|
XR Forearm 2 Views Right BCE
|
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
|
|
|
XR Forearm 2 Views Right BCE
|
Facility
|
IP
|
$535.00
|
|
|
Service Code
|
CPT 73090 RT,FY
|
| Hospital Charge Code |
3100708
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$470.80
|
|
|
XR Foreign Body Localization Child 1 Vw
|
Facility
|
OP
|
$401.00
|
|
|
Service Code
|
CPT 76010 FY
|
| Hospital Charge Code |
4904030
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$260.65 |
| Rate for Payer: Aetna Commercial |
$24.10
|
| Rate for Payer: Aetna Medicare |
$124.65
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$80.90
|
| 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 |
$352.88
|
| Rate for Payer: Cash Price |
$352.88
|
| Rate for Payer: Cash Price |
$352.88
|
| Rate for Payer: Cigna Commercial |
$188.25
|
| Rate for Payer: Cigna Medicaid |
$80.90
|
| 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 |
$80.90
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$83.10
|
| Rate for Payer: Molina Medicare |
$83.10
|
| Rate for Payer: Multiplan Auto |
$260.65
|
| Rate for Payer: Multiplan Commercial |
$260.65
|
| Rate for Payer: Multiplan Workers Comp |
$260.65
|
| Rate for Payer: Parkland Medicaid |
$80.90
|
| 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 |
$80.90
|
| 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 Foreign Body Localization Child 1 Vw BCE
|
Facility
|
IP
|
$401.00
|
|
|
Service Code
|
CPT 76010 FY
|
| Hospital Charge Code |
4904030
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$352.88
|
|
|
XR Foreign Body Localization Child 1 Vw BCE
|
Facility
|
OP
|
$401.00
|
|
|
Service Code
|
CPT 76010 FY
|
| Hospital Charge Code |
4904030
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$260.65 |
| Rate for Payer: Aetna Commercial |
$24.10
|
| Rate for Payer: Aetna Medicare |
$124.65
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$80.90
|
| 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 |
$352.88
|
| Rate for Payer: Cash Price |
$352.88
|
| Rate for Payer: Cash Price |
$352.88
|
| Rate for Payer: Cigna Commercial |
$188.25
|
| Rate for Payer: Cigna Medicaid |
$80.90
|
| 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 |
$80.90
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$83.10
|
| Rate for Payer: Molina Medicare |
$83.10
|
| Rate for Payer: Multiplan Auto |
$260.65
|
| Rate for Payer: Multiplan Commercial |
$260.65
|
| Rate for Payer: Multiplan Workers Comp |
$260.65
|
| Rate for Payer: Parkland Medicaid |
$80.90
|
| 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 |
$80.90
|
| 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 G Tube Placement Percutaneous
|
Facility
|
OP
|
$5,522.00
|
|
|
Service Code
|
CPT 49440 FY
|
| Hospital Charge Code |
4619440
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$38.38 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$2,200.00
|
| Rate for Payer: Aetna Medicare |
$2,610.33
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$564.97
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,740.22
|
| Rate for Payer: Amerigroup Medicare |
$1,740.22
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,600.86
|
| Rate for Payer: BCBS of TX Blue Essentials |
$3,114.80
|
| Rate for Payer: BCBS of TX Medicare |
$1,740.22
|
| Rate for Payer: BCBS of TX PPO |
$3,924.65
|
| Rate for Payer: Cash Price |
$4,859.36
|
| Rate for Payer: Cash Price |
$4,859.36
|
| Rate for Payer: Cigna Commercial |
$3,942.10
|
| Rate for Payer: Cigna Medicaid |
$564.97
|
| Rate for Payer: Cigna Medicare |
$1,740.22
|
| Rate for Payer: Employer Direct Commercial |
$1,740.22
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,740.22
|
| Rate for Payer: Molina CHIP/Medicaid |
$564.97
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,740.22
|
| Rate for Payer: Molina Medicare |
$1,740.22
|
| Rate for Payer: Multiplan Auto |
$10,000.00
|
| Rate for Payer: Multiplan Commercial |
