White Rock Medical Center

All Charges

Charge

Type

Setting

Price

COLL & INTERP DATA EA 30 DAYS

Facility

$613.00

Service Code	HCPCS 99091
Hospital Charge Code	6019904
Hospital Revenue Code	510
Rate for Payer: Cash Price	$416.84

COLL & INTERP DATA EA 30 DAYS

Facility

$613.00

Service Code	HCPCS 99091
Hospital Charge Code	6019904
Hospital Revenue Code	510
Min. Negotiated Rate	$55.17
Max. Negotiated Rate	$441.36
Rate for Payer: Amerigroup CHIP/Medicaid	$55.17
Rate for Payer: BCBS of TX Blue Advantage	$183.90
Rate for Payer: BCBS of TX Blue Essentials	$220.68
Rate for Payer: BCBS of TX PPO	$245.20
Rate for Payer: Cash Price	$416.84
Rate for Payer: Cash Price	$416.84
Rate for Payer: Cigna Medicaid	$441.36
Rate for Payer: Molina CHIP/Medicaid	$441.36
Rate for Payer: Multiplan Auto	$398.45
Rate for Payer: Multiplan Commercial	$398.45
Rate for Payer: Multiplan Workers Comp	$398.45
Rate for Payer: Parkland Medicaid	$441.36
Rate for Payer: Scott and White EPO/PPO	$66.11
Rate for Payer: Superior Health Plan CHIP/Medicaid	$441.36

Colonoscopy, flexible diagnostic, including collection of specimen(s) by brushing or washing, when

Facility

$4,761.90

Service Code	HCPCS 45378
Hospital Charge Code	9900699
Hospital Revenue Code	360
Min. Negotiated Rate	$328.50
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$328.50
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$934.20
Rate for Payer: Amerigroup Medicare	$934.20
Rate for Payer: BCBS of TX Blue Advantage	$1,275.68
Rate for Payer: BCBS of TX Blue Essentials	$1,527.76
Rate for Payer: BCBS of TX Medicare	$934.20
Rate for Payer: BCBS of TX PPO	$1,924.98
Rate for Payer: Cash Price	$3,238.09
Rate for Payer: Cash Price	$3,238.09
Rate for Payer: Cash Price	$3,238.09
Rate for Payer: Cigna Commercial	$1,974.73
Rate for Payer: Cigna Medicaid	$3,428.57
Rate for Payer: Cigna Medicare	$934.20
Rate for Payer: Employer Direct Commercial	$934.20
Rate for Payer: Humana Medicare/TRICARE	$934.20
Rate for Payer: Molina CHIP/Medicaid	$3,428.57
Rate for Payer: Molina Dual Medicare/Medicaid	$934.20
Rate for Payer: Molina Medicare	$934.20
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	$3,428.57
Rate for Payer: Scott and White EPO/PPO	$1,546.34
Rate for Payer: Scott and White Medicare	$934.20
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3,428.57
Rate for Payer: Superior Health Plan EPO	$934.20
Rate for Payer: Superior Health Plan Medicare	$934.20
Rate for Payer: Universal American Dual Medicare/Medicaid	$934.20
Rate for Payer: Universal American Medicare	$934.20
Rate for Payer: Wellcare Medicare	$934.20
Rate for Payer: Wellmed Medicare	$934.20

Colonoscopy, flexible diagnostic, including collection of specimen(s) by brushing or washing, when

Facility

$4,761.90

Service Code	HCPCS 45378
Hospital Charge Code	9900699
Hospital Revenue Code	360
Rate for Payer: Cash Price	$3,238.09

Colonoscopy, flexible diagnostic, including collection of specimen(s) by brushing or washing, when

