|
US Upper Extremity Joint Limited Left
|
Facility
|
OP
|
$844.00
|
|
|
Service Code
|
CPT 76882 LT
|
| Hospital Charge Code |
3530083
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$18.71 |
| 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: BCBS of TX Blue Advantage |
$184.93
|
| Rate for Payer: BCBS of TX Blue Essentials |
$221.92
|
| 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 |
$18.71
|
| Rate for Payer: Molina CHIP/Medicaid |
$18.71
|
| 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 |
$18.71
|
| Rate for Payer: Scott and White EPO/PPO |
$422.00
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$18.71
|
| Rate for Payer: Superior Health Plan EPO |
$114.78
|
|
|
US Upper Extremity Joint Limited Right
|
Facility
|
OP
|
$844.00
|
|
|
Service Code
|
CPT 76882 RT
|
| Hospital Charge Code |
3530083
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$18.71 |
| 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: BCBS of TX Blue Advantage |
$184.93
|
| Rate for Payer: BCBS of TX Blue Essentials |
$221.92
|
| 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 |
$18.71
|
| Rate for Payer: Molina CHIP/Medicaid |
$18.71
|
| 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 |
$18.71
|
| Rate for Payer: Scott and White EPO/PPO |
$422.00
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$18.71
|
| Rate for Payer: Superior Health Plan EPO |
$114.78
|
|
|
US Upper Extremity Joint Limited Right
|
Facility
|
IP
|
$844.00
|
|
|
Service Code
|
CPT 76882 RT
|
| Hospital Charge Code |
3530083
|
|
Hospital Revenue Code
|
402
|
| Rate for Payer: Cash Price |
$742.72
|
|
|
US Upper Extremity Soft Tissue Ltd Bilat
|
Facility
|
OP
|
$844.00
|
|
|
Service Code
|
CPT 76882
|
| Hospital Charge Code |
3530084
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$18.71 |
| 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 |
$78.16
|
| 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
|
|
|
US Upper Extremity Soft Tissue Ltd Left
|
Facility
|
OP
|
$844.00
|
|
|
Service Code
|
CPT 76882 LT
|
| Hospital Charge Code |
3530084
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$18.71 |
| 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: BCBS of TX Blue Advantage |
$184.93
|
| Rate for Payer: BCBS of TX Blue Essentials |
$221.92
|
| 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 |
$18.71
|
| Rate for Payer: Molina CHIP/Medicaid |
$18.71
|
| 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 |
$18.71
|
| Rate for Payer: Scott and White EPO/PPO |
$422.00
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$18.71
|
| Rate for Payer: Superior Health Plan EPO |
$114.78
|
|
|
US Upper Extremity Soft Tissue Ltd Right
|
Facility
|
IP
|
$844.00
|
|
|
Service Code
|
CPT 76882 RT
|
| Hospital Charge Code |
3530084
|
|
Hospital Revenue Code
|
402
|
| Rate for Payer: Cash Price |
$742.72
|
|
|
US Upper Extremity Soft Tissue Ltd Right
|
Facility
|
OP
|
$844.00
|
|
|
Service Code
|
CPT 76882 RT
|
| Hospital Charge Code |
3530084
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$18.71 |
| 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: BCBS of TX Blue Advantage |
$184.93
|
| Rate for Payer: BCBS of TX Blue Essentials |
$221.92
|
| 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 |
$18.71
|
| Rate for Payer: Molina CHIP/Medicaid |
$18.71
|
| 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 |
$18.71
|
| Rate for Payer: Scott and White EPO/PPO |
$422.00
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$18.71
|
| Rate for Payer: Superior Health Plan EPO |
$114.78
|
|
|
US Upper Ext Segmental Pressures (ABI)
|
Facility
|
OP
|
$720.00
|
|
|
Service Code
|
CPT 93922
|
| Hospital Charge Code |
5067196
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$64.80 |
| 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 |
$101.58
|
| 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 Upper Ext Segmental Pressures (ABI) BCE
|
Facility
|
OP
|
$720.00
|
|
|
Service Code
|
CPT 93922
|
| Hospital Charge Code |
5067196
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$64.80 |
| 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 |
$101.58
|
| 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 Upper Ext Segmental Pressures (ABI) BCE
|
Facility
|
IP
|
$720.00
|
|
|
Service Code
|
CPT 93922
|
| Hospital Charge Code |
5067196
|
|
Hospital Revenue Code
|
921
|
| Rate for Payer: Cash Price |
$633.60
|
|
|
US Upper Ext Venous Duplex Bilateral
|
Facility
|
OP
|
$2,850.00
