|
XR Spine Thoracolumbar 1 View
|
Facility
|
OP
|
$364.00
|
|
|
Service Code
|
CPT 72020 FY
|
| Hospital Charge Code |
3100377
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$236.60 |
| Rate for Payer: Aetna Commercial |
$19.08
|
| Rate for Payer: Aetna Medicare |
$124.65
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$24.73
|
| 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 |
$320.32
|
| Rate for Payer: Cash Price |
$320.32
|
| Rate for Payer: Cash Price |
$320.32
|
| Rate for Payer: Cigna Commercial |
$188.25
|
| Rate for Payer: Cigna Medicaid |
$24.73
|
| 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 |
$24.73
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$83.10
|
| Rate for Payer: Molina Medicare |
$83.10
|
| Rate for Payer: Multiplan Auto |
$236.60
|
| Rate for Payer: Multiplan Commercial |
$236.60
|
| Rate for Payer: Multiplan Workers Comp |
$236.60
|
| Rate for Payer: Parkland Medicaid |
$24.73
|
| 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 |
$24.73
|
| 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 Spine Thoracolumbar 2+ Views
|
Facility
|
OP
|
$336.00
|
|
|
Service Code
|
CPT 72080 FY
|
| Hospital Charge Code |
3160124
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$218.40 |
| Rate for Payer: Aetna Commercial |
$28.33
|
| Rate for Payer: Aetna Medicare |
$124.65
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$34.75
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$83.10
|
| Rate for Payer: Amerigroup Medicare |
$83.10
|
| Rate for Payer: BCBS of TX Blue Advantage |
$131.69
|
| Rate for Payer: BCBS of TX Blue Essentials |
$158.02
|
| Rate for Payer: BCBS of TX Medicare |
$83.10
|
| Rate for Payer: BCBS of TX PPO |
$176.38
|
| Rate for Payer: Cash Price |
$295.68
|
| Rate for Payer: Cash Price |
$295.68
|
| Rate for Payer: Cash Price |
$295.68
|
| Rate for Payer: Cigna Commercial |
$188.25
|
| Rate for Payer: Cigna Medicaid |
$34.75
|
| Rate for Payer: Cigna Medicare |
$83.10
|
| Rate for Payer: Employer Direct Commercial |
$83.10
|
| Rate for Payer: Humana Medicare/TRICARE |
$83.10
|
| Rate for Payer: Molina CHIP/Medicaid |
$34.75
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$83.10
|
| Rate for Payer: Molina Medicare |
$83.10
|
| Rate for Payer: Multiplan Auto |
$218.40
|
| Rate for Payer: Multiplan Commercial |
$218.40
|
| Rate for Payer: Multiplan Workers Comp |
$218.40
|
| Rate for Payer: Parkland Medicaid |
$34.75
|
| Rate for Payer: Scott and White EPO/PPO |
$1.49
|
| Rate for Payer: Scott and White Medicare |
$83.10
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$34.75
|
| Rate for Payer: Superior Health Plan EPO |
$83.10
|
| Rate for Payer: Superior Health Plan Medicare |
$83.10
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$83.10
|
| Rate for Payer: Universal American Medicare |
$83.10
|
| Rate for Payer: Wellcare Medicare |
$83.10
|
| Rate for Payer: Wellmed Medicare |
$83.10
|
|
|
XR Spine Thoracolumbar 2+ Views BCE
|
Facility
|
IP
|
$336.00
|
|
|
Service Code
|
CPT 72080 FY
|
| Hospital Charge Code |
3160124
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$295.68
|
|
|
XR Spine Thoracolumbar 2+ Views BCE
|
Facility
|
OP
|
$336.00
|
|
|
Service Code
|
CPT 72080 FY
|
| Hospital Charge Code |
3160124
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$218.40 |
| Rate for Payer: Aetna Commercial |
$28.33
|
| Rate for Payer: Aetna Medicare |
$124.65
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$34.75
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$83.10
|
| Rate for Payer: Amerigroup Medicare |
$83.10
|
| Rate for Payer: BCBS of TX Blue Advantage |
$131.69
|
| Rate for Payer: BCBS of TX Blue Essentials |
$158.02
|
| Rate for Payer: BCBS of TX Medicare |
$83.10
|
| Rate for Payer: BCBS of TX PPO |
$176.38
|
| Rate for Payer: Cash Price |
$295.68
|
| Rate for Payer: Cash Price |
$295.68
|
| Rate for Payer: Cash Price |
$295.68
|
