|
XR Elbow 2 Views Right
|
Facility
|
OP
|
$594.00
|
|
|
Service Code
|
CPT 73070 RT,FY
|
| Hospital Charge Code |
3100666
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$386.10 |
| Rate for Payer: Aetna Commercial |
$24.10
|
| Rate for Payer: Aetna Medicare |
$124.65
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$29.40
|
| 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 |
$522.72
|
| Rate for Payer: Cash Price |
$522.72
|
| Rate for Payer: Cash Price |
$522.72
|
| Rate for Payer: Cigna Commercial |
$188.25
|
| Rate for Payer: Cigna Medicaid |
$29.40
|
| 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 |
$29.40
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$83.10
|
| Rate for Payer: Molina Medicare |
$83.10
|
| Rate for Payer: Multiplan Auto |
$386.10
|
| Rate for Payer: Multiplan Commercial |
$386.10
|
| Rate for Payer: Multiplan Workers Comp |
$386.10
|
| Rate for Payer: Parkland Medicaid |
$29.40
|
| 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 |
$29.40
|
| 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 Elbow 2 Views Right BCE
|
Facility
|
IP
|
$594.00
|
|
|
Service Code
|
CPT 73070 RT,FY
|
| Hospital Charge Code |
3100666
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$522.72
|
|
|
XR Elbow 2 Views Right BCE
|
Facility
|
OP
|
$594.00
|
|
|
Service Code
|
CPT 73070 RT,FY
|
| Hospital Charge Code |
3100666
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$386.10 |
| Rate for Payer: Aetna Commercial |
$24.10
|
| Rate for Payer: Aetna Medicare |
$124.65
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$29.40
|
| 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 |
$522.72
|
| Rate for Payer: Cash Price |
$522.72
|
| Rate for Payer: Cash Price |
$522.72
|
| Rate for Payer: Cigna Commercial |
$188.25
|
| Rate for Payer: Cigna Medicaid |
$29.40
|
| 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 |
$29.40
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$83.10
|
| Rate for Payer: Molina Medicare |
$83.10
|
| Rate for Payer: Multiplan Auto |
$386.10
|
| Rate for Payer: Multiplan Commercial |
$386.10
|
| Rate for Payer: Multiplan Workers Comp |
$386.10
|
| Rate for Payer: Parkland Medicaid |
$29.40
|
| 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 |
$29.40
|
| 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 Elbow Complete 3+ Views Left
|
Facility
|
OP
|
$664.00
|
|
|
Service Code
|
CPT 73080 LT,FY
|
| Hospital Charge Code |
3100674
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$431.60 |
| Rate for Payer: Aetna Commercial |
$27.56
|
| 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 |
$584.32
|
| Rate for Payer: Cash Price |
$584.32
|
| Rate for Payer: Cash Price |
$584.32
|
| 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 |
$431.60
|
| Rate for Payer: Multiplan Commercial |
$431.60
|
| Rate for Payer: Multiplan Workers Comp |
$431.60
|
| 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 Elbow Complete 3+ Views Left BCE
|
Facility
|
IP
|
$664.00
|
|
|
Service Code
|
CPT 73080 LT,FY
|
| Hospital Charge Code |
3100674
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$584.32
|
|
|
XR Elbow Complete 3+ Views Left BCE
|
Facility
|
OP
|
$664.00
|
|
|
Service Code
|
CPT 73080 LT,FY
|
| Hospital Charge Code |
3100674
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$431.60 |
| Rate for Payer: Aetna Commercial |
$27.56
|
| 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 |
$584.32
|
| Rate for Payer: Cash Price |
$584.32
|
| Rate for Payer: Cash Price |
$584.32
|
| 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 |
$431.60
|
| Rate for Payer: Multiplan Commercial |
$431.60
|
| Rate for Payer: Multiplan Workers Comp |
$431.60
|
| 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 Elbow Complete 3+ Views Right
|
Facility
|
OP
|
$664.00
|
|
|
Service Code
|
CPT 73080 RT,FY
|
| Hospital Charge Code |
3100682
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$431.60 |
| Rate for Payer: Aetna Commercial |
$27.56
|
| 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 |
$584.32
|
| Rate for Payer: Cash Price |
$584.32
|
| Rate for Payer: Cash Price |
$584.32
|
| 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 |
$431.60
|
| Rate for Payer: Multiplan Commercial |
$431.60
|
| Rate for Payer: Multiplan Workers Comp |
$431.60
|
| 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 Elbow Complete 3+ Views Right BCE
