|
WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH CC
|
Facility
|
IP
|
$57,026.60
|
|
|
Service Code
|
MSDRG 464
|
| Min. Negotiated Rate |
$24,272.96 |
| Max. Negotiated Rate |
$57,026.60 |
| Rate for Payer: Aetna Commercial |
$33,765.75
|
| Rate for Payer: Aetna Medicare |
$36,409.44
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$24,272.96
|
| Rate for Payer: Amerigroup Medicare |
$24,272.96
|
| Rate for Payer: BCBS of TX Blue Advantage |
$26,223.12
|
| Rate for Payer: BCBS of TX Blue Essentials |
$30,379.14
|
| Rate for Payer: BCBS of TX Medicare |
$24,272.96
|
| Rate for Payer: BCBS of TX PPO |
$33,755.90
|
| Rate for Payer: Cigna Commercial |
$38,658.03
|
| Rate for Payer: Cigna Medicare |
$24,272.96
|
| Rate for Payer: Employer Direct Commercial |
$24,272.96
|
| Rate for Payer: Humana Medicare/TRICARE |
$24,272.96
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$24,272.96
|
| Rate for Payer: Molina Medicare |
$24,272.96
|
| Rate for Payer: Multiplan Auto |
$57,026.60
|
| Rate for Payer: Multiplan Commercial |
$57,026.60
|
| Rate for Payer: Multiplan Workers Comp |
$57,026.60
|
| Rate for Payer: Scott and White EPO/PPO |
$26,262.25
|
| Rate for Payer: Scott and White Medicare |
$24,272.96
|
| Rate for Payer: Superior Health Plan EPO |
$24,272.96
|
| Rate for Payer: Superior Health Plan Medicare |
$24,272.96
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$24,272.96
|
| Rate for Payer: Universal American Medicare |
$24,272.96
|
| Rate for Payer: Wellcare Medicare |
$24,272.96
|
| Rate for Payer: Wellmed Medicare |
$24,272.96
|
|
|
WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH MCC
|
Facility
|
IP
|
$107,610.30
|
|
|
Service Code
|
MSDRG 463
|
| Min. Negotiated Rate |
$43,271.29 |
| Max. Negotiated Rate |
$107,610.30 |
| Rate for Payer: Aetna Commercial |
$63,716.62
|
| Rate for Payer: Aetna Medicare |
$64,906.94
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$43,271.29
|
| Rate for Payer: Amerigroup Medicare |
$43,271.29
|
| Rate for Payer: BCBS of TX Blue Advantage |
$46,278.32
|
| Rate for Payer: BCBS of TX Blue Essentials |
$52,956.08
|
| Rate for Payer: BCBS of TX Medicare |
$43,271.29
|
| Rate for Payer: BCBS of TX PPO |
$58,842.37
|
| Rate for Payer: Cigna Commercial |
$72,948.46
|
| Rate for Payer: Cigna Medicare |
$43,271.29
|
| Rate for Payer: Employer Direct Commercial |
$43,271.29
|
| Rate for Payer: Humana Medicare/TRICARE |
$43,271.29
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$43,271.29
|
| Rate for Payer: Molina Medicare |
$43,271.29
|
| Rate for Payer: Multiplan Auto |
$107,610.30
|
| Rate for Payer: Multiplan Commercial |
$107,610.30
|
| Rate for Payer: Multiplan Workers Comp |
$107,610.30
|
| Rate for Payer: Scott and White EPO/PPO |
$49,557.38
|
| Rate for Payer: Scott and White Medicare |
$43,271.29
|
| Rate for Payer: Superior Health Plan EPO |
$43,271.29
|
| Rate for Payer: Superior Health Plan Medicare |
$43,271.29
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$43,271.29
|
| Rate for Payer: Universal American Medicare |
$43,271.29
|
| Rate for Payer: Wellcare Medicare |
$43,271.29
|
| Rate for Payer: Wellmed Medicare |
$43,271.29
|
|
|
WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC
|
Facility
|
IP
|
$35,545.20
|
|
|
Service Code
|
MSDRG 465
|
| Min. Negotiated Rate |
$16,204.91 |
| Max. Negotiated Rate |
$35,545.20 |
| Rate for Payer: Aetna Commercial |
$21,046.50
|
| Rate for Payer: Aetna Medicare |
$24,307.36
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$16,204.91
|
| Rate for Payer: Amerigroup Medicare |
$16,204.91
|
| Rate for Payer: BCBS of TX Blue Advantage |
$17,575.82