| Rate for Payer: Cigna Commercial |
$188.25
|
| Rate for Payer: Cigna Medicaid |
$34.75
|
| Rate for Payer: Cigna Medicare |
$83.10
|
| Rate for Payer: Employer Direct Commercial |
$83.10
|
| Rate for Payer: Humana Medicare/TRICARE |
$83.10
|
| Rate for Payer: Molina CHIP/Medicaid |
$34.75
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$83.10
|
| Rate for Payer: Molina Medicare |
$83.10
|
| Rate for Payer: Multiplan Auto |
$218.40
|
| Rate for Payer: Multiplan Commercial |
$218.40
|
| Rate for Payer: Multiplan Workers Comp |
$218.40
|
| Rate for Payer: Parkland Medicaid |
$34.75
|
| Rate for Payer: Scott and White EPO/PPO |
$1.49
|
| Rate for Payer: Scott and White Medicare |
$83.10
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$34.75
|
| Rate for Payer: Superior Health Plan EPO |
$83.10
|
| Rate for Payer: Superior Health Plan Medicare |
$83.10
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$83.10
|
| Rate for Payer: Universal American Medicare |
$83.10
|
| Rate for Payer: Wellcare Medicare |
$83.10
|
| Rate for Payer: Wellmed Medicare |
$83.10
|
|
|
XR Sternum 2+ Views
|
Facility
|
OP
|
$283.00
|
|
|
Service Code
|
CPT 71120 FY
|
| Hospital Charge Code |
3100328
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$188.25 |
| Rate for Payer: Aetna Commercial |
$27.95
|
| Rate for Payer: Aetna Medicare |
$124.65
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$33.75
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$83.10
|
| Rate for Payer: Amerigroup Medicare |
$83.10
|
| Rate for Payer: BCBS of TX Blue Advantage |
$131.69
|
| Rate for Payer: BCBS of TX Blue Essentials |
$158.02
|
| Rate for Payer: BCBS of TX Medicare |
$83.10
|
| Rate for Payer: BCBS of TX PPO |
$176.38
|
| Rate for Payer: Cash Price |
$249.04
|
| Rate for Payer: Cash Price |
$249.04
|
| Rate for Payer: Cash Price |
$249.04
|
| Rate for Payer: Cigna Commercial |
$188.25
|
| Rate for Payer: Cigna Medicaid |
$33.75
|
| Rate for Payer: Cigna Medicare |
$83.10
|
| Rate for Payer: Employer Direct Commercial |
$83.10
|
| Rate for Payer: Humana Medicare/TRICARE |
$83.10
|
| Rate for Payer: Molina CHIP/Medicaid |
$33.75
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$83.10
|
| Rate for Payer: Molina Medicare |
$83.10
|
| Rate for Payer: Multiplan Auto |
$183.95
|
| Rate for Payer: Multiplan Commercial |
$183.95
|
| Rate for Payer: Multiplan Workers Comp |
$183.95
|
| Rate for Payer: Parkland Medicaid |
$33.75
|
| Rate for Payer: Scott and White EPO/PPO |
$1.49
|
| Rate for Payer: Scott and White Medicare |
$83.10
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$33.75
|
| Rate for Payer: Superior Health Plan EPO |
$83.10
|
| Rate for Payer: Superior Health Plan Medicare |
$83.10
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$83.10
|
| Rate for Payer: Universal American Medicare |
$83.10
|
| Rate for Payer: Wellcare Medicare |
$83.10
|
| Rate for Payer: Wellmed Medicare |
$83.10
|
|
|
XR Sternum 2+ Views BCE
|
Facility
|
IP
|
$283.00
|
|
|
Service Code
|
CPT 71120 FY
|
| Hospital Charge Code |
3100328
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$249.04
|
|
|
XR Sternum 2+ Views BCE
|
Facility
|
OP
|
$283.00
|
|
|
Service Code
|
CPT 71120 FY
|
| Hospital Charge Code |
3100328
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$188.25 |
| Rate for Payer: Aetna Commercial |
$27.95
|
| Rate for Payer: Aetna Medicare |
$124.65
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$33.75
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$83.10
|
| Rate for Payer: Amerigroup Medicare |
$83.10
|
| Rate for Payer: BCBS of TX Blue Advantage |
$131.69
|
| Rate for Payer: BCBS of TX Blue Essentials |
$158.02
|
| Rate for Payer: BCBS of TX Medicare |
$83.10
|
| Rate for Payer: BCBS of TX PPO |
$176.38
|
| Rate for Payer: Cash Price |
$249.04
|
| Rate for Payer: Cash Price |
$249.04
|
| Rate for Payer: Cash Price |
$249.04
|
| Rate for Payer: Cigna Commercial |
$188.25
|
