|
US Segmental Pressures LE 3+ Lvls Bilat
|
Facility
|
OP
|
$1,579.00
|
|
|
Service Code
|
HCPCS 93923
|
| Hospital Charge Code |
3501038
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$142.11 |
| Max. Negotiated Rate |
$1,136.88 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$142.11
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$216.91
|
| Rate for Payer: Amerigroup Medicare |
$216.91
|
| Rate for Payer: BCBS of TX Blue Advantage |
$473.70
|
| Rate for Payer: BCBS of TX Blue Essentials |
$568.44
|
| Rate for Payer: BCBS of TX Medicare |
$216.91
|
| Rate for Payer: BCBS of TX PPO |
$631.60
|
| Rate for Payer: Cash Price |
$1,073.72
|
| Rate for Payer: Cash Price |
$1,073.72
|
| Rate for Payer: Cash Price |
$1,073.72
|
| Rate for Payer: Cigna Commercial |
$458.51
|
| Rate for Payer: Cigna Medicaid |
$1,136.88
|
| Rate for Payer: Cigna Medicare |
$216.91
|
| Rate for Payer: Employer Direct Commercial |
$216.91
|
| Rate for Payer: Humana Medicare/TRICARE |
$216.91
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,136.88
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$216.91
|
| Rate for Payer: Molina Medicare |
$216.91
|
| Rate for Payer: Multiplan Auto |
$1,026.35
|
| Rate for Payer: Multiplan Commercial |
$1,026.35
|
| Rate for Payer: Multiplan Workers Comp |
$1,026.35
|
| Rate for Payer: Parkland Medicaid |
$1,136.88
|
| Rate for Payer: Scott and White EPO/PPO |
$160.75
|
| Rate for Payer: Scott and White Medicare |
$216.91
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,136.88
|
| Rate for Payer: Superior Health Plan EPO |
$216.91
|
| Rate for Payer: Superior Health Plan Medicare |
$216.91
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$216.91
|
| Rate for Payer: Universal American Medicare |
$216.91
|
| Rate for Payer: Wellcare Medicare |
$216.91
|
| Rate for Payer: Wellmed Medicare |
$216.91
|
|
|
US Spinal Canal
|
Facility
|
OP
|
$704.00
|
|
|
Service Code
|
HCPCS 76800
|
| Hospital Charge Code |
3500253
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$104.75 |
| Max. Negotiated Rate |
$506.88 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$104.75
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$105.02
|
| Rate for Payer: Amerigroup Medicare |
$105.02
|
| Rate for Payer: BCBS of TX Blue Advantage |
$184.93
|
| Rate for Payer: BCBS of TX Blue Essentials |
$221.92
|
| Rate for Payer: BCBS of TX Medicare |
$105.02
|
| Rate for Payer: BCBS of TX PPO |
$247.70
|
| Rate for Payer: Cash Price |
$478.72
|
| Rate for Payer: Cash Price |
$478.72
|
| Rate for Payer: Cash Price |
$478.72
|
| Rate for Payer: Cigna Commercial |
$222.00
|
| Rate for Payer: Cigna Medicaid |
$506.88
|
| Rate for Payer: Cigna Medicare |
$105.02
|
| Rate for Payer: Employer Direct Commercial |
$105.02
|
| Rate for Payer: Humana Medicare/TRICARE |
$105.02
|
| Rate for Payer: Molina CHIP/Medicaid |
$506.88
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$105.02
|
| Rate for Payer: Molina Medicare |
$105.02
|
| Rate for Payer: Multiplan Auto |
$457.60
|
| Rate for Payer: Multiplan Commercial |
$457.60
|
| Rate for Payer: Multiplan Workers Comp |
$457.60
|
| Rate for Payer: Parkland Medicaid |
$506.88
|
| Rate for Payer: Scott and White EPO/PPO |
$213.04
|
| Rate for Payer: Scott and White Medicare |
$105.02