$10,000.00
|
| Rate for Payer: Multiplan Workers Comp |
$10,000.00
|
| Rate for Payer: Parkland Medicaid |
$564.97
|
| Rate for Payer: Scott and White EPO/PPO |
$38.38
|
| Rate for Payer: Scott and White Medicare |
$1,740.22
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$564.97
|
| Rate for Payer: Superior Health Plan EPO |
$1,740.22
|
| Rate for Payer: Superior Health Plan Medicare |
$1,740.22
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,740.22
|
| Rate for Payer: Universal American Medicare |
$1,740.22
|
| Rate for Payer: Wellcare Medicare |
$1,740.22
|
| Rate for Payer: Wellmed Medicare |
$1,740.22
|
|
|
XR G Tube Placement Percutaneous BCE
|
Facility
|
IP
|
$5,522.00
|
|
|
Service Code
|
CPT 49440 FY
|
| Hospital Charge Code |
4619440
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$4,859.36
|
|
|
XR G Tube Placement Percutaneous BCE
|
Facility
|
OP
|
$5,522.00
|
|
|
Service Code
|
CPT 49440 FY
|
| Hospital Charge Code |
4619440
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$38.38 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$2,200.00
|
| Rate for Payer: Aetna Medicare |
$2,610.33
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$564.97
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,740.22
|
| Rate for Payer: Amerigroup Medicare |
$1,740.22
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,600.86
|
| Rate for Payer: BCBS of TX Blue Essentials |
$3,114.80
|
| Rate for Payer: BCBS of TX Medicare |
$1,740.22
|
| Rate for Payer: BCBS of TX PPO |
$3,924.65
|
| Rate for Payer: Cash Price |
$4,859.36
|
| Rate for Payer: Cash Price |
$4,859.36
|
| Rate for Payer: Cigna Commercial |
$3,942.10
|
| Rate for Payer: Cigna Medicaid |
$564.97
|
| Rate for Payer: Cigna Medicare |
$1,740.22
|
| Rate for Payer: Employer Direct Commercial |
$1,740.22
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,740.22
|
| Rate for Payer: Molina CHIP/Medicaid |
$564.97
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,740.22
|
| Rate for Payer: Molina Medicare |
$1,740.22
|
| Rate for Payer: Multiplan Auto |
$10,000.00
|
| Rate for Payer: Multiplan Commercial |
$10,000.00
|
| Rate for Payer: Multiplan Workers Comp |
$10,000.00
|
| Rate for Payer: Parkland Medicaid |
$564.97
|
| Rate for Payer: Scott and White EPO/PPO |
$38.38
|
| Rate for Payer: Scott and White Medicare |
$1,740.22
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$564.97
|
| Rate for Payer: Superior Health Plan EPO |
$1,740.22
|
| Rate for Payer: Superior Health Plan Medicare |
$1,740.22
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,740.22
|
| Rate for Payer: Universal American Medicare |
$1,740.22
|
| Rate for Payer: Wellcare Medicare |
$1,740.22
|
| Rate for Payer: Wellmed Medicare |
$1,740.22
|
|
|
XR Hand 2 Views Left
|
Facility
|
OP
|
$768.00
|
|
|
Service Code
|
CPT 73120 LT,FY
|
| Hospital Charge Code |
3100757
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$499.20 |
| Rate for Payer: Aetna Commercial |
$26.41
|
| Rate for Payer: Aetna Medicare |
$150.82
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$31.41
|
| 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 |
$675.84
|
| Rate for Payer: Cash Price |
$675.84
|
| Rate for Payer: Cash Price |
$675.84
|
| Rate for Payer: Cigna Commercial |
$227.77
|
| Rate for Payer: Cigna Medicaid |
$31.41
|
| 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 |
$31.41
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$100.55
|
| Rate for Payer: Molina Medicare |
$100.55
|
| Rate for Payer: Multiplan Auto |
$499.20
|
| Rate for Payer: Multiplan Commercial |
$499.20
|
| Rate for Payer: Multiplan Workers Comp |
$499.20
|
| Rate for Payer: Parkland Medicaid |
$31.41
|
| 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 |
$31.41
|
| 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 Hand 2 Views Left BCE
|
Facility
|
IP
|
$768.00
|
|
|
Service Code
|
CPT 73120 LT,FY
|
| Hospital Charge Code |
3100757
