White Rock Medical Center

All Charges

Charge

Type

Setting

Price

Lactic Acid Level

Facility

$270.00

Service Code	HCPCS 83605 QW
Hospital Charge Code	1602085
Hospital Revenue Code	301
Min. Negotiated Rate	$4.51
Max. Negotiated Rate	$194.40
Rate for Payer: Amerigroup CHIP/Medicaid	$4.51
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$11.57
Rate for Payer: Amerigroup Medicare	$11.57
Rate for Payer: BCBS of TX Blue Advantage	$81.00
Rate for Payer: BCBS of TX Blue Essentials	$97.20
Rate for Payer: BCBS of TX Medicare	$11.57
Rate for Payer: BCBS of TX PPO	$108.00
Rate for Payer: Cash Price	$183.60
Rate for Payer: Cash Price	$183.60
Rate for Payer: Cigna Medicaid	$194.40
Rate for Payer: Cigna Medicare	$11.57
Rate for Payer: Employer Direct Commercial	$11.57
Rate for Payer: Humana Medicare/TRICARE	$11.57
Rate for Payer: Molina CHIP/Medicaid	$194.40
Rate for Payer: Molina Dual Medicare/Medicaid	$11.57
Rate for Payer: Molina Medicare	$11.57
Rate for Payer: Multiplan Auto	$175.50
Rate for Payer: Multiplan Commercial	$175.50
Rate for Payer: Multiplan Workers Comp	$175.50
Rate for Payer: Parkland Medicaid	$194.40
Rate for Payer: Scott and White EPO/PPO	$14.46
Rate for Payer: Scott and White Medicare	$11.57
Rate for Payer: Superior Health Plan CHIP/Medicaid	$194.40
Rate for Payer: Superior Health Plan EPO	$11.57
Rate for Payer: Superior Health Plan Medicare	$11.57
Rate for Payer: Universal American Dual Medicare/Medicaid	$11.57
Rate for Payer: Universal American Medicare	$11.57
Rate for Payer: Wellcare Medicare	$11.57
Rate for Payer: Wellmed Medicare	$11.57

lactobacillus acidophilus and bulgaricus Chew Tab

Facility

$7.65

Service Code	HCPCS J3490
Hospital Charge Code	77651483
Hospital Revenue Code	250
Min. Negotiated Rate	$0.69
Max. Negotiated Rate	$5.51
Rate for Payer: Amerigroup CHIP/Medicaid	$0.69
Rate for Payer: BCBS of TX Blue Advantage	$2.29
Rate for Payer: BCBS of TX Blue Essentials	$2.75
Rate for Payer: BCBS of TX PPO	$3.06
Rate for Payer: Cash Price	$5.20
Rate for Payer: Cigna Medicaid	$5.51
Rate for Payer: Molina CHIP/Medicaid	$5.51
Rate for Payer: Multiplan Auto	$4.97
Rate for Payer: Multiplan Commercial	$4.97
Rate for Payer: Multiplan Workers Comp	$4.97
Rate for Payer: Parkland Medicaid	$5.51
Rate for Payer: Scott and White EPO/PPO	$3.83
Rate for Payer: Superior Health Plan CHIP/Medicaid	$5.51
Rate for Payer: Superior Health Plan EPO	$1.04

lactobacillus acidophilus and bulgaricus Chew Tab

Facility

$7.65

Service Code	HCPCS J3490
Hospital Charge Code	77651483
Hospital Revenue Code	250
Rate for Payer: Cash Price	$5.20

lactobacillus acidophilus Cap

Facility

$7.65

Service Code	HCPCS J3490
Hospital Charge Code	77651589
Hospital Revenue Code	250
Rate for Payer: Cash Price	$5.20

lactobacillus acidophilus Cap

Facility

$7.65

Service Code	HCPCS J3490
Hospital Charge Code	77651589
Hospital Revenue Code	250
Min. Negotiated Rate	$0.69
Max. Negotiated Rate	$5.51
Rate for Payer: Amerigroup CHIP/Medicaid	$0.69
Rate for Payer: BCBS of TX Blue Advantage	$2.29
Rate for Payer: BCBS of TX Blue Essentials	$2.75
Rate for Payer: BCBS of TX PPO	$3.06
Rate for Payer: Cash Price	$5.20
Rate for Payer: Cigna Medicaid	$5.51
Rate for Payer: Molina CHIP/Medicaid	$5.51
Rate for Payer: Multiplan Auto	$4.97
Rate for Payer: Multiplan Commercial	$4.97
Rate for Payer: Multiplan Workers Comp	$4.97
Rate for Payer: Parkland Medicaid	$5.51
Rate for Payer: Scott and White EPO/PPO	$3.83
Rate for Payer: Superior Health Plan CHIP/Medicaid	$5.51
Rate for Payer: Superior Health Plan EPO	$1.04

