|
XR Arthrogram Hip Left BCE
|
Facility
|
IP
|
$558.00
|
|
|
Service Code
|
CPT 73525 LT,FY
|
| Hospital Charge Code |
3170063
|
|
Hospital Revenue Code
|
322
|
| Rate for Payer: Cash Price |
$491.04
|
|
|
XR Arthrogram Hip Right
|
Facility
|
OP
|
$558.00
|
|
|
Service Code
|
CPT 73525 RT,FY
|
| Hospital Charge Code |
3170062
|
|
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 Right BCE
|
Facility
|
IP
|
$558.00
|
|
|
Service Code
|
CPT 73525 RT,FY
|
| Hospital Charge Code |
3170062
|
|
Hospital Revenue Code
|
322
|
| Rate for Payer: Cash Price |
$491.04
|
|
|
XR Arthrogram Hip Right BCE
|
Facility
|
OP
|
$558.00
|
|
|
Service Code
|
CPT 73525 RT,FY
|
| Hospital Charge Code |
3170062
|
|
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 Knee Left
|
Facility
|
OP
|
$908.00
|
|
|
Service Code
|
CPT 73580 LT,FY
|
| Hospital Charge Code |
3170066
|
|
Hospital Revenue Code
|
322
|
| Min. Negotiated Rate |
$6.29 |
| Max. Negotiated Rate |
$843.89 |
| Rate for Payer: Aetna Commercial |
$139.67
|
| Rate for Payer: Aetna Medicare |
$527.56
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$128.31
|
| 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 |
$799.04
|
| Rate for Payer: Cash Price |
$799.04
|
| Rate for Payer: Cash Price |
$799.04
|
| Rate for Payer: Cigna Commercial |
$796.73
|
| Rate for Payer: Cigna Medicaid |
$128.31
|
| 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 |
$128.31
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$351.71
|
| Rate for Payer: Molina Medicare |
$351.71
|
| Rate for Payer: Multiplan Auto |
$590.20
|
| Rate for Payer: Multiplan Commercial |
$590.20
|
| Rate for Payer: Multiplan Workers Comp |
$590.20
|
| Rate for Payer: Parkland Medicaid |
$128.31
|
| 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 |
$128.31
|
| 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 Knee Left BCE
|
Facility
|
OP
|
$908.00
|
|
|
Service Code
|
CPT 73580 LT,FY
|
| Hospital Charge Code |
3170066
|
|
Hospital Revenue Code
|
322
|
| Min. Negotiated Rate |
$6.29 |
| Max. Negotiated Rate |
$843.89 |
| Rate for Payer: Aetna Commercial |
$139.67
|
| Rate for Payer: Aetna Medicare |
$527.56
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$128.31
|
| 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 |
$799.04
|
| Rate for Payer: Cash Price |
$799.04
|
| Rate for Payer: Cash Price |
$799.04
|
| Rate for Payer: Cigna Commercial |
$796.73
|
| Rate for Payer: Cigna Medicaid |
$128.31
|
| 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 |
$128.31
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$351.71
|
| Rate for Payer: Molina Medicare |
$351.71
|
| Rate for Payer: Multiplan Auto |
$590.20
|
| Rate for Payer: Multiplan Commercial |
$590.20
|
| Rate for Payer: Multiplan Workers Comp |
$590.20
|
| Rate for Payer: Parkland Medicaid |
$128.31
|
| 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 |
$128.31
|
| 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 Knee Left BCE
|
Facility
|
IP
|
$908.00
|
|
|
Service Code
|
CPT 73580 LT,FY
|
| Hospital Charge Code |
3170066
|
|
Hospital Revenue Code
|
322
|
| Rate for Payer: Cash Price |
$799.04
|
|
|
XR Arthrogram Knee Right
|
Facility
|
OP
|
$908.00
|
|
|
Service Code
|
CPT 73580 RT,FY
|
| Hospital Charge Code |
3170065
|
|
Hospital Revenue Code
|
322
|
| Min. Negotiated Rate |
$6.29 |
| Max. Negotiated Rate |
$843.89 |
| Rate for Payer: Aetna Commercial |
$139.67
|
| Rate for Payer: Aetna Medicare |
$527.56
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$128.31
|
| 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 |
$799.04
|
| Rate for Payer: Cash Price |
$799.04
|
| Rate for Payer: Cash Price |
$799.04
|
| Rate for Payer: Cigna Commercial |
$796.73
|
| Rate for Payer: Cigna Medicaid |
$128.31
|
| 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 |
$128.31