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$675.84
|
|
|
XR Hand 2 Views Left BCE
|
Facility
|
OP
|
$768.00
|
|
|
Service Code
|
CPT 73120 LT,FY
|
| Hospital Charge Code |
3100757
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$499.20 |
| Rate for Payer: Aetna Commercial |
$26.41
|
| Rate for Payer: Aetna Medicare |
$150.82
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$31.41
|
| 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 |
$675.84
|
| Rate for Payer: Cash Price |
$675.84
|
| Rate for Payer: Cash Price |
$675.84
|
| Rate for Payer: Cigna Commercial |
$227.77
|
| Rate for Payer: Cigna Medicaid |
$31.41
|
| 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 |
$31.41
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$100.55
|
| Rate for Payer: Molina Medicare |
$100.55
|
| Rate for Payer: Multiplan Auto |
$499.20
|
| Rate for Payer: Multiplan Commercial |
$499.20
|
| Rate for Payer: Multiplan Workers Comp |
$499.20
|
| Rate for Payer: Parkland Medicaid |
$31.41
|
| 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 |
$31.41
|
| 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 Hand 2 Views Right
|
Facility
|
OP
|
$768.00
|
|
|
Service Code
|
CPT 73120 RT,FY
|
| Hospital Charge Code |
3100765
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$499.20 |
| Rate for Payer: Aetna Commercial |
$26.41
|
| Rate for Payer: Aetna Medicare |
$150.82
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$31.41
|
| 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 |
$675.84
|
| Rate for Payer: Cash Price |
$675.84
|
| Rate for Payer: Cash Price |
$675.84
|
| Rate for Payer: Cigna Commercial |
$227.77
|
| Rate for Payer: Cigna Medicaid |
$31.41
|
| 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 |
$31.41
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$100.55
|
| Rate for Payer: Molina Medicare |
$100.55
|
| Rate for Payer: Multiplan Auto |
$499.20
|
| Rate for Payer: Multiplan Commercial |
$499.20
|
| Rate for Payer: Multiplan Workers Comp |
$499.20
|
| Rate for Payer: Parkland Medicaid |
$31.41
|
| 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 |
$31.41
|
| 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 Hand 2 Views Right BCE
|
Facility
|
IP
|
$768.00
|
|
|
Service Code
|
CPT 73120 RT,FY
|
| Hospital Charge Code |
3100765
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$675.84
|
|
|
XR Hand 2 Views Right BCE
|
Facility
|
OP
|
$768.00
|
|
|
Service Code
|
CPT 73120 RT,FY
|
| Hospital Charge Code |
3100765
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$499.20 |
| Rate for Payer: Aetna Commercial |
$26.41
|
| Rate for Payer: Aetna Medicare |
$150.82
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$31.41
|
| 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 |
$675.84
|
| Rate for Payer: Cash Price |
$675.84
|
| Rate for Payer: Cash Price |
$675.84
|
| Rate for Payer: Cigna Commercial |
$227.77
|
| Rate for Payer: Cigna Medicaid |
$31.41
|
| 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 |
$31.41
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$100.55
|
| Rate for Payer: Molina Medicare |
$100.55
|
| Rate for Payer: Multiplan Auto |
$499.20
|
| Rate for Payer: Multiplan Commercial |
$499.20
|
| Rate for Payer: Multiplan Workers Comp |
$499.20
|
| Rate for Payer: Parkland Medicaid |
$31.41
|
| 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 |
$31.41
|
| 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 Hand Complete 3+ Views Left
|
Facility
|
OP
|
$813.00
|
|
|
Service Code
|
CPT 73130 LT,FY
|
| Hospital Charge Code |
3160157
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$528.45 |
| Rate for Payer: Aetna Commercial |
$32.18
|
| Rate for Payer: Aetna Medicare |
$124.65
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$37.09
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$83.10
|
| Rate for Payer: Amerigroup Medicare |
$83.10
|
| Rate for Payer: BCBS of TX Blue Advantage |
