White Rock Medical Center

All Charges

Charge

Type

Setting

Price

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

ED GI/GU/Rectal Procedure -> Cystostomy/Foley change

Facility

$2,426.00

Service Code	HCPCS 51705
Hospital Charge Code	4901705
Hospital Revenue Code	450
Rate for Payer: Cash Price	$1,649.68

ED GI/GU/Rectal Procedure -> Cystostomy/Foley change

Facility

$2,426.00

Service Code	HCPCS 51705
Hospital Charge Code	4901705
Hospital Revenue Code	450
Min. Negotiated Rate	$102.45
Max. Negotiated Rate	$1,746.72
Rate for Payer: Amerigroup CHIP/Medicaid	$218.34
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$250.99
Rate for Payer: Amerigroup Medicare	$250.99
Rate for Payer: BCBS of TX Blue Advantage	$102.45
Rate for Payer: BCBS of TX Blue Essentials	$122.70
Rate for Payer: BCBS of TX Medicare	$250.99
Rate for Payer: BCBS of TX PPO	$154.60
Rate for Payer: Cash Price	$1,649.68
Rate for Payer: Cash Price	$1,649.68
Rate for Payer: Cash Price	$1,649.68
Rate for Payer: Cigna Commercial	$530.54
Rate for Payer: Cigna Medicaid	$1,746.72
Rate for Payer: Cigna Medicare	$250.99
Rate for Payer: Employer Direct Commercial	$250.99
Rate for Payer: Humana Medicare/TRICARE	$250.99
Rate for Payer: Molina CHIP/Medicaid	$1,746.72
Rate for Payer: Molina Dual Medicare/Medicaid	$250.99
Rate for Payer: Molina Medicare	$250.99
Rate for Payer: Multiplan Auto	$1,576.90
Rate for Payer: Multiplan Commercial	$1,576.90
Rate for Payer: Multiplan Workers Comp	$1,576.90
Rate for Payer: Parkland Medicaid	$1,746.72
Rate for Payer: Scott and White EPO/PPO	$1,213.00
Rate for Payer: Scott and White Medicare	$250.99
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,746.72
Rate for Payer: Superior Health Plan EPO	$250.99
Rate for Payer: Superior Health Plan Medicare	$250.99
Rate for Payer: Universal American Dual Medicare/Medicaid	$250.99
Rate for Payer: Universal American Medicare	$250.99
Rate for Payer: Wellcare Medicare	$250.99
Rate for Payer: Wellmed Medicare	$250.99

ED GI/GU/Rectal Procedure -> Gastric Intubation w/ Lavage

Facility

$576.00

Service Code	HCPCS 43753
Hospital Charge Code	5210316
Hospital Revenue Code	450
Rate for Payer: Cash Price	$391.68

ED GI/GU/Rectal Procedure -> Gastric Intubation w/ Lavage

Facility

$576.00

Service Code	HCPCS 43753
Hospital Charge Code	5210316
Hospital Revenue Code	450
Min. Negotiated Rate	$51.84
Max. Negotiated Rate	$637.81
Rate for Payer: Amerigroup CHIP/Medicaid	$51.84
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$216.91
Rate for Payer: Amerigroup Medicare	$216.91
Rate for Payer: BCBS of TX Blue Advantage	$422.68
Rate for Payer: BCBS of TX Blue Essentials	$506.20
Rate for Payer: BCBS of TX Medicare	$216.91
Rate for Payer: BCBS of TX PPO	$637.81
Rate for Payer: Cash Price	$391.68
Rate for Payer: Cash Price	$391.68
Rate for Payer: Cash Price	$391.68
Rate for Payer: Cigna Commercial	$458.51
Rate for Payer: Cigna Medicaid	$414.72
Rate for Payer: Cigna Medicare	$216.91
Rate for Payer: Employer Direct Commercial	$216.91
Rate for Payer: Humana Medicare/TRICARE	$216.91
Rate for Payer: Molina CHIP/Medicaid	$414.72
Rate for Payer: Molina Dual Medicare/Medicaid	$216.91
Rate for Payer: Molina Medicare	$216.91
Rate for Payer: Multiplan Auto	$374.40
Rate for Payer: Multiplan Commercial	$374.40
Rate for Payer: Multiplan Workers Comp	$374.40
Rate for Payer: Parkland Medicaid	$414.72
Rate for Payer: Scott and White EPO/PPO	$288.00
Rate for Payer: Scott and White Medicare	$216.91
Rate for Payer: Superior Health Plan CHIP/Medicaid	$414.72
Rate for Payer: Superior Health Plan EPO	$216.91
Rate for Payer: Superior Health Plan Medicare	$216.91
Rate for Payer: Universal American Dual Medicare/Medicaid	$216.91
Rate for Payer: Universal American Medicare	$216.91
Rate for Payer: Wellcare Medicare	$216.91
Rate for Payer: Wellmed Medicare	$216.91

