White Rock Medical Center

All Charges

Charge

Type

Setting

Price

ED Dislocation Repair Site -> Ankle w/o Anesthesia

Facility

$978.00

Service Code	HCPCS 27840
Hospital Charge Code	5202514
Hospital Revenue Code	450
Rate for Payer: Cash Price	$665.04

ED Dislocation Repair Site -> Elbow w/ Anesthesia

Facility

$4,544.00

Service Code	HCPCS 24605
Hospital Charge Code	5202507
Hospital Revenue Code	450
Rate for Payer: Cash Price	$3,089.92

ED Dislocation Repair Site -> Elbow w/ Anesthesia

Facility

$4,544.00

Service Code	HCPCS 24605
Hospital Charge Code	5202507
Hospital Revenue Code	450
Min. Negotiated Rate	$408.96
Max. Negotiated Rate	$3,415.58
Rate for Payer: Amerigroup CHIP/Medicaid	$408.96
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$1,615.32
Rate for Payer: Amerigroup Medicare	$1,615.32
Rate for Payer: BCBS of TX Blue Advantage	$2,263.50
Rate for Payer: BCBS of TX Blue Essentials	$2,710.78
Rate for Payer: BCBS of TX Medicare	$1,615.32
Rate for Payer: BCBS of TX PPO	$3,415.58
Rate for Payer: Cash Price	$3,089.92
Rate for Payer: Cash Price	$3,089.92
Rate for Payer: Cash Price	$3,089.92
Rate for Payer: Cigna Commercial	$3,414.49
Rate for Payer: Cigna Medicaid	$3,271.68
Rate for Payer: Cigna Medicare	$1,615.32
Rate for Payer: Employer Direct Commercial	$1,615.32
Rate for Payer: Humana Medicare/TRICARE	$1,615.32
Rate for Payer: Molina CHIP/Medicaid	$3,271.68
Rate for Payer: Molina Dual Medicare/Medicaid	$1,615.32
Rate for Payer: Molina Medicare	$1,615.32
Rate for Payer: Multiplan Auto	$2,953.60
Rate for Payer: Multiplan Commercial	$2,953.60
Rate for Payer: Multiplan Workers Comp	$2,953.60
Rate for Payer: Parkland Medicaid	$3,271.68
Rate for Payer: Scott and White EPO/PPO	$2,272.00
Rate for Payer: Scott and White Medicare	$1,615.32
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3,271.68
Rate for Payer: Superior Health Plan EPO	$1,615.32
Rate for Payer: Superior Health Plan Medicare	$1,615.32
Rate for Payer: Universal American Dual Medicare/Medicaid	$1,615.32
Rate for Payer: Universal American Medicare	$1,615.32
Rate for Payer: Wellcare Medicare	$1,615.32
Rate for Payer: Wellmed Medicare	$1,615.32

ED Dislocation Repair Site -> Elbow w/o Anesthesia

Facility

$1,399.00

Service Code	HCPCS 24600
Hospital Charge Code	5202506
Hospital Revenue Code	450
Min. Negotiated Rate	$125.91
Max. Negotiated Rate	$1,007.28
Rate for Payer: Amerigroup CHIP/Medicaid	$125.91
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$247.79
Rate for Payer: Amerigroup Medicare	$247.79
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	$247.79
Rate for Payer: BCBS of TX PPO	$543.41
Rate for Payer: Cash Price	$951.32
Rate for Payer: Cash Price	$951.32
Rate for Payer: Cash Price	$951.32
Rate for Payer: Cigna Commercial	$523.79
Rate for Payer: Cigna Medicaid	$1,007.28
Rate for Payer: Cigna Medicare	$247.79
Rate for Payer: Employer Direct Commercial	$247.79
Rate for Payer: Humana Medicare/TRICARE	$247.79
Rate for Payer: Molina CHIP/Medicaid	$1,007.28
Rate for Payer: Molina Dual Medicare/Medicaid	$247.79
Rate for Payer: Molina Medicare	$247.79
Rate for Payer: Multiplan Auto	$909.35
Rate for Payer: Multiplan Commercial	$909.35
Rate for Payer: Multiplan Workers Comp	$909.35
Rate for Payer: Parkland Medicaid	$1,007.28
Rate for Payer: Scott and White EPO/PPO	$699.50
Rate for Payer: Scott and White Medicare	$247.79
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,007.28
Rate for Payer: Superior Health Plan EPO	$247.79
Rate for Payer: Superior Health Plan Medicare	$247.79
Rate for Payer: Universal American Dual Medicare/Medicaid	$247.79
Rate for Payer: Universal American Medicare	$247.79
Rate for Payer: Wellcare Medicare	$247.79
Rate for Payer: Wellmed Medicare	$247.79