| Rate for Payer: Cigna Medicaid |
$33.75
|
| Rate for Payer: Cigna Medicare |
$83.10
|
| Rate for Payer: Employer Direct Commercial |
$83.10
|
| Rate for Payer: Humana Medicare/TRICARE |
$83.10
|
| Rate for Payer: Molina CHIP/Medicaid |
$33.75
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$83.10
|
| Rate for Payer: Molina Medicare |
$83.10
|
| Rate for Payer: Multiplan Auto |
$183.95
|
| Rate for Payer: Multiplan Commercial |
$183.95
|
| Rate for Payer: Multiplan Workers Comp |
$183.95
|
| Rate for Payer: Parkland Medicaid |
$33.75
|
| Rate for Payer: Scott and White EPO/PPO |
$1.49
|
| Rate for Payer: Scott and White Medicare |
$83.10
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$33.75
|
| Rate for Payer: Superior Health Plan EPO |
$83.10
|
| Rate for Payer: Superior Health Plan Medicare |
$83.10
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$83.10
|
| Rate for Payer: Universal American Medicare |
$83.10
|
| Rate for Payer: Wellcare Medicare |
$83.10
|
| Rate for Payer: Wellmed Medicare |
$83.10
|
|
|
XR Surgical Specimen
|
Facility
|
OP
|
$333.00
|
|
|
Service Code
|
CPT 76098 FY
|
| Hospital Charge Code |
3170074
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$9.02 |
| Max. Negotiated Rate |
$1,142.91 |
| Rate for Payer: Aetna Commercial |
$29.10
|
| Rate for Payer: Aetna Medicare |
$756.80
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$42.10
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$504.53
|
| Rate for Payer: Amerigroup Medicare |
$504.53
|
| Rate for Payer: BCBS of TX Blue Advantage |
$794.61
|
| Rate for Payer: BCBS of TX Blue Essentials |
$953.53
|
| Rate for Payer: BCBS of TX Medicare |
$504.53
|
| Rate for Payer: BCBS of TX PPO |
$1,064.29
|
| Rate for Payer: Cash Price |
$293.04
|
| Rate for Payer: Cash Price |
$293.04
|
| Rate for Payer: Cash Price |
$293.04
|
| Rate for Payer: Cigna Commercial |
$1,142.91
|
| Rate for Payer: Cigna Medicaid |
$12.03
|
| Rate for Payer: Cigna Medicare |
$504.53
|
| Rate for Payer: Employer Direct Commercial |
$504.53
|
| Rate for Payer: Humana Medicare/TRICARE |
$504.53
|
| Rate for Payer: Molina CHIP/Medicaid |
$12.03
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$504.53
|
| Rate for Payer: Molina Medicare |
$504.53
|
| Rate for Payer: Multiplan Auto |
$216.45
|
| Rate for Payer: Multiplan Commercial |
$216.45
|
| Rate for Payer: Multiplan Workers Comp |
$216.45
|
| Rate for Payer: Parkland Medicaid |
$12.03
|
| Rate for Payer: Scott and White EPO/PPO |
$9.02
|
| Rate for Payer: Scott and White Medicare |
$504.53
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$12.03
|
| Rate for Payer: Superior Health Plan EPO |
$504.53
|
| Rate for Payer: Superior Health Plan Medicare |
$504.53
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$504.53
|
| Rate for Payer: Universal American Medicare |
$504.53
|
| Rate for Payer: Wellcare Medicare |
$504.53
|
| Rate for Payer: Wellmed Medicare |
$504.53
|
|
|
XR Surgical Specimen BCE
|
Facility
|
IP
|
$333.00
|
|
|
Service Code
|
CPT 76098 FY
|
| Hospital Charge Code |
3170074
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$293.04
|
|
|
XR Surgical Specimen BCE
|
Facility
|
OP
|
$333.00
|
|
|
Service Code
|
CPT 76098 FY
|
| Hospital Charge Code |
3170074
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$9.02 |
| Max. Negotiated Rate |
$1,142.91 |
| Rate for Payer: Aetna Commercial |
$29.10
|
| Rate for Payer: Aetna Medicare |
$756.80
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$42.10
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$504.53
|
| Rate for Payer: Amerigroup Medicare |
$504.53
|
| Rate for Payer: BCBS of TX Blue Advantage |
$794.61
|
| Rate for Payer: BCBS of TX Blue Essentials |
$953.53
|
| Rate for Payer: BCBS of TX Medicare |
$504.53
|
| Rate for Payer: BCBS of TX PPO |
$1,064.29
|
| Rate for Payer: Cash Price |
$293.04
|
| Rate for Payer: Cash Price |
$293.04
|
| Rate for Payer: Cash Price |
$293.04
