White Rock Medical Center

All Charges

Charge

Type

Setting

Price

BG AMBU NEO -- DHF

Facility

$67.43

Hospital Charge Code	82015058
Hospital Revenue Code	270
Rate for Payer: Cash Price	$59.34

BG ICE DISP PL -- DHF

Facility

$26.48

Hospital Charge Code	80312408
Hospital Revenue Code	270
Min. Negotiated Rate	$2.38
Max. Negotiated Rate	$17.21
Rate for Payer: Aetna Commercial	$14.56
Rate for Payer: Amerigroup CHIP/Medicaid	$2.38
Rate for Payer: BCBS of TX Blue Advantage	$7.94
Rate for Payer: BCBS of TX Blue Essentials	$9.53
Rate for Payer: BCBS of TX PPO	$10.59
Rate for Payer: Cash Price	$23.30
Rate for Payer: Multiplan Auto	$17.21
Rate for Payer: Multiplan Commercial	$17.21
Rate for Payer: Multiplan Workers Comp	$17.21
Rate for Payer: Scott and White EPO/PPO	$13.24
Rate for Payer: Superior Health Plan EPO	$3.60

BG ICE DISP PL -- DHF

Facility

$26.48

Hospital Charge Code	80312408
Hospital Revenue Code	270
Rate for Payer: Cash Price	$23.30

BG INCNT -- DHF

Facility

$134.02

Hospital Charge Code	80312507
Hospital Revenue Code	272
Rate for Payer: Cash Price	$117.94

BG INCNT -- DHF

Facility

$134.02

Hospital Charge Code	80312507
Hospital Revenue Code	272
Min. Negotiated Rate	$12.06
Max. Negotiated Rate	$87.11
Rate for Payer: Aetna Commercial	$73.71
Rate for Payer: Amerigroup CHIP/Medicaid	$12.06
Rate for Payer: BCBS of TX Blue Advantage	$40.21
Rate for Payer: BCBS of TX Blue Essentials	$48.25
Rate for Payer: BCBS of TX PPO	$53.61
Rate for Payer: Cash Price	$117.94
Rate for Payer: Multiplan Auto	$87.11
Rate for Payer: Multiplan Commercial	$87.11
Rate for Payer: Multiplan Workers Comp	$87.11
Rate for Payer: Scott and White EPO/PPO	$67.01
Rate for Payer: Superior Health Plan EPO	$18.23

BG INTESTINE -- DHF

Facility

$593.22

Hospital Charge Code	81720559
Hospital Revenue Code	272
Min. Negotiated Rate	$53.39
Max. Negotiated Rate	$385.59
Rate for Payer: Aetna Commercial	$326.27
Rate for Payer: Amerigroup CHIP/Medicaid	$53.39
Rate for Payer: BCBS of TX Blue Advantage	$177.97
Rate for Payer: BCBS of TX Blue Essentials	$213.56
Rate for Payer: BCBS of TX PPO	$237.29
Rate for Payer: Cash Price	$522.03
Rate for Payer: Multiplan Auto	$385.59
Rate for Payer: Multiplan Commercial	$385.59
Rate for Payer: Multiplan Workers Comp	$385.59
Rate for Payer: Scott and White EPO/PPO	$296.61
Rate for Payer: Superior Health Plan EPO	$80.68

BG INTESTINE -- DHF

Facility

$593.22

Hospital Charge Code	81720559
Hospital Revenue Code	272
Rate for Payer: Cash Price	$522.03

BG PRESS INFU

Facility

$34.10

Hospital Charge Code	80910250
Hospital Revenue Code	270
Rate for Payer: Cash Price	$30.01

BG PRESS INFU

Facility

$34.10

Hospital Charge Code	80910250
Hospital Revenue Code	270
Min. Negotiated Rate	$3.07
Max. Negotiated Rate	$22.16
Rate for Payer: Aetna Commercial	$18.76
Rate for Payer: Amerigroup CHIP/Medicaid	$3.07
Rate for Payer: BCBS of TX Blue Advantage	$10.23
Rate for Payer: BCBS of TX Blue Essentials	$12.28
Rate for Payer: BCBS of TX PPO	$13.64
Rate for Payer: Cash Price	$30.01
Rate for Payer: Multiplan Auto	$22.16
Rate for Payer: Multiplan Commercial	$22.16
Rate for Payer: Multiplan Workers Comp	$22.16
Rate for Payer: Scott and White EPO/PPO	$17.05
Rate for Payer: Superior Health Plan EPO	$4.64

