|
US Pelvis Comp w/Transvag if indicated BCE
|
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 Ltd w/Transvag if indicated
|
Facility
|
OP
|
$613.00
|
|
|
Service Code
|
CPT 76857
|
| Hospital Charge Code |
3500535
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$398.45 |
| Rate for Payer: Aetna Commercial |
$27.95
|
| Rate for Payer: Aetna Medicare |
$150.82
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$50.79
|
| 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 |
$539.44
|
| Rate for Payer: Cash Price |
$539.44
|
| Rate for Payer: Cash Price |
$539.44
|
| Rate for Payer: Cigna Commercial |
$227.77
|
| Rate for Payer: Cigna Medicaid |
$50.79
|
| 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 |
$50.79
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$100.55
|
| Rate for Payer: Molina Medicare |
$100.55
|
| Rate for Payer: Multiplan Auto |
$398.45
|
| Rate for Payer: Multiplan Commercial |
$398.45
|
| Rate for Payer: Multiplan Workers Comp |
$398.45
|
| Rate for Payer: Parkland Medicaid |
$50.79
|
| 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 |
$50.79
|
| 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 Ltd w/Transvag if indicated BCE
|
Facility
|
OP
|
$613.00
|
|
|
Service Code
|
CPT 76857
|
| Hospital Charge Code |
3500535
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$398.45 |
| Rate for Payer: Aetna Commercial |
$27.95
|
| Rate for Payer: Aetna Medicare |
$150.82
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$50.79
|
| 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 |
$539.44
|
| Rate for Payer: Cash Price |
$539.44
|
| Rate for Payer: Cash Price |
$539.44
|
| Rate for Payer: Cigna Commercial |
$227.77
|
| Rate for Payer: Cigna Medicaid |
$50.79
|
| 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 |
$50.79
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$100.55
|
| Rate for Payer: Molina Medicare |
$100.55
|
| Rate for Payer: Multiplan Auto |
$398.45
|
| Rate for Payer: Multiplan Commercial |
$398.45
|
| Rate for Payer: Multiplan Workers Comp |
$398.45
|
| Rate for Payer: Parkland Medicaid |
$50.79
|
| 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 |
$50.79
|
| 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 Ltd w/Transvag if indicated BCE
|
Facility
|
IP
|
$613.00
|
|
|
Service Code
|
CPT 76857
|
| Hospital Charge Code |
3500535
|
|
Hospital Revenue Code
|
402
|
| Rate for Payer: Cash Price |
$539.44
|
|
|
US Retroperitoneal Complete
|
Facility
|
OP
|
$1,551.00
|
|
|
Service Code
|
CPT 76770
|
| Hospital Charge Code |
3501103
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$1,008.15 |
| Rate for Payer: Aetna Commercial |
$85.73
|
| Rate for Payer: Aetna Medicare |
$150.82
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$106.88
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$100.55
|
| Rate for Payer: Amerigroup Medicare |
$100.55
|
| Rate for Payer: BCBS of TX Blue Advantage |
$184.93
|
| Rate for Payer: BCBS of TX Blue Essentials |
$221.92
|
| Rate for Payer: BCBS of TX Medicare |
$100.55
|
| Rate for Payer: BCBS of TX PPO |
$247.70
|
| Rate for Payer: Cash Price |
$1,364.88
|
| Rate for Payer: Cash Price |
$1,364.88
|
| Rate for Payer: Cash Price |
$1,364.88
|
| 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 |
$1,008.15
|
| Rate for Payer: Multiplan Commercial |
$1,008.15
|
| Rate for Payer: Multiplan Workers Comp |
$1,008.15
|
| 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 Retroperitoneal Complete BCE
|
Facility
|
OP
|
$1,551.00
|
|
|
Service Code
|
