White Rock Medical Center

All Charges

Charge

Type

Setting

Price

Inguinofemoral lymphadenectomy, superficial, including Cloquet's node (separate procedure)

Facility

$12,960.81

Service Code	HCPCS 38760
Hospital Charge Code	9900638
Hospital Revenue Code	360
Min. Negotiated Rate	$1,845.21
Max. Negotiated Rate	$14,100.07
Rate for Payer: Amerigroup CHIP/Medicaid	$1,845.21
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$6,670.43
Rate for Payer: Amerigroup Medicare	$6,670.43
Rate for Payer: BCBS of TX Blue Advantage	$8,746.27
Rate for Payer: BCBS of TX Blue Essentials	$10,474.58
Rate for Payer: BCBS of TX Medicare	$6,670.43
Rate for Payer: BCBS of TX PPO	$13,197.97
Rate for Payer: Cash Price	$8,813.35
Rate for Payer: Cash Price	$8,813.35
Rate for Payer: Cash Price	$8,813.35
Rate for Payer: Cigna Commercial	$14,100.07
Rate for Payer: Cigna Medicaid	$9,331.78
Rate for Payer: Cigna Medicare	$6,670.43
Rate for Payer: Employer Direct Commercial	$6,670.43
Rate for Payer: Humana Medicare/TRICARE	$6,670.43
Rate for Payer: Molina CHIP/Medicaid	$9,331.78
Rate for Payer: Molina Dual Medicare/Medicaid	$6,670.43
Rate for Payer: Molina Medicare	$6,670.43
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	$9,331.78
Rate for Payer: Scott and White EPO/PPO	$11,033.10
Rate for Payer: Scott and White Medicare	$6,670.43
Rate for Payer: Superior Health Plan CHIP/Medicaid	$9,331.78
Rate for Payer: Superior Health Plan EPO	$6,670.43
Rate for Payer: Superior Health Plan Medicare	$6,670.43
Rate for Payer: Universal American Dual Medicare/Medicaid	$6,670.43
Rate for Payer: Universal American Medicare	$6,670.43
Rate for Payer: Wellcare Medicare	$6,670.43
Rate for Payer: Wellmed Medicare	$6,670.43

Inhibin A, Ultrasensitive SO

Facility

$239.60

Service Code	HCPCS 86336
Hospital Charge Code	1708908
Hospital Revenue Code	302
Min. Negotiated Rate	$6.08
Max. Negotiated Rate	$172.51
Rate for Payer: Amerigroup CHIP/Medicaid	$6.08
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$15.59
Rate for Payer: Amerigroup Medicare	$15.59
Rate for Payer: BCBS of TX Blue Advantage	$71.88
Rate for Payer: BCBS of TX Blue Essentials	$86.26
Rate for Payer: BCBS of TX Medicare	$15.59
Rate for Payer: BCBS of TX PPO	$95.84
Rate for Payer: Cash Price	$162.93
Rate for Payer: Cash Price	$162.93
Rate for Payer: Cigna Medicaid	$172.51
Rate for Payer: Cigna Medicare	$15.59
Rate for Payer: Employer Direct Commercial	$15.59
Rate for Payer: Humana Medicare/TRICARE	$15.59
Rate for Payer: Molina CHIP/Medicaid	$172.51
Rate for Payer: Molina Dual Medicare/Medicaid	$15.59
Rate for Payer: Molina Medicare	$15.59
Rate for Payer: Multiplan Auto	$155.74
Rate for Payer: Multiplan Commercial	$155.74
Rate for Payer: Multiplan Workers Comp	$155.74
Rate for Payer: Parkland Medicaid	$172.51
Rate for Payer: Scott and White EPO/PPO	$19.49
Rate for Payer: Scott and White Medicare	$15.59
Rate for Payer: Superior Health Plan CHIP/Medicaid	$172.51
Rate for Payer: Superior Health Plan EPO	$15.59
Rate for Payer: Superior Health Plan Medicare	$15.59
Rate for Payer: Universal American Dual Medicare/Medicaid	$15.59
Rate for Payer: Universal American Medicare	$15.59
Rate for Payer: Wellcare Medicare	$15.59
Rate for Payer: Wellmed Medicare	$15.59

