White Rock Medical Center

All Charges

Charge

Type

Setting

Price

ED Laceration Simple - Scalp -> 20.1 to 30.0 cm

Facility

$1,189.29

Service Code	HCPCS 12006
Hospital Charge Code	8414458
Hospital Revenue Code	450
Rate for Payer: Cash Price	$808.72

ED Laceration Simple - Scalp -> 20.1 to 30.0 cm

Facility

$1,189.29

Service Code	HCPCS 12006
Hospital Charge Code	8414458
Hospital Revenue Code	450
Min. Negotiated Rate	$107.04
Max. Negotiated Rate	$863.21
Rate for Payer: Amerigroup CHIP/Medicaid	$107.04
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$408.37
Rate for Payer: Amerigroup Medicare	$408.37
Rate for Payer: BCBS of TX Blue Advantage	$533.58
Rate for Payer: BCBS of TX Blue Essentials	$639.02
Rate for Payer: BCBS of TX Medicare	$408.37
Rate for Payer: BCBS of TX PPO	$805.17
Rate for Payer: Cash Price	$808.72
Rate for Payer: Cash Price	$808.72
Rate for Payer: Cash Price	$808.72
Rate for Payer: Cigna Commercial	$863.21
Rate for Payer: Cigna Medicaid	$856.29
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	$856.29
Rate for Payer: Molina Dual Medicare/Medicaid	$408.37
Rate for Payer: Molina Medicare	$408.37
Rate for Payer: Multiplan Auto	$773.04
Rate for Payer: Multiplan Commercial	$773.04
Rate for Payer: Multiplan Workers Comp	$773.04
Rate for Payer: Parkland Medicaid	$856.29
Rate for Payer: Scott and White EPO/PPO	$140.50
Rate for Payer: Scott and White Medicare	$408.37
Rate for Payer: Superior Health Plan CHIP/Medicaid	$856.29
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 Laceration Simple - Scalp -> <= 2.5 cm

Facility

$993.50

Service Code	HCPCS 12001
Hospital Charge Code	8914618
Hospital Revenue Code	450
Rate for Payer: Cash Price	$675.58

ED Laceration Simple - Scalp -> <= 2.5 cm

Facility

$993.50

Service Code	HCPCS 12001
Hospital Charge Code	8914618
Hospital Revenue Code	450
Min. Negotiated Rate	$54.51
Max. Negotiated Rate	$715.32
Rate for Payer: Amerigroup CHIP/Medicaid	$89.42
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$201.55
Rate for Payer: Amerigroup Medicare	$201.55
Rate for Payer: BCBS of TX Blue Advantage	$291.80
Rate for Payer: BCBS of TX Blue Essentials	$349.46
Rate for Payer: BCBS of TX Medicare	$201.55
Rate for Payer: BCBS of TX PPO	$440.32
Rate for Payer: Cash Price	$675.58
Rate for Payer: Cash Price	$675.58
Rate for Payer: Cash Price	$675.58
Rate for Payer: Cigna Commercial	$426.04
Rate for Payer: Cigna Medicaid	$715.32
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	$715.32
Rate for Payer: Molina Dual Medicare/Medicaid	$201.55
Rate for Payer: Molina Medicare	$201.55
Rate for Payer: Multiplan Auto	$645.77
Rate for Payer: Multiplan Commercial	$645.77
Rate for Payer: Multiplan Workers Comp	$645.77
Rate for Payer: Parkland Medicaid	$715.32
Rate for Payer: Scott and White EPO/PPO	$54.51
Rate for Payer: Scott and White Medicare	$201.55
Rate for Payer: Superior Health Plan CHIP/Medicaid	$715.32
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 Laceration Simple - Scalp -> 2.6 to 7.5 cm