ED Dislocation Repair Site -> Elbow w/o Anesthesia

Facility

$1,399.00

Service Code	HCPCS 24600
Hospital Charge Code	5202506
Hospital Revenue Code	450
Rate for Payer: Cash Price	$951.32

ED Dislocation Repair Site -> Finger w/o Anesthesia

Facility

$594.00

Service Code	HCPCS 26770
Hospital Charge Code	5202511
Hospital Revenue Code	450
Min. Negotiated Rate	$53.46
Max. Negotiated Rate	$543.41
Rate for Payer: Amerigroup CHIP/Medicaid	$53.46
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$247.79
Rate for Payer: Amerigroup Medicare	$247.79
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	$247.79
Rate for Payer: BCBS of TX PPO	$543.41
Rate for Payer: Cash Price	$403.92
Rate for Payer: Cash Price	$403.92
Rate for Payer: Cash Price	$403.92
Rate for Payer: Cigna Commercial	$523.79
Rate for Payer: Cigna Medicaid	$427.68
Rate for Payer: Cigna Medicare	$247.79
Rate for Payer: Employer Direct Commercial	$247.79
Rate for Payer: Humana Medicare/TRICARE	$247.79
Rate for Payer: Molina CHIP/Medicaid	$427.68
Rate for Payer: Molina Dual Medicare/Medicaid	$247.79
Rate for Payer: Molina Medicare	$247.79
Rate for Payer: Multiplan Auto	$386.10
Rate for Payer: Multiplan Commercial	$386.10
Rate for Payer: Multiplan Workers Comp	$386.10
Rate for Payer: Parkland Medicaid	$427.68
Rate for Payer: Scott and White EPO/PPO	$297.00
Rate for Payer: Scott and White Medicare	$247.79
Rate for Payer: Superior Health Plan CHIP/Medicaid	$427.68
Rate for Payer: Superior Health Plan EPO	$247.79
Rate for Payer: Superior Health Plan Medicare	$247.79
Rate for Payer: Universal American Dual Medicare/Medicaid	$247.79
Rate for Payer: Universal American Medicare	$247.79
Rate for Payer: Wellcare Medicare	$247.79
Rate for Payer: Wellmed Medicare	$247.79

ED Dislocation Repair Site -> Finger w/o Anesthesia

Facility

$594.00

Service Code	HCPCS 26770
Hospital Charge Code	5202511
Hospital Revenue Code	450
Rate for Payer: Cash Price	$403.92

