|
XR Hysterosalpingography
|
Facility
|
OP
|
$821.00
|
|
|
Service Code
|
CPT 74740 FY
|
| Hospital Charge Code |
3101268
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$4.01 |
| Max. Negotiated Rate |
$533.65 |
| Rate for Payer: Aetna Commercial |
$92.28
|
| Rate for Payer: Aetna Medicare |
$336.15
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$66.83
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$224.10
|
| Rate for Payer: Amerigroup Medicare |
$224.10
|
| Rate for Payer: BCBS of TX Blue Advantage |
$384.52
|
| Rate for Payer: BCBS of TX Blue Essentials |
$461.42
|
| Rate for Payer: BCBS of TX Medicare |
$224.10
|
| Rate for Payer: BCBS of TX PPO |
$515.02
|
| Rate for Payer: Cash Price |
$722.48
|
| Rate for Payer: Cash Price |
$722.48
|
| Rate for Payer: Cash Price |
$722.48
|
| Rate for Payer: Cigna Commercial |
$507.64
|
| Rate for Payer: Cigna Medicaid |
$14.43
|
| 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 |
$14.43
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$224.10
|
| Rate for Payer: Molina Medicare |
$224.10
|
| Rate for Payer: Multiplan Auto |
$533.65
|
| Rate for Payer: Multiplan Commercial |
$533.65
|
| Rate for Payer: Multiplan Workers Comp |
$533.65
|
| Rate for Payer: Parkland Medicaid |
$14.43
|
| 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 |
$14.43
|
| 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 Hysterosalpingography BCE
|
Facility
|
OP
|
$821.00
|
|
|
Service Code
|
CPT 74740 FY
|
| Hospital Charge Code |
3101268
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$4.01 |
| Max. Negotiated Rate |
$533.65 |
| Rate for Payer: Aetna Commercial |
$92.28
|
| Rate for Payer: Aetna Medicare |
$336.15
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$66.83
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$224.10
|
| Rate for Payer: Amerigroup Medicare |
$224.10
|
| Rate for Payer: BCBS of TX Blue Advantage |
$384.52
|
| Rate for Payer: BCBS of TX Blue Essentials |
$461.42
|
| Rate for Payer: BCBS of TX Medicare |
$224.10
|
| Rate for Payer: BCBS of TX PPO |
$515.02
|
| Rate for Payer: Cash Price |
$722.48
|
| Rate for Payer: Cash Price |
$722.48
|
| Rate for Payer: Cash Price |
$722.48
|
| Rate for Payer: Cigna Commercial |
$507.64
|
| Rate for Payer: Cigna Medicaid |
$14.43
|
| 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 |
$14.43
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$224.10
|
| Rate for Payer: Molina Medicare |
$224.10
|
| Rate for Payer: Multiplan Auto |
$533.65
|
| Rate for Payer: Multiplan Commercial |
$533.65
|
| Rate for Payer: Multiplan Workers Comp |
$533.65
|
| Rate for Payer: Parkland Medicaid |
$14.43
|
| 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 |
$14.43
|
| 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 Hysterosalpingography BCE
|
Facility
|
IP
|
$821.00
|
|
|
Service Code
|
CPT 74740 FY
|
| Hospital Charge Code |
3101268
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$722.48
|
|
|
XR Injection Contrast for Tube Eval
|
Facility
|
OP
|
$857.00
|
|
|
Service Code
|
CPT 49465 FY
|
| Hospital Charge Code |
3181070
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$4.01 |
| Max. Negotiated Rate |
$587.26 |
| Rate for Payer: Aetna Commercial |
$471.35
|
| Rate for Payer: Aetna Medicare |
$336.15
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$77.13
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$224.10
|
| Rate for Payer: Amerigroup Medicare |
$224.10
|
| Rate for Payer: BCBS of TX Blue Advantage |
$389.18
|
| Rate for Payer: BCBS of TX Blue Essentials |
$466.08
|
| Rate for Payer: BCBS of TX Medicare |