Facility

$737.00

Service Code	HCPCS 12002
Hospital Charge Code	5202569
Hospital Revenue Code	450
Min. Negotiated Rate	$66.33
Max. Negotiated Rate	$530.64
Rate for Payer: Amerigroup CHIP/Medicaid	$66.33
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$201.55
Rate for Payer: Amerigroup Medicare	$201.55
Rate for Payer: BCBS of TX Blue Advantage	$291.80
Rate for Payer: BCBS of TX Blue Essentials	$349.46
Rate for Payer: BCBS of TX Medicare	$201.55
Rate for Payer: BCBS of TX PPO	$440.32
Rate for Payer: Cash Price	$501.16
Rate for Payer: Cash Price	$501.16
Rate for Payer: Cash Price	$501.16
Rate for Payer: Cigna Commercial	$426.04
Rate for Payer: Cigna Medicaid	$530.64
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	$530.64
Rate for Payer: Molina Dual Medicare/Medicaid	$201.55
Rate for Payer: Molina Medicare	$201.55
Rate for Payer: Multiplan Auto	$479.05
Rate for Payer: Multiplan Commercial	$479.05
Rate for Payer: Multiplan Workers Comp	$479.05
Rate for Payer: Parkland Medicaid	$530.64
Rate for Payer: Scott and White EPO/PPO	$71.56
Rate for Payer: Scott and White Medicare	$201.55
Rate for Payer: Superior Health Plan CHIP/Medicaid	$530.64
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 Laceration Simple - Scalp -> 2.6 to 7.5 cm

Facility

$737.00

Service Code	HCPCS 12002
Hospital Charge Code	5202569
Hospital Revenue Code	450
Rate for Payer: Cash Price	$501.16

ED Laceration Simple - Scalp -> 7.6 to 12.5 cm

Facility

$751.00

Service Code	HCPCS 12004
Hospital Charge Code	5202570
Hospital Revenue Code	450
Rate for Payer: Cash Price	$510.68

ED Laceration Simple - Scalp -> 7.6 to 12.5 cm

Facility

$751.00

Service Code	HCPCS 12004
Hospital Charge Code	5202570
Hospital Revenue Code	450
Min. Negotiated Rate	$67.59
Max. Negotiated Rate	$540.72
Rate for Payer: Amerigroup CHIP/Medicaid	$67.59
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$201.55
Rate for Payer: Amerigroup Medicare	$201.55
Rate for Payer: BCBS of TX Blue Advantage	$291.80
Rate for Payer: BCBS of TX Blue Essentials	$349.46
Rate for Payer: BCBS of TX Medicare	$201.55
Rate for Payer: BCBS of TX PPO	$440.32
Rate for Payer: Cash Price	$510.68
Rate for Payer: Cash Price	$510.68
Rate for Payer: Cash Price	$510.68
Rate for Payer: Cigna Commercial	$426.04
Rate for Payer: Cigna Medicaid	$540.72
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	$540.72
Rate for Payer: Molina Dual Medicare/Medicaid	$201.55
Rate for Payer: Molina Medicare	$201.55
Rate for Payer: Multiplan Auto	$488.15
Rate for Payer: Multiplan Commercial	$488.15
Rate for Payer: Multiplan Workers Comp	$488.15
Rate for Payer: Parkland Medicaid	$540.72
Rate for Payer: Scott and White EPO/PPO	$89.38
Rate for Payer: Scott and White Medicare	$201.55
Rate for Payer: Superior Health Plan CHIP/Medicaid	$540.72
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 Lesion Procedure -> Removal of Skin Tags

Facility

$2,477.00

Service Code	HCPCS 11200
Hospital Charge Code	7150212
Hospital Revenue Code	450
Min. Negotiated Rate	$94.86
Max. Negotiated Rate	$1,783.44
Rate for Payer: Amerigroup CHIP/Medicaid	$222.93
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$201.55
Rate for Payer: Amerigroup Medicare	$201.55
Rate for Payer: BCBS of TX Blue Advantage	$291.80
Rate for Payer: BCBS of TX Blue Essentials	$349.46
Rate for Payer: BCBS of TX Medicare	$201.55
Rate for Payer: BCBS of TX PPO	$440.32
Rate for Payer: Cash Price	$1,684.36
Rate for Payer: Cash Price	$1,684.36
Rate for Payer: Cash Price	$1,684.36
Rate for Payer: Cigna Commercial	$426.04
Rate for Payer: Cigna Medicaid	$1,783.44
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	$1,783.44
Rate for Payer: Molina Dual Medicare/Medicaid	$201.55
Rate for Payer: Molina Medicare	$201.55
Rate for Payer: Multiplan Auto	$1,610.05
Rate for Payer: Multiplan Commercial	$1,610.05
Rate for Payer: Multiplan Workers Comp	$1,610.05
Rate for Payer: Parkland Medicaid	$1,783.44
Rate for Payer: Scott and White EPO/PPO	$94.86
Rate for Payer: Scott and White Medicare	$201.55
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,783.44
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 Lesion Procedure -> Removal of Skin Tags

