White Rock Medical Center

All Charges

Charge

Type

Setting

Price

ED Sedation - Same Physician First 15 mins < 5 years BCE

Facility

$488.00

Service Code	CPT 99151
Hospital Charge Code	5210309
Hospital Revenue Code	370
Rate for Payer: Cash Price	$429.44

ED Sedation - Same Physician First 15 mins < 5 years BCE

Facility

$488.00

Service Code	CPT 99151
Hospital Charge Code	5210309
Hospital Revenue Code	370
Min. Negotiated Rate	$43.92
Max. Negotiated Rate	$317.20
Rate for Payer: Aetna Commercial	$268.40
Rate for Payer: Amerigroup CHIP/Medicaid	$43.92
Rate for Payer: BCBS of TX Blue Advantage	$45.15
Rate for Payer: BCBS of TX Blue Essentials	$53.98
Rate for Payer: BCBS of TX PPO	$60.20
Rate for Payer: Cash Price	$429.44
Rate for Payer: Cash Price	$429.44
Rate for Payer: Multiplan Auto	$317.20
Rate for Payer: Multiplan Commercial	$317.20
Rate for Payer: Multiplan Workers Comp	$317.20
Rate for Payer: Scott and White EPO/PPO	$244.00
Rate for Payer: Superior Health Plan EPO	$66.37

ED Sedation - Same Physician First 15 mins >= 5 years BCE

Facility

$494.00

Service Code	CPT 99152
Hospital Charge Code	6100390
Hospital Revenue Code	370
Rate for Payer: Cash Price	$434.72

ED Sedation - Same Physician First 15 mins >= 5 years BCE

Facility

$494.00

Service Code	CPT 99152
Hospital Charge Code	6100390
Hospital Revenue Code	370
Min. Negotiated Rate	$21.94
Max. Negotiated Rate	$321.10
Rate for Payer: Aetna Commercial	$271.70
Rate for Payer: Amerigroup CHIP/Medicaid	$44.46
Rate for Payer: BCBS of TX Blue Advantage	$21.94
Rate for Payer: BCBS of TX Blue Essentials	$26.23
Rate for Payer: BCBS of TX PPO	$29.26
Rate for Payer: Cash Price	$434.72
Rate for Payer: Cash Price	$434.72
Rate for Payer: Multiplan Auto	$321.10
Rate for Payer: Multiplan Commercial	$321.10
Rate for Payer: Multiplan Workers Comp	$321.10
Rate for Payer: Scott and White EPO/PPO	$247.00
Rate for Payer: Superior Health Plan EPO	$67.18

ED SMPL RPR WND FACE/EAR/EYELID/NOSE/LIP 7.6 TO 12.5 CM BCE

Facility

$987.00

Service Code	CPT 12015
Hospital Charge Code	8422451
Hospital Revenue Code	450
Min. Negotiated Rate	$3.27
Max. Negotiated Rate	$641.55
Rate for Payer: Aetna Commercial	$542.85
Rate for Payer: Aetna Medicare	$274.64
Rate for Payer: Amerigroup CHIP/Medicaid	$88.83
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	$868.56
Rate for Payer: Cash Price	$868.56
Rate for Payer: Cash Price	$868.56
Rate for Payer: Cigna Commercial	$414.75
Rate for Payer: Cigna Medicaid	$74.34
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 CHIP/Medicaid	$74.34
Rate for Payer: Molina Dual Medicare/Medicaid	$183.09
Rate for Payer: Molina Medicare	$183.09
Rate for Payer: Multiplan Auto	$641.55
Rate for Payer: Multiplan Commercial	$641.55
Rate for Payer: Multiplan Workers Comp	$641.55
Rate for Payer: Parkland Medicaid	$74.34
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 CHIP/Medicaid	$74.34
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 SMPL RPR WND FACE/EAR/EYELID/NOSE/LIP 7.6 TO 12.5 CM BCE

Facility

$987.00

Service Code	CPT 12015
Hospital Charge Code	8422451
Hospital Revenue Code	450
Rate for Payer: Cash Price	$868.56

