White Rock Medical Center

All Charges

Charge

Type

Setting

Price

MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH MCC

Facility

$33,438.10

Service Code	MSDRG 435
Min. Negotiated Rate	$14,960.56
Max. Negotiated Rate	$33,438.10
Rate for Payer: Aetna Commercial	$19,798.88
Rate for Payer: Aetna Medicare	$23,120.28
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$15,413.52
Rate for Payer: Amerigroup Medicare	$15,413.52
Rate for Payer: BCBS of TX Blue Advantage	$14,960.56
Rate for Payer: BCBS of TX Blue Essentials	$17,518.57
Rate for Payer: BCBS of TX Medicare	$15,413.52
Rate for Payer: BCBS of TX PPO	$19,465.83
Rate for Payer: Cigna Commercial	$22,667.51
Rate for Payer: Cigna Medicare	$15,413.52
Rate for Payer: Employer Direct Commercial	$15,413.52
Rate for Payer: Humana Medicare/TRICARE	$15,413.52
Rate for Payer: Molina Dual Medicare/Medicaid	$15,413.52
Rate for Payer: Molina Medicare	$15,413.52
Rate for Payer: Multiplan Auto	$33,438.10
Rate for Payer: Multiplan Commercial	$33,438.10
Rate for Payer: Multiplan Workers Comp	$33,438.10
Rate for Payer: Scott and White EPO/PPO	$15,399.12
Rate for Payer: Scott and White Medicare	$15,413.52
Rate for Payer: Superior Health Plan EPO	$15,413.52
Rate for Payer: Superior Health Plan Medicare	$15,413.52
Rate for Payer: Universal American Dual Medicare/Medicaid	$15,413.52
Rate for Payer: Universal American Medicare	$15,413.52
Rate for Payer: Wellcare Medicare	$15,413.52
Rate for Payer: Wellmed Medicare	$15,413.52

MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITHOUT CC/MCC

Facility

$15,790.90

Service Code	MSDRG 437
Min. Negotiated Rate	$7,272.12
Max. Negotiated Rate	$15,790.90
Rate for Payer: Aetna Commercial	$9,349.88
Rate for Payer: Aetna Medicare	$13,178.32
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$8,785.55
Rate for Payer: Amerigroup Medicare	$8,785.55
Rate for Payer: BCBS of TX Blue Advantage	$8,002.30
Rate for Payer: BCBS of TX Blue Essentials	$8,934.19
Rate for Payer: BCBS of TX Medicare	$8,785.55
Rate for Payer: BCBS of TX PPO	$9,927.26
Rate for Payer: Cigna Commercial	$10,704.57
Rate for Payer: Cigna Medicare	$8,785.55
Rate for Payer: Employer Direct Commercial	$8,785.55
Rate for Payer: Humana Medicare/TRICARE	$8,785.55
Rate for Payer: Molina Dual Medicare/Medicaid	$8,785.55
Rate for Payer: Molina Medicare	$8,785.55
Rate for Payer: Multiplan Auto	$15,790.90
Rate for Payer: Multiplan Commercial	$15,790.90
Rate for Payer: Multiplan Workers Comp	$15,790.90
Rate for Payer: Scott and White EPO/PPO	$7,272.12
Rate for Payer: Scott and White Medicare	$8,785.55
Rate for Payer: Superior Health Plan EPO	$8,785.55
Rate for Payer: Superior Health Plan Medicare	$8,785.55
Rate for Payer: Universal American Dual Medicare/Medicaid	$8,785.55
Rate for Payer: Universal American Medicare	$8,785.55
Rate for Payer: Wellcare Medicare	$8,785.55
Rate for Payer: Wellmed Medicare	$8,785.55

