White Rock Medical Center

All Charges

Charge

Type

Setting

Price

ED Lesion Procedure: Incision of breast lesion

Facility

$7,177.00

Service Code	CPT 19020
Hospital Charge Code	5202572
Hospital Revenue Code	450
Min. Negotiated Rate	$26.52
Max. Negotiated Rate	$4,665.05
Rate for Payer: Aetna Commercial	$3,090.00
Rate for Payer: Aetna Medicare	$2,224.11
Rate for Payer: Amerigroup CHIP/Medicaid	$645.93
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$1,482.74
Rate for Payer: Amerigroup Medicare	$1,482.74
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	$1,482.74
Rate for Payer: BCBS of TX PPO	$3,458.95
Rate for Payer: Cash Price	$6,315.76
Rate for Payer: Cash Price	$6,315.76
Rate for Payer: Cash Price	$6,315.76
Rate for Payer: Cigna Commercial	$3,358.84
Rate for Payer: Cigna Medicaid	$486.45
Rate for Payer: Cigna Medicare	$1,482.74
Rate for Payer: Employer Direct Commercial	$1,482.74
Rate for Payer: Humana Medicare/TRICARE	$1,482.74
Rate for Payer: Molina CHIP/Medicaid	$486.45
Rate for Payer: Molina Dual Medicare/Medicaid	$1,482.74
Rate for Payer: Molina Medicare	$1,482.74
Rate for Payer: Multiplan Auto	$4,665.05
Rate for Payer: Multiplan Commercial	$4,665.05
Rate for Payer: Multiplan Workers Comp	$4,665.05
Rate for Payer: Parkland Medicaid	$486.45
Rate for Payer: Scott and White EPO/PPO	$26.52
Rate for Payer: Scott and White Medicare	$1,482.74
Rate for Payer: Superior Health Plan CHIP/Medicaid	$486.45
Rate for Payer: Superior Health Plan EPO	$1,482.74
Rate for Payer: Superior Health Plan Medicare	$1,482.74
Rate for Payer: Universal American Dual Medicare/Medicaid	$1,482.74
Rate for Payer: Universal American Medicare	$1,482.74
Rate for Payer: Wellcare Medicare	$1,482.74
Rate for Payer: Wellmed Medicare	$1,482.74

ED Lesion Procedure: Incision of breast lesion

Facility

$7,177.00

Service Code	CPT 19020
Hospital Charge Code	5202572
Hospital Revenue Code	450
Rate for Payer: Cash Price	$6,315.76

ED Lesion Procedure Incision of breast lesion BCE

Facility

$7,177.00

Service Code	CPT 19020
Hospital Charge Code	5202572
Hospital Revenue Code	450
Min. Negotiated Rate	$26.52
Max. Negotiated Rate	$4,665.05
Rate for Payer: Aetna Commercial	$3,090.00
Rate for Payer: Aetna Medicare	$2,224.11
Rate for Payer: Amerigroup CHIP/Medicaid	$645.93
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$1,482.74
Rate for Payer: Amerigroup Medicare	$1,482.74
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	$1,482.74
Rate for Payer: BCBS of TX PPO	$3,458.95
Rate for Payer: Cash Price	$6,315.76
Rate for Payer: Cash Price	$6,315.76
Rate for Payer: Cash Price	$6,315.76
Rate for Payer: Cigna Commercial	$3,358.84
Rate for Payer: Cigna Medicaid	$486.45
Rate for Payer: Cigna Medicare	$1,482.74
Rate for Payer: Employer Direct Commercial	$1,482.74
Rate for Payer: Humana Medicare/TRICARE	$1,482.74
Rate for Payer: Molina CHIP/Medicaid	$486.45
Rate for Payer: Molina Dual Medicare/Medicaid	$1,482.74
Rate for Payer: Molina Medicare	$1,482.74
Rate for Payer: Multiplan Auto	$4,665.05
Rate for Payer: Multiplan Commercial	$4,665.05
Rate for Payer: Multiplan Workers Comp	$4,665.05
Rate for Payer: Parkland Medicaid	$486.45
Rate for Payer: Scott and White EPO/PPO	$26.52
Rate for Payer: Scott and White Medicare	$1,482.74
Rate for Payer: Superior Health Plan CHIP/Medicaid	$486.45
Rate for Payer: Superior Health Plan EPO	$1,482.74
Rate for Payer: Superior Health Plan Medicare	$1,482.74
Rate for Payer: Universal American Dual Medicare/Medicaid	$1,482.74
Rate for Payer: Universal American Medicare	$1,482.74
Rate for Payer: Wellcare Medicare	$1,482.74
Rate for Payer: Wellmed Medicare	$1,482.74

