White Rock Medical Center

All Charges

Charge

Type

Setting

Price

EXFX TL ROCKER RAIL KIT

Facility

$6,106.94

Hospital Charge Code	139392
Hospital Revenue Code	272
Rate for Payer: Cash Price	$5,374.11

EXFX WASHER -- DHF

Facility

$36.00

Hospital Charge Code	81321887
Hospital Revenue Code	272
Min. Negotiated Rate	$3.24
Max. Negotiated Rate	$23.40
Rate for Payer: Aetna Commercial	$19.80
Rate for Payer: Amerigroup CHIP/Medicaid	$3.24
Rate for Payer: BCBS of TX Blue Advantage	$10.80
Rate for Payer: BCBS of TX Blue Essentials	$12.96
Rate for Payer: BCBS of TX PPO	$14.40
Rate for Payer: Cash Price	$31.68
Rate for Payer: Multiplan Auto	$23.40
Rate for Payer: Multiplan Commercial	$23.40
Rate for Payer: Multiplan Workers Comp	$23.40
Rate for Payer: Scott and White EPO/PPO	$18.00
Rate for Payer: Superior Health Plan EPO	$4.90

EXFX WASHER -- DHF

Facility

$36.00

Hospital Charge Code	81321887
Hospital Revenue Code	272
Rate for Payer: Cash Price	$31.68

EXFX WIRE BOLT ADAPTER

Facility

$1,325.91

Hospital Charge Code	115246
Hospital Revenue Code	272
Min. Negotiated Rate	$119.33
Max. Negotiated Rate	$861.84
Rate for Payer: Aetna Commercial	$729.25
Rate for Payer: Amerigroup CHIP/Medicaid	$119.33
Rate for Payer: BCBS of TX Blue Advantage	$397.77
Rate for Payer: BCBS of TX Blue Essentials	$477.33
Rate for Payer: BCBS of TX PPO	$530.36
Rate for Payer: Cash Price	$1,166.80
Rate for Payer: Multiplan Auto	$861.84
Rate for Payer: Multiplan Commercial	$861.84
Rate for Payer: Multiplan Workers Comp	$861.84
Rate for Payer: Scott and White EPO/PPO	$662.96
Rate for Payer: Superior Health Plan EPO	$180.32

EXFX WIRE BOLT ADAPTER

Facility

$1,325.91

Hospital Charge Code	115246
Hospital Revenue Code	272
Rate for Payer: Cash Price	$1,166.80

EXFX WIRE FIXATION BOLT

Facility

$430.21

Hospital Charge Code	130819
Hospital Revenue Code	272
Rate for Payer: Cash Price	$378.58

EXFX WIRE FIXATION BOLT

Facility

$430.21

Hospital Charge Code	130819
Hospital Revenue Code	272
Min. Negotiated Rate	$38.72
Max. Negotiated Rate	$279.64
Rate for Payer: Aetna Commercial	$236.62
Rate for Payer: Amerigroup CHIP/Medicaid	$38.72
Rate for Payer: BCBS of TX Blue Advantage	$129.06
Rate for Payer: BCBS of TX Blue Essentials	$154.88
Rate for Payer: BCBS of TX PPO	$172.08
Rate for Payer: Cash Price	$378.58
Rate for Payer: Multiplan Auto	$279.64
Rate for Payer: Multiplan Commercial	$279.64
Rate for Payer: Multiplan Workers Comp	$279.64
Rate for Payer: Scott and White EPO/PPO	$215.10
Rate for Payer: Superior Health Plan EPO	$58.51

EXFX WIRE W STOP -- DHF

Facility

$709.96

Service Code	HCPCS C1713
Hospital Charge Code	81321911
Hospital Revenue Code	278
Min. Negotiated Rate	$177.49
Max. Negotiated Rate	$354.98
Rate for Payer: Aetna Commercial	$212.99
Rate for Payer: Cash Price	$624.76
Rate for Payer: Cigna Commercial	$177.49
Rate for Payer: Multiplan Auto	$354.98
Rate for Payer: Multiplan Commercial	$354.98
Rate for Payer: Multiplan Workers Comp	$354.98
Rate for Payer: Scott and White EPO/PPO	$354.98