MALIGNANT BREAST DISORDERS WITH CC

Facility

$22,777.20

Service Code	MSDRG 598
Min. Negotiated Rate	$10,241.74
Max. Negotiated Rate	$22,777.20
Rate for Payer: Aetna Commercial	$13,486.50
Rate for Payer: Aetna Medicare	$17,114.20
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$11,409.47
Rate for Payer: Amerigroup Medicare	$11,409.47
Rate for Payer: BCBS of TX Blue Advantage	$10,241.74
Rate for Payer: BCBS of TX Blue Essentials	$11,993.77
Rate for Payer: BCBS of TX Medicare	$11,409.47
Rate for Payer: BCBS of TX PPO	$13,326.93
Rate for Payer: Cigna Commercial	$15,440.54
Rate for Payer: Cigna Medicare	$11,409.47
Rate for Payer: Employer Direct Commercial	$11,409.47
Rate for Payer: Humana Medicare/TRICARE	$11,409.47
Rate for Payer: Molina Dual Medicare/Medicaid	$11,409.47
Rate for Payer: Molina Medicare	$11,409.47
Rate for Payer: Multiplan Auto	$22,777.20
Rate for Payer: Multiplan Commercial	$22,777.20
Rate for Payer: Multiplan Workers Comp	$22,777.20
Rate for Payer: Scott and White EPO/PPO	$10,489.50
Rate for Payer: Scott and White Medicare	$11,409.47
Rate for Payer: Superior Health Plan EPO	$11,409.47
Rate for Payer: Superior Health Plan Medicare	$11,409.47
Rate for Payer: Universal American Dual Medicare/Medicaid	$11,409.47
Rate for Payer: Universal American Medicare	$11,409.47
Rate for Payer: Wellcare Medicare	$11,409.47
Rate for Payer: Wellmed Medicare	$11,409.47

MALIGNANT BREAST DISORDERS WITH MCC

Facility

$30,409.50

Service Code	MSDRG 597
Min. Negotiated Rate	$14,004.38
Max. Negotiated Rate	$30,409.50
Rate for Payer: Aetna Commercial	$18,005.62
Rate for Payer: Aetna Medicare	$21,414.04
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$14,276.03
Rate for Payer: Amerigroup Medicare	$14,276.03
Rate for Payer: BCBS of TX Blue Advantage	$15,121.38
Rate for Payer: BCBS of TX Blue Essentials	$17,748.68
Rate for Payer: BCBS of TX Medicare	$14,276.03
Rate for Payer: BCBS of TX PPO	$19,721.52
Rate for Payer: Cigna Commercial	$20,614.44
Rate for Payer: Cigna Medicare	$14,276.03
Rate for Payer: Employer Direct Commercial	$14,276.03
Rate for Payer: Humana Medicare/TRICARE	$14,276.03
Rate for Payer: Molina Dual Medicare/Medicaid	$14,276.03
Rate for Payer: Molina Medicare	$14,276.03
Rate for Payer: Multiplan Auto	$30,409.50
Rate for Payer: Multiplan Commercial	$30,409.50
Rate for Payer: Multiplan Workers Comp	$30,409.50
Rate for Payer: Scott and White EPO/PPO	$14,004.38
Rate for Payer: Scott and White Medicare	$14,276.03
Rate for Payer: Superior Health Plan EPO	$14,276.03
Rate for Payer: Superior Health Plan Medicare	$14,276.03
Rate for Payer: Universal American Dual Medicare/Medicaid	$14,276.03
Rate for Payer: Universal American Medicare	$14,276.03
Rate for Payer: Wellcare Medicare	$14,276.03
Rate for Payer: Wellmed Medicare	$14,276.03

MALIGNANT BREAST DISORDERS WITHOUT CC/MCC

Facility

$11,806.60

Service Code	MSDRG 599
Min. Negotiated Rate	$5,437.25
Max. Negotiated Rate	$11,806.60
Rate for Payer: Aetna Commercial	$6,990.75
Rate for Payer: Aetna Medicare	$11,483.88
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$7,655.92
Rate for Payer: Amerigroup Medicare	$7,655.92
Rate for Payer: BCBS of TX Blue Advantage	$6,100.84
Rate for Payer: BCBS of TX Blue Essentials	$7,392.53
Rate for Payer: BCBS of TX Medicare	$7,655.92
Rate for Payer: BCBS of TX PPO	$8,214.24
Rate for Payer: Cigna Commercial	$8,003.63
Rate for Payer: Cigna Medicare	$7,655.92
Rate for Payer: Employer Direct Commercial	$7,655.92
Rate for Payer: Humana Medicare/TRICARE	$7,655.92
Rate for Payer: Molina Dual Medicare/Medicaid	$7,655.92
Rate for Payer: Molina Medicare	$7,655.92
Rate for Payer: Multiplan Auto	$11,806.60
Rate for Payer: Multiplan Commercial	$11,806.60
Rate for Payer: Multiplan Workers Comp	$11,806.60
Rate for Payer: Scott and White EPO/PPO	$5,437.25
Rate for Payer: Scott and White Medicare	$7,655.92
Rate for Payer: Superior Health Plan EPO	$7,655.92
Rate for Payer: Superior Health Plan Medicare	$7,655.92
Rate for Payer: Universal American Dual Medicare/Medicaid	$7,655.92
Rate for Payer: Universal American Medicare	$7,655.92
Rate for Payer: Wellcare Medicare	$7,655.92
Rate for Payer: Wellmed Medicare	$7,655.92