ED Lesion Procedure: Removal of Skin Tags

Facility

$2,477.00

Service Code	CPT 11200
Hospital Charge Code	7150212
Hospital Revenue Code	450
Min. Negotiated Rate	$3.27
Max. Negotiated Rate	$1,610.05
Rate for Payer: Aetna Commercial	$1,362.35
Rate for Payer: Aetna Medicare	$274.64
Rate for Payer: Amerigroup CHIP/Medicaid	$222.93
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$183.09
Rate for Payer: Amerigroup Medicare	$183.09
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	$183.09
Rate for Payer: BCBS of TX PPO	$440.32
Rate for Payer: Cash Price	$2,179.76
Rate for Payer: Cash Price	$2,179.76
Rate for Payer: Cash Price	$2,179.76
Rate for Payer: Cigna Commercial	$414.75
Rate for Payer: Cigna Medicare	$183.09
Rate for Payer: Employer Direct Commercial	$183.09
Rate for Payer: Humana Medicare/TRICARE	$183.09
Rate for Payer: Molina Dual Medicare/Medicaid	$183.09
Rate for Payer: Molina Medicare	$183.09
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: Scott and White EPO/PPO	$3.27
Rate for Payer: Scott and White Medicare	$183.09
Rate for Payer: Superior Health Plan EPO	$183.09
Rate for Payer: Superior Health Plan Medicare	$183.09
Rate for Payer: Universal American Dual Medicare/Medicaid	$183.09
Rate for Payer: Universal American Medicare	$183.09
Rate for Payer: Wellcare Medicare	$183.09
Rate for Payer: Wellmed Medicare	$183.09

ED Lesion Procedure: Removal of Skin Tags

Facility

$2,477.00

Service Code	CPT 11200
Hospital Charge Code	7150212
Hospital Revenue Code	450
Rate for Payer: Cash Price	$2,179.76

ED Lesion Procedure Removal of Skin Tags BCE

Facility

$2,477.00

Service Code	CPT 11200
Hospital Charge Code	7150212
Hospital Revenue Code	450
Min. Negotiated Rate	$3.27
Max. Negotiated Rate	$1,610.05
Rate for Payer: Aetna Commercial	$1,362.35
Rate for Payer: Aetna Medicare	$274.64
Rate for Payer: Amerigroup CHIP/Medicaid	$222.93
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$183.09
Rate for Payer: Amerigroup Medicare	$183.09
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	$183.09
Rate for Payer: BCBS of TX PPO	$440.32
Rate for Payer: Cash Price	$2,179.76
Rate for Payer: Cash Price	$2,179.76
Rate for Payer: Cash Price	$2,179.76
Rate for Payer: Cigna Commercial	$414.75
Rate for Payer: Cigna Medicare	$183.09
Rate for Payer: Employer Direct Commercial	$183.09
Rate for Payer: Humana Medicare/TRICARE	$183.09
Rate for Payer: Molina Dual Medicare/Medicaid	$183.09
Rate for Payer: Molina Medicare	$183.09
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: Scott and White EPO/PPO	$3.27
Rate for Payer: Scott and White Medicare	$183.09
Rate for Payer: Superior Health Plan EPO	$183.09
Rate for Payer: Superior Health Plan Medicare	$183.09
Rate for Payer: Universal American Dual Medicare/Medicaid	$183.09
Rate for Payer: Universal American Medicare	$183.09
Rate for Payer: Wellcare Medicare	$183.09
Rate for Payer: Wellmed Medicare	$183.09