|
| Rate for Payer: BCBS of TX Blue Essentials |
$18,960.13
|
| Rate for Payer: BCBS of TX Medicare |
$16,204.91
|
| Rate for Payer: BCBS of TX PPO |
$21,067.63
|
| Rate for Payer: Cigna Commercial |
$24,095.90
|
| Rate for Payer: Cigna Medicare |
$16,204.91
|
| Rate for Payer: Employer Direct Commercial |
$16,204.91
|
| Rate for Payer: Humana Medicare/TRICARE |
$16,204.91
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$16,204.91
|
| Rate for Payer: Molina Medicare |
$16,204.91
|
| Rate for Payer: Multiplan Auto |
$35,545.20
|
| Rate for Payer: Multiplan Commercial |
$35,545.20
|
| Rate for Payer: Multiplan Workers Comp |
$35,545.20
|
| Rate for Payer: Scott and White EPO/PPO |
$16,369.50
|
| Rate for Payer: Scott and White Medicare |
$16,204.91
|
| Rate for Payer: Superior Health Plan EPO |
$16,204.91
|
| Rate for Payer: Superior Health Plan Medicare |
$16,204.91
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$16,204.91
|
| Rate for Payer: Universal American Medicare |
$16,204.91
|
| Rate for Payer: Wellcare Medicare |
$16,204.91
|
| Rate for Payer: Wellmed Medicare |
$16,204.91
|
|
|
WOUND DEBRIDEMENTS FOR INJURIES WITH CC
|
Facility
|
IP
|
$35,809.30
|
|
|
Service Code
|
MSDRG 902
|
| Min. Negotiated Rate |
$16,267.76 |
| Max. Negotiated Rate |
$35,809.30 |
| Rate for Payer: Aetna Commercial |
$21,202.88
|
| Rate for Payer: Aetna Medicare |
$24,456.16
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$16,304.11
|
| Rate for Payer: Amerigroup Medicare |
$16,304.11
|
| Rate for Payer: BCBS of TX Blue Advantage |
$16,267.76
|
| Rate for Payer: BCBS of TX Blue Essentials |
$19,816.61
|
| Rate for Payer: BCBS of TX Medicare |
$16,304.11
|
| Rate for Payer: BCBS of TX PPO |
$22,019.31
|
| Rate for Payer: Cigna Commercial |
$24,274.94
|
| Rate for Payer: Cigna Medicare |
$16,304.11
|
| Rate for Payer: Employer Direct Commercial |
$16,304.11
|
| Rate for Payer: Humana Medicare/TRICARE |
$16,304.11
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$16,304.11
|
| Rate for Payer: Molina Medicare |
$16,304.11
|
| Rate for Payer: Multiplan Auto |
$35,809.30
|
| Rate for Payer: Multiplan Commercial |
$35,809.30
|
| Rate for Payer: Multiplan Workers Comp |
$35,809.30
|
| Rate for Payer: Scott and White EPO/PPO |
$16,491.12
|
| Rate for Payer: Scott and White Medicare |
$16,304.11
|
| Rate for Payer: Superior Health Plan EPO |
$16,304.11
|
| Rate for Payer: Superior Health Plan Medicare |
$16,304.11
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$16,304.11
|
| Rate for Payer: Universal American Medicare |
$16,304.11
|
| Rate for Payer: Wellcare Medicare |
$16,304.11
|
| Rate for Payer: Wellmed Medicare |
$16,304.11
|
|
|
WOUND DEBRIDEMENTS FOR INJURIES WITH MCC
|
Facility
|
IP
|
$82,228.20
|
|
|
Service Code
|
MSDRG 901
|
| Min. Negotiated Rate |
$33,738.22 |
| Max. Negotiated Rate |
$82,228.20 |
| Rate for Payer: Aetna Commercial |
$48,687.75
|
| Rate for Payer: Aetna Medicare |
$50,607.33
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$33,738.22
|
| Rate for Payer: Amerigroup Medicare |
$33,738.22
|
| Rate for Payer: BCBS of TX Blue Advantage |
$37,207.04
|
| Rate for Payer: BCBS of TX Blue Essentials |
$46,073.30
|
| Rate for Payer: BCBS of TX Medicare |
$33,738.22
|
| Rate for Payer: BCBS of TX PPO |
$51,194.54
|
| Rate for Payer: Cigna Commercial |
$55,742.06
|
| Rate for Payer: Cigna Medicare |
$33,738.22
|
| Rate for Payer: Employer Direct Commercial |
$33,738.22
|
| Rate for Payer: Humana Medicare/TRICARE |
$33,738.22
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$33,738.22
|
| Rate for Payer: Molina Medicare |
$33,738.22
|