ED GI/GU/Rectal Procedure -> Paraphimosis treatment

Facility

$2,269.00

Service Code	HCPCS 54450
Hospital Charge Code	5202534
Hospital Revenue Code	450
Min. Negotiated Rate	$204.21
Max. Negotiated Rate	$1,633.68
Rate for Payer: Amerigroup CHIP/Medicaid	$204.21
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$250.99
Rate for Payer: Amerigroup Medicare	$250.99
Rate for Payer: BCBS of TX Blue Advantage	$392.28
Rate for Payer: BCBS of TX Blue Essentials	$469.80
Rate for Payer: BCBS of TX Medicare	$250.99
Rate for Payer: BCBS of TX PPO	$591.95
Rate for Payer: Cash Price	$1,542.92
Rate for Payer: Cash Price	$1,542.92
Rate for Payer: Cash Price	$1,542.92
Rate for Payer: Cigna Commercial	$530.54
Rate for Payer: Cigna Medicaid	$1,633.68
Rate for Payer: Cigna Medicare	$250.99
Rate for Payer: Employer Direct Commercial	$250.99
Rate for Payer: Humana Medicare/TRICARE	$250.99
Rate for Payer: Molina CHIP/Medicaid	$1,633.68
Rate for Payer: Molina Dual Medicare/Medicaid	$250.99
Rate for Payer: Molina Medicare	$250.99
Rate for Payer: Multiplan Auto	$1,474.85
Rate for Payer: Multiplan Commercial	$1,474.85
Rate for Payer: Multiplan Workers Comp	$1,474.85
Rate for Payer: Parkland Medicaid	$1,633.68
Rate for Payer: Scott and White EPO/PPO	$1,134.50
Rate for Payer: Scott and White Medicare	$250.99
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,633.68
Rate for Payer: Superior Health Plan EPO	$250.99
Rate for Payer: Superior Health Plan Medicare	$250.99
Rate for Payer: Universal American Dual Medicare/Medicaid	$250.99
Rate for Payer: Universal American Medicare	$250.99
Rate for Payer: Wellcare Medicare	$250.99
Rate for Payer: Wellmed Medicare	$250.99

ED GI/GU/Rectal Procedure -> Paraphimosis treatment

Facility

$2,269.00

Service Code	HCPCS 54450
Hospital Charge Code	5202534
Hospital Revenue Code	450
Rate for Payer: Cash Price	$1,542.92

ED GI/GU/Rectal Procedure -> Removal of hemorrhoid clot

Facility

$6,289.00

Service Code	HCPCS 46320
Hospital Charge Code	5202532
Hospital Revenue Code	450
Rate for Payer: Cash Price	$4,276.52