ED Lesion Procedure: Shaving, corn or callus

Facility

$358.00

Service Code	CPT 11055
Hospital Charge Code	7150778
Hospital Revenue Code	450
Min. Negotiated Rate	$3.27
Max. Negotiated Rate	$440.32
Rate for Payer: Aetna Commercial	$196.90
Rate for Payer: Aetna Medicare	$274.64
Rate for Payer: Amerigroup CHIP/Medicaid	$32.22
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$183.09
Rate for Payer: Amerigroup Medicare	$183.09
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	$183.09
Rate for Payer: BCBS of TX PPO	$440.32
Rate for Payer: Cash Price	$315.04
Rate for Payer: Cash Price	$315.04
Rate for Payer: Cash Price	$315.04
Rate for Payer: Cigna Commercial	$414.75
Rate for Payer: Cigna Medicare	$183.09
Rate for Payer: Employer Direct Commercial	$183.09
Rate for Payer: Humana Medicare/TRICARE	$183.09
Rate for Payer: Molina Dual Medicare/Medicaid	$183.09
Rate for Payer: Molina Medicare	$183.09
Rate for Payer: Multiplan Auto	$232.70
Rate for Payer: Multiplan Commercial	$232.70
Rate for Payer: Multiplan Workers Comp	$232.70
Rate for Payer: Scott and White EPO/PPO	$3.27
Rate for Payer: Scott and White Medicare	$183.09
Rate for Payer: Superior Health Plan EPO	$183.09
Rate for Payer: Superior Health Plan Medicare	$183.09
Rate for Payer: Universal American Dual Medicare/Medicaid	$183.09
Rate for Payer: Universal American Medicare	$183.09
Rate for Payer: Wellcare Medicare	$183.09
Rate for Payer: Wellmed Medicare	$183.09

ED Lesion Procedure: Shaving, corn or callus

Facility

$358.00

Service Code	CPT 11055
Hospital Charge Code	7150778
Hospital Revenue Code	450
Rate for Payer: Cash Price	$315.04

ED Lesion Procedure Shaving, corn or callus BCE

Facility

$358.00

Service Code	CPT 11055
Hospital Charge Code	7150778
Hospital Revenue Code	450
Min. Negotiated Rate	$3.27
Max. Negotiated Rate	$440.32
Rate for Payer: Aetna Commercial	$196.90
Rate for Payer: Aetna Medicare	$274.64
Rate for Payer: Amerigroup CHIP/Medicaid	$32.22
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$183.09
Rate for Payer: Amerigroup Medicare	$183.09
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	$183.09
Rate for Payer: BCBS of TX PPO	$440.32
Rate for Payer: Cash Price	$315.04
Rate for Payer: Cash Price	$315.04
Rate for Payer: Cash Price	$315.04
Rate for Payer: Cigna Commercial	$414.75
Rate for Payer: Cigna Medicare	$183.09
Rate for Payer: Employer Direct Commercial	$183.09
Rate for Payer: Humana Medicare/TRICARE	$183.09
Rate for Payer: Molina Dual Medicare/Medicaid	$183.09
Rate for Payer: Molina Medicare	$183.09
Rate for Payer: Multiplan Auto	$232.70
Rate for Payer: Multiplan Commercial	$232.70
Rate for Payer: Multiplan Workers Comp	$232.70
Rate for Payer: Scott and White EPO/PPO	$3.27
Rate for Payer: Scott and White Medicare	$183.09
Rate for Payer: Superior Health Plan EPO	$183.09
Rate for Payer: Superior Health Plan Medicare	$183.09
Rate for Payer: Universal American Dual Medicare/Medicaid	$183.09
Rate for Payer: Universal American Medicare	$183.09
Rate for Payer: Wellcare Medicare	$183.09
Rate for Payer: Wellmed Medicare	$183.09