CPT 76770
|
| Hospital Charge Code |
3501103
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$1,008.15 |
| Rate for Payer: Aetna Commercial |
$85.73
|
| Rate for Payer: Aetna Medicare |
$150.82
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$106.88
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$100.55
|
| Rate for Payer: Amerigroup Medicare |
$100.55
|
| Rate for Payer: BCBS of TX Blue Advantage |
$184.93
|
| Rate for Payer: BCBS of TX Blue Essentials |
$221.92
|
| Rate for Payer: BCBS of TX Medicare |
$100.55
|
| Rate for Payer: BCBS of TX PPO |
$247.70
|
| Rate for Payer: Cash Price |
$1,364.88
|
| Rate for Payer: Cash Price |
$1,364.88
|
| Rate for Payer: Cash Price |
$1,364.88
|
| 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 |
$1,008.15
|
| Rate for Payer: Multiplan Commercial |
$1,008.15
|
| Rate for Payer: Multiplan Workers Comp |
$1,008.15
|
| 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 Retroperitoneal Complete BCE
|
Facility
|
IP
|
$1,551.00
|
|
|
Service Code
|
CPT 76770
|
| Hospital Charge Code |
3501103
|
|
Hospital Revenue Code
|
402
|
| Rate for Payer: Cash Price |
$1,364.88
|
|
|
US Scrotum (Contents) w/ Doppler if ind
|
Facility
|
OP
|
$1,241.00
|
|
|
Service Code
|
CPT 76870
|
| Hospital Charge Code |
3500121
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$806.65 |
| Rate for Payer: Aetna Commercial |
$81.88
|
| Rate for Payer: Aetna Medicare |
$150.82
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$101.58
|
| 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 |
$1,092.08
|
| Rate for Payer: Cash Price |
$1,092.08
|
| Rate for Payer: Cash Price |
$1,092.08
|
| Rate for Payer: Cigna Commercial |
$227.77
|
| Rate for Payer: Cigna Medicaid |
$101.58
|
| 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 |
$101.58
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$100.55
|
| Rate for Payer: Molina Medicare |
$100.55
|
| Rate for Payer: Multiplan Auto |
$806.65
|
| Rate for Payer: Multiplan Commercial |
$806.65
|
| Rate for Payer: Multiplan Workers Comp |
$806.65
|
| Rate for Payer: Parkland Medicaid |
$101.58
|
| 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 |
$101.58
|
| 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 Scrotum (Contents) w/ Doppler if ind BCE
|
Facility
|
IP
|
$1,241.00
|
|
|
Service Code
|
CPT 76870
|
| Hospital Charge Code |
3500121
|
|
Hospital Revenue Code
|
402
|
| Rate for Payer: Cash Price |
$1,092.08
|
|
|
US Scrotum (Contents) w/ Doppler if ind BCE
|
Facility
|
OP
|
$1,241.00
|
|
|
Service Code
|
CPT 76870
|
| Hospital Charge Code |
3500121
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$806.65 |
| Rate for Payer: Aetna Commercial |
$81.88
|
| Rate for Payer: Aetna Medicare |
$150.82
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$101.58
|
| 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 |
$1,092.08
|
| Rate for Payer: Cash Price |
$1,092.08
|
| Rate for Payer: Cash Price |
$1,092.08
|
| Rate for Payer: Cigna Commercial |
$227.77
|
| Rate for Payer: Cigna Medicaid |
$101.58
|
| 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 |
$101.58
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$100.55
|
| Rate for Payer: Molina Medicare |
$100.55
|
| Rate for Payer: Multiplan Auto |
$806.65
|
| Rate for Payer: Multiplan Commercial |
$806.65
|
| Rate for Payer: Multiplan Workers Comp |
$806.65
|
| Rate for Payer: Parkland Medicaid |
$101.58
|
| 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 |
$101.58
|
| 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 Segmental Pressures LE 1-2 Lvls Bilat