Facility

$10,000.00

Service Code	CPT 45378
Hospital Charge Code	36045378
Hospital Revenue Code	360
Min. Negotiated Rate	$328.50
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$328.50
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$934.20
Rate for Payer: Amerigroup Medicare	$934.20
Rate for Payer: BCBS of TX Blue Advantage	$1,275.68
Rate for Payer: BCBS of TX Blue Essentials	$1,527.76
Rate for Payer: BCBS of TX Medicare	$934.20
Rate for Payer: BCBS of TX PPO	$1,924.98
Rate for Payer: Cigna Commercial	$1,974.73
Rate for Payer: Cigna Medicare	$934.20
Rate for Payer: Employer Direct Commercial	$934.20
Rate for Payer: Humana Medicare/TRICARE	$934.20
Rate for Payer: Molina Dual Medicare/Medicaid	$934.20
Rate for Payer: Molina Medicare	$934.20
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	$1,546.34
Rate for Payer: Scott and White Medicare	$934.20
Rate for Payer: Superior Health Plan EPO	$934.20
Rate for Payer: Superior Health Plan Medicare	$934.20
Rate for Payer: Universal American Dual Medicare/Medicaid	$934.20
Rate for Payer: Universal American Medicare	$934.20
Rate for Payer: Wellcare Medicare	$934.20
Rate for Payer: Wellmed Medicare	$934.20

Colonoscopy, flexible; with biopsy, single or multiple

Facility

$8,295.68

Service Code	HCPCS 45380
Hospital Charge Code	9900700
Hospital Revenue Code	360
Min. Negotiated Rate	$429.26
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$429.26
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$1,202.09
Rate for Payer: Amerigroup Medicare	$1,202.09
Rate for Payer: BCBS of TX Blue Advantage	$1,677.05
Rate for Payer: BCBS of TX Blue Essentials	$2,008.44
Rate for Payer: BCBS of TX Medicare	$1,202.09
Rate for Payer: BCBS of TX PPO	$2,530.63
Rate for Payer: Cash Price	$5,641.06
Rate for Payer: Cash Price	$5,641.06
Rate for Payer: Cash Price	$5,641.06
Rate for Payer: Cigna Commercial	$2,541.00
Rate for Payer: Cigna Medicaid	$5,972.89
Rate for Payer: Cigna Medicare	$1,202.09
Rate for Payer: Employer Direct Commercial	$1,202.09
Rate for Payer: Humana Medicare/TRICARE	$1,202.09
Rate for Payer: Molina CHIP/Medicaid	$5,972.89
Rate for Payer: Molina Dual Medicare/Medicaid	$1,202.09
Rate for Payer: Molina Medicare	$1,202.09
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	$5,972.89
Rate for Payer: Scott and White EPO/PPO	$1,996.58
Rate for Payer: Scott and White Medicare	$1,202.09
Rate for Payer: Superior Health Plan CHIP/Medicaid	$5,972.89
Rate for Payer: Superior Health Plan EPO	$1,202.09
Rate for Payer: Superior Health Plan Medicare	$1,202.09
Rate for Payer: Universal American Dual Medicare/Medicaid	$1,202.09
Rate for Payer: Universal American Medicare	$1,202.09
Rate for Payer: Wellcare Medicare	$1,202.09
Rate for Payer: Wellmed Medicare	$1,202.09

Colonoscopy, flexible; with biopsy, single or multiple

Facility

$8,295.68

Service Code	HCPCS 45380
Hospital Charge Code	9900700
Hospital Revenue Code	360
Rate for Payer: Cash Price	$5,641.06