Inhibin A, Ultrasensitive SO

Facility

$239.60

Service Code	HCPCS 86336
Hospital Charge Code	1708908
Hospital Revenue Code	302
Rate for Payer: Cash Price	$162.93

Initial hospital or birthing center care normal newborn

Facility

$515.48

Service Code	HCPCS 99463
Hospital Charge Code	994129
Hospital Revenue Code	450
Min. Negotiated Rate	$46.39
Max. Negotiated Rate	$3,520.00
Rate for Payer: Amerigroup CHIP/Medicaid	$46.39
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$133.74
Rate for Payer: Amerigroup Medicare	$133.74
Rate for Payer: BCBS of TX Blue Advantage	$154.64
Rate for Payer: BCBS of TX Blue Essentials	$185.57
Rate for Payer: BCBS of TX Medicare	$133.74
Rate for Payer: BCBS of TX PPO	$3,520.00
Rate for Payer: Cash Price	$350.53
Rate for Payer: Cash Price	$350.53
Rate for Payer: Cash Price	$350.53
Rate for Payer: Cigna Commercial	$282.70
Rate for Payer: Cigna Medicaid	$371.15
Rate for Payer: Cigna Medicare	$133.74
Rate for Payer: Employer Direct Commercial	$133.74
Rate for Payer: Humana Medicare/TRICARE	$133.74
Rate for Payer: Molina CHIP/Medicaid	$371.15
Rate for Payer: Molina Dual Medicare/Medicaid	$133.74
Rate for Payer: Molina Medicare	$133.74
Rate for Payer: Multiplan Auto	$335.06
Rate for Payer: Multiplan Commercial	$335.06
Rate for Payer: Multiplan Workers Comp	$335.06
Rate for Payer: Parkland Medicaid	$371.15
Rate for Payer: Scott and White EPO/PPO	$131.86
Rate for Payer: Scott and White Medicare	$133.74
Rate for Payer: Superior Health Plan CHIP/Medicaid	$371.15
Rate for Payer: Superior Health Plan EPO	$133.74
Rate for Payer: Superior Health Plan Medicare	$133.74
Rate for Payer: Universal American Dual Medicare/Medicaid	$133.74
Rate for Payer: Universal American Medicare	$133.74
Rate for Payer: Wellcare Medicare	$133.74
Rate for Payer: Wellmed Medicare	$133.74

Initial hospital or birthing center care normal newborn

Facility

$515.48

Service Code	HCPCS 99463
Hospital Charge Code	994129
Hospital Revenue Code	450
Rate for Payer: Cash Price	$350.53

Initial treatment, first degree burn, when no more than local treatment is required

Facility

$794.80

Service Code	HCPCS 16000
Hospital Charge Code	991215
Hospital Revenue Code	360
Rate for Payer: Cash Price	$540.46

Initial treatment, first degree burn, when no more than local treatment is required

Facility

$794.80

Service Code	HCPCS 16000
Hospital Charge Code	991215
Hospital Revenue Code	360
Min. Negotiated Rate	$71.53
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$71.53
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	$540.46
Rate for Payer: Cash Price	$540.46
Rate for Payer: Cash Price	$540.46
Rate for Payer: Cigna Commercial	$426.04
Rate for Payer: Cigna Medicaid	$572.26
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	$572.26
Rate for Payer: Molina Dual Medicare/Medicaid	$201.55
Rate for Payer: Molina Medicare	$201.55
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	$572.26
Rate for Payer: Scott and White EPO/PPO	$338.72
Rate for Payer: Scott and White Medicare	$201.55
Rate for Payer: Superior Health Plan CHIP/Medicaid	$572.26
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

