White Rock Medical Center

All Charges

Charge

Type

Setting

Price

CHED Laceration Simple - Face 2.6 to 5.0 cm BCE

Facility

$600.90

Service Code	HCPCS 12013
Hospital Charge Code	8910634
Hospital Revenue Code	450
Rate for Payer: Cash Price	$408.61

CHED Laceration Simple - Face 2.6 to 5.0 cm BCE

Facility

$600.90

Service Code	HCPCS 12013
Hospital Charge Code	8910634
Hospital Revenue Code	450
Min. Negotiated Rate	$54.08
Max. Negotiated Rate	$440.32
Rate for Payer: Amerigroup CHIP/Medicaid	$54.08
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$201.55
Rate for Payer: Amerigroup Medicare	$201.55
Rate for Payer: BCBS of TX Blue Advantage	$291.80
Rate for Payer: BCBS of TX Blue Essentials	$349.46
Rate for Payer: BCBS of TX Medicare	$201.55
Rate for Payer: BCBS of TX PPO	$440.32
Rate for Payer: Cash Price	$408.61
Rate for Payer: Cash Price	$408.61
Rate for Payer: Cash Price	$408.61
Rate for Payer: Cigna Commercial	$426.04
Rate for Payer: Cigna Medicaid	$432.65
Rate for Payer: Cigna Medicare	$201.55
Rate for Payer: Employer Direct Commercial	$201.55
Rate for Payer: Humana Medicare/TRICARE	$201.55
Rate for Payer: Molina CHIP/Medicaid	$432.65
Rate for Payer: Molina Dual Medicare/Medicaid	$201.55
Rate for Payer: Molina Medicare	$201.55
Rate for Payer: Multiplan Auto	$390.58
Rate for Payer: Multiplan Commercial	$390.58
Rate for Payer: Multiplan Workers Comp	$390.58
Rate for Payer: Parkland Medicaid	$432.65
Rate for Payer: Scott and White EPO/PPO	$70.22
Rate for Payer: Scott and White Medicare	$201.55
Rate for Payer: Superior Health Plan CHIP/Medicaid	$432.65
Rate for Payer: Superior Health Plan EPO	$201.55
Rate for Payer: Superior Health Plan Medicare	$201.55
Rate for Payer: Universal American Dual Medicare/Medicaid	$201.55
Rate for Payer: Universal American Medicare	$201.55
Rate for Payer: Wellcare Medicare	$201.55
Rate for Payer: Wellmed Medicare	$201.55

CHED Laceration Simple - Face > 30.0 cm BCE

Facility

$1,570.00

Service Code	HCPCS 12018
Hospital Charge Code	8910633
Hospital Revenue Code	450
Min. Negotiated Rate	$141.30
Max. Negotiated Rate	$1,130.40
Rate for Payer: Amerigroup CHIP/Medicaid	$141.30
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$201.55
Rate for Payer: Amerigroup Medicare	$201.55
Rate for Payer: BCBS of TX Blue Advantage	$291.80
Rate for Payer: BCBS of TX Blue Essentials	$349.46
Rate for Payer: BCBS of TX Medicare	$201.55
Rate for Payer: BCBS of TX PPO	$440.32
Rate for Payer: Cash Price	$1,067.60
Rate for Payer: Cash Price	$1,067.60
Rate for Payer: Cash Price	$1,067.60
Rate for Payer: Cigna Commercial	$426.04
Rate for Payer: Cigna Medicaid	$1,130.40
Rate for Payer: Cigna Medicare	$201.55
Rate for Payer: Employer Direct Commercial	$201.55
Rate for Payer: Humana Medicare/TRICARE	$201.55
Rate for Payer: Molina CHIP/Medicaid	$1,130.40
Rate for Payer: Molina Dual Medicare/Medicaid	$201.55
Rate for Payer: Molina Medicare	$201.55
Rate for Payer: Multiplan Auto	$1,020.50
Rate for Payer: Multiplan Commercial	$1,020.50
Rate for Payer: Multiplan Workers Comp	$1,020.50
Rate for Payer: Parkland Medicaid	$1,130.40
Rate for Payer: Scott and White EPO/PPO	$210.00
Rate for Payer: Scott and White Medicare	$201.55
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,130.40
Rate for Payer: Superior Health Plan EPO	$201.55
Rate for Payer: Superior Health Plan Medicare	$201.55
Rate for Payer: Universal American Dual Medicare/Medicaid	$201.55
Rate for Payer: Universal American Medicare	$201.55
Rate for Payer: Wellcare Medicare	$201.55
Rate for Payer: Wellmed Medicare	$201.55