$224.10
|
| Rate for Payer: BCBS of TX PPO |
$587.26
|
| Rate for Payer: Cash Price |
$754.16
|
| Rate for Payer: Cash Price |
$754.16
|
| Rate for Payer: Cash Price |
$754.16
|
| Rate for Payer: Cigna Commercial |
$507.64
|
| 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 Dual Medicare/Medicaid |
$224.10
|
| Rate for Payer: Molina Medicare |
$224.10
|
| Rate for Payer: Multiplan Auto |
$557.05
|
| Rate for Payer: Multiplan Commercial |
$557.05
|
| Rate for Payer: Multiplan Workers Comp |
$557.05
|
| 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 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 Injection Contrast for Tube Eval BCE
|
Facility
|
OP
|
$857.00
|
|
|
Service Code
|
CPT 49465 FY
|
| Hospital Charge Code |
3181070
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$4.01 |
| Max. Negotiated Rate |
$587.26 |
| Rate for Payer: Aetna Commercial |
$471.35
|
| Rate for Payer: Aetna Medicare |
$336.15
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$77.13
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$224.10
|
| Rate for Payer: Amerigroup Medicare |
$224.10
|
| Rate for Payer: BCBS of TX Blue Advantage |
$389.18
|
| Rate for Payer: BCBS of TX Blue Essentials |
$466.08
|
| Rate for Payer: BCBS of TX Medicare |
$224.10
|
| Rate for Payer: BCBS of TX PPO |
$587.26
|
| Rate for Payer: Cash Price |
$754.16
|
| Rate for Payer: Cash Price |
$754.16
|
| Rate for Payer: Cash Price |
$754.16
|
| Rate for Payer: Cigna Commercial |
$507.64
|
| 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 Dual Medicare/Medicaid |
$224.10
|
| Rate for Payer: Molina Medicare |
$224.10
|
| Rate for Payer: Multiplan Auto |
$557.05
|
| Rate for Payer: Multiplan Commercial |
$557.05
|
| Rate for Payer: Multiplan Workers Comp |
$557.05
|
| 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 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 Injection Contrast for Tube Eval BCE
|
Facility
|
IP
|
$857.00
|
|
|
Service Code
|
CPT 49465 FY
|
| Hospital Charge Code |
3181070
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$754.16
|
|
|
XR Insertion of G-Tube
|
Facility
|
OP
|
$638.00
|
|
|
Service Code
|
CPT 74340 FY
|
| Hospital Charge Code |
4904340
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$45.79 |
| Max. Negotiated Rate |
$414.70 |
| Rate for Payer: Aetna Commercial |
$86.84
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$57.42
|
| Rate for Payer: BCBS of TX Blue Advantage |
$45.79
|
| Rate for Payer: BCBS of TX Blue Essentials |
$54.94
|
| Rate for Payer: BCBS of TX PPO |
$61.33
|
| Rate for Payer: Cash Price |
$561.44
|
| Rate for Payer: Cash Price |
$561.44
|
| Rate for Payer: Multiplan Auto |
$414.70
|
| Rate for Payer: Multiplan Commercial |
$414.70
|
| Rate for Payer: Multiplan Workers Comp |
$414.70
|
| Rate for Payer: Scott and White EPO/PPO |
$319.00
|
| Rate for Payer: Superior Health Plan EPO |
$86.77
|
|
|
XR Insertion of G-Tube BCE
|
Facility
|
OP
|
$638.00
|
|
|
Service Code
|
CPT 74340 FY
|
| Hospital Charge Code |
4904340
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$45.79 |
| Max. Negotiated Rate |
$414.70 |
| Rate for Payer: Aetna Commercial |
$86.84
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$57.42
|
| Rate for Payer: BCBS of TX Blue Advantage |
$45.79
|
| Rate for Payer: BCBS of TX Blue Essentials |
$54.94
|
| Rate for Payer: BCBS of TX PPO |
$61.33
|
| Rate for Payer: Cash Price |
$561.44
|
| Rate for Payer: Cash Price |
$561.44
|
| Rate for Payer: Multiplan Auto |
$414.70
|
| Rate for Payer: Multiplan Commercial |
$414.70
|
| Rate for Payer: Multiplan Workers Comp |