|
Facility
|
OP
|
$664.00
|
|
|
Service Code
|
CPT 73080 RT,FY
|
| Hospital Charge Code |
3100682
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$431.60 |
| Rate for Payer: Aetna Commercial |
$27.56
|
| 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 |
$584.32
|
| Rate for Payer: Cash Price |
$584.32
|
| Rate for Payer: Cash Price |
$584.32
|
| 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 |
$431.60
|
| Rate for Payer: Multiplan Commercial |
$431.60
|
| Rate for Payer: Multiplan Workers Comp |
$431.60
|
| 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 Elbow Complete 3+ Views Right BCE
|
Facility
|
IP
|
$664.00
|
|
|
Service Code
|
CPT 73080 RT,FY
|
| Hospital Charge Code |
3100682
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$584.32
|
|
|
XR ERCP Biliary and Pancreatic Duct
|
Facility
|
OP
|
$2,508.00
|
|
|
Service Code
|
CPT 74330 FY
|
| Hospital Charge Code |
2161004
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$76.71 |
| Max. Negotiated Rate |
$1,630.20 |
| Rate for Payer: Aetna Commercial |
$86.84
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$225.72
|
| Rate for Payer: BCBS of TX Blue Advantage |
$76.71
|
| Rate for Payer: BCBS of TX Blue Essentials |
$92.05
|
| Rate for Payer: BCBS of TX PPO |
$102.74
|
| Rate for Payer: Cash Price |
$2,207.04
|
| Rate for Payer: Cash Price |
$2,207.04
|
| Rate for Payer: Multiplan Auto |
$1,630.20
|
| Rate for Payer: Multiplan Commercial |
$1,630.20
|
| Rate for Payer: Multiplan Workers Comp |
$1,630.20
|
| Rate for Payer: Scott and White EPO/PPO |
$1,254.00
|
| Rate for Payer: Superior Health Plan EPO |
$341.09
|
|
|
XR ERCP Biliary and Pancreatic Duct BCE
|
Facility
|
OP
|
$2,508.00
|
|
|
Service Code
|
CPT 74330 FY
|
| Hospital Charge Code |
2161004
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$76.71 |
| Max. Negotiated Rate |
$1,630.20 |
| Rate for Payer: Aetna Commercial |
$86.84
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$225.72
|
| Rate for Payer: BCBS of TX Blue Advantage |
$76.71
|
| Rate for Payer: BCBS of TX Blue Essentials |
$92.05
|
| Rate for Payer: BCBS of TX PPO |
$102.74
|
| Rate for Payer: Cash Price |
$2,207.04
|
| Rate for Payer: Cash Price |
$2,207.04
|
| Rate for Payer: Multiplan Auto |
$1,630.20
|
| Rate for Payer: Multiplan Commercial |
$1,630.20
|
| Rate for Payer: Multiplan Workers Comp |
$1,630.20
|
| Rate for Payer: Scott and White EPO/PPO |
$1,254.00
|
| Rate for Payer: Superior Health Plan EPO |
$341.09
|
|
|
XR ERCP Biliary and Pancreatic Duct BCE
|
Facility
|
IP
|
$2,508.00
|
|
|
Service Code
|
CPT 74330 FY
|
| Hospital Charge Code |
2161004
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$2,207.04
|
|
|
XR Esophagus
|
Facility
|
OP
|
$631.00
|
|
|
Service Code
|
CPT 74220 FY
|
| Hospital Charge Code |
3101094
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$3.01 |
| Max. Negotiated Rate |
$410.15 |
| Rate for Payer: Aetna Commercial |
$83.04
|
| Rate for Payer: Aetna Medicare |
$252.04
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$99.90
|
| 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 |
$555.28
|
| Rate for Payer: Cash Price |
$555.28
|
| Rate for Payer: Cash Price |
$555.28
|
| Rate for Payer: Cigna Commercial |
$380.65
|
| Rate for Payer: Cigna Medicaid |
$99.90
|
| 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 |
$99.90
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$168.03
|
| Rate for Payer: Molina Medicare |
$168.03
|
| Rate for Payer: Multiplan Auto |
$410.15
|
| Rate for Payer: Multiplan Commercial |
$410.15
|
| Rate for Payer: Multiplan Workers Comp |
$410.15
|
| Rate for Payer: Parkland Medicaid |
$99.90
|
| 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 |
$99.90
|
| 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 Esophagus BCE
|
Facility
|
IP
|
$631.00
|
|
|
Service Code
|
CPT 74220 FY
|
| Hospital Charge Code |
3101094
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$555.28
|
|
|
XR Esophagus BCE
|
Facility
|
OP
|
$631.00
|
|
|
Service Code
|
CPT 74220 FY
|
| Hospital Charge Code |
3101094
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$3.01 |
| Max. Negotiated Rate |
$410.15 |
| Rate for Payer: Aetna Commercial |
$83.04
|
| Rate for Payer: Aetna Medicare |
$252.04
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$99.90
|