ED SMPL RPR WND S/N/A/GEN/TRNK 20.1 TO 30.0 CM BCE

Facility

$1,251.00

Service Code	CPT 12006
Hospital Charge Code	8414458
Hospital Revenue Code	450
Min. Negotiated Rate	$6.52
Max. Negotiated Rate	$826.08
Rate for Payer: Aetna Commercial	$688.05
Rate for Payer: Aetna Medicare	$547.00
Rate for Payer: Amerigroup CHIP/Medicaid	$112.59
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$364.67
Rate for Payer: Amerigroup Medicare	$364.67
Rate for Payer: BCBS of TX Blue Advantage	$533.58
Rate for Payer: BCBS of TX Blue Essentials	$639.02
Rate for Payer: BCBS of TX Medicare	$364.67
Rate for Payer: BCBS of TX PPO	$805.17
Rate for Payer: Cash Price	$1,100.88
Rate for Payer: Cash Price	$1,100.88
Rate for Payer: Cash Price	$1,100.88
Rate for Payer: Cigna Commercial	$826.08
Rate for Payer: Cigna Medicaid	$143.08
Rate for Payer: Cigna Medicare	$364.67
Rate for Payer: Employer Direct Commercial	$364.67
Rate for Payer: Humana Medicare/TRICARE	$364.67
Rate for Payer: Molina CHIP/Medicaid	$143.08
Rate for Payer: Molina Dual Medicare/Medicaid	$364.67
Rate for Payer: Molina Medicare	$364.67
Rate for Payer: Multiplan Auto	$813.15
Rate for Payer: Multiplan Commercial	$813.15
Rate for Payer: Multiplan Workers Comp	$813.15
Rate for Payer: Parkland Medicaid	$143.08
Rate for Payer: Scott and White EPO/PPO	$6.52
Rate for Payer: Scott and White Medicare	$364.67
Rate for Payer: Superior Health Plan CHIP/Medicaid	$143.08
Rate for Payer: Superior Health Plan EPO	$364.67
Rate for Payer: Superior Health Plan Medicare	$364.67
Rate for Payer: Universal American Dual Medicare/Medicaid	$364.67
Rate for Payer: Universal American Medicare	$364.67
Rate for Payer: Wellcare Medicare	$364.67
Rate for Payer: Wellmed Medicare	$364.67

ED SMPL RPR WND S/N/A/GEN/TRNK 20.1 TO 30.0 CM BCE

Facility

$1,251.00

Service Code	CPT 12006
Hospital Charge Code	8414458
Hospital Revenue Code	450
Rate for Payer: Cash Price	$1,100.88

ED Throat Procedures: Dental Surgery

Facility

$16,334.00

Service Code	CPT 41899
Hospital Charge Code	5202582
Hospital Revenue Code	450
Min. Negotiated Rate	$4.00
Max. Negotiated Rate	$10,617.10
Rate for Payer: Aetna Commercial	$8,983.70
Rate for Payer: Aetna Medicare	$335.08
Rate for Payer: Amerigroup CHIP/Medicaid	$1,470.06
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$223.39
Rate for Payer: Amerigroup Medicare	$223.39
Rate for Payer: BCBS of TX Blue Advantage	$340.08
Rate for Payer: BCBS of TX Blue Essentials	$407.28
Rate for Payer: BCBS of TX Medicare	$223.39
Rate for Payer: BCBS of TX PPO	$513.17
Rate for Payer: Cash Price	$14,373.92
Rate for Payer: Cash Price	$14,373.92
Rate for Payer: Cash Price	$14,373.92
Rate for Payer: Cigna Commercial	$506.05
Rate for Payer: Cigna Medicare	$223.39
Rate for Payer: Employer Direct Commercial	$223.39
Rate for Payer: Humana Medicare/TRICARE	$223.39
Rate for Payer: Molina Dual Medicare/Medicaid	$223.39
Rate for Payer: Molina Medicare	$223.39
Rate for Payer: Multiplan Auto	$10,617.10
Rate for Payer: Multiplan Commercial	$10,617.10
Rate for Payer: Multiplan Workers Comp	$10,617.10
Rate for Payer: Scott and White EPO/PPO	$4.00
Rate for Payer: Scott and White Medicare	$223.39
Rate for Payer: Superior Health Plan EPO	$223.39
Rate for Payer: Superior Health Plan Medicare	$223.39
Rate for Payer: Universal American Dual Medicare/Medicaid	$223.39
Rate for Payer: Universal American Medicare	$223.39
Rate for Payer: Wellcare Medicare	$223.39
Rate for Payer: Wellmed Medicare	$223.39