EXFX WIRE W STOP -- DHF

Facility

$709.96

Service Code	HCPCS C1713
Hospital Charge Code	81321911
Hospital Revenue Code	278
Min. Negotiated Rate	$63.90
Max. Negotiated Rate	$354.98
Rate for Payer: Aetna Commercial	$212.99
Rate for Payer: Amerigroup CHIP/Medicaid	$63.90
Rate for Payer: BCBS of TX Blue Advantage	$212.99
Rate for Payer: BCBS of TX Blue Essentials	$255.59
Rate for Payer: BCBS of TX PPO	$283.98
Rate for Payer: Cash Price	$624.76
Rate for Payer: Multiplan Auto	$354.98
Rate for Payer: Multiplan Commercial	$354.98
Rate for Payer: Multiplan Workers Comp	$354.98
Rate for Payer: Scott and White EPO/PPO	$354.98
Rate for Payer: Superior Health Plan EPO	$96.55

Exploration of penetrating wound (separate procedure) extremity

Facility

$10,000.00

Service Code	CPT 20103
Hospital Charge Code	36020103
Hospital Revenue Code	360
Min. Negotiated Rate	$32.70
Max. Negotiated Rate	$10,000.00
Rate for Payer: Aetna Commercial	$1,400.00
Rate for Payer: Aetna Medicare	$2,224.11
Rate for Payer: Amerigroup CHIP/Medicaid	$257.60
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	$1,018.72
Rate for Payer: BCBS of TX Blue Essentials	$1,220.02
Rate for Payer: BCBS of TX Medicare	$1,482.74
Rate for Payer: BCBS of TX PPO	$1,537.23
Rate for Payer: Cigna Commercial	$3,358.84
Rate for Payer: Cigna Medicaid	$257.60
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	$257.60
Rate for Payer: Molina Dual Medicare/Medicaid	$1,482.74
Rate for Payer: Molina Medicare	$1,482.74
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	$257.60
Rate for Payer: Scott and White EPO/PPO	$32.70
Rate for Payer: Scott and White Medicare	$1,482.74
Rate for Payer: Superior Health Plan CHIP/Medicaid	$257.60
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

expressbraid graft manipulator

Facility

$267.41

Hospital Charge Code	8720588
Hospital Revenue Code	272
Rate for Payer: Cash Price	$235.32

expressbraid graft manipulator

Facility

$267.41

Hospital Charge Code	8720588
Hospital Revenue Code	272
Min. Negotiated Rate	$24.07
Max. Negotiated Rate	$173.82
Rate for Payer: Aetna Commercial	$147.08
Rate for Payer: Amerigroup CHIP/Medicaid	$24.07
Rate for Payer: BCBS of TX Blue Advantage	$80.22
Rate for Payer: BCBS of TX Blue Essentials	$96.27
Rate for Payer: BCBS of TX PPO	$106.96
Rate for Payer: Cash Price	$235.32
Rate for Payer: Multiplan Auto	$173.82
Rate for Payer: Multiplan Commercial	$173.82
Rate for Payer: Multiplan Workers Comp	$173.82
Rate for Payer: Scott and White EPO/PPO	$133.70
Rate for Payer: Superior Health Plan EPO	$36.37

Extend-Spect.Beta-Lacta.Detct. SO

Facility

$114.00

Service Code	CPT 87185
Hospital Charge Code	1630041
Hospital Revenue Code	306
Min. Negotiated Rate	$1.85
Max. Negotiated Rate	$74.10
Rate for Payer: Aetna Commercial	$4.99
Rate for Payer: Aetna Medicare	$7.12
Rate for Payer: Amerigroup CHIP/Medicaid	$1.85
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$4.75
Rate for Payer: Amerigroup Medicare	$4.75
Rate for Payer: BCBS of TX Blue Advantage	$7.84
Rate for Payer: BCBS of TX Blue Essentials	$9.40
Rate for Payer: BCBS of TX Medicare	$4.75
Rate for Payer: BCBS of TX PPO	$10.50
Rate for Payer: Cash Price	$100.32
Rate for Payer: Cash Price	$100.32
Rate for Payer: Cigna Medicaid	$4.75
Rate for Payer: Cigna Medicare	$4.75
Rate for Payer: Employer Direct Commercial	$4.75
Rate for Payer: Humana Medicare/TRICARE	$4.75
Rate for Payer: Molina CHIP/Medicaid	$4.75
Rate for Payer: Molina Dual Medicare/Medicaid	$4.75
Rate for Payer: Molina Medicare	$4.75
Rate for Payer: Multiplan Auto	$74.10
Rate for Payer: Multiplan Commercial	$74.10
Rate for Payer: Multiplan Workers Comp	$74.10
Rate for Payer: Parkland Medicaid	$4.75
Rate for Payer: Scott and White EPO/PPO	$5.94
Rate for Payer: Scott and White Medicare	$4.75
Rate for Payer: Superior Health Plan CHIP/Medicaid	$4.75
Rate for Payer: Superior Health Plan EPO	$4.75
Rate for Payer: Superior Health Plan Medicare	$4.75
Rate for Payer: Universal American Dual Medicare/Medicaid	$4.75
Rate for Payer: Universal American Medicare	$4.75
Rate for Payer: Wellcare Medicare	$4.75
Rate for Payer: Wellmed Medicare	$4.75

EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITHOUT SKIN GRAFT

Facility

$57,608.00

Service Code	MSDRG 933
Min. Negotiated Rate	$24,491.33
Max. Negotiated Rate	$57,608.00
Rate for Payer: Aetna Commercial	$34,110.00
Rate for Payer: Aetna Medicare	$36,737.00
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$24,491.33
Rate for Payer: Amerigroup Medicare	$24,491.33
Rate for Payer: BCBS of TX Blue Advantage	$26,876.72
Rate for Payer: BCBS of TX Blue Essentials	$29,515.44
Rate for Payer: BCBS of TX Medicare	$24,491.33
Rate for Payer: BCBS of TX PPO	$32,796.20
Rate for Payer: Cigna Commercial	$39,052.16
Rate for Payer: Cigna Medicare	$24,491.33
Rate for Payer: Employer Direct Commercial	$24,491.33
Rate for Payer: Humana Medicare/TRICARE	$24,491.33
Rate for Payer: Molina Dual Medicare/Medicaid	$24,491.33
Rate for Payer: Molina Medicare	$24,491.33
Rate for Payer: Multiplan Auto	$57,608.00
Rate for Payer: Multiplan Commercial	$57,608.00
Rate for Payer: Multiplan Workers Comp	$57,608.00
Rate for Payer: Scott and White EPO/PPO	$26,530.00
Rate for Payer: Scott and White Medicare	$24,491.33
Rate for Payer: Superior Health Plan EPO	$24,491.33
Rate for Payer: Superior Health Plan Medicare	$24,491.33
Rate for Payer: Universal American Dual Medicare/Medicaid	$24,491.33
Rate for Payer: Universal American Medicare	$24,491.33
Rate for Payer: Wellcare Medicare	$24,491.33
Rate for Payer: Wellmed Medicare	$24,491.33

EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITH SKIN GRAFT

Facility

$500,815.30

Service Code	MSDRG 927
Min. Negotiated Rate	$124,263.98
Max. Negotiated Rate	$500,815.30
Rate for Payer: Aetna Commercial	$296,535.38
Rate for Payer: Aetna Medicare	$286,428.08
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$190,952.05
Rate for Payer: Amerigroup Medicare	$190,952.05
Rate for Payer: BCBS of TX Blue Advantage	$124,263.98
Rate for Payer: BCBS of TX Blue Essentials	$189,709.66
Rate for Payer: BCBS of TX Medicare	$190,952.05
Rate for Payer: BCBS of TX PPO	$210,796.68
Rate for Payer: Cigna Commercial	$339,500.06
Rate for Payer: Cigna Medicare	$190,952.05
Rate for Payer: Employer Direct Commercial	$190,952.05
Rate for Payer: Humana Medicare/TRICARE	$190,952.05
Rate for Payer: Molina Dual Medicare/Medicaid	$190,952.05
Rate for Payer: Molina Medicare	$190,952.05
Rate for Payer: Multiplan Auto	$500,815.30
Rate for Payer: Multiplan Commercial	$500,815.30
Rate for Payer: Multiplan Workers Comp	$500,815.30
Rate for Payer: Scott and White EPO/PPO	$230,638.62
Rate for Payer: Scott and White Medicare	$190,952.05
Rate for Payer: Superior Health Plan EPO	$190,952.05
Rate for Payer: Superior Health Plan Medicare	$190,952.05
Rate for Payer: Universal American Dual Medicare/Medicaid	$190,952.05
Rate for Payer: Universal American Medicare	$190,952.05
Rate for Payer: Wellcare Medicare	$190,952.05
Rate for Payer: Wellmed Medicare	$190,952.05

EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC

Facility

$47,234.00

Service Code	MSDRG 982
Min. Negotiated Rate	$20,595.02
Max. Negotiated Rate	$47,234.00
Rate for Payer: Aetna Commercial	$27,967.50
Rate for Payer: Aetna Medicare	$30,892.53
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$20,595.02
Rate for Payer: Amerigroup Medicare	$20,595.02
Rate for Payer: BCBS of TX Blue Advantage	$23,495.20
Rate for Payer: BCBS of TX Blue Essentials	$25,311.48
Rate for Payer: BCBS of TX Medicare	$20,595.02
Rate for Payer: BCBS of TX PPO	$28,124.95
Rate for Payer: Cigna Commercial	$32,019.68
Rate for Payer: Cigna Medicare	$20,595.02
Rate for Payer: Employer Direct Commercial	$20,595.02
Rate for Payer: Humana Medicare/TRICARE	$20,595.02
Rate for Payer: Molina Dual Medicare/Medicaid	$20,595.02
Rate for Payer: Molina Medicare	$20,595.02
Rate for Payer: Multiplan Auto	$47,234.00
Rate for Payer: Multiplan Commercial	$47,234.00
Rate for Payer: Multiplan Workers Comp	$47,234.00
Rate for Payer: Scott and White EPO/PPO	$21,752.50
Rate for Payer: Scott and White Medicare	$20,595.02
Rate for Payer: Superior Health Plan EPO	$20,595.02
Rate for Payer: Superior Health Plan Medicare	$20,595.02
Rate for Payer: Universal American Dual Medicare/Medicaid	$20,595.02
Rate for Payer: Universal American Medicare	$20,595.02
Rate for Payer: Wellcare Medicare	$20,595.02
Rate for Payer: Wellmed Medicare	$20,595.02

EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC

Facility

$90,067.60

Service Code	MSDRG 981
Min. Negotiated Rate	$36,682.56
Max. Negotiated Rate	$90,067.60
Rate for Payer: Aetna Commercial	$53,329.50
Rate for Payer: Aetna Medicare	$55,023.84
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$36,682.56
Rate for Payer: Amerigroup Medicare	$36,682.56
Rate for Payer: BCBS of TX Blue Advantage	$42,527.86
Rate for Payer: BCBS of TX Blue Essentials	$45,099.19
Rate for Payer: BCBS of TX Medicare	$36,682.56
Rate for Payer: BCBS of TX PPO	$50,112.15
Rate for Payer: Cigna Commercial	$61,056.35
Rate for Payer: Cigna Medicare	$36,682.56
Rate for Payer: Employer Direct Commercial	$36,682.56
Rate for Payer: Humana Medicare/TRICARE	$36,682.56
Rate for Payer: Molina Dual Medicare/Medicaid	$36,682.56
Rate for Payer: Molina Medicare	$36,682.56
Rate for Payer: Multiplan Auto	$90,067.60
Rate for Payer: Multiplan Commercial	$90,067.60
Rate for Payer: Multiplan Workers Comp	$90,067.60
Rate for Payer: Scott and White EPO/PPO	$41,478.50
Rate for Payer: Scott and White Medicare	$36,682.56
Rate for Payer: Superior Health Plan EPO	$36,682.56
Rate for Payer: Superior Health Plan Medicare	$36,682.56
Rate for Payer: Universal American Dual Medicare/Medicaid	$36,682.56
Rate for Payer: Universal American Medicare	$36,682.56
Rate for Payer: Wellcare Medicare	$36,682.56
Rate for Payer: Wellmed Medicare	$36,682.56

EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC

Facility

$31,068.80

Service Code	MSDRG 983
Min. Negotiated Rate	$14,308.00
Max. Negotiated Rate	$31,068.80
Rate for Payer: Aetna Commercial	$18,396.00
Rate for Payer: Aetna Medicare	$21,785.49
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$14,523.66
Rate for Payer: Amerigroup Medicare	$14,523.66
Rate for Payer: BCBS of TX Blue Advantage	$15,320.90
Rate for Payer: BCBS of TX Blue Essentials	$16,191.54
Rate for Payer: BCBS of TX Medicare	$14,523.66
Rate for Payer: BCBS of TX PPO	$17,991.30
Rate for Payer: Cigna Commercial	$21,061.38
Rate for Payer: Cigna Medicare	$14,523.66
Rate for Payer: Employer Direct Commercial	$14,523.66
Rate for Payer: Humana Medicare/TRICARE	$14,523.66
Rate for Payer: Molina Dual Medicare/Medicaid	$14,523.66
Rate for Payer: Molina Medicare	$14,523.66
Rate for Payer: Multiplan Auto	$31,068.80
Rate for Payer: Multiplan Commercial	$31,068.80
Rate for Payer: Multiplan Workers Comp	$31,068.80
Rate for Payer: Scott and White EPO/PPO	$14,308.00
Rate for Payer: Scott and White Medicare	$14,523.66
Rate for Payer: Superior Health Plan EPO	$14,523.66
Rate for Payer: Superior Health Plan Medicare	$14,523.66
Rate for Payer: Universal American Dual Medicare/Medicaid	$14,523.66
Rate for Payer: Universal American Medicare	$14,523.66
Rate for Payer: Wellcare Medicare	$14,523.66
Rate for Payer: Wellmed Medicare	$14,523.66

External Cephalic Version

Facility

$3,271.00

Service Code	CPT 59412
Hospital Charge Code	300491
Hospital Revenue Code	361
Min. Negotiated Rate	$63.06
Max. Negotiated Rate	$10,000.00
Rate for Payer: Aetna Commercial	$3,090.00
Rate for Payer: Aetna Medicare	$4,288.80
Rate for Payer: Amerigroup CHIP/Medicaid	$294.39
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$2,859.20
Rate for Payer: Amerigroup Medicare	$2,859.20
Rate for Payer: BCBS of TX Blue Advantage	$4,171.83
Rate for Payer: BCBS of TX Blue Essentials	$4,996.20
Rate for Payer: BCBS of TX Medicare	$2,859.20
Rate for Payer: BCBS of TX PPO	$6,295.21
Rate for Payer: Cash Price	$2,878.48
Rate for Payer: Cash Price	$2,878.48
Rate for Payer: Cash Price	$2,878.48
Rate for Payer: Cigna Commercial	$6,476.93
Rate for Payer: Cigna Medicare	$2,859.20
Rate for Payer: Employer Direct Commercial	$2,859.20
Rate for Payer: Humana Medicare/TRICARE	$2,859.20
Rate for Payer: Molina Dual Medicare/Medicaid	$2,859.20
Rate for Payer: Molina Medicare	$2,859.20
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	$63.06
Rate for Payer: Scott and White Medicare	$2,859.20
Rate for Payer: Superior Health Plan EPO	$2,859.20
Rate for Payer: Superior Health Plan Medicare	$2,859.20
Rate for Payer: Universal American Dual Medicare/Medicaid	$2,859.20
Rate for Payer: Universal American Medicare	$2,859.20
Rate for Payer: Wellcare Medicare	$2,859.20
Rate for Payer: Wellmed Medicare	$2,859.20

External Cephalic Version

Facility

$3,271.00

Service Code	CPT 59412
Hospital Charge Code	300491
Hospital Revenue Code	361
Rate for Payer: Cash Price	$2,878.48

Extracapsular cataract removal

Facility

$10,000.00

Service Code	CPT 66984
Hospital Charge Code	36066984
Hospital Revenue Code	360
Min. Negotiated Rate	$47.01
Max. Negotiated Rate	$10,000.00
Rate for Payer: Aetna Commercial	$3,090.00
Rate for Payer: Aetna Medicare	$3,196.84
Rate for Payer: Amerigroup CHIP/Medicaid	$849.94
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$2,131.23
Rate for Payer: Amerigroup Medicare	$2,131.23
Rate for Payer: BCBS of TX Blue Advantage	$3,376.51
Rate for Payer: BCBS of TX Blue Essentials	$4,043.72
Rate for Payer: BCBS of TX Medicare	$2,131.23
Rate for Payer: BCBS of TX PPO	$5,095.09
Rate for Payer: Cigna Commercial	$4,827.84
Rate for Payer: Cigna Medicaid	$849.94
Rate for Payer: Cigna Medicare	$2,131.23
Rate for Payer: Employer Direct Commercial	$2,131.23
Rate for Payer: Humana Medicare/TRICARE	$2,131.23
Rate for Payer: Molina CHIP/Medicaid	$849.94
Rate for Payer: Molina Dual Medicare/Medicaid	$2,131.23
Rate for Payer: Molina Medicare	$2,131.23
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	$849.94
Rate for Payer: Scott and White EPO/PPO	$47.01
Rate for Payer: Scott and White Medicare	$2,131.23
Rate for Payer: Superior Health Plan CHIP/Medicaid	$849.94
Rate for Payer: Superior Health Plan EPO	$2,131.23
Rate for Payer: Superior Health Plan Medicare	$2,131.23
Rate for Payer: Universal American Dual Medicare/Medicaid	$2,131.23
Rate for Payer: Universal American Medicare	$2,131.23
Rate for Payer: Wellcare Medicare	$2,131.23
Rate for Payer: Wellmed Medicare	$2,131.23