|
| Rate for Payer: Cigna Commercial |
$1,142.91
|
| Rate for Payer: Cigna Medicaid |
$12.03
|
| Rate for Payer: Cigna Medicare |
$504.53
|
| Rate for Payer: Employer Direct Commercial |
$504.53
|
| Rate for Payer: Humana Medicare/TRICARE |
$504.53
|
| Rate for Payer: Molina CHIP/Medicaid |
$12.03
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$504.53
|
| Rate for Payer: Molina Medicare |
$504.53
|
| Rate for Payer: Multiplan Auto |
$216.45
|
| Rate for Payer: Multiplan Commercial |
$216.45
|
| Rate for Payer: Multiplan Workers Comp |
$216.45
|
| Rate for Payer: Parkland Medicaid |
$12.03
|
| Rate for Payer: Scott and White EPO/PPO |
$9.02
|
| Rate for Payer: Scott and White Medicare |
$504.53
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$12.03
|
| Rate for Payer: Superior Health Plan EPO |
$504.53
|
| Rate for Payer: Superior Health Plan Medicare |
$504.53
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$504.53
|
| Rate for Payer: Universal American Medicare |
$504.53
|
| Rate for Payer: Wellcare Medicare |
$504.53
|
| Rate for Payer: Wellmed Medicare |
$504.53
|
|
|
XR Swallowing Function w/ Speech
|
Facility
|
OP
|
$788.00
|
|
|
Service Code
|
CPT 74230 FY
|
| Hospital Charge Code |
3101102
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$3.01 |
| Max. Negotiated Rate |
$512.20 |
| Rate for Payer: Aetna Commercial |
$120.78
|
| Rate for Payer: Aetna Medicare |
$252.04
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$127.64
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$168.03
|
| Rate for Payer: Amerigroup Medicare |
$168.03
|
| Rate for Payer: BCBS of TX Blue Advantage |
$300.66
|
| Rate for Payer: BCBS of TX Blue Essentials |
$360.80
|
| Rate for Payer: BCBS of TX Medicare |
$168.03
|
| Rate for Payer: BCBS of TX PPO |
$402.71
|
| Rate for Payer: Cash Price |
$693.44
|
| Rate for Payer: Cash Price |
$693.44
|
| Rate for Payer: Cash Price |
$693.44
|
| Rate for Payer: Cigna Commercial |
$380.65
|
| Rate for Payer: Cigna Medicaid |
$127.64
|
| 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 |
$127.64
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$168.03
|
| Rate for Payer: Molina Medicare |
$168.03
|
| Rate for Payer: Multiplan Auto |
$512.20
|
| Rate for Payer: Multiplan Commercial |
$512.20
|
| Rate for Payer: Multiplan Workers Comp |
$512.20
|
| Rate for Payer: Parkland Medicaid |
$127.64
|
| 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 |
$127.64
|
| 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 Swallowing Function w/ Speech BCE
|
Facility
|
IP
|
$788.00
|
|
|
Service Code
|
CPT 74230 FY
|
| Hospital Charge Code |
3101102
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$693.44
|
|
|
XR Swallowing Function w/ Speech BCE
|
Facility
|
OP
|
$788.00
|
|
|
Service Code
|
CPT 74230 FY
|
| Hospital Charge Code |
3101102
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$3.01 |
| Max. Negotiated Rate |
$512.20 |
| Rate for Payer: Aetna Commercial |
$120.78
|
| Rate for Payer: Aetna Medicare |
$252.04
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$127.64
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$168.03
|
| Rate for Payer: Amerigroup Medicare |
$168.03
|
| Rate for Payer: BCBS of TX Blue Advantage |
$300.66
|
| Rate for Payer: BCBS of TX Blue Essentials |
$360.80
|
| Rate for Payer: BCBS of TX Medicare |
$168.03
|
| Rate for Payer: BCBS of TX PPO |
$402.71
|
| Rate for Payer: Cash Price |
$693.44
|
| Rate for Payer: Cash Price |
$693.44
|
| Rate for Payer: Cash Price |
$693.44
|
| Rate for Payer: Cigna Commercial |
$380.65
|
| Rate for Payer: Cigna Medicaid |
$127.64
|
| 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 |
$127.64
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$168.03
|
| Rate for Payer: Molina Medicare |
$168.03
|
| Rate for Payer: Multiplan Auto |
$512.20
|
| Rate for Payer: Multiplan Commercial |
$512.20
|
| Rate for Payer: Multiplan Workers Comp |