| 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 |
$555.28
|
| Rate for Payer: Cash Price |
$555.28
|
| Rate for Payer: Cash Price |
$555.28
|
| Rate for Payer: Cigna Commercial |
$380.65
|
| Rate for Payer: Cigna Medicaid |
$99.90
|
| 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 |
$99.90
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$168.03
|
| Rate for Payer: Molina Medicare |
$168.03
|
| Rate for Payer: Multiplan Auto |
$410.15
|
| Rate for Payer: Multiplan Commercial |
$410.15
|
| Rate for Payer: Multiplan Workers Comp |
$410.15
|
| Rate for Payer: Parkland Medicaid |
$99.90
|
| 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 |
$99.90
|
| 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 Facial Bones < 3 Views
|
Facility
|
OP
|
$315.00
|
|
|
Service Code
|
CPT 70140 FY
|
| Hospital Charge Code |
3160397
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$204.75 |
| Rate for Payer: Aetna Commercial |
$25.64
|
| Rate for Payer: Aetna Medicare |
$124.65
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$32.41
|
| 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 |
$277.20
|
| Rate for Payer: Cash Price |
$277.20
|
| Rate for Payer: Cash Price |
$277.20
|
| Rate for Payer: Cigna Commercial |
$188.25
|
| Rate for Payer: Cigna Medicaid |
$32.41
|
| 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 |
$32.41
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$83.10
|
| Rate for Payer: Molina Medicare |
$83.10
|
| Rate for Payer: Multiplan Auto |
$204.75
|
| Rate for Payer: Multiplan Commercial |
$204.75
|
| Rate for Payer: Multiplan Workers Comp |
$204.75
|
| Rate for Payer: Parkland Medicaid |
$32.41
|
| 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 |
$32.41
|
| 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 Facial Bones 3+ Views
|
Facility
|
OP
|
$381.00
|
|
|
Service Code
|
CPT 70150 FY
|
| Hospital Charge Code |
3100146
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$247.70 |
| Rate for Payer: Aetna Commercial |
$40.27
|
| Rate for Payer: Aetna Medicare |
$150.82
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$47.11
|
| 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 |
$335.28
|
| Rate for Payer: Cash Price |
$335.28
|
| Rate for Payer: Cash Price |
$335.28
|
| Rate for Payer: Cigna Commercial |
$227.77
|
| Rate for Payer: Cigna Medicaid |
$47.11
|
| 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 |
$47.11
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$100.55
|
| Rate for Payer: Molina Medicare |
$100.55
|
| Rate for Payer: Multiplan Auto |
$247.65
|
| Rate for Payer: Multiplan Commercial |
$247.65
|
| Rate for Payer: Multiplan Workers Comp |
$247.65
|
| Rate for Payer: Parkland Medicaid |
$47.11
|
| 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 |
$47.11
|
| 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 Facial Bones < 3 Views BCE
|
Facility
|
IP
|
$315.00
|
|
|
Service Code
|
CPT 70140 FY
|
| Hospital Charge Code |
3160397
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$277.20
|
|
|
XR Facial Bones < 3 Views BCE
|
Facility
|
OP
|
$315.00
|
|
|
Service Code
|
CPT 70140 FY
|
| Hospital Charge Code |
3160397
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$204.75 |
| Rate for Payer: Aetna Commercial |
$25.64
|
| Rate for Payer: Aetna Medicare |
$124.65
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$32.41
|
| 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 |
$277.20
|
| Rate for Payer: Cash Price |
$277.20
|
| Rate for Payer: Cash Price |
$277.20
|
| Rate for Payer: Cigna Commercial |
$188.25
|
| Rate for Payer: Cigna Medicaid |
$32.41
|
| 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 |
$32.41
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$83.10
|
| Rate for Payer: Molina Medicare |
$83.10
|
| Rate for Payer: Multiplan Auto |
$204.75
|
| Rate for Payer: Multiplan Commercial |
$204.75
|
| Rate for Payer: Multiplan Workers Comp |
$204.75
|
| Rate for Payer: Parkland Medicaid |
$32.41
|
| 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 |
$32.41
|
| 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 Facial Bones 3+ Views BCE
|
Facility
|
IP
|
$381.00
|
|
|
Service Code
|
CPT 70150 FY
|
| Hospital Charge Code |
3100146
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$335.28
|
|
|
XR Facial Bones 3+ Views BCE
|
Facility
|
OP
|
$381.00
|
|
|
Service Code
|