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$351.71
|
| Rate for Payer: Molina Medicare |
$351.71
|
| Rate for Payer: Multiplan Auto |
$590.20
|
| Rate for Payer: Multiplan Commercial |
$590.20
|
| Rate for Payer: Multiplan Workers Comp |
$590.20
|
| Rate for Payer: Parkland Medicaid |
$128.31
|
| 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 |
$128.31
|
| 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 Knee Right BCE
|
Facility
|
IP
|
$908.00
|
|
|
Service Code
|
CPT 73580 RT,FY
|
| Hospital Charge Code |
3170065
|
|
Hospital Revenue Code
|
322
|
| Rate for Payer: Cash Price |
$799.04
|
|
|
XR Arthrogram Knee Right BCE
|
Facility
|
OP
|
$908.00
|
|
|
Service Code
|
CPT 73580 RT,FY
|
| Hospital Charge Code |
3170065
|
|
Hospital Revenue Code
|
322
|
| Min. Negotiated Rate |
$6.29 |
| Max. Negotiated Rate |
$843.89 |
| Rate for Payer: Aetna Commercial |
$139.67
|
| Rate for Payer: Aetna Medicare |
$527.56
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$128.31
|
| 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 |
$799.04
|
| Rate for Payer: Cash Price |
$799.04
|
| Rate for Payer: Cash Price |
$799.04
|
| Rate for Payer: Cigna Commercial |
$796.73
|
| Rate for Payer: Cigna Medicaid |
$128.31
|
| 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 |
$128.31
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$351.71
|
| Rate for Payer: Molina Medicare |
$351.71
|
| Rate for Payer: Multiplan Auto |
$590.20
|
| Rate for Payer: Multiplan Commercial |
$590.20
|
| Rate for Payer: Multiplan Workers Comp |
$590.20
|
| Rate for Payer: Parkland Medicaid |
$128.31
|
| 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 |
$128.31
|
| 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 Shoulder Left
|
Facility
|
OP
|
$681.00
|
|
|
Service Code
|
CPT 73040 LT,FY
|
| Hospital Charge Code |
3101771
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$6.29 |
| Max. Negotiated Rate |
$843.89 |
| Rate for Payer: Aetna Commercial |
$122.32
|
| Rate for Payer: Aetna Medicare |
$527.56
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$132.31
|
| 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 |
$599.28
|
| Rate for Payer: Cash Price |
$599.28
|
| Rate for Payer: Cash Price |
$599.28
|
| Rate for Payer: Cigna Commercial |
$796.73
|
| Rate for Payer: Cigna Medicaid |
$132.31
|
| 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 |
$132.31
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$351.71
|
| Rate for Payer: Molina Medicare |
$351.71
|
| Rate for Payer: Multiplan Auto |
$442.65
|
| Rate for Payer: Multiplan Commercial |
$442.65
|
| Rate for Payer: Multiplan Workers Comp |
$442.65
|
| Rate for Payer: Parkland Medicaid |
$132.31
|
| 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 |
$132.31
|
| 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 Shoulder Left BCE
|
Facility
|
OP
|
$681.00
|
|
|
Service Code
|
CPT 73040 LT,FY
|
| Hospital Charge Code |
3101771
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$6.29 |
| Max. Negotiated Rate |
$843.89 |
| Rate for Payer: Aetna Commercial |
$122.32
|
| Rate for Payer: Aetna Medicare |
$527.56
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$132.31
|
| 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 |
$599.28
|
| Rate for Payer: Cash Price |
$599.28
|
| Rate for Payer: Cash Price |
$599.28
|
| Rate for Payer: Cigna Commercial |
$796.73
|
| Rate for Payer: Cigna Medicaid |
$132.31
|
| 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 |
$132.31
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$351.71
|
| Rate for Payer: Molina Medicare |
$351.71
|
| Rate for Payer: Multiplan Auto |
$442.65
|
| Rate for Payer: Multiplan Commercial |
$442.65
|
| Rate for Payer: Multiplan Workers Comp |
$442.65
|
| Rate for Payer: Parkland Medicaid |
$132.31
|
| 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 |