lactulose 10 g/15 mL Oral Syrup 30 mL

Facility

$7.65

Service Code	HCPCS J3490
Hospital Charge Code	77652409
Hospital Revenue Code	250
Rate for Payer: Cash Price	$5.20

lactulose 10 g/15 mL Oral Syrup 30 mL

Facility

$7.65

Service Code	HCPCS J3490
Hospital Charge Code	77652409
Hospital Revenue Code	250
Min. Negotiated Rate	$0.69
Max. Negotiated Rate	$5.51
Rate for Payer: Amerigroup CHIP/Medicaid	$0.69
Rate for Payer: BCBS of TX Blue Advantage	$2.29
Rate for Payer: BCBS of TX Blue Essentials	$2.75
Rate for Payer: BCBS of TX PPO	$3.06
Rate for Payer: Cash Price	$5.20
Rate for Payer: Cigna Medicaid	$5.51
Rate for Payer: Molina CHIP/Medicaid	$5.51
Rate for Payer: Multiplan Auto	$4.97
Rate for Payer: Multiplan Commercial	$4.97
Rate for Payer: Multiplan Workers Comp	$4.97
Rate for Payer: Parkland Medicaid	$5.51
Rate for Payer: Scott and White EPO/PPO	$3.83
Rate for Payer: Superior Health Plan CHIP/Medicaid	$5.51
Rate for Payer: Superior Health Plan EPO	$1.04

LAG SCREW

Facility

$5,048.19

Service Code	HCPCS C1713
Hospital Charge Code	992223
Hospital Revenue Code	278
Min. Negotiated Rate	$454.34
Max. Negotiated Rate	$3,634.70
Rate for Payer: Amerigroup CHIP/Medicaid	$454.34
Rate for Payer: BCBS of TX Blue Advantage	$1,514.46
Rate for Payer: BCBS of TX Blue Essentials	$1,817.35
Rate for Payer: BCBS of TX PPO	$2,019.28
Rate for Payer: Cash Price	$3,432.77
Rate for Payer: Cigna Medicaid	$3,634.70
Rate for Payer: Molina CHIP/Medicaid	$3,634.70
Rate for Payer: Multiplan Auto	$2,524.09
Rate for Payer: Multiplan Commercial	$2,524.09
Rate for Payer: Multiplan Workers Comp	$2,524.09
Rate for Payer: Parkland Medicaid	$3,634.70
Rate for Payer: Scott and White EPO/PPO	$2,524.09
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3,634.70
Rate for Payer: Superior Health Plan EPO	$686.55

LAG SCREW

Facility

$5,048.19

Service Code	HCPCS C1713
Hospital Charge Code	992223
Hospital Revenue Code	278
Min. Negotiated Rate	$1,262.05
Max. Negotiated Rate	$2,524.09
Rate for Payer: Cash Price	$3,432.77
Rate for Payer: Cigna Commercial	$1,262.05
Rate for Payer: Multiplan Auto	$2,524.09
Rate for Payer: Multiplan Commercial	$2,524.09
Rate for Payer: Multiplan Workers Comp	$2,524.09
Rate for Payer: Scott and White EPO/PPO	$2,524.09

LAG SCREW STEP DRILL GAMMA 3

Facility

$15,855.42

Service Code	HCPCS C1713
Hospital Charge Code	993144
Hospital Revenue Code	278
Min. Negotiated Rate	$1,426.99
Max. Negotiated Rate	$11,415.90
Rate for Payer: Amerigroup CHIP/Medicaid	$1,426.99
Rate for Payer: BCBS of TX Blue Advantage	$4,756.63
Rate for Payer: BCBS of TX Blue Essentials	$5,707.95
Rate for Payer: BCBS of TX PPO	$6,342.17
Rate for Payer: Cash Price	$10,781.69
Rate for Payer: Cigna Medicaid	$11,415.90
Rate for Payer: Molina CHIP/Medicaid	$11,415.90
Rate for Payer: Multiplan Auto	$7,927.71
Rate for Payer: Multiplan Commercial	$7,927.71
Rate for Payer: Multiplan Workers Comp	$7,927.71
Rate for Payer: Parkland Medicaid	$11,415.90
Rate for Payer: Scott and White EPO/PPO	$7,927.71
Rate for Payer: Superior Health Plan CHIP/Medicaid	$11,415.90
Rate for Payer: Superior Health Plan EPO	$2,156.34

