White Rock Medical Center

All Charges

Charge

Type

Setting

Price

Myoglobin

Facility

$184.00

Service Code	CPT 83874
Hospital Charge Code	1706035
Hospital Revenue Code	301
Min. Negotiated Rate	$5.04
Max. Negotiated Rate	$119.60
Rate for Payer: Aetna Commercial	$13.56
Rate for Payer: Aetna Medicare	$19.38
Rate for Payer: Amerigroup CHIP/Medicaid	$5.04
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$12.92
Rate for Payer: Amerigroup Medicare	$12.92
Rate for Payer: BCBS of TX Blue Advantage	$21.32
Rate for Payer: BCBS of TX Blue Essentials	$25.58
Rate for Payer: BCBS of TX Medicare	$12.92
Rate for Payer: BCBS of TX PPO	$28.55
Rate for Payer: Cash Price	$161.92
Rate for Payer: Cash Price	$161.92
Rate for Payer: Cigna Medicaid	$12.92
Rate for Payer: Cigna Medicare	$12.92
Rate for Payer: Employer Direct Commercial	$12.92
Rate for Payer: Humana Medicare/TRICARE	$12.92
Rate for Payer: Molina CHIP/Medicaid	$12.92
Rate for Payer: Molina Dual Medicare/Medicaid	$12.92
Rate for Payer: Molina Medicare	$12.92
Rate for Payer: Multiplan Auto	$119.60
Rate for Payer: Multiplan Commercial	$119.60
Rate for Payer: Multiplan Workers Comp	$119.60
Rate for Payer: Parkland Medicaid	$12.92
Rate for Payer: Scott and White EPO/PPO	$16.15
Rate for Payer: Scott and White Medicare	$12.92
Rate for Payer: Superior Health Plan CHIP/Medicaid	$12.92
Rate for Payer: Superior Health Plan EPO	$12.92
Rate for Payer: Superior Health Plan Medicare	$12.92
Rate for Payer: Universal American Dual Medicare/Medicaid	$12.92
Rate for Payer: Universal American Medicare	$12.92
Rate for Payer: Wellcare Medicare	$12.92
Rate for Payer: Wellmed Medicare	$12.92

Myoglobin, Serum SO

Facility

$184.00

Service Code	CPT 83874
Hospital Charge Code	1706035
Hospital Revenue Code	301
Rate for Payer: Cash Price	$161.92

Myoglobin, Serum SO

Facility

$184.00

Service Code	CPT 83874
Hospital Charge Code	1706035
Hospital Revenue Code	301
Min. Negotiated Rate	$5.04
Max. Negotiated Rate	$119.60
Rate for Payer: Aetna Commercial	$13.56
Rate for Payer: Aetna Medicare	$19.38
Rate for Payer: Amerigroup CHIP/Medicaid	$5.04
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$12.92
Rate for Payer: Amerigroup Medicare	$12.92
Rate for Payer: BCBS of TX Blue Advantage	$21.32
Rate for Payer: BCBS of TX Blue Essentials	$25.58
Rate for Payer: BCBS of TX Medicare	$12.92
Rate for Payer: BCBS of TX PPO	$28.55
Rate for Payer: Cash Price	$161.92
Rate for Payer: Cash Price	$161.92
Rate for Payer: Cigna Medicaid	$12.92
Rate for Payer: Cigna Medicare	$12.92
Rate for Payer: Employer Direct Commercial	$12.92
Rate for Payer: Humana Medicare/TRICARE	$12.92
Rate for Payer: Molina CHIP/Medicaid	$12.92
Rate for Payer: Molina Dual Medicare/Medicaid	$12.92
Rate for Payer: Molina Medicare	$12.92
Rate for Payer: Multiplan Auto	$119.60
Rate for Payer: Multiplan Commercial	$119.60
Rate for Payer: Multiplan Workers Comp	$119.60
Rate for Payer: Parkland Medicaid	$12.92
Rate for Payer: Scott and White EPO/PPO	$16.15
Rate for Payer: Scott and White Medicare	$12.92
Rate for Payer: Superior Health Plan CHIP/Medicaid	$12.92
Rate for Payer: Superior Health Plan EPO	$12.92
Rate for Payer: Superior Health Plan Medicare	$12.92
Rate for Payer: Universal American Dual Medicare/Medicaid	$12.92
Rate for Payer: Universal American Medicare	$12.92
Rate for Payer: Wellcare Medicare	$12.92
Rate for Payer: Wellmed Medicare	$12.92

