White Rock Medical Center

All Charges

Charge

Type

Setting

Price

ED Fracture Site -> Phalangeal, finger or thumb w/ manipulation

Facility

$785.00

Service Code	HCPCS 26725
Hospital Charge Code	9220213
Hospital Revenue Code	450
Min. Negotiated Rate	$70.65
Max. Negotiated Rate	$565.20
Rate for Payer: Amerigroup CHIP/Medicaid	$70.65
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	$533.80
Rate for Payer: Cash Price	$533.80
Rate for Payer: Cash Price	$533.80
Rate for Payer: Cigna Commercial	$523.79
Rate for Payer: Cigna Medicaid	$565.20
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	$565.20
Rate for Payer: Molina Dual Medicare/Medicaid	$247.79
Rate for Payer: Molina Medicare	$247.79
Rate for Payer: Multiplan Auto	$510.25
Rate for Payer: Multiplan Commercial	$510.25
Rate for Payer: Multiplan Workers Comp	$510.25
Rate for Payer: Parkland Medicaid	$565.20
Rate for Payer: Scott and White EPO/PPO	$392.50
Rate for Payer: Scott and White Medicare	$247.79
Rate for Payer: Superior Health Plan CHIP/Medicaid	$565.20
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 Fracture Site -> Phalangeal, finger or thumb w/ manipulation

Facility

$785.00

Service Code	HCPCS 26725
Hospital Charge Code	9220213
Hospital Revenue Code	450
Rate for Payer: Cash Price	$533.80

ED Fracture Site -> Phalangeal, finger or thumb w/o manipulation

Facility

$715.00

Service Code	HCPCS 26720
Hospital Charge Code	8912604
Hospital Revenue Code	450
Min. Negotiated Rate	$64.35
Max. Negotiated Rate	$523.79
Rate for Payer: Amerigroup CHIP/Medicaid	$64.35
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	$486.20
Rate for Payer: Cash Price	$486.20
Rate for Payer: Cash Price	$486.20
Rate for Payer: Cigna Commercial	$523.79
Rate for Payer: Cigna Medicaid	$514.80
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	$514.80
Rate for Payer: Molina Dual Medicare/Medicaid	$247.79
Rate for Payer: Molina Medicare	$247.79
Rate for Payer: Multiplan Auto	$464.75
Rate for Payer: Multiplan Commercial	$464.75
Rate for Payer: Multiplan Workers Comp	$464.75
Rate for Payer: Parkland Medicaid	$514.80
Rate for Payer: Scott and White EPO/PPO	$357.50
Rate for Payer: Scott and White Medicare	$247.79
Rate for Payer: Superior Health Plan CHIP/Medicaid	$514.80
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 Fracture Site -> Phalangeal, finger or thumb w/o manipulation

Facility

$715.00

Service Code	HCPCS 26720
Hospital Charge Code	8912604
Hospital Revenue Code	450
Rate for Payer: Cash Price	$486.20

ED Fracture Site -> Radial Shaft fx / Distal radioulnar joint dislocation

Facility

$3,323.00

Service Code	HCPCS 25520
Hospital Charge Code	8546479
Hospital Revenue Code	450
Min. Negotiated Rate	$299.07
Max. Negotiated Rate	$3,415.58
Rate for Payer: Amerigroup CHIP/Medicaid	$299.07
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	$2,259.64
Rate for Payer: Cash Price	$2,259.64
Rate for Payer: Cash Price	$2,259.64
Rate for Payer: Cigna Commercial	$3,414.49
Rate for Payer: Cigna Medicaid	$2,392.56
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	$2,392.56
Rate for Payer: Molina Dual Medicare/Medicaid	$1,615.32
Rate for Payer: Molina Medicare	$1,615.32
Rate for Payer: Multiplan Auto	$2,159.95
Rate for Payer: Multiplan Commercial	$2,159.95
Rate for Payer: Multiplan Workers Comp	$2,159.95
Rate for Payer: Parkland Medicaid	$2,392.56
Rate for Payer: Scott and White EPO/PPO	$1,661.50
Rate for Payer: Scott and White Medicare	$1,615.32
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2,392.56
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 Fracture Site -> Radial Shaft fx / Distal radioulnar joint dislocation

