|
XR Spine Scoliosis 4-5 Views
|
Facility
|
OP
|
$674.00
|
|
|
Service Code
|
HCPCS 72083
|
| Hospital Charge Code |
3181202
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$79.53 |
| Max. Negotiated Rate |
$485.28 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$79.53
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$105.02
|
| Rate for Payer: Amerigroup Medicare |
$105.02
|
| Rate for Payer: BCBS of TX Blue Advantage |
$97.52
|
| Rate for Payer: BCBS of TX Blue Essentials |
$117.02
|
| Rate for Payer: BCBS of TX Medicare |
$105.02
|
| Rate for Payer: BCBS of TX PPO |
$130.61
|
| Rate for Payer: Cash Price |
$458.32
|
| Rate for Payer: Cash Price |
$458.32
|
| Rate for Payer: Cash Price |
$458.32
|
| Rate for Payer: Cigna Commercial |
$222.00
|
| Rate for Payer: Cigna Medicaid |
$485.28
|
| 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 |
$485.28
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$105.02
|
| Rate for Payer: Molina Medicare |
$105.02
|
| Rate for Payer: Multiplan Auto |
$438.10
|
| Rate for Payer: Multiplan Commercial |
$438.10
|
| Rate for Payer: Multiplan Workers Comp |
$438.10
|
| Rate for Payer: Parkland Medicaid |
$485.28
|
| Rate for Payer: Scott and White EPO/PPO |
$98.05
|
| Rate for Payer: Scott and White Medicare |
$105.02
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$485.28
|
| 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
|
|
|
XR Spine Scoliosis 4-5 Views
|
Facility
|
IP
|
$674.00
|
|
|
Service Code
|
HCPCS 72083
|
| Hospital Charge Code |
3181202
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$458.32
|
|
|
XR Spine Scoliosis 6+ Views
|
Facility
|
IP
|
$944.00
|
|
|
Service Code
|
HCPCS 72084
|
| Hospital Charge Code |
3181203
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$641.92
|
|
|
XR Spine Scoliosis 6+ Views
|
Facility
|
OP
|
$944.00
|
|
|
Service Code
|
HCPCS 72084
|
| Hospital Charge Code |
3181203
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$98.90 |
| Max. Negotiated Rate |
$679.68 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$98.90
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$105.02
|
| Rate for Payer: Amerigroup Medicare |
$105.02
|
| Rate for Payer: BCBS of TX Blue Advantage |
$114.18
|
| Rate for Payer: BCBS of TX Blue Essentials |
$137.02
|
| Rate for Payer: BCBS of TX Medicare |
$105.02
|
| Rate for Payer: BCBS of TX PPO |
$152.93
|
| Rate for Payer: Cash Price |
$641.92
|
| Rate for Payer: Cash Price |
$641.92
|
| Rate for Payer: Cash Price |
$641.92
|
| Rate for Payer: Cigna Commercial |
$222.00
|
| Rate for Payer: Cigna Medicaid |
$679.68
|
| 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 |
$679.68
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$105.02
|
| Rate for Payer: Molina Medicare |
$105.02
|
| Rate for Payer: Multiplan Auto |
$613.60
|
| Rate for Payer: Multiplan Commercial |
$613.60
|
| Rate for Payer: Multiplan Workers Comp |
$613.60
|
| Rate for Payer: Parkland Medicaid |
$679.68
|
| Rate for Payer: Scott and White EPO/PPO |
$121.85
|
| Rate for Payer: Scott and White Medicare |
$105.02
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$679.68
|
| 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
|
|
|
XR Spine Thoracic 2 Views
|
Facility
|
OP
|
$845.00
|
|
|
Service Code
|
HCPCS 72070
|
| Hospital Charge Code |
3100443
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$33.08 |
| Max. Negotiated Rate |
$608.40 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$33.08
|
| 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 |
$574.60
|
| Rate for Payer: Cash Price |
$574.60
|
| Rate for Payer: Cash Price |
$574.60
|
| Rate for Payer: Cigna Commercial |
$222.00
|
| Rate for Payer: Cigna Medicaid |
$608.40
|
| 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 |
$608.40
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$105.02
|
| Rate for Payer: Molina Medicare |
$105.02
|
| Rate for Payer: Multiplan Auto |
$549.25
|
| Rate for Payer: Multiplan Commercial |
$549.25
|
| Rate for Payer: Multiplan Workers Comp |
$549.25
|
| Rate for Payer: Parkland Medicaid |
$608.40
|
| Rate for Payer: Scott and White EPO/PPO |
$40.73
|