Myoglobin, Urine SO

Facility

$184.00

Service Code	CPT 83874
Hospital Charge Code	1706035
Hospital Revenue Code	301
Min. Negotiated Rate	$5.04
Max. Negotiated Rate	$119.60
Rate for Payer: Aetna Commercial	$13.56
Rate for Payer: Aetna Medicare	$19.38
Rate for Payer: Amerigroup CHIP/Medicaid	$5.04
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$12.92
Rate for Payer: Amerigroup Medicare	$12.92
Rate for Payer: BCBS of TX Blue Advantage	$21.32
Rate for Payer: BCBS of TX Blue Essentials	$25.58
Rate for Payer: BCBS of TX Medicare	$12.92
Rate for Payer: BCBS of TX PPO	$28.55
Rate for Payer: Cash Price	$161.92
Rate for Payer: Cash Price	$161.92
Rate for Payer: Cigna Medicaid	$12.92
Rate for Payer: Cigna Medicare	$12.92
Rate for Payer: Employer Direct Commercial	$12.92
Rate for Payer: Humana Medicare/TRICARE	$12.92
Rate for Payer: Molina CHIP/Medicaid	$12.92
Rate for Payer: Molina Dual Medicare/Medicaid	$12.92
Rate for Payer: Molina Medicare	$12.92
Rate for Payer: Multiplan Auto	$119.60
Rate for Payer: Multiplan Commercial	$119.60
Rate for Payer: Multiplan Workers Comp	$119.60
Rate for Payer: Parkland Medicaid	$12.92
Rate for Payer: Scott and White EPO/PPO	$16.15
Rate for Payer: Scott and White Medicare	$12.92
Rate for Payer: Superior Health Plan CHIP/Medicaid	$12.92
Rate for Payer: Superior Health Plan EPO	$12.92
Rate for Payer: Superior Health Plan Medicare	$12.92
Rate for Payer: Universal American Dual Medicare/Medicaid	$12.92
Rate for Payer: Universal American Medicare	$12.92
Rate for Payer: Wellcare Medicare	$12.92
Rate for Payer: Wellmed Medicare	$12.92

MyoMarker 3 Profile (RDL) SO

Facility

$222.00

Service Code	CPT 83520
Hospital Charge Code	8654550
Hospital Revenue Code	301
Rate for Payer: Cash Price	$195.36

MyoMarker 3 Profile (RDL) SO

Facility

$222.00

Service Code	CPT 83520
Hospital Charge Code	8654550
Hospital Revenue Code	301
Min. Negotiated Rate	$6.74
Max. Negotiated Rate	$144.30
Rate for Payer: Aetna Commercial	$18.13
Rate for Payer: Aetna Medicare	$25.90
Rate for Payer: Amerigroup CHIP/Medicaid	$6.74
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$17.27
Rate for Payer: Amerigroup Medicare	$17.27
Rate for Payer: BCBS of TX Blue Advantage	$28.50
Rate for Payer: BCBS of TX Blue Essentials	$34.19
Rate for Payer: BCBS of TX Medicare	$17.27
Rate for Payer: BCBS of TX PPO	$38.17
Rate for Payer: Cash Price	$195.36
Rate for Payer: Cash Price	$195.36
Rate for Payer: Cigna Medicaid	$17.27
Rate for Payer: Cigna Medicare	$17.27
Rate for Payer: Employer Direct Commercial	$17.27
Rate for Payer: Humana Medicare/TRICARE	$17.27
Rate for Payer: Molina CHIP/Medicaid	$17.27
Rate for Payer: Molina Dual Medicare/Medicaid	$17.27
Rate for Payer: Molina Medicare	$17.27
Rate for Payer: Multiplan Auto	$144.30
Rate for Payer: Multiplan Commercial	$144.30
Rate for Payer: Multiplan Workers Comp	$144.30
Rate for Payer: Parkland Medicaid	$17.27
Rate for Payer: Scott and White EPO/PPO	$21.59
Rate for Payer: Scott and White Medicare	$17.27
Rate for Payer: Superior Health Plan CHIP/Medicaid	$17.27
Rate for Payer: Superior Health Plan EPO	$17.27
Rate for Payer: Superior Health Plan Medicare	$17.27
Rate for Payer: Universal American Dual Medicare/Medicaid	$17.27
Rate for Payer: Universal American Medicare	$17.27
Rate for Payer: Wellcare Medicare	$17.27
Rate for Payer: Wellmed Medicare	$17.27

