White Rock Medical Center

All Charges

Charge

Type

Setting

Price

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
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	$792.48
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 -> 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 -> 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	$400.51
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
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	$99.47
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 -> 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 -> 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	$384.12
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	$487.40
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

ED Dislocation Repair Site -> Toe, Interphalangeal w/o Anes

Facility

$328.00

Service Code	HCPCS 28660
Hospital Charge Code	8912593
Hospital Revenue Code	450
Rate for Payer: Cash Price	$223.04

ED Dislocation Repair Site -> Toe, Interphalangeal w/o Anes

Facility

$328.00

Service Code	HCPCS 28660
Hospital Charge Code	8912593
Hospital Revenue Code	450
Min. Negotiated Rate	$29.52
Max. Negotiated Rate	$523.79
Rate for Payer: Amerigroup CHIP/Medicaid	$29.52
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$247.79
Rate for Payer: Amerigroup Medicare	$247.79
Rate for Payer: BCBS of TX Blue Advantage	$115.11
Rate for Payer: BCBS of TX Blue Essentials	$137.86
Rate for Payer: BCBS of TX Medicare	$247.79
Rate for Payer: BCBS of TX PPO	$173.70
Rate for Payer: Cash Price	$223.04
Rate for Payer: Cash Price	$223.04
Rate for Payer: Cash Price	$223.04
Rate for Payer: Cigna Commercial	$523.79
Rate for Payer: Cigna Medicaid	$236.16
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	$236.16
Rate for Payer: Molina Dual Medicare/Medicaid	$247.79
Rate for Payer: Molina Medicare	$247.79
Rate for Payer: Multiplan Auto	$213.20
Rate for Payer: Multiplan Commercial	$213.20
Rate for Payer: Multiplan Workers Comp	$213.20
Rate for Payer: Parkland Medicaid	$236.16
Rate for Payer: Scott and White EPO/PPO	$117.64
Rate for Payer: Scott and White Medicare	$247.79
Rate for Payer: Superior Health Plan CHIP/Medicaid	$236.16
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 -> Toe, Metatarsophalangeal w/o Anesthesia

Facility

$480.00

Service Code	HCPCS 28630
Hospital Charge Code	5202515
Hospital Revenue Code	450
Min. Negotiated Rate	$43.20
Max. Negotiated Rate	$523.79
Rate for Payer: Amerigroup CHIP/Medicaid	$43.20
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$247.79
Rate for Payer: Amerigroup Medicare	$247.79
Rate for Payer: BCBS of TX Blue Advantage	$148.86
Rate for Payer: BCBS of TX Blue Essentials	$178.28
Rate for Payer: BCBS of TX Medicare	$247.79
Rate for Payer: BCBS of TX PPO	$224.63
Rate for Payer: Cash Price	$326.40
Rate for Payer: Cash Price	$326.40
Rate for Payer: Cash Price	$326.40
Rate for Payer: Cigna Commercial	$523.79
Rate for Payer: Cigna Medicaid	$345.60
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	$345.60
Rate for Payer: Molina Dual Medicare/Medicaid	$247.79
Rate for Payer: Molina Medicare	$247.79
Rate for Payer: Multiplan Auto	$312.00
Rate for Payer: Multiplan Commercial	$312.00
Rate for Payer: Multiplan Workers Comp	$312.00
Rate for Payer: Parkland Medicaid	$345.60
Rate for Payer: Scott and White EPO/PPO	$137.75
Rate for Payer: Scott and White Medicare	$247.79
Rate for Payer: Superior Health Plan CHIP/Medicaid	$345.60
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 -> Toe, Metatarsophalangeal w/o Anesthesia

Facility

$480.00

Service Code	HCPCS 28630
Hospital Charge Code	5202515
Hospital Revenue Code	450
Rate for Payer: Cash Price	$326.40

ED DRAINAGE EXTERNAL EAR ABSCESS/HEMATOMA SIMPLE BCE

Facility

$1,518.43

Service Code	HCPCS 69000
Hospital Charge Code	8914577
Hospital Revenue Code	450
Rate for Payer: Cash Price	$1,032.53