ED GI/GU/Rectal Procedure -> Removal of hemorrhoid clot

Facility

$6,289.00

Service Code	HCPCS 46320
Hospital Charge Code	5202532
Hospital Revenue Code	450
Min. Negotiated Rate	$224.80
Max. Negotiated Rate	$4,528.08
Rate for Payer: Amerigroup CHIP/Medicaid	$566.01
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	$224.80
Rate for Payer: BCBS of TX Blue Essentials	$269.22
Rate for Payer: BCBS of TX Medicare	$1,202.09
Rate for Payer: BCBS of TX PPO	$339.22
Rate for Payer: Cash Price	$4,276.52
Rate for Payer: Cash Price	$4,276.52
Rate for Payer: Cash Price	$4,276.52
Rate for Payer: Cigna Commercial	$2,541.00
Rate for Payer: Cigna Medicaid	$4,528.08
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	$4,528.08
Rate for Payer: Molina Dual Medicare/Medicaid	$1,202.09
Rate for Payer: Molina Medicare	$1,202.09
Rate for Payer: Multiplan Auto	$4,087.85
Rate for Payer: Multiplan Commercial	$4,087.85
Rate for Payer: Multiplan Workers Comp	$4,087.85
Rate for Payer: Parkland Medicaid	$4,528.08
Rate for Payer: Scott and White EPO/PPO	$3,144.50
Rate for Payer: Scott and White Medicare	$1,202.09
Rate for Payer: Superior Health Plan CHIP/Medicaid	$4,528.08
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

ED GI/GU/Rectal Procedure -> Removal of rectal obstruction

Facility

$4,010.00

Service Code	HCPCS 45915
Hospital Charge Code	5202531
Hospital Revenue Code	450
Min. Negotiated Rate	$360.90
Max. Negotiated Rate	$2,887.20
Rate for Payer: Amerigroup CHIP/Medicaid	$360.90
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	$2,726.80
Rate for Payer: Cash Price	$2,726.80
Rate for Payer: Cash Price	$2,726.80
Rate for Payer: Cigna Commercial	$2,541.00
Rate for Payer: Cigna Medicaid	$2,887.20
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	$2,887.20
Rate for Payer: Molina Dual Medicare/Medicaid	$1,202.09
Rate for Payer: Molina Medicare	$1,202.09
Rate for Payer: Multiplan Auto	$2,606.50
Rate for Payer: Multiplan Commercial	$2,606.50
Rate for Payer: Multiplan Workers Comp	$2,606.50
Rate for Payer: Parkland Medicaid	$2,887.20
Rate for Payer: Scott and White EPO/PPO	$2,005.00
Rate for Payer: Scott and White Medicare	$1,202.09
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2,887.20
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

ED GI/GU/Rectal Procedure -> Removal of rectal obstruction

Facility

$4,010.00

Service Code	HCPCS 45915
Hospital Charge Code	5202531
Hospital Revenue Code	450
Rate for Payer: Cash Price	$2,726.80

ED GI/GU/Rectal Procedure -> Replace G-J Tube

Facility

$1,457.00

Service Code	HCPCS 49452
Hospital Charge Code	2181015
Hospital Revenue Code	450
Rate for Payer: Cash Price	$990.76