ED Line Procedure: Arterial Catheterization

Facility

$1,000.00

Service Code	CPT 36620
Hospital Charge Code	320002
Hospital Revenue Code	450
Min. Negotiated Rate	$90.00
Max. Negotiated Rate	$650.00
Rate for Payer: Aetna Commercial	$550.00
Rate for Payer: Amerigroup CHIP/Medicaid	$90.00
Rate for Payer: Cash Price	$880.00
Rate for Payer: Multiplan Auto	$650.00
Rate for Payer: Multiplan Commercial	$650.00
Rate for Payer: Multiplan Workers Comp	$650.00
Rate for Payer: Scott and White EPO/PPO	$500.00
Rate for Payer: Superior Health Plan EPO	$136.00

ED Line Procedure Arterial Catheterization BCE

Facility

$1,000.00

Service Code	CPT 36620
Hospital Charge Code	320002
Hospital Revenue Code	450
Rate for Payer: Cash Price	$880.00

ED Line Procedure Arterial Catheterization BCE

Facility

$1,000.00

Service Code	CPT 36620
Hospital Charge Code	320002
Hospital Revenue Code	450
Min. Negotiated Rate	$90.00
Max. Negotiated Rate	$650.00
Rate for Payer: Aetna Commercial	$550.00
Rate for Payer: Amerigroup CHIP/Medicaid	$90.00
Rate for Payer: Cash Price	$880.00
Rate for Payer: Multiplan Auto	$650.00
Rate for Payer: Multiplan Commercial	$650.00
Rate for Payer: Multiplan Workers Comp	$650.00
Rate for Payer: Scott and White EPO/PPO	$500.00
Rate for Payer: Superior Health Plan EPO	$136.00

ED Line Procedure: Central Line >= 5 y/o

Facility

$4,645.00

Service Code	CPT 36556
Hospital Charge Code	2170058
Hospital Revenue Code	450
Min. Negotiated Rate	$52.13
Max. Negotiated Rate	$6,603.56
Rate for Payer: Aetna Commercial	$1,400.00
Rate for Payer: Aetna Medicare	$4,372.65
Rate for Payer: Amerigroup CHIP/Medicaid	$418.05
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$2,915.10
Rate for Payer: Amerigroup Medicare	$2,915.10
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	$2,915.10
Rate for Payer: BCBS of TX PPO	$4,110.45
Rate for Payer: Cash Price	$4,087.60
Rate for Payer: Cash Price	$4,087.60
Rate for Payer: Cash Price	$4,087.60
Rate for Payer: Cigna Commercial	$6,603.56
Rate for Payer: Cigna Medicaid	$1,118.22
Rate for Payer: Cigna Medicare	$2,915.10
Rate for Payer: Employer Direct Commercial	$2,915.10
Rate for Payer: Humana Medicare/TRICARE	$2,915.10
Rate for Payer: Molina CHIP/Medicaid	$1,118.22
Rate for Payer: Molina Dual Medicare/Medicaid	$2,915.10
Rate for Payer: Molina Medicare	$2,915.10
Rate for Payer: Multiplan Auto	$3,019.25
Rate for Payer: Multiplan Commercial	$3,019.25
Rate for Payer: Multiplan Workers Comp	$3,019.25
Rate for Payer: Parkland Medicaid	$1,118.22
Rate for Payer: Scott and White EPO/PPO	$52.13
Rate for Payer: Scott and White Medicare	$2,915.10
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,118.22
Rate for Payer: Superior Health Plan EPO	$2,915.10
Rate for Payer: Superior Health Plan Medicare	$2,915.10
Rate for Payer: Universal American Dual Medicare/Medicaid	$2,915.10
Rate for Payer: Universal American Medicare	$2,915.10
Rate for Payer: Wellcare Medicare	$2,915.10
Rate for Payer: Wellmed Medicare	$2,915.10

ED Line Procedure Central Line >= 5 y/o BCE

Facility

$4,645.00

Service Code	CPT 36556
Hospital Charge Code	2170058
Hospital Revenue Code	450
Rate for Payer: Cash Price	$4,087.60