MYRIAD MATRIX 20X20CM

Facility

$73.19

Service Code	HCPCS C1781
Hospital Charge Code	145556
Hospital Revenue Code	278
Min. Negotiated Rate	$6.59
Max. Negotiated Rate	$36.60
Rate for Payer: Aetna Commercial	$21.96
Rate for Payer: Amerigroup CHIP/Medicaid	$6.59
Rate for Payer: BCBS of TX Blue Advantage	$21.96
Rate for Payer: BCBS of TX Blue Essentials	$26.35
Rate for Payer: BCBS of TX PPO	$29.28
Rate for Payer: Cash Price	$64.41
Rate for Payer: Multiplan Auto	$36.60
Rate for Payer: Multiplan Commercial	$36.60
Rate for Payer: Multiplan Workers Comp	$36.60
Rate for Payer: Scott and White EPO/PPO	$36.60
Rate for Payer: Superior Health Plan EPO	$9.95

MYRIAD MATRIX 20X20CM

Facility

$73.19

Service Code	HCPCS C1781
Hospital Charge Code	145556
Hospital Revenue Code	278
Min. Negotiated Rate	$18.30
Max. Negotiated Rate	$36.60
Rate for Payer: Aetna Commercial	$21.96
Rate for Payer: Cash Price	$64.41
Rate for Payer: Cigna Commercial	$18.30
Rate for Payer: Multiplan Auto	$36.60
Rate for Payer: Multiplan Commercial	$36.60
Rate for Payer: Multiplan Workers Comp	$36.60
Rate for Payer: Scott and White EPO/PPO	$36.60

MYRIAD MATRIX THICK 7X10CM

Facility

$82.05

Service Code	HCPCS C1781
Hospital Charge Code	145555
Hospital Revenue Code	278
Min. Negotiated Rate	$7.38
Max. Negotiated Rate	$41.02
Rate for Payer: Aetna Commercial	$24.62
Rate for Payer: Amerigroup CHIP/Medicaid	$7.38
Rate for Payer: BCBS of TX Blue Advantage	$24.62
Rate for Payer: BCBS of TX Blue Essentials	$29.54
Rate for Payer: BCBS of TX PPO	$32.82
Rate for Payer: Cash Price	$72.20
Rate for Payer: Multiplan Auto	$41.02
Rate for Payer: Multiplan Commercial	$41.02
Rate for Payer: Multiplan Workers Comp	$41.02
Rate for Payer: Scott and White EPO/PPO	$41.02
Rate for Payer: Superior Health Plan EPO	$11.16

MYRIAD MATRIX THICK 7X10CM

Facility

$82.05

Service Code	HCPCS C1781
Hospital Charge Code	145555
Hospital Revenue Code	278
Min. Negotiated Rate	$20.51
Max. Negotiated Rate	$41.02
Rate for Payer: Aetna Commercial	$24.62
Rate for Payer: Cash Price	$72.20
Rate for Payer: Cigna Commercial	$20.51
Rate for Payer: Multiplan Auto	$41.02
Rate for Payer: Multiplan Commercial	$41.02
Rate for Payer: Multiplan Workers Comp	$41.02
Rate for Payer: Scott and White EPO/PPO	$41.02

MYRIAD MATRIX THIN 7X10 CM

Facility

$59.30

Service Code	HCPCS C1781
Hospital Charge Code	145554
Hospital Revenue Code	278
Min. Negotiated Rate	$5.34
Max. Negotiated Rate	$29.65
Rate for Payer: Aetna Commercial	$17.79
Rate for Payer: Amerigroup CHIP/Medicaid	$5.34
Rate for Payer: BCBS of TX Blue Advantage	$17.79
Rate for Payer: BCBS of TX Blue Essentials	$21.35
Rate for Payer: BCBS of TX PPO	$23.72
Rate for Payer: Cash Price	$52.18
Rate for Payer: Multiplan Auto	$29.65
Rate for Payer: Multiplan Commercial	$29.65
Rate for Payer: Multiplan Workers Comp	$29.65
Rate for Payer: Scott and White EPO/PPO	$29.65
Rate for Payer: Superior Health Plan EPO	$8.06