CHED Laceration Simple - Face > 30.0 cm BCE

Facility

$1,570.00

Service Code	HCPCS 12018
Hospital Charge Code	8910633
Hospital Revenue Code	450
Rate for Payer: Cash Price	$1,067.60

CHED Laceration Simple - Face 5.1 to 7.5 cm BCE

Facility

$664.14

Service Code	HCPCS 12014
Hospital Charge Code	8910636
Hospital Revenue Code	450
Min. Negotiated Rate	$59.77
Max. Negotiated Rate	$478.18
Rate for Payer: Amerigroup CHIP/Medicaid	$59.77
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$201.55
Rate for Payer: Amerigroup Medicare	$201.55
Rate for Payer: BCBS of TX Blue Advantage	$291.80
Rate for Payer: BCBS of TX Blue Essentials	$349.46
Rate for Payer: BCBS of TX Medicare	$201.55
Rate for Payer: BCBS of TX PPO	$440.32
Rate for Payer: Cash Price	$451.62
Rate for Payer: Cash Price	$451.62
Rate for Payer: Cash Price	$451.62
Rate for Payer: Cigna Commercial	$426.04
Rate for Payer: Cigna Medicaid	$478.18
Rate for Payer: Cigna Medicare	$201.55
Rate for Payer: Employer Direct Commercial	$201.55
Rate for Payer: Humana Medicare/TRICARE	$201.55
Rate for Payer: Molina CHIP/Medicaid	$478.18
Rate for Payer: Molina Dual Medicare/Medicaid	$201.55
Rate for Payer: Molina Medicare	$201.55
Rate for Payer: Multiplan Auto	$431.69
Rate for Payer: Multiplan Commercial	$431.69
Rate for Payer: Multiplan Workers Comp	$431.69
Rate for Payer: Parkland Medicaid	$478.18
Rate for Payer: Scott and White EPO/PPO	$90.88
Rate for Payer: Scott and White Medicare	$201.55
Rate for Payer: Superior Health Plan CHIP/Medicaid	$478.18
Rate for Payer: Superior Health Plan EPO	$201.55
Rate for Payer: Superior Health Plan Medicare	$201.55
Rate for Payer: Universal American Dual Medicare/Medicaid	$201.55
Rate for Payer: Universal American Medicare	$201.55
Rate for Payer: Wellcare Medicare	$201.55
Rate for Payer: Wellmed Medicare	$201.55

CHED Laceration Simple - Face 5.1 to 7.5 cm BCE

Facility

$664.14

Service Code	HCPCS 12014
Hospital Charge Code	8910636
Hospital Revenue Code	450
Rate for Payer: Cash Price	$451.62