ED Dislocation Repair Site -> Hand

Facility

$811.00

Service Code	HCPCS 26670
Hospital Charge Code	5202509
Hospital Revenue Code	450
Min. Negotiated Rate	$72.99
Max. Negotiated Rate	$583.92
Rate for Payer: Amerigroup CHIP/Medicaid	$72.99
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$247.79
Rate for Payer: Amerigroup Medicare	$247.79
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	$247.79
Rate for Payer: BCBS of TX PPO	$274.58
Rate for Payer: Cash Price	$551.48
Rate for Payer: Cash Price	$551.48
Rate for Payer: Cash Price	$551.48
Rate for Payer: Cigna Commercial	$523.79
Rate for Payer: Cigna Medicaid	$583.92
Rate for Payer: Cigna Medicare	$247.79
Rate for Payer: Employer Direct Commercial	$247.79
Rate for Payer: Humana Medicare/TRICARE	$247.79
Rate for Payer: Molina CHIP/Medicaid	$583.92
Rate for Payer: Molina Dual Medicare/Medicaid	$247.79
Rate for Payer: Molina Medicare	$247.79
Rate for Payer: Multiplan Auto	$527.15
Rate for Payer: Multiplan Commercial	$527.15
Rate for Payer: Multiplan Workers Comp	$527.15
Rate for Payer: Parkland Medicaid	$583.92
Rate for Payer: Scott and White EPO/PPO	$405.50
Rate for Payer: Scott and White Medicare	$247.79
Rate for Payer: Superior Health Plan CHIP/Medicaid	$583.92
Rate for Payer: Superior Health Plan EPO	$247.79
Rate for Payer: Superior Health Plan Medicare	$247.79
Rate for Payer: Universal American Dual Medicare/Medicaid	$247.79
Rate for Payer: Universal American Medicare	$247.79
Rate for Payer: Wellcare Medicare	$247.79
Rate for Payer: Wellmed Medicare	$247.79

ED Dislocation Repair Site -> Hand

Facility

$811.00

Service Code	HCPCS 26670
Hospital Charge Code	5202509
Hospital Revenue Code	450
Rate for Payer: Cash Price	$551.48

ED Dislocation Repair Site -> Hip Post Arthroplasty

Facility

$1,045.00

Service Code	HCPCS 27265
Hospital Charge Code	9220218
Hospital Revenue Code	450
Min. Negotiated Rate	$94.05
Max. Negotiated Rate	$752.40
Rate for Payer: Amerigroup CHIP/Medicaid	$94.05
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$247.79
Rate for Payer: Amerigroup Medicare	$247.79
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	$247.79
Rate for Payer: BCBS of TX PPO	$543.41
Rate for Payer: Cash Price	$710.60
Rate for Payer: Cash Price	$710.60
Rate for Payer: Cash Price	$710.60
Rate for Payer: Cigna Commercial	$523.79
Rate for Payer: Cigna Medicaid	$752.40
Rate for Payer: Cigna Medicare	$247.79
Rate for Payer: Employer Direct Commercial	$247.79
Rate for Payer: Humana Medicare/TRICARE	$247.79
Rate for Payer: Molina CHIP/Medicaid	$752.40
Rate for Payer: Molina Dual Medicare/Medicaid	$247.79
Rate for Payer: Molina Medicare	$247.79
Rate for Payer: Multiplan Auto	$679.25
Rate for Payer: Multiplan Commercial	$679.25
Rate for Payer: Multiplan Workers Comp	$679.25
Rate for Payer: Parkland Medicaid	$752.40
Rate for Payer: Scott and White EPO/PPO	$522.50
Rate for Payer: Scott and White Medicare	$247.79
Rate for Payer: Superior Health Plan CHIP/Medicaid	$752.40
Rate for Payer: Superior Health Plan EPO	$247.79
Rate for Payer: Superior Health Plan Medicare	$247.79
Rate for Payer: Universal American Dual Medicare/Medicaid	$247.79
Rate for Payer: Universal American Medicare	$247.79
Rate for Payer: Wellcare Medicare	$247.79
Rate for Payer: Wellmed Medicare	$247.79

ED Dislocation Repair Site -> Hip Post Arthroplasty

Facility

$1,045.00

Service Code	HCPCS 27265
Hospital Charge Code	9220218
Hospital Revenue Code	450
Rate for Payer: Cash Price	$710.60

