White Rock Medical Center

All Charges

Charge

Type

Setting

Price

Bill Only GTT 1st 3 Specimens

Facility

$379.00

Service Code	HCPCS 82951
Hospital Charge Code	1602853
Hospital Revenue Code	301
Min. Negotiated Rate	$5.02
Max. Negotiated Rate	$272.88
Rate for Payer: Amerigroup CHIP/Medicaid	$5.02
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$12.87
Rate for Payer: Amerigroup Medicare	$12.87
Rate for Payer: BCBS of TX Blue Advantage	$113.70
Rate for Payer: BCBS of TX Blue Essentials	$136.44
Rate for Payer: BCBS of TX Medicare	$12.87
Rate for Payer: BCBS of TX PPO	$151.60
Rate for Payer: Cash Price	$257.72
Rate for Payer: Cash Price	$257.72
Rate for Payer: Cigna Medicaid	$272.88
Rate for Payer: Cigna Medicare	$12.87
Rate for Payer: Employer Direct Commercial	$12.87
Rate for Payer: Humana Medicare/TRICARE	$12.87
Rate for Payer: Molina CHIP/Medicaid	$272.88
Rate for Payer: Molina Dual Medicare/Medicaid	$12.87
Rate for Payer: Molina Medicare	$12.87
Rate for Payer: Multiplan Auto	$246.35
Rate for Payer: Multiplan Commercial	$246.35
Rate for Payer: Multiplan Workers Comp	$246.35
Rate for Payer: Parkland Medicaid	$272.88
Rate for Payer: Scott and White EPO/PPO	$16.09
Rate for Payer: Scott and White Medicare	$12.87
Rate for Payer: Superior Health Plan CHIP/Medicaid	$272.88
Rate for Payer: Superior Health Plan EPO	$12.87
Rate for Payer: Superior Health Plan Medicare	$12.87
Rate for Payer: Universal American Dual Medicare/Medicaid	$12.87
Rate for Payer: Universal American Medicare	$12.87
Rate for Payer: Wellcare Medicare	$12.87
Rate for Payer: Wellmed Medicare	$12.87

Bill Only Specimen Processing

Facility

$138.00

Service Code	HCPCS 99001
Hospital Charge Code	1605815
Hospital Revenue Code	300
Rate for Payer: Cash Price	$93.84

Bill Only Specimen Processing

Facility

$138.00

Service Code	HCPCS 99001
Hospital Charge Code	1605815
Hospital Revenue Code	300
Min. Negotiated Rate	$12.42
Max. Negotiated Rate	$99.36
Rate for Payer: Amerigroup CHIP/Medicaid	$12.42
Rate for Payer: BCBS of TX Blue Advantage	$41.40
Rate for Payer: BCBS of TX Blue Essentials	$49.68
Rate for Payer: BCBS of TX PPO	$55.20
Rate for Payer: Cash Price	$93.84
Rate for Payer: Cigna Medicaid	$99.36
Rate for Payer: Molina CHIP/Medicaid	$99.36
Rate for Payer: Multiplan Auto	$89.70
Rate for Payer: Multiplan Commercial	$89.70
Rate for Payer: Multiplan Workers Comp	$89.70
Rate for Payer: Parkland Medicaid	$99.36
Rate for Payer: Scott and White EPO/PPO	$69.00
Rate for Payer: Superior Health Plan CHIP/Medicaid	$99.36
Rate for Payer: Superior Health Plan EPO	$18.77

BIOBRACE 5 X 250MM

Facility

$15,895.00

Service Code	HCPCS C1734
Hospital Charge Code	145855
Hospital Revenue Code	278
Min. Negotiated Rate	$3,973.75
Max. Negotiated Rate	$7,947.50
Rate for Payer: Cash Price	$10,808.60
Rate for Payer: Cigna Commercial	$3,973.75
Rate for Payer: Multiplan Auto	$7,947.50
Rate for Payer: Multiplan Commercial	$7,947.50
Rate for Payer: Multiplan Workers Comp	$7,947.50
Rate for Payer: Scott and White EPO/PPO	$7,947.50