CHED Laceration Simple - Scalp <= 2.5 cm BCE

Facility

$993.50

Service Code	HCPCS 12001
Hospital Charge Code	5202568
Hospital Revenue Code	450
Min. Negotiated Rate	$54.51
Max. Negotiated Rate	$715.32
Rate for Payer: Amerigroup CHIP/Medicaid	$89.42
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$201.55
Rate for Payer: Amerigroup Medicare	$201.55
Rate for Payer: BCBS of TX Blue Advantage	$291.80
Rate for Payer: BCBS of TX Blue Essentials	$349.46
Rate for Payer: BCBS of TX Medicare	$201.55
Rate for Payer: BCBS of TX PPO	$440.32
Rate for Payer: Cash Price	$675.58
Rate for Payer: Cash Price	$675.58
Rate for Payer: Cash Price	$675.58
Rate for Payer: Cigna Commercial	$426.04
Rate for Payer: Cigna Medicaid	$715.32
Rate for Payer: Cigna Medicare	$201.55
Rate for Payer: Employer Direct Commercial	$201.55
Rate for Payer: Humana Medicare/TRICARE	$201.55
Rate for Payer: Molina CHIP/Medicaid	$715.32
Rate for Payer: Molina Dual Medicare/Medicaid	$201.55
Rate for Payer: Molina Medicare	$201.55
Rate for Payer: Multiplan Auto	$645.77
Rate for Payer: Multiplan Commercial	$645.77
Rate for Payer: Multiplan Workers Comp	$645.77
Rate for Payer: Parkland Medicaid	$715.32
Rate for Payer: Scott and White EPO/PPO	$54.51
Rate for Payer: Scott and White Medicare	$201.55
Rate for Payer: Superior Health Plan CHIP/Medicaid	$715.32
Rate for Payer: Superior Health Plan EPO	$201.55
Rate for Payer: Superior Health Plan Medicare	$201.55
Rate for Payer: Universal American Dual Medicare/Medicaid	$201.55
Rate for Payer: Universal American Medicare	$201.55
Rate for Payer: Wellcare Medicare	$201.55
Rate for Payer: Wellmed Medicare	$201.55

CHED Laceration Simple - Scalp <= 2.5 cm BCE

Facility

$993.50

Service Code	HCPCS 12001
Hospital Charge Code	5202568
Hospital Revenue Code	450
Rate for Payer: Cash Price	$675.58

CHED Laceration Simple - Scalp 2.6 to 7.5 cm BCE

Facility

$680.25

Service Code	HCPCS 12002
Hospital Charge Code	8912638
Hospital Revenue Code	450
Rate for Payer: Cash Price	$462.57

CHED Laceration Simple - Scalp 2.6 to 7.5 cm BCE

Facility

$680.25

Service Code	HCPCS 12002
Hospital Charge Code	8912638
Hospital Revenue Code	450
Min. Negotiated Rate	$61.22
Max. Negotiated Rate	$489.78
Rate for Payer: Amerigroup CHIP/Medicaid	$61.22
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$201.55
Rate for Payer: Amerigroup Medicare	$201.55
Rate for Payer: BCBS of TX Blue Advantage	$291.80
Rate for Payer: BCBS of TX Blue Essentials	$349.46
Rate for Payer: BCBS of TX Medicare	$201.55
Rate for Payer: BCBS of TX PPO	$440.32
Rate for Payer: Cash Price	$462.57
Rate for Payer: Cash Price	$462.57
Rate for Payer: Cash Price	$462.57
Rate for Payer: Cigna Commercial	$426.04
Rate for Payer: Cigna Medicaid	$489.78
Rate for Payer: Cigna Medicare	$201.55
Rate for Payer: Employer Direct Commercial	$201.55
Rate for Payer: Humana Medicare/TRICARE	$201.55
Rate for Payer: Molina CHIP/Medicaid	$489.78
Rate for Payer: Molina Dual Medicare/Medicaid	$201.55
Rate for Payer: Molina Medicare	$201.55
Rate for Payer: Multiplan Auto	$442.16
Rate for Payer: Multiplan Commercial	$442.16
Rate for Payer: Multiplan Workers Comp	$442.16
Rate for Payer: Parkland Medicaid	$489.78
Rate for Payer: Scott and White EPO/PPO	$71.56
Rate for Payer: Scott and White Medicare	$201.55
Rate for Payer: Superior Health Plan CHIP/Medicaid	$489.78
Rate for Payer: Superior Health Plan EPO	$201.55
Rate for Payer: Superior Health Plan Medicare	$201.55
Rate for Payer: Universal American Dual Medicare/Medicaid	$201.55
Rate for Payer: Universal American Medicare	$201.55
Rate for Payer: Wellcare Medicare	$201.55
Rate for Payer: Wellmed Medicare	$201.55