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$506.88
|
| Rate for Payer: Superior Health Plan EPO |
$105.02
|
| Rate for Payer: Superior Health Plan Medicare |
$105.02
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$105.02
|
| Rate for Payer: Universal American Medicare |
$105.02
|
| Rate for Payer: Wellcare Medicare |
$105.02
|
| Rate for Payer: Wellmed Medicare |
$105.02
|
|
|
US Spinal Canal
|
Facility
|
IP
|
$704.00
|
|
|
Service Code
|
HCPCS 76800
|
| Hospital Charge Code |
3500253
|
|
Hospital Revenue Code
|
402
|
| Rate for Payer: Cash Price |
$478.72
|
|
|
US Thoracentesis Right
|
Facility
|
IP
|
$1,959.00
|
|
|
Service Code
|
HCPCS 32555
|
| Hospital Charge Code |
3500000
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$1,332.12
|
|
|
US Thoracentesis Right
|
Facility
|
OP
|
$1,959.00
|
|
|
Service Code
|
HCPCS 32555
|
| Hospital Charge Code |
3500000
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$223.75 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$223.75
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$630.16
|
| Rate for Payer: Amerigroup Medicare |
$630.16
|
| Rate for Payer: BCBS of TX Blue Advantage |
$1,052.95
|
| Rate for Payer: BCBS of TX Blue Essentials |
$1,261.02
|
| Rate for Payer: BCBS of TX Medicare |
$630.16
|
| Rate for Payer: BCBS of TX PPO |
$1,588.89
|
| Rate for Payer: Cash Price |
$1,332.12
|
| Rate for Payer: Cash Price |
$1,332.12
|
| Rate for Payer: Cash Price |
$1,332.12
|
| Rate for Payer: Cigna Commercial |
$1,332.05
|
| Rate for Payer: Cigna Medicaid |
$1,410.48
|
| Rate for Payer: Cigna Medicare |
$630.16
|
| Rate for Payer: Employer Direct Commercial |
$630.16
|
| Rate for Payer: Humana Medicare/TRICARE |
$630.16
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,410.48
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$630.16
|
| Rate for Payer: Molina Medicare |
$630.16
|
| 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 |
$1,410.48
|
| Rate for Payer: Scott and White EPO/PPO |
$1,062.86
|
| Rate for Payer: Scott and White Medicare |
$630.16
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,410.48
|
| Rate for Payer: Superior Health Plan EPO |
$630.16
|
| Rate for Payer: Superior Health Plan Medicare |
$630.16
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$630.16
|
| Rate for Payer: Universal American Medicare |
$630.16
|
| Rate for Payer: Wellcare Medicare |
$630.16
|
| Rate for Payer: Wellmed Medicare |
$630.16
|
|
|
US Transcranial Doppler Complete
|
Facility
|
OP
|
$1,509.00
|
|
|
Service Code
|
HCPCS 93886
|
| Hospital Charge Code |
5063886
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$135.81 |
| Max. Negotiated Rate |
$1,086.48 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$135.81
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$239.69
|
| Rate for Payer: Amerigroup Medicare |
$239.69
|
| Rate for Payer: BCBS of TX Blue Advantage |
$452.70
|
| Rate for Payer: BCBS of TX Blue Essentials |
$543.24
|
| Rate for Payer: BCBS of TX Medicare |
$239.69
|
| Rate for Payer: BCBS of TX PPO |
$603.60
|
| Rate for Payer: Cash Price |
$1,026.12
|
| Rate for Payer: Cash Price |
$1,026.12
|
| Rate for Payer: Cash Price |
$1,026.12
|
| Rate for Payer: Cigna Commercial |
$506.65
|
| Rate for Payer: Cigna Medicaid |
$1,086.48
|
| Rate for Payer: Cigna Medicare |
$239.69
|