Mammaplasty, augmentation with prosthetic implant

Facility

$20,501.61

Service Code	CPT 19325
Hospital Charge Code	36019325
Hospital Revenue Code	360
Min. Negotiated Rate	$190.15
Max. Negotiated Rate	$20,501.61
Rate for Payer: Aetna Commercial	$7,210.00
Rate for Payer: Aetna Medicare	$12,931.65
Rate for Payer: Amerigroup CHIP/Medicaid	$2,281.73
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$8,621.10
Rate for Payer: Amerigroup Medicare	$8,621.10
Rate for Payer: BCBS of TX Blue Advantage	$13,586.39
Rate for Payer: BCBS of TX Blue Essentials	$16,271.12
Rate for Payer: BCBS of TX Medicare	$8,621.10
Rate for Payer: BCBS of TX PPO	$20,501.61
Rate for Payer: Cigna Commercial	$19,529.28
Rate for Payer: Cigna Medicaid	$2,281.73
Rate for Payer: Cigna Medicare	$8,621.10
Rate for Payer: Employer Direct Commercial	$8,621.10
Rate for Payer: Humana Medicare/TRICARE	$8,621.10
Rate for Payer: Molina CHIP/Medicaid	$2,281.73
Rate for Payer: Molina Dual Medicare/Medicaid	$8,621.10
Rate for Payer: Molina Medicare	$8,621.10
Rate for Payer: Multiplan Auto	$10,000.00
Rate for Payer: Multiplan Commercial	$10,000.00
Rate for Payer: Multiplan Workers Comp	$10,000.00
Rate for Payer: Parkland Medicaid	$2,281.73
Rate for Payer: Scott and White EPO/PPO	$190.15
Rate for Payer: Scott and White Medicare	$8,621.10
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2,281.73
Rate for Payer: Superior Health Plan EPO	$8,621.10
Rate for Payer: Superior Health Plan Medicare	$8,621.10
Rate for Payer: Universal American Dual Medicare/Medicaid	$8,621.10
Rate for Payer: Universal American Medicare	$8,621.10
Rate for Payer: Wellcare Medicare	$8,621.10
Rate for Payer: Wellmed Medicare	$8,621.10

MANIFOLD, STANDARD 4-PORT FOR NEPTUNE II ROVER -- DHF

Facility

$91.70

Hospital Charge Code	80325541
Hospital Revenue Code	272
Rate for Payer: Cash Price	$80.70

MANIFOLD, STANDARD 4-PORT FOR NEPTUNE II ROVER -- DHF

Facility

$91.70

Hospital Charge Code	80325541
Hospital Revenue Code	272
Min. Negotiated Rate	$8.25
Max. Negotiated Rate	$59.60
Rate for Payer: Aetna Commercial	$50.44
Rate for Payer: Amerigroup CHIP/Medicaid	$8.25
Rate for Payer: BCBS of TX Blue Advantage	$27.51
Rate for Payer: BCBS of TX Blue Essentials	$33.01
Rate for Payer: BCBS of TX PPO	$36.68
Rate for Payer: Cash Price	$80.70
Rate for Payer: Multiplan Auto	$59.60
Rate for Payer: Multiplan Commercial	$59.60
Rate for Payer: Multiplan Workers Comp	$59.60
Rate for Payer: Scott and White EPO/PPO	$45.85
Rate for Payer: Superior Health Plan EPO	$12.47