$132.31
|
| 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 Shoulder Left BCE
|
Facility
|
IP
|
$681.00
|
|
|
Service Code
|
CPT 73040 LT,FY
|
| Hospital Charge Code |
3101771
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$599.28
|
|
|
XR Arthrogram Shoulder Right
|
Facility
|
OP
|
$681.00
|
|
|
Service Code
|
CPT 73040 RT,FY
|
| Hospital Charge Code |
3101763
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$6.29 |
| Max. Negotiated Rate |
$843.89 |
| Rate for Payer: Aetna Commercial |
$122.32
|
| Rate for Payer: Aetna Medicare |
$527.56
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$132.31
|
| 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 |
$599.28
|
| Rate for Payer: Cash Price |
$599.28
|
| Rate for Payer: Cash Price |
$599.28
|
| Rate for Payer: Cigna Commercial |
$796.73
|
| Rate for Payer: Cigna Medicaid |
$132.31
|
| 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 |
$132.31
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$351.71
|
| Rate for Payer: Molina Medicare |
$351.71
|
| Rate for Payer: Multiplan Auto |
$442.65
|
| Rate for Payer: Multiplan Commercial |
$442.65
|
| Rate for Payer: Multiplan Workers Comp |
$442.65
|
| Rate for Payer: Parkland Medicaid |
$132.31
|
| 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 |
$132.31
|
| 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 Shoulder Right BCE
|
Facility
|
IP
|
$681.00
|
|
|
Service Code
|
CPT 73040 RT,FY
|
| Hospital Charge Code |
3101763
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$599.28
|
|
|
XR Arthrogram Shoulder Right BCE
|
Facility
|
OP
|
$681.00
|
|
|
Service Code
|
CPT 73040 RT,FY
|
| Hospital Charge Code |
3101763
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$6.29 |
| Max. Negotiated Rate |
$843.89 |
| Rate for Payer: Aetna Commercial |
$122.32
|
| Rate for Payer: Aetna Medicare |
$527.56
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$132.31
|
| 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 |
$599.28
|
| Rate for Payer: Cash Price |
$599.28
|
| Rate for Payer: Cash Price |
$599.28
|
| Rate for Payer: Cigna Commercial |
$796.73
|
| Rate for Payer: Cigna Medicaid |
$132.31
|
| 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 |
$132.31
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$351.71
|
| Rate for Payer: Molina Medicare |
$351.71
|
| Rate for Payer: Multiplan Auto |
$442.65
|
| Rate for Payer: Multiplan Commercial |
$442.65
|
| Rate for Payer: Multiplan Workers Comp |
$442.65
|
| Rate for Payer: Parkland Medicaid |
$132.31
|
| 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 |
$132.31
|
| 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 Wrist Left
|
Facility
|
OP
|
$896.00
|
|
|
Service Code
|
CPT 73115 LT,FY
|
| Hospital Charge Code |
3170061
|
|
Hospital Revenue Code
|
322
|
| Min. Negotiated Rate |
$6.29 |
| Max. Negotiated Rate |
$843.89 |
| Rate for Payer: Aetna Commercial |
$127.72
|
| Rate for Payer: Aetna Medicare |
$527.56
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$136.33
|
| 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 |
$788.48
|
| Rate for Payer: Cash Price |
$788.48
|
| Rate for Payer: Cash Price |
$788.48
|
| Rate for Payer: Cigna Commercial |
$796.73
|
| Rate for Payer: Cigna Medicaid |
$136.33
|
| 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 |
$136.33
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$351.71
|
| Rate for Payer: Molina Medicare |
$351.71
|
| Rate for Payer: Multiplan Auto |
$582.40
|
| Rate for Payer: Multiplan Commercial |
$582.40
|
| Rate for Payer: Multiplan Workers Comp |
$582.40
|
| Rate for Payer: Parkland Medicaid |
$136.33
|
| 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 |
$136.33
|
| 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 Wrist Left BCE
|
Facility
|
OP
|
$896.00
|
|
|