CHED Laceration Simple - Scalp > 30 cm BCE

Facility

$393.64

Service Code	HCPCS 12007
Hospital Charge Code	5202571
Hospital Revenue Code	450
Min. Negotiated Rate	$35.43
Max. Negotiated Rate	$440.32
Rate for Payer: Amerigroup CHIP/Medicaid	$35.43
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$201.55
Rate for Payer: Amerigroup Medicare	$201.55
Rate for Payer: BCBS of TX Blue Advantage	$291.80
Rate for Payer: BCBS of TX Blue Essentials	$349.46
Rate for Payer: BCBS of TX Medicare	$201.55
Rate for Payer: BCBS of TX PPO	$440.32
Rate for Payer: Cash Price	$267.68
Rate for Payer: Cash Price	$267.68
Rate for Payer: Cash Price	$267.68
Rate for Payer: Cigna Commercial	$426.04
Rate for Payer: Cigna Medicaid	$283.42
Rate for Payer: Cigna Medicare	$201.55
Rate for Payer: Employer Direct Commercial	$201.55
Rate for Payer: Humana Medicare/TRICARE	$201.55
Rate for Payer: Molina CHIP/Medicaid	$283.42
Rate for Payer: Molina Dual Medicare/Medicaid	$201.55
Rate for Payer: Molina Medicare	$201.55
Rate for Payer: Multiplan Auto	$255.87
Rate for Payer: Multiplan Commercial	$255.87
Rate for Payer: Multiplan Workers Comp	$255.87
Rate for Payer: Parkland Medicaid	$283.42
Rate for Payer: Scott and White EPO/PPO	$174.62
Rate for Payer: Scott and White Medicare	$201.55
Rate for Payer: Superior Health Plan CHIP/Medicaid	$283.42
Rate for Payer: Superior Health Plan EPO	$201.55
Rate for Payer: Superior Health Plan Medicare	$201.55
Rate for Payer: Universal American Dual Medicare/Medicaid	$201.55
Rate for Payer: Universal American Medicare	$201.55
Rate for Payer: Wellcare Medicare	$201.55
Rate for Payer: Wellmed Medicare	$201.55

CHED Laceration Simple - Scalp > 30 cm BCE

Facility

$393.64

Service Code	HCPCS 12007
Hospital Charge Code	8910637
Hospital Revenue Code	450
Rate for Payer: Cash Price	$267.68

CHED Laceration Simple - Scalp > 30 cm BCE

Facility

$393.64

Service Code	HCPCS 12007
Hospital Charge Code	8910637
Hospital Revenue Code	450
Min. Negotiated Rate	$35.43
Max. Negotiated Rate	$440.32
Rate for Payer: Amerigroup CHIP/Medicaid	$35.43
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$201.55
Rate for Payer: Amerigroup Medicare	$201.55
Rate for Payer: BCBS of TX Blue Advantage	$291.80
Rate for Payer: BCBS of TX Blue Essentials	$349.46
Rate for Payer: BCBS of TX Medicare	$201.55
Rate for Payer: BCBS of TX PPO	$440.32
Rate for Payer: Cash Price	$267.68
Rate for Payer: Cash Price	$267.68
Rate for Payer: Cash Price	$267.68
Rate for Payer: Cigna Commercial	$426.04
Rate for Payer: Cigna Medicaid	$283.42
Rate for Payer: Cigna Medicare	$201.55
Rate for Payer: Employer Direct Commercial	$201.55
Rate for Payer: Humana Medicare/TRICARE	$201.55
Rate for Payer: Molina CHIP/Medicaid	$283.42
Rate for Payer: Molina Dual Medicare/Medicaid	$201.55
Rate for Payer: Molina Medicare	$201.55
Rate for Payer: Multiplan Auto	$255.87
Rate for Payer: Multiplan Commercial	$255.87
Rate for Payer: Multiplan Workers Comp	$255.87
Rate for Payer: Parkland Medicaid	$283.42
Rate for Payer: Scott and White EPO/PPO	$174.62
Rate for Payer: Scott and White Medicare	$201.55
Rate for Payer: Superior Health Plan CHIP/Medicaid	$283.42
Rate for Payer: Superior Health Plan EPO	$201.55
Rate for Payer: Superior Health Plan Medicare	$201.55
Rate for Payer: Universal American Dual Medicare/Medicaid	$201.55
Rate for Payer: Universal American Medicare	$201.55
Rate for Payer: Wellcare Medicare	$201.55
Rate for Payer: Wellmed Medicare	$201.55