Manipulation, elbow, under anesthesia

Facility

$10,000.00

Service Code	CPT 24300
Hospital Charge Code	36024300
Hospital Revenue Code	360
Min. Negotiated Rate	$32.42
Max. Negotiated Rate	$10,000.00
Rate for Payer: Aetna Commercial	$2,200.00
Rate for Payer: Aetna Medicare	$2,204.79
Rate for Payer: Amerigroup CHIP/Medicaid	$593.04
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$1,469.86
Rate for Payer: Amerigroup Medicare	$1,469.86
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	$1,469.86
Rate for Payer: BCBS of TX PPO	$3,415.58
Rate for Payer: Cigna Commercial	$3,329.66
Rate for Payer: Cigna Medicaid	$593.04
Rate for Payer: Cigna Medicare	$1,469.86
Rate for Payer: Employer Direct Commercial	$1,469.86
Rate for Payer: Humana Medicare/TRICARE	$1,469.86
Rate for Payer: Molina CHIP/Medicaid	$593.04
Rate for Payer: Molina Dual Medicare/Medicaid	$1,469.86
Rate for Payer: Molina Medicare	$1,469.86
Rate for Payer: Multiplan Auto	$10,000.00
Rate for Payer: Multiplan Commercial	$10,000.00
Rate for Payer: Multiplan Workers Comp	$10,000.00
Rate for Payer: Parkland Medicaid	$593.04
Rate for Payer: Scott and White EPO/PPO	$32.42
Rate for Payer: Scott and White Medicare	$1,469.86
Rate for Payer: Superior Health Plan CHIP/Medicaid	$593.04
Rate for Payer: Superior Health Plan EPO	$1,469.86
Rate for Payer: Superior Health Plan Medicare	$1,469.86
Rate for Payer: Universal American Dual Medicare/Medicaid	$1,469.86
Rate for Payer: Universal American Medicare	$1,469.86
Rate for Payer: Wellcare Medicare	$1,469.86
Rate for Payer: Wellmed Medicare	$1,469.86

Manipulation of knee joint under general anesthesia (includes application of traction or other fixat

Facility

$10,000.00

Service Code	CPT 27570
Hospital Charge Code	36027570
Hospital Revenue Code	360
Min. Negotiated Rate	$32.42
Max. Negotiated Rate	$10,000.00
Rate for Payer: Aetna Commercial	$2,200.00
Rate for Payer: Aetna Medicare	$2,204.79
Rate for Payer: Amerigroup CHIP/Medicaid	$593.04
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$1,469.86
Rate for Payer: Amerigroup Medicare	$1,469.86
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	$1,469.86
Rate for Payer: BCBS of TX PPO	$3,415.58
Rate for Payer: Cigna Commercial	$3,329.66
Rate for Payer: Cigna Medicaid	$593.04
Rate for Payer: Cigna Medicare	$1,469.86
Rate for Payer: Employer Direct Commercial	$1,469.86
Rate for Payer: Humana Medicare/TRICARE	$1,469.86
Rate for Payer: Molina CHIP/Medicaid	$593.04
Rate for Payer: Molina Dual Medicare/Medicaid	$1,469.86
Rate for Payer: Molina Medicare	$1,469.86
Rate for Payer: Multiplan Auto	$10,000.00
Rate for Payer: Multiplan Commercial	$10,000.00
Rate for Payer: Multiplan Workers Comp	$10,000.00
Rate for Payer: Parkland Medicaid	$593.04
Rate for Payer: Scott and White EPO/PPO	$32.42
Rate for Payer: Scott and White Medicare	$1,469.86
Rate for Payer: Superior Health Plan CHIP/Medicaid	$593.04
Rate for Payer: Superior Health Plan EPO	$1,469.86
Rate for Payer: Superior Health Plan Medicare	$1,469.86
Rate for Payer: Universal American Dual Medicare/Medicaid	$1,469.86
Rate for Payer: Universal American Medicare	$1,469.86
Rate for Payer: Wellcare Medicare	$1,469.86
Rate for Payer: Wellmed Medicare	$1,469.86

Manipulation under anesthesia, shoulder joint, including application of fixation apparatus (dislocat