| Rate for Payer: Multiplan Auto |
$82,228.20
|
| Rate for Payer: Multiplan Commercial |
$82,228.20
|
| Rate for Payer: Multiplan Workers Comp |
$82,228.20
|
| Rate for Payer: Scott and White EPO/PPO |
$37,868.25
|
| Rate for Payer: Scott and White Medicare |
$33,738.22
|
| Rate for Payer: Superior Health Plan EPO |
$33,738.22
|
| Rate for Payer: Superior Health Plan Medicare |
$33,738.22
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$33,738.22
|
| Rate for Payer: Universal American Medicare |
$33,738.22
|
| Rate for Payer: Wellcare Medicare |
$33,738.22
|
| Rate for Payer: Wellmed Medicare |
$33,738.22
|
|
|
WOUND DEBRIDEMENTS FOR INJURIES WITHOUT CC/MCC
|
Facility
|
IP
|
$23,588.50
|
|
|
Service Code
|
MSDRG 903
|
| Min. Negotiated Rate |
$9,558.04 |
| Max. Negotiated Rate |
$23,588.50 |
| Rate for Payer: Aetna Commercial |
$13,966.88
|
| Rate for Payer: Aetna Medicare |
$17,571.30
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$11,714.20
|
| Rate for Payer: Amerigroup Medicare |
$11,714.20
|
| Rate for Payer: BCBS of TX Blue Advantage |
$9,558.04
|
| Rate for Payer: BCBS of TX Blue Essentials |
$12,010.28
|
| Rate for Payer: BCBS of TX Medicare |
$11,714.20
|
| Rate for Payer: BCBS of TX PPO |
$13,345.28
|
| Rate for Payer: Cigna Commercial |
$15,990.52
|
| Rate for Payer: Cigna Medicare |
$11,714.20
|
| Rate for Payer: Employer Direct Commercial |
$11,714.20
|
| Rate for Payer: Humana Medicare/TRICARE |
$11,714.20
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$11,714.20
|
| Rate for Payer: Molina Medicare |
$11,714.20
|
| Rate for Payer: Multiplan Auto |
$23,588.50
|
| Rate for Payer: Multiplan Commercial |
$23,588.50
|
| Rate for Payer: Multiplan Workers Comp |
$23,588.50
|
| Rate for Payer: Scott and White EPO/PPO |
$10,863.12
|
| Rate for Payer: Scott and White Medicare |
$11,714.20
|
| Rate for Payer: Superior Health Plan EPO |
$11,714.20
|
| Rate for Payer: Superior Health Plan Medicare |
$11,714.20
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$11,714.20
|
| Rate for Payer: Universal American Medicare |
$11,714.20
|
| Rate for Payer: Wellcare Medicare |
$11,714.20
|
| Rate for Payer: Wellmed Medicare |
$11,714.20
|
|
|
WRENCH KIT TORQUE 5873W
|
Facility
|
OP
|
$163.44
|
|
| Hospital Charge Code |
114630
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.71 |
| Max. Negotiated Rate |
$106.24 |
| Rate for Payer: Aetna Commercial |
$89.89
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$14.71
|
| Rate for Payer: BCBS of TX Blue Advantage |
$49.03
|
| Rate for Payer: BCBS of TX Blue Essentials |
$58.84
|
| Rate for Payer: BCBS of TX PPO |
$65.38
|
| Rate for Payer: Cash Price |
$143.83
|
| Rate for Payer: Multiplan Auto |
$106.24
|
| Rate for Payer: Multiplan Commercial |
$106.24
|
| Rate for Payer: Multiplan Workers Comp |
$106.24
|
| Rate for Payer: Scott and White EPO/PPO |
$81.72
|
| Rate for Payer: Superior Health Plan EPO |
$22.23
|
|
|
WRENCH KIT TORQUE 5873W
|
Facility
|
IP
|
$163.44
|
|
| Hospital Charge Code |
114630
|
|
Hospital Revenue Code
|
272
|
| Rate for Payer: Cash Price |
$143.83
|
|
|
WRENCH TW TOOL CARD
|
Facility
|
IP
|
$202.71
|
|
| Hospital Charge Code |
114623
|
|
Hospital Revenue Code
|
272
|
| Rate for Payer: Cash Price |
$178.38
|
|
|
WRENCH TW TOOL CARD
|
Facility
|
OP
|
$202.71
|
|
| Hospital Charge Code |
114623
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$18.24 |
| Max. Negotiated Rate |
$131.76 |
| Rate for Payer: Aetna Commercial |
$111.49
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$18.24
|
| Rate for Payer: BCBS of TX Blue Advantage |
$60.81
|
| Rate for Payer: BCBS of TX Blue Essentials |