ED Line Procedure Central Line >= 5 y/o BCE

Facility

$4,645.00

Service Code	CPT 36556
Hospital Charge Code	2170058
Hospital Revenue Code	450
Min. Negotiated Rate	$52.13
Max. Negotiated Rate	$6,603.56
Rate for Payer: Aetna Commercial	$1,400.00
Rate for Payer: Aetna Medicare	$4,372.65
Rate for Payer: Amerigroup CHIP/Medicaid	$418.05
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$2,915.10
Rate for Payer: Amerigroup Medicare	$2,915.10
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	$2,915.10
Rate for Payer: BCBS of TX PPO	$4,110.45
Rate for Payer: Cash Price	$4,087.60
Rate for Payer: Cash Price	$4,087.60
Rate for Payer: Cash Price	$4,087.60
Rate for Payer: Cigna Commercial	$6,603.56
Rate for Payer: Cigna Medicaid	$1,118.22
Rate for Payer: Cigna Medicare	$2,915.10
Rate for Payer: Employer Direct Commercial	$2,915.10
Rate for Payer: Humana Medicare/TRICARE	$2,915.10
Rate for Payer: Molina CHIP/Medicaid	$1,118.22
Rate for Payer: Molina Dual Medicare/Medicaid	$2,915.10
Rate for Payer: Molina Medicare	$2,915.10
Rate for Payer: Multiplan Auto	$3,019.25
Rate for Payer: Multiplan Commercial	$3,019.25
Rate for Payer: Multiplan Workers Comp	$3,019.25
Rate for Payer: Parkland Medicaid	$1,118.22
Rate for Payer: Scott and White EPO/PPO	$52.13
Rate for Payer: Scott and White Medicare	$2,915.10
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,118.22
Rate for Payer: Superior Health Plan EPO	$2,915.10
Rate for Payer: Superior Health Plan Medicare	$2,915.10
Rate for Payer: Universal American Dual Medicare/Medicaid	$2,915.10
Rate for Payer: Universal American Medicare	$2,915.10
Rate for Payer: Wellcare Medicare	$2,915.10
Rate for Payer: Wellmed Medicare	$2,915.10

ED Line Procedure: Intraosseous Infusion

Facility

$536.00

Service Code	CPT 36680
Hospital Charge Code	5202573
Hospital Revenue Code	450
Min. Negotiated Rate	$6.52
Max. Negotiated Rate	$916.25
Rate for Payer: Aetna Commercial	$294.80
Rate for Payer: Aetna Medicare	$546.58
Rate for Payer: Amerigroup CHIP/Medicaid	$48.24
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$364.39
Rate for Payer: Amerigroup Medicare	$364.39
Rate for Payer: BCBS of TX Blue Advantage	$607.20
Rate for Payer: BCBS of TX Blue Essentials	$727.18
Rate for Payer: BCBS of TX Medicare	$364.39
Rate for Payer: BCBS of TX PPO	$916.25
Rate for Payer: Cash Price	$471.68
Rate for Payer: Cash Price	$471.68
Rate for Payer: Cash Price	$471.68
Rate for Payer: Cigna Commercial	$825.46
Rate for Payer: Cigna Medicare	$364.39
Rate for Payer: Employer Direct Commercial	$364.39
Rate for Payer: Humana Medicare/TRICARE	$364.39
Rate for Payer: Molina Dual Medicare/Medicaid	$364.39
Rate for Payer: Molina Medicare	$364.39
Rate for Payer: Multiplan Auto	$348.40
Rate for Payer: Multiplan Commercial	$348.40
Rate for Payer: Multiplan Workers Comp	$348.40
Rate for Payer: Scott and White EPO/PPO	$6.52
Rate for Payer: Scott and White Medicare	$364.39
Rate for Payer: Superior Health Plan EPO	$364.39
Rate for Payer: Superior Health Plan Medicare	$364.39
Rate for Payer: Universal American Dual Medicare/Medicaid	$364.39
Rate for Payer: Universal American Medicare	$364.39
Rate for Payer: Wellcare Medicare	$364.39
Rate for Payer: Wellmed Medicare	$364.39