BG URINE DRN -- DHF

Facility

$90.80

Hospital Charge Code	80410558
Hospital Revenue Code	272
Min. Negotiated Rate	$8.17
Max. Negotiated Rate	$59.02
Rate for Payer: Aetna Commercial	$49.94
Rate for Payer: Amerigroup CHIP/Medicaid	$8.17
Rate for Payer: BCBS of TX Blue Advantage	$27.24
Rate for Payer: BCBS of TX Blue Essentials	$32.69
Rate for Payer: BCBS of TX PPO	$36.32
Rate for Payer: Cash Price	$79.90
Rate for Payer: Multiplan Auto	$59.02
Rate for Payer: Multiplan Commercial	$59.02
Rate for Payer: Multiplan Workers Comp	$59.02
Rate for Payer: Scott and White EPO/PPO	$45.40
Rate for Payer: Superior Health Plan EPO	$12.35

BG URINE DRN -- DHF

Facility

$90.80

Hospital Charge Code	80410558
Hospital Revenue Code	272
Rate for Payer: Cash Price	$79.90

BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITH MCC

Facility

$129,551.50

Service Code	MSDRG 461
Min. Negotiated Rate	$44,152.40
Max. Negotiated Rate	$129,551.50
Rate for Payer: Aetna Commercial	$76,708.12
Rate for Payer: Aetna Medicare	$77,268.02
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$51,512.01
Rate for Payer: Amerigroup Medicare	$51,512.01
Rate for Payer: BCBS of TX Blue Advantage	$44,152.40
Rate for Payer: BCBS of TX Blue Essentials	$46,254.92
Rate for Payer: BCBS of TX Medicare	$51,512.01
Rate for Payer: BCBS of TX PPO	$51,396.34
Rate for Payer: Cigna Commercial	$87,822.28
Rate for Payer: Cigna Medicare	$51,512.01
Rate for Payer: Employer Direct Commercial	$51,512.01
Rate for Payer: Humana Medicare/TRICARE	$51,512.01
Rate for Payer: Molina Dual Medicare/Medicaid	$51,512.01
Rate for Payer: Molina Medicare	$51,512.01
Rate for Payer: Multiplan Auto	$129,551.50
Rate for Payer: Multiplan Commercial	$129,551.50
Rate for Payer: Multiplan Workers Comp	$129,551.50
Rate for Payer: Scott and White EPO/PPO	$59,661.88
Rate for Payer: Scott and White Medicare	$51,512.01
Rate for Payer: Superior Health Plan EPO	$51,512.01
Rate for Payer: Superior Health Plan Medicare	$51,512.01
Rate for Payer: Universal American Dual Medicare/Medicaid	$51,512.01
Rate for Payer: Universal American Medicare	$51,512.01
Rate for Payer: Wellcare Medicare	$51,512.01
Rate for Payer: Wellmed Medicare	$51,512.01

BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITHOUT MCC

Facility

$54,079.70

Service Code	MSDRG 462
Min. Negotiated Rate	$23,166.14
Max. Negotiated Rate	$54,079.70
Rate for Payer: Aetna Commercial	$32,020.88
Rate for Payer: Aetna Medicare	$34,749.21
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$23,166.14
Rate for Payer: Amerigroup Medicare	$23,166.14
Rate for Payer: BCBS of TX Blue Advantage	$28,206.28
Rate for Payer: BCBS of TX Blue Essentials	$32,959.92
Rate for Payer: BCBS of TX Medicare	$23,166.14
Rate for Payer: BCBS of TX PPO	$36,623.55
Rate for Payer: Cigna Commercial	$36,660.34
Rate for Payer: Cigna Medicare	$23,166.14
Rate for Payer: Employer Direct Commercial	$23,166.14
Rate for Payer: Humana Medicare/TRICARE	$23,166.14
Rate for Payer: Molina Dual Medicare/Medicaid	$23,166.14
Rate for Payer: Molina Medicare	$23,166.14
Rate for Payer: Multiplan Auto	$54,079.70
Rate for Payer: Multiplan Commercial	$54,079.70
Rate for Payer: Multiplan Workers Comp	$54,079.70
Rate for Payer: Scott and White EPO/PPO	$24,905.12
Rate for Payer: Scott and White Medicare	$23,166.14
Rate for Payer: Superior Health Plan EPO	$23,166.14
Rate for Payer: Superior Health Plan Medicare	$23,166.14
Rate for Payer: Universal American Dual Medicare/Medicaid	$23,166.14
Rate for Payer: Universal American Medicare	$23,166.14
Rate for Payer: Wellcare Medicare	$23,166.14
Rate for Payer: Wellmed Medicare	$23,166.14