|
Facility
|
OP
|
$720.00
|
|
|
Service Code
|
CPT 93922
|
| Hospital Charge Code |
3501020
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$2.09 |
| Max. Negotiated Rate |
$468.00 |
| Rate for Payer: Aetna Commercial |
$141.36
|
| Rate for Payer: Aetna Medicare |
$175.23
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$64.80
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$116.82
|
| Rate for Payer: Amerigroup Medicare |
$116.82
|
| Rate for Payer: BCBS of TX Blue Advantage |
$189.71
|
| Rate for Payer: BCBS of TX Blue Essentials |
$226.78
|
| Rate for Payer: BCBS of TX Medicare |
$116.82
|
| Rate for Payer: BCBS of TX PPO |
$252.95
|
| Rate for Payer: Cash Price |
$633.60
|
| Rate for Payer: Cash Price |
$633.60
|
| Rate for Payer: Cash Price |
$633.60
|
| Rate for Payer: Cigna Commercial |
$264.63
|
| Rate for Payer: Cigna Medicare |
$116.82
|
| Rate for Payer: Employer Direct Commercial |
$116.82
|
| Rate for Payer: Humana Medicare/TRICARE |
$116.82
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$116.82
|
| Rate for Payer: Molina Medicare |
$116.82
|
| Rate for Payer: Multiplan Auto |
$468.00
|
| Rate for Payer: Multiplan Commercial |
$468.00
|
| Rate for Payer: Multiplan Workers Comp |
$468.00
|
| Rate for Payer: Scott and White EPO/PPO |
$2.09
|
| Rate for Payer: Scott and White Medicare |
$116.82
|
| Rate for Payer: Superior Health Plan EPO |
$116.82
|
| Rate for Payer: Superior Health Plan Medicare |
$116.82
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$116.82
|
| Rate for Payer: Universal American Medicare |
$116.82
|
| Rate for Payer: Wellcare Medicare |
$116.82
|
| Rate for Payer: Wellmed Medicare |
$116.82
|
|
|
US Segmental Pressures LE 1-2 Lvls Bilat BCE
|
Facility
|
IP
|
$720.00
|
|
|
Service Code
|
CPT 93922
|
| Hospital Charge Code |
3501020
|
|
Hospital Revenue Code
|
921
|
| Rate for Payer: Cash Price |
$633.60
|
|
|
US Segmental Pressures LE 1-2 Lvls Bilat BCE
|
Facility
|
OP
|
$720.00
|
|
|
Service Code
|
CPT 93922
|
| Hospital Charge Code |
3501020
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$2.09 |
| Max. Negotiated Rate |
$468.00 |
| Rate for Payer: Aetna Commercial |
$141.36
|
| Rate for Payer: Aetna Medicare |
$175.23
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$64.80
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$116.82
|
| Rate for Payer: Amerigroup Medicare |
$116.82
|
| Rate for Payer: BCBS of TX Blue Advantage |
$189.71
|
| Rate for Payer: BCBS of TX Blue Essentials |
$226.78
|
| Rate for Payer: BCBS of TX Medicare |
$116.82
|
| Rate for Payer: BCBS of TX PPO |
$252.95
|
| Rate for Payer: Cash Price |
$633.60
|
| Rate for Payer: Cash Price |
$633.60
|
| Rate for Payer: Cash Price |
$633.60
|
| Rate for Payer: Cigna Commercial |
$264.63
|
| Rate for Payer: Cigna Medicare |
$116.82
|
| Rate for Payer: Employer Direct Commercial |
$116.82
|
| Rate for Payer: Humana Medicare/TRICARE |
$116.82
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$116.82
|
| Rate for Payer: Molina Medicare |
$116.82
|
| Rate for Payer: Multiplan Auto |
$468.00
|
| Rate for Payer: Multiplan Commercial |
$468.00
|
| Rate for Payer: Multiplan Workers Comp |
$468.00
|
| Rate for Payer: Scott and White EPO/PPO |
$2.09
|
| Rate for Payer: Scott and White Medicare |
$116.82
|
| Rate for Payer: Superior Health Plan EPO |
$116.82
|
| Rate for Payer: Superior Health Plan Medicare |
$116.82
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$116.82
|
| Rate for Payer: Universal American Medicare |