MYRIAD MATRIX THIN 7X10 CM

Facility

$59.30

Service Code	HCPCS C1781
Hospital Charge Code	145554
Hospital Revenue Code	278
Min. Negotiated Rate	$14.82
Max. Negotiated Rate	$29.65
Rate for Payer: Aetna Commercial	$17.79
Rate for Payer: Cash Price	$52.18
Rate for Payer: Cigna Commercial	$14.82
Rate for Payer: Multiplan Auto	$29.65
Rate for Payer: Multiplan Commercial	$29.65
Rate for Payer: Multiplan Workers Comp	$29.65
Rate for Payer: Scott and White EPO/PPO	$29.65

MYRIAD THICK 5X5, 10X10, 10X20

Facility

$75.57

Service Code	HCPCS C1781
Hospital Charge Code	145550
Hospital Revenue Code	278
Min. Negotiated Rate	$6.80
Max. Negotiated Rate	$37.78
Rate for Payer: Aetna Commercial	$22.67
Rate for Payer: Amerigroup CHIP/Medicaid	$6.80
Rate for Payer: BCBS of TX Blue Advantage	$22.67
Rate for Payer: BCBS of TX Blue Essentials	$27.21
Rate for Payer: BCBS of TX PPO	$30.23
Rate for Payer: Cash Price	$66.50
Rate for Payer: Multiplan Auto	$37.78
Rate for Payer: Multiplan Commercial	$37.78
Rate for Payer: Multiplan Workers Comp	$37.78
Rate for Payer: Scott and White EPO/PPO	$37.78
Rate for Payer: Superior Health Plan EPO	$10.28

MYRIAD THICK 5X5, 10X10, 10X20

Facility

$75.57

Service Code	HCPCS C1781
Hospital Charge Code	145550
Hospital Revenue Code	278
Min. Negotiated Rate	$18.89
Max. Negotiated Rate	$37.78
Rate for Payer: Aetna Commercial	$22.67
Rate for Payer: Cash Price	$66.50
Rate for Payer: Cigna Commercial	$18.89
Rate for Payer: Multiplan Auto	$37.78
Rate for Payer: Multiplan Commercial	$37.78
Rate for Payer: Multiplan Workers Comp	$37.78
Rate for Payer: Scott and White EPO/PPO	$37.78

MYRIAD THIN 5X5, 10X10, 10X20CM

Facility

$55.35

Service Code	HCPCS C1781
Hospital Charge Code	145546
Hospital Revenue Code	278
Min. Negotiated Rate	$13.84
Max. Negotiated Rate	$27.68
Rate for Payer: Aetna Commercial	$16.60
Rate for Payer: Cash Price	$48.71
Rate for Payer: Cigna Commercial	$13.84
Rate for Payer: Multiplan Auto	$27.68
Rate for Payer: Multiplan Commercial	$27.68
Rate for Payer: Multiplan Workers Comp	$27.68
Rate for Payer: Scott and White EPO/PPO	$27.68

MYRIAD THIN 5X5, 10X10, 10X20CM

Facility

$55.35

Service Code	HCPCS C1781
Hospital Charge Code	145546
Hospital Revenue Code	278
Min. Negotiated Rate	$4.98
Max. Negotiated Rate	$27.68
Rate for Payer: Aetna Commercial	$16.60
Rate for Payer: Amerigroup CHIP/Medicaid	$4.98
Rate for Payer: BCBS of TX Blue Advantage	$16.60
Rate for Payer: BCBS of TX Blue Essentials	$19.93
Rate for Payer: BCBS of TX PPO	$22.14
Rate for Payer: Cash Price	$48.71
Rate for Payer: Multiplan Auto	$27.68
Rate for Payer: Multiplan Commercial	$27.68
Rate for Payer: Multiplan Workers Comp	$27.68
Rate for Payer: Scott and White EPO/PPO	$27.68
Rate for Payer: Superior Health Plan EPO	$7.53

