|
XR AC Joints Bilateral BCE
|
Facility
|
IP
|
$701.00
|
|
|
Service Code
|
CPT 73050 FY
|
| Hospital Charge Code |
3100617
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$616.88
|
|
|
XR AC Joints Bilateral BCE
|
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
|
|
|
XR Angio Extremity in OR Left
|
Facility
|
OP
|
$4,768.00
|
|
|
Service Code
|
CPT 75710 LT,FY
|
| Hospital Charge Code |
3160561
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$52.13 |
| Max. Negotiated Rate |
$6,603.56 |
| Rate for Payer: Aetna Commercial |
$79.96
|
| Rate for Payer: Aetna Medicare |
$4,372.65
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$150.36
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$2,915.10
|
| Rate for Payer: Amerigroup Medicare |
$2,915.10
|
| Rate for Payer: BCBS of TX Blue Advantage |
$4,572.61
|
| Rate for Payer: BCBS of TX Blue Essentials |
$5,487.13
|
| Rate for Payer: BCBS of TX Medicare |
$2,915.10
|
| Rate for Payer: BCBS of TX PPO |
$6,124.53
|
| Rate for Payer: Cash Price |
$4,195.84
|
| Rate for Payer: Cash Price |
$4,195.84
|
| Rate for Payer: Cash Price |
$4,195.84
|
| Rate for Payer: Cigna Commercial |
$6,603.56
|
| Rate for Payer: Cigna Medicaid |
$150.36
|
| Rate for Payer: Cigna Medicare |
$2,915.10
|
| Rate for Payer: Employer Direct Commercial |
$2,915.10
|
| Rate for Payer: Humana Medicare/TRICARE |
$2,915.10
|
| Rate for Payer: Molina CHIP/Medicaid |
$150.36
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$2,915.10
|
| Rate for Payer: Molina Medicare |
$2,915.10
|
| Rate for Payer: Multiplan Auto |
$3,099.20
|
| Rate for Payer: Multiplan Commercial |
$3,099.20
|
| Rate for Payer: Multiplan Workers Comp |
$3,099.20
|
| Rate for Payer: Parkland Medicaid |
$150.36
|
| Rate for Payer: Scott and White EPO/PPO |
$52.13
|
| Rate for Payer: Scott and White Medicare |
$2,915.10
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$150.36
|
| Rate for Payer: Superior Health Plan EPO |
$2,915.10
|
| Rate for Payer: Superior Health Plan Medicare |
$2,915.10
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$2,915.10
|
| Rate for Payer: Universal American Medicare |
$2,915.10
|
| Rate for Payer: Wellcare Medicare |
$2,915.10
|
| Rate for Payer: Wellmed Medicare |
$2,915.10
|
|
|
XR Angio Extremity in OR Left BCE
|
Facility
|
IP
|
$4,768.00
|
|
|
Service Code
|
CPT 75710 LT,FY
|
| Hospital Charge Code |
3160561
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$4,195.84
|
|
|
XR Angio Extremity in OR Left BCE
|
Facility
|
OP
|
$4,768.00
|
|
|
Service Code
|
CPT 75710 LT,FY
|
| Hospital Charge Code |
3160561
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$52.13 |
| Max. Negotiated Rate |
$6,603.56 |
| Rate for Payer: Aetna Commercial |
$79.96
|
| Rate for Payer: Aetna Medicare |
$4,372.65
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$150.36
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$2,915.10
|
| Rate for Payer: Amerigroup Medicare |
$2,915.10
|
| Rate for Payer: BCBS of TX Blue Advantage |
$4,572.61
|
| Rate for Payer: BCBS of TX Blue Essentials |
$5,487.13
|
| Rate for Payer: BCBS of TX Medicare |
$2,915.10
|
| Rate for Payer: BCBS of TX PPO |
$6,124.53
|
| Rate for Payer: Cash Price |
$4,195.84
|
| Rate for Payer: Cash Price |
$4,195.84
|
| Rate for Payer: Cash Price |
$4,195.84
|
| Rate for Payer: Cigna Commercial |
$6,603.56
|
| Rate for Payer: Cigna Medicaid |
$150.36
|
| Rate for Payer: Cigna Medicare |
$2,915.10
|
| Rate for Payer: Employer Direct Commercial |
$2,915.10
|
| Rate for Payer: Humana Medicare/TRICARE |
$2,915.10
|
| Rate for Payer: Molina CHIP/Medicaid |
$150.36
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$2,915.10
|
| Rate for Payer: Molina Medicare |