LAG SCREW STEP DRILL GAMMA 3

Facility

$15,855.42

Service Code	HCPCS C1713
Hospital Charge Code	993144
Hospital Revenue Code	278
Min. Negotiated Rate	$3,963.86
Max. Negotiated Rate	$7,927.71
Rate for Payer: Cash Price	$10,781.69
Rate for Payer: Cigna Commercial	$3,963.86
Rate for Payer: Multiplan Auto	$7,927.71
Rate for Payer: Multiplan Commercial	$7,927.71
Rate for Payer: Multiplan Workers Comp	$7,927.71
Rate for Payer: Scott and White EPO/PPO	$7,927.71

Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord

Facility

$28,192.28

Service Code	HCPCS 63047
Hospital Charge Code	9900764
Hospital Revenue Code	360
Min. Negotiated Rate	$2,398.52
Max. Negotiated Rate	$20,298.44
Rate for Payer: Amerigroup CHIP/Medicaid	$2,398.52
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$7,289.28
Rate for Payer: Amerigroup Medicare	$7,289.28
Rate for Payer: BCBS of TX Blue Advantage	$9,989.86
Rate for Payer: BCBS of TX Blue Essentials	$11,963.90
Rate for Payer: BCBS of TX Medicare	$7,289.28
Rate for Payer: BCBS of TX PPO	$15,074.51
Rate for Payer: Cash Price	$19,170.75
Rate for Payer: Cash Price	$19,170.75
Rate for Payer: Cash Price	$19,170.75
Rate for Payer: Cigna Commercial	$15,408.22
Rate for Payer: Cigna Medicaid	$20,298.44
Rate for Payer: Cigna Medicare	$7,289.28
Rate for Payer: Employer Direct Commercial	$7,289.28
Rate for Payer: Humana Medicare/TRICARE	$7,289.28
Rate for Payer: Molina CHIP/Medicaid	$20,298.44
Rate for Payer: Molina Dual Medicare/Medicaid	$7,289.28
Rate for Payer: Molina Medicare	$7,289.28
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	$20,298.44
Rate for Payer: Scott and White EPO/PPO	$13,485.17
Rate for Payer: Scott and White Medicare	$7,289.28
Rate for Payer: Superior Health Plan CHIP/Medicaid	$20,298.44
Rate for Payer: Superior Health Plan EPO	$7,289.28
Rate for Payer: Superior Health Plan Medicare	$7,289.28
Rate for Payer: Universal American Dual Medicare/Medicaid	$7,289.28
Rate for Payer: Universal American Medicare	$7,289.28
Rate for Payer: Wellcare Medicare	$7,289.28
Rate for Payer: Wellmed Medicare	$7,289.28

Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord

Facility

$10,000.00

Service Code	CPT 63048
Hospital Charge Code	36063048
Hospital Revenue Code	360
Min. Negotiated Rate	$10,000.00
Max. Negotiated Rate	$10,000.00
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

Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord

Facility

$15,408.22

Service Code	CPT 63047
Hospital Charge Code	36063047
Hospital Revenue Code	360
Min. Negotiated Rate	$2,398.52
Max. Negotiated Rate	$15,408.22
Rate for Payer: Amerigroup CHIP/Medicaid	$2,398.52
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$7,289.28
Rate for Payer: Amerigroup Medicare	$7,289.28
Rate for Payer: BCBS of TX Blue Advantage	$9,989.86
Rate for Payer: BCBS of TX Blue Essentials	$11,963.90
Rate for Payer: BCBS of TX Medicare	$7,289.28
Rate for Payer: BCBS of TX PPO	$15,074.51
Rate for Payer: Cigna Commercial	$15,408.22
Rate for Payer: Cigna Medicare	$7,289.28
Rate for Payer: Employer Direct Commercial	$7,289.28
Rate for Payer: Humana Medicare/TRICARE	$7,289.28
Rate for Payer: Molina Dual Medicare/Medicaid	$7,289.28
Rate for Payer: Molina Medicare	$7,289.28
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	$13,485.17
Rate for Payer: Scott and White Medicare	$7,289.28
Rate for Payer: Superior Health Plan EPO	$7,289.28
Rate for Payer: Superior Health Plan Medicare	$7,289.28
Rate for Payer: Universal American Dual Medicare/Medicaid	$7,289.28
Rate for Payer: Universal American Medicare	$7,289.28
Rate for Payer: Wellcare Medicare	$7,289.28
Rate for Payer: Wellmed Medicare	$7,289.28

Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord

Facility

$28,192.28

Service Code	HCPCS 63048
Hospital Charge Code	9900765
Hospital Revenue Code	360
Min. Negotiated Rate	$2,537.31
Max. Negotiated Rate	$20,298.44
Rate for Payer: Amerigroup CHIP/Medicaid	$2,537.31
Rate for Payer: BCBS of TX Blue Advantage	$8,457.68
Rate for Payer: BCBS of TX Blue Essentials	$10,149.22
Rate for Payer: BCBS of TX PPO	$11,276.91
Rate for Payer: Cash Price	$19,170.75
Rate for Payer: Cash Price	$19,170.75
Rate for Payer: Cigna Medicaid	$20,298.44
Rate for Payer: Molina CHIP/Medicaid	$20,298.44
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	$20,298.44
Rate for Payer: Scott and White EPO/PPO	$14,096.14
Rate for Payer: Superior Health Plan CHIP/Medicaid	$20,298.44
Rate for Payer: Superior Health Plan EPO	$3,834.15

Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord

Facility

$28,192.28

Service Code	HCPCS 63048
Hospital Charge Code	9900765
Hospital Revenue Code	360
Rate for Payer: Cash Price	$19,170.75

Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord

Facility

$28,192.28

Service Code	HCPCS 63047
Hospital Charge Code	9900764
Hospital Revenue Code	360
Rate for Payer: Cash Price	$19,170.75

Laminectomy for excision or evacuation of intraspinal lesion other than neoplasm, extradural; lumbar

Facility

$48,000.00

Service Code	HCPCS 63267
Hospital Charge Code	9900770
Hospital Revenue Code	360
Rate for Payer: Cash Price	$32,640.00

Laminectomy for excision or evacuation of intraspinal lesion other than neoplasm, extradural; lumbar

Facility

$15,408.22

Service Code	CPT 63267
Hospital Charge Code	36063267
Hospital Revenue Code	360
Min. Negotiated Rate	$7,289.28
Max. Negotiated Rate	$15,408.22
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$7,289.28
Rate for Payer: Amerigroup Medicare	$7,289.28
Rate for Payer: BCBS of TX Blue Advantage	$9,989.86
Rate for Payer: BCBS of TX Blue Essentials	$11,963.90
Rate for Payer: BCBS of TX Medicare	$7,289.28
Rate for Payer: BCBS of TX PPO	$15,074.51
Rate for Payer: Cigna Commercial	$15,408.22
Rate for Payer: Cigna Medicare	$7,289.28
Rate for Payer: Employer Direct Commercial	$7,289.28
Rate for Payer: Humana Medicare/TRICARE	$7,289.28
Rate for Payer: Molina Dual Medicare/Medicaid	$7,289.28
Rate for Payer: Molina Medicare	$7,289.28
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	$13,485.17
Rate for Payer: Scott and White Medicare	$7,289.28
Rate for Payer: Superior Health Plan EPO	$7,289.28
Rate for Payer: Superior Health Plan Medicare	$7,289.28
Rate for Payer: Universal American Dual Medicare/Medicaid	$7,289.28
Rate for Payer: Universal American Medicare	$7,289.28
Rate for Payer: Wellcare Medicare	$7,289.28
Rate for Payer: Wellmed Medicare	$7,289.28

Laminectomy for excision or evacuation of intraspinal lesion other than neoplasm, extradural; lumbar