| Rate for Payer: Employer Direct Commercial |
$239.69
|
| Rate for Payer: Humana Medicare/TRICARE |
$239.69
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,086.48
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$239.69
|
| Rate for Payer: Molina Medicare |
$239.69
|
| Rate for Payer: Multiplan Auto |
$980.85
|
| Rate for Payer: Multiplan Commercial |
$980.85
|
| Rate for Payer: Multiplan Workers Comp |
$980.85
|
| Rate for Payer: Parkland Medicaid |
$1,086.48
|
| Rate for Payer: Scott and White EPO/PPO |
$338.94
|
| Rate for Payer: Scott and White Medicare |
$239.69
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,086.48
|
| Rate for Payer: Superior Health Plan EPO |
$239.69
|
| Rate for Payer: Superior Health Plan Medicare |
$239.69
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$239.69
|
| Rate for Payer: Universal American Medicare |
$239.69
|
| Rate for Payer: Wellcare Medicare |
$239.69
|
| Rate for Payer: Wellmed Medicare |
$239.69
|
|
|
US Transcranial Doppler Complete
|
Facility
|
IP
|
$1,509.00
|
|
|
Service Code
|
HCPCS 93886
|
| Hospital Charge Code |
5063886
|
|
Hospital Revenue Code
|
921
|
| Rate for Payer: Cash Price |
$1,026.12
|
|
|
US Transcranial Doppler Limited
|
Facility
|
OP
|
$991.00
|
|
|
Service Code
|
HCPCS 93888
|
| Hospital Charge Code |
5063888
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$89.19 |
| Max. Negotiated Rate |
$713.52 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$89.19
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$105.02
|
| Rate for Payer: Amerigroup Medicare |
$105.02
|
| Rate for Payer: BCBS of TX Blue Advantage |
$297.30
|
| Rate for Payer: BCBS of TX Blue Essentials |
$356.76
|
| Rate for Payer: BCBS of TX Medicare |
$105.02
|
| Rate for Payer: BCBS of TX PPO |
$396.40
|
| Rate for Payer: Cash Price |
$673.88
|
| Rate for Payer: Cash Price |
$673.88
|
| Rate for Payer: Cash Price |
$673.88
|
| Rate for Payer: Cigna Commercial |
$222.00
|
| Rate for Payer: Cigna Medicaid |
$713.52
|
| Rate for Payer: Cigna Medicare |
$105.02
|
| Rate for Payer: Employer Direct Commercial |
$105.02
|
| Rate for Payer: Humana Medicare/TRICARE |
$105.02
|
| Rate for Payer: Molina CHIP/Medicaid |
$713.52
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$105.02
|
| Rate for Payer: Molina Medicare |
$105.02
|
| Rate for Payer: Multiplan Auto |
$644.15
|
| Rate for Payer: Multiplan Commercial |
$644.15
|
| Rate for Payer: Multiplan Workers Comp |
$644.15
|
| Rate for Payer: Parkland Medicaid |
$713.52
|
| Rate for Payer: Scott and White EPO/PPO |
$197.25
|
| Rate for Payer: Scott and White Medicare |
$105.02
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$713.52
|
| Rate for Payer: Superior Health Plan EPO |
$105.02
|
| Rate for Payer: Superior Health Plan Medicare |
$105.02
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$105.02
|
| Rate for Payer: Universal American Medicare |
$105.02
|
| Rate for Payer: Wellcare Medicare |
$105.02
|
| Rate for Payer: Wellmed Medicare |
$105.02
|
|
|
US Transcranial Doppler Limited
|
Facility
|
IP
|
$991.00
|
|
|
Service Code
|
HCPCS 93888
|
| Hospital Charge Code |
5063888
|
|
Hospital Revenue Code
|
921
|
| Rate for Payer: Cash Price |
$673.88
|
|
|
US Transvaginal Non-OB
|
Facility
|
OP
|
$978.00
|
|
|
Service Code
|
HCPCS 76830
|
| Hospital Charge Code |