ED Dislocation Repair Site -> Jaw

Facility

$514.00

Service Code	HCPCS 21480
Hospital Charge Code	5202504
Hospital Revenue Code	450
Min. Negotiated Rate	$46.26
Max. Negotiated Rate	$543.41
Rate for Payer: Amerigroup CHIP/Medicaid	$46.26
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$247.79
Rate for Payer: Amerigroup Medicare	$247.79
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	$247.79
Rate for Payer: BCBS of TX PPO	$543.41
Rate for Payer: Cash Price	$349.52
Rate for Payer: Cash Price	$349.52
Rate for Payer: Cash Price	$349.52
Rate for Payer: Cigna Commercial	$523.79
Rate for Payer: Cigna Medicaid	$370.08
Rate for Payer: Cigna Medicare	$247.79
Rate for Payer: Employer Direct Commercial	$247.79
Rate for Payer: Humana Medicare/TRICARE	$247.79
Rate for Payer: Molina CHIP/Medicaid	$370.08
Rate for Payer: Molina Dual Medicare/Medicaid	$247.79
Rate for Payer: Molina Medicare	$247.79
Rate for Payer: Multiplan Auto	$334.10
Rate for Payer: Multiplan Commercial	$334.10
Rate for Payer: Multiplan Workers Comp	$334.10
Rate for Payer: Parkland Medicaid	$370.08
Rate for Payer: Scott and White EPO/PPO	$257.00
Rate for Payer: Scott and White Medicare	$247.79
Rate for Payer: Superior Health Plan CHIP/Medicaid	$370.08
Rate for Payer: Superior Health Plan EPO	$247.79
Rate for Payer: Superior Health Plan Medicare	$247.79
Rate for Payer: Universal American Dual Medicare/Medicaid	$247.79
Rate for Payer: Universal American Medicare	$247.79
Rate for Payer: Wellcare Medicare	$247.79
Rate for Payer: Wellmed Medicare	$247.79

ED Dislocation Repair Site -> Jaw

Facility

$514.00

Service Code	HCPCS 21480
Hospital Charge Code	5202504
Hospital Revenue Code	450
Rate for Payer: Cash Price	$349.52

ED Dislocation Repair Site -> Kneecap w/o Anesthesia

Facility

$825.00

Service Code	HCPCS 27560
Hospital Charge Code	5202513
Hospital Revenue Code	450
Min. Negotiated Rate	$74.25
Max. Negotiated Rate	$594.00
Rate for Payer: Amerigroup CHIP/Medicaid	$74.25
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$247.79
Rate for Payer: Amerigroup Medicare	$247.79
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	$247.79
Rate for Payer: BCBS of TX PPO	$543.41
Rate for Payer: Cash Price	$561.00
Rate for Payer: Cash Price	$561.00
Rate for Payer: Cash Price	$561.00
Rate for Payer: Cigna Commercial	$523.79
Rate for Payer: Cigna Medicaid	$594.00
Rate for Payer: Cigna Medicare	$247.79
Rate for Payer: Employer Direct Commercial	$247.79
Rate for Payer: Humana Medicare/TRICARE	$247.79
Rate for Payer: Molina CHIP/Medicaid	$594.00
Rate for Payer: Molina Dual Medicare/Medicaid	$247.79
Rate for Payer: Molina Medicare	$247.79
Rate for Payer: Multiplan Auto	$536.25
Rate for Payer: Multiplan Commercial	$536.25
Rate for Payer: Multiplan Workers Comp	$536.25
Rate for Payer: Parkland Medicaid	$594.00
Rate for Payer: Scott and White EPO/PPO	$412.50
Rate for Payer: Scott and White Medicare	$247.79
Rate for Payer: Superior Health Plan CHIP/Medicaid	$594.00
Rate for Payer: Superior Health Plan EPO	$247.79
Rate for Payer: Superior Health Plan Medicare	$247.79
Rate for Payer: Universal American Dual Medicare/Medicaid	$247.79
Rate for Payer: Universal American Medicare	$247.79
Rate for Payer: Wellcare Medicare	$247.79
Rate for Payer: Wellmed Medicare	$247.79