Facility

$10,000.00

Service Code	CPT 23700
Hospital Charge Code	36023700
Hospital Revenue Code	360
Min. Negotiated Rate	$32.42
Max. Negotiated Rate	$10,000.00
Rate for Payer: Aetna Commercial	$2,200.00
Rate for Payer: Aetna Medicare	$2,204.79
Rate for Payer: Amerigroup CHIP/Medicaid	$593.04
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$1,469.86
Rate for Payer: Amerigroup Medicare	$1,469.86
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	$1,469.86
Rate for Payer: BCBS of TX PPO	$3,415.58
Rate for Payer: Cigna Commercial	$3,329.66
Rate for Payer: Cigna Medicaid	$593.04
Rate for Payer: Cigna Medicare	$1,469.86
Rate for Payer: Employer Direct Commercial	$1,469.86
Rate for Payer: Humana Medicare/TRICARE	$1,469.86
Rate for Payer: Molina CHIP/Medicaid	$593.04
Rate for Payer: Molina Dual Medicare/Medicaid	$1,469.86
Rate for Payer: Molina Medicare	$1,469.86
Rate for Payer: Multiplan Auto	$10,000.00
Rate for Payer: Multiplan Commercial	$10,000.00
Rate for Payer: Multiplan Workers Comp	$10,000.00
Rate for Payer: Parkland Medicaid	$593.04
Rate for Payer: Scott and White EPO/PPO	$32.42
Rate for Payer: Scott and White Medicare	$1,469.86
Rate for Payer: Superior Health Plan CHIP/Medicaid	$593.04
Rate for Payer: Superior Health Plan EPO	$1,469.86
Rate for Payer: Superior Health Plan Medicare	$1,469.86
Rate for Payer: Universal American Dual Medicare/Medicaid	$1,469.86
Rate for Payer: Universal American Medicare	$1,469.86
Rate for Payer: Wellcare Medicare	$1,469.86
Rate for Payer: Wellmed Medicare	$1,469.86

Manipulation, wrist, under anesthesia

Facility

$10,000.00

Service Code	CPT 25259
Hospital Charge Code	36025259
Hospital Revenue Code	360
Min. Negotiated Rate	$32.42
Max. Negotiated Rate	$10,000.00
Rate for Payer: Aetna Commercial	$2,200.00
Rate for Payer: Aetna Medicare	$2,204.79
Rate for Payer: Amerigroup CHIP/Medicaid	$593.04
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$1,469.86
Rate for Payer: Amerigroup Medicare	$1,469.86
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	$1,469.86
Rate for Payer: BCBS of TX PPO	$3,415.58
Rate for Payer: Cigna Commercial	$3,329.66
Rate for Payer: Cigna Medicaid	$593.04
Rate for Payer: Cigna Medicare	$1,469.86
Rate for Payer: Employer Direct Commercial	$1,469.86
Rate for Payer: Humana Medicare/TRICARE	$1,469.86
Rate for Payer: Molina CHIP/Medicaid	$593.04
Rate for Payer: Molina Dual Medicare/Medicaid	$1,469.86
Rate for Payer: Molina Medicare	$1,469.86
Rate for Payer: Multiplan Auto	$10,000.00
Rate for Payer: Multiplan Commercial	$10,000.00
Rate for Payer: Multiplan Workers Comp	$10,000.00
Rate for Payer: Parkland Medicaid	$593.04
Rate for Payer: Scott and White EPO/PPO	$32.42
Rate for Payer: Scott and White Medicare	$1,469.86
Rate for Payer: Superior Health Plan CHIP/Medicaid	$593.04
Rate for Payer: Superior Health Plan EPO	$1,469.86
Rate for Payer: Superior Health Plan Medicare	$1,469.86
Rate for Payer: Universal American Dual Medicare/Medicaid	$1,469.86
Rate for Payer: Universal American Medicare	$1,469.86
Rate for Payer: Wellcare Medicare	$1,469.86
Rate for Payer: Wellmed Medicare	$1,469.86