ED GI/GU/Rectal Procedure -> Replace G-J Tube

Facility

$1,457.00

Service Code	HCPCS 49452
Hospital Charge Code	2181015
Hospital Revenue Code	450
Min. Negotiated Rate	$131.13
Max. Negotiated Rate	$1,980.52
Rate for Payer: Amerigroup CHIP/Medicaid	$131.13
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$911.12
Rate for Payer: Amerigroup Medicare	$911.12
Rate for Payer: BCBS of TX Blue Advantage	$1,312.49
Rate for Payer: BCBS of TX Blue Essentials	$1,571.84
Rate for Payer: BCBS of TX Medicare	$911.12
Rate for Payer: BCBS of TX PPO	$1,980.52
Rate for Payer: Cash Price	$990.76
Rate for Payer: Cash Price	$990.76
Rate for Payer: Cash Price	$990.76
Rate for Payer: Cigna Commercial	$1,925.93
Rate for Payer: Cigna Medicaid	$1,049.04
Rate for Payer: Cigna Medicare	$911.12
Rate for Payer: Employer Direct Commercial	$911.12
Rate for Payer: Humana Medicare/TRICARE	$911.12
Rate for Payer: Molina CHIP/Medicaid	$1,049.04
Rate for Payer: Molina Dual Medicare/Medicaid	$911.12
Rate for Payer: Molina Medicare	$911.12
Rate for Payer: Multiplan Auto	$947.05
Rate for Payer: Multiplan Commercial	$947.05
Rate for Payer: Multiplan Workers Comp	$947.05
Rate for Payer: Parkland Medicaid	$1,049.04
Rate for Payer: Scott and White EPO/PPO	$728.50
Rate for Payer: Scott and White Medicare	$911.12
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,049.04
Rate for Payer: Superior Health Plan EPO	$911.12
Rate for Payer: Superior Health Plan Medicare	$911.12
Rate for Payer: Universal American Dual Medicare/Medicaid	$911.12
Rate for Payer: Universal American Medicare	$911.12
Rate for Payer: Wellcare Medicare	$911.12
Rate for Payer: Wellmed Medicare	$911.12

ED GI/GU/Rectal Procedure -> Replace G-Tube

Facility

$620.00

Service Code	HCPCS 43762
Hospital Charge Code	8424451
Hospital Revenue Code	450
Min. Negotiated Rate	$55.80
Max. Negotiated Rate	$591.95
Rate for Payer: Amerigroup CHIP/Medicaid	$55.80
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$250.99
Rate for Payer: Amerigroup Medicare	$250.99
Rate for Payer: BCBS of TX Blue Advantage	$392.28
Rate for Payer: BCBS of TX Blue Essentials	$469.80
Rate for Payer: BCBS of TX Medicare	$250.99
Rate for Payer: BCBS of TX PPO	$591.95
Rate for Payer: Cash Price	$421.60
Rate for Payer: Cash Price	$421.60
Rate for Payer: Cash Price	$421.60
Rate for Payer: Cigna Commercial	$530.54
Rate for Payer: Cigna Medicaid	$446.40
Rate for Payer: Cigna Medicare	$250.99
Rate for Payer: Employer Direct Commercial	$250.99
Rate for Payer: Humana Medicare/TRICARE	$250.99
Rate for Payer: Molina CHIP/Medicaid	$446.40
Rate for Payer: Molina Dual Medicare/Medicaid	$250.99
Rate for Payer: Molina Medicare	$250.99
Rate for Payer: Multiplan Auto	$403.00
Rate for Payer: Multiplan Commercial	$403.00
Rate for Payer: Multiplan Workers Comp	$403.00
Rate for Payer: Parkland Medicaid	$446.40
Rate for Payer: Scott and White EPO/PPO	$310.00
Rate for Payer: Scott and White Medicare	$250.99
Rate for Payer: Superior Health Plan CHIP/Medicaid	$446.40
Rate for Payer: Superior Health Plan EPO	$250.99
Rate for Payer: Superior Health Plan Medicare	$250.99
Rate for Payer: Universal American Dual Medicare/Medicaid	$250.99
Rate for Payer: Universal American Medicare	$250.99
Rate for Payer: Wellcare Medicare	$250.99
Rate for Payer: Wellmed Medicare	$250.99

ED GI/GU/Rectal Procedure -> Replace G-Tube

Facility

$620.00

Service Code	HCPCS 43762
Hospital Charge Code	8424451
Hospital Revenue Code	450
Rate for Payer: Cash Price	$421.60