$414.70
|
| Rate for Payer: Scott and White EPO/PPO |
$319.00
|
| Rate for Payer: Superior Health Plan EPO |
$86.77
|
|
|
XR Insertion of G-Tube BCE
|
Facility
|
IP
|
$638.00
|
|
|
Service Code
|
CPT 74340 FY
|
| Hospital Charge Code |
4904340
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$561.44
|
|
|
XR Insert NG tube w/ Fluoro Guide
|
Facility
|
OP
|
$601.00
|
|
|
Service Code
|
CPT 43752 FY
|
| Hospital Charge Code |
4613752
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$8.04 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$330.55
|
| Rate for Payer: Aetna Medicare |
$546.58
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$112.34
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$364.39
|
| Rate for Payer: Amerigroup Medicare |
$364.39
|
| Rate for Payer: BCBS of TX Blue Advantage |
$607.20
|
| Rate for Payer: BCBS of TX Blue Essentials |
$727.18
|
| Rate for Payer: BCBS of TX Medicare |
$364.39
|
| Rate for Payer: BCBS of TX PPO |
$916.25
|
| Rate for Payer: Cash Price |
$528.88
|
| Rate for Payer: Cash Price |
$528.88
|
| Rate for Payer: Cash Price |
$528.88
|
| Rate for Payer: Cigna Commercial |
$825.46
|
| Rate for Payer: Cigna Medicaid |
$112.34
|
| Rate for Payer: Cigna Medicare |
$364.39
|
| Rate for Payer: Employer Direct Commercial |
$364.39
|
| Rate for Payer: Humana Medicare/TRICARE |
$364.39
|
| Rate for Payer: Molina CHIP/Medicaid |
$112.34
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$364.39
|
| Rate for Payer: Molina Medicare |
$364.39
|
| 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 |
$112.34
|
| Rate for Payer: Scott and White EPO/PPO |
$8.04
|
| Rate for Payer: Scott and White Medicare |
$364.39
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$112.34
|
| Rate for Payer: Superior Health Plan EPO |
$364.39
|
| Rate for Payer: Superior Health Plan Medicare |
$364.39
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$364.39
|
| Rate for Payer: Universal American Medicare |
$364.39
|
| Rate for Payer: Wellcare Medicare |
$364.39
|
| Rate for Payer: Wellmed Medicare |
$364.39
|
|
|
XR Insert NG Tube w/ Fluoro Guide BCE
|
Facility
|
IP
|
$601.00
|
|
|
Service Code
|
CPT 43752 FY
|
| Hospital Charge Code |
4613752
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$528.88
|
|
|
XR Insert NG Tube w/ Fluoro Guide BCE
|
Facility
|
OP
|
$601.00
|
|
|
Service Code
|
CPT 43752 FY
|
| Hospital Charge Code |
4613752
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$8.04 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$330.55
|
| Rate for Payer: Aetna Medicare |
$546.58
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$112.34
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$364.39
|
| Rate for Payer: Amerigroup Medicare |
$364.39
|
| Rate for Payer: BCBS of TX Blue Advantage |
$607.20
|
| Rate for Payer: BCBS of TX Blue Essentials |
$727.18
|
| Rate for Payer: BCBS of TX Medicare |
$364.39
|
| Rate for Payer: BCBS of TX PPO |
$916.25
|
| Rate for Payer: Cash Price |
$528.88
|
| Rate for Payer: Cash Price |
$528.88
|
| Rate for Payer: Cash Price |
$528.88
|
| Rate for Payer: Cigna Commercial |
$825.46
|
| Rate for Payer: Cigna Medicaid |
$112.34
|
| Rate for Payer: Cigna Medicare |
$364.39
|
| Rate for Payer: Employer Direct Commercial |
$364.39
|
| Rate for Payer: Humana Medicare/TRICARE |
$364.39
|
| Rate for Payer: Molina CHIP/Medicaid |
$112.34
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$364.39
|
| Rate for Payer: Molina Medicare |
$364.39
|
| 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 |
$112.34
|
| Rate for Payer: Scott and White EPO/PPO |
$8.04