$72.98
|
| Rate for Payer: BCBS of TX PPO |
$81.08
|
| Rate for Payer: Cash Price |
$178.38
|
| Rate for Payer: Multiplan Auto |
$131.76
|
| Rate for Payer: Multiplan Commercial |
$131.76
|
| Rate for Payer: Multiplan Workers Comp |
$131.76
|
| Rate for Payer: Scott and White EPO/PPO |
$101.36
|
| Rate for Payer: Superior Health Plan EPO |
$27.57
|
|
|
WSTNT B ENDPR UNISTEP+DS -- DHF
|
Facility
|
IP
|
$5,544.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
82404229
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,386.00 |
| Max. Negotiated Rate |
$2,772.00 |
| Rate for Payer: Aetna Commercial |
$1,663.20
|
| Rate for Payer: Cash Price |
$4,878.72
|
| Rate for Payer: Cigna Commercial |
$1,386.00
|
| Rate for Payer: Multiplan Auto |
$2,772.00
|
| Rate for Payer: Multiplan Commercial |
$2,772.00
|
| Rate for Payer: Multiplan Workers Comp |
$2,772.00
|
| Rate for Payer: Scott and White EPO/PPO |
$2,772.00
|
|
|
WSTNT B ENDPR UNISTEP+DS -- DHF
|
Facility
|
OP
|
$5,544.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
82404229
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$498.96 |
| Max. Negotiated Rate |
$2,772.00 |
| Rate for Payer: Aetna Commercial |
$1,663.20
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$498.96
|
| Rate for Payer: BCBS of TX Blue Advantage |
$1,663.20
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,995.84
|
| Rate for Payer: BCBS of TX PPO |
$2,217.60
|
| Rate for Payer: Cash Price |
$4,878.72
|
| Rate for Payer: Multiplan Auto |
$2,772.00
|
| Rate for Payer: Multiplan Commercial |
$2,772.00
|
| Rate for Payer: Multiplan Workers Comp |
$2,772.00
|
| Rate for Payer: Scott and White EPO/PPO |
$2,772.00
|
| Rate for Payer: Superior Health Plan EPO |
$753.98
|
|
|
XR Abdomen 2 Views
|
Facility
|
IP
|
$808.00
|
|
|
Service Code
|
CPT 74019 FY
|
| Hospital Charge Code |
3181558
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$711.04
|
|
|
XR Abdomen 2 Views
|
Facility
|
OP
|
$808.00
|
|
|
Service Code
|
CPT 74019 FY
|
| Hospital Charge Code |
3181558
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$525.20 |
| Rate for Payer: Aetna Commercial |
$29.49
|
| Rate for Payer: Aetna Medicare |
$150.82
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$37.09
|
| 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 |
$711.04
|
| Rate for Payer: Cash Price |
$711.04
|
| Rate for Payer: Cash Price |
$711.04
|
| Rate for Payer: Cigna Commercial |
$227.77
|
| Rate for Payer: Cigna Medicaid |
$20.85
|
| 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 |
$20.85
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$100.55
|
| Rate for Payer: Molina Medicare |
$100.55
|
| Rate for Payer: Multiplan Auto |
$525.20
|
| Rate for Payer: Multiplan Commercial |
$525.20
|
| Rate for Payer: Multiplan Workers Comp |
$525.20
|
| Rate for Payer: Parkland Medicaid |
$20.85
|
| 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 |
$20.85
|
| 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
|
|
|
XR Abdomen 2 Views BCE
|
Facility
|
OP
|
$808.00
|
|
|
Service Code
|
CPT 74019 FY
|
| Hospital Charge Code |
3181558
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$525.20 |
| Rate for Payer: Aetna Commercial |
$29.49
|
| Rate for Payer: Aetna Medicare |
$150.82
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$37.09
|
| 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 |
$711.04
|
| Rate for Payer: Cash Price |
$711.04
|
| Rate for Payer: Cash Price |
$711.04
|
| Rate for Payer: Cigna Commercial |
$227.77
|
| Rate for Payer: Cigna Medicaid |
$20.85
|
| 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 |
$20.85