$2,915.10
|
| Rate for Payer: Multiplan Auto |
$3,099.20
|
| Rate for Payer: Multiplan Commercial |
$3,099.20
|
| Rate for Payer: Multiplan Workers Comp |
$3,099.20
|
| Rate for Payer: Parkland Medicaid |
$150.36
|
| Rate for Payer: Scott and White EPO/PPO |
$52.13
|
| Rate for Payer: Scott and White Medicare |
$2,915.10
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$150.36
|
| Rate for Payer: Superior Health Plan EPO |
$2,915.10
|
| Rate for Payer: Superior Health Plan Medicare |
$2,915.10
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$2,915.10
|
| Rate for Payer: Universal American Medicare |
$2,915.10
|
| Rate for Payer: Wellcare Medicare |
$2,915.10
|
| Rate for Payer: Wellmed Medicare |
$2,915.10
|
|
|
XR Angio Extremity in OR Right
|
Facility
|
OP
|
$4,768.00
|
|
|
Service Code
|
CPT 75710 RT,FY
|
| Hospital Charge Code |
3160579
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$52.13 |
| Max. Negotiated Rate |
$6,603.56 |
| Rate for Payer: Aetna Commercial |
$79.96
|
| Rate for Payer: Aetna Medicare |
$4,372.65
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$150.36
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$2,915.10
|
| Rate for Payer: Amerigroup Medicare |
$2,915.10
|
| Rate for Payer: BCBS of TX Blue Advantage |
$4,572.61
|
| Rate for Payer: BCBS of TX Blue Essentials |
$5,487.13
|
| Rate for Payer: BCBS of TX Medicare |
$2,915.10
|
| Rate for Payer: BCBS of TX PPO |
$6,124.53
|
| Rate for Payer: Cash Price |
$4,195.84
|
| Rate for Payer: Cash Price |
$4,195.84
|
| Rate for Payer: Cash Price |
$4,195.84
|
| Rate for Payer: Cigna Commercial |
$6,603.56
|
| Rate for Payer: Cigna Medicaid |
$150.36
|
| Rate for Payer: Cigna Medicare |
$2,915.10
|
| Rate for Payer: Employer Direct Commercial |
$2,915.10
|
| Rate for Payer: Humana Medicare/TRICARE |
$2,915.10
|
| Rate for Payer: Molina CHIP/Medicaid |
$150.36
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$2,915.10
|
| Rate for Payer: Molina Medicare |
$2,915.10
|
| Rate for Payer: Multiplan Auto |
$3,099.20
|
| Rate for Payer: Multiplan Commercial |
$3,099.20
|
| Rate for Payer: Multiplan Workers Comp |
$3,099.20
|
| Rate for Payer: Parkland Medicaid |
$150.36
|
| Rate for Payer: Scott and White EPO/PPO |
$52.13
|
| Rate for Payer: Scott and White Medicare |
$2,915.10
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$150.36
|
| Rate for Payer: Superior Health Plan EPO |
$2,915.10
|
| Rate for Payer: Superior Health Plan Medicare |
$2,915.10
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$2,915.10
|
| Rate for Payer: Universal American Medicare |
$2,915.10
|
| Rate for Payer: Wellcare Medicare |
$2,915.10
|
| Rate for Payer: Wellmed Medicare |
$2,915.10
|
|
|
XR Angio Extremity in OR Right BCE
|
Facility
|
IP
|
$4,768.00
|
|
|
Service Code
|
CPT 75710 RT,FY
|
| Hospital Charge Code |
3160579
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$4,195.84
|
|
|
XR Angio Extremity in OR Right BCE
|
Facility
|
OP
|
$4,768.00
|
|
|
Service Code
|
CPT 75710 RT,FY
|
| Hospital Charge Code |
3160579
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$52.13 |
| Max. Negotiated Rate |
$6,603.56 |
| Rate for Payer: Aetna Commercial |
$79.96
|
| Rate for Payer: Aetna Medicare |
$4,372.65
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$150.36
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$2,915.10
|
| Rate for Payer: Amerigroup Medicare |
$2,915.10
|
| Rate for Payer: BCBS of TX Blue Advantage |
$4,572.61
|
| Rate for Payer: BCBS of TX Blue Essentials |
$5,487.13
|
| Rate for Payer: BCBS of TX Medicare |
$2,915.10
|
| Rate for Payer: BCBS of TX PPO |
$6,124.53
|
| Rate for Payer: Cash Price |
$4,195.84
|
| Rate for Payer: Cash Price |