Facility

$3,323.00

Service Code	HCPCS 25520
Hospital Charge Code	8546479
Hospital Revenue Code	450
Rate for Payer: Cash Price	$2,259.64

ED Fracture Site -> Radius/Ulna fx, distal, w/ manipulation

Facility

$2,762.00

Service Code	HCPCS 25605
Hospital Charge Code	9220208
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 Fracture Site -> Radius/Ulna fx, distal, w/ manipulation

Facility

$2,762.00

Service Code	HCPCS 25605
Hospital Charge Code	9220208
Hospital Revenue Code	450
Rate for Payer: Cash Price	$1,878.16

ED Fracture Site -> Radius/Ulna fx, distal, w/o manipulation

Facility

$913.00

Service Code	HCPCS 25600
Hospital Charge Code	9220207
Hospital Revenue Code	450
Min. Negotiated Rate	$82.17
Max. Negotiated Rate	$657.36
Rate for Payer: Amerigroup CHIP/Medicaid	$82.17
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	$620.84
Rate for Payer: Cash Price	$620.84
Rate for Payer: Cash Price	$620.84
Rate for Payer: Cigna Commercial	$523.79
Rate for Payer: Cigna Medicaid	$657.36
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	$657.36
Rate for Payer: Molina Dual Medicare/Medicaid	$247.79
Rate for Payer: Molina Medicare	$247.79
Rate for Payer: Multiplan Auto	$593.45
Rate for Payer: Multiplan Commercial	$593.45
Rate for Payer: Multiplan Workers Comp	$593.45
Rate for Payer: Parkland Medicaid	$657.36
Rate for Payer: Scott and White EPO/PPO	$456.50
Rate for Payer: Scott and White Medicare	$247.79
Rate for Payer: Superior Health Plan CHIP/Medicaid	$657.36
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 Fracture Site -> Radius/Ulna fx, distal, w/o manipulation

Facility

$913.00

Service Code	HCPCS 25600
Hospital Charge Code	9220207
Hospital Revenue Code	450
Rate for Payer: Cash Price	$620.84

ED Fracture Site -> Radius/Ulna fx, shaft, w/o manipulation

Facility

$791.00

Service Code	HCPCS 25560
Hospital Charge Code	8914596
Hospital Revenue Code	450
Min. Negotiated Rate	$71.19
Max. Negotiated Rate	$569.52
Rate for Payer: Amerigroup CHIP/Medicaid	$71.19
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	$537.88
Rate for Payer: Cash Price	$537.88
Rate for Payer: Cash Price	$537.88
Rate for Payer: Cigna Commercial	$523.79
Rate for Payer: Cigna Medicaid	$569.52
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	$569.52
Rate for Payer: Molina Dual Medicare/Medicaid	$247.79
Rate for Payer: Molina Medicare	$247.79
Rate for Payer: Multiplan Auto	$514.15
Rate for Payer: Multiplan Commercial	$514.15
Rate for Payer: Multiplan Workers Comp	$514.15
Rate for Payer: Parkland Medicaid	$569.52
Rate for Payer: Scott and White EPO/PPO	$395.50
Rate for Payer: Scott and White Medicare	$247.79
Rate for Payer: Superior Health Plan CHIP/Medicaid	$569.52
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 Fracture Site -> Radius/Ulna fx, shaft, w/o manipulation

Facility

$791.00

Service Code	HCPCS 25560
Hospital Charge Code	8914596
Hospital Revenue Code	450
Rate for Payer: Cash Price	$537.88

