|
XR Fluoro Guidance Needle Placement
|
Facility
|
OP
|
$559.00
|
|
|
Service Code
|
CPT 77002 FY
|
| Hospital Charge Code |
3120011
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$50.31 |
| Max. Negotiated Rate |
$363.35 |
| Rate for Payer: Aetna Commercial |
$103.44
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$50.31
|
| Rate for Payer: BCBS of TX Blue Advantage |
$123.09
|
| Rate for Payer: BCBS of TX Blue Essentials |
$147.71
|
| Rate for Payer: BCBS of TX PPO |
$164.87
|
| Rate for Payer: Cash Price |
$491.92
|
| Rate for Payer: Cash Price |
$491.92
|
| Rate for Payer: Multiplan Auto |
$363.35
|
| Rate for Payer: Multiplan Commercial |
$363.35
|
| Rate for Payer: Multiplan Workers Comp |
$363.35
|
| Rate for Payer: Scott and White EPO/PPO |
$279.50
|
| Rate for Payer: Superior Health Plan EPO |
$76.02
|
|
|
XR Fluoro Guidance Needle Placement BCE
|
Facility
|
OP
|
$559.00
|
|
|
Service Code
|
CPT 77002 FY
|
| Hospital Charge Code |
3120011
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$50.31 |
| Max. Negotiated Rate |
$363.35 |
| Rate for Payer: Aetna Commercial |
$103.44
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$50.31
|
| Rate for Payer: BCBS of TX Blue Advantage |
$123.09
|
| Rate for Payer: BCBS of TX Blue Essentials |
$147.71
|
| Rate for Payer: BCBS of TX PPO |
$164.87
|
| Rate for Payer: Cash Price |
$491.92
|
| Rate for Payer: Cash Price |
$491.92
|
| Rate for Payer: Multiplan Auto |
$363.35
|
| Rate for Payer: Multiplan Commercial |
$363.35
|
| Rate for Payer: Multiplan Workers Comp |
$363.35
|
| Rate for Payer: Scott and White EPO/PPO |
$279.50
|
| Rate for Payer: Superior Health Plan EPO |
$76.02
|
|
|
XR Fluoro Guidance Needle Placement BCE
|
Facility
|
IP
|
$559.00
|
|
|
Service Code
|
CPT 77002 FY
|
| Hospital Charge Code |
3120011
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$491.92
|
|
|
XR Fluoroscopy Eval Diaphragm Sniff Test
|
Facility
|
OP
|
$480.00
|
|
|
Service Code
|
CPT 76000 FY
|
| Hospital Charge Code |
3101276
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$4.01 |
| Max. Negotiated Rate |
$507.64 |
| Rate for Payer: Aetna Commercial |
$31.80
|
| Rate for Payer: Aetna Medicare |
$336.15
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$43.44
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$224.10
|
| Rate for Payer: Amerigroup Medicare |
$224.10
|
| Rate for Payer: BCBS of TX Blue Advantage |
$52.92
|
| Rate for Payer: BCBS of TX Blue Essentials |
$63.50
|
| Rate for Payer: BCBS of TX Medicare |
$224.10
|
| Rate for Payer: BCBS of TX PPO |
$70.87
|
| Rate for Payer: Cash Price |
$422.40
|
| Rate for Payer: Cash Price |
$422.40
|
| Rate for Payer: Cash Price |
$422.40
|
| Rate for Payer: Cigna Commercial |
$507.64
|
| Rate for Payer: Cigna Medicaid |
$43.44
|
| Rate for Payer: Cigna Medicare |
$224.10
|
| Rate for Payer: Employer Direct Commercial |
$224.10
|
| Rate for Payer: Humana Medicare/TRICARE |
$224.10
|
| Rate for Payer: Molina CHIP/Medicaid |
$43.44
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$224.10
|
| Rate for Payer: Molina Medicare |
$224.10
|
| Rate for Payer: Multiplan Auto |
$312.00
|
| Rate for Payer: Multiplan Commercial |
$312.00
|
| Rate for Payer: Multiplan Workers Comp |
$312.00
|
| Rate for Payer: Parkland Medicaid |
$43.44
|
| Rate for Payer: Scott and White EPO/PPO |
$4.01
|
| Rate for Payer: Scott and White Medicare |
$224.10
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$43.44
|
| Rate for Payer: Superior Health Plan EPO |
$224.10
|
| Rate for Payer: Superior Health Plan Medicare |
$224.10
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$224.10
|
| Rate for Payer: Universal American Medicare |
$224.10
|
| Rate for Payer: Wellcare Medicare |
$224.10
|
| Rate for Payer: Wellmed Medicare |
$224.10
|
|
|
XR Fluoroscopy Guide Vein Device
|
Facility
|
OP
|
$619.00
|
|
|
Service Code
|
CPT 77001 FY
|
| Hospital Charge Code |
3120003
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$55.71 |
| Max. Negotiated Rate |
$402.35 |
| Rate for Payer: Aetna Commercial |
$97.67
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$55.71
|
| Rate for Payer: BCBS of TX Blue Advantage |
$120.12
|
| Rate for Payer: BCBS of TX Blue Essentials |
$144.14
|
| Rate for Payer: BCBS of TX PPO |
$160.89
|
| Rate for Payer: Cash Price |
$544.72
|
| Rate for Payer: Cash Price |
$544.72
|
| Rate for Payer: Multiplan Auto |
$402.35
|
| Rate for Payer: Multiplan Commercial |
$402.35
|
| Rate for Payer: Multiplan Workers Comp |