ED I AND D OF BARTHOLINS GLND ABS BCE

Facility

$695.00

Service Code	HCPCS 56420
Hospital Charge Code	8912614
Hospital Revenue Code	450
Min. Negotiated Rate	$62.55
Max. Negotiated Rate	$500.40
Rate for Payer: Amerigroup CHIP/Medicaid	$62.55
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$203.09
Rate for Payer: Amerigroup Medicare	$203.09
Rate for Payer: BCBS of TX Blue Advantage	$140.11
Rate for Payer: BCBS of TX Blue Essentials	$167.80
Rate for Payer: BCBS of TX Medicare	$203.09
Rate for Payer: BCBS of TX PPO	$211.43
Rate for Payer: Cash Price	$472.60
Rate for Payer: Cash Price	$472.60
Rate for Payer: Cash Price	$472.60
Rate for Payer: Cigna Commercial	$429.31
Rate for Payer: Cigna Medicaid	$500.40
Rate for Payer: Cigna Medicare	$203.09
Rate for Payer: Employer Direct Commercial	$203.09
Rate for Payer: Humana Medicare/TRICARE	$203.09
Rate for Payer: Molina CHIP/Medicaid	$500.40
Rate for Payer: Molina Dual Medicare/Medicaid	$203.09
Rate for Payer: Molina Medicare	$203.09
Rate for Payer: Multiplan Auto	$451.75
Rate for Payer: Multiplan Commercial	$451.75
Rate for Payer: Multiplan Workers Comp	$451.75
Rate for Payer: Parkland Medicaid	$500.40
Rate for Payer: Scott and White EPO/PPO	$347.50
Rate for Payer: Scott and White Medicare	$203.09
Rate for Payer: Superior Health Plan CHIP/Medicaid	$500.40
Rate for Payer: Superior Health Plan EPO	$203.09
Rate for Payer: Superior Health Plan Medicare	$203.09
Rate for Payer: Universal American Dual Medicare/Medicaid	$203.09
Rate for Payer: Universal American Medicare	$203.09
Rate for Payer: Wellcare Medicare	$203.09
Rate for Payer: Wellmed Medicare	$203.09

ED I AND D OF BARTHOLINS GLND ABS BCE

Facility

$695.00

Service Code	HCPCS 56420
Hospital Charge Code	8912614
Hospital Revenue Code	450
Rate for Payer: Cash Price	$472.60

ED ID Aspiration -> Abscess/Cyst/Hematoma

Facility

$895.00

Service Code	HCPCS 10160
Hospital Charge Code	3521001
Hospital Revenue Code	450
Min. Negotiated Rate	$80.55
Max. Negotiated Rate	$863.21
Rate for Payer: Amerigroup CHIP/Medicaid	$80.55
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$408.37
Rate for Payer: Amerigroup Medicare	$408.37
Rate for Payer: BCBS of TX Blue Advantage	$139.23
Rate for Payer: BCBS of TX Blue Essentials	$166.74
Rate for Payer: BCBS of TX Medicare	$408.37
Rate for Payer: BCBS of TX PPO	$210.09
Rate for Payer: Cash Price	$608.60
Rate for Payer: Cash Price	$608.60
Rate for Payer: Cash Price	$608.60
Rate for Payer: Cigna Commercial	$863.21
Rate for Payer: Cigna Medicaid	$644.40
Rate for Payer: Cigna Medicare	$408.37
Rate for Payer: Employer Direct Commercial	$408.37
Rate for Payer: Humana Medicare/TRICARE	$408.37
Rate for Payer: Molina CHIP/Medicaid	$644.40
Rate for Payer: Molina Dual Medicare/Medicaid	$408.37
Rate for Payer: Molina Medicare	$408.37
Rate for Payer: Multiplan Auto	$581.75
Rate for Payer: Multiplan Commercial	$581.75
Rate for Payer: Multiplan Workers Comp	$581.75
Rate for Payer: Parkland Medicaid	$644.40
Rate for Payer: Scott and White EPO/PPO	$447.50
Rate for Payer: Scott and White Medicare	$408.37
Rate for Payer: Superior Health Plan CHIP/Medicaid	$644.40
Rate for Payer: Superior Health Plan EPO	$408.37
Rate for Payer: Superior Health Plan Medicare	$408.37
Rate for Payer: Universal American Dual Medicare/Medicaid	$408.37
Rate for Payer: Universal American Medicare	$408.37
Rate for Payer: Wellcare Medicare	$408.37
Rate for Payer: Wellmed Medicare	$408.37