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$100.55
|
| Rate for Payer: Molina Medicare |
$100.55
|
| Rate for Payer: Multiplan Auto |
$525.20
|
| Rate for Payer: Multiplan Commercial |
$525.20
|
| Rate for Payer: Multiplan Workers Comp |
$525.20
|
| Rate for Payer: Parkland Medicaid |
$20.85
|
| 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 |
$20.85
|
| 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
|
|
|
XR Abdomen Complete 3 Views
|
Facility
|
OP
|
$819.00
|
|
|
Service Code
|
CPT 74021 FY
|
| Hospital Charge Code |
3181560
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$532.35 |
| Rate for Payer: Aetna Commercial |
$34.88
|
| Rate for Payer: Aetna Medicare |
$150.82
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$43.10
|
| 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 |
$720.72
|
| Rate for Payer: Cash Price |
$720.72
|
| Rate for Payer: Cash Price |
$720.72
|
| Rate for Payer: Cigna Commercial |
$227.77
|
| Rate for Payer: Cigna Medicaid |
$43.10
|
| 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 |
$43.10
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$100.55
|
| Rate for Payer: Molina Medicare |
$100.55
|
| Rate for Payer: Multiplan Auto |
$532.35
|
| Rate for Payer: Multiplan Commercial |
$532.35
|
| Rate for Payer: Multiplan Workers Comp |
$532.35
|
| Rate for Payer: Parkland Medicaid |
$43.10
|
| 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 |
$43.10
|
| 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
|
|
|
XR Abdomen Complete 3 Views BCE
|
Facility
|
OP
|
$819.00
|
|
|
Service Code
|
CPT 74021 FY
|
| Hospital Charge Code |
3181560
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$532.35 |
| Rate for Payer: Aetna Commercial |
$34.88
|
| Rate for Payer: Aetna Medicare |
$150.82
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$43.10
|
| 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 |
$720.72
|
| Rate for Payer: Cash Price |
$720.72
|
| Rate for Payer: Cash Price |
$720.72
|
| Rate for Payer: Cigna Commercial |
$227.77
|
| Rate for Payer: Cigna Medicaid |
$43.10
|
| 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 |
$43.10
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$100.55
|
| Rate for Payer: Molina Medicare |
$100.55
|
| Rate for Payer: Multiplan Auto |
$532.35
|
| Rate for Payer: Multiplan Commercial |
$532.35
|
| Rate for Payer: Multiplan Workers Comp |
$532.35
|
| Rate for Payer: Parkland Medicaid |
$43.10
|
| 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 |
$43.10
|
| 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
|
|
|
XR Abdomen Complete 3 Views BCE
|
Facility
|
IP
|
$819.00
|
|
|
Service Code
|
CPT 74021 FY
|
| Hospital Charge Code |
3181560
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$720.72
|
|
|
XR Abdomen KUB 1 View
|
Facility
|
OP
|
$739.00
|
|
|
Service Code
|
CPT 74018 FY
|
| Hospital Charge Code |
3181556
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$480.35 |
| Rate for Payer: Aetna Commercial |
$24.48
|
| Rate for Payer: Aetna Medicare |
$124.65
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$30.08
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$83.10
|
| Rate for Payer: Amerigroup Medicare |
$83.10
|
| Rate for Payer: BCBS of TX Blue Advantage |
$131.69
|
| Rate for Payer: BCBS of TX Blue Essentials |
$158.02
|
| Rate for Payer: BCBS of TX Medicare |
$83.10
|
| Rate for Payer: BCBS of TX PPO |
$176.38
|
| Rate for Payer: Cash Price |
$650.32
|
| Rate for Payer: Cash Price |
$650.32
|
| Rate for Payer: Cash Price |
$650.32
|
| Rate for Payer: Cigna Commercial |
$188.25
|
| Rate for Payer: Cigna Medicaid |
$17.11