$512.20
|
| Rate for Payer: Parkland Medicaid |
$127.64
|
| 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 |
$127.64
|
| 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 Thoracostomy Tube Left
|
Facility
|
OP
|
$819.00
|
|
|
Service Code
|
CPT 32551 LT,FY
|
| Hospital Charge Code |
4907772
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$32.31 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$1,400.00
|
| Rate for Payer: Aetna Medicare |
$2,197.02
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$73.71
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,464.68
|
| Rate for Payer: Amerigroup Medicare |
$1,464.68
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,723.99
|
| Rate for Payer: BCBS of TX Blue Essentials |
$3,262.26
|
| Rate for Payer: BCBS of TX Medicare |
$1,464.68
|
| Rate for Payer: BCBS of TX PPO |
$4,110.45
|
| Rate for Payer: Cash Price |
$720.72
|
| Rate for Payer: Cash Price |
$720.72
|
| Rate for Payer: Cash Price |
$720.72
|
| Rate for Payer: Cigna Commercial |
$3,317.93
|
| Rate for Payer: Cigna Medicare |
$1,464.68
|
| Rate for Payer: Employer Direct Commercial |
$1,464.68
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,464.68
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,464.68
|
| Rate for Payer: Molina Medicare |
$1,464.68
|
| 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: Scott and White EPO/PPO |
$32.31
|
| Rate for Payer: Scott and White Medicare |
$1,464.68
|
| Rate for Payer: Superior Health Plan EPO |
$1,464.68
|
| Rate for Payer: Superior Health Plan Medicare |
$1,464.68
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,464.68
|
| Rate for Payer: Universal American Medicare |
$1,464.68
|
| Rate for Payer: Wellcare Medicare |
$1,464.68
|
| Rate for Payer: Wellmed Medicare |
$1,464.68
|
|
|
XR Thoracostomy Tube Left BCE
|
Facility
|
OP
|
$819.00
|
|
|
Service Code
|
CPT 32551 LT,FY
|
| Hospital Charge Code |
4907772
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$32.31 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$1,400.00
|
| Rate for Payer: Aetna Medicare |
$2,197.02
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$73.71
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,464.68
|
| Rate for Payer: Amerigroup Medicare |
$1,464.68
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,723.99
|
| Rate for Payer: BCBS of TX Blue Essentials |
$3,262.26
|
| Rate for Payer: BCBS of TX Medicare |
$1,464.68
|
| Rate for Payer: BCBS of TX PPO |
$4,110.45
|
| Rate for Payer: Cash Price |
$720.72
|
| Rate for Payer: Cash Price |
$720.72
|
| Rate for Payer: Cash Price |
$720.72
|
| Rate for Payer: Cigna Commercial |
$3,317.93
|
| Rate for Payer: Cigna Medicare |
$1,464.68
|
| Rate for Payer: Employer Direct Commercial |
$1,464.68
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,464.68
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,464.68
|
| Rate for Payer: Molina Medicare |
$1,464.68
|
| 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: Scott and White EPO/PPO |
$32.31
|
| Rate for Payer: Scott and White Medicare |
$1,464.68
|
| Rate for Payer: Superior Health Plan EPO |
$1,464.68
|
| Rate for Payer: Superior Health Plan Medicare |
$1,464.68
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,464.68
|
| Rate for Payer: Universal American Medicare |
$1,464.68
|
| Rate for Payer: Wellcare Medicare |
$1,464.68
|
| Rate for Payer: Wellmed Medicare |
$1,464.68
|
|
|
XR Thoracostomy Tube Right
|
Facility
|
OP
|
$819.00
|
|
|
Service Code
|
CPT 32551 RT,FY
|
| Hospital Charge Code |
4907772
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$32.31 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$1,400.00
|
| Rate for Payer: Aetna Medicare |
$2,197.02
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$73.71
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,464.68
|
| Rate for Payer: Amerigroup Medicare |
$1,464.68