$402.35
|
| Rate for Payer: Scott and White EPO/PPO |
$309.50
|
| Rate for Payer: Superior Health Plan EPO |
$84.18
|
|
|
XR Fluoroscopy Guide Vein Device BCE
|
Facility
|
OP
|
$619.00
|
|
|
Service Code
|
CPT 77001 FY
|
| Hospital Charge Code |
3120003
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$55.71 |
| Max. Negotiated Rate |
$402.35 |
| Rate for Payer: Aetna Commercial |
$97.67
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$55.71
|
| Rate for Payer: BCBS of TX Blue Advantage |
$120.12
|
| Rate for Payer: BCBS of TX Blue Essentials |
$144.14
|
| Rate for Payer: BCBS of TX PPO |
$160.89
|
| Rate for Payer: Cash Price |
$544.72
|
| Rate for Payer: Cash Price |
$544.72
|
| Rate for Payer: Multiplan Auto |
$402.35
|
| Rate for Payer: Multiplan Commercial |
$402.35
|
| Rate for Payer: Multiplan Workers Comp |
$402.35
|
| Rate for Payer: Scott and White EPO/PPO |
$309.50
|
| Rate for Payer: Superior Health Plan EPO |
$84.18
|
|
|
XR Fluoroscopy Guide Vein Device BCE
|
Facility
|
IP
|
$619.00
|
|
|
Service Code
|
CPT 77001 FY
|
| Hospital Charge Code |
3120003
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$544.72
|
|
|
XR Fluoroscopy in Imaging per Hour
|
Facility
|
OP
|
$480.00
|
|
|
Service Code
|
CPT 76000 FY
|
| Hospital Charge Code |
3101276
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$4.01 |
| Max. Negotiated Rate |
$507.64 |
| Rate for Payer: Aetna Commercial |
$31.80
|
| Rate for Payer: Aetna Medicare |
$336.15
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$43.44
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$224.10
|
| Rate for Payer: Amerigroup Medicare |
$224.10
|
| Rate for Payer: BCBS of TX Blue Advantage |
$52.92
|
| Rate for Payer: BCBS of TX Blue Essentials |
$63.50
|
| Rate for Payer: BCBS of TX Medicare |
$224.10
|
| Rate for Payer: BCBS of TX PPO |
$70.87
|
| Rate for Payer: Cash Price |
$422.40
|
| Rate for Payer: Cash Price |
$422.40
|
| Rate for Payer: Cash Price |
$422.40
|
| Rate for Payer: Cigna Commercial |
$507.64
|
| Rate for Payer: Cigna Medicaid |
$43.44
|
| Rate for Payer: Cigna Medicare |
$224.10
|
| Rate for Payer: Employer Direct Commercial |
$224.10
|
| Rate for Payer: Humana Medicare/TRICARE |
$224.10
|
| Rate for Payer: Molina CHIP/Medicaid |
$43.44
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$224.10
|
| Rate for Payer: Molina Medicare |
$224.10
|
| Rate for Payer: Multiplan Auto |
$312.00
|
| Rate for Payer: Multiplan Commercial |
$312.00
|
| Rate for Payer: Multiplan Workers Comp |
$312.00
|
| Rate for Payer: Parkland Medicaid |
$43.44
|
| Rate for Payer: Scott and White EPO/PPO |
$4.01
|
| Rate for Payer: Scott and White Medicare |
$224.10
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$43.44
|
| Rate for Payer: Superior Health Plan EPO |
$224.10
|
| Rate for Payer: Superior Health Plan Medicare |
$224.10
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$224.10
|
| Rate for Payer: Universal American Medicare |
$224.10
|
| Rate for Payer: Wellcare Medicare |
$224.10
|
| Rate for Payer: Wellmed Medicare |
$224.10
|
|
|
XR Fluoroscopy in Imaging per Hour BCE
|
Facility
|
OP
|
$480.00
|
|
|
Service Code
|
CPT 76000 FY
|
| Hospital Charge Code |
3101276
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$4.01 |
| Max. Negotiated Rate |
$507.64 |
| Rate for Payer: Aetna Commercial |
$31.80
|
| Rate for Payer: Aetna Medicare |
$336.15
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$43.44
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$224.10
|
| Rate for Payer: Amerigroup Medicare |
$224.10
|
| Rate for Payer: BCBS of TX Blue Advantage |
$52.92
|
| Rate for Payer: BCBS of TX Blue Essentials |
$63.50
|
| Rate for Payer: BCBS of TX Medicare |
$224.10
|
| Rate for Payer: BCBS of TX PPO |
$70.87
|
| Rate for Payer: Cash Price |
$422.40
|
| Rate for Payer: Cash Price |
$422.40
|
| Rate for Payer: Cash Price |
$422.40
|
| Rate for Payer: Cigna Commercial |
$507.64
|
| Rate for Payer: Cigna Medicaid |
$43.44
|
| Rate for Payer: Cigna Medicare |
$224.10
|
| Rate for Payer: Employer Direct Commercial |
$224.10
|
| Rate for Payer: Humana Medicare/TRICARE |
$224.10
|
| Rate for Payer: Molina CHIP/Medicaid |
$43.44
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$224.10
|
| Rate for Payer: Molina Medicare |
$224.10
|
| Rate for Payer: Multiplan Auto |
$312.00
|
| Rate for Payer: Multiplan Commercial |
$312.00
|
| Rate for Payer: Multiplan Workers Comp |
$312.00
|
| Rate for Payer: Parkland Medicaid |
$43.44
|
| Rate for Payer: Scott and White EPO/PPO |