CHED Laceration Simple - Scalp > 30 cm BCE

Facility

$393.64

Service Code	HCPCS 12007
Hospital Charge Code	5202571
Hospital Revenue Code	450
Rate for Payer: Cash Price	$267.68

CHED Laceration Simple - Scalp 7.6 to 12.5 cm BCE

Facility

$691.09

Service Code	HCPCS 12004
Hospital Charge Code	8910638
Hospital Revenue Code	450
Min. Negotiated Rate	$62.20
Max. Negotiated Rate	$497.58
Rate for Payer: Amerigroup CHIP/Medicaid	$62.20
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$201.55
Rate for Payer: Amerigroup Medicare	$201.55
Rate for Payer: BCBS of TX Blue Advantage	$291.80
Rate for Payer: BCBS of TX Blue Essentials	$349.46
Rate for Payer: BCBS of TX Medicare	$201.55
Rate for Payer: BCBS of TX PPO	$440.32
Rate for Payer: Cash Price	$469.94
Rate for Payer: Cash Price	$469.94
Rate for Payer: Cash Price	$469.94
Rate for Payer: Cigna Commercial	$426.04
Rate for Payer: Cigna Medicaid	$497.58
Rate for Payer: Cigna Medicare	$201.55
Rate for Payer: Employer Direct Commercial	$201.55
Rate for Payer: Humana Medicare/TRICARE	$201.55
Rate for Payer: Molina CHIP/Medicaid	$497.58
Rate for Payer: Molina Dual Medicare/Medicaid	$201.55
Rate for Payer: Molina Medicare	$201.55
Rate for Payer: Multiplan Auto	$449.21
Rate for Payer: Multiplan Commercial	$449.21
Rate for Payer: Multiplan Workers Comp	$449.21
Rate for Payer: Parkland Medicaid	$497.58
Rate for Payer: Scott and White EPO/PPO	$89.38
Rate for Payer: Scott and White Medicare	$201.55
Rate for Payer: Superior Health Plan CHIP/Medicaid	$497.58
Rate for Payer: Superior Health Plan EPO	$201.55
Rate for Payer: Superior Health Plan Medicare	$201.55
Rate for Payer: Universal American Dual Medicare/Medicaid	$201.55
Rate for Payer: Universal American Medicare	$201.55
Rate for Payer: Wellcare Medicare	$201.55
Rate for Payer: Wellmed Medicare	$201.55

CHED Laceration Simple - Scalp 7.6 to 12.5 cm BCE

Facility

$691.09

Service Code	HCPCS 12004
Hospital Charge Code	8910638
Hospital Revenue Code	450
Rate for Payer: Cash Price	$469.94

CHED Lap Band Adjustment BCE

Facility

$1,947.00

Service Code	HCPCS 43999
Hospital Charge Code	9900693
Hospital Revenue Code	450
Min. Negotiated Rate	$175.23
Max. Negotiated Rate	$1,980.52
Rate for Payer: Amerigroup CHIP/Medicaid	$175.23
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$911.12
Rate for Payer: Amerigroup Medicare	$911.12
Rate for Payer: BCBS of TX Blue Advantage	$1,312.49
Rate for Payer: BCBS of TX Blue Essentials	$1,571.84
Rate for Payer: BCBS of TX Medicare	$911.12
Rate for Payer: BCBS of TX PPO	$1,980.52
Rate for Payer: Cash Price	$1,323.96
Rate for Payer: Cash Price	$1,323.96
Rate for Payer: Cash Price	$1,323.96
Rate for Payer: Cigna Commercial	$1,925.93
Rate for Payer: Cigna Medicaid	$1,401.84
Rate for Payer: Cigna Medicare	$911.12
Rate for Payer: Employer Direct Commercial	$911.12
Rate for Payer: Humana Medicare/TRICARE	$911.12
Rate for Payer: Molina CHIP/Medicaid	$1,401.84
Rate for Payer: Molina Dual Medicare/Medicaid	$911.12
Rate for Payer: Molina Medicare	$911.12
Rate for Payer: Multiplan Auto	$1,265.55
Rate for Payer: Multiplan Commercial	$1,265.55
Rate for Payer: Multiplan Workers Comp	$1,265.55
Rate for Payer: Parkland Medicaid	$1,401.84
Rate for Payer: Scott and White EPO/PPO	$973.50
Rate for Payer: Scott and White Medicare	$911.12
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,401.84
Rate for Payer: Superior Health Plan EPO	$911.12
Rate for Payer: Superior Health Plan Medicare	$911.12
Rate for Payer: Universal American Dual Medicare/Medicaid	$911.12
Rate for Payer: Universal American Medicare	$911.12
Rate for Payer: Wellcare Medicare	$911.12
Rate for Payer: Wellmed Medicare	$911.12