$4,195.84
|
| Rate for Payer: Cash Price |
$4,195.84
|
| Rate for Payer: Cigna Commercial |
$6,603.56
|
| Rate for Payer: Cigna Medicaid |
$150.36
|
| Rate for Payer: Cigna Medicare |
$2,915.10
|
| Rate for Payer: Employer Direct Commercial |
$2,915.10
|
| Rate for Payer: Humana Medicare/TRICARE |
$2,915.10
|
| Rate for Payer: Molina CHIP/Medicaid |
$150.36
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$2,915.10
|
| Rate for Payer: Molina Medicare |
$2,915.10
|
| Rate for Payer: Multiplan Auto |
$3,099.20
|
| Rate for Payer: Multiplan Commercial |
$3,099.20
|
| Rate for Payer: Multiplan Workers Comp |
$3,099.20
|
| Rate for Payer: Parkland Medicaid |
$150.36
|
| Rate for Payer: Scott and White EPO/PPO |
$52.13
|
| Rate for Payer: Scott and White Medicare |
$2,915.10
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$150.36
|
| Rate for Payer: Superior Health Plan EPO |
$2,915.10
|
| Rate for Payer: Superior Health Plan Medicare |
$2,915.10
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$2,915.10
|
| Rate for Payer: Universal American Medicare |
$2,915.10
|
| Rate for Payer: Wellcare Medicare |
$2,915.10
|
| Rate for Payer: Wellmed Medicare |
$2,915.10
|
|
|
XR Angiogram Internal Mammary
|
Facility
|
OP
|
$2,911.00
|
|
|
Service Code
|
CPT 75756 FY
|
| Hospital Charge Code |
4615757
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$52.13 |
| Max. Negotiated Rate |
$6,603.56 |
| Rate for Payer: Aetna Commercial |
$119.07
|
| Rate for Payer: Aetna Medicare |
$4,372.65
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$161.73
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$2,915.10
|
| Rate for Payer: Amerigroup Medicare |
$2,915.10
|
| Rate for Payer: BCBS of TX Blue Advantage |
$4,572.61
|
| Rate for Payer: BCBS of TX Blue Essentials |
$5,487.13
|
| Rate for Payer: BCBS of TX Medicare |
$2,915.10
|
| Rate for Payer: BCBS of TX PPO |
$6,124.53
|
| Rate for Payer: Cash Price |
$2,561.68
|
| Rate for Payer: Cash Price |
$2,561.68
|
| Rate for Payer: Cash Price |
$2,561.68
|
| Rate for Payer: Cigna Commercial |
$6,603.56
|
| Rate for Payer: Cigna Medicaid |
$161.73
|
| Rate for Payer: Cigna Medicare |
$2,915.10
|
| Rate for Payer: Employer Direct Commercial |
$2,915.10
|
| Rate for Payer: Humana Medicare/TRICARE |
$2,915.10
|
| Rate for Payer: Molina CHIP/Medicaid |
$161.73
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$2,915.10
|
| Rate for Payer: Molina Medicare |
$2,915.10
|
| Rate for Payer: Multiplan Auto |
$1,892.15
|
| Rate for Payer: Multiplan Commercial |
$1,892.15
|
| Rate for Payer: Multiplan Workers Comp |
$1,892.15
|
| Rate for Payer: Parkland Medicaid |
$161.73
|
| Rate for Payer: Scott and White EPO/PPO |
$52.13
|
| Rate for Payer: Scott and White Medicare |
$2,915.10
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$161.73
|
| Rate for Payer: Superior Health Plan EPO |
$2,915.10
|
| Rate for Payer: Superior Health Plan Medicare |
$2,915.10
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$2,915.10
|
| Rate for Payer: Universal American Medicare |
$2,915.10
|
| Rate for Payer: Wellcare Medicare |
$2,915.10
|
| Rate for Payer: Wellmed Medicare |
$2,915.10
|
|
|
XR Angiogram Internal Mammary BCE
|
Facility
|
IP
|
$2,911.00
|
|
|
Service Code
|
CPT 75756 FY
|
| Hospital Charge Code |
4615757
|
|
Hospital Revenue Code
|
323
|
| Rate for Payer: Cash Price |
$2,561.68
|
|
|
XR Angiogram Internal Mammary BCE
|
Facility
|
OP
|
$2,911.00
|
|
|
Service Code
|
CPT 75756 FY
|
| Hospital Charge Code |
4615757
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$52.13 |
| Max. Negotiated Rate |
$6,603.56 |
| Rate for Payer: Aetna Commercial |
$119.07
|
| Rate for Payer: Aetna Medicare |
$4,372.65