$4.01
|
| Rate for Payer: Scott and White Medicare |
$224.10
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$43.44
|
| Rate for Payer: Superior Health Plan EPO |
$224.10
|
| Rate for Payer: Superior Health Plan Medicare |
$224.10
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$224.10
|
| Rate for Payer: Universal American Medicare |
$224.10
|
| Rate for Payer: Wellcare Medicare |
$224.10
|
| Rate for Payer: Wellmed Medicare |
$224.10
|
|
|
XR Foot 2 Views Left
|
Facility
|
OP
|
$537.00
|
|
|
Service Code
|
CPT 73620 LT,FY
|
| Hospital Charge Code |
3100997
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$349.05 |
| Rate for Payer: Aetna Commercial |
$23.71
|
| Rate for Payer: Aetna Medicare |
$124.65
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$28.40
|
| 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 |
$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 |
$28.40
|
| 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 |
$28.40
|
| 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 |
$28.40
|
| 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 |
$28.40
|
| 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 Foot 2 Views Left BCE
|
Facility
|
OP
|
$537.00
|
|
|
Service Code
|
CPT 73620 LT,FY
|
| Hospital Charge Code |
3100997
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$349.05 |
| Rate for Payer: Aetna Commercial |
$23.71
|
| Rate for Payer: Aetna Medicare |
$124.65
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$28.40
|
| 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 |
$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 |
$28.40
|
| 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 |
$28.40
|
| 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 |
$28.40
|
| 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 |
$28.40
|
| 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 Foot 2 Views Left BCE
|
Facility
|
IP
|
$537.00
|
|
|
Service Code
|
CPT 73620 LT,FY
|
| Hospital Charge Code |
3100997
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$472.56
|
|
|
XR Foot 2 Views Right
|
Facility
|
OP
|
$537.00
|
|
|
Service Code
|
CPT 73620 RT,FY
|
| Hospital Charge Code |
3101003
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$349.05 |
| Rate for Payer: Aetna Commercial |
$23.71
|
| Rate for Payer: Aetna Medicare |
$124.65
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$28.40
|
| 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 |
$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 |
$28.40
|
| 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 |
$28.40
|
| 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 |
$28.40
|
| 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 |
$28.40
|
| 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 Foot 2 Views Right BCE
|
Facility
|
IP
|
$537.00
|
|
|
Service Code
|
CPT 73620 RT,FY
|
| Hospital Charge Code |
3101003
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$472.56
|
|
|
XR Foot 2 Views Right BCE
|
Facility
|
OP
|
$537.00
|
|
|
Service Code
|
CPT 73620 RT,FY
|
| Hospital Charge Code |
3101003
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$349.05 |
| Rate for Payer: Aetna Commercial |
$23.71
|
| Rate for Payer: Aetna Medicare |
$124.65
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$28.40
|
| 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 |
$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 |
$28.40
|
| 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 |
$28.40
|
| 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 |
$28.40
|
| 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 |
$28.40
|
| 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 Foot Complete 3+ Views Left
|
Facility
|
OP
|
$608.00
|
|
|
Service Code
|
CPT 73630 LT,FY
|
| Hospital Charge Code |
3101011
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$395.20 |
| Rate for Payer: Aetna Commercial |
$30.26
|
| Rate for Payer: Aetna Medicare |
$124.65
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$34.41
|
| 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 |
$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 |
$34.41
|
| 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 |
$34.41
|
| 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 |
$34.41
|
| 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 |
$34.41
|
| 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 Foot Complete 3+ Views Left BCE
|
Facility
|
IP
|
$608.00
|
|
|
Service Code
|