|
|
|
Service Code
|
CPT 93970
|
| Hospital Charge Code |
3500246
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$188.79 |
| Max. Negotiated Rate |
$1,852.50 |
| Rate for Payer: Aetna Commercial |
$315.95
|
| Rate for Payer: Aetna Medicare |
$336.15
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$256.50
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$224.10
|
| Rate for Payer: Amerigroup Medicare |
$224.10
|
| Rate for Payer: BCBS of TX Blue Advantage |
$284.70
|
| Rate for Payer: BCBS of TX Blue Essentials |
$340.33
|
| Rate for Payer: BCBS of TX Medicare |
$224.10
|
| Rate for Payer: BCBS of TX PPO |
$379.60
|
| Rate for Payer: Cash Price |
$2,508.00
|
| Rate for Payer: Cash Price |
$2,508.00
|
| Rate for Payer: Cash Price |
$2,508.00
|
| Rate for Payer: Cigna Commercial |
$507.64
|
| Rate for Payer: Cigna Medicaid |
$188.79
|
| 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 |
$188.79
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$224.10
|
| Rate for Payer: Molina Medicare |
$224.10
|
| Rate for Payer: Multiplan Auto |
$1,852.50
|
| Rate for Payer: Multiplan Commercial |
$1,852.50
|
| Rate for Payer: Multiplan Workers Comp |
$1,852.50
|
| Rate for Payer: Parkland Medicaid |
$188.79
|
| Rate for Payer: Scott and White EPO/PPO |
$230.86
|
| Rate for Payer: Scott and White Medicare |
$224.10
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$188.79
|
| 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 Venous Duplex Bilateral BCE
|
Facility
|
OP
|
$2,850.00
|
|
|
Service Code
|
CPT 93970
|
| Hospital Charge Code |
3500246
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$188.79 |
| Max. Negotiated Rate |
$1,852.50 |
| Rate for Payer: Aetna Commercial |
$315.95
|
| Rate for Payer: Aetna Medicare |
$336.15
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$256.50
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$224.10
|
| Rate for Payer: Amerigroup Medicare |
$224.10
|
| Rate for Payer: BCBS of TX Blue Advantage |
$284.70
|
| Rate for Payer: BCBS of TX Blue Essentials |
$340.33
|
| Rate for Payer: BCBS of TX Medicare |
$224.10
|
| Rate for Payer: BCBS of TX PPO |
$379.60
|
| Rate for Payer: Cash Price |
$2,508.00
|
| Rate for Payer: Cash Price |
$2,508.00
|
| Rate for Payer: Cash Price |
$2,508.00
|
| Rate for Payer: Cigna Commercial |
$507.64
|
| Rate for Payer: Cigna Medicaid |
$188.79
|
| 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 |
$188.79
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$224.10
|
| Rate for Payer: Molina Medicare |
$224.10
|
| Rate for Payer: Multiplan Auto |
$1,852.50
|
| Rate for Payer: Multiplan Commercial |
$1,852.50
|
| Rate for Payer: Multiplan Workers Comp |
$1,852.50
|
| Rate for Payer: Parkland Medicaid |
$188.79
|
| Rate for Payer: Scott and White EPO/PPO |
$230.86
|
| Rate for Payer: Scott and White Medicare |
$224.10
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$188.79
|
| 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 Venous Duplex Bilateral BCE
|
Facility
|
IP
|
$2,850.00
|
|
|
Service Code
|
CPT 93970
|
| Hospital Charge Code |
3500246
|
|
Hospital Revenue Code
|
921
|
| Rate for Payer: Cash Price |
$2,508.00
|
|
|
US Upper Ext Venous Duplex Left
|
Facility
|
OP
|
$1,906.00
|
|
|
Service Code
|
CPT 93971 LT
|
| Hospital Charge Code |
3500840
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$16.84 |
| 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: BCBS of TX Blue Advantage |
$174.33
|
| Rate for Payer: BCBS of TX Blue Essentials |
$208.40
|
| 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: Molina CHIP/Medicaid |
$16.84
|
| 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 |
$953.00
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$16.84
|
| Rate for Payer: Superior Health Plan EPO |
$259.22
|
|
|
US Upper Ext Venous Duplex Left BCE
|
Facility
|
IP
|
$1,906.00
|
|
|
Service Code
|
CPT 93971 LT
|
| Hospital Charge Code |
3500840
|
|
Hospital Revenue Code
|
921
|
| Rate for Payer: Cash Price |
$1,677.28
|
|
|
US Upper Ext Venous Duplex Left BCE
|
Facility
|
OP
|
$1,906.00
|
|
|
Service Code
|
CPT 93971 LT
|
| Hospital Charge Code |
3500840
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$16.84 |
| 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: BCBS of TX Blue Advantage |
$174.33
|
| Rate for Payer: BCBS of TX Blue Essentials |
$208.40
|
| 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: Molina CHIP/Medicaid |
$16.84
|
| 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 |