ED Dislocation Repair Site -> Kneecap w/o Anesthesia

Facility

$825.00

Service Code	HCPCS 27560
Hospital Charge Code	5202513
Hospital Revenue Code	450
Rate for Payer: Cash Price	$561.00

ED Dislocation Repair Site -> Knee w/ Anesthesia

Facility

$2,762.00

Service Code	HCPCS 27552
Hospital Charge Code	5202512
Hospital Revenue Code	450
Rate for Payer: Cash Price	$1,878.16

ED Dislocation Repair Site -> Knee w/ Anesthesia

Facility

$2,762.00

Service Code	HCPCS 27552
Hospital Charge Code	5202512
Hospital Revenue Code	450
Min. Negotiated Rate	$248.58
Max. Negotiated Rate	$3,415.58
Rate for Payer: Amerigroup CHIP/Medicaid	$248.58
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$1,615.32
Rate for Payer: Amerigroup Medicare	$1,615.32
Rate for Payer: BCBS of TX Blue Advantage	$2,263.50
Rate for Payer: BCBS of TX Blue Essentials	$2,710.78
Rate for Payer: BCBS of TX Medicare	$1,615.32
Rate for Payer: BCBS of TX PPO	$3,415.58
Rate for Payer: Cash Price	$1,878.16
Rate for Payer: Cash Price	$1,878.16
Rate for Payer: Cash Price	$1,878.16
Rate for Payer: Cigna Commercial	$3,414.49
Rate for Payer: Cigna Medicaid	$1,988.64
Rate for Payer: Cigna Medicare	$1,615.32
Rate for Payer: Employer Direct Commercial	$1,615.32
Rate for Payer: Humana Medicare/TRICARE	$1,615.32
Rate for Payer: Molina CHIP/Medicaid	$1,988.64
Rate for Payer: Molina Dual Medicare/Medicaid	$1,615.32
Rate for Payer: Molina Medicare	$1,615.32
Rate for Payer: Multiplan Auto	$1,795.30
Rate for Payer: Multiplan Commercial	$1,795.30
Rate for Payer: Multiplan Workers Comp	$1,795.30
Rate for Payer: Parkland Medicaid	$1,988.64
Rate for Payer: Scott and White EPO/PPO	$1,381.00
Rate for Payer: Scott and White Medicare	$1,615.32
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,988.64
Rate for Payer: Superior Health Plan EPO	$1,615.32
Rate for Payer: Superior Health Plan Medicare	$1,615.32
Rate for Payer: Universal American Dual Medicare/Medicaid	$1,615.32
Rate for Payer: Universal American Medicare	$1,615.32
Rate for Payer: Wellcare Medicare	$1,615.32
Rate for Payer: Wellmed Medicare	$1,615.32

ED Dislocation Repair Site -> Knuckle

Facility

$800.00

Service Code	HCPCS 26700
Hospital Charge Code	5202510
Hospital Revenue Code	450
Rate for Payer: Cash Price	$544.00