Facility

$2,477.00

Service Code	HCPCS 11200
Hospital Charge Code	7150212
Hospital Revenue Code	450
Rate for Payer: Cash Price	$1,684.36

ED Lesion Procedure -> Shaving, corn or callus

Facility

$993.50

Service Code	HCPCS 11055
Hospital Charge Code	7150778
Hospital Revenue Code	450
Min. Negotiated Rate	$18.86
Max. Negotiated Rate	$715.32
Rate for Payer: Amerigroup CHIP/Medicaid	$89.42
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$201.55
Rate for Payer: Amerigroup Medicare	$201.55
Rate for Payer: BCBS of TX Blue Advantage	$291.80
Rate for Payer: BCBS of TX Blue Essentials	$349.46
Rate for Payer: BCBS of TX Medicare	$201.55
Rate for Payer: BCBS of TX PPO	$440.32
Rate for Payer: Cash Price	$675.58
Rate for Payer: Cash Price	$675.58
Rate for Payer: Cash Price	$675.58
Rate for Payer: Cigna Commercial	$426.04
Rate for Payer: Cigna Medicaid	$715.32
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	$715.32
Rate for Payer: Molina Dual Medicare/Medicaid	$201.55
Rate for Payer: Molina Medicare	$201.55
Rate for Payer: Multiplan Auto	$645.77
Rate for Payer: Multiplan Commercial	$645.77
Rate for Payer: Multiplan Workers Comp	$645.77
Rate for Payer: Parkland Medicaid	$715.32
Rate for Payer: Scott and White EPO/PPO	$18.86
Rate for Payer: Scott and White Medicare	$201.55
Rate for Payer: Superior Health Plan CHIP/Medicaid	$715.32
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 Lesion Procedure -> Shaving, corn or callus

Facility

$993.50

Service Code	HCPCS 11055
Hospital Charge Code	7150778
Hospital Revenue Code	450
Rate for Payer: Cash Price	$675.58

ED Line Procedure -> Arterial Catheterization

Facility

$1,000.00

Service Code	HCPCS 36620
Hospital Charge Code	320002
Hospital Revenue Code	450
Min. Negotiated Rate	$53.26
Max. Negotiated Rate	$3,520.00
Rate for Payer: Amerigroup CHIP/Medicaid	$90.00
Rate for Payer: BCBS of TX Blue Advantage	$300.00
Rate for Payer: BCBS of TX Blue Essentials	$360.00
Rate for Payer: BCBS of TX PPO	$3,520.00
Rate for Payer: Cash Price	$680.00
Rate for Payer: Cash Price	$680.00
Rate for Payer: Cash Price	$680.00
Rate for Payer: Cigna Medicaid	$720.00
Rate for Payer: Molina CHIP/Medicaid	$720.00
Rate for Payer: Multiplan Auto	$650.00
Rate for Payer: Multiplan Commercial	$650.00
Rate for Payer: Multiplan Workers Comp	$650.00
Rate for Payer: Parkland Medicaid	$720.00
Rate for Payer: Scott and White EPO/PPO	$53.26
Rate for Payer: Superior Health Plan CHIP/Medicaid	$720.00
Rate for Payer: Superior Health Plan EPO	$136.00

ED Line Procedure -> Arterial Catheterization

Facility

$1,000.00

Service Code	HCPCS 36620
Hospital Charge Code	320002
Hospital Revenue Code	450
Rate for Payer: Cash Price	$680.00

ED Line Procedure -> Central Line >= 5 y/o

Facility

$4,645.00

Service Code	HCPCS 36556
Hospital Charge Code	2170058
Hospital Revenue Code	450
Rate for Payer: Cash Price	$3,158.60