| Rate for Payer: Scott and White Medicare |
$105.02
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$608.40
|
| 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
|
|
|
XR Spine Thoracic 2 Views
|
Facility
|
IP
|
$845.00
|
|
|
Service Code
|
HCPCS 72070
|
| Hospital Charge Code |
3100443
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$574.60
|
|
|
XR Spine Thoracolumbar 1 View
|
Facility
|
OP
|
$364.00
|
|
|
Service Code
|
HCPCS 72020
|
| Hospital Charge Code |
3100377
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$24.39 |
| Max. Negotiated Rate |
$262.08 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$24.39
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$87.42
|
| Rate for Payer: Amerigroup Medicare |
$87.42
|
| 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 |
$87.42
|
| Rate for Payer: BCBS of TX PPO |
$176.38
|
| Rate for Payer: Cash Price |
$247.52
|
| Rate for Payer: Cash Price |
$247.52
|
| Rate for Payer: Cash Price |
$247.52
|
| Rate for Payer: Cigna Commercial |
$184.79
|
| Rate for Payer: Cigna Medicaid |
$262.08
|
| Rate for Payer: Cigna Medicare |
$87.42
|
| Rate for Payer: Employer Direct Commercial |
$87.42
|
| Rate for Payer: Humana Medicare/TRICARE |
$87.42
|
| Rate for Payer: Molina CHIP/Medicaid |
$262.08
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$87.42
|
| Rate for Payer: Molina Medicare |
$87.42
|
| 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 |
$262.08
|
| Rate for Payer: Scott and White EPO/PPO |
$30.01
|
| Rate for Payer: Scott and White Medicare |
$87.42
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$262.08
|
| Rate for Payer: Superior Health Plan EPO |
$87.42
|
| Rate for Payer: Superior Health Plan Medicare |
$87.42
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$87.42
|
| Rate for Payer: Universal American Medicare |
$87.42
|
| Rate for Payer: Wellcare Medicare |
$87.42
|
| Rate for Payer: Wellmed Medicare |
$87.42
|
|
|
XR Spine Thoracolumbar 1 View
|
Facility
|
IP
|
$364.00
|
|
|
Service Code
|
HCPCS 72020
|
| Hospital Charge Code |
3100377
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$247.52
|
|
|
XR Spine Thoracolumbar 2+ Views
|
Facility
|
OP
|
$336.00
|
|
|
Service Code
|
HCPCS 72080
|
| Hospital Charge Code |
3160124
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$34.75 |
| Max. Negotiated Rate |
$241.92 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$34.75
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$87.42
|
| Rate for Payer: Amerigroup Medicare |
$87.42
|
| 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 |
$87.42
|
| Rate for Payer: BCBS of TX PPO |
$176.38
|
| Rate for Payer: Cash Price |
$228.48
|
| Rate for Payer: Cash Price |
$228.48
|
| Rate for Payer: Cash Price |
$228.48
|
| Rate for Payer: Cigna Commercial |
$184.79
|
| Rate for Payer: Cigna Medicaid |
$241.92
|
| Rate for Payer: Cigna Medicare |
$87.42
|
| Rate for Payer: Employer Direct Commercial |
$87.42
|
| Rate for Payer: Humana Medicare/TRICARE |
$87.42
|
| Rate for Payer: Molina CHIP/Medicaid |
$241.92
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$87.42
|
| Rate for Payer: Molina Medicare |
$87.42
|
| 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 |
$241.92
|
| Rate for Payer: Scott and White EPO/PPO |
$42.79
|
| Rate for Payer: Scott and White Medicare |
$87.42
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$241.92
|
| Rate for Payer: Superior Health Plan EPO |
$87.42
|
| Rate for Payer: Superior Health Plan Medicare |
$87.42
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$87.42
|
| Rate for Payer: Universal American Medicare |
$87.42
|
| Rate for Payer: Wellcare Medicare |
$87.42
|
| Rate for Payer: Wellmed Medicare |
$87.42
|
|
|
XR Spine Thoracolumbar 2+ Views
|
Facility
|
IP
|
$336.00
|
|
|
Service Code
|
HCPCS 72080
|
| Hospital Charge Code |
3160124
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$228.48
|
|
|
XR Sternum 2+ Views
|
Facility
|
OP
|
$283.00
|
|
|
Service Code
|
HCPCS 71120
|
| Hospital Charge Code |
3100328
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$33.75 |
| Max. Negotiated Rate |
$203.76 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$33.75