Bile Acids, Fractionated LCMS SO

Facility

$314.00

Service Code	CPT 82542
Hospital Charge Code	1708155
Hospital Revenue Code	301
Min. Negotiated Rate	$9.40
Max. Negotiated Rate	$204.10
Rate for Payer: Aetna Commercial	$25.29
Rate for Payer: Aetna Medicare	$36.14
Rate for Payer: Amerigroup CHIP/Medicaid	$9.40
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$24.09
Rate for Payer: Amerigroup Medicare	$24.09
Rate for Payer: BCBS of TX Blue Advantage	$39.75
Rate for Payer: BCBS of TX Blue Essentials	$47.70
Rate for Payer: BCBS of TX Medicare	$24.09
Rate for Payer: BCBS of TX PPO	$53.24
Rate for Payer: Cash Price	$276.32
Rate for Payer: Cash Price	$276.32
Rate for Payer: Cigna Medicaid	$24.09
Rate for Payer: Cigna Medicare	$24.09
Rate for Payer: Employer Direct Commercial	$24.09
Rate for Payer: Humana Medicare/TRICARE	$24.09
Rate for Payer: Molina CHIP/Medicaid	$24.09
Rate for Payer: Molina Dual Medicare/Medicaid	$24.09
Rate for Payer: Molina Medicare	$24.09
Rate for Payer: Multiplan Auto	$204.10
Rate for Payer: Multiplan Commercial	$204.10
Rate for Payer: Multiplan Workers Comp	$204.10
Rate for Payer: Parkland Medicaid	$24.09
Rate for Payer: Scott and White EPO/PPO	$30.11
Rate for Payer: Scott and White Medicare	$24.09
Rate for Payer: Superior Health Plan CHIP/Medicaid	$24.09
Rate for Payer: Superior Health Plan EPO	$24.09
Rate for Payer: Superior Health Plan Medicare	$24.09
Rate for Payer: Universal American Dual Medicare/Medicaid	$24.09
Rate for Payer: Universal American Medicare	$24.09
Rate for Payer: Wellcare Medicare	$24.09
Rate for Payer: Wellmed Medicare	$24.09

Bile Acids SO

Facility

$161.00

Service Code	CPT 82239
Hospital Charge Code	1706159
Hospital Revenue Code	301
Min. Negotiated Rate	$6.68
Max. Negotiated Rate	$104.65
Rate for Payer: Aetna Commercial	$17.97
Rate for Payer: Aetna Medicare	$25.68
Rate for Payer: Amerigroup CHIP/Medicaid	$6.68
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$17.12
Rate for Payer: Amerigroup Medicare	$17.12
Rate for Payer: BCBS of TX Blue Advantage	$28.25
Rate for Payer: BCBS of TX Blue Essentials	$33.90
Rate for Payer: BCBS of TX Medicare	$17.12
Rate for Payer: BCBS of TX PPO	$37.84
Rate for Payer: Cash Price	$141.68
Rate for Payer: Cash Price	$141.68
Rate for Payer: Cigna Medicaid	$17.12
Rate for Payer: Cigna Medicare	$17.12
Rate for Payer: Employer Direct Commercial	$17.12
Rate for Payer: Humana Medicare/TRICARE	$17.12
Rate for Payer: Molina CHIP/Medicaid	$17.12
Rate for Payer: Molina Dual Medicare/Medicaid	$17.12
Rate for Payer: Molina Medicare	$17.12
Rate for Payer: Multiplan Auto	$104.65
Rate for Payer: Multiplan Commercial	$104.65
Rate for Payer: Multiplan Workers Comp	$104.65
Rate for Payer: Parkland Medicaid	$17.12
Rate for Payer: Scott and White EPO/PPO	$21.40
Rate for Payer: Scott and White Medicare	$17.12
Rate for Payer: Superior Health Plan CHIP/Medicaid	$17.12
Rate for Payer: Superior Health Plan EPO	$17.12
Rate for Payer: Superior Health Plan Medicare	$17.12
Rate for Payer: Universal American Dual Medicare/Medicaid	$17.12
Rate for Payer: Universal American Medicare	$17.12
Rate for Payer: Wellcare Medicare	$17.12
Rate for Payer: Wellmed Medicare	$17.12