ED ID Aspiration -> Abscess/Cyst/Hematoma

Facility

$895.00

Service Code	HCPCS 10160
Hospital Charge Code	3521001
Hospital Revenue Code	450
Rate for Payer: Cash Price	$608.60

ED ID Aspiration -> Arthrocentesis - fingers or toes

Facility

$622.00

Service Code	HCPCS 20600
Hospital Charge Code	2100012
Hospital Revenue Code	450
Rate for Payer: Cash Price	$422.96

ED ID Aspiration -> Arthrocentesis - fingers or toes

Facility

$622.00

Service Code	HCPCS 20600
Hospital Charge Code	2100012
Hospital Revenue Code	450
Min. Negotiated Rate	$41.58
Max. Negotiated Rate	$651.79
Rate for Payer: Amerigroup CHIP/Medicaid	$55.98
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$308.35
Rate for Payer: Amerigroup Medicare	$308.35
Rate for Payer: BCBS of TX Blue Advantage	$41.58
Rate for Payer: BCBS of TX Blue Essentials	$49.80
Rate for Payer: BCBS of TX Medicare	$308.35
Rate for Payer: BCBS of TX PPO	$62.75
Rate for Payer: Cash Price	$422.96
Rate for Payer: Cash Price	$422.96
Rate for Payer: Cash Price	$422.96
Rate for Payer: Cigna Commercial	$651.79
Rate for Payer: Cigna Medicaid	$447.84
Rate for Payer: Cigna Medicare	$308.35
Rate for Payer: Employer Direct Commercial	$308.35
Rate for Payer: Humana Medicare/TRICARE	$308.35
Rate for Payer: Molina CHIP/Medicaid	$447.84
Rate for Payer: Molina Dual Medicare/Medicaid	$308.35
Rate for Payer: Molina Medicare	$308.35
Rate for Payer: Multiplan Auto	$404.30
Rate for Payer: Multiplan Commercial	$404.30
Rate for Payer: Multiplan Workers Comp	$404.30
Rate for Payer: Parkland Medicaid	$447.84
Rate for Payer: Scott and White EPO/PPO	$311.00
Rate for Payer: Scott and White Medicare	$308.35
Rate for Payer: Superior Health Plan CHIP/Medicaid	$447.84
Rate for Payer: Superior Health Plan EPO	$308.35
Rate for Payer: Superior Health Plan Medicare	$308.35
Rate for Payer: Universal American Dual Medicare/Medicaid	$308.35
Rate for Payer: Universal American Medicare	$308.35
Rate for Payer: Wellcare Medicare	$308.35
Rate for Payer: Wellmed Medicare	$308.35

ED ID Aspiration -> Arthrocentesis - shoulder, hip, knee, or subacromial bursa

Facility

$1,676.00

Service Code	HCPCS 20610
Hospital Charge Code	6110555
Hospital Revenue Code	450
Rate for Payer: Cash Price	$1,139.68