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$161.73
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$2,915.10
|
| Rate for Payer: Amerigroup Medicare |
$2,915.10
|
| Rate for Payer: BCBS of TX Blue Advantage |
$4,572.61
|
| Rate for Payer: BCBS of TX Blue Essentials |
$5,487.13
|
| Rate for Payer: BCBS of TX Medicare |
$2,915.10
|
| Rate for Payer: BCBS of TX PPO |
$6,124.53
|
| Rate for Payer: Cash Price |
$2,561.68
|
| Rate for Payer: Cash Price |
$2,561.68
|
| Rate for Payer: Cash Price |
$2,561.68
|
| Rate for Payer: Cigna Commercial |
$6,603.56
|
| Rate for Payer: Cigna Medicaid |
$161.73
|
| Rate for Payer: Cigna Medicare |
$2,915.10
|
| Rate for Payer: Employer Direct Commercial |
$2,915.10
|
| Rate for Payer: Humana Medicare/TRICARE |
$2,915.10
|
| Rate for Payer: Molina CHIP/Medicaid |
$161.73
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$2,915.10
|
| Rate for Payer: Molina Medicare |
$2,915.10
|
| Rate for Payer: Multiplan Auto |
$1,892.15
|
| Rate for Payer: Multiplan Commercial |
$1,892.15
|
| Rate for Payer: Multiplan Workers Comp |
$1,892.15
|
| Rate for Payer: Parkland Medicaid |
$161.73
|
| Rate for Payer: Scott and White EPO/PPO |
$52.13
|
| Rate for Payer: Scott and White Medicare |
$2,915.10
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$161.73
|
| Rate for Payer: Superior Health Plan EPO |
$2,915.10
|
| Rate for Payer: Superior Health Plan Medicare |
$2,915.10
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$2,915.10
|
| Rate for Payer: Universal American Medicare |
$2,915.10
|
| Rate for Payer: Wellcare Medicare |
$2,915.10
|
| Rate for Payer: Wellmed Medicare |
$2,915.10
|
|
|
XR Ankle 2 Views Left
|
Facility
|
OP
|
$537.00
|
|
|
Service Code
|
CPT 73600 LT,FY
|
| Hospital Charge Code |
3100955
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$349.05 |
| Rate for Payer: Aetna Commercial |
$27.95
|
| Rate for Payer: Aetna Medicare |
$124.65
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$32.75
|
| 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 |
$472.56
|
| Rate for Payer: Cash Price |
$472.56
|
| Rate for Payer: Cash Price |
$472.56
|
| Rate for Payer: Cigna Commercial |
$188.25
|
| Rate for Payer: Cigna Medicaid |
$32.75
|
| 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 |
$32.75
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$83.10
|
| Rate for Payer: Molina Medicare |
$83.10
|
| Rate for Payer: Multiplan Auto |
$349.05
|
| Rate for Payer: Multiplan Commercial |
$349.05
|
| Rate for Payer: Multiplan Workers Comp |
$349.05
|
| Rate for Payer: Parkland Medicaid |
$32.75
|
| 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 |
$32.75
|
| 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 Ankle 2 Views Left BCE
|
Facility
|
IP
|
$537.00
|
|
|
Service Code
|
CPT 73600 LT,FY
|
| Hospital Charge Code |
3100955
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$472.56
|
|
|
XR Ankle 2 Views Left BCE
|
Facility
|
OP
|
$537.00
|
|
|
Service Code
|
CPT 73600 LT,FY
|
| Hospital Charge Code |
3100955
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$349.05 |
| Rate for Payer: Aetna Commercial |
$27.95
|
| Rate for Payer: Aetna Medicare |
$124.65
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$32.75
|
| 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 |
$472.56
|
| Rate for Payer: Cash Price |
$472.56
|
| Rate for Payer: Cash Price |
$472.56
|
| Rate for Payer: Cigna Commercial |
$188.25
|
| Rate for Payer: Cigna Medicaid |
$32.75
|
| 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 |
$32.75
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$83.10
|
| Rate for Payer: Molina Medicare |
$83.10
|
| Rate for Payer: Multiplan Auto |
$349.05
|
