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All Charges

Charge Type Setting Price  
Service Code HCPCS J3490
Hospital Charge Code 77887089
Hospital Revenue Code 250
Rate for Payer: Cash Price $5.44
Service Code HCPCS J3490
Hospital Charge Code 77887089
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