Service Code
|
CPT 73115 LT,FY
|
| Hospital Charge Code |
3170061
|
|
Hospital Revenue Code
|
322
|
| Min. Negotiated Rate |
$6.29 |
| Max. Negotiated Rate |
$843.89 |
| Rate for Payer: Aetna Commercial |
$127.72
|
| Rate for Payer: Aetna Medicare |
$527.56
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$136.33
|
| 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 |
$788.48
|
| Rate for Payer: Cash Price |
$788.48
|
| Rate for Payer: Cash Price |
$788.48
|
| Rate for Payer: Cigna Commercial |
$796.73
|
| Rate for Payer: Cigna Medicaid |
$136.33
|
| 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 |
$136.33
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$351.71
|
| Rate for Payer: Molina Medicare |
$351.71
|
| Rate for Payer: Multiplan Auto |
$582.40
|
| Rate for Payer: Multiplan Commercial |
$582.40
|
| Rate for Payer: Multiplan Workers Comp |
$582.40
|
| Rate for Payer: Parkland Medicaid |
$136.33
|
| 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 |
$136.33
|
| 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 Wrist Left BCE
|
Facility
|
IP
|
$896.00
|
|
|
Service Code
|
CPT 73115 LT,FY
|
| Hospital Charge Code |
3170061
|
|
Hospital Revenue Code
|
322
|
| Rate for Payer: Cash Price |
$788.48
|
|
|
XR Arthrogram Wrist Right
|
Facility
|
OP
|
$896.00
|
|
|
Service Code
|
CPT 73115 RT,FY
|
| Hospital Charge Code |
3170060
|
|
Hospital Revenue Code
|
322
|
| Min. Negotiated Rate |
$6.29 |
| Max. Negotiated Rate |
$843.89 |
| Rate for Payer: Aetna Commercial |
$127.72
|
| Rate for Payer: Aetna Medicare |
$527.56
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$136.33
|
| 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 |
$788.48
|
| Rate for Payer: Cash Price |
$788.48
|
| Rate for Payer: Cash Price |
$788.48
|
| Rate for Payer: Cigna Commercial |
$796.73
|
| Rate for Payer: Cigna Medicaid |
$136.33
|
| 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 |
$136.33
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$351.71
|
| Rate for Payer: Molina Medicare |
$351.71
|
| Rate for Payer: Multiplan Auto |
$582.40
|
| Rate for Payer: Multiplan Commercial |
$582.40
|
| Rate for Payer: Multiplan Workers Comp |
$582.40
|
| Rate for Payer: Parkland Medicaid |
$136.33
|
| 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 |
$136.33
|
| 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 Wrist Right BCE
|
Facility
|
OP
|
$896.00
|
|
|
Service Code
|
CPT 73115 RT,FY
|
| Hospital Charge Code |
3170060
|
|
Hospital Revenue Code
|
322
|
| Min. Negotiated Rate |
$6.29 |
| Max. Negotiated Rate |
$843.89 |
| Rate for Payer: Aetna Commercial |
$127.72
|
| Rate for Payer: Aetna Medicare |
$527.56
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$136.33
|
| 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 |
$788.48
|
| Rate for Payer: Cash Price |
$788.48
|
| Rate for Payer: Cash Price |
$788.48
|
| Rate for Payer: Cigna Commercial |
$796.73
|
| Rate for Payer: Cigna Medicaid |
$136.33
|
| 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 |
$136.33
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$351.71
|
| Rate for Payer: Molina Medicare |
$351.71
|
| Rate for Payer: Multiplan Auto |
$582.40
|
| Rate for Payer: Multiplan Commercial |
$582.40
|
| Rate for Payer: Multiplan Workers Comp |
$582.40
|
| Rate for Payer: Parkland Medicaid |
$136.33
|
| 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 |
$136.33
|
| 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 Wrist Right BCE
|
Facility
|
IP
|
$896.00
|
|
|
Service Code
|
CPT 73115 RT,FY
|
| Hospital Charge Code |
3170060
|
|
Hospital Revenue Code
|
322
|
| Rate for Payer: Cash Price |
$788.48
|
|
|
XR Barium Enema Complete
|
Facility
|
OP
|
$779.00
|
|
|
Service Code
|
CPT 74270 FY
|
| Hospital Charge Code |
3101144
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$3.01 |