ED Fracture Site -> Radius w/o manipulation

Facility

$699.00

Service Code	HCPCS 25500
Hospital Charge Code	9220204
Hospital Revenue Code	450
Min. Negotiated Rate	$62.91
Max. Negotiated Rate	$523.79
Rate for Payer: Amerigroup CHIP/Medicaid	$62.91
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$247.79
Rate for Payer: Amerigroup Medicare	$247.79
Rate for Payer: BCBS of TX Blue Advantage	$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	$475.32
Rate for Payer: Cash Price	$475.32
Rate for Payer: Cash Price	$475.32
Rate for Payer: Cigna Commercial	$523.79
Rate for Payer: Cigna Medicaid	$503.28
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	$503.28
Rate for Payer: Molina Dual Medicare/Medicaid	$247.79
Rate for Payer: Molina Medicare	$247.79
Rate for Payer: Multiplan Auto	$454.35
Rate for Payer: Multiplan Commercial	$454.35
Rate for Payer: Multiplan Workers Comp	$454.35
Rate for Payer: Parkland Medicaid	$503.28
Rate for Payer: Scott and White EPO/PPO	$349.50
Rate for Payer: Scott and White Medicare	$247.79
Rate for Payer: Superior Health Plan CHIP/Medicaid	$503.28
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 Fracture Site -> Radius w/o manipulation

Facility

$699.00

Service Code	HCPCS 25500
Hospital Charge Code	9220204
Hospital Revenue Code	450
Rate for Payer: Cash Price	$475.32

ED Fracture Site -> Tibia fx, Distal, w/ manipulation

Facility

$4,765.00

Service Code	HCPCS 27825
Hospital Charge Code	8910620
Hospital Revenue Code	450
Rate for Payer: Cash Price	$3,240.20

ED Fracture Site -> Tibia fx, Distal, w/ manipulation

Facility

$4,765.00

Service Code	HCPCS 27825
Hospital Charge Code	8910620
Hospital Revenue Code	450
Min. Negotiated Rate	$428.85
Max. Negotiated Rate	$3,430.80
Rate for Payer: Amerigroup CHIP/Medicaid	$428.85
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	$3,240.20
Rate for Payer: Cash Price	$3,240.20
Rate for Payer: Cash Price	$3,240.20
Rate for Payer: Cigna Commercial	$3,414.49
Rate for Payer: Cigna Medicaid	$3,430.80
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	$3,430.80
Rate for Payer: Molina Dual Medicare/Medicaid	$1,615.32
Rate for Payer: Molina Medicare	$1,615.32
Rate for Payer: Multiplan Auto	$3,097.25
Rate for Payer: Multiplan Commercial	$3,097.25
Rate for Payer: Multiplan Workers Comp	$3,097.25
Rate for Payer: Parkland Medicaid	$3,430.80
Rate for Payer: Scott and White EPO/PPO	$2,382.50
Rate for Payer: Scott and White Medicare	$1,615.32
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3,430.80
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 Fracture Site -> Toe, other than Great Toe, w/ manipulation

Facility

$1,001.00

Service Code	HCPCS 28515
Hospital Charge Code	5202530
Hospital Revenue Code	450
Rate for Payer: Cash Price	$680.68

ED Fracture Site -> Toe, other than Great Toe, w/ manipulation

Facility

$1,001.00

Service Code	HCPCS 28515
Hospital Charge Code	5202530
Hospital Revenue Code	450
Min. Negotiated Rate	$90.09
Max. Negotiated Rate	$720.72
Rate for Payer: Amerigroup CHIP/Medicaid	$90.09
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$247.79
Rate for Payer: Amerigroup Medicare	$247.79
Rate for Payer: BCBS of TX Blue Advantage	$176.59
Rate for Payer: BCBS of TX Blue Essentials	$211.48
Rate for Payer: BCBS of TX Medicare	$247.79
Rate for Payer: BCBS of TX PPO	$266.46
Rate for Payer: Cash Price	$680.68
Rate for Payer: Cash Price	$680.68
Rate for Payer: Cash Price	$680.68
Rate for Payer: Cigna Commercial	$523.79
Rate for Payer: Cigna Medicaid	$720.72
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	$720.72
Rate for Payer: Molina Dual Medicare/Medicaid	$247.79
Rate for Payer: Molina Medicare	$247.79
Rate for Payer: Multiplan Auto	$650.65
Rate for Payer: Multiplan Commercial	$650.65
Rate for Payer: Multiplan Workers Comp	$650.65
Rate for Payer: Parkland Medicaid	$720.72
Rate for Payer: Scott and White EPO/PPO	$500.50
Rate for Payer: Scott and White Medicare	$247.79
Rate for Payer: Superior Health Plan CHIP/Medicaid	$720.72
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 Fracture Site -> Toe, other than Great Toe, w/o manipulation

