|
XR Voiding Urethrocystography BCE
|
Facility
|
IP
|
$686.00
|
|
|
Service Code
|
CPT 74455 FY
|
| Hospital Charge Code |
3101250
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$603.68
|
|
|
XR Voiding Urethrocystography BCE
|
Facility
|
OP
|
$686.00
|
|
|
Service Code
|
CPT 74455 FY
|
| Hospital Charge Code |
3101250
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$4.01 |
| Max. Negotiated Rate |
$515.02 |
| Rate for Payer: Aetna Commercial |
$104.98
|
| Rate for Payer: Aetna Medicare |
$336.15
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$105.25
|
| 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 |
$603.68
|
| Rate for Payer: Cash Price |
$603.68
|
| Rate for Payer: Cash Price |
$603.68
|
| Rate for Payer: Cigna Commercial |
$507.64
|
| Rate for Payer: Cigna Medicaid |
$105.25
|
| 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 |
$105.25
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$224.10
|
| Rate for Payer: Molina Medicare |
$224.10
|
| Rate for Payer: Multiplan Auto |
$445.90
|
| Rate for Payer: Multiplan Commercial |
$445.90
|
| Rate for Payer: Multiplan Workers Comp |
$445.90
|
| Rate for Payer: Parkland Medicaid |
$105.25
|
| 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 |
$105.25
|
| 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 Wrist 2 Views Left
|
Facility
|
OP
|
$465.00
|
|
|
Service Code
|
CPT 73100 LT,FY
|
| Hospital Charge Code |
3100716
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$302.25 |
| Rate for Payer: Aetna Commercial |
$29.49
|
| Rate for Payer: Aetna Medicare |
$124.65
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$34.09
|
| 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 |
$409.20
|
| Rate for Payer: Cash Price |
$409.20
|
| Rate for Payer: Cash Price |
$409.20
|
| Rate for Payer: Cigna Commercial |
$188.25
|
| Rate for Payer: Cigna Medicaid |
$34.09
|
| 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 |
$34.09
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$83.10
|
| Rate for Payer: Molina Medicare |
$83.10
|
| Rate for Payer: Multiplan Auto |
$302.25
|
| Rate for Payer: Multiplan Commercial |
$302.25
|
| Rate for Payer: Multiplan Workers Comp |
$302.25
|
| Rate for Payer: Parkland Medicaid |
$34.09
|
| 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 |
$34.09
|
| 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 Wrist 2 Views Left BCE
|
Facility
|
IP
|
$465.00
|
|
|
Service Code
|
CPT 73100 LT,FY
|
| Hospital Charge Code |
3100716
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$409.20
|
|
|
XR Wrist 2 Views Left BCE
|
Facility
|
OP
|
$465.00
|
|
|
Service Code
|
CPT 73100 LT,FY
|
| Hospital Charge Code |
3100716
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$302.25 |
| Rate for Payer: Aetna Commercial |
$29.49
|
| Rate for Payer: Aetna Medicare |
$124.65
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$34.09
|
| 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 |
$409.20
|
| Rate for Payer: Cash Price |
$409.20
|
| Rate for Payer: Cash Price |
$409.20
|
| Rate for Payer: Cigna Commercial |
$188.25
|
| Rate for Payer: Cigna Medicaid |
$34.09
|
| 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 |
$34.09
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$83.10
|
| Rate for Payer: Molina Medicare |
$83.10
|
| Rate for Payer: Multiplan Auto |
$302.25
|
| Rate for Payer: Multiplan Commercial |
$302.25
|
| Rate for Payer: Multiplan Workers Comp |
$302.25
|
| Rate for Payer: Parkland Medicaid |
$34.09
|
| 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 |
$34.09
|
| 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 Wrist 2 Views Right
|
Facility
|
OP
|
$465.00
|
|
|
Service Code
|
CPT 73100 RT,FY
|
| Hospital Charge Code |
3100724
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$302.25 |
| Rate for Payer: Aetna Commercial |
$29.49
|
| Rate for Payer: Aetna Medicare |
$124.65
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$34.09
|
| 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 |
$409.20
|
| Rate for Payer: Cash Price |
$409.20
|
| Rate for Payer: Cash Price |