ED Line Procedure -> Central Line >= 5 y/o

Facility

$4,645.00

Service Code	HCPCS 36556
Hospital Charge Code	2170058
Hospital Revenue Code	450
Min. Negotiated Rate	$101.69
Max. Negotiated Rate	$6,704.76
Rate for Payer: Amerigroup CHIP/Medicaid	$418.05
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$3,171.87
Rate for Payer: Amerigroup Medicare	$3,171.87
Rate for Payer: BCBS of TX Blue Advantage	$2,723.99
Rate for Payer: BCBS of TX Blue Essentials	$3,262.26
Rate for Payer: BCBS of TX Medicare	$3,171.87
Rate for Payer: BCBS of TX PPO	$4,110.45
Rate for Payer: Cash Price	$3,158.60
Rate for Payer: Cash Price	$3,158.60
Rate for Payer: Cash Price	$3,158.60
Rate for Payer: Cigna Commercial	$6,704.76
Rate for Payer: Cigna Medicaid	$3,344.40
Rate for Payer: Cigna Medicare	$3,171.87
Rate for Payer: Employer Direct Commercial	$3,171.87
Rate for Payer: Humana Medicare/TRICARE	$3,171.87
Rate for Payer: Molina CHIP/Medicaid	$3,344.40
Rate for Payer: Molina Dual Medicare/Medicaid	$3,171.87
Rate for Payer: Molina Medicare	$3,171.87
Rate for Payer: Multiplan Auto	$3,019.25
Rate for Payer: Multiplan Commercial	$3,019.25
Rate for Payer: Multiplan Workers Comp	$3,019.25
Rate for Payer: Parkland Medicaid	$3,344.40
Rate for Payer: Scott and White EPO/PPO	$101.69
Rate for Payer: Scott and White Medicare	$3,171.87
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3,344.40
Rate for Payer: Superior Health Plan EPO	$3,171.87
Rate for Payer: Superior Health Plan Medicare	$3,171.87
Rate for Payer: Universal American Dual Medicare/Medicaid	$3,171.87
Rate for Payer: Universal American Medicare	$3,171.87
Rate for Payer: Wellcare Medicare	$3,171.87
Rate for Payer: Wellmed Medicare	$3,171.87

ED Line Procedure -> Intraosseous Infusion

Facility

$536.00

Service Code	HCPCS 36680
Hospital Charge Code	5202573
Hospital Revenue Code	450
Min. Negotiated Rate	$48.24
Max. Negotiated Rate	$948.59
Rate for Payer: Amerigroup CHIP/Medicaid	$48.24
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$448.76
Rate for Payer: Amerigroup Medicare	$448.76
Rate for Payer: BCBS of TX Blue Advantage	$607.20
Rate for Payer: BCBS of TX Blue Essentials	$727.18
Rate for Payer: BCBS of TX Medicare	$448.76
Rate for Payer: BCBS of TX PPO	$916.25
Rate for Payer: Cash Price	$364.48
Rate for Payer: Cash Price	$364.48
Rate for Payer: Cash Price	$364.48
Rate for Payer: Cigna Commercial	$948.59
Rate for Payer: Cigna Medicaid	$385.92
Rate for Payer: Cigna Medicare	$448.76
Rate for Payer: Employer Direct Commercial	$448.76
Rate for Payer: Humana Medicare/TRICARE	$448.76
Rate for Payer: Molina CHIP/Medicaid	$385.92
Rate for Payer: Molina Dual Medicare/Medicaid	$448.76
Rate for Payer: Molina Medicare	$448.76
Rate for Payer: Multiplan Auto	$348.40
Rate for Payer: Multiplan Commercial	$348.40
Rate for Payer: Multiplan Workers Comp	$348.40
Rate for Payer: Parkland Medicaid	$385.92
Rate for Payer: Scott and White EPO/PPO	$71.97
Rate for Payer: Scott and White Medicare	$448.76
Rate for Payer: Superior Health Plan CHIP/Medicaid	$385.92
Rate for Payer: Superior Health Plan EPO	$448.76
Rate for Payer: Superior Health Plan Medicare	$448.76
Rate for Payer: Universal American Dual Medicare/Medicaid	$448.76
Rate for Payer: Universal American Medicare	$448.76
Rate for Payer: Wellcare Medicare	$448.76
Rate for Payer: Wellmed Medicare	$448.76

ED Line Procedure -> Intraosseous Infusion

Facility

$536.00

Service Code	HCPCS 36680
Hospital Charge Code	5202573
Hospital Revenue Code	450
Rate for Payer: Cash Price	$364.48

ED Nail Repair Procedure -> Debridement of Nail 1-5

Facility

$993.50

Service Code	HCPCS 11720
Hospital Charge Code	7150246
Hospital Revenue Code	450
Rate for Payer: Cash Price	$675.58