Bile Acids SO

Facility

$161.00

Service Code	CPT 82239
Hospital Charge Code	1706159
Hospital Revenue Code	301
Rate for Payer: Cash Price	$141.68

BILIARY DIL W/WO STENT

Facility

$2,655.00

Service Code	CPT 74363
Hospital Charge Code	4614363
Hospital Revenue Code	320
Rate for Payer: Cash Price	$2,336.40

BILIARY DIL W/WO STENT

Facility

$2,655.00

Service Code	CPT 74363
Hospital Charge Code	4614363
Hospital Revenue Code	320
Min. Negotiated Rate	$72.55
Max. Negotiated Rate	$1,725.75
Rate for Payer: Aetna Commercial	$85.86
Rate for Payer: Amerigroup CHIP/Medicaid	$238.95
Rate for Payer: BCBS of TX Blue Advantage	$72.55
Rate for Payer: BCBS of TX Blue Essentials	$87.06
Rate for Payer: BCBS of TX PPO	$97.17
Rate for Payer: Cash Price	$2,336.40
Rate for Payer: Cash Price	$2,336.40
Rate for Payer: Multiplan Auto	$1,725.75
Rate for Payer: Multiplan Commercial	$1,725.75
Rate for Payer: Multiplan Workers Comp	$1,725.75
Rate for Payer: Scott and White EPO/PPO	$1,327.50
Rate for Payer: Superior Health Plan EPO	$361.08

BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH CC

Facility

$37,188.70

Service Code	MSDRG 409
Min. Negotiated Rate	$16,822.18
Max. Negotiated Rate	$37,188.70
Rate for Payer: Aetna Commercial	$22,019.62
Rate for Payer: Aetna Medicare	$25,233.27
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$16,822.18
Rate for Payer: Amerigroup Medicare	$16,822.18
Rate for Payer: BCBS of TX Blue Advantage	$18,973.32
Rate for Payer: BCBS of TX Blue Essentials	$23,967.94
Rate for Payer: BCBS of TX Medicare	$16,822.18
Rate for Payer: BCBS of TX PPO	$26,632.08
Rate for Payer: Cigna Commercial	$25,210.02
Rate for Payer: Cigna Medicare	$16,822.18
Rate for Payer: Employer Direct Commercial	$16,822.18
Rate for Payer: Humana Medicare/TRICARE	$16,822.18
Rate for Payer: Molina Dual Medicare/Medicaid	$16,822.18
Rate for Payer: Molina Medicare	$16,822.18
Rate for Payer: Multiplan Auto	$37,188.70
Rate for Payer: Multiplan Commercial	$37,188.70
Rate for Payer: Multiplan Workers Comp	$37,188.70
Rate for Payer: Scott and White EPO/PPO	$17,126.38
Rate for Payer: Scott and White Medicare	$16,822.18
Rate for Payer: Superior Health Plan EPO	$16,822.18
Rate for Payer: Superior Health Plan Medicare	$16,822.18
Rate for Payer: Universal American Dual Medicare/Medicaid	$16,822.18
Rate for Payer: Universal American Medicare	$16,822.18
Rate for Payer: Wellcare Medicare	$16,822.18
Rate for Payer: Wellmed Medicare	$16,822.18

BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH MCC

Facility

$70,721.80

Service Code	MSDRG 408
Min. Negotiated Rate	$29,416.62
Max. Negotiated Rate	$70,721.80
Rate for Payer: Aetna Commercial	$41,874.75
Rate for Payer: Aetna Medicare	$44,124.93
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$29,416.62
Rate for Payer: Amerigroup Medicare	$29,416.62
Rate for Payer: BCBS of TX Blue Advantage	$33,480.66
Rate for Payer: BCBS of TX Blue Essentials	$41,755.83
Rate for Payer: BCBS of TX Medicare	$29,416.62
Rate for Payer: BCBS of TX PPO	$46,397.17
Rate for Payer: Cigna Commercial	$47,941.94
Rate for Payer: Cigna Medicare	$29,416.62
Rate for Payer: Employer Direct Commercial	$29,416.62
Rate for Payer: Humana Medicare/TRICARE	$29,416.62
Rate for Payer: Molina Dual Medicare/Medicaid	$29,416.62
Rate for Payer: Molina Medicare	$29,416.62
Rate for Payer: Multiplan Auto	$70,721.80
Rate for Payer: Multiplan Commercial	$70,721.80
Rate for Payer: Multiplan Workers Comp	$70,721.80
Rate for Payer: Scott and White EPO/PPO	$32,569.25
Rate for Payer: Scott and White Medicare	$29,416.62
Rate for Payer: Superior Health Plan EPO	$29,416.62
Rate for Payer: Superior Health Plan Medicare	$29,416.62
Rate for Payer: Universal American Dual Medicare/Medicaid	$29,416.62
Rate for Payer: Universal American Medicare	$29,416.62
Rate for Payer: Wellcare Medicare	$29,416.62
Rate for Payer: Wellmed Medicare	$29,416.62

BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITHOUT CC/MCC

Facility

$29,738.80

Service Code	MSDRG 410
Min. Negotiated Rate	$13,695.50
Max. Negotiated Rate	$29,738.80
Rate for Payer: Aetna Commercial	$17,608.50
Rate for Payer: Aetna Medicare	$21,036.21
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$14,024.14
Rate for Payer: Amerigroup Medicare	$14,024.14
Rate for Payer: BCBS of TX Blue Advantage	$14,285.46
Rate for Payer: BCBS of TX Blue Essentials	$17,053.18
Rate for Payer: BCBS of TX Medicare	$14,024.14
Rate for Payer: BCBS of TX PPO	$18,948.71
Rate for Payer: Cigna Commercial	$20,159.78
Rate for Payer: Cigna Medicare	$14,024.14
Rate for Payer: Employer Direct Commercial	$14,024.14
Rate for Payer: Humana Medicare/TRICARE	$14,024.14
Rate for Payer: Molina Dual Medicare/Medicaid	$14,024.14
Rate for Payer: Molina Medicare	$14,024.14
Rate for Payer: Multiplan Auto	$29,738.80
Rate for Payer: Multiplan Commercial	$29,738.80
Rate for Payer: Multiplan Workers Comp	$29,738.80
Rate for Payer: Scott and White EPO/PPO	$13,695.50
Rate for Payer: Scott and White Medicare	$14,024.14
Rate for Payer: Superior Health Plan EPO	$14,024.14
Rate for Payer: Superior Health Plan Medicare	$14,024.14
Rate for Payer: Universal American Dual Medicare/Medicaid	$14,024.14
Rate for Payer: Universal American Medicare	$14,024.14
Rate for Payer: Wellcare Medicare	$14,024.14
Rate for Payer: Wellmed Medicare	$14,024.14

Bili Direct Neonate

Facility

$178.00

Service Code	CPT 82248
Hospital Charge Code	1600907
Hospital Revenue Code	301
Min. Negotiated Rate	$1.96
Max. Negotiated Rate	$115.70
Rate for Payer: Aetna Commercial	$5.27
Rate for Payer: Aetna Medicare	$7.53
Rate for Payer: Amerigroup CHIP/Medicaid	$1.96
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$5.02
Rate for Payer: Amerigroup Medicare	$5.02
Rate for Payer: BCBS of TX Blue Advantage	$8.28
Rate for Payer: BCBS of TX Blue Essentials	$9.94
Rate for Payer: BCBS of TX Medicare	$5.02
Rate for Payer: BCBS of TX PPO	$11.09
Rate for Payer: Cash Price	$156.64
Rate for Payer: Cash Price	$156.64
Rate for Payer: Cigna Medicaid	$5.02
Rate for Payer: Cigna Medicare	$5.02
Rate for Payer: Employer Direct Commercial	$5.02
Rate for Payer: Humana Medicare/TRICARE	$5.02
Rate for Payer: Molina CHIP/Medicaid	$5.02
Rate for Payer: Molina Dual Medicare/Medicaid	$5.02
Rate for Payer: Molina Medicare	$5.02
Rate for Payer: Multiplan Auto	$115.70
Rate for Payer: Multiplan Commercial	$115.70
Rate for Payer: Multiplan Workers Comp	$115.70
Rate for Payer: Parkland Medicaid	$5.02
Rate for Payer: Scott and White EPO/PPO	$6.28
Rate for Payer: Scott and White Medicare	$5.02
Rate for Payer: Superior Health Plan CHIP/Medicaid	$5.02
Rate for Payer: Superior Health Plan EPO	$5.02
Rate for Payer: Superior Health Plan Medicare	$5.02
Rate for Payer: Universal American Dual Medicare/Medicaid	$5.02
Rate for Payer: Universal American Medicare	$5.02
Rate for Payer: Wellcare Medicare	$5.02
Rate for Payer: Wellmed Medicare	$5.02