|
| Rate for Payer: Scott and White Medicare |
$364.39
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$112.34
|
| Rate for Payer: Superior Health Plan EPO |
$364.39
|
| Rate for Payer: Superior Health Plan Medicare |
$364.39
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$364.39
|
| Rate for Payer: Universal American Medicare |
$364.39
|
| Rate for Payer: Wellcare Medicare |
$364.39
|
| Rate for Payer: Wellmed Medicare |
$364.39
|
|
|
XR IVP
|
Facility
|
OP
|
$1,041.00
|
|
|
Service Code
|
CPT 74400 FY
|
| Hospital Charge Code |
4904400
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$3.01 |
| Max. Negotiated Rate |
$676.65 |
| Rate for Payer: Aetna Commercial |
$132.72
|
| Rate for Payer: Aetna Medicare |
$252.04
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$137.00
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$168.03
|
| Rate for Payer: Amerigroup Medicare |
$168.03
|
| Rate for Payer: BCBS of TX Blue Advantage |
$158.17
|
| Rate for Payer: BCBS of TX Blue Essentials |
$189.80
|
| Rate for Payer: BCBS of TX Medicare |
$168.03
|
| Rate for Payer: BCBS of TX PPO |
$211.85
|
| Rate for Payer: Cash Price |
$916.08
|
| Rate for Payer: Cash Price |
$916.08
|
| Rate for Payer: Cash Price |
$916.08
|
| Rate for Payer: Cigna Commercial |
$380.65
|
| Rate for Payer: Cigna Medicaid |
$137.00
|
| 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 |
$137.00
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$168.03
|
| Rate for Payer: Molina Medicare |
$168.03
|
| Rate for Payer: Multiplan Auto |
$676.65
|
| Rate for Payer: Multiplan Commercial |
$676.65
|
| Rate for Payer: Multiplan Workers Comp |
$676.65
|
| Rate for Payer: Parkland Medicaid |
$137.00
|
| 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 |
$137.00
|
| 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 IVP BCE
|
Facility
|
IP
|
$1,041.00
|
|
|
Service Code
|
CPT 74400 FY
|
| Hospital Charge Code |
4904400
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$916.08
|
|
|
XR IVP BCE
|
Facility
|
OP
|
$1,041.00
|
|
|
Service Code
|
CPT 74400 FY
|
| Hospital Charge Code |
4904400
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$3.01 |
| Max. Negotiated Rate |
$676.65 |
| Rate for Payer: Aetna Commercial |
$132.72
|
| Rate for Payer: Aetna Medicare |
$252.04
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$137.00
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$168.03
|
| Rate for Payer: Amerigroup Medicare |
$168.03
|
| Rate for Payer: BCBS of TX Blue Advantage |
$158.17
|
| Rate for Payer: BCBS of TX Blue Essentials |
$189.80
|
| Rate for Payer: BCBS of TX Medicare |
$168.03
|
| Rate for Payer: BCBS of TX PPO |
$211.85
|
| Rate for Payer: Cash Price |
$916.08
|
| Rate for Payer: Cash Price |
$916.08
|
| Rate for Payer: Cash Price |
$916.08
|
| Rate for Payer: Cigna Commercial |
$380.65
|
| Rate for Payer: Cigna Medicaid |
$137.00
|
| 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 |
$137.00
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$168.03
|
| Rate for Payer: Molina Medicare |
$168.03
|
| Rate for Payer: Multiplan Auto |
$676.65
|
| Rate for Payer: Multiplan Commercial |
$676.65
|
| Rate for Payer: Multiplan Workers Comp |
$676.65
|
| Rate for Payer: Parkland Medicaid |
$137.00
|
| 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 |
$137.00
|
| 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 Joint/Bursa Major Arthr/Asp/Inj Left
|
Facility
|
OP
|
$1,676.00
|
|
|
Service Code
|
CPT 20610 LT,FY
|
| Hospital Charge Code |
3170080
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5.97 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$921.80