|
| Rate for Payer: Cigna Medicare |
$83.10
|
| Rate for Payer: Employer Direct Commercial |
$83.10
|
| Rate for Payer: Humana Medicare/TRICARE |
$83.10
|
| Rate for Payer: Molina CHIP/Medicaid |
$17.11
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$83.10
|
| Rate for Payer: Molina Medicare |
$83.10
|
| Rate for Payer: Multiplan Auto |
$480.35
|
| Rate for Payer: Multiplan Commercial |
$480.35
|
| Rate for Payer: Multiplan Workers Comp |
$480.35
|
| Rate for Payer: Parkland Medicaid |
$17.11
|
| Rate for Payer: Scott and White EPO/PPO |
$1.49
|
| Rate for Payer: Scott and White Medicare |
$83.10
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$17.11
|
| Rate for Payer: Superior Health Plan EPO |
$83.10
|
| Rate for Payer: Superior Health Plan Medicare |
$83.10
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$83.10
|
| Rate for Payer: Universal American Medicare |
$83.10
|
| Rate for Payer: Wellcare Medicare |
$83.10
|
| Rate for Payer: Wellmed Medicare |
$83.10
|
|
|
XR Abdomen KUB 1 View BCE
|
Facility
|
OP
|
$739.00
|
|
|
Service Code
|
CPT 74018 FY
|
| Hospital Charge Code |
3181556
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$480.35 |
| Rate for Payer: Aetna Commercial |
$24.48
|
| Rate for Payer: Aetna Medicare |
$124.65
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$30.08
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$83.10
|
| Rate for Payer: Amerigroup Medicare |
$83.10
|
| Rate for Payer: BCBS of TX Blue Advantage |
$131.69
|
| Rate for Payer: BCBS of TX Blue Essentials |
$158.02
|
| Rate for Payer: BCBS of TX Medicare |
$83.10
|
| Rate for Payer: BCBS of TX PPO |
$176.38
|
| Rate for Payer: Cash Price |
$650.32
|
| Rate for Payer: Cash Price |
$650.32
|
| Rate for Payer: Cash Price |
$650.32
|
| Rate for Payer: Cigna Commercial |
$188.25
|
| Rate for Payer: Cigna Medicaid |
$17.11
|
| Rate for Payer: Cigna Medicare |
$83.10
|
| Rate for Payer: Employer Direct Commercial |
$83.10
|
| Rate for Payer: Humana Medicare/TRICARE |
$83.10
|
| Rate for Payer: Molina CHIP/Medicaid |
$17.11
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$83.10
|
| Rate for Payer: Molina Medicare |
$83.10
|
| Rate for Payer: Multiplan Auto |
$480.35
|
| Rate for Payer: Multiplan Commercial |
$480.35
|
| Rate for Payer: Multiplan Workers Comp |
$480.35
|
| Rate for Payer: Parkland Medicaid |
$17.11
|
| Rate for Payer: Scott and White EPO/PPO |
$1.49
|
| Rate for Payer: Scott and White Medicare |
$83.10
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$17.11
|
| Rate for Payer: Superior Health Plan EPO |
$83.10
|
| Rate for Payer: Superior Health Plan Medicare |
$83.10
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$83.10
|
| Rate for Payer: Universal American Medicare |
$83.10
|
| Rate for Payer: Wellcare Medicare |
$83.10
|
| Rate for Payer: Wellmed Medicare |
$83.10
|
|
|
XR Abdomen KUB 1 View BCE
|
Facility
|
IP
|
$739.00
|
|
|
Service Code
|
CPT 74018 FY
|
| Hospital Charge Code |
3181556
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$650.32
|
|
|
XR Abdomen Series + Chest 1 View
|
Facility
|
OP
|
$827.00
|
|
|
Service Code
|
CPT 74022 FY
|
| Hospital Charge Code |
3160314
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$537.55 |
| Rate for Payer: Aetna Commercial |
$39.88
|
| Rate for Payer: Aetna Medicare |
$150.82
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$50.13
|
| 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 |
$727.76
|
| Rate for Payer: Cash Price |
$727.76
|
| Rate for Payer: Cash Price |
$727.76
|
| Rate for Payer: Cigna Commercial |
$227.77
|
| Rate for Payer: Cigna Medicaid |
$50.13
|