ED Line Procedure Intraosseous Infusion BCE

Facility

$536.00

Service Code	CPT 36680
Hospital Charge Code	5202573
Hospital Revenue Code	450
Min. Negotiated Rate	$6.52
Max. Negotiated Rate	$916.25
Rate for Payer: Aetna Commercial	$294.80
Rate for Payer: Aetna Medicare	$546.58
Rate for Payer: Amerigroup CHIP/Medicaid	$48.24
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$364.39
Rate for Payer: Amerigroup Medicare	$364.39
Rate for Payer: BCBS of TX Blue Advantage	$607.20
Rate for Payer: BCBS of TX Blue Essentials	$727.18
Rate for Payer: BCBS of TX Medicare	$364.39
Rate for Payer: BCBS of TX PPO	$916.25
Rate for Payer: Cash Price	$471.68
Rate for Payer: Cash Price	$471.68
Rate for Payer: Cash Price	$471.68
Rate for Payer: Cigna Commercial	$825.46
Rate for Payer: Cigna Medicare	$364.39
Rate for Payer: Employer Direct Commercial	$364.39
Rate for Payer: Humana Medicare/TRICARE	$364.39
Rate for Payer: Molina Dual Medicare/Medicaid	$364.39
Rate for Payer: Molina Medicare	$364.39
Rate for Payer: Multiplan Auto	$348.40
Rate for Payer: Multiplan Commercial	$348.40
Rate for Payer: Multiplan Workers Comp	$348.40
Rate for Payer: Scott and White EPO/PPO	$6.52
Rate for Payer: Scott and White Medicare	$364.39
Rate for Payer: Superior Health Plan EPO	$364.39
Rate for Payer: Superior Health Plan Medicare	$364.39
Rate for Payer: Universal American Dual Medicare/Medicaid	$364.39
Rate for Payer: Universal American Medicare	$364.39
Rate for Payer: Wellcare Medicare	$364.39
Rate for Payer: Wellmed Medicare	$364.39

ED Line Procedure Intraosseous Infusion BCE

Facility

$536.00

Service Code	CPT 36680
Hospital Charge Code	5202573
Hospital Revenue Code	450
Rate for Payer: Cash Price	$471.68

ED Nail Repair Procedure: Debridement of Nail 1-5

Facility

$203.00

Service Code	CPT 11720
Hospital Charge Code	7150246
Hospital Revenue Code	450
Rate for Payer: Cash Price	$178.64

ED Nail Repair Procedure: Debridement of Nail 1-5

Facility

$203.00

Service Code	CPT 11720
Hospital Charge Code	7150246
Hospital Revenue Code	450
Min. Negotiated Rate	$1.00
Max. Negotiated Rate	$138.63
Rate for Payer: Aetna Commercial	$111.65
Rate for Payer: Aetna Medicare	$83.91
Rate for Payer: Amerigroup CHIP/Medicaid	$18.27
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$55.94
Rate for Payer: Amerigroup Medicare	$55.94
Rate for Payer: BCBS of TX Blue Advantage	$91.87
Rate for Payer: BCBS of TX Blue Essentials	$110.02
Rate for Payer: BCBS of TX Medicare	$55.94
Rate for Payer: BCBS of TX PPO	$138.63
Rate for Payer: Cash Price	$178.64
Rate for Payer: Cash Price	$178.64
Rate for Payer: Cash Price	$178.64
Rate for Payer: Cigna Commercial	$126.71
Rate for Payer: Cigna Medicare	$55.94
Rate for Payer: Employer Direct Commercial	$55.94
Rate for Payer: Humana Medicare/TRICARE	$55.94
Rate for Payer: Molina Dual Medicare/Medicaid	$55.94
Rate for Payer: Molina Medicare	$55.94
Rate for Payer: Multiplan Auto	$131.95
Rate for Payer: Multiplan Commercial	$131.95
Rate for Payer: Multiplan Workers Comp	$131.95
Rate for Payer: Scott and White EPO/PPO	$1.00
Rate for Payer: Scott and White Medicare	$55.94
Rate for Payer: Superior Health Plan EPO	$55.94
Rate for Payer: Superior Health Plan Medicare	$55.94
Rate for Payer: Universal American Dual Medicare/Medicaid	$55.94
Rate for Payer: Universal American Medicare	$55.94
Rate for Payer: Wellcare Medicare	$55.94
Rate for Payer: Wellmed Medicare	$55.94