ED DRAINAGE EXTERNAL EAR ABSCESS/HEMATOMA SIMPLE BCE

Facility

$1,518.43

Service Code	HCPCS 69000
Hospital Charge Code	8914577
Hospital Revenue Code	450
Min. Negotiated Rate	$136.66
Max. Negotiated Rate	$1,503.68
Rate for Payer: Amerigroup CHIP/Medicaid	$136.66
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$711.36
Rate for Payer: Amerigroup Medicare	$711.36
Rate for Payer: BCBS of TX Blue Advantage	$217.57
Rate for Payer: BCBS of TX Blue Essentials	$260.56
Rate for Payer: BCBS of TX Medicare	$711.36
Rate for Payer: BCBS of TX PPO	$328.31
Rate for Payer: Cash Price	$1,032.53
Rate for Payer: Cash Price	$1,032.53
Rate for Payer: Cash Price	$1,032.53
Rate for Payer: Cigna Commercial	$1,503.68
Rate for Payer: Cigna Medicaid	$1,093.27
Rate for Payer: Cigna Medicare	$711.36
Rate for Payer: Employer Direct Commercial	$711.36
Rate for Payer: Humana Medicare/TRICARE	$711.36
Rate for Payer: Molina CHIP/Medicaid	$1,093.27
Rate for Payer: Molina Dual Medicare/Medicaid	$711.36
Rate for Payer: Molina Medicare	$711.36
Rate for Payer: Multiplan Auto	$986.98
Rate for Payer: Multiplan Commercial	$986.98
Rate for Payer: Multiplan Workers Comp	$986.98
Rate for Payer: Parkland Medicaid	$1,093.27
Rate for Payer: Scott and White EPO/PPO	$155.65
Rate for Payer: Scott and White Medicare	$711.36
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,093.27
Rate for Payer: Superior Health Plan EPO	$711.36
Rate for Payer: Superior Health Plan Medicare	$711.36
Rate for Payer: Universal American Dual Medicare/Medicaid	$711.36
Rate for Payer: Universal American Medicare	$711.36
Rate for Payer: Wellcare Medicare	$711.36
Rate for Payer: Wellmed Medicare	$711.36

ED Drainage of abscess, cyst, hematoma from dentoalveolar structures BCE

Facility

$413.00

Service Code	HCPCS 41800
Hospital Charge Code	8640516
Hospital Revenue Code	450
Rate for Payer: Cash Price	$280.84

ED Drainage of abscess, cyst, hematoma from dentoalveolar structures BCE

Facility

$413.00

Service Code	HCPCS 41800
Hospital Charge Code	8640516
Hospital Revenue Code	450
Min. Negotiated Rate	$37.17
Max. Negotiated Rate	$297.36
Rate for Payer: Amerigroup CHIP/Medicaid	$37.17
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$133.65
Rate for Payer: Amerigroup Medicare	$133.65
Rate for Payer: BCBS of TX Blue Advantage	$182.08
Rate for Payer: BCBS of TX Blue Essentials	$218.06
Rate for Payer: BCBS of TX Medicare	$133.65
Rate for Payer: BCBS of TX PPO	$274.76
Rate for Payer: Cash Price	$280.84
Rate for Payer: Cash Price	$280.84
Rate for Payer: Cash Price	$280.84
Rate for Payer: Cigna Commercial	$282.53
Rate for Payer: Cigna Medicaid	$297.36
Rate for Payer: Cigna Medicare	$133.65
Rate for Payer: Employer Direct Commercial	$133.65
Rate for Payer: Humana Medicare/TRICARE	$133.65
Rate for Payer: Molina CHIP/Medicaid	$297.36
Rate for Payer: Molina Dual Medicare/Medicaid	$133.65
Rate for Payer: Molina Medicare	$133.65
Rate for Payer: Multiplan Auto	$268.45
Rate for Payer: Multiplan Commercial	$268.45
Rate for Payer: Multiplan Workers Comp	$268.45
Rate for Payer: Parkland Medicaid	$297.36
Rate for Payer: Scott and White EPO/PPO	$191.11
Rate for Payer: Scott and White Medicare	$133.65
Rate for Payer: Superior Health Plan CHIP/Medicaid	$297.36
Rate for Payer: Superior Health Plan EPO	$133.65
Rate for Payer: Superior Health Plan Medicare	$133.65
Rate for Payer: Universal American Dual Medicare/Medicaid	$133.65
Rate for Payer: Universal American Medicare	$133.65
Rate for Payer: Wellcare Medicare	$133.65
Rate for Payer: Wellmed Medicare	$133.65