Colonoscopy, flexible; with biopsy, single or multiple

Facility

$10,000.00

Service Code	CPT 45380
Hospital Charge Code	36045380
Hospital Revenue Code	360
Min. Negotiated Rate	$429.26
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$429.26
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$1,202.09
Rate for Payer: Amerigroup Medicare	$1,202.09
Rate for Payer: BCBS of TX Blue Advantage	$1,677.05
Rate for Payer: BCBS of TX Blue Essentials	$2,008.44
Rate for Payer: BCBS of TX Medicare	$1,202.09
Rate for Payer: BCBS of TX PPO	$2,530.63
Rate for Payer: Cigna Commercial	$2,541.00
Rate for Payer: Cigna Medicare	$1,202.09
Rate for Payer: Employer Direct Commercial	$1,202.09
Rate for Payer: Humana Medicare/TRICARE	$1,202.09
Rate for Payer: Molina Dual Medicare/Medicaid	$1,202.09
Rate for Payer: Molina Medicare	$1,202.09
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	$1,996.58
Rate for Payer: Scott and White Medicare	$1,202.09
Rate for Payer: Superior Health Plan EPO	$1,202.09
Rate for Payer: Superior Health Plan Medicare	$1,202.09
Rate for Payer: Universal American Dual Medicare/Medicaid	$1,202.09
Rate for Payer: Universal American Medicare	$1,202.09
Rate for Payer: Wellcare Medicare	$1,202.09
Rate for Payer: Wellmed Medicare	$1,202.09

Colonoscopy, flexible with directed submucosal injection(s), any substance

Facility

$6,221.76

Service Code	HCPCS 45381
Hospital Charge Code	9900701
Hospital Revenue Code	360
Min. Negotiated Rate	$429.26
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$429.26
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$1,202.09
Rate for Payer: Amerigroup Medicare	$1,202.09
Rate for Payer: BCBS of TX Blue Advantage	$1,677.05
Rate for Payer: BCBS of TX Blue Essentials	$2,008.44
Rate for Payer: BCBS of TX Medicare	$1,202.09
Rate for Payer: BCBS of TX PPO	$2,530.63
Rate for Payer: Cash Price	$4,230.80
Rate for Payer: Cash Price	$4,230.80
Rate for Payer: Cash Price	$4,230.80
Rate for Payer: Cigna Commercial	$2,541.00
Rate for Payer: Cigna Medicaid	$4,479.67
Rate for Payer: Cigna Medicare	$1,202.09
Rate for Payer: Employer Direct Commercial	$1,202.09
Rate for Payer: Humana Medicare/TRICARE	$1,202.09
Rate for Payer: Molina CHIP/Medicaid	$4,479.67
Rate for Payer: Molina Dual Medicare/Medicaid	$1,202.09
Rate for Payer: Molina Medicare	$1,202.09
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	$4,479.67
Rate for Payer: Scott and White EPO/PPO	$1,996.58
Rate for Payer: Scott and White Medicare	$1,202.09
Rate for Payer: Superior Health Plan CHIP/Medicaid	$4,479.67
Rate for Payer: Superior Health Plan EPO	$1,202.09
Rate for Payer: Superior Health Plan Medicare	$1,202.09
Rate for Payer: Universal American Dual Medicare/Medicaid	$1,202.09
Rate for Payer: Universal American Medicare	$1,202.09
Rate for Payer: Wellcare Medicare	$1,202.09
Rate for Payer: Wellmed Medicare	$1,202.09

Colonoscopy, flexible with directed submucosal injection(s), any substance

Facility

$10,000.00

Service Code	CPT 45381
Hospital Charge Code	36045381
Hospital Revenue Code	360
Min. Negotiated Rate	$429.26
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$429.26
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$1,202.09
Rate for Payer: Amerigroup Medicare	$1,202.09
Rate for Payer: BCBS of TX Blue Advantage	$1,677.05
Rate for Payer: BCBS of TX Blue Essentials	$2,008.44
Rate for Payer: BCBS of TX Medicare	$1,202.09
Rate for Payer: BCBS of TX PPO	$2,530.63
Rate for Payer: Cigna Commercial	$2,541.00
Rate for Payer: Cigna Medicare	$1,202.09
Rate for Payer: Employer Direct Commercial	$1,202.09
Rate for Payer: Humana Medicare/TRICARE	$1,202.09
Rate for Payer: Molina Dual Medicare/Medicaid	$1,202.09
Rate for Payer: Molina Medicare	$1,202.09
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	$1,996.58
Rate for Payer: Scott and White Medicare	$1,202.09
Rate for Payer: Superior Health Plan EPO	$1,202.09
Rate for Payer: Superior Health Plan Medicare	$1,202.09
Rate for Payer: Universal American Dual Medicare/Medicaid	$1,202.09
Rate for Payer: Universal American Medicare	$1,202.09
Rate for Payer: Wellcare Medicare	$1,202.09
Rate for Payer: Wellmed Medicare	$1,202.09