$409.20
|
| Rate for Payer: Cigna Commercial |
$188.25
|
| Rate for Payer: Cigna Medicaid |
$34.09
|
| 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 |
$34.09
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$83.10
|
| Rate for Payer: Molina Medicare |
$83.10
|
| Rate for Payer: Multiplan Auto |
$302.25
|
| Rate for Payer: Multiplan Commercial |
$302.25
|
| Rate for Payer: Multiplan Workers Comp |
$302.25
|
| Rate for Payer: Parkland Medicaid |
$34.09
|
| 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 |
$34.09
|
| 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 Wrist 2 Views Right BCE
|
Facility
|
IP
|
$465.00
|
|
|
Service Code
|
CPT 73100 RT,FY
|
| Hospital Charge Code |
3100724
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$409.20
|
|
|
XR Wrist 2 Views Right BCE
|
Facility
|
OP
|
$465.00
|
|
|
Service Code
|
CPT 73100 RT,FY
|
| Hospital Charge Code |
3100724
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$302.25 |
| Rate for Payer: Aetna Commercial |
$29.49
|
| Rate for Payer: Aetna Medicare |
$124.65
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$34.09
|
| 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 |
$409.20
|
| Rate for Payer: Cash Price |
$409.20
|
| Rate for Payer: Cash Price |
$409.20
|
| Rate for Payer: Cigna Commercial |
$188.25
|
| Rate for Payer: Cigna Medicaid |
$34.09
|
| 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 |
$34.09
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$83.10
|
| Rate for Payer: Molina Medicare |
$83.10
|
| Rate for Payer: Multiplan Auto |
$302.25
|
| Rate for Payer: Multiplan Commercial |
$302.25
|
| Rate for Payer: Multiplan Workers Comp |
$302.25
|
| Rate for Payer: Parkland Medicaid |
$34.09
|
| 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 |
$34.09
|
| 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 Wrist Complete 3+ Views Left
|
Facility
|
OP
|
$535.00
|
|
|
Service Code
|
CPT 73110 LT,FY
|
| Hospital Charge Code |
3100732
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$347.75 |
| Rate for Payer: Aetna Commercial |
$37.19
|
| Rate for Payer: Aetna Medicare |
$124.65
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$41.10
|
| 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 |
$41.10
|
| 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 |
$41.10
|
| 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 |
$41.10
|
| 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 |
$41.10
|
| 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 Wrist Complete 3+ Views Left BCE
|
Facility
|
IP
|
$535.00
|
|
|
Service Code
|
CPT 73110 LT,FY
|
| Hospital Charge Code |
3100732
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$470.80
|
|
|
XR Wrist Complete 3+ Views Left BCE
|
Facility
|
OP
|
$535.00
|
|
|
Service Code
|
CPT 73110 LT,FY
|
| Hospital Charge Code |
3100732
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$347.75 |
| Rate for Payer: Aetna Commercial |
$37.19
|
| Rate for Payer: Aetna Medicare |
$124.65
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$41.10
|
| 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 |
$41.10
|
| 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 |
$41.10
|
| 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 |
$41.10
|
| 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 |
$41.10
|
| 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 Wrist Complete 3+ Views Right
|
Facility
|
OP
|
$535.00
|
|
|
Service Code
|
CPT 73110 RT,FY
|
| Hospital Charge Code |
3100740
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$347.75 |
| Rate for Payer: Aetna Commercial |
$37.19
|
| Rate for Payer: Aetna Medicare |
$124.65
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$41.10
|
| 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 |
$41.10
|
| 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 |
$41.10
|
| 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 |
$41.10
|
| 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 |
$41.10
|
| 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 Wrist Complete 3+ Views Right BCE