INJ CM EVAL JTUBE

Facility

$857.00

Service Code	HCPCS 49465
Hospital Charge Code	4619467
Hospital Revenue Code	361
Rate for Payer: Cash Price	$582.76

INJ CM EVAL JTUBE

Facility

$857.00

Service Code	HCPCS 49465
Hospital Charge Code	4619467
Hospital Revenue Code	361
Min. Negotiated Rate	$77.13
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$77.13
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$239.69
Rate for Payer: Amerigroup Medicare	$239.69
Rate for Payer: BCBS of TX Blue Advantage	$389.18
Rate for Payer: BCBS of TX Blue Essentials	$466.08
Rate for Payer: BCBS of TX Medicare	$239.69
Rate for Payer: BCBS of TX PPO	$587.26
Rate for Payer: Cash Price	$582.76
Rate for Payer: Cash Price	$582.76
Rate for Payer: Cash Price	$582.76
Rate for Payer: Cigna Commercial	$506.65
Rate for Payer: Cigna Medicaid	$617.04
Rate for Payer: Cigna Medicare	$239.69
Rate for Payer: Employer Direct Commercial	$239.69
Rate for Payer: Humana Medicare/TRICARE	$239.69
Rate for Payer: Molina CHIP/Medicaid	$617.04
Rate for Payer: Molina Dual Medicare/Medicaid	$239.69
Rate for Payer: Molina Medicare	$239.69
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	$617.04
Rate for Payer: Scott and White EPO/PPO	$414.58
Rate for Payer: Scott and White Medicare	$239.69
Rate for Payer: Superior Health Plan CHIP/Medicaid	$617.04
Rate for Payer: Superior Health Plan EPO	$239.69
Rate for Payer: Superior Health Plan Medicare	$239.69
Rate for Payer: Universal American Dual Medicare/Medicaid	$239.69
Rate for Payer: Universal American Medicare	$239.69
Rate for Payer: Wellcare Medicare	$239.69
Rate for Payer: Wellmed Medicare	$239.69

INJECT CONGEN CARD CATH

Facility

$2,708.00

Service Code	HCPCS 93563
Hospital Charge Code	4613563
Hospital Revenue Code	481
Rate for Payer: Cash Price	$1,841.44

INJECT CONGEN CARD CATH

Facility

$2,708.00

Service Code	HCPCS 93563
Hospital Charge Code	4613563
Hospital Revenue Code	481
Min. Negotiated Rate	$61.55
Max. Negotiated Rate	$1,949.76
Rate for Payer: Amerigroup CHIP/Medicaid	$243.72
Rate for Payer: BCBS of TX Blue Advantage	$812.40
Rate for Payer: BCBS of TX Blue Essentials	$974.88
Rate for Payer: BCBS of TX PPO	$1,083.20
Rate for Payer: Cash Price	$1,841.44
Rate for Payer: Cash Price	$1,841.44
Rate for Payer: Cigna Medicaid	$1,949.76
Rate for Payer: Molina CHIP/Medicaid	$1,949.76
Rate for Payer: Multiplan Auto	$1,760.20
Rate for Payer: Multiplan Commercial	$1,760.20
Rate for Payer: Multiplan Workers Comp	$1,760.20
Rate for Payer: Parkland Medicaid	$1,949.76
Rate for Payer: Scott and White EPO/PPO	$61.55
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,949.76
Rate for Payer: Superior Health Plan EPO	$368.29