Extracapsular cataract removal with insertion of intraocular lens prosthesis (1-stage procedure), m

Facility

$10,827.87

Service Code	CPT 66989
Hospital Charge Code	36066989
Hospital Revenue Code	360
Min. Negotiated Rate	$105.43
Max. Negotiated Rate	$10,827.87
Rate for Payer: Aetna Commercial	$6,077.00
Rate for Payer: Aetna Medicare	$7,169.86
Rate for Payer: Amerigroup CHIP/Medicaid	$2,595.66
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$4,779.91
Rate for Payer: Amerigroup Medicare	$4,779.91
Rate for Payer: BCBS of TX Blue Advantage	$7,098.34
Rate for Payer: BCBS of TX Blue Essentials	$8,501.00
Rate for Payer: BCBS of TX Medicare	$4,779.91
Rate for Payer: BCBS of TX PPO	$10,711.26
Rate for Payer: Cigna Commercial	$10,827.87
Rate for Payer: Cigna Medicaid	$2,595.66
Rate for Payer: Cigna Medicare	$4,779.91
Rate for Payer: Employer Direct Commercial	$4,779.91
Rate for Payer: Humana Medicare/TRICARE	$4,779.91
Rate for Payer: Molina CHIP/Medicaid	$2,595.66
Rate for Payer: Molina Dual Medicare/Medicaid	$4,779.91
Rate for Payer: Molina Medicare	$4,779.91
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	$2,595.66
Rate for Payer: Scott and White EPO/PPO	$105.43
Rate for Payer: Scott and White Medicare	$4,779.91
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2,595.66
Rate for Payer: Superior Health Plan EPO	$4,779.91
Rate for Payer: Superior Health Plan Medicare	$4,779.91
Rate for Payer: Universal American Dual Medicare/Medicaid	$4,779.91
Rate for Payer: Universal American Medicare	$4,779.91
Rate for Payer: Wellcare Medicare	$4,779.91
Rate for Payer: Wellmed Medicare	$4,779.91

Extracapsular cataract removal with insertion of intraocular lens prosthesis (1 stage procedure), ma

Facility

$10,000.00

Service Code	CPT 66982
Hospital Charge Code	36066982
Hospital Revenue Code	360
Min. Negotiated Rate	$47.01
Max. Negotiated Rate	$10,000.00
Rate for Payer: Aetna Commercial	$3,090.00
Rate for Payer: Aetna Medicare	$3,196.84
Rate for Payer: Amerigroup CHIP/Medicaid	$849.94
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$2,131.23
Rate for Payer: Amerigroup Medicare	$2,131.23
Rate for Payer: BCBS of TX Blue Advantage	$3,376.51
Rate for Payer: BCBS of TX Blue Essentials	$4,043.72
Rate for Payer: BCBS of TX Medicare	$2,131.23
Rate for Payer: BCBS of TX PPO	$5,095.09
Rate for Payer: Cigna Commercial	$4,827.84
Rate for Payer: Cigna Medicaid	$849.94
Rate for Payer: Cigna Medicare	$2,131.23
Rate for Payer: Employer Direct Commercial	$2,131.23
Rate for Payer: Humana Medicare/TRICARE	$2,131.23
Rate for Payer: Molina CHIP/Medicaid	$849.94
Rate for Payer: Molina Dual Medicare/Medicaid	$2,131.23
Rate for Payer: Molina Medicare	$2,131.23
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	$849.94
Rate for Payer: Scott and White EPO/PPO	$47.01
Rate for Payer: Scott and White Medicare	$2,131.23
Rate for Payer: Superior Health Plan CHIP/Medicaid	$849.94
Rate for Payer: Superior Health Plan EPO	$2,131.23
Rate for Payer: Superior Health Plan Medicare	$2,131.23
Rate for Payer: Universal American Dual Medicare/Medicaid	$2,131.23
Rate for Payer: Universal American Medicare	$2,131.23
Rate for Payer: Wellcare Medicare	$2,131.23
Rate for Payer: Wellmed Medicare	$2,131.23