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$87.42
|
| Rate for Payer: Amerigroup Medicare |
$87.42
|
| 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 |
$87.42
|
| Rate for Payer: BCBS of TX PPO |
$176.38
|
| Rate for Payer: Cash Price |
$192.44
|
| Rate for Payer: Cash Price |
$192.44
|
| Rate for Payer: Cash Price |
$192.44
|
| Rate for Payer: Cigna Commercial |
$184.79
|
| Rate for Payer: Cigna Medicaid |
$203.76
|
| Rate for Payer: Cigna Medicare |
$87.42
|
| Rate for Payer: Employer Direct Commercial |
$87.42
|
| Rate for Payer: Humana Medicare/TRICARE |
$87.42
|
| Rate for Payer: Molina CHIP/Medicaid |
$203.76
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$87.42
|
| Rate for Payer: Molina Medicare |
$87.42
|
| 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 |
$203.76
|
| Rate for Payer: Scott and White EPO/PPO |
$41.55
|
| Rate for Payer: Scott and White Medicare |
$87.42
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$203.76
|
| Rate for Payer: Superior Health Plan EPO |
$87.42
|
| Rate for Payer: Superior Health Plan Medicare |
$87.42
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$87.42
|
| Rate for Payer: Universal American Medicare |
$87.42
|
| Rate for Payer: Wellcare Medicare |
$87.42
|
| Rate for Payer: Wellmed Medicare |
$87.42
|
|
|
XR Sternum 2+ Views
|
Facility
|
IP
|
$283.00
|
|
|
Service Code
|
HCPCS 71120
|
| Hospital Charge Code |
3100328
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$192.44
|
|
|
XR Surgical Specimen
|
Facility
|
OP
|
$333.00
|
|
|
Service Code
|
HCPCS 76098
|
| Hospital Charge Code |
3170074
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$42.78 |
| Max. Negotiated Rate |
$1,160.29 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$42.78
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$548.90
|
| Rate for Payer: Amerigroup Medicare |
$548.90
|
| 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 |
$548.90
|
| Rate for Payer: BCBS of TX PPO |
$1,064.29
|
| Rate for Payer: Cash Price |
$226.44
|
| Rate for Payer: Cash Price |
$226.44
|
| Rate for Payer: Cash Price |
$226.44
|
| Rate for Payer: Cigna Commercial |
$1,160.29
|
| Rate for Payer: Cigna Medicaid |
$239.76
|
| Rate for Payer: Cigna Medicare |
$548.90
|
| Rate for Payer: Employer Direct Commercial |
$548.90
|
| Rate for Payer: Humana Medicare/TRICARE |
$548.90
|
| Rate for Payer: Molina CHIP/Medicaid |
$239.76
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$548.90
|
| Rate for Payer: Molina Medicare |
$548.90
|
| 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 |
$239.76
|
| Rate for Payer: Scott and White EPO/PPO |
$52.65
|
| Rate for Payer: Scott and White Medicare |
$548.90
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$239.76
|
| Rate for Payer: Superior Health Plan EPO |
$548.90
|
| Rate for Payer: Superior Health Plan Medicare |
$548.90
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$548.90
|
| Rate for Payer: Universal American Medicare |
$548.90
|
| Rate for Payer: Wellcare Medicare |
$548.90
|
| Rate for Payer: Wellmed Medicare |
$548.90
|
|
|
XR Surgical Specimen
|
Facility
|
IP
|
$333.00
|
|
|
Service Code
|
HCPCS 76098
|
| Hospital Charge Code |
3170074
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$226.44
|
|
|
XR Swallowing Function w/ Speech
|
Facility
|
OP
|
$788.00
|
|
|
Service Code
|
HCPCS 74230
|
| Hospital Charge Code |
3101102
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$124.96 |
| Max. Negotiated Rate |
$567.36 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$124.96
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$176.20
|
| Rate for Payer: Amerigroup Medicare |
$176.20
|
| 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 |
$176.20
|
| Rate for Payer: BCBS of TX PPO |
$402.71
|
| Rate for Payer: Cash Price |
$535.84
|
| Rate for Payer: Cash Price |
$535.84
|
| Rate for Payer: Cash Price |
$535.84
|
| Rate for Payer: Cigna Commercial |
$372.46
|
| Rate for Payer: Cigna Medicaid |
$567.36
|
| Rate for Payer: Cigna Medicare |
$176.20
|
| Rate for Payer: Employer Direct Commercial |
$176.20
|
| Rate for Payer: Humana Medicare/TRICARE |
$176.20
|
| Rate for Payer: Molina CHIP/Medicaid |