Colonoscopy, flexible with directed submucosal injection(s), any substance

Facility

$6,221.76

Service Code	HCPCS 45381
Hospital Charge Code	9900701
Hospital Revenue Code	360
Rate for Payer: Cash Price	$4,230.80

Colonoscopy, flexible with removal of tumor(s), polyp(s), or other lesion(s) by snare technique

Facility

$10,000.00

Service Code	CPT 45385
Hospital Charge Code	36045385
Hospital Revenue Code	360
Min. Negotiated Rate	$429.26
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$429.26
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$1,202.09
Rate for Payer: Amerigroup Medicare	$1,202.09
Rate for Payer: BCBS of TX Blue Advantage	$1,677.05
Rate for Payer: BCBS of TX Blue Essentials	$2,008.44
Rate for Payer: BCBS of TX Medicare	$1,202.09
Rate for Payer: BCBS of TX PPO	$2,530.63
Rate for Payer: Cigna Commercial	$2,541.00
Rate for Payer: Cigna Medicare	$1,202.09
Rate for Payer: Employer Direct Commercial	$1,202.09
Rate for Payer: Humana Medicare/TRICARE	$1,202.09
Rate for Payer: Molina Dual Medicare/Medicaid	$1,202.09
Rate for Payer: Molina Medicare	$1,202.09
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	$1,996.58
Rate for Payer: Scott and White Medicare	$1,202.09
Rate for Payer: Superior Health Plan EPO	$1,202.09
Rate for Payer: Superior Health Plan Medicare	$1,202.09
Rate for Payer: Universal American Dual Medicare/Medicaid	$1,202.09
Rate for Payer: Universal American Medicare	$1,202.09
Rate for Payer: Wellcare Medicare	$1,202.09
Rate for Payer: Wellmed Medicare	$1,202.09

Colonoscopy, flexible with removal of tumor(s), polyp(s), or other lesion(s) by snare technique

Facility

$4,497.44

Service Code	HCPCS 45385
Hospital Charge Code	9900702
Hospital Revenue Code	360
Rate for Payer: Cash Price	$3,058.26

Colonoscopy, flexible with removal of tumor(s), polyp(s), or other lesion(s) by snare technique

Facility

$4,497.44

Service Code	HCPCS 45385
Hospital Charge Code	9900702
Hospital Revenue Code	360
Min. Negotiated Rate	$429.26
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$429.26
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$1,202.09
Rate for Payer: Amerigroup Medicare	$1,202.09
Rate for Payer: BCBS of TX Blue Advantage	$1,677.05
Rate for Payer: BCBS of TX Blue Essentials	$2,008.44
Rate for Payer: BCBS of TX Medicare	$1,202.09
Rate for Payer: BCBS of TX PPO	$2,530.63
Rate for Payer: Cash Price	$3,058.26
Rate for Payer: Cash Price	$3,058.26
Rate for Payer: Cash Price	$3,058.26
Rate for Payer: Cigna Commercial	$2,541.00
Rate for Payer: Cigna Medicaid	$3,238.16
Rate for Payer: Cigna Medicare	$1,202.09
Rate for Payer: Employer Direct Commercial	$1,202.09
Rate for Payer: Humana Medicare/TRICARE	$1,202.09
Rate for Payer: Molina CHIP/Medicaid	$3,238.16
Rate for Payer: Molina Dual Medicare/Medicaid	$1,202.09
Rate for Payer: Molina Medicare	$1,202.09
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	$3,238.16
Rate for Payer: Scott and White EPO/PPO	$1,996.58
Rate for Payer: Scott and White Medicare	$1,202.09
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3,238.16
Rate for Payer: Superior Health Plan EPO	$1,202.09
Rate for Payer: Superior Health Plan Medicare	$1,202.09
Rate for Payer: Universal American Dual Medicare/Medicaid	$1,202.09
Rate for Payer: Universal American Medicare	$1,202.09
Rate for Payer: Wellcare Medicare	$1,202.09
Rate for Payer: Wellmed Medicare	$1,202.09