$131.69
|
| Rate for Payer: BCBS of TX Blue Essentials |
$158.02
|
| Rate for Payer: BCBS of TX Medicare |
$83.10
|
| Rate for Payer: BCBS of TX PPO |
$176.38
|
| Rate for Payer: Cash Price |
$715.44
|
| Rate for Payer: Cash Price |
$715.44
|
| Rate for Payer: Cash Price |
$715.44
|
| Rate for Payer: Cigna Commercial |
$188.25
|
| Rate for Payer: Cigna Medicaid |
$37.09
|
| Rate for Payer: Cigna Medicare |
$83.10
|
| Rate for Payer: Employer Direct Commercial |
$83.10
|
| Rate for Payer: Humana Medicare/TRICARE |
$83.10
|
| Rate for Payer: Molina CHIP/Medicaid |
$37.09
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$83.10
|
| Rate for Payer: Molina Medicare |
$83.10
|
| Rate for Payer: Multiplan Auto |
$528.45
|
| Rate for Payer: Multiplan Commercial |
$528.45
|
| Rate for Payer: Multiplan Workers Comp |
$528.45
|
| Rate for Payer: Parkland Medicaid |
$37.09
|
| Rate for Payer: Scott and White EPO/PPO |
$1.49
|
| Rate for Payer: Scott and White Medicare |
$83.10
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$37.09
|
| Rate for Payer: Superior Health Plan EPO |
$83.10
|
| Rate for Payer: Superior Health Plan Medicare |
$83.10
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$83.10
|
| Rate for Payer: Universal American Medicare |
$83.10
|
| Rate for Payer: Wellcare Medicare |
$83.10
|
| Rate for Payer: Wellmed Medicare |
$83.10
|
|
|
XR Hand Complete 3+ Views Left BCE
|
Facility
|
OP
|
$813.00
|
|
|
Service Code
|
CPT 73130 LT,FY
|
| Hospital Charge Code |
3160157
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$528.45 |
| Rate for Payer: Aetna Commercial |
$32.18
|
| Rate for Payer: Aetna Medicare |
$124.65
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$37.09
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$83.10
|
| Rate for Payer: Amerigroup Medicare |
$83.10
|
| Rate for Payer: BCBS of TX Blue Advantage |
$131.69
|
| Rate for Payer: BCBS of TX Blue Essentials |
$158.02
|
| Rate for Payer: BCBS of TX Medicare |
$83.10
|
| Rate for Payer: BCBS of TX PPO |
$176.38
|
| Rate for Payer: Cash Price |
$715.44
|
| Rate for Payer: Cash Price |
$715.44
|
| Rate for Payer: Cash Price |
$715.44
|
| Rate for Payer: Cigna Commercial |
$188.25
|
| Rate for Payer: Cigna Medicaid |
$37.09
|
| Rate for Payer: Cigna Medicare |
$83.10
|
| Rate for Payer: Employer Direct Commercial |
$83.10
|
| Rate for Payer: Humana Medicare/TRICARE |
$83.10
|
| Rate for Payer: Molina CHIP/Medicaid |
$37.09
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$83.10
|
| Rate for Payer: Molina Medicare |
$83.10
|
| Rate for Payer: Multiplan Auto |
$528.45
|
| Rate for Payer: Multiplan Commercial |
$528.45
|
| Rate for Payer: Multiplan Workers Comp |
$528.45
|
| Rate for Payer: Parkland Medicaid |
$37.09
|
| Rate for Payer: Scott and White EPO/PPO |
$1.49
|
| Rate for Payer: Scott and White Medicare |
$83.10
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$37.09
|
| Rate for Payer: Superior Health Plan EPO |
$83.10
|
| Rate for Payer: Superior Health Plan Medicare |
$83.10
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$83.10
|
| Rate for Payer: Universal American Medicare |
$83.10
|
| Rate for Payer: Wellcare Medicare |
$83.10
|
| Rate for Payer: Wellmed Medicare |
$83.10
|
|
|
XR Hand Complete 3+ Views Left BCE
|
Facility
|
IP
|
$813.00
|
|
|
Service Code
|
CPT 73130 LT,FY
|
| Hospital Charge Code |
3160157
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$715.44
|
|
|
XR Hand Complete 3+ Views Right
|
Facility
|
OP
|
$813.00
|
|
|
Service Code
|
CPT 73130 RT,FY
|
| Hospital Charge Code |
3160140
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$528.45 |
| Rate for Payer: Aetna Commercial |
$32.18
|
| Rate for Payer: Aetna Medicare |
$124.65
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$37.09
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$83.10
|
| Rate for Payer: Amerigroup Medicare |
$83.10
|
| Rate for Payer: BCBS of TX Blue Advantage |