3500220
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$104.75 |
| Max. Negotiated Rate |
$704.16 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$104.75
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$105.02
|
| Rate for Payer: Amerigroup Medicare |
$105.02
|
| Rate for Payer: BCBS of TX Blue Advantage |
$145.69
|
| Rate for Payer: BCBS of TX Blue Essentials |
$174.83
|
| Rate for Payer: BCBS of TX Medicare |
$105.02
|
| Rate for Payer: BCBS of TX PPO |
$195.14
|
| Rate for Payer: Cash Price |
$665.04
|
| Rate for Payer: Cash Price |
$665.04
|
| Rate for Payer: Cash Price |
$665.04
|
| Rate for Payer: Cigna Commercial |
$222.00
|
| Rate for Payer: Cigna Medicaid |
$704.16
|
| Rate for Payer: Cigna Medicare |
$105.02
|
| Rate for Payer: Employer Direct Commercial |
$105.02
|
| Rate for Payer: Humana Medicare/TRICARE |
$105.02
|
| Rate for Payer: Molina CHIP/Medicaid |
$704.16
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$105.02
|
| Rate for Payer: Molina Medicare |
$105.02
|
| Rate for Payer: Multiplan Auto |
$635.70
|
| Rate for Payer: Multiplan Commercial |
$635.70
|
| Rate for Payer: Multiplan Workers Comp |
$635.70
|
| Rate for Payer: Parkland Medicaid |
$704.16
|
| Rate for Payer: Scott and White EPO/PPO |
$147.40
|
| Rate for Payer: Scott and White Medicare |
$105.02
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$704.16
|
| Rate for Payer: Superior Health Plan EPO |
$105.02
|
| Rate for Payer: Superior Health Plan Medicare |
$105.02
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$105.02
|
| Rate for Payer: Universal American Medicare |
$105.02
|
| Rate for Payer: Wellcare Medicare |
$105.02
|
| Rate for Payer: Wellmed Medicare |
$105.02
|
|
|
US Transvaginal Non-OB
|
Facility
|
IP
|
$978.00
|
|
|
Service Code
|
HCPCS 76830
|
| Hospital Charge Code |
3500220
|
|
Hospital Revenue Code
|
402
|
| Rate for Payer: Cash Price |
$665.04
|
|
|
US Upper Ext Art Doppler 3+ Lvls Bilat
|
Facility
|
IP
|
$1,579.00
|
|
|
Service Code
|
HCPCS 93923
|
| Hospital Charge Code |
5067198
|
|
Hospital Revenue Code
|
921
|
| Rate for Payer: Cash Price |
$1,073.72
|
|
|
US Upper Ext Art Doppler 3+ Lvls Bilat
|
Facility
|
OP
|
$1,579.00
|
|
|
Service Code
|
HCPCS 93923
|
| Hospital Charge Code |
5067198
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$142.11 |
| Max. Negotiated Rate |
$1,136.88 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$142.11
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$216.91
|
| Rate for Payer: Amerigroup Medicare |
$216.91
|
| Rate for Payer: BCBS of TX Blue Advantage |
$473.70
|
| Rate for Payer: BCBS of TX Blue Essentials |
$568.44
|
| Rate for Payer: BCBS of TX Medicare |
$216.91
|
| Rate for Payer: BCBS of TX PPO |
$631.60
|
| Rate for Payer: Cash Price |
$1,073.72
|
| Rate for Payer: Cash Price |
$1,073.72
|
| Rate for Payer: Cash Price |
$1,073.72
|
| Rate for Payer: Cigna Commercial |
$458.51
|
| Rate for Payer: Cigna Medicaid |
$1,136.88
|
| Rate for Payer: Cigna Medicare |
$216.91
|
| Rate for Payer: Employer Direct Commercial |
$216.91
|
| Rate for Payer: Humana Medicare/TRICARE |
$216.91
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,136.88
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$216.91
|
| Rate for Payer: Molina Medicare |
$216.91
|
| Rate for Payer: Multiplan Auto |