|
| Rate for Payer: Aetna Medicare |
$406.30
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$27.96
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$270.87
|
| Rate for Payer: Amerigroup Medicare |
$270.87
|
| Rate for Payer: BCBS of TX Blue Advantage |
$51.84
|
| Rate for Payer: BCBS of TX Blue Essentials |
$62.08
|
| Rate for Payer: BCBS of TX Medicare |
$270.87
|
| Rate for Payer: BCBS of TX PPO |
$78.22
|
| Rate for Payer: Cash Price |
$1,474.88
|
| Rate for Payer: Cash Price |
$1,474.88
|
| Rate for Payer: Cash Price |
$1,474.88
|
| Rate for Payer: Cigna Commercial |
$613.60
|
| Rate for Payer: Cigna Medicaid |
$27.96
|
| Rate for Payer: Cigna Medicare |
$270.87
|
| Rate for Payer: Employer Direct Commercial |
$270.87
|
| Rate for Payer: Humana Medicare/TRICARE |
$270.87
|
| Rate for Payer: Molina CHIP/Medicaid |
$27.96
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$270.87
|
| Rate for Payer: Molina Medicare |
$270.87
|
| 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 |
$27.96
|
| Rate for Payer: Scott and White EPO/PPO |
$5.97
|
| Rate for Payer: Scott and White Medicare |
$270.87
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$27.96
|
| Rate for Payer: Superior Health Plan EPO |
$270.87
|
| Rate for Payer: Superior Health Plan Medicare |
$270.87
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$270.87
|
| Rate for Payer: Universal American Medicare |
$270.87
|
| Rate for Payer: Wellcare Medicare |
$270.87
|
| Rate for Payer: Wellmed Medicare |
$270.87
|
|
|
XR Joint/Bursa Major Arthr/Asp/Inj Left BCE
|
Facility
|
OP
|
$1,676.00
|
|
|
Service Code
|
CPT 20610 LT,FY
|
| Hospital Charge Code |
3170080
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5.97 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$921.80
|
| Rate for Payer: Aetna Medicare |
$406.30
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$27.96
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$270.87
|
| Rate for Payer: Amerigroup Medicare |
$270.87
|
| Rate for Payer: BCBS of TX Blue Advantage |
$51.84
|
| Rate for Payer: BCBS of TX Blue Essentials |
$62.08
|
| Rate for Payer: BCBS of TX Medicare |
$270.87
|
| Rate for Payer: BCBS of TX PPO |
$78.22
|
| Rate for Payer: Cash Price |
$1,474.88
|
| Rate for Payer: Cash Price |
$1,474.88
|
| Rate for Payer: Cash Price |
$1,474.88
|
| Rate for Payer: Cigna Commercial |
$613.60
|
| Rate for Payer: Cigna Medicaid |
$27.96
|
| Rate for Payer: Cigna Medicare |
$270.87
|
| Rate for Payer: Employer Direct Commercial |
$270.87
|
| Rate for Payer: Humana Medicare/TRICARE |
$270.87
|
| Rate for Payer: Molina CHIP/Medicaid |
$27.96
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$270.87
|
| Rate for Payer: Molina Medicare |
$270.87
|
| 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 |
$27.96
|
| Rate for Payer: Scott and White EPO/PPO |
$5.97
|
| Rate for Payer: Scott and White Medicare |
$270.87
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$27.96
|
| Rate for Payer: Superior Health Plan EPO |
$270.87
|
| Rate for Payer: Superior Health Plan Medicare |
$270.87
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$270.87
|
| Rate for Payer: Universal American Medicare |
$270.87
|
| Rate for Payer: Wellcare Medicare |
$270.87
|
| Rate for Payer: Wellmed Medicare |
$270.87
|
|
|
XR Joint/Bursa Major Arthr/Asp/Inj Right
|
Facility
|
OP
|
$1,676.00
|
|
|
Service Code
|
CPT 20610 RT,FY
|
| Hospital Charge Code |
3170080
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5.97 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$921.80
|