ED Nail Repair Procedure Debridement of Nail 1-5 BCE

Facility

$203.00

Service Code	CPT 11720
Hospital Charge Code	7150246
Hospital Revenue Code	450
Min. Negotiated Rate	$1.00
Max. Negotiated Rate	$138.63
Rate for Payer: Aetna Commercial	$111.65
Rate for Payer: Aetna Medicare	$83.91
Rate for Payer: Amerigroup CHIP/Medicaid	$18.27
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$55.94
Rate for Payer: Amerigroup Medicare	$55.94
Rate for Payer: BCBS of TX Blue Advantage	$91.87
Rate for Payer: BCBS of TX Blue Essentials	$110.02
Rate for Payer: BCBS of TX Medicare	$55.94
Rate for Payer: BCBS of TX PPO	$138.63
Rate for Payer: Cash Price	$178.64
Rate for Payer: Cash Price	$178.64
Rate for Payer: Cash Price	$178.64
Rate for Payer: Cigna Commercial	$126.71
Rate for Payer: Cigna Medicare	$55.94
Rate for Payer: Employer Direct Commercial	$55.94
Rate for Payer: Humana Medicare/TRICARE	$55.94
Rate for Payer: Molina Dual Medicare/Medicaid	$55.94
Rate for Payer: Molina Medicare	$55.94
Rate for Payer: Multiplan Auto	$131.95
Rate for Payer: Multiplan Commercial	$131.95
Rate for Payer: Multiplan Workers Comp	$131.95
Rate for Payer: Scott and White EPO/PPO	$1.00
Rate for Payer: Scott and White Medicare	$55.94
Rate for Payer: Superior Health Plan EPO	$55.94
Rate for Payer: Superior Health Plan Medicare	$55.94
Rate for Payer: Universal American Dual Medicare/Medicaid	$55.94
Rate for Payer: Universal American Medicare	$55.94
Rate for Payer: Wellcare Medicare	$55.94
Rate for Payer: Wellmed Medicare	$55.94

ED Nail Repair Procedure: Debridement of Nail 6+

Facility

$415.00

Service Code	CPT 11721
Hospital Charge Code	7150253
Hospital Revenue Code	450
Rate for Payer: Cash Price	$365.20

ED Nail Repair Procedure: Debridement of Nail 6+

Facility

$415.00

Service Code	CPT 11721
Hospital Charge Code	7150253
Hospital Revenue Code	450
Min. Negotiated Rate	$1.00
Max. Negotiated Rate	$269.75
Rate for Payer: Aetna Commercial	$228.25
Rate for Payer: Aetna Medicare	$83.91
Rate for Payer: Amerigroup CHIP/Medicaid	$37.35
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$55.94
Rate for Payer: Amerigroup Medicare	$55.94
Rate for Payer: BCBS of TX Blue Advantage	$91.87
Rate for Payer: BCBS of TX Blue Essentials	$110.02
Rate for Payer: BCBS of TX Medicare	$55.94
Rate for Payer: BCBS of TX PPO	$138.63
Rate for Payer: Cash Price	$365.20
Rate for Payer: Cash Price	$365.20
Rate for Payer: Cash Price	$365.20
Rate for Payer: Cigna Commercial	$126.71
Rate for Payer: Cigna Medicare	$55.94
Rate for Payer: Employer Direct Commercial	$55.94
Rate for Payer: Humana Medicare/TRICARE	$55.94
Rate for Payer: Molina Dual Medicare/Medicaid	$55.94
Rate for Payer: Molina Medicare	$55.94
Rate for Payer: Multiplan Auto	$269.75
Rate for Payer: Multiplan Commercial	$269.75
Rate for Payer: Multiplan Workers Comp	$269.75
Rate for Payer: Scott and White EPO/PPO	$1.00
Rate for Payer: Scott and White Medicare	$55.94
Rate for Payer: Superior Health Plan EPO	$55.94
Rate for Payer: Superior Health Plan Medicare	$55.94
Rate for Payer: Universal American Dual Medicare/Medicaid	$55.94
Rate for Payer: Universal American Medicare	$55.94
Rate for Payer: Wellcare Medicare	$55.94
Rate for Payer: Wellmed Medicare	$55.94