$116.82
|
| Rate for Payer: Wellcare Medicare |
$116.82
|
| Rate for Payer: Wellmed Medicare |
$116.82
|
|
|
US Segmental Pressures LE 3+ Lvls Bilat
|
Facility
|
OP
|
$1,579.00
|
|
|
Service Code
|
CPT 93923
|
| Hospital Charge Code |
3501038
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$2.55 |
| Max. Negotiated Rate |
$1,026.35 |
| Rate for Payer: Aetna Commercial |
$215.61
|
| Rate for Payer: Aetna Medicare |
$214.29
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$142.11
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$142.86
|
| Rate for Payer: Amerigroup Medicare |
$142.86
|
| Rate for Payer: BCBS of TX Blue Advantage |
$197.52
|
| Rate for Payer: BCBS of TX Blue Essentials |
$236.12
|
| Rate for Payer: BCBS of TX Medicare |
$142.86
|
| Rate for Payer: BCBS of TX PPO |
$263.37
|
| Rate for Payer: Cash Price |
$1,389.52
|
| Rate for Payer: Cash Price |
$1,389.52
|
| Rate for Payer: Cash Price |
$1,389.52
|
| Rate for Payer: Cigna Commercial |
$323.61
|
| Rate for Payer: Cigna Medicaid |
$128.31
|
| Rate for Payer: Cigna Medicare |
$142.86
|
| Rate for Payer: Employer Direct Commercial |
$142.86
|
| Rate for Payer: Humana Medicare/TRICARE |
$142.86
|
| Rate for Payer: Molina CHIP/Medicaid |
$128.31
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$142.86
|
| Rate for Payer: Molina Medicare |
$142.86
|
| Rate for Payer: Multiplan Auto |
$1,026.35
|
| Rate for Payer: Multiplan Commercial |
$1,026.35
|
| Rate for Payer: Multiplan Workers Comp |
$1,026.35
|
| Rate for Payer: Parkland Medicaid |
$128.31
|
| Rate for Payer: Scott and White EPO/PPO |
$2.55
|
| Rate for Payer: Scott and White Medicare |
$142.86
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$128.31
|
| Rate for Payer: Superior Health Plan EPO |
$142.86
|
| Rate for Payer: Superior Health Plan Medicare |
$142.86
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$142.86
|
| Rate for Payer: Universal American Medicare |
$142.86
|
| Rate for Payer: Wellcare Medicare |
$142.86
|
| Rate for Payer: Wellmed Medicare |
$142.86
|
|
|
US Segmental Pressures LE 3+ Lvls Bilat BCE
|
Facility
|
IP
|
$1,579.00
|
|
|
Service Code
|
CPT 93923
|
| Hospital Charge Code |
3501038
|
|
Hospital Revenue Code
|
921
|
| Rate for Payer: Cash Price |
$1,389.52
|
|
|
US Segmental Pressures LE 3+ Lvls Bilat BCE
|
Facility
|
OP
|
$1,579.00
|
|
|
Service Code
|
CPT 93923
|
| Hospital Charge Code |
3501038
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$2.55 |
| Max. Negotiated Rate |
$1,026.35 |
| Rate for Payer: Aetna Commercial |
$215.61
|
| Rate for Payer: Aetna Medicare |
$214.29
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$142.11
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$142.86
|
| Rate for Payer: Amerigroup Medicare |
$142.86
|
| Rate for Payer: BCBS of TX Blue Advantage |
$197.52
|
| Rate for Payer: BCBS of TX Blue Essentials |
$236.12
|
| Rate for Payer: BCBS of TX Medicare |
$142.86
|
| Rate for Payer: BCBS of TX PPO |
$263.37
|
| Rate for Payer: Cash Price |
$1,389.52
|
| Rate for Payer: Cash Price |
$1,389.52
|
| Rate for Payer: Cash Price |
$1,389.52
|
| Rate for Payer: Cigna Commercial |
$323.61
|
| Rate for Payer: Cigna Medicaid |
$128.31
|
| Rate for Payer: Cigna Medicare |
$142.86
|
| Rate for Payer: Employer Direct Commercial |
$142.86
|
| Rate for Payer: Humana Medicare/TRICARE |
$142.86
|
| Rate for Payer: Molina CHIP/Medicaid |
$128.31
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$142.86
|
| Rate for Payer: Molina Medicare |
$142.86
|
| Rate for Payer: Multiplan Auto |