MANIPULATOR, UTERINE CERVICAL CUP V-CARE LARGE -- DHF

Facility

$471.74

Hospital Charge Code	81778219
Hospital Revenue Code	272
Min. Negotiated Rate	$42.46
Max. Negotiated Rate	$306.63
Rate for Payer: Aetna Commercial	$259.46
Rate for Payer: Amerigroup CHIP/Medicaid	$42.46
Rate for Payer: BCBS of TX Blue Advantage	$141.52
Rate for Payer: BCBS of TX Blue Essentials	$169.83
Rate for Payer: BCBS of TX PPO	$188.70
Rate for Payer: Cash Price	$415.13
Rate for Payer: Multiplan Auto	$306.63
Rate for Payer: Multiplan Commercial	$306.63
Rate for Payer: Multiplan Workers Comp	$306.63
Rate for Payer: Scott and White EPO/PPO	$235.87
Rate for Payer: Superior Health Plan EPO	$64.16

MANIPULATOR, UTERINE CERVICAL CUP V-CARE XL 40MM -- DHF

Facility

$471.74

Hospital Charge Code	81778219
Hospital Revenue Code	272
Min. Negotiated Rate	$42.46
Max. Negotiated Rate	$306.63
Rate for Payer: Aetna Commercial	$259.46
Rate for Payer: Amerigroup CHIP/Medicaid	$42.46
Rate for Payer: BCBS of TX Blue Advantage	$141.52
Rate for Payer: BCBS of TX Blue Essentials	$169.83
Rate for Payer: BCBS of TX PPO	$188.70
Rate for Payer: Cash Price	$415.13
Rate for Payer: Multiplan Auto	$306.63
Rate for Payer: Multiplan Commercial	$306.63
Rate for Payer: Multiplan Workers Comp	$306.63
Rate for Payer: Scott and White EPO/PPO	$235.87
Rate for Payer: Superior Health Plan EPO	$64.16

MANIPULATOR, UTERINE ELEVATOR V-CARE MEDIUM CUP -- DHF

Facility

$471.74

Hospital Charge Code	81778219
Hospital Revenue Code	272
Rate for Payer: Cash Price	$415.13

MANIPULATOR, UTERINE ELEVATOR V-CARE MEDIUM CUP -- DHF

Facility

$471.74

Hospital Charge Code	81778219
Hospital Revenue Code	272
Min. Negotiated Rate	$42.46
Max. Negotiated Rate	$306.63
Rate for Payer: Aetna Commercial	$259.46
Rate for Payer: Amerigroup CHIP/Medicaid	$42.46
Rate for Payer: BCBS of TX Blue Advantage	$141.52
Rate for Payer: BCBS of TX Blue Essentials	$169.83
Rate for Payer: BCBS of TX PPO	$188.70
Rate for Payer: Cash Price	$415.13
Rate for Payer: Multiplan Auto	$306.63
Rate for Payer: Multiplan Commercial	$306.63
Rate for Payer: Multiplan Workers Comp	$306.63
Rate for Payer: Scott and White EPO/PPO	$235.87
Rate for Payer: Superior Health Plan EPO	$64.16

MANOMETER DISP -- DHF

Facility

$89.91

Hospital Charge Code	80826019
Hospital Revenue Code	270
Rate for Payer: Cash Price	$79.12

MANOMETER DISP -- DHF

Facility

$89.91

Hospital Charge Code	80826019
Hospital Revenue Code	270
Min. Negotiated Rate	$8.09
Max. Negotiated Rate	$58.44
Rate for Payer: Aetna Commercial	$49.45
Rate for Payer: Amerigroup CHIP/Medicaid	$8.09
Rate for Payer: BCBS of TX Blue Advantage	$26.97
Rate for Payer: BCBS of TX Blue Essentials	$32.37
Rate for Payer: BCBS of TX PPO	$35.96
Rate for Payer: Cash Price	$79.12
Rate for Payer: Multiplan Auto	$58.44
Rate for Payer: Multiplan Commercial	$58.44
Rate for Payer: Multiplan Workers Comp	$58.44
Rate for Payer: Scott and White EPO/PPO	$44.96
Rate for Payer: Superior Health Plan EPO	$12.23

Manual Differential

Facility

$81.00

Service Code	CPT 85007
Hospital Charge Code	1600485
Hospital Revenue Code	305
Rate for Payer: Cash Price	$71.28