| Rate for Payer: Multiplan Commercial |
$349.05
|
| Rate for Payer: Multiplan Workers Comp |
$349.05
|
| Rate for Payer: Parkland Medicaid |
$32.75
|
| 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 |
$32.75
|
| 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 Ankle 2 Views Right
|
Facility
|
OP
|
$537.00
|
|
|
Service Code
|
CPT 73600 RT,FY
|
| Hospital Charge Code |
3100963
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$349.05 |
| Rate for Payer: Aetna Commercial |
$27.95
|
| Rate for Payer: Aetna Medicare |
$124.65
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$32.75
|
| 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 |
$472.56
|
| Rate for Payer: Cash Price |
$472.56
|
| Rate for Payer: Cash Price |
$472.56
|
| Rate for Payer: Cigna Commercial |
$188.25
|
| Rate for Payer: Cigna Medicaid |
$32.75
|
| 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 |
$32.75
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$83.10
|
| Rate for Payer: Molina Medicare |
$83.10
|
| Rate for Payer: Multiplan Auto |
$349.05
|
| Rate for Payer: Multiplan Commercial |
$349.05
|
| Rate for Payer: Multiplan Workers Comp |
$349.05
|
| Rate for Payer: Parkland Medicaid |
$32.75
|
| 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 |
$32.75
|
| 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 Ankle 2 Views Right BCE
|
Facility
|
IP
|
$537.00
|
|
|
Service Code
|
CPT 73600 RT,FY
|
| Hospital Charge Code |
3100963
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$472.56
|
|
|
XR Ankle 2 Views Right BCE
|
Facility
|
OP
|
$537.00
|
|
|
Service Code
|
CPT 73600 RT,FY
|
| Hospital Charge Code |
3100963
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$349.05 |
| Rate for Payer: Aetna Commercial |
$27.95
|
| Rate for Payer: Aetna Medicare |
$124.65
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$32.75
|
| 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 |
$472.56
|
| Rate for Payer: Cash Price |
$472.56
|
| Rate for Payer: Cash Price |
$472.56
|
| Rate for Payer: Cigna Commercial |
$188.25
|
| Rate for Payer: Cigna Medicaid |
$32.75
|
| 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 |
$32.75
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$83.10
|
| Rate for Payer: Molina Medicare |
$83.10
|
| Rate for Payer: Multiplan Auto |
$349.05
|
| Rate for Payer: Multiplan Commercial |
$349.05
|
| Rate for Payer: Multiplan Workers Comp |
$349.05
|
| Rate for Payer: Parkland Medicaid |
$32.75
|
| 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 |
$32.75
|
| 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 Ankle Complete 3+ Views Left
|
Facility
|
OP
|
$608.00
|
|
|
Service Code
|
CPT 73610 LT,FY
|
| Hospital Charge Code |
3100971
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$395.20 |
| Rate for Payer: Aetna Commercial |
$32.57
|
| Rate for Payer: Aetna Medicare |
$124.65
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$37.09
|
| 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 |
$535.04
|
| Rate for Payer: Cash Price |
$535.04
|
| Rate for Payer: Cash Price |
$535.04
|
| Rate for Payer: Cigna Commercial |
$188.25
|
| Rate for Payer: Cigna Medicaid |
$37.09
|
| 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 |
$37.09
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$83.10
|
| Rate for Payer: Molina Medicare |
$83.10
|
| Rate for Payer: Multiplan Auto |
$395.20
|
| Rate for Payer: Multiplan Commercial |
$395.20
|
| Rate for Payer: Multiplan Workers Comp |
$395.20
|
| Rate for Payer: Parkland Medicaid |
$37.09
|
| 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 |
$37.09
|
| 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 Ankle Complete 3+ Views Left BCE
|
Facility
|
OP
|