|
Facility
|
OP
|
$535.00
|
|
|
Service Code
|
CPT 73110 RT,FY
|
| Hospital Charge Code |
3100740
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$347.75 |
| Rate for Payer: Aetna Commercial |
$37.19
|
| Rate for Payer: Aetna Medicare |
$124.65
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$41.10
|
| 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 |
$41.10
|
| 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 |
$41.10
|
| 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 |
$41.10
|
| 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 |
$41.10
|
| 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 Wrist Complete 3+ Views Right BCE
|
Facility
|
IP
|
$535.00
|
|
|
Service Code
|
CPT 73110 RT,FY
|
| Hospital Charge Code |
3100740
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$470.80
|
|
|
Y-KNOT DISP BROACH PUNCH
|
Facility
|
OP
|
$616.17
|
|
| Hospital Charge Code |
145132
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$55.46 |
| Max. Negotiated Rate |
$400.51 |
| Rate for Payer: Aetna Commercial |
$338.89
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$55.46
|
| Rate for Payer: BCBS of TX Blue Advantage |
$184.85
|
| Rate for Payer: BCBS of TX Blue Essentials |
$221.82
|
| Rate for Payer: BCBS of TX PPO |
$246.47
|
| Rate for Payer: Cash Price |
$542.23
|
| Rate for Payer: Multiplan Auto |
$400.51
|
| Rate for Payer: Multiplan Commercial |
$400.51
|
| Rate for Payer: Multiplan Workers Comp |
$400.51
|
| Rate for Payer: Scott and White EPO/PPO |
$308.08
|
| Rate for Payer: Superior Health Plan EPO |
$83.80
|
|
|
Y-KNOT DISP BROACH PUNCH
|
Facility
|
IP
|
$616.17
|
|
| Hospital Charge Code |
145132
|
|
Hospital Revenue Code
|
272
|
| Rate for Payer: Cash Price |
$542.23
|
|
|
Y-KNOT LFEX OBTURATOR
|
Facility
|
OP
|
$81.72
|
|
| Hospital Charge Code |
144849
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.35 |
| Max. Negotiated Rate |
$53.12 |
| Rate for Payer: Aetna Commercial |
$44.95
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$7.35
|
| Rate for Payer: BCBS of TX Blue Advantage |
$24.52
|
| Rate for Payer: BCBS of TX Blue Essentials |
$29.42
|
| Rate for Payer: BCBS of TX PPO |
$32.69
|
| Rate for Payer: Cash Price |
$71.91
|
| Rate for Payer: Multiplan Auto |
$53.12
|
| Rate for Payer: Multiplan Commercial |
$53.12
|
| Rate for Payer: Multiplan Workers Comp |
$53.12
|
| Rate for Payer: Scott and White EPO/PPO |
$40.86
|
| Rate for Payer: Superior Health Plan EPO |
$11.11
|
|
|
Y-KNOT LFEX OBTURATOR
|
Facility
|
IP
|
$81.72
|
|
| Hospital Charge Code |
144849
|
|
Hospital Revenue Code
|
272
|
| Rate for Payer: Cash Price |
$71.91
|
|
|
Zinc, Plasma or Serum SO
|
Facility
|
OP
|
$97.00
|
|
|
Service Code
|
CPT 84630
|
| Hospital Charge Code |
1700434
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.44 |
| Max. Negotiated Rate |
$63.05 |
| Rate for Payer: Aetna Commercial |
$11.95
|
| Rate for Payer: Aetna Medicare |
$17.08
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$4.44
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$11.39
|
| Rate for Payer: Amerigroup Medicare |
$11.39
|
| Rate for Payer: BCBS of TX Blue Advantage |
$18.79
|
| Rate for Payer: BCBS of TX Blue Essentials |
$22.55
|
| Rate for Payer: BCBS of TX Medicare |
$11.39
|
| Rate for Payer: BCBS of TX PPO |
$25.17
|
| Rate for Payer: Cash Price |
$85.36
|
| Rate for Payer: Cash Price |
$85.36
|
| Rate for Payer: Cigna Medicaid |
$11.39
|
| Rate for Payer: Cigna Medicare |
$11.39
|
| Rate for Payer: Employer Direct Commercial |
$11.39
|
| Rate for Payer: Humana Medicare/TRICARE |
$11.39
|
| Rate for Payer: Molina CHIP/Medicaid |
$11.39
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$11.39
|
| Rate for Payer: Molina Medicare |
$11.39
|
| Rate for Payer: Multiplan Auto |
$63.05
|
| Rate for Payer: Multiplan Commercial |
$63.05
|
| Rate for Payer: Multiplan Workers Comp |
$63.05
|
| Rate for Payer: Parkland Medicaid |
$11.39
|
| Rate for Payer: Scott and White EPO/PPO |
$14.24
|
| Rate for Payer: Scott and White Medicare |
$11.39
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$11.39