| Rate for Payer: Aetna Medicare |
$406.30
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$27.96
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$270.87
|
| Rate for Payer: Amerigroup Medicare |
$270.87
|
| Rate for Payer: BCBS of TX Blue Advantage |
$51.84
|
| Rate for Payer: BCBS of TX Blue Essentials |
$62.08
|
| Rate for Payer: BCBS of TX Medicare |
$270.87
|
| Rate for Payer: BCBS of TX PPO |
$78.22
|
| Rate for Payer: Cash Price |
$1,474.88
|
| Rate for Payer: Cash Price |
$1,474.88
|
| Rate for Payer: Cash Price |
$1,474.88
|
| Rate for Payer: Cigna Commercial |
$613.60
|
| Rate for Payer: Cigna Medicaid |
$27.96
|
| Rate for Payer: Cigna Medicare |
$270.87
|
| Rate for Payer: Employer Direct Commercial |
$270.87
|
| Rate for Payer: Humana Medicare/TRICARE |
$270.87
|
| Rate for Payer: Molina CHIP/Medicaid |
$27.96
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$270.87
|
| Rate for Payer: Molina Medicare |
$270.87
|
| 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 |
$27.96
|
| Rate for Payer: Scott and White EPO/PPO |
$5.97
|
| Rate for Payer: Scott and White Medicare |
$270.87
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$27.96
|
| Rate for Payer: Superior Health Plan EPO |
$270.87
|
| Rate for Payer: Superior Health Plan Medicare |
$270.87
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$270.87
|
| Rate for Payer: Universal American Medicare |
$270.87
|
| Rate for Payer: Wellcare Medicare |
$270.87
|
| Rate for Payer: Wellmed Medicare |
$270.87
|
|
|
XR Joint/Bursa Major Arthr/Asp/Inj Right BCE
|
Facility
|
OP
|
$1,676.00
|
|
|
Service Code
|
CPT 20610 RT,FY
|
| Hospital Charge Code |
3170080
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5.97 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$921.80
|
| Rate for Payer: Aetna Medicare |
$406.30
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$27.96
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$270.87
|
| Rate for Payer: Amerigroup Medicare |
$270.87
|
| Rate for Payer: BCBS of TX Blue Advantage |
$51.84
|
| Rate for Payer: BCBS of TX Blue Essentials |
$62.08
|
| Rate for Payer: BCBS of TX Medicare |
$270.87
|
| Rate for Payer: BCBS of TX PPO |
$78.22
|
| Rate for Payer: Cash Price |
$1,474.88
|
| Rate for Payer: Cash Price |
$1,474.88
|
| Rate for Payer: Cash Price |
$1,474.88
|
| Rate for Payer: Cigna Commercial |
$613.60
|
| Rate for Payer: Cigna Medicaid |
$27.96
|
| Rate for Payer: Cigna Medicare |
$270.87
|
| Rate for Payer: Employer Direct Commercial |
$270.87
|
| Rate for Payer: Humana Medicare/TRICARE |
$270.87
|
| Rate for Payer: Molina CHIP/Medicaid |
$27.96
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$270.87
|
| Rate for Payer: Molina Medicare |
$270.87
|
| 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 |
$27.96
|
| Rate for Payer: Scott and White EPO/PPO |
$5.97
|
| Rate for Payer: Scott and White Medicare |
$270.87
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$27.96
|
| Rate for Payer: Superior Health Plan EPO |
$270.87
|
| Rate for Payer: Superior Health Plan Medicare |
$270.87
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$270.87
|
| Rate for Payer: Universal American Medicare |
$270.87
|
| Rate for Payer: Wellcare Medicare |
$270.87
|
| Rate for Payer: Wellmed Medicare |
$270.87
|
|
|
XR Joint/Bursa Major Arthr/Asp/Inj Right BCE
|
Facility
|
IP
|
$1,676.00
|
|
|
Service Code
|
CPT 20610 RT,FY
|
| Hospital Charge Code |
3170080
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$1,474.88
|
|
|
XR Joint/Bursa Small Arthr/Asp/Inj Left
|
Facility
|
OP
|
$622.00
|
|
|
Service Code
|
