|
WC Dressing/Debridement Burns, Small BCE
|
Facility
|
OP
|
$413.00
|
|
|
Service Code
|
CPT 16020
|
| Hospital Charge Code |
7150819
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3.27 |
| Max. Negotiated Rate |
$440.32 |
| Rate for Payer: Aetna Commercial |
$227.15
|
| Rate for Payer: Aetna Medicare |
$274.64
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$37.17
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$183.09
|
| Rate for Payer: Amerigroup Medicare |
$183.09
|
| Rate for Payer: BCBS of TX Blue Advantage |
$291.80
|
| Rate for Payer: BCBS of TX Blue Essentials |
$349.46
|
| Rate for Payer: BCBS of TX Medicare |
$183.09
|
| Rate for Payer: BCBS of TX PPO |
$440.32
|
| Rate for Payer: Cash Price |
$363.44
|
| Rate for Payer: Cash Price |
$363.44
|
| Rate for Payer: Cash Price |
$363.44
|
| Rate for Payer: Cigna Commercial |
$414.75
|
| Rate for Payer: Cigna Medicaid |
$44.31
|
| Rate for Payer: Cigna Medicare |
$183.09
|
| Rate for Payer: Employer Direct Commercial |
$183.09
|
| Rate for Payer: Humana Medicare/TRICARE |
$183.09
|
| Rate for Payer: Molina CHIP/Medicaid |
$44.31
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$183.09
|
| Rate for Payer: Molina Medicare |
$183.09
|
| Rate for Payer: Multiplan Auto |
$268.45
|
| Rate for Payer: Multiplan Commercial |
$268.45
|
| Rate for Payer: Multiplan Workers Comp |
$268.45
|
| Rate for Payer: Parkland Medicaid |
$44.31
|
| Rate for Payer: Scott and White EPO/PPO |
$3.27
|
| Rate for Payer: Scott and White Medicare |
$183.09
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$44.31
|
| Rate for Payer: Superior Health Plan EPO |
$183.09
|
| Rate for Payer: Superior Health Plan Medicare |
$183.09
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$183.09
|
| Rate for Payer: Universal American Medicare |
$183.09
|
| Rate for Payer: Wellcare Medicare |
$183.09
|
| Rate for Payer: Wellmed Medicare |
$183.09
|
|
|
WC Duplex Scan Extremity Veins Complete Bilateral BCE
|
Facility
|
OP
|
$2,850.00
|
|
|
Service Code
|
CPT 93970
|
| Hospital Charge Code |
7100332
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$4.01 |
| 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 |
$4.01
|
| 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
|
|
|
WC Duplex Scan Extremity Veins Complete Bilateral BCE
|
Facility
|
IP
|
$2,850.00
|
|
|
Service Code
|
CPT 93970
|
| Hospital Charge Code |
7100332
|
|
Hospital Revenue Code
|
921
|
| Rate for Payer: Cash Price |
$2,508.00
|
|
|
WC Epdrml Atgrft,Face/Nk/Hf BCE
|
Facility
|
OP
|
$5,070.00
|
|
|
Service Code
|
CPT 15115
|
| Hospital Charge Code |
7150914
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$36.79 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$2,200.00
|
| Rate for Payer: Aetna Medicare |
$2,501.68
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$709.01
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,667.79
|
| Rate for Payer: Amerigroup Medicare |
$1,667.79
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,709.98
|
| Rate for Payer: BCBS of TX Blue Essentials |
$3,245.48
|
| Rate for Payer: BCBS of TX Medicare |
$1,667.79
|
| Rate for Payer: BCBS of TX PPO |
$4,089.30
|
| Rate for Payer: Cash Price |
$4,461.60
|
| Rate for Payer: Cash Price |
$4,461.60
|
| Rate for Payer: Cigna Commercial |
$3,778.02
|
| Rate for Payer: Cigna Medicaid |
$709.01
|
| Rate for Payer: Cigna Medicare |
$1,667.79
|
| Rate for Payer: Employer Direct Commercial |
$1,667.79
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,667.79
|
| Rate for Payer: Molina CHIP/Medicaid |
$709.01
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,667.79
|
| Rate for Payer: Molina Medicare |
$1,667.79
|
| 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 |
$709.01
|
| Rate for Payer: Scott and White EPO/PPO |
$36.79
|
| Rate for Payer: Scott and White Medicare |
$1,667.79
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$709.01
|