$1,026.35
|
| Rate for Payer: Multiplan Commercial |
$1,026.35
|
| Rate for Payer: Multiplan Workers Comp |
$1,026.35
|
| Rate for Payer: Parkland Medicaid |
$128.31
|
| Rate for Payer: Scott and White EPO/PPO |
$2.55
|
| Rate for Payer: Scott and White Medicare |
$142.86
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$128.31
|
| Rate for Payer: Superior Health Plan EPO |
$142.86
|
| Rate for Payer: Superior Health Plan Medicare |
$142.86
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$142.86
|
| Rate for Payer: Universal American Medicare |
$142.86
|
| Rate for Payer: Wellcare Medicare |
$142.86
|
| Rate for Payer: Wellmed Medicare |
$142.86
|
|
|
US Spinal Canal
|
Facility
|
OP
|
$704.00
|
|
|
Service Code
|
CPT 76800
|
| Hospital Charge Code |
3500253
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$457.60 |
| Rate for Payer: Aetna Commercial |
$101.13
|
| 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 |
$619.52
|
| Rate for Payer: Cash Price |
$619.52
|
| Rate for Payer: Cash Price |
$619.52
|
| 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 |
$457.60
|
| Rate for Payer: Multiplan Commercial |
$457.60
|
| Rate for Payer: Multiplan Workers Comp |
$457.60
|
| 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 Spinal Canal BCE
|
Facility
|
OP
|
$704.00
|
|
|
Service Code
|
CPT 76800
|
| Hospital Charge Code |
3500253
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$457.60 |
| Rate for Payer: Aetna Commercial |
$101.13
|
| 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 |
$619.52
|
| Rate for Payer: Cash Price |
$619.52
|
| Rate for Payer: Cash Price |
$619.52
|
| 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 |
$457.60
|
| Rate for Payer: Multiplan Commercial |
$457.60
|
| Rate for Payer: Multiplan Workers Comp |
$457.60
|
| 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 Spinal Canal BCE
|
Facility
|
IP
|
$704.00
|
|
|
Service Code
|
CPT 76800
|
| Hospital Charge Code |
3500253
|
|
Hospital Revenue Code
|
402
|
| Rate for Payer: Cash Price |
$619.52
|
|
|
US Thoracentesis Left
|
Facility
|
OP
|
$1,959.00
|
|
|
Service Code
|
CPT 32555 LT
|
| Hospital Charge Code |
3500000
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$12.67 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$1,400.00
|
| Rate for Payer: Aetna Medicare |
$861.78
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$223.75
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$574.52
|
| Rate for Payer: Amerigroup Medicare |
$574.52
|
| Rate for Payer: BCBS of TX Blue Advantage |
$1,052.95
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,261.02
|
| Rate for Payer: BCBS of TX Medicare |
$574.52
|
| Rate for Payer: BCBS of TX PPO |
$1,588.89
|
| Rate for Payer: Cash Price |
$1,723.92
|
| Rate for Payer: Cash Price |
$1,723.92
|
| Rate for Payer: Cigna Commercial |
$1,301.46
|
| Rate for Payer: Cigna Medicaid |
$223.75
|
| Rate for Payer: Cigna Medicare |
$574.52
|
| Rate for Payer: Employer Direct Commercial |
$574.52
|
| Rate for Payer: Humana Medicare/TRICARE |
$574.52
|
| Rate for Payer: Molina CHIP/Medicaid |
$223.75
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$574.52
|
| Rate for Payer: Molina Medicare |
$574.52
|
| 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 |
$223.75
|
| Rate for Payer: Scott and White EPO/PPO |
$12.67
|
| Rate for Payer: Scott and White Medicare |
$574.52
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$223.75
|
| Rate for Payer: Superior Health Plan EPO |
$574.52
|
| Rate for Payer: Superior Health Plan Medicare |