| Max. Negotiated Rate |
$506.35 |
| Rate for Payer: Aetna Commercial |
$125.79
|
| Rate for Payer: Aetna Medicare |
$252.04
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$156.04
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$168.03
|
| Rate for Payer: Amerigroup Medicare |
$168.03
|
| Rate for Payer: BCBS of TX Blue Advantage |
$300.66
|
| Rate for Payer: BCBS of TX Blue Essentials |
$360.80
|
| Rate for Payer: BCBS of TX Medicare |
$168.03
|
| Rate for Payer: BCBS of TX PPO |
$402.71
|
| Rate for Payer: Cash Price |
$685.52
|
| Rate for Payer: Cash Price |
$685.52
|
| Rate for Payer: Cash Price |
$685.52
|
| Rate for Payer: Cigna Commercial |
$380.65
|
| Rate for Payer: Cigna Medicaid |
$156.04
|
| Rate for Payer: Cigna Medicare |
$168.03
|
| Rate for Payer: Employer Direct Commercial |
$168.03
|
| Rate for Payer: Humana Medicare/TRICARE |
$168.03
|
| Rate for Payer: Molina CHIP/Medicaid |
$156.04
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$168.03
|
| Rate for Payer: Molina Medicare |
$168.03
|
| Rate for Payer: Multiplan Auto |
$506.35
|
| Rate for Payer: Multiplan Commercial |
$506.35
|
| Rate for Payer: Multiplan Workers Comp |
$506.35
|
| Rate for Payer: Parkland Medicaid |
$156.04
|
| Rate for Payer: Scott and White EPO/PPO |
$3.01
|
| Rate for Payer: Scott and White Medicare |
$168.03
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$156.04
|
| Rate for Payer: Superior Health Plan EPO |
$168.03
|
| Rate for Payer: Superior Health Plan Medicare |
$168.03
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$168.03
|
| Rate for Payer: Universal American Medicare |
$168.03
|
| Rate for Payer: Wellcare Medicare |
$168.03
|
| Rate for Payer: Wellmed Medicare |
$168.03
|
|
|
XR Barium Enema Complete BCE
|
Facility
|
IP
|
$779.00
|
|
|
Service Code
|
CPT 74270 FY
|
| Hospital Charge Code |
3101144
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$685.52
|
|
|
XR Barium Enema Complete BCE
|
Facility
|
OP
|
$779.00
|
|
|
Service Code
|
CPT 74270 FY
|
| Hospital Charge Code |
3101144
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$3.01 |
| Max. Negotiated Rate |
$506.35 |
| Rate for Payer: Aetna Commercial |
$125.79
|
| Rate for Payer: Aetna Medicare |
$252.04
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$156.04
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$168.03
|
| Rate for Payer: Amerigroup Medicare |
$168.03
|
| Rate for Payer: BCBS of TX Blue Advantage |
$300.66
|
| Rate for Payer: BCBS of TX Blue Essentials |
$360.80
|
| Rate for Payer: BCBS of TX Medicare |
$168.03
|
| Rate for Payer: BCBS of TX PPO |
$402.71
|
| Rate for Payer: Cash Price |
$685.52
|
| Rate for Payer: Cash Price |
$685.52
|
| Rate for Payer: Cash Price |
$685.52
|
| Rate for Payer: Cigna Commercial |
$380.65
|
| Rate for Payer: Cigna Medicaid |
$156.04
|
| Rate for Payer: Cigna Medicare |
$168.03
|
| Rate for Payer: Employer Direct Commercial |
$168.03
|
| Rate for Payer: Humana Medicare/TRICARE |
$168.03
|
| Rate for Payer: Molina CHIP/Medicaid |
$156.04
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$168.03
|
| Rate for Payer: Molina Medicare |
$168.03
|
| Rate for Payer: Multiplan Auto |
$506.35
|
| Rate for Payer: Multiplan Commercial |
$506.35
|
| Rate for Payer: Multiplan Workers Comp |
$506.35
|
| Rate for Payer: Parkland Medicaid |
$156.04
|
| Rate for Payer: Scott and White EPO/PPO |
$3.01
|
| Rate for Payer: Scott and White Medicare |
$168.03
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$156.04
|
| Rate for Payer: Superior Health Plan EPO |
$168.03
|
| Rate for Payer: Superior Health Plan Medicare |
$168.03
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$168.03
|
| Rate for Payer: Universal American Medicare |
$168.03
|
| Rate for Payer: Wellcare Medicare |
$168.03
|
| Rate for Payer: Wellmed Medicare |
$168.03
|
|