CPT 20600 LT,FY
|
| Hospital Charge Code |
4900600
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5.97 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$342.10
|
| Rate for Payer: Aetna Medicare |
$406.30
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$22.70
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$270.87
|
| Rate for Payer: Amerigroup Medicare |
$270.87
|
| Rate for Payer: BCBS of TX Blue Advantage |
$41.58
|
| Rate for Payer: BCBS of TX Blue Essentials |
$49.80
|
| Rate for Payer: BCBS of TX Medicare |
$270.87
|
| Rate for Payer: BCBS of TX PPO |
$62.75
|
| Rate for Payer: Cash Price |
$547.36
|
| Rate for Payer: Cash Price |
$547.36
|
| Rate for Payer: Cash Price |
$547.36
|
| Rate for Payer: Cigna Commercial |
$613.60
|
| Rate for Payer: Cigna Medicaid |
$22.70
|
| Rate for Payer: Cigna Medicare |
$270.87
|
| Rate for Payer: Employer Direct Commercial |
$270.87
|
| Rate for Payer: Humana Medicare/TRICARE |
$270.87
|
| Rate for Payer: Molina CHIP/Medicaid |
$22.70
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$270.87
|
| Rate for Payer: Molina Medicare |
$270.87
|
| 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 |
$22.70
|
| Rate for Payer: Scott and White EPO/PPO |
$5.97
|
| Rate for Payer: Scott and White Medicare |
$270.87
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$22.70
|
| Rate for Payer: Superior Health Plan EPO |
$270.87
|
| Rate for Payer: Superior Health Plan Medicare |
$270.87
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$270.87
|
| Rate for Payer: Universal American Medicare |
$270.87
|
| Rate for Payer: Wellcare Medicare |
$270.87
|
| Rate for Payer: Wellmed Medicare |
$270.87
|
|
|
XR Joint/Bursa Small Arthr/Asp/Inj Left BCE
|
Facility
|
OP
|
$622.00
|
|
|
Service Code
|
CPT 20600 LT,FY
|
| Hospital Charge Code |
4900600
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5.97 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$342.10
|
| Rate for Payer: Aetna Medicare |
$406.30
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$22.70
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$270.87
|
| Rate for Payer: Amerigroup Medicare |
$270.87
|
| Rate for Payer: BCBS of TX Blue Advantage |
$41.58
|
| Rate for Payer: BCBS of TX Blue Essentials |
$49.80
|
| Rate for Payer: BCBS of TX Medicare |
$270.87
|
| Rate for Payer: BCBS of TX PPO |
$62.75
|
| Rate for Payer: Cash Price |
$547.36
|
| Rate for Payer: Cash Price |
$547.36
|
| Rate for Payer: Cash Price |
$547.36
|
| Rate for Payer: Cigna Commercial |
$613.60
|
| Rate for Payer: Cigna Medicaid |
$22.70
|
| Rate for Payer: Cigna Medicare |
$270.87
|
| Rate for Payer: Employer Direct Commercial |
$270.87
|
| Rate for Payer: Humana Medicare/TRICARE |
$270.87
|
| Rate for Payer: Molina CHIP/Medicaid |
$22.70
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$270.87
|
| Rate for Payer: Molina Medicare |
$270.87
|
| 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 |
$22.70
|
| Rate for Payer: Scott and White EPO/PPO |
$5.97
|
| Rate for Payer: Scott and White Medicare |
$270.87
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$22.70
|
| Rate for Payer: Superior Health Plan EPO |
$270.87
|
| Rate for Payer: Superior Health Plan Medicare |
$270.87
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$270.87
|
| Rate for Payer: Universal American Medicare |
$270.87
|
| Rate for Payer: Wellcare Medicare |
$270.87
|
| Rate for Payer: Wellmed Medicare |
$270.87
|
|
|
XR Joint/Bursa Small Arthr/Asp/Inj Right
|
Facility
|
OP
|
$622.00
|
|
|
Service Code
|
CPT 20600 RT,FY
|
| Hospital Charge Code |
4900600
