|
US Transcranial Doppler Complete BCE
|
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
|
|
|
US Transcranial Doppler Complete BCE
|
Facility
|
IP
|
$1,509.00
|
|
|
Service Code
|
CPT 93886
|
| Hospital Charge Code |
5063886
|
|
Hospital Revenue Code
|
921
|
| Rate for Payer: Cash Price |
$1,327.92
|
|
|
US Transcranial Doppler Limited
|
Facility
|
OP
|
$991.00
|
|
|
Service Code
|
CPT 93888
|
| Hospital Charge Code |
5063888
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$644.15 |
| Rate for Payer: Aetna Commercial |
$217.65
|
| Rate for Payer: Aetna Medicare |
$150.82
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$89.19
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$100.55
|
| Rate for Payer: Amerigroup Medicare |
$100.55
|
| Rate for Payer: BCBS of TX Blue Advantage |
$195.65
|
| Rate for Payer: BCBS of TX Blue Essentials |
$233.88
|
| Rate for Payer: BCBS of TX Medicare |
$100.55
|
| Rate for Payer: BCBS of TX PPO |
$260.86
|
| Rate for Payer: Cash Price |
$872.08
|
| Rate for Payer: Cash Price |
$872.08
|
| Rate for Payer: Cash Price |
$872.08
|
| 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 |
$644.15
|
| Rate for Payer: Multiplan Commercial |
$644.15
|
| Rate for Payer: Multiplan Workers Comp |
$644.15
|
| 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 Transcranial Doppler Limited BCE
|
Facility
|
IP
|
$991.00
|
|
|
Service Code
|
CPT 93888
|
| Hospital Charge Code |
5063888
|
|
Hospital Revenue Code
|
921
|
| Rate for Payer: Cash Price |
$872.08
|
|
|
US Transcranial Doppler Limited BCE
|
Facility
|
OP
|
$991.00
|
|
|
Service Code
|
CPT 93888
|
| Hospital Charge Code |
5063888
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$644.15 |
| Rate for Payer: Aetna Commercial |
$217.65
|
| Rate for Payer: Aetna Medicare |
$150.82
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$89.19
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$100.55
|
| Rate for Payer: Amerigroup Medicare |
$100.55
|
| Rate for Payer: BCBS of TX Blue Advantage |
$195.65
|
| Rate for Payer: BCBS of TX Blue Essentials |
$233.88
|
| Rate for Payer: BCBS of TX Medicare |
$100.55
|
| Rate for Payer: BCBS of TX PPO |
$260.86
|
| Rate for Payer: Cash Price |
$872.08
|
| Rate for Payer: Cash Price |
$872.08
|
| Rate for Payer: Cash Price |
$872.08
|
| 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 |
$644.15
|
| Rate for Payer: Multiplan Commercial |
$644.15
|
| Rate for Payer: Multiplan Workers Comp |
$644.15
|
| 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 Transvaginal Non-OB
|
Facility
|
OP
|
$978.00
|
|
|
Service Code
|
CPT 76830
|
| Hospital Charge Code |
3500220
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$635.70 |
| 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 |
$145.70
|
| Rate for Payer: BCBS of TX Blue Essentials |
$174.83
|
| Rate for Payer: BCBS of TX Medicare |
$100.55
|
| Rate for Payer: BCBS of TX PPO |
$195.14
|
| Rate for Payer: Cash Price |
$860.64
|
| Rate for Payer: Cash Price |
$860.64
|
| Rate for Payer: Cash Price |
$860.64
|
| 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 |
$635.70
|
| Rate for Payer: Multiplan Commercial |
$635.70
|
| Rate for Payer: Multiplan Workers Comp |
$635.70
|
| Rate for Payer: Parkland Medicaid |
$106.88
|
| Rate for Payer: Scott and White EPO/PPO |
$1.80
|
| Rate for Payer: Scott and White Medicare |
$100.55
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$106.88
|
| Rate for Payer: Superior Health Plan EPO |
$100.55
|
| Rate for Payer: Superior Health Plan Medicare |
$100.55
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$100.55
|
| Rate for Payer: Universal American Medicare |
$100.55
|
| Rate for Payer: Wellcare Medicare |
$100.55
|
| Rate for Payer: Wellmed Medicare |
$100.55
|
|
|
US Transvaginal Non-OB BCE
|
Facility
|
OP
|
$978.00
|
|
|
Service Code
|
CPT 76830
|
| Hospital Charge Code |
3500220