CPT 70150 FY
|
| Hospital Charge Code |
3100146
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$247.70 |
| Rate for Payer: Aetna Commercial |
$40.27
|
| Rate for Payer: Aetna Medicare |
$150.82
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$47.11
|
| 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 |
$335.28
|
| Rate for Payer: Cash Price |
$335.28
|
| Rate for Payer: Cash Price |
$335.28
|
| Rate for Payer: Cigna Commercial |
$227.77
|
| Rate for Payer: Cigna Medicaid |
$47.11
|
| 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 |
$47.11
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$100.55
|
| Rate for Payer: Molina Medicare |
$100.55
|
| Rate for Payer: Multiplan Auto |
$247.65
|
| Rate for Payer: Multiplan Commercial |
$247.65
|
| Rate for Payer: Multiplan Workers Comp |
$247.65
|
| Rate for Payer: Parkland Medicaid |
$47.11
|
| 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 |
$47.11
|
| 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 Femur 1 View Left
|
Facility
|
OP
|
$329.00
|
|
|
Service Code
|
CPT 73551 LT,FY
|
| Hospital Charge Code |
3181214
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$213.85 |
| Rate for Payer: Aetna Commercial |
$24.10
|
| Rate for Payer: Aetna Medicare |
$124.65
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$29.40
|
| 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 |
$289.52
|
| Rate for Payer: Cash Price |
$289.52
|
| Rate for Payer: Cash Price |
$289.52
|
| Rate for Payer: Cigna Commercial |
$188.25
|
| Rate for Payer: Cigna Medicaid |
$29.40
|
| 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 |
$29.40
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$83.10
|
| Rate for Payer: Molina Medicare |
$83.10
|
| Rate for Payer: Multiplan Auto |
$213.85
|
| Rate for Payer: Multiplan Commercial |
$213.85
|
| Rate for Payer: Multiplan Workers Comp |
$213.85
|
| Rate for Payer: Parkland Medicaid |
$29.40
|
| 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 |
$29.40
|
| 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 Femur 1 View Left BCE
|
Facility
|
OP
|
$329.00
|
|
|
Service Code
|
CPT 73551 LT,FY
|
| Hospital Charge Code |
3181214
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$213.85 |
| Rate for Payer: Aetna Commercial |
$24.10
|
| Rate for Payer: Aetna Medicare |
$124.65
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$29.40
|
| 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 |
$289.52
|
| Rate for Payer: Cash Price |
$289.52
|
| Rate for Payer: Cash Price |
$289.52
|
| Rate for Payer: Cigna Commercial |
$188.25
|
| Rate for Payer: Cigna Medicaid |
$29.40
|
| 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 |
$29.40
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$83.10
|
| Rate for Payer: Molina Medicare |
$83.10
|
| Rate for Payer: Multiplan Auto |
$213.85
|
| Rate for Payer: Multiplan Commercial |
$213.85
|
| Rate for Payer: Multiplan Workers Comp |
$213.85
|
| Rate for Payer: Parkland Medicaid |
$29.40
|
| 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 |
$29.40
|
| 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 Femur 1 View Left BCE
|
Facility
|
IP
|
$329.00
|
|
|
Service Code
|
CPT 73551 LT,FY
|
| Hospital Charge Code |
3181214
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$289.52
|
|
|
XR Femur 1 View Right
|
Facility
|
OP
|
$329.00
|
|
|
Service Code
|
CPT 73551 RT,FY
|
| Hospital Charge Code |
3181213
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$213.85 |
| Rate for Payer: Aetna Commercial |
$24.10
|
| Rate for Payer: Aetna Medicare |
$124.65
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$29.40
|
| 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 |
$289.52
|
| Rate for Payer: Cash Price |
$289.52
|
| Rate for Payer: Cash Price |
$289.52
|
| Rate for Payer: Cigna Commercial |
$188.25
|
| Rate for Payer: Cigna Medicaid |
$29.40
|
| 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 |
$29.40
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$83.10
|
| Rate for Payer: Molina Medicare |
$83.10
|
| Rate for Payer: Multiplan Auto |
$213.85
|
| Rate for Payer: Multiplan Commercial |
$213.85
|
| Rate for Payer: Multiplan Workers Comp |
$213.85
|
| Rate for Payer: Parkland Medicaid |
$29.40
|
| 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 |
$29.40
|
| 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
|
|