$574.52
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$574.52
|
| Rate for Payer: Universal American Medicare |
$574.52
|
| Rate for Payer: Wellcare Medicare |
$574.52
|
| Rate for Payer: Wellmed Medicare |
$574.52
|
|
|
US Thoracentesis Left BCE
|
Facility
|
OP
|
$1,959.00
|
|
|
Service Code
|
CPT 32555 LT
|
| Hospital Charge Code |
3500000
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$12.67 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$1,400.00
|
| Rate for Payer: Aetna Medicare |
$861.78
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$223.75
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$574.52
|
| Rate for Payer: Amerigroup Medicare |
$574.52
|
| Rate for Payer: BCBS of TX Blue Advantage |
$1,052.95
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,261.02
|
| Rate for Payer: BCBS of TX Medicare |
$574.52
|
| Rate for Payer: BCBS of TX PPO |
$1,588.89
|
| Rate for Payer: Cash Price |
$1,723.92
|
| Rate for Payer: Cash Price |
$1,723.92
|
| Rate for Payer: Cigna Commercial |
$1,301.46
|
| Rate for Payer: Cigna Medicaid |
$223.75
|
| Rate for Payer: Cigna Medicare |
$574.52
|
| Rate for Payer: Employer Direct Commercial |
$574.52
|
| Rate for Payer: Humana Medicare/TRICARE |
$574.52
|
| Rate for Payer: Molina CHIP/Medicaid |
$223.75
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$574.52
|
| Rate for Payer: Molina Medicare |
$574.52
|
| 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 |
$223.75
|
| Rate for Payer: Scott and White EPO/PPO |
$12.67
|
| Rate for Payer: Scott and White Medicare |
$574.52
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$223.75
|
| Rate for Payer: Superior Health Plan EPO |
$574.52
|
| Rate for Payer: Superior Health Plan Medicare |
$574.52
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$574.52
|
| Rate for Payer: Universal American Medicare |
$574.52
|
| Rate for Payer: Wellcare Medicare |
$574.52
|
| Rate for Payer: Wellmed Medicare |
$574.52
|
|
|
US Thoracentesis Right
|
Facility
|
OP
|
$1,959.00
|
|
|
Service Code
|
CPT 32555 RT
|
| Hospital Charge Code |
3500000
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$12.67 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$1,400.00
|
| Rate for Payer: Aetna Medicare |
$861.78
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$223.75
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$574.52
|
| Rate for Payer: Amerigroup Medicare |
$574.52
|
| Rate for Payer: BCBS of TX Blue Advantage |
$1,052.95
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,261.02
|
| Rate for Payer: BCBS of TX Medicare |
$574.52
|
| Rate for Payer: BCBS of TX PPO |
$1,588.89
|
| Rate for Payer: Cash Price |
$1,723.92
|
| Rate for Payer: Cash Price |
$1,723.92
|
| Rate for Payer: Cigna Commercial |
$1,301.46
|
| Rate for Payer: Cigna Medicaid |
$223.75
|
| Rate for Payer: Cigna Medicare |
$574.52
|
| Rate for Payer: Employer Direct Commercial |
$574.52
|
| Rate for Payer: Humana Medicare/TRICARE |
$574.52
|
| Rate for Payer: Molina CHIP/Medicaid |
$223.75
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$574.52
|
| Rate for Payer: Molina Medicare |
$574.52
|
| 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 |
$223.75
|
| Rate for Payer: Scott and White EPO/PPO |
$12.67
|
| Rate for Payer: Scott and White Medicare |
$574.52
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$223.75
|
| Rate for Payer: Superior Health Plan EPO |
$574.52
|
| Rate for Payer: Superior Health Plan Medicare |
$574.52