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$635.70 |
| 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 |
$145.70
|
| Rate for Payer: BCBS of TX Blue Essentials |
$174.83
|
| Rate for Payer: BCBS of TX Medicare |
$100.55
|
| Rate for Payer: BCBS of TX PPO |
$195.14
|
| Rate for Payer: Cash Price |
$860.64
|
| Rate for Payer: Cash Price |
$860.64
|
| Rate for Payer: Cash Price |
$860.64
|
| 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 |
$635.70
|
| Rate for Payer: Multiplan Commercial |
$635.70
|
| Rate for Payer: Multiplan Workers Comp |
$635.70
|
| Rate for Payer: Parkland Medicaid |
$106.88
|
| Rate for Payer: Scott and White EPO/PPO |
$1.80
|
| Rate for Payer: Scott and White Medicare |
$100.55
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$106.88
|
| Rate for Payer: Superior Health Plan EPO |
$100.55
|
| Rate for Payer: Superior Health Plan Medicare |
$100.55
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$100.55
|
| Rate for Payer: Universal American Medicare |
$100.55
|
| Rate for Payer: Wellcare Medicare |
$100.55
|
| Rate for Payer: Wellmed Medicare |
$100.55
|
|
|
US Transvaginal Non-OB BCE
|
Facility
|
IP
|
$978.00
|
|
|
Service Code
|
CPT 76830
|
| Hospital Charge Code |
3500220
|
|
Hospital Revenue Code
|
402
|
| Rate for Payer: Cash Price |
$860.64
|
|
|
US Upper Ext Art Doppler 3+ Lvls Bilat
|
Facility
|
OP
|
$1,579.00
|
|
|
Service Code
|
CPT 93923
|
| Hospital Charge Code |
5067198
|
|
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 Upper Ext Art Doppler 3+ Lvls Bilat BCE
|
Facility
|
IP
|
$1,579.00
|
|
|
Service Code
|
CPT 93923
|
| Hospital Charge Code |
5067198
|
|
Hospital Revenue Code
|
921
|
| Rate for Payer: Cash Price |
$1,389.52
|
|
|
US Upper Ext Art Doppler 3+ Lvls Bilat BCE
|
Facility
|
OP
|
$1,579.00
|
|
|
Service Code
|
CPT 93923
|
| Hospital Charge Code |
5067198
|
|
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 Upper Ext Arterial Duplex Bilateral
|
Facility
|
OP
|
$2,497.00
|
|
|
Service Code
|
CPT 93930
|
| Hospital Charge Code |
3501046
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$4.01 |
| Max. Negotiated Rate |
$1,623.05 |
| Rate for Payer: Aetna Commercial |
$322.76
|
| Rate for Payer: Aetna Medicare |
$336.15
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$224.73
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$224.10
|
| Rate for Payer: Amerigroup Medicare |
$224.10
|
| Rate for Payer: BCBS of TX Blue Advantage |
$294.09
|
| Rate for Payer: BCBS of TX Blue Essentials |
$351.56
|
| Rate for Payer: BCBS of TX Medicare |
$224.10
|
| Rate for Payer: BCBS of TX PPO |
$392.13
|
| Rate for Payer: Cash Price |
$2,197.36
|
| Rate for Payer: Cash Price |
$2,197.36
|
| Rate for Payer: Cash Price |
$2,197.36
|
| Rate for Payer: Cigna Commercial |
$507.64
|
| Rate for Payer: Cigna Medicaid |
$196.14
|
| 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 |
$196.14
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$224.10
|
| Rate for Payer: Molina Medicare |
$224.10
|
| Rate for Payer: Multiplan Auto |
$1,623.05
|
| Rate for Payer: Multiplan Commercial |
$1,623.05
|
| Rate for Payer: Multiplan Workers Comp |
$1,623.05
|
| Rate for Payer: Parkland Medicaid |
$196.14
|
| 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 |
$196.14
|
| 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 Upper Ext Arterial Duplex Bilateral BCE
|
Facility
|
IP
|
$2,497.00
|
|
|
Service Code
|
CPT 93930
|
| Hospital Charge Code |
3501046
|
|
Hospital Revenue Code
|
921
|
| Rate for Payer: Cash Price |
$2,197.36
|
|
|
US Upper Ext Arterial Duplex Bilateral BCE
|
Facility
|
OP
|
$2,497.00
|
|
|
Service Code
|
CPT 93930
|
| Hospital Charge Code |
3501046
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$4.01 |
| Max. Negotiated Rate |
$1,623.05 |
| Rate for Payer: Aetna Commercial |
$322.76
|
| Rate for Payer: Aetna Medicare |
$336.15