EXTRACRANIAL PROCEDURES WITH CC

Facility

$30,398.10

Service Code	MSDRG 038
Min. Negotiated Rate	$13,555.32
Max. Negotiated Rate	$30,398.10
Rate for Payer: Aetna Commercial	$17,998.88
Rate for Payer: Aetna Medicare	$21,407.64
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$14,271.76
Rate for Payer: Amerigroup Medicare	$14,271.76
Rate for Payer: BCBS of TX Blue Advantage	$13,555.32
Rate for Payer: BCBS of TX Blue Essentials	$17,250.27
Rate for Payer: BCBS of TX Medicare	$14,271.76
Rate for Payer: BCBS of TX PPO	$19,167.71
Rate for Payer: Cigna Commercial	$20,606.71
Rate for Payer: Cigna Medicare	$14,271.76
Rate for Payer: Employer Direct Commercial	$14,271.76
Rate for Payer: Humana Medicare/TRICARE	$14,271.76
Rate for Payer: Molina Dual Medicare/Medicaid	$14,271.76
Rate for Payer: Molina Medicare	$14,271.76
Rate for Payer: Multiplan Auto	$30,398.10
Rate for Payer: Multiplan Commercial	$30,398.10
Rate for Payer: Multiplan Workers Comp	$30,398.10
Rate for Payer: Scott and White EPO/PPO	$13,999.12
Rate for Payer: Scott and White Medicare	$14,271.76
Rate for Payer: Superior Health Plan EPO	$14,271.76
Rate for Payer: Superior Health Plan Medicare	$14,271.76
Rate for Payer: Universal American Dual Medicare/Medicaid	$14,271.76
Rate for Payer: Universal American Medicare	$14,271.76
Rate for Payer: Wellcare Medicare	$14,271.76
Rate for Payer: Wellmed Medicare	$14,271.76

EXTRACRANIAL PROCEDURES WITH MCC

Facility

$64,136.40

Service Code	MSDRG 037
Min. Negotiated Rate	$26,483.70
Max. Negotiated Rate	$64,136.40
Rate for Payer: Aetna Commercial	$37,975.50
Rate for Payer: Aetna Medicare	$40,414.90
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$26,943.27
Rate for Payer: Amerigroup Medicare	$26,943.27
Rate for Payer: BCBS of TX Blue Advantage	$26,483.70
Rate for Payer: BCBS of TX Blue Essentials	$33,121.93
Rate for Payer: BCBS of TX Medicare	$26,943.27
Rate for Payer: BCBS of TX PPO	$36,803.57
Rate for Payer: Cigna Commercial	$43,477.73
Rate for Payer: Cigna Medicare	$26,943.27
Rate for Payer: Employer Direct Commercial	$26,943.27
Rate for Payer: Humana Medicare/TRICARE	$26,943.27
Rate for Payer: Molina Dual Medicare/Medicaid	$26,943.27
Rate for Payer: Molina Medicare	$26,943.27
Rate for Payer: Multiplan Auto	$64,136.40
Rate for Payer: Multiplan Commercial	$64,136.40
Rate for Payer: Multiplan Workers Comp	$64,136.40
Rate for Payer: Scott and White EPO/PPO	$29,536.50
Rate for Payer: Scott and White Medicare	$26,943.27
Rate for Payer: Superior Health Plan EPO	$26,943.27
Rate for Payer: Superior Health Plan Medicare	$26,943.27
Rate for Payer: Universal American Dual Medicare/Medicaid	$26,943.27
Rate for Payer: Universal American Medicare	$26,943.27
Rate for Payer: Wellcare Medicare	$26,943.27
Rate for Payer: Wellmed Medicare	$26,943.27

Know your out-of-pocket cost for care.

All Charges