ED Nail Repair Procedure Debridement of Nail 6+ BCE

Facility

$415.00

Service Code	CPT 11721
Hospital Charge Code	7150253
Hospital Revenue Code	450
Min. Negotiated Rate	$1.00
Max. Negotiated Rate	$269.75
Rate for Payer: Aetna Commercial	$228.25
Rate for Payer: Aetna Medicare	$83.91
Rate for Payer: Amerigroup CHIP/Medicaid	$37.35
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$55.94
Rate for Payer: Amerigroup Medicare	$55.94
Rate for Payer: BCBS of TX Blue Advantage	$91.87
Rate for Payer: BCBS of TX Blue Essentials	$110.02
Rate for Payer: BCBS of TX Medicare	$55.94
Rate for Payer: BCBS of TX PPO	$138.63
Rate for Payer: Cash Price	$365.20
Rate for Payer: Cash Price	$365.20
Rate for Payer: Cash Price	$365.20
Rate for Payer: Cigna Commercial	$126.71
Rate for Payer: Cigna Medicare	$55.94
Rate for Payer: Employer Direct Commercial	$55.94
Rate for Payer: Humana Medicare/TRICARE	$55.94
Rate for Payer: Molina Dual Medicare/Medicaid	$55.94
Rate for Payer: Molina Medicare	$55.94
Rate for Payer: Multiplan Auto	$269.75
Rate for Payer: Multiplan Commercial	$269.75
Rate for Payer: Multiplan Workers Comp	$269.75
Rate for Payer: Scott and White EPO/PPO	$1.00
Rate for Payer: Scott and White Medicare	$55.94
Rate for Payer: Superior Health Plan EPO	$55.94
Rate for Payer: Superior Health Plan Medicare	$55.94
Rate for Payer: Universal American Dual Medicare/Medicaid	$55.94
Rate for Payer: Universal American Medicare	$55.94
Rate for Payer: Wellcare Medicare	$55.94
Rate for Payer: Wellmed Medicare	$55.94

ED Nail Repair Procedure: Evacuation of subungual hematoma

Facility

$308.00

Service Code	CPT 11740
Hospital Charge Code	5202574
Hospital Revenue Code	450
Min. Negotiated Rate	$2.09
Max. Negotiated Rate	$274.76
Rate for Payer: Aetna Commercial	$169.40
Rate for Payer: Aetna Medicare	$175.23
Rate for Payer: Amerigroup CHIP/Medicaid	$27.72
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$116.82
Rate for Payer: Amerigroup Medicare	$116.82
Rate for Payer: BCBS of TX Blue Advantage	$182.08
Rate for Payer: BCBS of TX Blue Essentials	$218.06
Rate for Payer: BCBS of TX Medicare	$116.82
Rate for Payer: BCBS of TX PPO	$274.76
Rate for Payer: Cash Price	$271.04
Rate for Payer: Cash Price	$271.04
Rate for Payer: Cash Price	$271.04
Rate for Payer: Cigna Commercial	$264.63
Rate for Payer: Cigna Medicare	$116.82
Rate for Payer: Employer Direct Commercial	$116.82
Rate for Payer: Humana Medicare/TRICARE	$116.82
Rate for Payer: Molina Dual Medicare/Medicaid	$116.82
Rate for Payer: Molina Medicare	$116.82
Rate for Payer: Multiplan Auto	$200.20
Rate for Payer: Multiplan Commercial	$200.20
Rate for Payer: Multiplan Workers Comp	$200.20
Rate for Payer: Scott and White EPO/PPO	$2.09
Rate for Payer: Scott and White Medicare	$116.82
Rate for Payer: Superior Health Plan EPO	$116.82
Rate for Payer: Superior Health Plan Medicare	$116.82
Rate for Payer: Universal American Dual Medicare/Medicaid	$116.82
Rate for Payer: Universal American Medicare	$116.82
Rate for Payer: Wellcare Medicare	$116.82
Rate for Payer: Wellmed Medicare	$116.82

Know your out-of-pocket cost for care.

All Charges