$608.00
|
|
|
Service Code
|
CPT 73610 LT,FY
|
| Hospital Charge Code |
3100971
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$395.20 |
| Rate for Payer: Aetna Commercial |
$32.57
|
| Rate for Payer: Aetna Medicare |
$124.65
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$37.09
|
| 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 |
$535.04
|
| Rate for Payer: Cash Price |
$535.04
|
| Rate for Payer: Cash Price |
$535.04
|
| Rate for Payer: Cigna Commercial |
$188.25
|
| Rate for Payer: Cigna Medicaid |
$37.09
|
| 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 |
$37.09
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$83.10
|
| Rate for Payer: Molina Medicare |
$83.10
|
| Rate for Payer: Multiplan Auto |
$395.20
|
| Rate for Payer: Multiplan Commercial |
$395.20
|
| Rate for Payer: Multiplan Workers Comp |
$395.20
|
| Rate for Payer: Parkland Medicaid |
$37.09
|
| 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 |
$37.09
|
| 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 Ankle Complete 3+ Views Left BCE
|
Facility
|
IP
|
$608.00
|
|
|
Service Code
|
CPT 73610 LT,FY
|
| Hospital Charge Code |
3100971
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$535.04
|
|
|
XR Ankle Complete 3+ Views Right
|
Facility
|
OP
|
$608.00
|
|
|
Service Code
|
CPT 73610 RT,FY
|
| Hospital Charge Code |
3100989
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$395.20 |
| Rate for Payer: Aetna Commercial |
$32.57
|
| Rate for Payer: Aetna Medicare |
$124.65
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$37.09
|
| 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 |
$535.04
|
| Rate for Payer: Cash Price |
$535.04
|
| Rate for Payer: Cash Price |
$535.04
|
| Rate for Payer: Cigna Commercial |
$188.25
|
| Rate for Payer: Cigna Medicaid |
$37.09
|
| 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 |
$37.09
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$83.10
|
| Rate for Payer: Molina Medicare |
$83.10
|
| Rate for Payer: Multiplan Auto |
$395.20
|
| Rate for Payer: Multiplan Commercial |
$395.20
|
| Rate for Payer: Multiplan Workers Comp |
$395.20
|
| Rate for Payer: Parkland Medicaid |
$37.09
|
| 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 |
$37.09
|
| 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 Ankle Complete 3+ Views Right BCE
|
Facility
|
IP
|
$608.00
|
|
|
Service Code
|
CPT 73610 RT,FY
|
| Hospital Charge Code |
3100989
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$535.04
|
|
|
XR Ankle Complete 3+ Views Right BCE
|
Facility
|
OP
|
$608.00
|
|
|
Service Code
|
CPT 73610 RT,FY
|
| Hospital Charge Code |
3100989
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$395.20 |
| Rate for Payer: Aetna Commercial |
$32.57
|
| Rate for Payer: Aetna Medicare |
$124.65
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$37.09
|
| 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 |
$535.04
|
| Rate for Payer: Cash Price |
$535.04
|
| Rate for Payer: Cash Price |
$535.04
|
| Rate for Payer: Cigna Commercial |
$188.25
|
| Rate for Payer: Cigna Medicaid |
$37.09
|
| 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 |
$37.09
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$83.10
|
| Rate for Payer: Molina Medicare |
$83.10
|
| Rate for Payer: Multiplan Auto |
$395.20
|
| Rate for Payer: Multiplan Commercial |
$395.20
|
| Rate for Payer: Multiplan Workers Comp |
$395.20
|
| Rate for Payer: Parkland Medicaid |
$37.09
|
| 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 |
$37.09
|
| 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 Arthrogram Hip Left
|
Facility
|
OP
|
$558.00
|
|
|
Service Code
|
CPT 73525 LT,FY
|
| Hospital Charge Code |
3170063
|
|