Nail Debride 1-5

Facility

$203.00

Service Code	CPT 11720
Hospital Charge Code	7150246
Hospital Revenue Code	761
Min. Negotiated Rate	$1.00
Max. Negotiated Rate	$138.63
Rate for Payer: Aetna Commercial	$111.65
Rate for Payer: Aetna Medicare	$83.91
Rate for Payer: Amerigroup CHIP/Medicaid	$18.27
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$55.94
Rate for Payer: Amerigroup Medicare	$55.94
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	$55.94
Rate for Payer: BCBS of TX PPO	$138.63
Rate for Payer: Cash Price	$178.64
Rate for Payer: Cash Price	$178.64
Rate for Payer: Cash Price	$178.64
Rate for Payer: Cigna Commercial	$126.71
Rate for Payer: Cigna Medicare	$55.94
Rate for Payer: Employer Direct Commercial	$55.94
Rate for Payer: Humana Medicare/TRICARE	$55.94
Rate for Payer: Molina Dual Medicare/Medicaid	$55.94
Rate for Payer: Molina Medicare	$55.94
Rate for Payer: Multiplan Auto	$131.95
Rate for Payer: Multiplan Commercial	$131.95
Rate for Payer: Multiplan Workers Comp	$131.95
Rate for Payer: Scott and White EPO/PPO	$1.00
Rate for Payer: Scott and White Medicare	$55.94
Rate for Payer: Superior Health Plan EPO	$55.94
Rate for Payer: Superior Health Plan Medicare	$55.94
Rate for Payer: Universal American Dual Medicare/Medicaid	$55.94
Rate for Payer: Universal American Medicare	$55.94
Rate for Payer: Wellcare Medicare	$55.94
Rate for Payer: Wellmed Medicare	$55.94

Nail Debridement 6 or more

Facility

$415.00

Service Code	CPT 11721
Hospital Charge Code	7150253
Hospital Revenue Code	761
Min. Negotiated Rate	$1.00
Max. Negotiated Rate	$269.75
Rate for Payer: Aetna Commercial	$228.25
Rate for Payer: Aetna Medicare	$83.91
Rate for Payer: Amerigroup CHIP/Medicaid	$37.35
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$55.94
Rate for Payer: Amerigroup Medicare	$55.94
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	$55.94
Rate for Payer: BCBS of TX PPO	$138.63
Rate for Payer: Cash Price	$365.20
Rate for Payer: Cash Price	$365.20
Rate for Payer: Cash Price	$365.20
Rate for Payer: Cigna Commercial	$126.71
Rate for Payer: Cigna Medicare	$55.94
Rate for Payer: Employer Direct Commercial	$55.94
Rate for Payer: Humana Medicare/TRICARE	$55.94
Rate for Payer: Molina Dual Medicare/Medicaid	$55.94
Rate for Payer: Molina Medicare	$55.94
Rate for Payer: Multiplan Auto	$269.75
Rate for Payer: Multiplan Commercial	$269.75
Rate for Payer: Multiplan Workers Comp	$269.75
Rate for Payer: Scott and White EPO/PPO	$1.00
Rate for Payer: Scott and White Medicare	$55.94
Rate for Payer: Superior Health Plan EPO	$55.94
Rate for Payer: Superior Health Plan Medicare	$55.94
Rate for Payer: Universal American Dual Medicare/Medicaid	$55.94
Rate for Payer: Universal American Medicare	$55.94
Rate for Payer: Wellcare Medicare	$55.94
Rate for Payer: Wellmed Medicare	$55.94

NAIL FIBULA

Facility

$25,777.11

Service Code	HCPCS C1713
Hospital Charge Code	145500
Hospital Revenue Code	278
Min. Negotiated Rate	$6,444.28
Max. Negotiated Rate	$12,888.56
Rate for Payer: Aetna Commercial	$7,733.13
Rate for Payer: Cash Price	$22,683.86
Rate for Payer: Cigna Commercial	$6,444.28
Rate for Payer: Multiplan Auto	$12,888.56
Rate for Payer: Multiplan Commercial	$12,888.56
Rate for Payer: Multiplan Workers Comp	$12,888.56
Rate for Payer: Scott and White EPO/PPO	$12,888.56

NAIL FIBULA

Facility

$25,777.11

Service Code	HCPCS C1713
Hospital Charge Code	145500
Hospital Revenue Code	278
Min. Negotiated Rate	$2,319.94
Max. Negotiated Rate	$12,888.56
Rate for Payer: Aetna Commercial	$7,733.13
Rate for Payer: Amerigroup CHIP/Medicaid	$2,319.94
Rate for Payer: BCBS of TX Blue Advantage	$7,733.13
Rate for Payer: BCBS of TX Blue Essentials	$9,279.76
Rate for Payer: BCBS of TX PPO	$10,310.84
Rate for Payer: Cash Price	$22,683.86
Rate for Payer: Multiplan Auto	$12,888.56
Rate for Payer: Multiplan Commercial	$12,888.56
Rate for Payer: Multiplan Workers Comp	$12,888.56
Rate for Payer: Scott and White EPO/PPO	$12,888.56
Rate for Payer: Superior Health Plan EPO	$3,505.69