$567.36
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$176.20
|
| Rate for Payer: Molina Medicare |
$176.20
|
| 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 |
$567.36
|
| Rate for Payer: Scott and White EPO/PPO |
$154.03
|
| Rate for Payer: Scott and White Medicare |
$176.20
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$567.36
|
| Rate for Payer: Superior Health Plan EPO |
$176.20
|
| Rate for Payer: Superior Health Plan Medicare |
$176.20
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$176.20
|
| Rate for Payer: Universal American Medicare |
$176.20
|
| Rate for Payer: Wellcare Medicare |
$176.20
|
| Rate for Payer: Wellmed Medicare |
$176.20
|
|
|
XR Swallowing Function w/ Speech
|
Facility
|
IP
|
$788.00
|
|
|
Service Code
|
HCPCS 74230
|
| Hospital Charge Code |
3101102
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$535.84
|
|
|
XR Thoracostomy Tube Right
|
Facility
|
OP
|
$819.00
|
|
|
Service Code
|
HCPCS 32551
|
| Hospital Charge Code |
4907772
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$73.71 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$73.71
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$1,581.33
|
| Rate for Payer: Amerigroup Medicare |
$1,581.33
|
| 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 |
$1,581.33
|
| Rate for Payer: BCBS of TX PPO |
$4,110.45
|
| Rate for Payer: Cash Price |
$556.92
|
| Rate for Payer: Cash Price |
$556.92
|
| Rate for Payer: Cash Price |
$556.92
|
| Rate for Payer: Cigna Commercial |
$3,342.63
|
| Rate for Payer: Cigna Medicaid |
$589.68
|
| Rate for Payer: Cigna Medicare |
$1,581.33
|
| Rate for Payer: Employer Direct Commercial |
$1,581.33
|
| Rate for Payer: Humana Medicare/TRICARE |
$1,581.33
|
| Rate for Payer: Molina CHIP/Medicaid |
$589.68
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$1,581.33
|
| Rate for Payer: Molina Medicare |
$1,581.33
|
| 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 |
$589.68
|
| Rate for Payer: Scott and White EPO/PPO |
$2,709.66
|
| Rate for Payer: Scott and White Medicare |
$1,581.33
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$589.68
|
| Rate for Payer: Superior Health Plan EPO |
$1,581.33
|
| Rate for Payer: Superior Health Plan Medicare |
$1,581.33
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$1,581.33
|
| Rate for Payer: Universal American Medicare |
$1,581.33
|
| Rate for Payer: Wellcare Medicare |
$1,581.33
|
| Rate for Payer: Wellmed Medicare |
$1,581.33
|
|
|
XR Thoracostomy Tube Right
|
Facility
|
IP
|
$819.00
|
|
|
Service Code
|
HCPCS 32551
|
| Hospital Charge Code |
4907772
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$556.92
|
|
|
XR Tibia/Fibula Left
|
Facility
|
OP
|
$535.00
|
|
|
Service Code
|
HCPCS 73590 LT
|
| Hospital Charge Code |
3100948
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$31.74 |
| Max. Negotiated Rate |
$385.20 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$31.74
|
| 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 PPO |
$176.38
|
| Rate for Payer: Cash Price |
$363.80
|
| Rate for Payer: Cash Price |
$363.80
|
| Rate for Payer: Cash Price |
$363.80
|
| Rate for Payer: Cigna Commercial |
$184.79
|
| Rate for Payer: Cigna Medicaid |
$385.20
|
| Rate for Payer: Molina CHIP/Medicaid |
$385.20
|
| 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 |
$385.20
|
| Rate for Payer: Scott and White EPO/PPO |
$267.50
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$385.20
|
| Rate for Payer: Superior Health Plan EPO |
$72.76
|
|
|
XR Tibia/Fibula Left
|
Facility
|
IP
|
$535.00
|
|
|
Service Code
|
HCPCS 73590 LT
|
| Hospital Charge Code |
3100948
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$363.80
|
|
|
XR Tibia/Fibula Right
|
Facility
|
OP
|
$535.00
|
|
|
Service Code
|
HCPCS 73590 RT
|
| Hospital Charge Code |
3100930
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$31.74 |
| Max. Negotiated Rate |
$385.20 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$31.74
|
| 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 PPO |
$176.38
|
| Rate for Payer: Cash Price |
$363.80
|
| Rate for Payer: Cash Price |
$363.80
|
| Rate for Payer: Cash Price |