ED DRAINAGE OF FINGER ABSCESS SIMPLE BCE

Facility

$533.00

Service Code	HCPCS 26010
Hospital Charge Code	8418454
Hospital Revenue Code	450
Rate for Payer: Cash Price	$362.44

ED DRAINAGE OF FINGER ABSCESS SIMPLE BCE

Facility

$533.00

Service Code	HCPCS 26010
Hospital Charge Code	8418454
Hospital Revenue Code	450
Min. Negotiated Rate	$47.97
Max. Negotiated Rate	$426.04
Rate for Payer: Amerigroup CHIP/Medicaid	$47.97
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$201.55
Rate for Payer: Amerigroup Medicare	$201.55
Rate for Payer: BCBS of TX Blue Advantage	$147.44
Rate for Payer: BCBS of TX Blue Essentials	$176.58
Rate for Payer: BCBS of TX Medicare	$201.55
Rate for Payer: BCBS of TX PPO	$222.49
Rate for Payer: Cash Price	$362.44
Rate for Payer: Cash Price	$362.44
Rate for Payer: Cash Price	$362.44
Rate for Payer: Cigna Commercial	$426.04
Rate for Payer: Cigna Medicaid	$383.76
Rate for Payer: Cigna Medicare	$201.55
Rate for Payer: Employer Direct Commercial	$201.55
Rate for Payer: Humana Medicare/TRICARE	$201.55
Rate for Payer: Molina CHIP/Medicaid	$383.76
Rate for Payer: Molina Dual Medicare/Medicaid	$201.55
Rate for Payer: Molina Medicare	$201.55
Rate for Payer: Multiplan Auto	$346.45
Rate for Payer: Multiplan Commercial	$346.45
Rate for Payer: Multiplan Workers Comp	$346.45
Rate for Payer: Parkland Medicaid	$383.76
Rate for Payer: Scott and White EPO/PPO	$176.05
Rate for Payer: Scott and White Medicare	$201.55
Rate for Payer: Superior Health Plan CHIP/Medicaid	$383.76
Rate for Payer: Superior Health Plan EPO	$201.55
Rate for Payer: Superior Health Plan Medicare	$201.55
Rate for Payer: Universal American Dual Medicare/Medicaid	$201.55
Rate for Payer: Universal American Medicare	$201.55
Rate for Payer: Wellcare Medicare	$201.55
Rate for Payer: Wellmed Medicare	$201.55

ED Ear Procedure -> Cerumen Irrigation/Lavage

Facility

$484.00

Service Code	HCPCS 69209
Hospital Charge Code	5202517
Hospital Revenue Code	450
Rate for Payer: Cash Price	$329.12