CPT 73630 LT,FY
|
| Hospital Charge Code |
3101011
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$535.04
|
|
|
XR Foot Complete 3+ Views Left BCE
|
Facility
|
OP
|
$608.00
|
|
|
Service Code
|
CPT 73630 LT,FY
|
| Hospital Charge Code |
3101011
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$395.20 |
| Rate for Payer: Aetna Commercial |
$30.26
|
| Rate for Payer: Aetna Medicare |
$124.65
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$34.41
|
| 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 |
$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 |
$34.41
|
| 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 |
$34.41
|
| 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 |
$34.41
|
| 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 |
$34.41
|
| 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 Foot Complete 3+ Views Right
|
Facility
|
OP
|
$608.00
|
|
|
Service Code
|
CPT 73630 RT,FY
|
| Hospital Charge Code |
3101029
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$395.20 |
| Rate for Payer: Aetna Commercial |
$30.26
|
| Rate for Payer: Aetna Medicare |
$124.65
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$34.41
|
| 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 |
$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 |
$34.41
|
| 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 |
$34.41
|
| 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 |
$34.41
|
| 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 |
$34.41
|
| 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 Foot Complete 3+ Views Right BCE
|
Facility
|
OP
|
$608.00
|
|
|
Service Code
|
CPT 73630 RT,FY
|
| Hospital Charge Code |
3101029
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$395.20 |
| Rate for Payer: Aetna Commercial |
$30.26
|
| Rate for Payer: Aetna Medicare |
$124.65
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$34.41
|
| 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 |
$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 |
$34.41
|
| 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 |
$34.41
|
| 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 |
$34.41
|
| 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 |
$34.41
|
| 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 Foot Complete 3+ Views Right BCE
|
Facility
|
IP
|
$608.00
|
|
|
Service Code
|
CPT 73630 RT,FY
|
| Hospital Charge Code |
3101029
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$535.04
|
|
|
XR Forearm 2 Views Left
|
Facility
|
OP
|
$535.00
|
|
|
Service Code
|
CPT 73090 LT,FY
|
| Hospital Charge Code |
3100690
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$347.75 |
| Rate for Payer: Aetna Commercial |
$24.48
|
| 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 |
$470.80
|
| Rate for Payer: Cash Price |
$470.80
|
| Rate for Payer: Cash Price |
$470.80
|
| 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 |
$347.75
|
| Rate for Payer: Multiplan Commercial |
$347.75
|
| Rate for Payer: Multiplan Workers Comp |
$347.75
|
| 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 Forearm 2 Views Left BCE
|
Facility
|
OP
|
$535.00
|
|
|
Service Code
|
CPT 73090 LT,FY
|
| Hospital Charge Code |
3100690
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$347.75 |
| Rate for Payer: Aetna Commercial |
$24.48
|
| 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 |
$470.80
|
| Rate for Payer: Cash Price |
$470.80
|
| Rate for Payer: Cash Price |
$470.80
|
| 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 |
$347.75
|
| Rate for Payer: Multiplan Commercial |
$347.75
|
| Rate for Payer: Multiplan Workers Comp |
$347.75
|
| 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 Forearm 2 Views Left BCE
|
Facility
|
IP
|
$535.00
|
|
|
Service Code
|
CPT 73090 LT,FY
|
| Hospital Charge Code |
3100690
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$470.80
|
|
|
XR Forearm 2 Views Right
|
Facility
|
OP
|
$535.00
|
|
|
Service Code
|
CPT 73090 RT,FY
|
| Hospital Charge Code |
3100708
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$347.75 |
| Rate for Payer: Aetna Commercial |
$24.48
|
| 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 |
$470.80
|
| Rate for Payer: Cash Price |
$470.80
|
| Rate for Payer: Cash Price |
$470.80
|
| 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 |
$347.75
|
| Rate for Payer: Multiplan Commercial |
$347.75
|
| Rate for Payer: Multiplan Workers Comp |
$347.75
|
| 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
|
|