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$224.73
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$224.10
|
| Rate for Payer: Amerigroup Medicare |
$224.10
|
| Rate for Payer: BCBS of TX Blue Advantage |
$294.09
|
| Rate for Payer: BCBS of TX Blue Essentials |
$351.56
|
| Rate for Payer: BCBS of TX Medicare |
$224.10
|
| Rate for Payer: BCBS of TX PPO |
$392.13
|
| Rate for Payer: Cash Price |
$2,197.36
|
| Rate for Payer: Cash Price |
$2,197.36
|
| Rate for Payer: Cash Price |
$2,197.36
|
| Rate for Payer: Cigna Commercial |
$507.64
|
| Rate for Payer: Cigna Medicaid |
$196.14
|
| 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 |
$196.14
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$224.10
|
| Rate for Payer: Molina Medicare |
$224.10
|
| Rate for Payer: Multiplan Auto |
$1,623.05
|
| Rate for Payer: Multiplan Commercial |
$1,623.05
|
| Rate for Payer: Multiplan Workers Comp |
$1,623.05
|
| Rate for Payer: Parkland Medicaid |
$196.14
|
| 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 |
$196.14
|
| 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 Upper Ext Arterial Duplex Left
|
Facility
|
OP
|
$1,946.00
|
|
|
Service Code
|
CPT 93931 LT
|
| Hospital Charge Code |
3500204
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$1,264.90 |
| Rate for Payer: Aetna Commercial |
$205.45
|
| Rate for Payer: Aetna Medicare |
$150.82
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$175.14
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$100.55
|
| Rate for Payer: Amerigroup Medicare |
$100.55
|
| Rate for Payer: BCBS of TX Blue Advantage |
$183.73
|
| Rate for Payer: BCBS of TX Blue Essentials |
$219.63
|
| Rate for Payer: BCBS of TX Medicare |
$100.55
|
| Rate for Payer: BCBS of TX PPO |
$244.97
|
| Rate for Payer: Cash Price |
$1,712.48
|
| Rate for Payer: Cash Price |
$1,712.48
|
| Rate for Payer: Cash Price |
$1,712.48
|
| 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 |
$1,264.90
|
| Rate for Payer: Multiplan Commercial |
$1,264.90
|
| Rate for Payer: Multiplan Workers Comp |
$1,264.90
|
| 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 Upper Ext Arterial Duplex Left BCE
|
Facility
|
IP
|
$1,946.00
|
|
|
Service Code
|
CPT 93931 LT
|
| Hospital Charge Code |
3500204
|
|
Hospital Revenue Code
|
921
|
| Rate for Payer: Cash Price |
$1,712.48
|
|
|
US Upper Ext Arterial Duplex Left BCE
|
Facility
|
OP
|
$1,946.00
|
|
|
Service Code
|
CPT 93931 LT
|
| Hospital Charge Code |
3500204
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$1,264.90 |
| Rate for Payer: Aetna Commercial |
$205.45
|
| Rate for Payer: Aetna Medicare |
$150.82
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$175.14
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$100.55
|
| Rate for Payer: Amerigroup Medicare |
$100.55
|
| Rate for Payer: BCBS of TX Blue Advantage |
$183.73
|
| Rate for Payer: BCBS of TX Blue Essentials |
$219.63
|
| Rate for Payer: BCBS of TX Medicare |
$100.55
|
| Rate for Payer: BCBS of TX PPO |
$244.97
|
| Rate for Payer: Cash Price |
$1,712.48
|
| Rate for Payer: Cash Price |
$1,712.48
|
| Rate for Payer: Cash Price |
$1,712.48
|
| 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 |
$1,264.90
|
| Rate for Payer: Multiplan Commercial |
$1,264.90
|
| Rate for Payer: Multiplan Workers Comp |
$1,264.90
|
| 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 Upper Ext Arterial Duplex Right
|
Facility
|
OP
|
$1,946.00
|
|
|
Service Code
|
CPT 93931 RT
|
| Hospital Charge Code |
3500881
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$1,264.90 |
| Rate for Payer: Aetna Commercial |
$205.45
|
| Rate for Payer: Aetna Medicare |
$150.82
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$175.14
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$100.55
|
| Rate for Payer: Amerigroup Medicare |
$100.55
|
| Rate for Payer: BCBS of TX Blue Advantage |
$183.73
|
| Rate for Payer: BCBS of TX Blue Essentials |