Colorectal cancer screening; colonoscopy on individual at high risk

Facility

$2,493.12

Service Code	HCPCS G0105
Hospital Charge Code	9900917
Hospital Revenue Code	300
Min. Negotiated Rate	$222.93
Max. Negotiated Rate	$1,974.73
Rate for Payer: Amerigroup CHIP/Medicaid	$224.38
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$934.20
Rate for Payer: Amerigroup Medicare	$934.20
Rate for Payer: BCBS of TX Blue Advantage	$1,275.68
Rate for Payer: BCBS of TX Blue Essentials	$1,527.76
Rate for Payer: BCBS of TX Medicare	$934.20
Rate for Payer: BCBS of TX PPO	$1,924.98
Rate for Payer: Cash Price	$1,695.32
Rate for Payer: Cash Price	$1,695.32
Rate for Payer: Cash Price	$1,695.32
Rate for Payer: Cigna Commercial	$1,974.73
Rate for Payer: Cigna Medicaid	$1,795.05
Rate for Payer: Cigna Medicare	$934.20
Rate for Payer: Employer Direct Commercial	$934.20
Rate for Payer: Humana Medicare/TRICARE	$934.20
Rate for Payer: Molina CHIP/Medicaid	$1,795.05
Rate for Payer: Molina Dual Medicare/Medicaid	$934.20
Rate for Payer: Molina Medicare	$934.20
Rate for Payer: Multiplan Auto	$1,620.53
Rate for Payer: Multiplan Commercial	$1,620.53
Rate for Payer: Multiplan Workers Comp	$1,620.53
Rate for Payer: Parkland Medicaid	$1,795.05
Rate for Payer: Scott and White EPO/PPO	$222.93
Rate for Payer: Scott and White Medicare	$934.20
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,795.05
Rate for Payer: Superior Health Plan EPO	$934.20
Rate for Payer: Superior Health Plan Medicare	$934.20
Rate for Payer: Universal American Dual Medicare/Medicaid	$934.20
Rate for Payer: Universal American Medicare	$934.20
Rate for Payer: Wellcare Medicare	$934.20
Rate for Payer: Wellmed Medicare	$934.20

Colorectal cancer screening; colonoscopy on individual at high risk

Facility

$10,000.00

Service Code	CPT G0105
Hospital Charge Code	360G0105
Hospital Revenue Code	360
Min. Negotiated Rate	$222.93
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$328.50
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$934.20
Rate for Payer: Amerigroup Medicare	$934.20
Rate for Payer: BCBS of TX Blue Advantage	$1,275.68
Rate for Payer: BCBS of TX Blue Essentials	$1,527.76
Rate for Payer: BCBS of TX Medicare	$934.20
Rate for Payer: BCBS of TX PPO	$1,924.98
Rate for Payer: Cigna Commercial	$1,974.73
Rate for Payer: Cigna Medicare	$934.20
Rate for Payer: Employer Direct Commercial	$934.20
Rate for Payer: Humana Medicare/TRICARE	$934.20
Rate for Payer: Molina Dual Medicare/Medicaid	$934.20
Rate for Payer: Molina Medicare	$934.20
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	$222.93
Rate for Payer: Scott and White Medicare	$934.20
Rate for Payer: Superior Health Plan EPO	$934.20
Rate for Payer: Superior Health Plan Medicare	$934.20
Rate for Payer: Universal American Dual Medicare/Medicaid	$934.20
Rate for Payer: Universal American Medicare	$934.20
Rate for Payer: Wellcare Medicare	$934.20
Rate for Payer: Wellmed Medicare	$934.20