Injection, anesthetic agent celiac plexus, with or without radiologic monitoring

Facility

$2,467.38

Service Code	HCPCS 64530
Hospital Charge Code	9900810
Hospital Revenue Code	360
Min. Negotiated Rate	$340.77
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$340.77
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$888.50
Rate for Payer: Amerigroup Medicare	$888.50
Rate for Payer: BCBS of TX Blue Advantage	$1,356.12
Rate for Payer: BCBS of TX Blue Essentials	$1,624.10
Rate for Payer: BCBS of TX Medicare	$888.50
Rate for Payer: BCBS of TX PPO	$2,046.37
Rate for Payer: Cash Price	$1,677.82
Rate for Payer: Cash Price	$1,677.82
Rate for Payer: Cash Price	$1,677.82
Rate for Payer: Cigna Commercial	$1,878.13
Rate for Payer: Cigna Medicaid	$1,776.51
Rate for Payer: Cigna Medicare	$888.50
Rate for Payer: Employer Direct Commercial	$888.50
Rate for Payer: Humana Medicare/TRICARE	$888.50
Rate for Payer: Molina CHIP/Medicaid	$1,776.51
Rate for Payer: Molina Dual Medicare/Medicaid	$888.50
Rate for Payer: Molina Medicare	$888.50
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	$1,776.51
Rate for Payer: Scott and White EPO/PPO	$1,542.14
Rate for Payer: Scott and White Medicare	$888.50
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,776.51
Rate for Payer: Superior Health Plan EPO	$888.50
Rate for Payer: Superior Health Plan Medicare	$888.50
Rate for Payer: Universal American Dual Medicare/Medicaid	$888.50
Rate for Payer: Universal American Medicare	$888.50
Rate for Payer: Wellcare Medicare	$888.50
Rate for Payer: Wellmed Medicare	$888.50

Injection, anesthetic agent celiac plexus, with or without radiologic monitoring

Facility

$2,467.38

Service Code	HCPCS 64530
Hospital Charge Code	9900810
Hospital Revenue Code	360
Rate for Payer: Cash Price	$1,677.82

Injection, anesthetic agent celiac plexus, with or without radiologic monitoring

Facility

$10,000.00

Service Code	CPT 64530
Hospital Charge Code	36064530
Hospital Revenue Code	360
Min. Negotiated Rate	$340.77
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$340.77
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$888.50
Rate for Payer: Amerigroup Medicare	$888.50
Rate for Payer: BCBS of TX Blue Advantage	$1,356.12
Rate for Payer: BCBS of TX Blue Essentials	$1,624.10
Rate for Payer: BCBS of TX Medicare	$888.50
Rate for Payer: BCBS of TX PPO	$2,046.37
Rate for Payer: Cigna Commercial	$1,878.13
Rate for Payer: Cigna Medicare	$888.50
Rate for Payer: Employer Direct Commercial	$888.50
Rate for Payer: Humana Medicare/TRICARE	$888.50
Rate for Payer: Molina Dual Medicare/Medicaid	$888.50
Rate for Payer: Molina Medicare	$888.50
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: Scott and White EPO/PPO	$1,542.14
Rate for Payer: Scott and White Medicare	$888.50
Rate for Payer: Superior Health Plan EPO	$888.50
Rate for Payer: Superior Health Plan Medicare	$888.50
Rate for Payer: Universal American Dual Medicare/Medicaid	$888.50
Rate for Payer: Universal American Medicare	$888.50
Rate for Payer: Wellcare Medicare	$888.50
Rate for Payer: Wellmed Medicare	$888.50

Injection, anesthetic agent lumbar or thoracic (paravertebral sympathetic)

Facility

$2,467.38

Service Code	HCPCS 64520
Hospital Charge Code	9900809
Hospital Revenue Code	360
Rate for Payer: Cash Price	$1,677.82

Injection, anesthetic agent lumbar or thoracic (paravertebral sympathetic)