ED Ear Procedure -> Cerumen Irrigation/Lavage

Facility

$484.00

Service Code	HCPCS 69209
Hospital Charge Code	5202517
Hospital Revenue Code	450
Min. Negotiated Rate	$19.73
Max. Negotiated Rate	$348.48
Rate for Payer: Amerigroup CHIP/Medicaid	$43.56
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$59.26
Rate for Payer: Amerigroup Medicare	$59.26
Rate for Payer: BCBS of TX Blue Advantage	$91.87
Rate for Payer: BCBS of TX Blue Essentials	$110.02
Rate for Payer: BCBS of TX Medicare	$59.26
Rate for Payer: BCBS of TX PPO	$138.63
Rate for Payer: Cash Price	$329.12
Rate for Payer: Cash Price	$329.12
Rate for Payer: Cash Price	$329.12
Rate for Payer: Cigna Commercial	$125.27
Rate for Payer: Cigna Medicaid	$348.48
Rate for Payer: Cigna Medicare	$59.26
Rate for Payer: Employer Direct Commercial	$59.26
Rate for Payer: Humana Medicare/TRICARE	$59.26
Rate for Payer: Molina CHIP/Medicaid	$348.48
Rate for Payer: Molina Dual Medicare/Medicaid	$59.26
Rate for Payer: Molina Medicare	$59.26
Rate for Payer: Multiplan Auto	$314.60
Rate for Payer: Multiplan Commercial	$314.60
Rate for Payer: Multiplan Workers Comp	$314.60
Rate for Payer: Parkland Medicaid	$348.48
Rate for Payer: Scott and White EPO/PPO	$19.73
Rate for Payer: Scott and White Medicare	$59.26
Rate for Payer: Superior Health Plan CHIP/Medicaid	$348.48
Rate for Payer: Superior Health Plan EPO	$59.26
Rate for Payer: Superior Health Plan Medicare	$59.26
Rate for Payer: Universal American Dual Medicare/Medicaid	$59.26
Rate for Payer: Universal American Medicare	$59.26
Rate for Payer: Wellcare Medicare	$59.26
Rate for Payer: Wellmed Medicare	$59.26

ED Ear Procedure -> Cerumen w/ Instrumentation

Facility

$1,639.00

Service Code	HCPCS 69210
Hospital Charge Code	7150378
Hospital Revenue Code	450
Min. Negotiated Rate	$39.65
Max. Negotiated Rate	$1,180.08
Rate for Payer: Amerigroup CHIP/Medicaid	$147.51
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$59.26
Rate for Payer: Amerigroup Medicare	$59.26
Rate for Payer: BCBS of TX Blue Advantage	$91.87
Rate for Payer: BCBS of TX Blue Essentials	$110.02
Rate for Payer: BCBS of TX Medicare	$59.26
Rate for Payer: BCBS of TX PPO	$138.63
Rate for Payer: Cash Price	$1,114.52
Rate for Payer: Cash Price	$1,114.52
Rate for Payer: Cash Price	$1,114.52
Rate for Payer: Cigna Commercial	$125.27
Rate for Payer: Cigna Medicaid	$1,180.08
Rate for Payer: Cigna Medicare	$59.26
Rate for Payer: Employer Direct Commercial	$59.26
Rate for Payer: Humana Medicare/TRICARE	$59.26
Rate for Payer: Molina CHIP/Medicaid	$1,180.08
Rate for Payer: Molina Dual Medicare/Medicaid	$59.26
Rate for Payer: Molina Medicare	$59.26
Rate for Payer: Multiplan Auto	$1,065.35
Rate for Payer: Multiplan Commercial	$1,065.35
Rate for Payer: Multiplan Workers Comp	$1,065.35
Rate for Payer: Parkland Medicaid	$1,180.08
Rate for Payer: Scott and White EPO/PPO	$39.65
Rate for Payer: Scott and White Medicare	$59.26
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,180.08
Rate for Payer: Superior Health Plan EPO	$59.26
Rate for Payer: Superior Health Plan Medicare	$59.26
Rate for Payer: Universal American Dual Medicare/Medicaid	$59.26
Rate for Payer: Universal American Medicare	$59.26
Rate for Payer: Wellcare Medicare	$59.26
Rate for Payer: Wellmed Medicare	$59.26

ED Ear Procedure -> Cerumen w/ Instrumentation

Facility

$1,639.00

Service Code	HCPCS 69210
Hospital Charge Code	7150378
Hospital Revenue Code	450
Rate for Payer: Cash Price	$1,114.52

Know your out-of-pocket cost for care.

All Charges