NAIL GAMMA LONG

Facility

$14,438.61

Service Code	HCPCS C1713
Hospital Charge Code	145506
Hospital Revenue Code	278
Min. Negotiated Rate	$3,609.65
Max. Negotiated Rate	$7,219.30
Rate for Payer: Aetna Commercial	$4,331.58
Rate for Payer: Cash Price	$12,705.98
Rate for Payer: Cigna Commercial	$3,609.65
Rate for Payer: Multiplan Auto	$7,219.30
Rate for Payer: Multiplan Commercial	$7,219.30
Rate for Payer: Multiplan Workers Comp	$7,219.30
Rate for Payer: Scott and White EPO/PPO	$7,219.30

NAIL GAMMA LONG

Facility

$14,438.61

Service Code	HCPCS C1713
Hospital Charge Code	145506
Hospital Revenue Code	278
Min. Negotiated Rate	$1,299.47
Max. Negotiated Rate	$7,219.30
Rate for Payer: Aetna Commercial	$4,331.58
Rate for Payer: Amerigroup CHIP/Medicaid	$1,299.47
Rate for Payer: BCBS of TX Blue Advantage	$4,331.58
Rate for Payer: BCBS of TX Blue Essentials	$5,197.90
Rate for Payer: BCBS of TX PPO	$5,775.44
Rate for Payer: Cash Price	$12,705.98
Rate for Payer: Multiplan Auto	$7,219.30
Rate for Payer: Multiplan Commercial	$7,219.30
Rate for Payer: Multiplan Workers Comp	$7,219.30
Rate for Payer: Scott and White EPO/PPO	$7,219.30
Rate for Payer: Superior Health Plan EPO	$1,963.65

NAIL HUMERAL

Facility

$9,352.71

Service Code	HCPCS C1713
Hospital Charge Code	145143
Hospital Revenue Code	278
Min. Negotiated Rate	$841.74
Max. Negotiated Rate	$4,676.36
Rate for Payer: Aetna Commercial	$2,805.81
Rate for Payer: Amerigroup CHIP/Medicaid	$841.74
Rate for Payer: BCBS of TX Blue Advantage	$2,805.81
Rate for Payer: BCBS of TX Blue Essentials	$3,366.98
Rate for Payer: BCBS of TX PPO	$3,741.08
Rate for Payer: Cash Price	$8,230.38
Rate for Payer: Multiplan Auto	$4,676.36
Rate for Payer: Multiplan Commercial	$4,676.36
Rate for Payer: Multiplan Workers Comp	$4,676.36
Rate for Payer: Scott and White EPO/PPO	$4,676.36
Rate for Payer: Superior Health Plan EPO	$1,271.97

NAIL HUMERAL

Facility

$9,352.71

Service Code	HCPCS C1713
Hospital Charge Code	145143
Hospital Revenue Code	278
Min. Negotiated Rate	$2,338.18
Max. Negotiated Rate	$4,676.36
Rate for Payer: Aetna Commercial	$2,805.81
Rate for Payer: Cash Price	$8,230.38
Rate for Payer: Cigna Commercial	$2,338.18
Rate for Payer: Multiplan Auto	$4,676.36
Rate for Payer: Multiplan Commercial	$4,676.36
Rate for Payer: Multiplan Workers Comp	$4,676.36
Rate for Payer: Scott and White EPO/PPO	$4,676.36

NAIL HUMERAL 8V22.5

Facility

$22,018.07

Service Code	HCPCS C1713
Hospital Charge Code	8428490
Hospital Revenue Code	278
Min. Negotiated Rate	$5,504.52
Max. Negotiated Rate	$11,009.04
Rate for Payer: Aetna Commercial	$6,605.42
Rate for Payer: Cash Price	$19,375.90
Rate for Payer: Cigna Commercial	$5,504.52
Rate for Payer: Multiplan Auto	$11,009.04
Rate for Payer: Multiplan Commercial	$11,009.04
Rate for Payer: Multiplan Workers Comp	$11,009.04
Rate for Payer: Scott and White EPO/PPO	$11,009.04

Know your out-of-pocket cost for care.

All Charges