BIOBRACE 5 X 250MM

Facility

$15,895.00

Service Code	HCPCS C1734
Hospital Charge Code	145855
Hospital Revenue Code	278
Min. Negotiated Rate	$1,430.55
Max. Negotiated Rate	$11,444.40
Rate for Payer: Amerigroup CHIP/Medicaid	$1,430.55
Rate for Payer: BCBS of TX Blue Advantage	$4,768.50
Rate for Payer: BCBS of TX Blue Essentials	$5,722.20
Rate for Payer: BCBS of TX PPO	$6,358.00
Rate for Payer: Cash Price	$10,808.60
Rate for Payer: Cigna Medicaid	$11,444.40
Rate for Payer: Molina CHIP/Medicaid	$11,444.40
Rate for Payer: Multiplan Auto	$7,947.50
Rate for Payer: Multiplan Commercial	$7,947.50
Rate for Payer: Multiplan Workers Comp	$7,947.50
Rate for Payer: Parkland Medicaid	$11,444.40
Rate for Payer: Scott and White EPO/PPO	$7,947.50
Rate for Payer: Superior Health Plan CHIP/Medicaid	$11,444.40
Rate for Payer: Superior Health Plan EPO	$2,161.72

BIO-COMP-TENOD SCRW W/DISP DRV 5.5 X 15MM

Facility

$4,066.27

Service Code	HCPCS C1734
Hospital Charge Code	992392
Hospital Revenue Code	278
Min. Negotiated Rate	$365.96
Max. Negotiated Rate	$2,927.71
Rate for Payer: Amerigroup CHIP/Medicaid	$365.96
Rate for Payer: BCBS of TX Blue Advantage	$1,219.88
Rate for Payer: BCBS of TX Blue Essentials	$1,463.86
Rate for Payer: BCBS of TX PPO	$1,626.51
Rate for Payer: Cash Price	$2,765.06
Rate for Payer: Cigna Medicaid	$2,927.71
Rate for Payer: Molina CHIP/Medicaid	$2,927.71
Rate for Payer: Multiplan Auto	$2,033.13
Rate for Payer: Multiplan Commercial	$2,033.13
Rate for Payer: Multiplan Workers Comp	$2,033.13
Rate for Payer: Parkland Medicaid	$2,927.71
Rate for Payer: Scott and White EPO/PPO	$2,033.13
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2,927.71
Rate for Payer: Superior Health Plan EPO	$553.01

BIO-COMP-TENOD SCRW W/DISP DRV 5.5 X 15MM

Facility

$4,066.27

Service Code	HCPCS C1734
Hospital Charge Code	992392
Hospital Revenue Code	278
Min. Negotiated Rate	$1,016.57
Max. Negotiated Rate	$2,033.13
Rate for Payer: Cash Price	$2,765.06
Rate for Payer: Cigna Commercial	$1,016.57
Rate for Payer: Multiplan Auto	$2,033.13
Rate for Payer: Multiplan Commercial	$2,033.13
Rate for Payer: Multiplan Workers Comp	$2,033.13
Rate for Payer: Scott and White EPO/PPO	$2,033.13

BIOFOAM COTTON WEDGE 16 X 14 X 10 X 4.5 STERILE

Facility

$27,289.16

Service Code	HCPCS C1713
Hospital Charge Code	992393
Hospital Revenue Code	278
Min. Negotiated Rate	$6,822.29
Max. Negotiated Rate	$13,644.58
Rate for Payer: Cash Price	$18,556.63
Rate for Payer: Cigna Commercial	$6,822.29
Rate for Payer: Multiplan Auto	$13,644.58
Rate for Payer: Multiplan Commercial	$13,644.58
Rate for Payer: Multiplan Workers Comp	$13,644.58
Rate for Payer: Scott and White EPO/PPO	$13,644.58

BIOFOAM COTTON WEDGE 16 X 14 X 10 X 4.5 STERILE

Facility

$27,289.16

Service Code	HCPCS C1713
Hospital Charge Code	992393
Hospital Revenue Code	278
Min. Negotiated Rate	$2,456.02
Max. Negotiated Rate	$19,648.20
Rate for Payer: Amerigroup CHIP/Medicaid	$2,456.02
Rate for Payer: BCBS of TX Blue Advantage	$8,186.75
Rate for Payer: BCBS of TX Blue Essentials	$9,824.10
Rate for Payer: BCBS of TX PPO	$10,915.66
Rate for Payer: Cash Price	$18,556.63
Rate for Payer: Cigna Medicaid	$19,648.20
Rate for Payer: Molina CHIP/Medicaid	$19,648.20
Rate for Payer: Multiplan Auto	$13,644.58
Rate for Payer: Multiplan Commercial	$13,644.58
Rate for Payer: Multiplan Workers Comp	$13,644.58
Rate for Payer: Parkland Medicaid	$19,648.20
Rate for Payer: Scott and White EPO/PPO	$13,644.58
Rate for Payer: Superior Health Plan CHIP/Medicaid	$19,648.20
Rate for Payer: Superior Health Plan EPO	$3,711.33