$1,026.35
|
| Rate for Payer: Multiplan Commercial |
$1,026.35
|
| Rate for Payer: Multiplan Workers Comp |
$1,026.35
|
| Rate for Payer: Parkland Medicaid |
$1,136.88
|
| Rate for Payer: Scott and White EPO/PPO |
$160.75
|
| Rate for Payer: Scott and White Medicare |
$216.91
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,136.88
|
| Rate for Payer: Superior Health Plan EPO |
$216.91
|
| Rate for Payer: Superior Health Plan Medicare |
$216.91
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$216.91
|
| Rate for Payer: Universal American Medicare |
$216.91
|
| Rate for Payer: Wellcare Medicare |
$216.91
|
| Rate for Payer: Wellmed Medicare |
$216.91
|
|
|
US Upper Ext Arterial Duplex Bilateral
|
Facility
|
IP
|
$2,497.00
|
|
|
Service Code
|
HCPCS 93930
|
| Hospital Charge Code |
3501046
|
|
Hospital Revenue Code
|
921
|
| Rate for Payer: Cash Price |
$1,697.96
|
|
|
US Upper Ext Arterial Duplex Bilateral
|
Facility
|
OP
|
$2,497.00
|
|
|
Service Code
|
HCPCS 93930
|
| Hospital Charge Code |
3501046
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$224.73 |
| Max. Negotiated Rate |
$1,797.84 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$224.73
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$239.69
|
| Rate for Payer: Amerigroup Medicare |
$239.69
|
| Rate for Payer: BCBS of TX Blue Advantage |
$749.10
|
| Rate for Payer: BCBS of TX Blue Essentials |
$898.92
|
| Rate for Payer: BCBS of TX Medicare |
$239.69
|
| Rate for Payer: BCBS of TX PPO |
$998.80
|
| Rate for Payer: Cash Price |
$1,697.96
|
| Rate for Payer: Cash Price |
$1,697.96
|
| Rate for Payer: Cash Price |
$1,697.96
|
| Rate for Payer: Cigna Commercial |
$506.65
|
| Rate for Payer: Cigna Medicaid |
$1,797.84
|
| Rate for Payer: Cigna Medicare |
$239.69
|
| Rate for Payer: Employer Direct Commercial |
$239.69
|
| Rate for Payer: Humana Medicare/TRICARE |
$239.69
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,797.84
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$239.69
|
| Rate for Payer: Molina Medicare |
$239.69
|
| Rate for Payer: Multiplan Auto |
$1,623.05
|
| Rate for Payer: Multiplan Commercial |
$1,623.05
|
| Rate for Payer: Multiplan Workers Comp |
$1,623.05
|
| Rate for Payer: Parkland Medicaid |
$1,797.84
|
| Rate for Payer: Scott and White EPO/PPO |
$244.38
|
| Rate for Payer: Scott and White Medicare |
$239.69
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,797.84
|
| Rate for Payer: Superior Health Plan EPO |
$239.69
|
| Rate for Payer: Superior Health Plan Medicare |
$239.69
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$239.69
|
| Rate for Payer: Universal American Medicare |
$239.69
|
| Rate for Payer: Wellcare Medicare |
$239.69
|
| Rate for Payer: Wellmed Medicare |
$239.69
|
|
|
US Upper Ext Arterial Duplex Left
|
Facility
|
IP
|
$1,946.00
|
|
|
Service Code
|
HCPCS 93931 LT
|
| Hospital Charge Code |
3500204
|
|
Hospital Revenue Code
|
921
|
| Rate for Payer: Cash Price |
$1,323.28
|
|
|
US Upper Ext Arterial Duplex Left
|
Facility
|
OP
|
$1,946.00
|
|
|
Service Code
|
HCPCS 93931 LT
|
| Hospital Charge Code |
3500204
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$175.14 |
| Max. Negotiated Rate |
$1,401.12 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$175.14
|
| Rate for Payer: BCBS of TX Blue Advantage |