| Rate for Payer: Superior Health Plan EPO |
$1,667.79
|
| Rate for Payer: Superior Health Plan Medicare |
$1,667.79
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,667.79
|
| Rate for Payer: Universal American Medicare |
$1,667.79
|
| Rate for Payer: Wellcare Medicare |
$1,667.79
|
| Rate for Payer: Wellmed Medicare |
$1,667.79
|
|
|
WC Epdrml Atgrft,Face/Nk/Hf BCE
|
Facility
|
IP
|
$5,070.00
|
|
|
Service Code
|
CPT 15115
|
| Hospital Charge Code |
7150914
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$4,461.60
|
|
|
WC Epi Auto Trnk/Arms/Legs ea/add 100 sqcm BCE
|
Facility
|
OP
|
$5,206.00
|
|
|
Service Code
|
CPT 15111
|
| Hospital Charge Code |
7150913
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$468.54 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$2,863.30
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$468.54
|
| Rate for Payer: Cash Price |
$4,581.28
|
| Rate for Payer: Cash Price |
$4,581.28
|
| 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: Scott and White EPO/PPO |
$2,603.00
|
| Rate for Payer: Superior Health Plan EPO |
$708.02
|
|
|
WC Epi Auto Trnk/Arms/Legs ea/add 100 sqcm BCE
|
Facility
|
IP
|
$5,206.00
|
|
|
Service Code
|
CPT 15111
|
| Hospital Charge Code |
7150913
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$4,581.28
|
|
|
WC Epidermal Autograft,T/A/L BCE
|
Facility
|
OP
|
$5,206.00
|
|
|
Service Code
|
CPT 15110
|
| Hospital Charge Code |
7150912
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$36.79 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$2,200.00
|
| Rate for Payer: Aetna Medicare |
$2,501.68
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$709.01
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,667.79
|
| Rate for Payer: Amerigroup Medicare |
$1,667.79
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,709.98
|
| Rate for Payer: BCBS of TX Blue Essentials |
$3,245.48
|
| Rate for Payer: BCBS of TX Medicare |
$1,667.79
|
| Rate for Payer: BCBS of TX PPO |
$4,089.30
|
| Rate for Payer: Cash Price |
$4,581.28
|
| Rate for Payer: Cash Price |
$4,581.28
|
| Rate for Payer: Cigna Commercial |
$3,778.02
|
| Rate for Payer: Cigna Medicaid |
$709.01
|
| Rate for Payer: Cigna Medicare |
$1,667.79
|
| Rate for Payer: Employer Direct Commercial |
$1,667.79
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,667.79
|
| Rate for Payer: Molina CHIP/Medicaid |
$709.01
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,667.79
|
| Rate for Payer: Molina Medicare |
$1,667.79
|
| 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 |
$709.01
|
| Rate for Payer: Scott and White EPO/PPO |
$36.79
|
| Rate for Payer: Scott and White Medicare |
$1,667.79
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$709.01
|
| Rate for Payer: Superior Health Plan EPO |
$1,667.79
|
| Rate for Payer: Superior Health Plan Medicare |
$1,667.79
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,667.79
|
| Rate for Payer: Universal American Medicare |
$1,667.79
|
| Rate for Payer: Wellcare Medicare |
$1,667.79
|
| Rate for Payer: Wellmed Medicare |
$1,667.79
|
|
|
WC Epidermal Autograft,T/A/L BCE
|
Facility
|
IP
|
$5,206.00
|
|
|
Service Code
|
CPT 15110
|
| Hospital Charge Code |
7150912
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$4,581.28
|
|
|
WC EST PT Visit Level 1 (0-15 Min) BCE
|
Facility
|
OP
|
$113.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
7150493
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$10.17 |
| Max. Negotiated Rate |
$73.45 |
| Rate for Payer: Aetna Commercial |
$62.15
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$10.17
|
| Rate for Payer: BCBS of TX Blue Advantage |
$16.30
|
| Rate for Payer: BCBS of TX Blue Essentials |
$19.49
|
| Rate for Payer: BCBS of TX PPO |
$21.74
|
| Rate for Payer: Cash Price |
$99.44
|
| Rate for Payer: Cash Price |
$99.44
|
| Rate for Payer: Cigna Medicaid |
$12.41
|
| Rate for Payer: Molina CHIP/Medicaid |