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,723.99
|
| Rate for Payer: BCBS of TX Blue Essentials |
$3,262.26
|
| Rate for Payer: BCBS of TX Medicare |
$1,464.68
|
| Rate for Payer: BCBS of TX PPO |
$4,110.45
|
| Rate for Payer: Cash Price |
$720.72
|
| Rate for Payer: Cash Price |
$720.72
|
| Rate for Payer: Cash Price |
$720.72
|
| Rate for Payer: Cigna Commercial |
$3,317.93
|
| Rate for Payer: Cigna Medicare |
$1,464.68
|
| Rate for Payer: Employer Direct Commercial |
$1,464.68
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,464.68
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,464.68
|
| Rate for Payer: Molina Medicare |
$1,464.68
|
| 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: Scott and White EPO/PPO |
$32.31
|
| Rate for Payer: Scott and White Medicare |
$1,464.68
|
| Rate for Payer: Superior Health Plan EPO |
$1,464.68
|
| Rate for Payer: Superior Health Plan Medicare |
$1,464.68
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,464.68
|
| Rate for Payer: Universal American Medicare |
$1,464.68
|
| Rate for Payer: Wellcare Medicare |
$1,464.68
|
| Rate for Payer: Wellmed Medicare |
$1,464.68
|
|
|
XR Thoracostomy Tube Right BCE
|
Facility
|
OP
|
$819.00
|
|
|
Service Code
|
CPT 32551 RT,FY
|
| Hospital Charge Code |
4907772
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$32.31 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$1,400.00
|
| Rate for Payer: Aetna Medicare |
$2,197.02
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$73.71
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,464.68
|
| Rate for Payer: Amerigroup Medicare |
$1,464.68
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,723.99
|
| Rate for Payer: BCBS of TX Blue Essentials |
$3,262.26
|
| Rate for Payer: BCBS of TX Medicare |
$1,464.68
|
| Rate for Payer: BCBS of TX PPO |
$4,110.45
|
| Rate for Payer: Cash Price |
$720.72
|
| Rate for Payer: Cash Price |
$720.72
|
| Rate for Payer: Cash Price |
$720.72
|
| Rate for Payer: Cigna Commercial |
$3,317.93
|
| Rate for Payer: Cigna Medicare |
$1,464.68
|
| Rate for Payer: Employer Direct Commercial |
$1,464.68
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,464.68
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,464.68
|
| Rate for Payer: Molina Medicare |
$1,464.68
|
| 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: Scott and White EPO/PPO |
$32.31
|
| Rate for Payer: Scott and White Medicare |
$1,464.68
|
| Rate for Payer: Superior Health Plan EPO |
$1,464.68
|
| Rate for Payer: Superior Health Plan Medicare |
$1,464.68
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,464.68
|
| Rate for Payer: Universal American Medicare |
$1,464.68
|
| Rate for Payer: Wellcare Medicare |
$1,464.68
|
| Rate for Payer: Wellmed Medicare |
$1,464.68
|
|
|
XR Thoracostomy Tube Right BCE
|
Facility
|
IP
|
$819.00
|
|
|
Service Code
|
CPT 32551 RT,FY
|
| Hospital Charge Code |
4907772
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$720.72
|
|
|
XR Tibia/Fibula Left
|
Facility
|
OP
|
$535.00
|
|
|
Service Code
|
CPT 73590 LT,FY
|
| Hospital Charge Code |
3100930
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$347.75 |
| Rate for Payer: Aetna Commercial |
$27.18
|
| Rate for Payer: Aetna Medicare |
$124.65
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$31.74
|
| 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 |
$31.74
|
| 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 |
$31.74
|
| 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 |
$31.74
|
| 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 |
$31.74
|
| 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 Tibia/Fibula Left BCE
|
Facility
|
OP
|
$535.00
|
|
|
Service Code
|
CPT 73590 LT,FY
|
| Hospital Charge Code |
3100930
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$347.75 |
| Rate for Payer: Aetna Commercial |
$27.18
|
| Rate for Payer: Aetna Medicare |
$124.65
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$31.74