ED Dislocation Repair Site -> Knuckle

Facility

$800.00

Service Code	HCPCS 26700
Hospital Charge Code	5202510
Hospital Revenue Code	450
Min. Negotiated Rate	$72.00
Max. Negotiated Rate	$576.00
Rate for Payer: Amerigroup CHIP/Medicaid	$72.00
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$247.79
Rate for Payer: Amerigroup Medicare	$247.79
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	$247.79
Rate for Payer: BCBS of TX PPO	$274.58
Rate for Payer: Cash Price	$544.00
Rate for Payer: Cash Price	$544.00
Rate for Payer: Cash Price	$544.00
Rate for Payer: Cigna Commercial	$523.79
Rate for Payer: Cigna Medicaid	$576.00
Rate for Payer: Cigna Medicare	$247.79
Rate for Payer: Employer Direct Commercial	$247.79
Rate for Payer: Humana Medicare/TRICARE	$247.79
Rate for Payer: Molina CHIP/Medicaid	$576.00
Rate for Payer: Molina Dual Medicare/Medicaid	$247.79
Rate for Payer: Molina Medicare	$247.79
Rate for Payer: Multiplan Auto	$520.00
Rate for Payer: Multiplan Commercial	$520.00
Rate for Payer: Multiplan Workers Comp	$520.00
Rate for Payer: Parkland Medicaid	$576.00
Rate for Payer: Scott and White EPO/PPO	$400.00
Rate for Payer: Scott and White Medicare	$247.79
Rate for Payer: Superior Health Plan CHIP/Medicaid	$576.00
Rate for Payer: Superior Health Plan EPO	$247.79
Rate for Payer: Superior Health Plan Medicare	$247.79
Rate for Payer: Universal American Dual Medicare/Medicaid	$247.79
Rate for Payer: Universal American Medicare	$247.79
Rate for Payer: Wellcare Medicare	$247.79
Rate for Payer: Wellmed Medicare	$247.79

ED Dislocation Repair Site -> Nursemaid Elbow Child w/ Manipulation

Facility

$777.00

Service Code	HCPCS 24640
Hospital Charge Code	8912586
Hospital Revenue Code	450
Rate for Payer: Cash Price	$528.36

ED Dislocation Repair Site -> Nursemaid Elbow Child w/ Manipulation

Facility

$777.00

Service Code	HCPCS 24640
Hospital Charge Code	8912586
Hospital Revenue Code	450
Min. Negotiated Rate	$69.93
Max. Negotiated Rate	$559.44
Rate for Payer: Amerigroup CHIP/Medicaid	$69.93
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$247.79
Rate for Payer: Amerigroup Medicare	$247.79
Rate for Payer: BCBS of TX Blue Advantage	$93.42
Rate for Payer: BCBS of TX Blue Essentials	$111.88
Rate for Payer: BCBS of TX Medicare	$247.79
Rate for Payer: BCBS of TX PPO	$140.97
Rate for Payer: Cash Price	$528.36
Rate for Payer: Cash Price	$528.36
Rate for Payer: Cash Price	$528.36
Rate for Payer: Cigna Commercial	$523.79
Rate for Payer: Cigna Medicaid	$559.44
Rate for Payer: Cigna Medicare	$247.79
Rate for Payer: Employer Direct Commercial	$247.79
Rate for Payer: Humana Medicare/TRICARE	$247.79
Rate for Payer: Molina CHIP/Medicaid	$559.44
Rate for Payer: Molina Dual Medicare/Medicaid	$247.79
Rate for Payer: Molina Medicare	$247.79
Rate for Payer: Multiplan Auto	$505.05
Rate for Payer: Multiplan Commercial	$505.05
Rate for Payer: Multiplan Workers Comp	$505.05
Rate for Payer: Parkland Medicaid	$559.44
Rate for Payer: Scott and White EPO/PPO	$388.50
Rate for Payer: Scott and White Medicare	$247.79
Rate for Payer: Superior Health Plan CHIP/Medicaid	$559.44
Rate for Payer: Superior Health Plan EPO	$247.79
Rate for Payer: Superior Health Plan Medicare	$247.79
Rate for Payer: Universal American Dual Medicare/Medicaid	$247.79
Rate for Payer: Universal American Medicare	$247.79
Rate for Payer: Wellcare Medicare	$247.79
Rate for Payer: Wellmed Medicare	$247.79