ED Throat Procedures: Dental Surgery

Facility

$16,334.00

Service Code	CPT 41899
Hospital Charge Code	5202582
Hospital Revenue Code	450
Rate for Payer: Cash Price	$14,373.92

ED Throat Procedures Dental Surgery BCE

Facility

$16,334.00

Service Code	CPT 41899
Hospital Charge Code	5202582
Hospital Revenue Code	450
Min. Negotiated Rate	$4.00
Max. Negotiated Rate	$10,617.10
Rate for Payer: Aetna Commercial	$8,983.70
Rate for Payer: Aetna Medicare	$335.08
Rate for Payer: Amerigroup CHIP/Medicaid	$1,470.06
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$223.39
Rate for Payer: Amerigroup Medicare	$223.39
Rate for Payer: BCBS of TX Blue Advantage	$340.08
Rate for Payer: BCBS of TX Blue Essentials	$407.28
Rate for Payer: BCBS of TX Medicare	$223.39
Rate for Payer: BCBS of TX PPO	$513.17
Rate for Payer: Cash Price	$14,373.92
Rate for Payer: Cash Price	$14,373.92
Rate for Payer: Cash Price	$14,373.92
Rate for Payer: Cigna Commercial	$506.05
Rate for Payer: Cigna Medicare	$223.39
Rate for Payer: Employer Direct Commercial	$223.39
Rate for Payer: Humana Medicare/TRICARE	$223.39
Rate for Payer: Molina Dual Medicare/Medicaid	$223.39
Rate for Payer: Molina Medicare	$223.39
Rate for Payer: Multiplan Auto	$10,617.10
Rate for Payer: Multiplan Commercial	$10,617.10
Rate for Payer: Multiplan Workers Comp	$10,617.10
Rate for Payer: Scott and White EPO/PPO	$4.00
Rate for Payer: Scott and White Medicare	$223.39
Rate for Payer: Superior Health Plan EPO	$223.39
Rate for Payer: Superior Health Plan Medicare	$223.39
Rate for Payer: Universal American Dual Medicare/Medicaid	$223.39
Rate for Payer: Universal American Medicare	$223.39
Rate for Payer: Wellcare Medicare	$223.39
Rate for Payer: Wellmed Medicare	$223.39

ED TRACHEOTOMY TUBE CHANGE PRIOR TO FISTULA TRACT BCE

Facility

$1,091.00

Service Code	CPT 31502
Hospital Charge Code	8686546
Hospital Revenue Code	450
Rate for Payer: Cash Price	$960.08