| 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 |
$50.13
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$100.55
|
| Rate for Payer: Molina Medicare |
$100.55
|
| Rate for Payer: Multiplan Auto |
$537.55
|
| Rate for Payer: Multiplan Commercial |
$537.55
|
| Rate for Payer: Multiplan Workers Comp |
$537.55
|
| Rate for Payer: Parkland Medicaid |
$50.13
|
| 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 |
$50.13
|
| 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
|
|
|
XR Abdomen Series + Chest 1 View BCE
|
Facility
|
IP
|
$827.00
|
|
|
Service Code
|
CPT 74022 FY
|
| Hospital Charge Code |
3160314
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$727.76
|
|
|
XR Abdomen Series + Chest 1 View BCE
|
Facility
|
OP
|
$827.00
|
|
|
Service Code
|
CPT 74022 FY
|
| Hospital Charge Code |
3160314
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$537.55 |
| Rate for Payer: Aetna Commercial |
$39.88
|
| Rate for Payer: Aetna Medicare |
$150.82
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$50.13
|
| 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 |
$727.76
|
| Rate for Payer: Cash Price |
$727.76
|
| Rate for Payer: Cash Price |
$727.76
|
| Rate for Payer: Cigna Commercial |
$227.77
|
| Rate for Payer: Cigna Medicaid |
$50.13
|
| 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 |
$50.13
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$100.55
|
| Rate for Payer: Molina Medicare |
$100.55
|
| Rate for Payer: Multiplan Auto |
$537.55
|
| Rate for Payer: Multiplan Commercial |
$537.55
|
| Rate for Payer: Multiplan Workers Comp |
$537.55
|
| Rate for Payer: Parkland Medicaid |
$50.13
|
| 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 |
$50.13
|
| 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
|
|
|
XR AC Joints Bilateral
|
Facility
|
OP
|
$701.00
|
|
|
Service Code
|
CPT 73050 FY
|
| Hospital Charge Code |
3100617
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$455.65 |
| Rate for Payer: Aetna Commercial |
$22.16
|
| Rate for Payer: Aetna Medicare |
$124.65
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$28.74
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$83.10
|
| Rate for Payer: Amerigroup Medicare |
$83.10
|
| Rate for Payer: BCBS of TX Blue Advantage |
$131.69
|
| Rate for Payer: BCBS of TX Blue Essentials |
$158.02
|
| Rate for Payer: BCBS of TX Medicare |
$83.10
|
| Rate for Payer: BCBS of TX PPO |
$176.38
|
| Rate for Payer: Cash Price |
$616.88
|
| Rate for Payer: Cash Price |
$616.88
|
| Rate for Payer: Cash Price |
$616.88
|
| Rate for Payer: Cigna Commercial |
$188.25
|
| Rate for Payer: Cigna Medicaid |
$28.74
|
| Rate for Payer: Cigna Medicare |
$83.10
|
| Rate for Payer: Employer Direct Commercial |
$83.10
|
| Rate for Payer: Humana Medicare/TRICARE |
$83.10
|
| Rate for Payer: Molina CHIP/Medicaid |
$28.74
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$83.10
|
| Rate for Payer: Molina Medicare |
$83.10
|
| Rate for Payer: Multiplan Auto |
$455.65
|
| Rate for Payer: Multiplan Commercial |
$455.65
|
| Rate for Payer: Multiplan Workers Comp |
$455.65
|
| Rate for Payer: Parkland Medicaid |
$28.74
|
| Rate for Payer: Scott and White EPO/PPO |
$1.49
|
| Rate for Payer: Scott and White Medicare |
$83.10
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$28.74
|
| Rate for Payer: Superior Health Plan EPO |
$83.10
|
| Rate for Payer: Superior Health Plan Medicare |
$83.10
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$83.10
|
| Rate for Payer: Universal American Medicare |
$83.10
|
| Rate for Payer: Wellcare Medicare |
$83.10
|
| Rate for Payer: Wellmed Medicare |
$83.10
|
|