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$574.52
|
| Rate for Payer: Universal American Medicare |
$574.52
|
| Rate for Payer: Wellcare Medicare |
$574.52
|
| Rate for Payer: Wellmed Medicare |
$574.52
|
|
|
US Thoracentesis Right BCE
|
Facility
|
OP
|
$1,959.00
|
|
|
Service Code
|
CPT 32555 RT
|
| Hospital Charge Code |
3500000
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$12.67 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$1,400.00
|
| Rate for Payer: Aetna Medicare |
$861.78
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$223.75
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$574.52
|
| Rate for Payer: Amerigroup Medicare |
$574.52
|
| Rate for Payer: BCBS of TX Blue Advantage |
$1,052.95
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,261.02
|
| Rate for Payer: BCBS of TX Medicare |
$574.52
|
| Rate for Payer: BCBS of TX PPO |
$1,588.89
|
| Rate for Payer: Cash Price |
$1,723.92
|
| Rate for Payer: Cash Price |
$1,723.92
|
| Rate for Payer: Cigna Commercial |
$1,301.46
|
| Rate for Payer: Cigna Medicaid |
$223.75
|
| Rate for Payer: Cigna Medicare |
$574.52
|
| Rate for Payer: Employer Direct Commercial |
$574.52
|
| Rate for Payer: Humana Medicare/TRICARE |
$574.52
|
| Rate for Payer: Molina CHIP/Medicaid |
$223.75
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$574.52
|
| Rate for Payer: Molina Medicare |
$574.52
|
| 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 |
$223.75
|
| Rate for Payer: Scott and White EPO/PPO |
$12.67
|
| Rate for Payer: Scott and White Medicare |
$574.52
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$223.75
|
| Rate for Payer: Superior Health Plan EPO |
$574.52
|
| Rate for Payer: Superior Health Plan Medicare |
$574.52
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$574.52
|
| Rate for Payer: Universal American Medicare |
$574.52
|
| Rate for Payer: Wellcare Medicare |
$574.52
|
| Rate for Payer: Wellmed Medicare |
$574.52
|
|
|
US Thoracentesis Right BCE
|
Facility
|
IP
|
$1,959.00
|
|
|
Service Code
|
CPT 32555 RT
|
| Hospital Charge Code |
3500000
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$1,723.92
|
|
|
US Transcranial Doppler Complete
|
Facility
|
OP
|
$1,509.00
|
|
|
Service Code
|
CPT 93886
|
| Hospital Charge Code |
5063886
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$4.01 |
| Max. Negotiated Rate |
$980.85 |
| Rate for Payer: Aetna Commercial |
$455.63
|
| Rate for Payer: Aetna Medicare |
$336.15
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$135.81
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$224.10
|
| Rate for Payer: Amerigroup Medicare |
$224.10
|
| Rate for Payer: BCBS of TX Blue Advantage |
$396.95
|
| Rate for Payer: BCBS of TX Blue Essentials |
$474.51
|
| Rate for Payer: BCBS of TX Medicare |
$224.10
|
| Rate for Payer: BCBS of TX PPO |
$529.26
|
| Rate for Payer: Cash Price |
$1,327.92
|
| Rate for Payer: Cash Price |
$1,327.92
|
| Rate for Payer: Cash Price |
$1,327.92
|
| Rate for Payer: Cigna Commercial |
$507.64
|
| Rate for Payer: Cigna Medicaid |
$233.52
|
| 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 |
$233.52
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$224.10
|
| Rate for Payer: Molina Medicare |
$224.10
|
| Rate for Payer: Multiplan Auto |
$980.85
|
| Rate for Payer: Multiplan Commercial |
$980.85
|
| Rate for Payer: Multiplan Workers Comp |
$980.85
|
| Rate for Payer: Parkland Medicaid |
$233.52
|
| 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 |
$233.52
|
| 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
|
|