ED TRACHEOTOMY TUBE CHANGE PRIOR TO FISTULA TRACT BCE

Facility

$1,091.00

Service Code	CPT 31502
Hospital Charge Code	8686546
Hospital Revenue Code	450
Min. Negotiated Rate	$4.00
Max. Negotiated Rate	$709.15
Rate for Payer: Aetna Commercial	$600.05
Rate for Payer: Aetna Medicare	$335.08
Rate for Payer: Amerigroup CHIP/Medicaid	$98.19
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$223.39
Rate for Payer: Amerigroup Medicare	$223.39
Rate for Payer: BCBS of TX Blue Advantage	$340.08
Rate for Payer: BCBS of TX Blue Essentials	$407.28
Rate for Payer: BCBS of TX Medicare	$223.39
Rate for Payer: BCBS of TX PPO	$513.17
Rate for Payer: Cash Price	$960.08
Rate for Payer: Cash Price	$960.08
Rate for Payer: Cash Price	$960.08
Rate for Payer: Cigna Commercial	$506.05
Rate for Payer: Cigna Medicaid	$87.58
Rate for Payer: Cigna Medicare	$223.39
Rate for Payer: Employer Direct Commercial	$223.39
Rate for Payer: Humana Medicare/TRICARE	$223.39
Rate for Payer: Molina CHIP/Medicaid	$87.58
Rate for Payer: Molina Dual Medicare/Medicaid	$223.39
Rate for Payer: Molina Medicare	$223.39
Rate for Payer: Multiplan Auto	$709.15
Rate for Payer: Multiplan Commercial	$709.15
Rate for Payer: Multiplan Workers Comp	$709.15
Rate for Payer: Parkland Medicaid	$87.58
Rate for Payer: Scott and White EPO/PPO	$4.00
Rate for Payer: Scott and White Medicare	$223.39
Rate for Payer: Superior Health Plan CHIP/Medicaid	$87.58
Rate for Payer: Superior Health Plan EPO	$223.39
Rate for Payer: Superior Health Plan Medicare	$223.39
Rate for Payer: Universal American Dual Medicare/Medicaid	$223.39
Rate for Payer: Universal American Medicare	$223.39
Rate for Payer: Wellcare Medicare	$223.39
Rate for Payer: Wellmed Medicare	$223.39

ED TX FX METACARPAL W/O MAN CLSD BCE

Facility

$745.00

Service Code	CPT 26600
Hospital Charge Code	8694547
Hospital Revenue Code	450
Rate for Payer: Cash Price	$655.60

ED TX FX METACARPAL W/O MAN CLSD BCE

Facility

$745.00

Service Code	CPT 26600
Hospital Charge Code	8694547
Hospital Revenue Code	450
Min. Negotiated Rate	$3.86
Max. Negotiated Rate	$488.55
Rate for Payer: Aetna Commercial	$409.75
Rate for Payer: Aetna Medicare	$323.50
Rate for Payer: Amerigroup CHIP/Medicaid	$67.05
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$215.67
Rate for Payer: Amerigroup Medicare	$215.67
Rate for Payer: BCBS of TX Blue Advantage	$181.96
Rate for Payer: BCBS of TX Blue Essentials	$217.92
Rate for Payer: BCBS of TX Medicare	$215.67
Rate for Payer: BCBS of TX PPO	$274.58
Rate for Payer: Cash Price	$655.60
Rate for Payer: Cash Price	$655.60
Rate for Payer: Cash Price	$655.60
Rate for Payer: Cigna Commercial	$488.55
Rate for Payer: Cigna Medicaid	$85.32
Rate for Payer: Cigna Medicare	$215.67
Rate for Payer: Employer Direct Commercial	$215.67
Rate for Payer: Humana Medicare/TRICARE	$215.67
Rate for Payer: Molina CHIP/Medicaid	$85.32
Rate for Payer: Molina Dual Medicare/Medicaid	$215.67
Rate for Payer: Molina Medicare	$215.67
Rate for Payer: Multiplan Auto	$484.25
Rate for Payer: Multiplan Commercial	$484.25
Rate for Payer: Multiplan Workers Comp	$484.25
Rate for Payer: Parkland Medicaid	$85.32
Rate for Payer: Scott and White EPO/PPO	$3.86
Rate for Payer: Scott and White Medicare	$215.67
Rate for Payer: Superior Health Plan CHIP/Medicaid	$85.32
Rate for Payer: Superior Health Plan EPO	$215.67
Rate for Payer: Superior Health Plan Medicare	$215.67
Rate for Payer: Universal American Dual Medicare/Medicaid	$215.67
Rate for Payer: Universal American Medicare	$215.67
Rate for Payer: Wellcare Medicare	$215.67
Rate for Payer: Wellmed Medicare	$215.67