$583.80
|
| Rate for Payer: BCBS of TX Blue Essentials |
$700.56
|
| Rate for Payer: BCBS of TX PPO |
$778.40
|
| Rate for Payer: Cash Price |
$1,323.28
|
| Rate for Payer: Cash Price |
$1,323.28
|
| Rate for Payer: Cigna Commercial |
$222.00
|
| Rate for Payer: Cigna Medicaid |
$1,401.12
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,401.12
|
| Rate for Payer: Multiplan Auto |
$1,264.90
|
| Rate for Payer: Multiplan Commercial |
$1,264.90
|
| Rate for Payer: Multiplan Workers Comp |
$1,264.90
|
| Rate for Payer: Parkland Medicaid |
$1,401.12
|
| Rate for Payer: Scott and White EPO/PPO |
$973.00
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,401.12
|
| Rate for Payer: Superior Health Plan EPO |
$264.66
|
|
|
US Upper Ext Arterial Duplex Right
|
Facility
|
IP
|
$1,946.00
|
|
|
Service Code
|
HCPCS 93931 RT
|
| Hospital Charge Code |
3500881
|
|
Hospital Revenue Code
|
921
|
| Rate for Payer: Cash Price |
$1,323.28
|
|
|
US Upper Ext Arterial Duplex Right
|
Facility
|
OP
|
$1,946.00
|
|
|
Service Code
|
HCPCS 93931 RT
|
| Hospital Charge Code |
3500881
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$175.14 |
| Max. Negotiated Rate |
$1,401.12 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$175.14
|
| Rate for Payer: BCBS of TX Blue Advantage |
$583.80
|
| Rate for Payer: BCBS of TX Blue Essentials |
$700.56
|
| Rate for Payer: BCBS of TX PPO |
$778.40
|
| Rate for Payer: Cash Price |
$1,323.28
|
| Rate for Payer: Cash Price |
$1,323.28
|
| Rate for Payer: Cigna Commercial |
$222.00
|
| Rate for Payer: Cigna Medicaid |
$1,401.12
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,401.12
|
| Rate for Payer: Multiplan Auto |
$1,264.90
|
| Rate for Payer: Multiplan Commercial |
$1,264.90
|
| Rate for Payer: Multiplan Workers Comp |
$1,264.90
|
| Rate for Payer: Parkland Medicaid |
$1,401.12
|
| Rate for Payer: Scott and White EPO/PPO |
$973.00
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,401.12
|
| Rate for Payer: Superior Health Plan EPO |
$264.66
|
|
|
US Upper Ext Segmental Pressures (ABI)
|
Facility
|
IP
|
$720.00
|
|
|
Service Code
|
HCPCS 93922
|
| Hospital Charge Code |
5067196
|
|
Hospital Revenue Code
|
921
|
| Rate for Payer: Cash Price |
$489.60
|
|
|
US Upper Ext Segmental Pressures (ABI)
|
Facility
|
OP
|
$720.00
|
|
|
Service Code
|
HCPCS 93922
|
| Hospital Charge Code |
5067196
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$64.80 |
| Max. Negotiated Rate |
$518.40 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$64.80
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$133.65
|
| Rate for Payer: Amerigroup Medicare |
$133.65
|
| Rate for Payer: BCBS of TX Blue Advantage |
$216.00
|
| Rate for Payer: BCBS of TX Blue Essentials |
$259.20
|
| Rate for Payer: BCBS of TX Medicare |
$133.65
|
| Rate for Payer: BCBS of TX PPO |
$288.00
|
| Rate for Payer: Cash Price |
$489.60
|
| Rate for Payer: Cash Price |
$489.60
|
| Rate for Payer: Cash Price |
$489.60
|
| Rate for Payer: Cigna Commercial |
$282.53
|
| Rate for Payer: Cigna Medicaid |
$518.40
|
| Rate for Payer: Cigna Medicare |
$133.65
|
| Rate for Payer: Employer Direct Commercial |
$133.65
|
| Rate for Payer: Humana Medicare/TRICARE |
$133.65
|
| Rate for Payer: Molina CHIP/Medicaid |
$518.40
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$133.65