$131.69
|
| Rate for Payer: BCBS of TX Blue Essentials |
$158.02
|
| Rate for Payer: BCBS of TX Medicare |
$83.10
|
| Rate for Payer: BCBS of TX PPO |
$176.38
|
| Rate for Payer: Cash Price |
$715.44
|
| Rate for Payer: Cash Price |
$715.44
|
| Rate for Payer: Cash Price |
$715.44
|
| Rate for Payer: Cigna Commercial |
$188.25
|
| Rate for Payer: Cigna Medicaid |
$37.09
|
| Rate for Payer: Cigna Medicare |
$83.10
|
| Rate for Payer: Employer Direct Commercial |
$83.10
|
| Rate for Payer: Humana Medicare/TRICARE |
$83.10
|
| Rate for Payer: Molina CHIP/Medicaid |
$37.09
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$83.10
|
| Rate for Payer: Molina Medicare |
$83.10
|
| Rate for Payer: Multiplan Auto |
$528.45
|
| Rate for Payer: Multiplan Commercial |
$528.45
|
| Rate for Payer: Multiplan Workers Comp |
$528.45
|
| Rate for Payer: Parkland Medicaid |
$37.09
|
| Rate for Payer: Scott and White EPO/PPO |
$1.49
|
| Rate for Payer: Scott and White Medicare |
$83.10
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$37.09
|
| Rate for Payer: Superior Health Plan EPO |
$83.10
|
| Rate for Payer: Superior Health Plan Medicare |
$83.10
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$83.10
|
| Rate for Payer: Universal American Medicare |
$83.10
|
| Rate for Payer: Wellcare Medicare |
$83.10
|
| Rate for Payer: Wellmed Medicare |
$83.10
|
|
|
XR Hand Complete 3+ Views Right BCE
|
Facility
|
IP
|
$813.00
|
|
|
Service Code
|
CPT 73130 RT,FY
|
| Hospital Charge Code |
3160140
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$715.44
|
|
|
XR Hand Complete 3+ Views Right BCE
|
Facility
|
OP
|
$813.00
|
|
|
Service Code
|
CPT 73130 RT,FY
|
| Hospital Charge Code |
3160140
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$528.45 |
| Rate for Payer: Aetna Commercial |
$32.18
|
| Rate for Payer: Aetna Medicare |
$124.65
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$37.09
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$83.10
|
| Rate for Payer: Amerigroup Medicare |
$83.10
|
| Rate for Payer: BCBS of TX Blue Advantage |
$131.69
|
| Rate for Payer: BCBS of TX Blue Essentials |
$158.02
|
| Rate for Payer: BCBS of TX Medicare |
$83.10
|
| Rate for Payer: BCBS of TX PPO |
$176.38
|
| Rate for Payer: Cash Price |
$715.44
|
| Rate for Payer: Cash Price |
$715.44
|
| Rate for Payer: Cash Price |
$715.44
|
| Rate for Payer: Cigna Commercial |
$188.25
|
| Rate for Payer: Cigna Medicaid |
$37.09
|
| Rate for Payer: Cigna Medicare |
$83.10
|
| Rate for Payer: Employer Direct Commercial |
$83.10
|
| Rate for Payer: Humana Medicare/TRICARE |
$83.10
|
| Rate for Payer: Molina CHIP/Medicaid |
$37.09
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$83.10
|
| Rate for Payer: Molina Medicare |
$83.10
|
| Rate for Payer: Multiplan Auto |
$528.45
|
| Rate for Payer: Multiplan Commercial |
$528.45
|
| Rate for Payer: Multiplan Workers Comp |
$528.45
|
| Rate for Payer: Parkland Medicaid |
$37.09
|
| Rate for Payer: Scott and White EPO/PPO |
$1.49
|
| Rate for Payer: Scott and White Medicare |
$83.10
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$37.09
|
| Rate for Payer: Superior Health Plan EPO |
$83.10
|
| Rate for Payer: Superior Health Plan Medicare |
$83.10
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$83.10
|
| Rate for Payer: Universal American Medicare |
$83.10
|
| Rate for Payer: Wellcare Medicare |
$83.10
|
| Rate for Payer: Wellmed Medicare |
$83.10
|
|
|
XR Hip 1 View Left
|
Facility
|
OP
|
$530.00
|
|
|
Service Code
|
CPT 73501 LT,FY
|
| Hospital Charge Code |
3181205
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$344.50 |
| Rate for Payer: Aetna Commercial |
$26.79
|
| Rate for Payer: Aetna Medicare |
$124.65
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$33.08
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$83.10
|
| Rate for Payer: Amerigroup Medicare |
$83.10
|
| Rate for Payer: BCBS of TX Blue Advantage |