ED ID Aspiration -> Arthrocentesis - shoulder, hip, knee, or subacromial bursa

Facility

$1,676.00

Service Code	HCPCS 20610
Hospital Charge Code	6110555
Hospital Revenue Code	450
Min. Negotiated Rate	$51.84
Max. Negotiated Rate	$1,206.72
Rate for Payer: Amerigroup CHIP/Medicaid	$150.84
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$308.35
Rate for Payer: Amerigroup Medicare	$308.35
Rate for Payer: BCBS of TX Blue Advantage	$51.84
Rate for Payer: BCBS of TX Blue Essentials	$62.08
Rate for Payer: BCBS of TX Medicare	$308.35
Rate for Payer: BCBS of TX PPO	$78.22
Rate for Payer: Cash Price	$1,139.68
Rate for Payer: Cash Price	$1,139.68
Rate for Payer: Cash Price	$1,139.68
Rate for Payer: Cigna Commercial	$651.79
Rate for Payer: Cigna Medicaid	$1,206.72
Rate for Payer: Cigna Medicare	$308.35
Rate for Payer: Employer Direct Commercial	$308.35
Rate for Payer: Humana Medicare/TRICARE	$308.35
Rate for Payer: Molina CHIP/Medicaid	$1,206.72
Rate for Payer: Molina Dual Medicare/Medicaid	$308.35
Rate for Payer: Molina Medicare	$308.35
Rate for Payer: Multiplan Auto	$1,089.40
Rate for Payer: Multiplan Commercial	$1,089.40
Rate for Payer: Multiplan Workers Comp	$1,089.40
Rate for Payer: Parkland Medicaid	$1,206.72
Rate for Payer: Scott and White EPO/PPO	$838.00
Rate for Payer: Scott and White Medicare	$308.35
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,206.72
Rate for Payer: Superior Health Plan EPO	$308.35
Rate for Payer: Superior Health Plan Medicare	$308.35
Rate for Payer: Universal American Dual Medicare/Medicaid	$308.35
Rate for Payer: Universal American Medicare	$308.35
Rate for Payer: Wellcare Medicare	$308.35
Rate for Payer: Wellmed Medicare	$308.35

ED ID Aspiration -> Arthrocentesis - temporomandibular, AC, wrist, elbow or ankl

Facility

$719.00

Service Code	HCPCS 20605
Hospital Charge Code	6110548
Hospital Revenue Code	450
Min. Negotiated Rate	$43.39
Max. Negotiated Rate	$651.79
Rate for Payer: Amerigroup CHIP/Medicaid	$64.71
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$308.35
Rate for Payer: Amerigroup Medicare	$308.35
Rate for Payer: BCBS of TX Blue Advantage	$43.39
Rate for Payer: BCBS of TX Blue Essentials	$51.96
Rate for Payer: BCBS of TX Medicare	$308.35
Rate for Payer: BCBS of TX PPO	$65.47
Rate for Payer: Cash Price	$488.92
Rate for Payer: Cash Price	$488.92
Rate for Payer: Cash Price	$488.92
Rate for Payer: Cigna Commercial	$651.79
Rate for Payer: Cigna Medicaid	$517.68
Rate for Payer: Cigna Medicare	$308.35
Rate for Payer: Employer Direct Commercial	$308.35
Rate for Payer: Humana Medicare/TRICARE	$308.35
Rate for Payer: Molina CHIP/Medicaid	$517.68
Rate for Payer: Molina Dual Medicare/Medicaid	$308.35
Rate for Payer: Molina Medicare	$308.35
Rate for Payer: Multiplan Auto	$467.35
Rate for Payer: Multiplan Commercial	$467.35
Rate for Payer: Multiplan Workers Comp	$467.35
Rate for Payer: Parkland Medicaid	$517.68
Rate for Payer: Scott and White EPO/PPO	$359.50
Rate for Payer: Scott and White Medicare	$308.35
Rate for Payer: Superior Health Plan CHIP/Medicaid	$517.68
Rate for Payer: Superior Health Plan EPO	$308.35
Rate for Payer: Superior Health Plan Medicare	$308.35
Rate for Payer: Universal American Dual Medicare/Medicaid	$308.35
Rate for Payer: Universal American Medicare	$308.35
Rate for Payer: Wellcare Medicare	$308.35
Rate for Payer: Wellmed Medicare	$308.35

ED ID Aspiration -> Arthrocentesis - temporomandibular, AC, wrist, elbow or ankl

Facility

$719.00

Service Code	HCPCS 20605
Hospital Charge Code	6110548
Hospital Revenue Code	450
Rate for Payer: Cash Price	$488.92

Know your out-of-pocket cost for care.

All Charges