Facility

$2,467.38

Service Code	HCPCS 64520
Hospital Charge Code	9900809
Hospital Revenue Code	360
Min. Negotiated Rate	$340.77
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$340.77
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$888.50
Rate for Payer: Amerigroup Medicare	$888.50
Rate for Payer: BCBS of TX Blue Advantage	$1,356.12
Rate for Payer: BCBS of TX Blue Essentials	$1,624.10
Rate for Payer: BCBS of TX Medicare	$888.50
Rate for Payer: BCBS of TX PPO	$2,046.37
Rate for Payer: Cash Price	$1,677.82
Rate for Payer: Cash Price	$1,677.82
Rate for Payer: Cash Price	$1,677.82
Rate for Payer: Cigna Commercial	$1,878.13
Rate for Payer: Cigna Medicaid	$1,776.51
Rate for Payer: Cigna Medicare	$888.50
Rate for Payer: Employer Direct Commercial	$888.50
Rate for Payer: Humana Medicare/TRICARE	$888.50
Rate for Payer: Molina CHIP/Medicaid	$1,776.51
Rate for Payer: Molina Dual Medicare/Medicaid	$888.50
Rate for Payer: Molina Medicare	$888.50
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	$1,776.51
Rate for Payer: Scott and White EPO/PPO	$1,542.14
Rate for Payer: Scott and White Medicare	$888.50
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,776.51
Rate for Payer: Superior Health Plan EPO	$888.50
Rate for Payer: Superior Health Plan Medicare	$888.50
Rate for Payer: Universal American Dual Medicare/Medicaid	$888.50
Rate for Payer: Universal American Medicare	$888.50
Rate for Payer: Wellcare Medicare	$888.50
Rate for Payer: Wellmed Medicare	$888.50

Injection, anesthetic agent lumbar or thoracic (paravertebral sympathetic)

Facility

$10,000.00

Service Code	CPT 64520
Hospital Charge Code	36064520
Hospital Revenue Code	360
Min. Negotiated Rate	$340.77
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$340.77
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$888.50
Rate for Payer: Amerigroup Medicare	$888.50
Rate for Payer: BCBS of TX Blue Advantage	$1,356.12
Rate for Payer: BCBS of TX Blue Essentials	$1,624.10
Rate for Payer: BCBS of TX Medicare	$888.50
Rate for Payer: BCBS of TX PPO	$2,046.37
Rate for Payer: Cigna Commercial	$1,878.13
Rate for Payer: Cigna Medicare	$888.50
Rate for Payer: Employer Direct Commercial	$888.50
Rate for Payer: Humana Medicare/TRICARE	$888.50
Rate for Payer: Molina Dual Medicare/Medicaid	$888.50
Rate for Payer: Molina Medicare	$888.50
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: Scott and White EPO/PPO	$1,542.14
Rate for Payer: Scott and White Medicare	$888.50
Rate for Payer: Superior Health Plan EPO	$888.50
Rate for Payer: Superior Health Plan Medicare	$888.50
Rate for Payer: Universal American Dual Medicare/Medicaid	$888.50
Rate for Payer: Universal American Medicare	$888.50
Rate for Payer: Wellcare Medicare	$888.50
Rate for Payer: Wellmed Medicare	$888.50

Injection, anesthetic agent stellate ganglion (cervical sympathetic)

Facility

$2,467.38

Service Code	HCPCS 64510
Hospital Charge Code	9900807
Hospital Revenue Code	360
Min. Negotiated Rate	$340.77
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$340.77
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$888.50
Rate for Payer: Amerigroup Medicare	$888.50
Rate for Payer: BCBS of TX Blue Advantage	$1,356.12
Rate for Payer: BCBS of TX Blue Essentials	$1,624.10
Rate for Payer: BCBS of TX Medicare	$888.50
Rate for Payer: BCBS of TX PPO	$2,046.37
Rate for Payer: Cash Price	$1,677.82
Rate for Payer: Cash Price	$1,677.82
Rate for Payer: Cash Price	$1,677.82
Rate for Payer: Cigna Commercial	$1,878.13
Rate for Payer: Cigna Medicaid	$1,776.51
Rate for Payer: Cigna Medicare	$888.50
Rate for Payer: Employer Direct Commercial	$888.50
Rate for Payer: Humana Medicare/TRICARE	$888.50
Rate for Payer: Molina CHIP/Medicaid	$1,776.51
Rate for Payer: Molina Dual Medicare/Medicaid	$888.50
Rate for Payer: Molina Medicare	$888.50
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	$1,776.51
Rate for Payer: Scott and White EPO/PPO	$1,542.14
Rate for Payer: Scott and White Medicare	$888.50
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,776.51
Rate for Payer: Superior Health Plan EPO	$888.50
Rate for Payer: Superior Health Plan Medicare	$888.50
Rate for Payer: Universal American Dual Medicare/Medicaid	$888.50
Rate for Payer: Universal American Medicare	$888.50
Rate for Payer: Wellcare Medicare	$888.50
Rate for Payer: Wellmed Medicare	$888.50