ED TX FX TIBIAL SHAFT W/O MAN CLSD BCE

Facility

$834.00

Service Code	CPT 27750
Hospital Charge Code	8764560
Hospital Revenue Code	450
Rate for Payer: Cash Price	$733.92

ED TX FX TIBIAL SHAFT W/O MAN CLSD BCE

Facility

$834.00

Service Code	CPT 27750
Hospital Charge Code	8764560
Hospital Revenue Code	450
Min. Negotiated Rate	$3.86
Max. Negotiated Rate	$543.41
Rate for Payer: Aetna Commercial	$458.70
Rate for Payer: Aetna Medicare	$323.50
Rate for Payer: Amerigroup CHIP/Medicaid	$75.06
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$215.67
Rate for Payer: Amerigroup Medicare	$215.67
Rate for Payer: BCBS of TX Blue Advantage	$360.12
Rate for Payer: BCBS of TX Blue Essentials	$431.28
Rate for Payer: BCBS of TX Medicare	$215.67
Rate for Payer: BCBS of TX PPO	$543.41
Rate for Payer: Cash Price	$733.92
Rate for Payer: Cash Price	$733.92
Rate for Payer: Cash Price	$733.92
Rate for Payer: Cigna Commercial	$488.55
Rate for Payer: Cigna Medicaid	$85.32
Rate for Payer: Cigna Medicare	$215.67
Rate for Payer: Employer Direct Commercial	$215.67
Rate for Payer: Humana Medicare/TRICARE	$215.67
Rate for Payer: Molina CHIP/Medicaid	$85.32
Rate for Payer: Molina Dual Medicare/Medicaid	$215.67
Rate for Payer: Molina Medicare	$215.67
Rate for Payer: Multiplan Auto	$542.10
Rate for Payer: Multiplan Commercial	$542.10
Rate for Payer: Multiplan Workers Comp	$542.10
Rate for Payer: Parkland Medicaid	$85.32
Rate for Payer: Scott and White EPO/PPO	$3.86
Rate for Payer: Scott and White Medicare	$215.67
Rate for Payer: Superior Health Plan CHIP/Medicaid	$85.32
Rate for Payer: Superior Health Plan EPO	$215.67
Rate for Payer: Superior Health Plan Medicare	$215.67
Rate for Payer: Universal American Dual Medicare/Medicaid	$215.67
Rate for Payer: Universal American Medicare	$215.67
Rate for Payer: Wellcare Medicare	$215.67
Rate for Payer: Wellmed Medicare	$215.67

ED TX SPONTAN HIP DISLC ABDCT SPLNT/TRCJ W/O ANES BCE

Facility

$1,067.00

Service Code	CPT 27256
Hospital Charge Code	8622505
Hospital Revenue Code	450
Min. Negotiated Rate	$3.86
Max. Negotiated Rate	$693.55
Rate for Payer: Aetna Commercial	$586.85
Rate for Payer: Aetna Medicare	$323.50
Rate for Payer: Amerigroup CHIP/Medicaid	$96.03
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$215.67
Rate for Payer: Amerigroup Medicare	$215.67
Rate for Payer: BCBS of TX Blue Advantage	$360.12
Rate for Payer: BCBS of TX Blue Essentials	$431.28
Rate for Payer: BCBS of TX Medicare	$215.67
Rate for Payer: BCBS of TX PPO	$543.41
Rate for Payer: Cash Price	$938.96
Rate for Payer: Cash Price	$938.96
Rate for Payer: Cash Price	$938.96
Rate for Payer: Cigna Commercial	$488.55
Rate for Payer: Cigna Medicaid	$85.32
Rate for Payer: Cigna Medicare	$215.67
Rate for Payer: Employer Direct Commercial	$215.67
Rate for Payer: Humana Medicare/TRICARE	$215.67
Rate for Payer: Molina CHIP/Medicaid	$85.32
Rate for Payer: Molina Dual Medicare/Medicaid	$215.67
Rate for Payer: Molina Medicare	$215.67
Rate for Payer: Multiplan Auto	$693.55
Rate for Payer: Multiplan Commercial	$693.55
Rate for Payer: Multiplan Workers Comp	$693.55
Rate for Payer: Parkland Medicaid	$85.32
Rate for Payer: Scott and White EPO/PPO	$3.86
Rate for Payer: Scott and White Medicare	$215.67
Rate for Payer: Superior Health Plan CHIP/Medicaid	$85.32
Rate for Payer: Superior Health Plan EPO	$215.67
Rate for Payer: Superior Health Plan Medicare	$215.67
Rate for Payer: Universal American Dual Medicare/Medicaid	$215.67
Rate for Payer: Universal American Medicare	$215.67
Rate for Payer: Wellcare Medicare	$215.67
Rate for Payer: Wellmed Medicare	$215.67