$12.41
|
| Rate for Payer: Multiplan Auto |
$73.45
|
| Rate for Payer: Multiplan Commercial |
$73.45
|
| Rate for Payer: Multiplan Workers Comp |
$73.45
|
| Rate for Payer: Parkland Medicaid |
$12.41
|
| Rate for Payer: Scott and White EPO/PPO |
$56.50
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$12.41
|
|
|
WC EST PT Visit Level 1 (0-15 Min) BCE
|
Facility
|
IP
|
$113.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
7150493
|
|
Hospital Revenue Code
|
510
|
| Rate for Payer: Cash Price |
$99.44
|
|
|
WC EST PT Visit Level 2 (16-30 Min) BCE
|
Facility
|
OP
|
$174.00
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
7150501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$15.66 |
| Max. Negotiated Rate |
$113.10 |
| Rate for Payer: Aetna Commercial |
$95.70
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$15.66
|
| Rate for Payer: BCBS of TX Blue Advantage |
$45.15
|
| Rate for Payer: BCBS of TX Blue Essentials |
$53.98
|
| Rate for Payer: BCBS of TX PPO |
$60.20
|
| Rate for Payer: Cash Price |
$153.12
|
| Rate for Payer: Cash Price |
$153.12
|
| Rate for Payer: Cigna Medicaid |
$20.78
|
| Rate for Payer: Molina CHIP/Medicaid |
$20.78
|
| Rate for Payer: Multiplan Auto |
$113.10
|
| Rate for Payer: Multiplan Commercial |
$113.10
|
| Rate for Payer: Multiplan Workers Comp |
$113.10
|
| Rate for Payer: Parkland Medicaid |
$20.78
|
| Rate for Payer: Scott and White EPO/PPO |
$87.00
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$20.78
|
|
|
WC EST PT Visit Level 2 (16-30 Min) BCE
|
Facility
|
IP
|
$174.00
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
7150501
|
|
Hospital Revenue Code
|
510
|
| Rate for Payer: Cash Price |
$153.12
|
|
|
WC EST PT Visit Level 3 (31-45 Min) BCE
|
Facility
|
OP
|
$211.00
|
|
|
Service Code
|
CPT 99213
|
| Hospital Charge Code |
7150519
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$18.99 |
| Max. Negotiated Rate |
$137.15 |
| Rate for Payer: Aetna Commercial |
$116.05
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$18.99
|
| Rate for Payer: BCBS of TX Blue Advantage |
$90.31
|
| Rate for Payer: BCBS of TX Blue Essentials |
$107.95
|
| Rate for Payer: BCBS of TX PPO |
$120.41
|
| Rate for Payer: Cash Price |
$185.68
|
| Rate for Payer: Cash Price |
$185.68
|
| Rate for Payer: Cigna Medicaid |
$31.23
|
| Rate for Payer: Molina CHIP/Medicaid |
$31.23
|
| Rate for Payer: Multiplan Auto |
$137.15
|
| Rate for Payer: Multiplan Commercial |
$137.15
|
| Rate for Payer: Multiplan Workers Comp |
$137.15
|
| Rate for Payer: Parkland Medicaid |
$31.23
|
| Rate for Payer: Scott and White EPO/PPO |
$105.50
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$31.23
|
|
|
WC EST PT Visit Level 3 (31-45 Min) BCE
|
Facility
|
IP
|
$211.00
|
|
|
Service Code
|
CPT 99213
|
| Hospital Charge Code |
7150519
|
|
Hospital Revenue Code
|
510
|
| Rate for Payer: Cash Price |
$185.68
|
|
|
WC EST PT Visit Level 4 (46-60 Min) BCE
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
CPT 99214
|
| Hospital Charge Code |
7150527
|
|
Hospital Revenue Code
|
510
|
| Rate for Payer: Cash Price |
$343.20
|
|
|
WC EST PT Visit Level 4 (46-60 Min) BCE
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
CPT 99214
|
| Hospital Charge Code |
7150527
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$35.10 |
| Max. Negotiated Rate |
$253.50 |
| Rate for Payer: Aetna Commercial |
$214.50
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$35.10
|
| Rate for Payer: BCBS of TX Blue Advantage |
$139.22
|
| Rate for Payer: BCBS of TX Blue Essentials |
$166.42
|
| Rate for Payer: BCBS of TX PPO |
$185.62
|
| Rate for Payer: Cash Price |
$343.20
|
| Rate for Payer: Cash Price |
$343.20
|
| Rate for Payer: Cigna Medicaid |
$43.87
|
| Rate for Payer: Molina CHIP/Medicaid |
$43.87
|
| Rate for Payer: Multiplan Auto |
$253.50
|
| Rate for Payer: Multiplan Commercial |
$253.50
|
| Rate for Payer: Multiplan Workers Comp |
$253.50