$219.63
|
| Rate for Payer: BCBS of TX Medicare |
$100.55
|
| Rate for Payer: BCBS of TX PPO |
$244.97
|
| Rate for Payer: Cash Price |
$1,712.48
|
| Rate for Payer: Cash Price |
$1,712.48
|
| Rate for Payer: Cash Price |
$1,712.48
|
| 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 |
$1,264.90
|
| Rate for Payer: Multiplan Commercial |
$1,264.90
|
| Rate for Payer: Multiplan Workers Comp |
$1,264.90
|
| 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 Upper Ext Arterial Duplex Right BCE
|
Facility
|
IP
|
$1,946.00
|
|
|
Service Code
|
CPT 93931 RT
|
| Hospital Charge Code |
3500881
|
|
Hospital Revenue Code
|
921
|
| Rate for Payer: Cash Price |
$1,712.48
|
|
|
US Upper Ext Arterial Duplex Right BCE
|
Facility
|
OP
|
$1,946.00
|
|
|
Service Code
|
CPT 93931 RT
|
| Hospital Charge Code |
3500881
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$1,264.90 |
| Rate for Payer: Aetna Commercial |
$205.45
|
| Rate for Payer: Aetna Medicare |
$150.82
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$175.14
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$100.55
|
| Rate for Payer: Amerigroup Medicare |
$100.55
|
| Rate for Payer: BCBS of TX Blue Advantage |
$183.73
|
| Rate for Payer: BCBS of TX Blue Essentials |
$219.63
|
| Rate for Payer: BCBS of TX Medicare |
$100.55
|
| Rate for Payer: BCBS of TX PPO |
$244.97
|
| Rate for Payer: Cash Price |
$1,712.48
|
| Rate for Payer: Cash Price |
$1,712.48
|
| Rate for Payer: Cash Price |
$1,712.48
|
| 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 |
$1,264.90
|
| Rate for Payer: Multiplan Commercial |
$1,264.90
|
| Rate for Payer: Multiplan Workers Comp |
$1,264.90
|
| 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 Upper Extremity Joint Complete Left
|
Facility
|
OP
|
$974.00
|
|
|
Service Code
|
CPT 76881 LT
|
| Hospital Charge Code |
3530082
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$633.10 |
| Rate for Payer: Aetna Commercial |
$32.57
|
| Rate for Payer: Aetna Medicare |
$150.82
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$96.28
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$100.55
|
| Rate for Payer: Amerigroup Medicare |
$100.55
|
| Rate for Payer: BCBS of TX Blue Advantage |
$95.73
|
| Rate for Payer: BCBS of TX Blue Essentials |
$114.88
|
| Rate for Payer: BCBS of TX Medicare |
$100.55
|
| Rate for Payer: BCBS of TX PPO |
$128.22
|
| Rate for Payer: Cash Price |
$857.12
|
| Rate for Payer: Cash Price |
$857.12
|
| Rate for Payer: Cash Price |
$857.12
|
| Rate for Payer: Cigna Commercial |
$227.77
|
| Rate for Payer: Cigna Medicaid |
$24.06
|
| Rate for Payer: Cigna Medicare |
$100.55
|
| Rate for Payer: Employer Direct Commercial |
$100.55
|
| Rate for Payer: Humana Medicare/TRICARE |
$100.55
|
| Rate for Payer: Molina CHIP/Medicaid |
$24.06
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$100.55
|
| Rate for Payer: Molina Medicare |
$100.55
|
| Rate for Payer: Multiplan Auto |
$633.10
|
| Rate for Payer: Multiplan Commercial |
$633.10
|
| Rate for Payer: Multiplan Workers Comp |
$633.10
|
| Rate for Payer: Parkland Medicaid |
$24.06
|
| Rate for Payer: Scott and White EPO/PPO |
$1.80
|
| Rate for Payer: Scott and White Medicare |
$100.55
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$24.06
|
| Rate for Payer: Superior Health Plan EPO |
$100.55
|
| Rate for Payer: Superior Health Plan Medicare |
$100.55
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$100.55
|
| Rate for Payer: Universal American Medicare |
$100.55
|
| Rate for Payer: Wellcare Medicare |
$100.55
|
| Rate for Payer: Wellmed Medicare |
$100.55
|
|
|
US Upper Extremity Joint Complete Left
|
Facility
|
IP
|
$974.00
|
|
|
Service Code
|
CPT 76881 LT
|
| Hospital Charge Code |
3530082
|
|
Hospital Revenue Code
|
402
|
| Rate for Payer: Cash Price |
$857.12
|
|
|
US Upper Extremity Joint Complete Right
|
Facility
|
OP
|
$974.00
|
|
|
Service Code