ED Dislocation Repair Site -> Shoulder w/o Anesthesia

Facility

$1,737.00

Service Code	HCPCS 23650
Hospital Charge Code	9220198
Hospital Revenue Code	450
Min. Negotiated Rate	$156.33
Max. Negotiated Rate	$1,250.64
Rate for Payer: Amerigroup CHIP/Medicaid	$156.33
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$247.79
Rate for Payer: Amerigroup Medicare	$247.79
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	$247.79
Rate for Payer: BCBS of TX PPO	$543.41
Rate for Payer: Cash Price	$1,181.16
Rate for Payer: Cash Price	$1,181.16
Rate for Payer: Cash Price	$1,181.16
Rate for Payer: Cigna Commercial	$523.79
Rate for Payer: Cigna Medicaid	$1,250.64
Rate for Payer: Cigna Medicare	$247.79
Rate for Payer: Employer Direct Commercial	$247.79
Rate for Payer: Humana Medicare/TRICARE	$247.79
Rate for Payer: Molina CHIP/Medicaid	$1,250.64
Rate for Payer: Molina Dual Medicare/Medicaid	$247.79
Rate for Payer: Molina Medicare	$247.79
Rate for Payer: Multiplan Auto	$1,129.05
Rate for Payer: Multiplan Commercial	$1,129.05
Rate for Payer: Multiplan Workers Comp	$1,129.05
Rate for Payer: Parkland Medicaid	$1,250.64
Rate for Payer: Scott and White EPO/PPO	$868.50
Rate for Payer: Scott and White Medicare	$247.79
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,250.64
Rate for Payer: Superior Health Plan EPO	$247.79
Rate for Payer: Superior Health Plan Medicare	$247.79
Rate for Payer: Universal American Dual Medicare/Medicaid	$247.79
Rate for Payer: Universal American Medicare	$247.79
Rate for Payer: Wellcare Medicare	$247.79
Rate for Payer: Wellmed Medicare	$247.79

ED Dislocation Repair Site -> Shoulder w/o Anesthesia

Facility

$1,737.00

Service Code	HCPCS 23650
Hospital Charge Code	9220198
Hospital Revenue Code	450
Rate for Payer: Cash Price	$1,181.16

ED Dislocation Repair Site -> Thumb

Facility

$986.00

Service Code	HCPCS 26641
Hospital Charge Code	5202508
Hospital Revenue Code	450
Rate for Payer: Cash Price	$670.48

ED Dislocation Repair Site -> Thumb

Facility

$986.00

Service Code	HCPCS 26641
Hospital Charge Code	5202508
Hospital Revenue Code	450
Min. Negotiated Rate	$88.74
Max. Negotiated Rate	$709.92
Rate for Payer: Amerigroup CHIP/Medicaid	$88.74
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$247.79
Rate for Payer: Amerigroup Medicare	$247.79
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	$247.79
Rate for Payer: BCBS of TX PPO	$274.58
Rate for Payer: Cash Price	$670.48
Rate for Payer: Cash Price	$670.48
Rate for Payer: Cash Price	$670.48
Rate for Payer: Cigna Commercial	$523.79
Rate for Payer: Cigna Medicaid	$709.92
Rate for Payer: Cigna Medicare	$247.79
Rate for Payer: Employer Direct Commercial	$247.79
Rate for Payer: Humana Medicare/TRICARE	$247.79
Rate for Payer: Molina CHIP/Medicaid	$709.92
Rate for Payer: Molina Dual Medicare/Medicaid	$247.79
Rate for Payer: Molina Medicare	$247.79
Rate for Payer: Multiplan Auto	$640.90
Rate for Payer: Multiplan Commercial	$640.90
Rate for Payer: Multiplan Workers Comp	$640.90
Rate for Payer: Parkland Medicaid	$709.92
Rate for Payer: Scott and White EPO/PPO	$493.00
Rate for Payer: Scott and White Medicare	$247.79
Rate for Payer: Superior Health Plan CHIP/Medicaid	$709.92
Rate for Payer: Superior Health Plan EPO	$247.79
Rate for Payer: Superior Health Plan Medicare	$247.79
Rate for Payer: Universal American Dual Medicare/Medicaid	$247.79
Rate for Payer: Universal American Medicare	$247.79
Rate for Payer: Wellcare Medicare	$247.79
Rate for Payer: Wellmed Medicare	$247.79

Know your out-of-pocket cost for care.

All Charges