CHED Lap Band Adjustment BCE

Facility

$1,947.00

Service Code	HCPCS 43999
Hospital Charge Code	9900693
Hospital Revenue Code	450
Rate for Payer: Cash Price	$1,323.96

CHED LesionProcedure Incision of breast lesion BCE

Facility

$7,177.02

Service Code	HCPCS 19020
Hospital Charge Code	5202572
Hospital Revenue Code	450
Rate for Payer: Cash Price	$4,880.37

CHED LesionProcedure Incision of breast lesion BCE

Facility

$7,177.02

Service Code	HCPCS 19020
Hospital Charge Code	5202572
Hospital Revenue Code	450
Min. Negotiated Rate	$388.06
Max. Negotiated Rate	$5,167.45
Rate for Payer: Amerigroup CHIP/Medicaid	$645.93
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	$4,880.37
Rate for Payer: Cash Price	$4,880.37
Rate for Payer: Cash Price	$4,880.37
Rate for Payer: Cigna Commercial	$3,507.10
Rate for Payer: Cigna Medicaid	$5,167.45
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	$5,167.45
Rate for Payer: Molina Dual Medicare/Medicaid	$1,659.12
Rate for Payer: Molina Medicare	$1,659.12
Rate for Payer: Multiplan Auto	$4,665.06
Rate for Payer: Multiplan Commercial	$4,665.06
Rate for Payer: Multiplan Workers Comp	$4,665.06
Rate for Payer: Parkland Medicaid	$5,167.45
Rate for Payer: Scott and White EPO/PPO	$388.06
Rate for Payer: Scott and White Medicare	$1,659.12
Rate for Payer: Superior Health Plan CHIP/Medicaid	$5,167.45
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

CHED LesionProcedure Removal of Skin Tags BCE

Facility

$2,477.00

Service Code	HCPCS 11200
Hospital Charge Code	8912639
Hospital Revenue Code	450
Min. Negotiated Rate	$94.86
Max. Negotiated Rate	$1,783.44
Rate for Payer: Amerigroup CHIP/Medicaid	$222.93
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$201.55
Rate for Payer: Amerigroup Medicare	$201.55
Rate for Payer: BCBS of TX Blue Advantage	$291.80
Rate for Payer: BCBS of TX Blue Essentials	$349.46
Rate for Payer: BCBS of TX Medicare	$201.55
Rate for Payer: BCBS of TX PPO	$440.32
Rate for Payer: Cash Price	$1,684.36
Rate for Payer: Cash Price	$1,684.36
Rate for Payer: Cash Price	$1,684.36
Rate for Payer: Cigna Commercial	$426.04
Rate for Payer: Cigna Medicaid	$1,783.44
Rate for Payer: Cigna Medicare	$201.55
Rate for Payer: Employer Direct Commercial	$201.55
Rate for Payer: Humana Medicare/TRICARE	$201.55
Rate for Payer: Molina CHIP/Medicaid	$1,783.44
Rate for Payer: Molina Dual Medicare/Medicaid	$201.55
Rate for Payer: Molina Medicare	$201.55
Rate for Payer: Multiplan Auto	$1,610.05
Rate for Payer: Multiplan Commercial	$1,610.05
Rate for Payer: Multiplan Workers Comp	$1,610.05
Rate for Payer: Parkland Medicaid	$1,783.44
Rate for Payer: Scott and White EPO/PPO	$94.86
Rate for Payer: Scott and White Medicare	$201.55
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,783.44
Rate for Payer: Superior Health Plan EPO	$201.55
Rate for Payer: Superior Health Plan Medicare	$201.55
Rate for Payer: Universal American Dual Medicare/Medicaid	$201.55
Rate for Payer: Universal American Medicare	$201.55
Rate for Payer: Wellcare Medicare	$201.55
Rate for Payer: Wellmed Medicare	$201.55