|
| Rate for Payer: Molina Medicare |
$133.65
|
| Rate for Payer: Multiplan Auto |
$468.00
|
| Rate for Payer: Multiplan Commercial |
$468.00
|
| Rate for Payer: Multiplan Workers Comp |
$468.00
|
| Rate for Payer: Parkland Medicaid |
$518.40
|
| Rate for Payer: Scott and White EPO/PPO |
$101.58
|
| Rate for Payer: Scott and White Medicare |
$133.65
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$518.40
|
| Rate for Payer: Superior Health Plan EPO |
$133.65
|
| Rate for Payer: Superior Health Plan Medicare |
$133.65
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$133.65
|
| Rate for Payer: Universal American Medicare |
$133.65
|
| Rate for Payer: Wellcare Medicare |
$133.65
|
| Rate for Payer: Wellmed Medicare |
$133.65
|
|
|
US Upper Ext Venous Duplex Left
|
Facility
|
IP
|
$1,906.00
|
|
|
Service Code
|
HCPCS 93971 LT
|
| Hospital Charge Code |
994147
|
|
Hospital Revenue Code
|
921
|
| Rate for Payer: Cash Price |
$1,296.08
|
|
|
US Upper Ext Venous Duplex Left
|
Facility
|
OP
|
$1,906.00
|
|
|
Service Code
|
HCPCS 93971 LT
|
| Hospital Charge Code |
994147
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$171.54 |
| Max. Negotiated Rate |
$1,372.32 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$171.54
|
| Rate for Payer: BCBS of TX Blue Advantage |
$571.80
|
| Rate for Payer: BCBS of TX Blue Essentials |
$686.16
|
| Rate for Payer: BCBS of TX PPO |
$762.40
|
| Rate for Payer: Cash Price |
$1,296.08
|
| Rate for Payer: Cash Price |
$1,296.08
|
| Rate for Payer: Cigna Commercial |
$222.00
|
| Rate for Payer: Cigna Medicaid |
$1,372.32
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,372.32
|
| Rate for Payer: Multiplan Auto |
$1,238.90
|
| Rate for Payer: Multiplan Commercial |
$1,238.90
|
| Rate for Payer: Multiplan Workers Comp |
$1,238.90
|
| Rate for Payer: Parkland Medicaid |
$1,372.32
|
| Rate for Payer: Scott and White EPO/PPO |
$953.00
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,372.32
|
| Rate for Payer: Superior Health Plan EPO |
$259.22
|
|
|
US Upper Ext Venous Duplex Right
|
Facility
|
OP
|
$1,906.00
|
|
|
Service Code
|
HCPCS 93971 RT
|
| Hospital Charge Code |
994148
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$171.54 |
| Max. Negotiated Rate |
$1,372.32 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$171.54
|
| Rate for Payer: BCBS of TX Blue Advantage |
$571.80
|
| Rate for Payer: BCBS of TX Blue Essentials |
$686.16
|
| Rate for Payer: BCBS of TX PPO |
$762.40
|
| Rate for Payer: Cash Price |
$1,296.08
|
| Rate for Payer: Cash Price |
$1,296.08
|
| Rate for Payer: Cigna Commercial |
$222.00
|
| Rate for Payer: Cigna Medicaid |
$1,372.32
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,372.32
|
| Rate for Payer: Multiplan Auto |
$1,238.90
|
| Rate for Payer: Multiplan Commercial |
$1,238.90
|
| Rate for Payer: Multiplan Workers Comp |
$1,238.90
|
| Rate for Payer: Parkland Medicaid |
$1,372.32
|
| Rate for Payer: Scott and White EPO/PPO |
$953.00
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,372.32
|
| Rate for Payer: Superior Health Plan EPO |
$259.22
|
|
|
US Upper Ext Venous Duplex Right
|
Facility
|
IP
|
$1,906.00
|
|
|
Service Code
|
HCPCS 93971 RT
|
| Hospital Charge Code |
994148
|
|
Hospital Revenue Code
|
921
|
| Rate for Payer: Cash Price |
$1,296.08
|
|