$953.00
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$16.84
|
| Rate for Payer: Superior Health Plan EPO |
$259.22
|
|
|
US Upper 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 |
$16.84 |
| 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: BCBS of TX Blue Advantage |
$174.33
|
| Rate for Payer: BCBS of TX Blue Essentials |
$208.40
|
| 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: Molina CHIP/Medicaid |
$16.84
|
| 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 |
$953.00
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$16.84
|
| Rate for Payer: Superior Health Plan EPO |
$259.22
|
|
|
US Upper 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 |
$16.84 |
| 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: BCBS of TX Blue Advantage |
$174.33
|
| Rate for Payer: BCBS of TX Blue Essentials |
$208.40
|
| 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: Molina CHIP/Medicaid |
$16.84
|
| 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 |
$953.00
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$16.84
|
| Rate for Payer: Superior Health Plan EPO |
$259.22
|
|
|
US Upper Ext Venous Duplex Right BCE
|
Facility
|
IP
|
$1,906.00
|
|
|
Service Code
|
CPT 93971 RT
|
| Hospital Charge Code |
3500279
|
|
Hospital Revenue Code
|
921
|
| Rate for Payer: Cash Price |
$1,677.28
|
|
|
UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITH CC/MCC
|
Facility
|
IP
|
$23,355.78
|
|
|
Service Code
|
MSDRG 742
|
| Min. Negotiated Rate |
$13,834.82 |
| Max. Negotiated Rate |
$23,355.78 |
| Rate for Payer: Aetna Commercial |
$20,046.38
|
| Rate for Payer: Aetna Medicare |
$23,355.78
|
| Rate for Payer: BCBS of TX Blue Advantage |
$13,834.82
|
| Rate for Payer: BCBS of TX Blue Essentials |
$17,686.77
|
| Rate for Payer: BCBS of TX PPO |
$19,652.72
|
| Rate for Payer: Cigna Commercial |
$22,950.87
|
|
|
UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITHOUT CC/MCC
|
Facility
|
IP
|
$16,720.32
|
|
|
Service Code
|
MSDRG 743
|
| Min. Negotiated Rate |
$8,743.62 |
| Max. Negotiated Rate |
$16,720.32 |
| Rate for Payer: Aetna Commercial |
$13,072.50
|
| Rate for Payer: Aetna Medicare |
$16,720.32
|
| Rate for Payer: BCBS of TX Blue Advantage |
$8,743.62
|
| Rate for Payer: BCBS of TX Blue Essentials |
$11,511.88
|
| Rate for Payer: BCBS of TX PPO |
$12,791.47
|
| Rate for Payer: Cigna Commercial |
$14,966.56
|
|
|
UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH CC
|
Facility
|
IP
|
$23,410.37
|
|
|
Service Code
|
MSDRG 740
|
| Min. Negotiated Rate |
$14,670.74 |
| Max. Negotiated Rate |
$23,410.37 |
| Rate for Payer: Aetna Commercial |
$20,103.75
|
| Rate for Payer: Aetna Medicare |
$23,410.37
|
| Rate for Payer: BCBS of TX Blue Advantage |
$14,670.74
|
| Rate for Payer: BCBS of TX Blue Essentials |
$17,984.99
|
| Rate for Payer: BCBS of TX PPO |
$19,984.09
|
| Rate for Payer: Cigna Commercial |
$23,016.56
|
|
|
UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH MCC
|
Facility
|
IP
|
$46,577.94
|
|
|
Service Code
|
MSDRG 739
|
| Min. Negotiated Rate |
$30,093.12 |
| Max. Negotiated Rate |
$46,577.94 |
| Rate for Payer: Aetna Commercial |
$40,683.38
|
| Rate for Payer: Aetna Medicare |
$42,991.36
|
| Rate for Payer: BCBS of TX Blue Advantage |
$30,093.12
|
| Rate for Payer: BCBS of TX Blue Essentials |
$37,124.67
|
| Rate for Payer: BCBS of TX PPO |
$41,251.23
|
| Rate for Payer: Cigna Commercial |
$46,577.94
|
|
|
UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITHOUT CC/MCC
|
Facility
|
IP
|
$18,189.97
|
|
|
Service Code
|
MSDRG 741
|
| Min. Negotiated Rate |
$10,627.88 |
| Max. Negotiated Rate |
$18,189.97 |
| Rate for Payer: Aetna Commercial |
$14,617.12
|
| Rate for Payer: Aetna Medicare |
$18,189.97
|
| Rate for Payer: BCBS of TX Blue Advantage |
$10,627.88
|
| Rate for Payer: BCBS of TX Blue Essentials |
$13,701.57
|
| Rate for Payer: BCBS of TX PPO |
$15,224.55
|
| Rate for Payer: Cigna Commercial |
$16,734.98
|
|
|
UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH CC
|
Facility
|
IP
|
$25,422.54
|
|
|
Service Code
|
MSDRG 737
|
| Min. Negotiated Rate |
$16,781.18 |
| Max. Negotiated Rate |
$25,422.54 |
| Rate for Payer: Aetna Commercial |
$22,205.25
|
| Rate for Payer: Aetna Medicare |
$25,409.91
|
| Rate for Payer: BCBS of TX Blue Advantage |
$16,781.18
|
| Rate for Payer: BCBS of TX Blue Essentials |
$20,962.02
|
| Rate for Payer: BCBS of TX PPO |
$23,292.03
|
| Rate for Payer: Cigna Commercial |
$25,422.54
|
|