|
| 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 |
$31.74
|
| 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 |
$31.74
|
| 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 |
$31.74
|
| 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 |
$31.74
|
| 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 Tibia/Fibula Left BCE
|
Facility
|
IP
|
$535.00
|
|
|
Service Code
|
CPT 73590 LT,FY
|
| Hospital Charge Code |
3100930
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$470.80
|
|
|
XR Tibia/Fibula Right
|
Facility
|
OP
|
$535.00
|
|
|
Service Code
|
CPT 73590 RT,FY
|
| Hospital Charge Code |
3100948
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$347.75 |
| Rate for Payer: Aetna Commercial |
$27.18
|
| Rate for Payer: Aetna Medicare |
$124.65
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$31.74
|
| 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 |
$31.74
|
| 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 |
$31.74
|
| 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 |
$31.74
|
| 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 |
$31.74
|
| 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 Tibia/Fibula Right BCE
|
Facility
|
IP
|
$535.00
|
|
|
Service Code
|
CPT 73590 RT,FY
|
| Hospital Charge Code |
3100948
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$470.80
|
|
|
XR Tibia/Fibula Right BCE
|
Facility
|
OP
|
$535.00
|
|
|
Service Code
|
CPT 73590 RT,FY
|
| Hospital Charge Code |
3100948
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$347.75 |
| Rate for Payer: Aetna Commercial |
$27.18
|
| Rate for Payer: Aetna Medicare |
$124.65
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$31.74
|
| 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 |
$31.74
|
| 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 |
$31.74
|
| 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 |
$31.74
|
| 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 |
$31.74
|
| 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 Tilt Table
|
Facility
|
OP
|
$1,399.00
|
|
|
Service Code
|
CPT 93660 FY
|
| Hospital Charge Code |
3170085
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$8.77 |
| Max. Negotiated Rate |
$1,110.40 |
| Rate for Payer: Aetna Commercial |
$769.45
|
| Rate for Payer: Aetna Medicare |
$735.27
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$125.91
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$490.18
|
| Rate for Payer: Amerigroup Medicare |
$490.18
|
| Rate for Payer: BCBS of TX Blue Advantage |
$115.38
|
| Rate for Payer: BCBS of TX Blue Essentials |
$137.92
|
| Rate for Payer: BCBS of TX Medicare |
$490.18
|
| Rate for Payer: BCBS of TX PPO |
$153.84
|
| Rate for Payer: Cash Price |
$1,231.12
|
| Rate for Payer: Cash Price |
$1,231.12
|
| Rate for Payer: Cash Price |
$1,231.12
|
| Rate for Payer: Cigna Commercial |
$1,110.40
|
| Rate for Payer: Cigna Medicaid |
$56.13
|
| Rate for Payer: Cigna Medicare |
$490.18
|
| Rate for Payer: Employer Direct Commercial |
$490.18
|
| Rate for Payer: Humana Medicare/TRICARE |
$490.18
|
| Rate for Payer: Molina CHIP/Medicaid |
$56.13
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$490.18
|
| Rate for Payer: Molina Medicare |
$490.18
|
| Rate for Payer: Multiplan Auto |
$909.35
|
| Rate for Payer: Multiplan Commercial |
$909.35
|
| Rate for Payer: Multiplan Workers Comp |
$909.35
|
| Rate for Payer: Parkland Medicaid |
$56.13
|
| Rate for Payer: Scott and White EPO/PPO |
$8.77
|
| Rate for Payer: Scott and White Medicare |
$490.18
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$56.13
|
| Rate for Payer: Superior Health Plan EPO |
$490.18
|
| Rate for Payer: Superior Health Plan Medicare |
$490.18
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$490.18
|
| Rate for Payer: Universal American Medicare |
$490.18
|
| Rate for Payer: Wellcare Medicare |
$490.18
|
| Rate for Payer: Wellmed Medicare |
$490.18
|
|