$131.69
|
| Rate for Payer: BCBS of TX Blue Essentials |
$158.02
|
| Rate for Payer: BCBS of TX Medicare |
$83.10
|
| Rate for Payer: BCBS of TX PPO |
$176.38
|
| Rate for Payer: Cash Price |
$466.40
|
| Rate for Payer: Cash Price |
$466.40
|
| Rate for Payer: Cash Price |
$466.40
|
| Rate for Payer: Cigna Commercial |
$188.25
|
| Rate for Payer: Cigna Medicaid |
$33.08
|
| 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 |
$33.08
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$83.10
|
| Rate for Payer: Molina Medicare |
$83.10
|
| Rate for Payer: Multiplan Auto |
$344.50
|
| Rate for Payer: Multiplan Commercial |
$344.50
|
| Rate for Payer: Multiplan Workers Comp |
$344.50
|
| Rate for Payer: Parkland Medicaid |
$33.08
|
| 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 |
$33.08
|
| 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 Hip 1 View Left BCE
|
Facility
|
IP
|
$530.00
|
|
|
Service Code
|
CPT 73501 LT,FY
|
| Hospital Charge Code |
3181205
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$466.40
|
|
|
XR Hip 1 View Left BCE
|
Facility
|
OP
|
$530.00
|
|
|
Service Code
|
CPT 73501 LT,FY
|
| Hospital Charge Code |
3181205
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$344.50 |
| Rate for Payer: Aetna Commercial |
$26.79
|
| Rate for Payer: Aetna Medicare |
$124.65
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$33.08
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$83.10
|
| Rate for Payer: Amerigroup Medicare |
$83.10
|
| Rate for Payer: BCBS of TX Blue Advantage |
$131.69
|
| Rate for Payer: BCBS of TX Blue Essentials |
$158.02
|
| Rate for Payer: BCBS of TX Medicare |
$83.10
|
| Rate for Payer: BCBS of TX PPO |
$176.38
|
| Rate for Payer: Cash Price |
$466.40
|
| Rate for Payer: Cash Price |
$466.40
|
| Rate for Payer: Cash Price |
$466.40
|
| Rate for Payer: Cigna Commercial |
$188.25
|
| Rate for Payer: Cigna Medicaid |
$33.08
|
| 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 |
$33.08
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$83.10
|
| Rate for Payer: Molina Medicare |
$83.10
|
| Rate for Payer: Multiplan Auto |
$344.50
|
| Rate for Payer: Multiplan Commercial |
$344.50
|
| Rate for Payer: Multiplan Workers Comp |
$344.50
|
| Rate for Payer: Parkland Medicaid |
$33.08
|
| 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 |
$33.08
|
| 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 Hip 1 View Right
|
Facility
|
OP
|
$530.00
|
|
|
Service Code
|
CPT 73501 RT,FY
|
| Hospital Charge Code |
3181204
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$344.50 |
| Rate for Payer: Aetna Commercial |
$26.79
|
| Rate for Payer: Aetna Medicare |
$124.65
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$33.08
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$83.10
|
| Rate for Payer: Amerigroup Medicare |
$83.10
|
| Rate for Payer: BCBS of TX Blue Advantage |
$131.69
|
| Rate for Payer: BCBS of TX Blue Essentials |
$158.02
|
| Rate for Payer: BCBS of TX Medicare |
$83.10
|
| Rate for Payer: BCBS of TX PPO |
$176.38
|
| Rate for Payer: Cash Price |
$466.40
|
| Rate for Payer: Cash Price |
$466.40
|
| Rate for Payer: Cash Price |
$466.40
|
| Rate for Payer: Cigna Commercial |
$188.25
|
| Rate for Payer: Cigna Medicaid |
$33.08
|
| 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 |
$33.08
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$83.10
|
| Rate for Payer: Molina Medicare |
$83.10
|
| Rate for Payer: Multiplan Auto |
$344.50
|
| Rate for Payer: Multiplan Commercial |
$344.50
|
| Rate for Payer: Multiplan Workers Comp |
$344.50
|
| Rate for Payer: Parkland Medicaid |
$33.08
|
| 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 |
$33.08
|
| 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 Hip 1 View Right BCE
|
Facility
|
IP
|
$530.00
|
|
|
Service Code
|
CPT 73501 RT,FY
|
| Hospital Charge Code |
3181204
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$466.40
|
|