ED TX SPONTAN HIP DISLC ABDCT SPLNT/TRCJ W/O ANES BCE

Facility

$1,067.00

Service Code	CPT 27256
Hospital Charge Code	8622505
Hospital Revenue Code	450
Rate for Payer: Cash Price	$938.96

ED UNLISTED PROCEDURE ESOPHAGUS BCE

Facility

$7,811.00

Service Code	CPT 43499
Hospital Charge Code	8398501
Hospital Revenue Code	450
Min. Negotiated Rate	$14.83
Max. Negotiated Rate	$5,077.15
Rate for Payer: Aetna Commercial	$2,200.00
Rate for Payer: Aetna Medicare	$1,243.53
Rate for Payer: Amerigroup CHIP/Medicaid	$702.99
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$829.02
Rate for Payer: Amerigroup Medicare	$829.02
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	$829.02
Rate for Payer: BCBS of TX PPO	$1,980.52
Rate for Payer: Cash Price	$6,873.68
Rate for Payer: Cash Price	$6,873.68
Rate for Payer: Cash Price	$6,873.68
Rate for Payer: Cigna Commercial	$1,877.98
Rate for Payer: Cigna Medicare	$829.02
Rate for Payer: Employer Direct Commercial	$829.02
Rate for Payer: Humana Medicare/TRICARE	$829.02
Rate for Payer: Molina Dual Medicare/Medicaid	$829.02
Rate for Payer: Molina Medicare	$829.02
Rate for Payer: Multiplan Auto	$5,077.15
Rate for Payer: Multiplan Commercial	$5,077.15
Rate for Payer: Multiplan Workers Comp	$5,077.15
Rate for Payer: Scott and White EPO/PPO	$14.83
Rate for Payer: Scott and White Medicare	$829.02
Rate for Payer: Superior Health Plan EPO	$829.02
Rate for Payer: Superior Health Plan Medicare	$829.02
Rate for Payer: Universal American Dual Medicare/Medicaid	$829.02
Rate for Payer: Universal American Medicare	$829.02
Rate for Payer: Wellcare Medicare	$829.02
Rate for Payer: Wellmed Medicare	$829.02

ED UNLISTED PROCEDURE ESOPHAGUS BCE

Facility

$7,811.00

Service Code	CPT 43499
Hospital Charge Code	8398501
Hospital Revenue Code	450
Rate for Payer: Cash Price	$6,873.68