Biofoam Evans wdge 18X18X08mm

Facility

$13,388.46

Service Code	HCPCS C1713
Hospital Charge Code	993398
Hospital Revenue Code	278
Min. Negotiated Rate	$3,347.11
Max. Negotiated Rate	$6,694.23
Rate for Payer: Cash Price	$9,104.15
Rate for Payer: Cigna Commercial	$3,347.11
Rate for Payer: Multiplan Auto	$6,694.23
Rate for Payer: Multiplan Commercial	$6,694.23
Rate for Payer: Multiplan Workers Comp	$6,694.23
Rate for Payer: Scott and White EPO/PPO	$6,694.23

Biofoam Evans wdge 18X18X08mm

Facility

$13,388.46

Service Code	HCPCS C1713
Hospital Charge Code	993398
Hospital Revenue Code	278
Min. Negotiated Rate	$1,204.96
Max. Negotiated Rate	$9,639.69
Rate for Payer: Amerigroup CHIP/Medicaid	$1,204.96
Rate for Payer: BCBS of TX Blue Advantage	$4,016.54
Rate for Payer: BCBS of TX Blue Essentials	$4,819.85
Rate for Payer: BCBS of TX PPO	$5,355.38
Rate for Payer: Cash Price	$9,104.15
Rate for Payer: Cigna Medicaid	$9,639.69
Rate for Payer: Molina CHIP/Medicaid	$9,639.69
Rate for Payer: Multiplan Auto	$6,694.23
Rate for Payer: Multiplan Commercial	$6,694.23
Rate for Payer: Multiplan Workers Comp	$6,694.23
Rate for Payer: Parkland Medicaid	$9,639.69
Rate for Payer: Scott and White EPO/PPO	$6,694.23
Rate for Payer: Superior Health Plan CHIP/Medicaid	$9,639.69
Rate for Payer: Superior Health Plan EPO	$1,820.83

Biofoam wedge 16mm X 4.5mm

Facility

$12,998.02

Service Code	HCPCS C1713
Hospital Charge Code	993397
Hospital Revenue Code	278
Min. Negotiated Rate	$1,169.82
Max. Negotiated Rate	$9,358.57
Rate for Payer: Amerigroup CHIP/Medicaid	$1,169.82
Rate for Payer: BCBS of TX Blue Advantage	$3,899.41
Rate for Payer: BCBS of TX Blue Essentials	$4,679.29
Rate for Payer: BCBS of TX PPO	$5,199.21
Rate for Payer: Cash Price	$8,838.65
Rate for Payer: Cigna Medicaid	$9,358.57
Rate for Payer: Molina CHIP/Medicaid	$9,358.57
Rate for Payer: Multiplan Auto	$6,499.01
Rate for Payer: Multiplan Commercial	$6,499.01
Rate for Payer: Multiplan Workers Comp	$6,499.01
Rate for Payer: Parkland Medicaid	$9,358.57
Rate for Payer: Scott and White EPO/PPO	$6,499.01
Rate for Payer: Superior Health Plan CHIP/Medicaid	$9,358.57
Rate for Payer: Superior Health Plan EPO	$1,767.73

Biofoam wedge 16mm X 4.5mm

Facility

$12,998.02

Service Code	HCPCS C1713
Hospital Charge Code	993397
Hospital Revenue Code	278
Min. Negotiated Rate	$3,249.51
Max. Negotiated Rate	$6,499.01
Rate for Payer: Cash Price	$8,838.65
Rate for Payer: Cigna Commercial	$3,249.51
Rate for Payer: Multiplan Auto	$6,499.01
Rate for Payer: Multiplan Commercial	$6,499.01
Rate for Payer: Multiplan Workers Comp	$6,499.01
Rate for Payer: Scott and White EPO/PPO	$6,499.01