ED Nail Repair Procedure -> Debridement of Nail 1-5

Facility

$993.50

Service Code	HCPCS 11720
Hospital Charge Code	7150246
Hospital Revenue Code	450
Min. Negotiated Rate	$17.20
Max. Negotiated Rate	$715.32
Rate for Payer: Amerigroup CHIP/Medicaid	$89.42
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	$675.58
Rate for Payer: Cash Price	$675.58
Rate for Payer: Cash Price	$675.58
Rate for Payer: Cigna Commercial	$125.27
Rate for Payer: Cigna Medicaid	$715.32
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	$715.32
Rate for Payer: Molina Dual Medicare/Medicaid	$59.26
Rate for Payer: Molina Medicare	$59.26
Rate for Payer: Multiplan Auto	$645.77
Rate for Payer: Multiplan Commercial	$645.77
Rate for Payer: Multiplan Workers Comp	$645.77
Rate for Payer: Parkland Medicaid	$715.32
Rate for Payer: Scott and White EPO/PPO	$17.20
Rate for Payer: Scott and White Medicare	$59.26
Rate for Payer: Superior Health Plan CHIP/Medicaid	$715.32
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 Nail Repair Procedure -> Debridement of Nail 6+

Facility

$993.50

Service Code	HCPCS 11721
Hospital Charge Code	7150253
Hospital Revenue Code	450
Rate for Payer: Cash Price	$675.58

ED Nail Repair Procedure -> Debridement of Nail 6+

Facility

$993.50

Service Code	HCPCS 11721
Hospital Charge Code	7150253
Hospital Revenue Code	450
Min. Negotiated Rate	$28.73
Max. Negotiated Rate	$715.32
Rate for Payer: Amerigroup CHIP/Medicaid	$89.42
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	$675.58
Rate for Payer: Cash Price	$675.58
Rate for Payer: Cash Price	$675.58
Rate for Payer: Cigna Commercial	$125.27
Rate for Payer: Cigna Medicaid	$715.32
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	$715.32
Rate for Payer: Molina Dual Medicare/Medicaid	$59.26
Rate for Payer: Molina Medicare	$59.26
Rate for Payer: Multiplan Auto	$645.77
Rate for Payer: Multiplan Commercial	$645.77
Rate for Payer: Multiplan Workers Comp	$645.77
Rate for Payer: Parkland Medicaid	$715.32
Rate for Payer: Scott and White EPO/PPO	$28.73
Rate for Payer: Scott and White Medicare	$59.26
Rate for Payer: Superior Health Plan CHIP/Medicaid	$715.32
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 Nail Repair Procedure -> Evacuation of subungual hematoma

Facility

$993.50

Service Code	HCPCS 11740
Hospital Charge Code	5202574
Hospital Revenue Code	450
Min. Negotiated Rate	$39.88
Max. Negotiated Rate	$715.32
Rate for Payer: Amerigroup CHIP/Medicaid	$89.42
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	$675.58
Rate for Payer: Cash Price	$675.58
Rate for Payer: Cash Price	$675.58
Rate for Payer: Cigna Commercial	$282.53
Rate for Payer: Cigna Medicaid	$715.32
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	$715.32
Rate for Payer: Molina Dual Medicare/Medicaid	$133.65
Rate for Payer: Molina Medicare	$133.65
Rate for Payer: Multiplan Auto	$645.77
Rate for Payer: Multiplan Commercial	$645.77
Rate for Payer: Multiplan Workers Comp	$645.77
Rate for Payer: Parkland Medicaid	$715.32
Rate for Payer: Scott and White EPO/PPO	$39.88
Rate for Payer: Scott and White Medicare	$133.65
Rate for Payer: Superior Health Plan CHIP/Medicaid	$715.32
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 Nail Repair Procedure -> Evacuation of subungual hematoma

Facility

$993.50

Service Code	HCPCS 11740
Hospital Charge Code	5202574
Hospital Revenue Code	450
Rate for Payer: Cash Price	$675.58

ED Nail Repair Procedure -> Nail and Nail Matrix, Excision

Facility

$8,017.06

Service Code	HCPCS 11750
Hospital Charge Code	7150818
Hospital Revenue Code	450
Rate for Payer: Cash Price	$5,451.60

Know your out-of-pocket cost for care.

All Charges