Manual Differential

Facility

$81.00

Service Code	CPT 85007
Hospital Charge Code	1600485
Hospital Revenue Code	305
Min. Negotiated Rate	$1.48
Max. Negotiated Rate	$52.65
Rate for Payer: Aetna Commercial	$3.99
Rate for Payer: Aetna Medicare	$5.70
Rate for Payer: Amerigroup CHIP/Medicaid	$1.48
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$3.80
Rate for Payer: Amerigroup Medicare	$3.80
Rate for Payer: BCBS of TX Blue Advantage	$6.27
Rate for Payer: BCBS of TX Blue Essentials	$7.52
Rate for Payer: BCBS of TX Medicare	$3.80
Rate for Payer: BCBS of TX PPO	$8.40
Rate for Payer: Cash Price	$71.28
Rate for Payer: Cash Price	$71.28
Rate for Payer: Cigna Medicaid	$3.80
Rate for Payer: Cigna Medicare	$3.80
Rate for Payer: Employer Direct Commercial	$3.80
Rate for Payer: Humana Medicare/TRICARE	$3.80
Rate for Payer: Molina CHIP/Medicaid	$3.80
Rate for Payer: Molina Dual Medicare/Medicaid	$3.80
Rate for Payer: Molina Medicare	$3.80
Rate for Payer: Multiplan Auto	$52.65
Rate for Payer: Multiplan Commercial	$52.65
Rate for Payer: Multiplan Workers Comp	$52.65
Rate for Payer: Parkland Medicaid	$3.80
Rate for Payer: Scott and White EPO/PPO	$4.75
Rate for Payer: Scott and White Medicare	$3.80
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3.80
Rate for Payer: Superior Health Plan EPO	$3.80
Rate for Payer: Superior Health Plan Medicare	$3.80
Rate for Payer: Universal American Dual Medicare/Medicaid	$3.80
Rate for Payer: Universal American Medicare	$3.80
Rate for Payer: Wellcare Medicare	$3.80
Rate for Payer: Wellmed Medicare	$3.80

MARKER BIOPSY SITE IDENT -- DHF

Facility

$422.05

Hospital Charge Code	81829095
Hospital Revenue Code	272
Min. Negotiated Rate	$37.98
Max. Negotiated Rate	$274.33
Rate for Payer: Aetna Commercial	$232.13
Rate for Payer: Amerigroup CHIP/Medicaid	$37.98
Rate for Payer: BCBS of TX Blue Advantage	$126.62
Rate for Payer: BCBS of TX Blue Essentials	$151.94
Rate for Payer: BCBS of TX PPO	$168.82
Rate for Payer: Cash Price	$371.40
Rate for Payer: Multiplan Auto	$274.33
Rate for Payer: Multiplan Commercial	$274.33
Rate for Payer: Multiplan Workers Comp	$274.33
Rate for Payer: Scott and White EPO/PPO	$211.02
Rate for Payer: Superior Health Plan EPO	$57.40

MARKER BIOPSY SITE IDENT -- DHF

Facility

$422.05

Hospital Charge Code	81829095
Hospital Revenue Code	272
Rate for Payer: Cash Price	$371.40

MARKER BREAST CLIP 17GX10CM BARD

Facility

$383.22

Hospital Charge Code	8182909
Hospital Revenue Code	272
Min. Negotiated Rate	$34.49
Max. Negotiated Rate	$249.09
Rate for Payer: Aetna Commercial	$210.77
Rate for Payer: Amerigroup CHIP/Medicaid	$34.49
Rate for Payer: BCBS of TX Blue Advantage	$114.97
Rate for Payer: BCBS of TX Blue Essentials	$137.96
Rate for Payer: BCBS of TX PPO	$153.29
Rate for Payer: Cash Price	$337.23
Rate for Payer: Multiplan Auto	$249.09
Rate for Payer: Multiplan Commercial	$249.09
Rate for Payer: Multiplan Workers Comp	$249.09
Rate for Payer: Scott and White EPO/PPO	$191.61
Rate for Payer: Superior Health Plan EPO	$52.12

MARKER BREAST CLIP 17GX10CM BARD

Facility

$383.22

Hospital Charge Code	8182909
Hospital Revenue Code	272
Rate for Payer: Cash Price	$337.23

MARKER ENDOSCOPIC ENDOLINK

Facility

$111.37

Hospital Charge Code	145333
Hospital Revenue Code	272
Rate for Payer: Cash Price	$98.01

Know your out-of-pocket cost for care.

All Charges