Bili Indirect Neonate

Facility

$190.00

Service Code	CPT 82247
Hospital Charge Code	1602408
Hospital Revenue Code	301
Min. Negotiated Rate	$1.96
Max. Negotiated Rate	$123.50
Rate for Payer: Aetna Commercial	$5.27
Rate for Payer: Aetna Medicare	$7.53
Rate for Payer: Amerigroup CHIP/Medicaid	$1.96
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$5.02
Rate for Payer: Amerigroup Medicare	$5.02
Rate for Payer: BCBS of TX Blue Advantage	$8.28
Rate for Payer: BCBS of TX Blue Essentials	$9.94
Rate for Payer: BCBS of TX Medicare	$5.02
Rate for Payer: BCBS of TX PPO	$11.09
Rate for Payer: Cash Price	$167.20
Rate for Payer: Cash Price	$167.20
Rate for Payer: Cigna Medicaid	$5.02
Rate for Payer: Cigna Medicare	$5.02
Rate for Payer: Employer Direct Commercial	$5.02
Rate for Payer: Humana Medicare/TRICARE	$5.02
Rate for Payer: Molina CHIP/Medicaid	$5.02
Rate for Payer: Molina Dual Medicare/Medicaid	$5.02
Rate for Payer: Molina Medicare	$5.02
Rate for Payer: Multiplan Auto	$123.50
Rate for Payer: Multiplan Commercial	$123.50
Rate for Payer: Multiplan Workers Comp	$123.50
Rate for Payer: Parkland Medicaid	$5.02
Rate for Payer: Scott and White EPO/PPO	$6.28
Rate for Payer: Scott and White Medicare	$5.02
Rate for Payer: Superior Health Plan CHIP/Medicaid	$5.02
Rate for Payer: Superior Health Plan EPO	$5.02
Rate for Payer: Superior Health Plan Medicare	$5.02
Rate for Payer: Universal American Dual Medicare/Medicaid	$5.02
Rate for Payer: Universal American Medicare	$5.02
Rate for Payer: Wellcare Medicare	$5.02
Rate for Payer: Wellmed Medicare	$5.02

Bilirubin Direct

Facility

$178.00

Service Code	CPT 82248
Hospital Charge Code	1600907
Hospital Revenue Code	301
Min. Negotiated Rate	$1.96
Max. Negotiated Rate	$115.70
Rate for Payer: Aetna Commercial	$5.27
Rate for Payer: Aetna Medicare	$7.53
Rate for Payer: Amerigroup CHIP/Medicaid	$1.96
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$5.02
Rate for Payer: Amerigroup Medicare	$5.02
Rate for Payer: BCBS of TX Blue Advantage	$8.28
Rate for Payer: BCBS of TX Blue Essentials	$9.94
Rate for Payer: BCBS of TX Medicare	$5.02
Rate for Payer: BCBS of TX PPO	$11.09
Rate for Payer: Cash Price	$156.64
Rate for Payer: Cash Price	$156.64
Rate for Payer: Cigna Medicaid	$5.02
Rate for Payer: Cigna Medicare	$5.02
Rate for Payer: Employer Direct Commercial	$5.02
Rate for Payer: Humana Medicare/TRICARE	$5.02
Rate for Payer: Molina CHIP/Medicaid	$5.02
Rate for Payer: Molina Dual Medicare/Medicaid	$5.02
Rate for Payer: Molina Medicare	$5.02
Rate for Payer: Multiplan Auto	$115.70
Rate for Payer: Multiplan Commercial	$115.70
Rate for Payer: Multiplan Workers Comp	$115.70
Rate for Payer: Parkland Medicaid	$5.02
Rate for Payer: Scott and White EPO/PPO	$6.28
Rate for Payer: Scott and White Medicare	$5.02
Rate for Payer: Superior Health Plan CHIP/Medicaid	$5.02
Rate for Payer: Superior Health Plan EPO	$5.02
Rate for Payer: Superior Health Plan Medicare	$5.02
Rate for Payer: Universal American Dual Medicare/Medicaid	$5.02
Rate for Payer: Universal American Medicare	$5.02
Rate for Payer: Wellcare Medicare	$5.02
Rate for Payer: Wellmed Medicare	$5.02

Bilirubin Direct

Facility

$178.00

Service Code	CPT 82248
Hospital Charge Code	1600907
Hospital Revenue Code	301
Rate for Payer: Cash Price	$156.64

Know your out-of-pocket cost for care.

All Charges