|
| Rate for Payer: Parkland Medicaid |
$43.87
|
| Rate for Payer: Scott and White EPO/PPO |
$195.00
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$43.87
|
|
|
WC EST PT Visit Level 5 (60+ Min) BCE
|
Facility
|
OP
|
$426.00
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
7150535
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$38.34 |
| Max. Negotiated Rate |
$276.90 |
| Rate for Payer: Aetna Commercial |
$234.30
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$38.34
|
| Rate for Payer: BCBS of TX Blue Advantage |
$196.27
|
| Rate for Payer: BCBS of TX Blue Essentials |
$234.62
|
| Rate for Payer: BCBS of TX PPO |
$261.70
|
| Rate for Payer: Cash Price |
$374.88
|
| Rate for Payer: Cash Price |
$374.88
|
| Rate for Payer: Cigna Medicaid |
$67.53
|
| Rate for Payer: Molina CHIP/Medicaid |
$67.53
|
| Rate for Payer: Multiplan Auto |
$276.90
|
| Rate for Payer: Multiplan Commercial |
$276.90
|
| Rate for Payer: Multiplan Workers Comp |
$276.90
|
| Rate for Payer: Parkland Medicaid |
$67.53
|
| Rate for Payer: Scott and White EPO/PPO |
$213.00
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$67.53
|
|
|
WC EST PT Visit Level 5 (60+ Min) BCE
|
Facility
|
IP
|
$426.00
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
7150535
|
|
Hospital Revenue Code
|
510
|
| Rate for Payer: Cash Price |
$374.88
|
|
|
WC Extremity Study Bilateral 1-2 Levels BCE
|
Facility
|
IP
|
$720.00
|
|
|
Service Code
|
CPT 93922
|
| Hospital Charge Code |
7150844
|
|
Hospital Revenue Code
|
921
|
| Rate for Payer: Cash Price |
$633.60
|
|
|
WC Extremity Study Bilateral 1-2 Levels BCE
|
Facility
|
OP
|
$720.00
|
|
|
Service Code
|
CPT 93922
|
| Hospital Charge Code |
7150844
|
|
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
|
|
|
WC Extremity Study Bilateral 3+ Levels BCE
|
Facility
|
OP
|
$1,579.00
|
|
|
Service Code
|
CPT 93923
|
| Hospital Charge Code |
6620804
|
|
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
|
|
|
WC Extremity Study Bilateral 3+ Levels BCE
|
Facility
|
IP
|
$1,579.00
|
|
|
Service Code
|
CPT 93923
|
| Hospital Charge Code |
6620804
|
|
Hospital Revenue Code
|
921
|
| Rate for Payer: Cash Price |
$1,389.52
|
|
|
WC Glucose Blood Test BCE
|
Facility
|
IP
|
$43.00
|
|
|
Service Code
|
CPT 82962
|
| Hospital Charge Code |
7150733
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$37.84
|
|
|
WC Glucose Blood Test BCE
|
Facility
|
OP
|
$43.00
|
|
|
Service Code
|
CPT 82962
|
| Hospital Charge Code |
7150733
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.28 |
| Max. Negotiated Rate |
$27.95 |
| Rate for Payer: Aetna Commercial |
$3.45
|
| Rate for Payer: Aetna Medicare |
$4.92
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1.28
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3.28
|
| Rate for Payer: Amerigroup Medicare |
$3.28
|
| Rate for Payer: BCBS of TX Blue Advantage |
$5.41
|
| Rate for Payer: BCBS of TX Blue Essentials |
$6.49
|
| Rate for Payer: BCBS of TX Medicare |
$3.28
|
| Rate for Payer: BCBS of TX PPO |
$7.25
|
| Rate for Payer: Cash Price |
$37.84
|
| Rate for Payer: Cash Price |
$37.84
|
| Rate for Payer: Cigna Medicare |
$3.28
|
| Rate for Payer: Employer Direct Commercial |
$3.28
|
| Rate for Payer: Humana Medicare/TRICARE |
$3.28
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3.28
|
| Rate for Payer: Molina Medicare |
$3.28
|
| Rate for Payer: Multiplan Auto |
$27.95
|
| Rate for Payer: Multiplan Commercial |
$27.95
|
| Rate for Payer: Multiplan Workers Comp |
$27.95
|
| Rate for Payer: Scott and White EPO/PPO |
$4.10
|
| Rate for Payer: Scott and White Medicare |
$3.28
|
| Rate for Payer: Superior Health Plan EPO |
$3.28
|
| Rate for Payer: Superior Health Plan Medicare |
$3.28
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3.28
|
| Rate for Payer: Universal American Medicare |
$3.28
|
| Rate for Payer: Wellcare Medicare |
$3.28
|
| Rate for Payer: Wellmed Medicare |
$3.28
|
|