Hospital Revenue Code
|
322
|
| Min. Negotiated Rate |
$6.29 |
| Max. Negotiated Rate |
$843.89 |
| Rate for Payer: Aetna Commercial |
$123.48
|
| Rate for Payer: Aetna Medicare |
$527.56
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$131.31
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$351.71
|
| Rate for Payer: Amerigroup Medicare |
$351.71
|
| Rate for Payer: BCBS of TX Blue Advantage |
$630.05
|
| Rate for Payer: BCBS of TX Blue Essentials |
$756.06
|
| Rate for Payer: BCBS of TX Medicare |
$351.71
|
| Rate for Payer: BCBS of TX PPO |
$843.89
|
| Rate for Payer: Cash Price |
$491.04
|
| Rate for Payer: Cash Price |
$491.04
|
| Rate for Payer: Cash Price |
$491.04
|
| Rate for Payer: Cigna Commercial |
$796.73
|
| Rate for Payer: Cigna Medicaid |
$131.31
|
| Rate for Payer: Cigna Medicare |
$351.71
|
| Rate for Payer: Employer Direct Commercial |
$351.71
|
| Rate for Payer: Humana Medicare/TRICARE |
$351.71
|
| Rate for Payer: Molina CHIP/Medicaid |
$131.31
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$351.71
|
| Rate for Payer: Molina Medicare |
$351.71
|
| Rate for Payer: Multiplan Auto |
$362.70
|
| Rate for Payer: Multiplan Commercial |
$362.70
|
| Rate for Payer: Multiplan Workers Comp |
$362.70
|
| Rate for Payer: Parkland Medicaid |
$131.31
|
| Rate for Payer: Scott and White EPO/PPO |
$6.29
|
| Rate for Payer: Scott and White Medicare |
$351.71
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$131.31
|
| Rate for Payer: Superior Health Plan EPO |
$351.71
|
| Rate for Payer: Superior Health Plan Medicare |
$351.71
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$351.71
|
| Rate for Payer: Universal American Medicare |
$351.71
|
| Rate for Payer: Wellcare Medicare |
$351.71
|
| Rate for Payer: Wellmed Medicare |
$351.71
|
|
|
XR Arthrogram Hip Left BCE
|
Facility
|
OP
|
$558.00
|
|
|
Service Code
|
CPT 73525 LT,FY
|
| Hospital Charge Code |
3170063
|
|
Hospital Revenue Code
|
322
|
| Min. Negotiated Rate |
$6.29 |
| Max. Negotiated Rate |
$843.89 |
| Rate for Payer: Aetna Commercial |
$123.48
|
| Rate for Payer: Aetna Medicare |
$527.56
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$131.31
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$351.71
|
| Rate for Payer: Amerigroup Medicare |
$351.71
|
| Rate for Payer: BCBS of TX Blue Advantage |
$630.05
|
| Rate for Payer: BCBS of TX Blue Essentials |
$756.06
|
| Rate for Payer: BCBS of TX Medicare |
$351.71
|
| Rate for Payer: BCBS of TX PPO |
$843.89
|
| Rate for Payer: Cash Price |
$491.04
|
| Rate for Payer: Cash Price |
$491.04
|
| Rate for Payer: Cash Price |
$491.04
|
| Rate for Payer: Cigna Commercial |
$796.73
|
| Rate for Payer: Cigna Medicaid |
$131.31
|
| Rate for Payer: Cigna Medicare |
$351.71
|
| Rate for Payer: Employer Direct Commercial |
$351.71
|
| Rate for Payer: Humana Medicare/TRICARE |
$351.71
|
| Rate for Payer: Molina CHIP/Medicaid |
$131.31
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$351.71
|
| Rate for Payer: Molina Medicare |
$351.71
|
| Rate for Payer: Multiplan Auto |
$362.70
|
| Rate for Payer: Multiplan Commercial |
$362.70
|
| Rate for Payer: Multiplan Workers Comp |
$362.70
|
| Rate for Payer: Parkland Medicaid |
$131.31
|
| Rate for Payer: Scott and White EPO/PPO |
$6.29
|
| Rate for Payer: Scott and White Medicare |
$351.71
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$131.31
|
| Rate for Payer: Superior Health Plan EPO |
$351.71
|
| Rate for Payer: Superior Health Plan Medicare |
$351.71
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$351.71
|
| Rate for Payer: Universal American Medicare |
$351.71
|
| Rate for Payer: Wellcare Medicare |
$351.71
|
| Rate for Payer: Wellmed Medicare |
$351.71
|
|