BIOFOAM WEDGE 20MM X 5.5MM

Facility

$28,246.99

Service Code	HCPCS C1713
Hospital Charge Code	993138
Hospital Revenue Code	278
Min. Negotiated Rate	$2,542.23
Max. Negotiated Rate	$20,337.83
Rate for Payer: Amerigroup CHIP/Medicaid	$2,542.23
Rate for Payer: BCBS of TX Blue Advantage	$8,474.10
Rate for Payer: BCBS of TX Blue Essentials	$10,168.92
Rate for Payer: BCBS of TX PPO	$11,298.80
Rate for Payer: Cash Price	$19,207.95
Rate for Payer: Cigna Medicaid	$20,337.83
Rate for Payer: Molina CHIP/Medicaid	$20,337.83
Rate for Payer: Multiplan Auto	$14,123.50
Rate for Payer: Multiplan Commercial	$14,123.50
Rate for Payer: Multiplan Workers Comp	$14,123.50
Rate for Payer: Parkland Medicaid	$20,337.83
Rate for Payer: Scott and White EPO/PPO	$14,123.50
Rate for Payer: Superior Health Plan CHIP/Medicaid	$20,337.83
Rate for Payer: Superior Health Plan EPO	$3,841.59

BIOFOAM WEDGE 20MM X 5.5MM

Facility

$28,246.99

Service Code	HCPCS C1713
Hospital Charge Code	993138
Hospital Revenue Code	278
Min. Negotiated Rate	$7,061.75
Max. Negotiated Rate	$14,123.50
Rate for Payer: Cash Price	$19,207.95
Rate for Payer: Cigna Commercial	$7,061.75
Rate for Payer: Multiplan Auto	$14,123.50
Rate for Payer: Multiplan Commercial	$14,123.50
Rate for Payer: Multiplan Workers Comp	$14,123.50
Rate for Payer: Scott and White EPO/PPO	$14,123.50

BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC

Facility

$44,629.10

Service Code	MSDRG 478
Min. Negotiated Rate	$19,601.12
Max. Negotiated Rate	$44,629.10
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$22,783.63
Rate for Payer: Amerigroup Medicare	$22,783.63
Rate for Payer: BCBS of TX Medicare	$22,783.63
Rate for Payer: Cigna Commercial	$31,674.50
Rate for Payer: Cigna Medicare	$22,783.63
Rate for Payer: Employer Direct Commercial	$22,783.63
Rate for Payer: Humana Medicare/TRICARE	$22,783.63
Rate for Payer: Molina Dual Medicare/Medicaid	$22,783.63
Rate for Payer: Molina Medicare	$22,783.63
Rate for Payer: Multiplan Auto	$44,629.10
Rate for Payer: Multiplan Commercial	$44,629.10
Rate for Payer: Multiplan Workers Comp	$44,629.10
Rate for Payer: Scott and White EPO/PPO	$20,552.88
Rate for Payer: Scott and White Medicare	$22,783.63
Rate for Payer: Superior Health Plan EPO	$22,783.63
Rate for Payer: Superior Health Plan Medicare	$22,783.63
Rate for Payer: Universal American Dual Medicare/Medicaid	$22,783.63
Rate for Payer: Universal American Medicare	$22,783.63
Rate for Payer: Wellcare Medicare	$22,783.63
Rate for Payer: Wellmed Medicare	$22,783.63

BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC

Facility

$64,653.20

Service Code	MSDRG 477
Min. Negotiated Rate	$26,990.24
Max. Negotiated Rate	$64,653.20
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$30,078.94
Rate for Payer: Amerigroup Medicare	$30,078.94
Rate for Payer: BCBS of TX Medicare	$30,078.94
Rate for Payer: Cigna Commercial	$44,495.25
Rate for Payer: Cigna Medicare	$30,078.94
Rate for Payer: Employer Direct Commercial	$30,078.94
Rate for Payer: Humana Medicare/TRICARE	$30,078.94
Rate for Payer: Molina Dual Medicare/Medicaid	$30,078.94
Rate for Payer: Molina Medicare	$30,078.94
Rate for Payer: Multiplan Auto	$64,653.20
Rate for Payer: Multiplan Commercial	$64,653.20
Rate for Payer: Multiplan Workers Comp	$64,653.20
Rate for Payer: Scott and White EPO/PPO	$29,774.50
Rate for Payer: Scott and White Medicare	$30,078.94
Rate for Payer: Superior Health Plan EPO	$30,078.94
Rate for Payer: Superior Health Plan Medicare	$30,078.94
Rate for Payer: Universal American Dual Medicare/Medicaid	$30,078.94
Rate for Payer: Universal American Medicare	$30,078.94
Rate for Payer: Wellcare Medicare	$30,078.94
Rate for Payer: Wellmed Medicare	$30,078.94

BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC

Facility

$33,599.60

Service Code	MSDRG 479
Min. Negotiated Rate	$15,462.80
Max. Negotiated Rate	$33,599.60
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$18,384.00
Rate for Payer: Amerigroup Medicare	$18,384.00
Rate for Payer: BCBS of TX Medicare	$18,384.00
Rate for Payer: Cigna Commercial	$23,942.63
Rate for Payer: Cigna Medicare	$18,384.00
Rate for Payer: Employer Direct Commercial	$18,384.00
Rate for Payer: Humana Medicare/TRICARE	$18,384.00
Rate for Payer: Molina Dual Medicare/Medicaid	$18,384.00
Rate for Payer: Molina Medicare	$18,384.00
Rate for Payer: Multiplan Auto	$33,599.60
Rate for Payer: Multiplan Commercial	$33,599.60
Rate for Payer: Multiplan Workers Comp	$33,599.60
Rate for Payer: Scott and White EPO/PPO	$15,473.50
Rate for Payer: Scott and White Medicare	$18,384.00
Rate for Payer: Superior Health Plan EPO	$18,384.00
Rate for Payer: Superior Health Plan Medicare	$18,384.00
Rate for Payer: Universal American Dual Medicare/Medicaid	$18,384.00
Rate for Payer: Universal American Medicare	$18,384.00
Rate for Payer: Wellcare Medicare	$18,384.00
Rate for Payer: Wellmed Medicare	$18,384.00

BIOPSIES OF MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE W CC

Facility

$44,629.10

Service Code	MSDRG 478
Min. Negotiated Rate	$19,601.12
Max. Negotiated Rate	$44,629.10
Rate for Payer: BCBS of TX Blue Advantage	$19,601.12
Rate for Payer: BCBS of TX Blue Essentials	$23,519.06
Rate for Payer: BCBS of TX PPO	$26,133.31

BIOPSIES OF MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE W MCC

Facility

$64,653.20

Service Code	MSDRG 477
Min. Negotiated Rate	$26,990.24
Max. Negotiated Rate	$64,653.20
Rate for Payer: BCBS of TX Blue Advantage	$26,990.24
Rate for Payer: BCBS of TX Blue Essentials	$32,385.15
Rate for Payer: BCBS of TX PPO	$35,984.89

BIOPSIES OF MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE W/O CC/MCC

Facility

$33,599.60

Service Code	MSDRG 479
Min. Negotiated Rate	$15,462.80
Max. Negotiated Rate	$33,599.60
Rate for Payer: BCBS of TX Blue Advantage	$15,462.80
Rate for Payer: BCBS of TX Blue Essentials	$18,553.56
Rate for Payer: BCBS of TX PPO	$20,615.87

Biopsy, bone, trocar, or needle; superficial (eg, ilium, sternum, spinous process, ribs)

Facility

$5,747.96

Service Code	HCPCS 20220
Hospital Charge Code	9900167
Hospital Revenue Code	360
Min. Negotiated Rate	$486.45
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$486.45
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$1,659.12
Rate for Payer: Amerigroup Medicare	$1,659.12
Rate for Payer: BCBS of TX Blue Advantage	$2,292.24
Rate for Payer: BCBS of TX Blue Essentials	$2,745.20
Rate for Payer: BCBS of TX Medicare	$1,659.12
Rate for Payer: BCBS of TX PPO	$3,458.95
Rate for Payer: Cash Price	$3,908.61
Rate for Payer: Cash Price	$3,908.61
Rate for Payer: Cash Price	$3,908.61
Rate for Payer: Cigna Commercial	$3,507.10
Rate for Payer: Cigna Medicaid	$4,138.53
Rate for Payer: Cigna Medicare	$1,659.12
Rate for Payer: Employer Direct Commercial	$1,659.12
Rate for Payer: Humana Medicare/TRICARE	$1,659.12
Rate for Payer: Molina CHIP/Medicaid	$4,138.53
Rate for Payer: Molina Dual Medicare/Medicaid	$1,659.12
Rate for Payer: Molina Medicare	$1,659.12
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	$4,138.53
Rate for Payer: Scott and White EPO/PPO	$2,743.07
Rate for Payer: Scott and White Medicare	$1,659.12
Rate for Payer: Superior Health Plan CHIP/Medicaid	$4,138.53
Rate for Payer: Superior Health Plan EPO	$1,659.12
Rate for Payer: Superior Health Plan Medicare	$1,659.12
Rate for Payer: Universal American Dual Medicare/Medicaid	$1,659.12
Rate for Payer: Universal American Medicare	$1,659.12
Rate for Payer: Wellcare Medicare	$1,659.12
Rate for Payer: Wellmed Medicare	$1,659.12