|
CPT 76881 RT
|
| Hospital Charge Code |
3530081
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$633.10 |
| Rate for Payer: Aetna Commercial |
$32.57
|
| Rate for Payer: Aetna Medicare |
$150.82
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$96.28
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$100.55
|
| Rate for Payer: Amerigroup Medicare |
$100.55
|
| Rate for Payer: BCBS of TX Blue Advantage |
$95.73
|
| Rate for Payer: BCBS of TX Blue Essentials |
$114.88
|
| Rate for Payer: BCBS of TX Medicare |
$100.55
|
| Rate for Payer: BCBS of TX PPO |
$128.22
|
| Rate for Payer: Cash Price |
$857.12
|
| Rate for Payer: Cash Price |
$857.12
|
| Rate for Payer: Cash Price |
$857.12
|
| Rate for Payer: Cigna Commercial |
$227.77
|
| Rate for Payer: Cigna Medicaid |
$24.06
|
| Rate for Payer: Cigna Medicare |
$100.55
|
| Rate for Payer: Employer Direct Commercial |
$100.55
|
| Rate for Payer: Humana Medicare/TRICARE |
$100.55
|
| Rate for Payer: Molina CHIP/Medicaid |
$24.06
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$100.55
|
| Rate for Payer: Molina Medicare |
$100.55
|
| Rate for Payer: Multiplan Auto |
$633.10
|
| Rate for Payer: Multiplan Commercial |
$633.10
|
| Rate for Payer: Multiplan Workers Comp |
$633.10
|
| Rate for Payer: Parkland Medicaid |
$24.06
|
| Rate for Payer: Scott and White EPO/PPO |
$1.80
|
| Rate for Payer: Scott and White Medicare |
$100.55
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$24.06
|
| Rate for Payer: Superior Health Plan EPO |
$100.55
|
| Rate for Payer: Superior Health Plan Medicare |
$100.55
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$100.55
|
| Rate for Payer: Universal American Medicare |
$100.55
|
| Rate for Payer: Wellcare Medicare |
$100.55
|
| Rate for Payer: Wellmed Medicare |
$100.55
|
|
|
US Upper Extremity Joint Complete Right
|
Facility
|
IP
|
$974.00
|
|
|
Service Code
|
CPT 76881 RT
|
| Hospital Charge Code |
3530081
|
|
Hospital Revenue Code
|
402
|
| Rate for Payer: Cash Price |
$857.12
|
|
|
US Upper Extremity Joint Limited Bilat
|
Facility
|
OP
|
$844.00
|
|
|
Service Code
|
CPT 76882
|
| Hospital Charge Code |
3530083
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$548.60 |
| Rate for Payer: Aetna Commercial |
$37.96
|
| Rate for Payer: Aetna Medicare |
$150.82
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$30.35
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$100.55
|
| Rate for Payer: Amerigroup Medicare |
$100.55
|
| Rate for Payer: BCBS of TX Blue Advantage |
$184.93
|
| Rate for Payer: BCBS of TX Blue Essentials |
$221.92
|
| Rate for Payer: BCBS of TX Medicare |
$100.55
|
| Rate for Payer: BCBS of TX PPO |
$247.70
|
| Rate for Payer: Cash Price |
$742.72
|
| Rate for Payer: Cash Price |
$742.72
|
| Rate for Payer: Cash Price |
$742.72
|
| Rate for Payer: Cigna Commercial |
$227.77
|
| Rate for Payer: Cigna Medicaid |
$30.35
|
| Rate for Payer: Cigna Medicare |
$100.55
|
| Rate for Payer: Employer Direct Commercial |
$100.55
|
| Rate for Payer: Humana Medicare/TRICARE |
$100.55
|
| Rate for Payer: Molina CHIP/Medicaid |
$30.35
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$100.55
|
| Rate for Payer: Molina Medicare |
$100.55
|
| Rate for Payer: Multiplan Auto |
$548.60
|
| Rate for Payer: Multiplan Commercial |
$548.60
|
| Rate for Payer: Multiplan Workers Comp |
$548.60
|
| Rate for Payer: Parkland Medicaid |
$30.35
|
| Rate for Payer: Scott and White EPO/PPO |
$1.80
|
| Rate for Payer: Scott and White Medicare |
$100.55
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$30.35
|
| Rate for Payer: Superior Health Plan EPO |
$100.55
|
| Rate for Payer: Superior Health Plan Medicare |
$100.55
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$100.55
|
| Rate for Payer: Universal American Medicare |
$100.55
|
| Rate for Payer: Wellcare Medicare |
$100.55
|
| Rate for Payer: Wellmed Medicare |
$100.55
|
|