CHED LesionProcedure Removal of Skin Tags BCE

Facility

$2,477.00

Service Code	HCPCS 11200
Hospital Charge Code	8912639
Hospital Revenue Code	450
Rate for Payer: Cash Price	$1,684.36

CHED LesionProcedure Shaving, corn or callus BCE

Facility

$993.50

Service Code	HCPCS 11055
Hospital Charge Code	8912640
Hospital Revenue Code	450
Rate for Payer: Cash Price	$675.58

CHED LesionProcedure Shaving, corn or callus BCE

Facility

$993.50

Service Code	HCPCS 11055
Hospital Charge Code	8912640
Hospital Revenue Code	450
Min. Negotiated Rate	$18.86
Max. Negotiated Rate	$715.32
Rate for Payer: Amerigroup CHIP/Medicaid	$89.42
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$201.55
Rate for Payer: Amerigroup Medicare	$201.55
Rate for Payer: BCBS of TX Blue Advantage	$291.80
Rate for Payer: BCBS of TX Blue Essentials	$349.46
Rate for Payer: BCBS of TX Medicare	$201.55
Rate for Payer: BCBS of TX PPO	$440.32
Rate for Payer: Cash Price	$675.58
Rate for Payer: Cash Price	$675.58
Rate for Payer: Cash Price	$675.58
Rate for Payer: Cigna Commercial	$426.04
Rate for Payer: Cigna Medicaid	$715.32
Rate for Payer: Cigna Medicare	$201.55
Rate for Payer: Employer Direct Commercial	$201.55
Rate for Payer: Humana Medicare/TRICARE	$201.55
Rate for Payer: Molina CHIP/Medicaid	$715.32
Rate for Payer: Molina Dual Medicare/Medicaid	$201.55
Rate for Payer: Molina Medicare	$201.55
Rate for Payer: Multiplan Auto	$645.77
Rate for Payer: Multiplan Commercial	$645.77
Rate for Payer: Multiplan Workers Comp	$645.77
Rate for Payer: Parkland Medicaid	$715.32
Rate for Payer: Scott and White EPO/PPO	$18.86
Rate for Payer: Scott and White Medicare	$201.55
Rate for Payer: Superior Health Plan CHIP/Medicaid	$715.32
Rate for Payer: Superior Health Plan EPO	$201.55
Rate for Payer: Superior Health Plan Medicare	$201.55
Rate for Payer: Universal American Dual Medicare/Medicaid	$201.55
Rate for Payer: Universal American Medicare	$201.55
Rate for Payer: Wellcare Medicare	$201.55
Rate for Payer: Wellmed Medicare	$201.55

CHED LineProcedure Arterial Catheterization BCE

Facility

$1,751.63

Service Code	HCPCS 36620
Hospital Charge Code	8910639
Hospital Revenue Code	450
Min. Negotiated Rate	$53.26
Max. Negotiated Rate	$3,520.00
Rate for Payer: Amerigroup CHIP/Medicaid	$157.65
Rate for Payer: BCBS of TX Blue Advantage	$525.49
Rate for Payer: BCBS of TX Blue Essentials	$630.59
Rate for Payer: BCBS of TX PPO	$3,520.00
Rate for Payer: Cash Price	$1,191.11
Rate for Payer: Cash Price	$1,191.11
Rate for Payer: Cash Price	$1,191.11
Rate for Payer: Cigna Medicaid	$1,261.17
Rate for Payer: Molina CHIP/Medicaid	$1,261.17
Rate for Payer: Multiplan Auto	$1,138.56
Rate for Payer: Multiplan Commercial	$1,138.56
Rate for Payer: Multiplan Workers Comp	$1,138.56
Rate for Payer: Parkland Medicaid	$1,261.17
Rate for Payer: Scott and White EPO/PPO	$53.26
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,261.17
Rate for Payer: Superior Health Plan EPO	$238.22

Know your out-of-pocket cost for care.

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