Facility

$579.00

Service Code	HCPCS 28510
Hospital Charge Code	8544471
Hospital Revenue Code	450
Min. Negotiated Rate	$52.11
Max. Negotiated Rate	$523.79
Rate for Payer: Amerigroup CHIP/Medicaid	$52.11
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$247.79
Rate for Payer: Amerigroup Medicare	$247.79
Rate for Payer: BCBS of TX Blue Advantage	$130.78
Rate for Payer: BCBS of TX Blue Essentials	$156.62
Rate for Payer: BCBS of TX Medicare	$247.79
Rate for Payer: BCBS of TX PPO	$197.34
Rate for Payer: Cash Price	$393.72
Rate for Payer: Cash Price	$393.72
Rate for Payer: Cash Price	$393.72
Rate for Payer: Cigna Commercial	$523.79
Rate for Payer: Cigna Medicaid	$416.88
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	$416.88
Rate for Payer: Molina Dual Medicare/Medicaid	$247.79
Rate for Payer: Molina Medicare	$247.79
Rate for Payer: Multiplan Auto	$376.35
Rate for Payer: Multiplan Commercial	$376.35
Rate for Payer: Multiplan Workers Comp	$376.35
Rate for Payer: Parkland Medicaid	$416.88
Rate for Payer: Scott and White EPO/PPO	$289.50
Rate for Payer: Scott and White Medicare	$247.79
Rate for Payer: Superior Health Plan CHIP/Medicaid	$416.88
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 Fracture Site -> Toe, other than Great Toe, w/o manipulation

Facility

$579.00

Service Code	HCPCS 28510
Hospital Charge Code	8544471
Hospital Revenue Code	450
Rate for Payer: Cash Price	$393.72

ED Fracture Site -> Trimalleolar fx, w/ manipulation

Facility

$2,762.00

Service Code	HCPCS 27818
Hospital Charge Code	5202528
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 Fracture Site -> Trimalleolar fx, w/ manipulation

Facility

$2,762.00

Service Code	HCPCS 27818
Hospital Charge Code	5202528
Hospital Revenue Code	450
Rate for Payer: Cash Price	$1,878.16

ED Fracture Site -> Ulnar Shaft, w/ manipulation

Facility

$5,129.00

Service Code	HCPCS 25535
Hospital Charge Code	5202524
Hospital Revenue Code	450
Rate for Payer: Cash Price	$3,487.72

ED Fracture Site -> Ulnar Shaft, w/ manipulation

Facility

$5,129.00

Service Code	HCPCS 25535
Hospital Charge Code	5202524
Hospital Revenue Code	450
Min. Negotiated Rate	$247.79
Max. Negotiated Rate	$3,692.88
Rate for Payer: Amerigroup CHIP/Medicaid	$461.61
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	$3,487.72
Rate for Payer: Cash Price	$3,487.72
Rate for Payer: Cash Price	$3,487.72
Rate for Payer: Cigna Commercial	$523.79
Rate for Payer: Cigna Medicaid	$3,692.88
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	$3,692.88
Rate for Payer: Molina Dual Medicare/Medicaid	$247.79
Rate for Payer: Molina Medicare	$247.79
Rate for Payer: Multiplan Auto	$3,333.85
Rate for Payer: Multiplan Commercial	$3,333.85
Rate for Payer: Multiplan Workers Comp	$3,333.85
Rate for Payer: Parkland Medicaid	$3,692.88
Rate for Payer: Scott and White EPO/PPO	$2,564.50
Rate for Payer: Scott and White Medicare	$247.79
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3,692.88
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 GI/GU/Rectal Procedure -> Anoscopy

Facility

$712.00

Service Code	HCPCS 46600
Hospital Charge Code	9330051
Hospital Revenue Code	450
Rate for Payer: Cash Price	$484.16

Know your out-of-pocket cost for care.

All Charges