ED WEDGE EXCISION SKIN NAIL FOLD (EG, TOENAIL) BCE

Facility

$828.00

Service Code	CPT 11765
Hospital Charge Code	8578508
Hospital Revenue Code	450
Min. Negotiated Rate	$6.52
Max. Negotiated Rate	$826.08
Rate for Payer: Molina Medicare	$364.67
Rate for Payer: Multiplan Auto	$538.20
Rate for Payer: Multiplan Commercial	$538.20
Rate for Payer: Multiplan Workers Comp	$538.20
Rate for Payer: Scott and White EPO/PPO	$6.52
Rate for Payer: Scott and White Medicare	$364.67
Rate for Payer: Aetna Commercial	$455.40
Rate for Payer: Aetna Medicare	$547.00
Rate for Payer: Amerigroup CHIP/Medicaid	$74.52
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$364.67
Rate for Payer: Amerigroup Medicare	$364.67
Rate for Payer: BCBS of TX Blue Advantage	$533.58
Rate for Payer: BCBS of TX Blue Essentials	$639.02
Rate for Payer: BCBS of TX Medicare	$364.67
Rate for Payer: BCBS of TX PPO	$805.17
Rate for Payer: Cash Price	$728.64
Rate for Payer: Cash Price	$728.64
Rate for Payer: Cash Price	$728.64
Rate for Payer: Cigna Commercial	$826.08
Rate for Payer: Cigna Medicare	$364.67
Rate for Payer: Employer Direct Commercial	$364.67
Rate for Payer: Humana Medicare/TRICARE	$364.67
Rate for Payer: Molina Dual Medicare/Medicaid	$364.67
Rate for Payer: Superior Health Plan EPO	$364.67
Rate for Payer: Superior Health Plan Medicare	$364.67
Rate for Payer: Universal American Dual Medicare/Medicaid	$364.67
Rate for Payer: Universal American Medicare	$364.67
Rate for Payer: Wellcare Medicare	$364.67
Rate for Payer: Wellmed Medicare	$364.67

ED WEDGE EXCISION SKIN NAIL FOLD (EG, TOENAIL) BCE

Facility

$828.00

Service Code	CPT 11765
Hospital Charge Code	8578508
Hospital Revenue Code	450
Rate for Payer: Cash Price	$728.64

ED Wound Dehiscence: Superficial

Facility

$1,641.00

Service Code	CPT 12020
Hospital Charge Code	5202583
Hospital Revenue Code	450
Min. Negotiated Rate	$10.27
Max. Negotiated Rate	$1,301.14
Rate for Payer: Aetna Commercial	$902.55
Rate for Payer: Aetna Medicare	$861.57
Rate for Payer: Amerigroup CHIP/Medicaid	$147.69
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$574.38
Rate for Payer: Amerigroup Medicare	$574.38
Rate for Payer: BCBS of TX Blue Advantage	$830.02
Rate for Payer: BCBS of TX Blue Essentials	$994.04
Rate for Payer: BCBS of TX Medicare	$574.38
Rate for Payer: BCBS of TX PPO	$1,252.49
Rate for Payer: Cash Price	$1,444.08
Rate for Payer: Cash Price	$1,444.08
Rate for Payer: Cash Price	$1,444.08
Rate for Payer: Cigna Commercial	$1,301.14
Rate for Payer: Cigna Medicaid	$216.80
Rate for Payer: Cigna Medicare	$574.38
Rate for Payer: Employer Direct Commercial	$574.38
Rate for Payer: Humana Medicare/TRICARE	$574.38
Rate for Payer: Molina CHIP/Medicaid	$216.80
Rate for Payer: Molina Dual Medicare/Medicaid	$574.38
Rate for Payer: Molina Medicare	$574.38
Rate for Payer: Multiplan Auto	$1,066.65
Rate for Payer: Multiplan Commercial	$1,066.65
Rate for Payer: Multiplan Workers Comp	$1,066.65
Rate for Payer: Parkland Medicaid	$216.80
Rate for Payer: Scott and White EPO/PPO	$10.27
Rate for Payer: Scott and White Medicare	$574.38
Rate for Payer: Superior Health Plan CHIP/Medicaid	$216.80
Rate for Payer: Superior Health Plan EPO	$574.38
Rate for Payer: Superior Health Plan Medicare	$574.38
Rate for Payer: Universal American Dual Medicare/Medicaid	$574.38
Rate for Payer: Universal American Medicare	$574.38
Rate for Payer: Wellcare Medicare	$574.38
Rate for Payer: Wellmed Medicare	$574.38

ED Wound Dehiscence Superficial BCE

Facility

$1,641.00

Service Code	CPT 12020
Hospital Charge Code	5202583
Hospital Revenue Code	450
Rate for Payer: Cash Price	$1,444.08

Know your out-of-pocket cost for care.

All Charges