Injection, anesthetic agent stellate ganglion (cervical sympathetic)

Facility

$2,467.38

Service Code	HCPCS 64510
Hospital Charge Code	9900807
Hospital Revenue Code	360
Rate for Payer: Cash Price	$1,677.82

Injection, anesthetic agent stellate ganglion (cervical sympathetic)

Facility

$10,000.00

Service Code	CPT 64510
Hospital Charge Code	36064510
Hospital Revenue Code	360
Min. Negotiated Rate	$340.77
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$340.77
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$888.50
Rate for Payer: Amerigroup Medicare	$888.50
Rate for Payer: BCBS of TX Blue Advantage	$1,356.12
Rate for Payer: BCBS of TX Blue Essentials	$1,624.10
Rate for Payer: BCBS of TX Medicare	$888.50
Rate for Payer: BCBS of TX PPO	$2,046.37
Rate for Payer: Cigna Commercial	$1,878.13
Rate for Payer: Cigna Medicare	$888.50
Rate for Payer: Employer Direct Commercial	$888.50
Rate for Payer: Humana Medicare/TRICARE	$888.50
Rate for Payer: Molina Dual Medicare/Medicaid	$888.50
Rate for Payer: Molina Medicare	$888.50
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: Scott and White EPO/PPO	$1,542.14
Rate for Payer: Scott and White Medicare	$888.50
Rate for Payer: Superior Health Plan EPO	$888.50
Rate for Payer: Superior Health Plan Medicare	$888.50
Rate for Payer: Universal American Dual Medicare/Medicaid	$888.50
Rate for Payer: Universal American Medicare	$888.50
Rate for Payer: Wellcare Medicare	$888.50
Rate for Payer: Wellmed Medicare	$888.50

Injection, anesthetic agent superior hypogastric plexus

Facility

$10,000.00

Service Code	CPT 64517
Hospital Charge Code	36064517
Hospital Revenue Code	360
Min. Negotiated Rate	$340.77
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$340.77
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$888.50
Rate for Payer: Amerigroup Medicare	$888.50
Rate for Payer: BCBS of TX Blue Advantage	$1,356.12
Rate for Payer: BCBS of TX Blue Essentials	$1,624.10
Rate for Payer: BCBS of TX Medicare	$888.50
Rate for Payer: BCBS of TX PPO	$2,046.37
Rate for Payer: Cigna Commercial	$1,878.13
Rate for Payer: Cigna Medicare	$888.50
Rate for Payer: Employer Direct Commercial	$888.50
Rate for Payer: Humana Medicare/TRICARE	$888.50
Rate for Payer: Molina Dual Medicare/Medicaid	$888.50
Rate for Payer: Molina Medicare	$888.50
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: Scott and White EPO/PPO	$1,542.14
Rate for Payer: Scott and White Medicare	$888.50
Rate for Payer: Superior Health Plan EPO	$888.50
Rate for Payer: Superior Health Plan Medicare	$888.50
Rate for Payer: Universal American Dual Medicare/Medicaid	$888.50
Rate for Payer: Universal American Medicare	$888.50
Rate for Payer: Wellcare Medicare	$888.50
Rate for Payer: Wellmed Medicare	$888.50