Colorectal cancer screening; colonoscopy on individual at high risk

Facility

$2,493.12

Service Code	HCPCS G0105
Hospital Charge Code	9900917
Hospital Revenue Code	300
Rate for Payer: Cash Price	$1,695.32

Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk

Facility

$685.00

Service Code	HCPCS G0121
Hospital Charge Code	9900918
Hospital Revenue Code	300
Rate for Payer: Cash Price	$465.80

Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk

Facility

$685.00

Service Code	HCPCS G0121
Hospital Charge Code	9900918
Hospital Revenue Code	300
Min. Negotiated Rate	$61.65
Max. Negotiated Rate	$1,974.73
Rate for Payer: Amerigroup CHIP/Medicaid	$61.65
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$934.20
Rate for Payer: Amerigroup Medicare	$934.20
Rate for Payer: BCBS of TX Blue Advantage	$1,275.68
Rate for Payer: BCBS of TX Blue Essentials	$1,527.76
Rate for Payer: BCBS of TX Medicare	$934.20
Rate for Payer: BCBS of TX PPO	$1,924.98
Rate for Payer: Cash Price	$465.80
Rate for Payer: Cash Price	$465.80
Rate for Payer: Cash Price	$465.80
Rate for Payer: Cigna Commercial	$1,974.73
Rate for Payer: Cigna Medicaid	$493.20
Rate for Payer: Cigna Medicare	$934.20
Rate for Payer: Employer Direct Commercial	$934.20
Rate for Payer: Humana Medicare/TRICARE	$934.20
Rate for Payer: Molina CHIP/Medicaid	$493.20
Rate for Payer: Molina Dual Medicare/Medicaid	$934.20
Rate for Payer: Molina Medicare	$934.20
Rate for Payer: Multiplan Auto	$445.25
Rate for Payer: Multiplan Commercial	$445.25
Rate for Payer: Multiplan Workers Comp	$445.25
Rate for Payer: Parkland Medicaid	$493.20
Rate for Payer: Scott and White EPO/PPO	$223.29
Rate for Payer: Scott and White Medicare	$934.20
Rate for Payer: Superior Health Plan CHIP/Medicaid	$493.20
Rate for Payer: Superior Health Plan EPO	$934.20
Rate for Payer: Superior Health Plan Medicare	$934.20
Rate for Payer: Universal American Dual Medicare/Medicaid	$934.20
Rate for Payer: Universal American Medicare	$934.20
Rate for Payer: Wellcare Medicare	$934.20
Rate for Payer: Wellmed Medicare	$934.20

Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk

Facility

$10,000.00

Service Code	CPT G0121
Hospital Charge Code	360G0121
Hospital Revenue Code	360
Min. Negotiated Rate	$223.29
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$328.50
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$934.20
Rate for Payer: Amerigroup Medicare	$934.20
Rate for Payer: BCBS of TX Blue Advantage	$1,275.68
Rate for Payer: BCBS of TX Blue Essentials	$1,527.76
Rate for Payer: BCBS of TX Medicare	$934.20
Rate for Payer: BCBS of TX PPO	$1,924.98
Rate for Payer: Cigna Commercial	$1,974.73
Rate for Payer: Cigna Medicare	$934.20
Rate for Payer: Employer Direct Commercial	$934.20
Rate for Payer: Humana Medicare/TRICARE	$934.20
Rate for Payer: Molina Dual Medicare/Medicaid	$934.20
Rate for Payer: Molina Medicare	$934.20
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	$223.29
Rate for Payer: Scott and White Medicare	$934.20
Rate for Payer: Superior Health Plan EPO	$934.20
Rate for Payer: Superior Health Plan Medicare	$934.20
Rate for Payer: Universal American Dual Medicare/Medicaid	$934.20
Rate for Payer: Universal American Medicare	$934.20
Rate for Payer: Wellcare Medicare	$934.20
Rate for Payer: Wellmed Medicare	$934.20