$363.80
|
| Rate for Payer: Cigna Commercial |
$184.79
|
| Rate for Payer: Cigna Medicaid |
$385.20
|
| Rate for Payer: Molina CHIP/Medicaid |
$385.20
|
| 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 |
$385.20
|
| Rate for Payer: Scott and White EPO/PPO |
$267.50
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$385.20
|
| Rate for Payer: Superior Health Plan EPO |
$72.76
|
|
|
XR Tibia/Fibula Right
|
Facility
|
IP
|
$535.00
|
|
|
Service Code
|
HCPCS 73590 RT
|
| Hospital Charge Code |
3100930
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$363.80
|
|
|
XR Tilt Table
|
Facility
|
OP
|
$1,399.00
|
|
|
Service Code
|
HCPCS 93660
|
| Hospital Charge Code |
3170085
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$125.91 |
| Max. Negotiated Rate |
$1,007.28 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$125.91
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$374.86
|
| Rate for Payer: Amerigroup Medicare |
$374.86
|
| Rate for Payer: BCBS of TX Blue Advantage |
$419.70
|
| Rate for Payer: BCBS of TX Blue Essentials |
$503.64
|
| Rate for Payer: BCBS of TX Medicare |
$374.86
|
| Rate for Payer: BCBS of TX PPO |
$559.60
|
| Rate for Payer: Cash Price |
$951.32
|
| Rate for Payer: Cash Price |
$951.32
|
| Rate for Payer: Cash Price |
$951.32
|
| Rate for Payer: Cigna Commercial |
$792.38
|
| Rate for Payer: Cigna Medicaid |
$1,007.28
|
| Rate for Payer: Cigna Medicare |
$374.86
|
| Rate for Payer: Employer Direct Commercial |
$374.86
|
| Rate for Payer: Humana Medicare/TRICARE |
$374.86
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,007.28
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$374.86
|
| Rate for Payer: Molina Medicare |
$374.86
|
| 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 |
$1,007.28
|
| Rate for Payer: Scott and White EPO/PPO |
$200.15
|
| Rate for Payer: Scott and White Medicare |
$374.86
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,007.28
|
| Rate for Payer: Superior Health Plan EPO |
$374.86
|
| Rate for Payer: Superior Health Plan Medicare |
$374.86
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$374.86
|
| Rate for Payer: Universal American Medicare |
$374.86
|
| Rate for Payer: Wellcare Medicare |
$374.86
|
| Rate for Payer: Wellmed Medicare |
$374.86
|
|
|
XR Tilt Table
|
Facility
|
OP
|
$1,399.00
|
|
|
Service Code
|
HCPCS 93660
|
| Hospital Charge Code |
2301141
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$125.91 |
| Max. Negotiated Rate |
$1,007.28 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$125.91
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$374.86
|
| Rate for Payer: Amerigroup Medicare |
$374.86
|
| Rate for Payer: BCBS of TX Blue Advantage |
$419.70
|
| Rate for Payer: BCBS of TX Blue Essentials |
$503.64
|
| Rate for Payer: BCBS of TX Medicare |
$374.86
|
| Rate for Payer: BCBS of TX PPO |
$559.60
|
| Rate for Payer: Cash Price |
$951.32
|
| Rate for Payer: Cash Price |
$951.32
|
| Rate for Payer: Cash Price |
$951.32
|
| Rate for Payer: Cigna Commercial |
$792.38
|
| Rate for Payer: Cigna Medicaid |
$1,007.28
|
| Rate for Payer: Cigna Medicare |
$374.86
|
| Rate for Payer: Employer Direct Commercial |
$374.86
|
| Rate for Payer: Humana Medicare/TRICARE |
$374.86
|
| Rate for Payer: Molina CHIP/Medicaid |
$1,007.28
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$374.86
|
| Rate for Payer: Molina Medicare |
$374.86
|
| 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 |
$1,007.28
|
| Rate for Payer: Scott and White EPO/PPO |
$200.15
|
| Rate for Payer: Scott and White Medicare |
$374.86
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$1,007.28
|
| Rate for Payer: Superior Health Plan EPO |
$374.86
|
| Rate for Payer: Superior Health Plan Medicare |
$374.86
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$374.86
|
| Rate for Payer: Universal American Medicare |
$374.86
|
| Rate for Payer: Wellcare Medicare |
$374.86
|
| Rate for Payer: Wellmed Medicare |
$374.86
|
|
|
XR Tilt Table
|
Facility
|
IP
|
$1,399.00
|
|
|
Service Code
|
HCPCS 93660
|
| Hospital Charge Code |
3170085
|
|
Hospital Revenue Code
|
480
|
| Rate for Payer: Cash Price |
$951.32
|
|