|
| Rate for Payer: Superior Health Plan EPO |
$11.39
|
| Rate for Payer: Superior Health Plan Medicare |
$11.39
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$11.39
|
| Rate for Payer: Universal American Medicare |
$11.39
|
| Rate for Payer: Wellcare Medicare |
$11.39
|
| Rate for Payer: Wellmed Medicare |
$11.39
|
|
|
zinc sulfate 220 mg Cap
|
Facility
|
OP
|
$7.65
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
77885668
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.69 |
| Max. Negotiated Rate |
$4.97 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$0.69
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2.30
|
| Rate for Payer: BCBS of TX Blue Essentials |
$2.75
|
| Rate for Payer: BCBS of TX PPO |
$3.06
|
| Rate for Payer: Cash Price |
$5.20
|
| Rate for Payer: Multiplan Auto |
$4.97
|
| Rate for Payer: Multiplan Commercial |
$4.97
|
| Rate for Payer: Multiplan Workers Comp |
$4.97
|
| Rate for Payer: Scott and White EPO/PPO |
$3.82
|
| Rate for Payer: Superior Health Plan EPO |
$1.04
|
|
|
zinc sulfate 220 mg Cap
|
Facility
|
IP
|
$7.65
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
77885668
|
|
Hospital Revenue Code
|
250
|
| Rate for Payer: Cash Price |
$5.20
|
|
|
Zinc, Whole Blood SO
|
Facility
|
OP
|
$97.00
|
|
|
Service Code
|
CPT 84630
|
| Hospital Charge Code |
1700434
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.44 |
| Max. Negotiated Rate |
$63.05 |
| Rate for Payer: Aetna Commercial |
$11.95
|
| Rate for Payer: Aetna Medicare |
$17.08
|
| Rate for Payer: Amerigroup CHIP/Medicaid |
$4.44
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$11.39
|
| Rate for Payer: Amerigroup Medicare |
$11.39
|
| Rate for Payer: BCBS of TX Blue Advantage |
$18.79
|
| Rate for Payer: BCBS of TX Blue Essentials |
$22.55
|
| Rate for Payer: BCBS of TX Medicare |
$11.39
|
| Rate for Payer: BCBS of TX PPO |
$25.17
|
| Rate for Payer: Cash Price |
$85.36
|
| Rate for Payer: Cash Price |
$85.36
|
| Rate for Payer: Cigna Medicaid |
$11.39
|
| Rate for Payer: Cigna Medicare |
$11.39
|
| Rate for Payer: Employer Direct Commercial |
$11.39
|
| Rate for Payer: Humana Medicare/TRICARE |
$11.39
|
| Rate for Payer: Molina CHIP/Medicaid |
$11.39
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$11.39
|
| Rate for Payer: Molina Medicare |
$11.39
|
| Rate for Payer: Multiplan Auto |
$63.05
|
| Rate for Payer: Multiplan Commercial |
$63.05
|
| Rate for Payer: Multiplan Workers Comp |
$63.05
|
| Rate for Payer: Parkland Medicaid |
$11.39
|
| Rate for Payer: Scott and White EPO/PPO |
$14.24
|
| Rate for Payer: Scott and White Medicare |
$11.39
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$11.39
|
| Rate for Payer: Superior Health Plan EPO |
$11.39
|
| Rate for Payer: Superior Health Plan Medicare |
$11.39
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$11.39
|
| Rate for Payer: Universal American Medicare |
$11.39
|
| Rate for Payer: Wellcare Medicare |
$11.39
|
| Rate for Payer: Wellmed Medicare |
$11.39
|
|
|
Zinc, Whole Blood SO
|
Facility
|
IP
|
$97.00
|
|
|
Service Code
|
CPT 84630
|
| Hospital Charge Code |
1700434
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$85.36
|
|
|
ziprasidone 20 mg Cap
|
Facility
|
IP
|
$8.00
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
77885878
|
|
Hospital Revenue Code
|
250
|
| Rate for Payer: Cash Price |
$5.44
|
|
|
ziprasidone 20 mg Cap
|
Facility
|
OP
|
$8.00
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
77885878
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.72 |
| Max. Negotiated Rate |
$5.20 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$0.72
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2.40
|
| Rate for Payer: BCBS of TX Blue Essentials |
$2.88
|
| Rate for Payer: BCBS of TX PPO |
$3.20
|
| Rate for Payer: Cash Price |
$5.44
|
| Rate for Payer: Multiplan Auto |
$5.20
|
| Rate for Payer: Multiplan Commercial |
$5.20
|
| Rate for Payer: Multiplan Workers Comp |
$5.20
|
| Rate for Payer: Scott and White EPO/PPO |
$4.00
|
| Rate for Payer: Superior Health Plan EPO |
$1.09
|
|