Biopsy, bone, trocar, or needle; superficial (eg, ilium, sternum, spinous process, ribs)

Facility

$5,747.96

Service Code	HCPCS 20220
Hospital Charge Code	3802022
Hospital Revenue Code	360
Min. Negotiated Rate	$486.45
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$486.45
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$1,659.12
Rate for Payer: Amerigroup Medicare	$1,659.12
Rate for Payer: BCBS of TX Blue Advantage	$2,292.24
Rate for Payer: BCBS of TX Blue Essentials	$2,745.20
Rate for Payer: BCBS of TX Medicare	$1,659.12
Rate for Payer: BCBS of TX PPO	$3,458.95
Rate for Payer: Cash Price	$3,908.61
Rate for Payer: Cash Price	$3,908.61
Rate for Payer: Cash Price	$3,908.61
Rate for Payer: Cigna Commercial	$3,507.10
Rate for Payer: Cigna Medicaid	$4,138.53
Rate for Payer: Cigna Medicare	$1,659.12
Rate for Payer: Employer Direct Commercial	$1,659.12
Rate for Payer: Humana Medicare/TRICARE	$1,659.12
Rate for Payer: Molina CHIP/Medicaid	$4,138.53
Rate for Payer: Molina Dual Medicare/Medicaid	$1,659.12
Rate for Payer: Molina Medicare	$1,659.12
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	$4,138.53
Rate for Payer: Scott and White EPO/PPO	$2,743.07
Rate for Payer: Scott and White Medicare	$1,659.12
Rate for Payer: Superior Health Plan CHIP/Medicaid	$4,138.53
Rate for Payer: Superior Health Plan EPO	$1,659.12
Rate for Payer: Superior Health Plan Medicare	$1,659.12
Rate for Payer: Universal American Dual Medicare/Medicaid	$1,659.12
Rate for Payer: Universal American Medicare	$1,659.12
Rate for Payer: Wellcare Medicare	$1,659.12
Rate for Payer: Wellmed Medicare	$1,659.12

Biopsy, bone, trocar, or needle; superficial (eg, ilium, sternum, spinous process, ribs)

Facility

$5,747.96

Service Code	HCPCS 20220
Hospital Charge Code	3802022
Hospital Revenue Code	360
Rate for Payer: Cash Price	$3,908.61

Biopsy, bone, trocar, or needle; superficial (eg, ilium, sternum, spinous process, ribs)

Facility

$10,000.00

Service Code	CPT 20220
Hospital Charge Code	36020220
Hospital Revenue Code	360
Min. Negotiated Rate	$486.45
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$486.45
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$1,659.12
Rate for Payer: Amerigroup Medicare	$1,659.12
Rate for Payer: BCBS of TX Blue Advantage	$2,292.24
Rate for Payer: BCBS of TX Blue Essentials	$2,745.20
Rate for Payer: BCBS of TX Medicare	$1,659.12
Rate for Payer: BCBS of TX PPO	$3,458.95
Rate for Payer: Cigna Commercial	$3,507.10
Rate for Payer: Cigna Medicare	$1,659.12
Rate for Payer: Employer Direct Commercial	$1,659.12
Rate for Payer: Humana Medicare/TRICARE	$1,659.12
Rate for Payer: Molina Dual Medicare/Medicaid	$1,659.12
Rate for Payer: Molina Medicare	$1,659.12
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	$2,743.07
Rate for Payer: Scott and White Medicare	$1,659.12
Rate for Payer: Superior Health Plan EPO	$1,659.12
Rate for Payer: Superior Health Plan Medicare	$1,659.12
Rate for Payer: Universal American Dual Medicare/Medicaid	$1,659.12
Rate for Payer: Universal American Medicare	$1,659.12
Rate for Payer: Wellcare Medicare	$1,659.12
Rate for Payer: Wellmed Medicare	$1,659.12

Know your out-of-pocket cost for care.

All Charges