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5.97 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$342.10
|
| Rate for Payer: Aetna Medicare |
$406.30
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$22.70
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$270.87
|
| Rate for Payer: Amerigroup Medicare |
$270.87
|
| Rate for Payer: BCBS of TX Blue Advantage |
$41.58
|
| Rate for Payer: BCBS of TX Blue Essentials |
$49.80
|
| Rate for Payer: BCBS of TX Medicare |
$270.87
|
| Rate for Payer: BCBS of TX PPO |
$62.75
|
| Rate for Payer: Cash Price |
$547.36
|
| Rate for Payer: Cash Price |
$547.36
|
| Rate for Payer: Cash Price |
$547.36
|
| Rate for Payer: Cigna Commercial |
$613.60
|
| Rate for Payer: Cigna Medicaid |
$22.70
|
| Rate for Payer: Cigna Medicare |
$270.87
|
| Rate for Payer: Employer Direct Commercial |
$270.87
|
| Rate for Payer: Humana Medicare/TRICARE |
$270.87
|
| Rate for Payer: Molina CHIP/Medicaid |
$22.70
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$270.87
|
| Rate for Payer: Molina Medicare |
$270.87
|
| 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 |
$22.70
|
| Rate for Payer: Scott and White EPO/PPO |
$5.97
|
| Rate for Payer: Scott and White Medicare |
$270.87
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$22.70
|
| Rate for Payer: Superior Health Plan EPO |
$270.87
|
| Rate for Payer: Superior Health Plan Medicare |
$270.87
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$270.87
|
| Rate for Payer: Universal American Medicare |
$270.87
|
| Rate for Payer: Wellcare Medicare |
$270.87
|
| Rate for Payer: Wellmed Medicare |
$270.87
|
|
|
XR Joint/Bursa Small Arthr/Asp/Inj Right BCE
|
Facility
|
OP
|
$622.00
|
|
|
Service Code
|
CPT 20600 RT,FY
|
| Hospital Charge Code |
4900600
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5.97 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$342.10
|
| Rate for Payer: Aetna Medicare |
$406.30
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$22.70
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$270.87
|
| Rate for Payer: Amerigroup Medicare |
$270.87
|
| Rate for Payer: BCBS of TX Blue Advantage |
$41.58
|
| Rate for Payer: BCBS of TX Blue Essentials |
$49.80
|
| Rate for Payer: BCBS of TX Medicare |
$270.87
|
| Rate for Payer: BCBS of TX PPO |
$62.75
|
| Rate for Payer: Cash Price |
$547.36
|
| Rate for Payer: Cash Price |
$547.36
|
| Rate for Payer: Cash Price |
$547.36
|
| Rate for Payer: Cigna Commercial |
$613.60
|
| Rate for Payer: Cigna Medicaid |
$22.70
|
| Rate for Payer: Cigna Medicare |
$270.87
|
| Rate for Payer: Employer Direct Commercial |
$270.87
|
| Rate for Payer: Humana Medicare/TRICARE |
$270.87
|
| Rate for Payer: Molina CHIP/Medicaid |
$22.70
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$270.87
|
| Rate for Payer: Molina Medicare |
$270.87
|
| 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 |
$22.70
|
| Rate for Payer: Scott and White EPO/PPO |
$5.97
|
| Rate for Payer: Scott and White Medicare |
$270.87
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$22.70
|
| Rate for Payer: Superior Health Plan EPO |
$270.87
|
| Rate for Payer: Superior Health Plan Medicare |
$270.87
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$270.87
|
| Rate for Payer: Universal American Medicare |
$270.87
|
| Rate for Payer: Wellcare Medicare |
$270.87
|
| Rate for Payer: Wellmed Medicare |
$270.87
|
|
|
XR Joint/Bursa Small Arthr/Asp/Inj Right BCE
|
Facility
|
IP
|
$622.00
|
|
|
Service Code
|
CPT 20600 RT,FY
|
| Hospital Charge Code |
4900600
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$547.36
|
|
