500089
|
|
Hospital Revenue Code
|
402
|
| Rate for Payer: Cash Price |
$1,305.04
|
|