Colostomy or skin level cecostomy

Facility

$46,200.00

Service Code	HCPCS 44320
Hospital Charge Code	994101
Hospital Revenue Code	360
Min. Negotiated Rate	$2,097.45
Max. Negotiated Rate	$33,264.00
Rate for Payer: Amerigroup CHIP/Medicaid	$4,158.00
Rate for Payer: BCBS of TX Blue Advantage	$2,097.45
Rate for Payer: BCBS of TX Blue Essentials	$2,511.92
Rate for Payer: BCBS of TX PPO	$3,165.02
Rate for Payer: Cash Price	$31,416.00
Rate for Payer: Cash Price	$31,416.00
Rate for Payer: Cash Price	$31,416.00
Rate for Payer: Cigna Medicaid	$33,264.00
Rate for Payer: Molina CHIP/Medicaid	$33,264.00
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	$33,264.00
Rate for Payer: Scott and White EPO/PPO	$23,100.00
Rate for Payer: Superior Health Plan CHIP/Medicaid	$33,264.00
Rate for Payer: Superior Health Plan EPO	$6,283.20

Colostomy or skin level cecostomy

Facility

$46,200.00

Service Code	HCPCS 44320
Hospital Charge Code	994101
Hospital Revenue Code	360
Rate for Payer: Cash Price	$31,416.00

COLUMBIA CNA AGAR COLISTIN AND NALI

Facility

$4.91

Hospital Charge Code	993359
Hospital Revenue Code	270
Min. Negotiated Rate	$0.44
Max. Negotiated Rate	$3.54
Rate for Payer: Amerigroup CHIP/Medicaid	$0.44
Rate for Payer: BCBS of TX Blue Advantage	$1.47
Rate for Payer: BCBS of TX Blue Essentials	$1.77
Rate for Payer: BCBS of TX PPO	$1.96
Rate for Payer: Cash Price	$3.34
Rate for Payer: Cigna Medicaid	$3.54
Rate for Payer: Molina CHIP/Medicaid	$3.54
Rate for Payer: Multiplan Auto	$3.19
Rate for Payer: Multiplan Commercial	$3.19
Rate for Payer: Multiplan Workers Comp	$3.19
Rate for Payer: Parkland Medicaid	$3.54
Rate for Payer: Scott and White EPO/PPO	$2.46
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3.54
Rate for Payer: Superior Health Plan EPO	$0.67

COLUMBIA CNA AGAR COLISTIN AND NALI

Facility

$4.91

Hospital Charge Code	993359
Hospital Revenue Code	270
Rate for Payer: Cash Price	$3.34

COMBINED ANTERIOR AND POSTERIOR CERVICAL SPINAL FUSION WITH MCC

Facility

$116,043.65

Service Code	MSDRG 429
Min. Negotiated Rate	$70,791.69
Max. Negotiated Rate	$116,043.65
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$70,791.69
Rate for Payer: Amerigroup Medicare	$70,791.69
Rate for Payer: BCBS of TX Medicare	$70,791.69
Rate for Payer: Cigna Commercial	$116,043.65
Rate for Payer: Cigna Medicare	$70,791.69
Rate for Payer: Employer Direct Commercial	$70,791.69
Rate for Payer: Humana Medicare/TRICARE	$70,791.69
Rate for Payer: Molina Dual Medicare/Medicaid	$70,791.69
Rate for Payer: Molina Medicare	$70,791.69
Rate for Payer: Scott and White Medicare	$70,791.69
Rate for Payer: Superior Health Plan EPO	$70,791.69
Rate for Payer: Superior Health Plan Medicare	$70,791.69
Rate for Payer: Universal American Dual Medicare/Medicaid	$70,791.69
Rate for Payer: Universal American Medicare	$70,791.69
Rate for Payer: Wellcare Medicare	$70,791.69
Rate for Payer: Wellmed Medicare	$70,791.69

Know your out-of-pocket cost for care.

All Charges