Injection, anesthetic agent superior hypogastric plexus

Facility

$2,467.38

Service Code	HCPCS 64517
Hospital Charge Code	9900808
Hospital Revenue Code	360
Min. Negotiated Rate	$340.77
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$340.77
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$888.50
Rate for Payer: Amerigroup Medicare	$888.50
Rate for Payer: BCBS of TX Blue Advantage	$1,356.12
Rate for Payer: BCBS of TX Blue Essentials	$1,624.10
Rate for Payer: BCBS of TX Medicare	$888.50
Rate for Payer: BCBS of TX PPO	$2,046.37
Rate for Payer: Cash Price	$1,677.82
Rate for Payer: Cash Price	$1,677.82
Rate for Payer: Cash Price	$1,677.82
Rate for Payer: Cigna Commercial	$1,878.13
Rate for Payer: Cigna Medicaid	$1,776.51
Rate for Payer: Cigna Medicare	$888.50
Rate for Payer: Employer Direct Commercial	$888.50
Rate for Payer: Humana Medicare/TRICARE	$888.50
Rate for Payer: Molina CHIP/Medicaid	$1,776.51
Rate for Payer: Molina Dual Medicare/Medicaid	$888.50
Rate for Payer: Molina Medicare	$888.50
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	$1,776.51
Rate for Payer: Scott and White EPO/PPO	$1,542.14
Rate for Payer: Scott and White Medicare	$888.50
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,776.51
Rate for Payer: Superior Health Plan EPO	$888.50
Rate for Payer: Superior Health Plan Medicare	$888.50
Rate for Payer: Universal American Dual Medicare/Medicaid	$888.50
Rate for Payer: Universal American Medicare	$888.50
Rate for Payer: Wellcare Medicare	$888.50
Rate for Payer: Wellmed Medicare	$888.50

Injection, anesthetic agent superior hypogastric plexus

Facility

$2,467.38

Service Code	HCPCS 64517
Hospital Charge Code	9900808
Hospital Revenue Code	360
Rate for Payer: Cash Price	$1,677.82

Injection, epidural, of blood or clot patch

Facility

$3,807.54

Service Code	HCPCS 62273
Hospital Charge Code	9900743
Hospital Revenue Code	360
Rate for Payer: Cash Price	$2,589.13

Injection, epidural, of blood or clot patch

Facility

$3,807.54

Service Code	HCPCS 62273
Hospital Charge Code	10157
Hospital Revenue Code	360
Min. Negotiated Rate	$262.86
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$262.86
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$709.10
Rate for Payer: Amerigroup Medicare	$709.10
Rate for Payer: BCBS of TX Blue Advantage	$1,043.83
Rate for Payer: BCBS of TX Blue Essentials	$1,250.10
Rate for Payer: BCBS of TX Medicare	$709.10
Rate for Payer: BCBS of TX PPO	$1,575.13
Rate for Payer: Cash Price	$2,589.13
Rate for Payer: Cash Price	$2,589.13
Rate for Payer: Cash Price	$2,589.13
Rate for Payer: Cigna Commercial	$1,498.91
Rate for Payer: Cigna Medicaid	$2,741.43
Rate for Payer: Cigna Medicare	$709.10
Rate for Payer: Employer Direct Commercial	$709.10
Rate for Payer: Humana Medicare/TRICARE	$709.10
Rate for Payer: Molina CHIP/Medicaid	$2,741.43
Rate for Payer: Molina Dual Medicare/Medicaid	$709.10
Rate for Payer: Molina Medicare	$709.10
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	$2,741.43
Rate for Payer: Scott and White EPO/PPO	$1,170.03
Rate for Payer: Scott and White Medicare	$709.10
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2,741.43
Rate for Payer: Superior Health Plan EPO	$709.10
Rate for Payer: Superior Health Plan Medicare	$709.10
Rate for Payer: Universal American Dual Medicare/Medicaid	$709.10
Rate for Payer: Universal American Medicare	$709.10
Rate for Payer: Wellcare Medicare	$709.10
Rate for Payer: Wellmed Medicare	$709.10

Know your out-of-pocket cost for care.

All Charges