Facility

$48,000.00

Service Code	HCPCS 63267
Hospital Charge Code	9900770
Hospital Revenue Code	360
Min. Negotiated Rate	$4,320.00
Max. Negotiated Rate	$34,560.00
Rate for Payer: Amerigroup CHIP/Medicaid	$4,320.00
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$7,289.28
Rate for Payer: Amerigroup Medicare	$7,289.28
Rate for Payer: BCBS of TX Blue Advantage	$9,989.86
Rate for Payer: BCBS of TX Blue Essentials	$11,963.90
Rate for Payer: BCBS of TX Medicare	$7,289.28
Rate for Payer: BCBS of TX PPO	$15,074.51
Rate for Payer: Cash Price	$32,640.00
Rate for Payer: Cash Price	$32,640.00
Rate for Payer: Cash Price	$32,640.00
Rate for Payer: Cigna Commercial	$15,408.22
Rate for Payer: Cigna Medicaid	$34,560.00
Rate for Payer: Cigna Medicare	$7,289.28
Rate for Payer: Employer Direct Commercial	$7,289.28
Rate for Payer: Humana Medicare/TRICARE	$7,289.28
Rate for Payer: Molina CHIP/Medicaid	$34,560.00
Rate for Payer: Molina Dual Medicare/Medicaid	$7,289.28
Rate for Payer: Molina Medicare	$7,289.28
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	$34,560.00
Rate for Payer: Scott and White EPO/PPO	$13,485.17
Rate for Payer: Scott and White Medicare	$7,289.28
Rate for Payer: Superior Health Plan CHIP/Medicaid	$34,560.00
Rate for Payer: Superior Health Plan EPO	$7,289.28
Rate for Payer: Superior Health Plan Medicare	$7,289.28
Rate for Payer: Universal American Dual Medicare/Medicaid	$7,289.28
Rate for Payer: Universal American Medicare	$7,289.28
Rate for Payer: Wellcare Medicare	$7,289.28
Rate for Payer: Wellmed Medicare	$7,289.28

Laminectomy for implantation of neurostimulator electrodes, plate/paddle, epidural

Facility

$61,439.34

Service Code	HCPCS 63655
Hospital Charge Code	9900772
Hospital Revenue Code	360
Min. Negotiated Rate	$10,000.00
Max. Negotiated Rate	$48,584.14
Rate for Payer: Amerigroup CHIP/Medicaid	$13,714.30
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$19,488.52
Rate for Payer: Amerigroup Medicare	$19,488.52
Rate for Payer: BCBS of TX Blue Advantage	$32,196.63
Rate for Payer: BCBS of TX Blue Essentials	$38,558.84
Rate for Payer: BCBS of TX Medicare	$19,488.52
Rate for Payer: BCBS of TX PPO	$48,584.14
Rate for Payer: Cash Price	$41,778.75
Rate for Payer: Cash Price	$41,778.75
Rate for Payer: Cash Price	$41,778.75
Rate for Payer: Cigna Commercial	$41,195.19
Rate for Payer: Cigna Medicaid	$44,236.32
Rate for Payer: Cigna Medicare	$19,488.52
Rate for Payer: Employer Direct Commercial	$19,488.52
Rate for Payer: Humana Medicare/TRICARE	$19,488.52
Rate for Payer: Molina CHIP/Medicaid	$44,236.32
Rate for Payer: Molina Dual Medicare/Medicaid	$19,488.52
Rate for Payer: Molina Medicare	$19,488.52
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	$44,236.32
Rate for Payer: Scott and White EPO/PPO	$36,053.76
Rate for Payer: Scott and White Medicare	$19,488.52
Rate for Payer: Superior Health Plan CHIP/Medicaid	$44,236.32
Rate for Payer: Superior Health Plan EPO	$19,488.52
Rate for Payer: Superior Health Plan Medicare	$19,488.52
Rate for Payer: Universal American Dual Medicare/Medicaid	$19,488.52
Rate for Payer: Universal American Medicare	$19,488.52
Rate for Payer: Wellcare Medicare	$19,488.52
Rate for Payer: Wellmed Medicare	$19,488.52

Laminectomy for implantation of neurostimulator electrodes, plate/paddle, epidural

Facility

$48,584.14

Service Code	CPT 63655
Hospital Charge Code	36063655
Hospital Revenue Code	360
Min. Negotiated Rate	$10,000.00
Max. Negotiated Rate	$48,584.14
Rate for Payer: Amerigroup CHIP/Medicaid	$13,714.30
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$19,488.52
Rate for Payer: Amerigroup Medicare	$19,488.52
Rate for Payer: BCBS of TX Blue Advantage	$32,196.63
Rate for Payer: BCBS of TX Blue Essentials	$38,558.84
Rate for Payer: BCBS of TX Medicare	$19,488.52
Rate for Payer: BCBS of TX PPO	$48,584.14
Rate for Payer: Cigna Commercial	$41,195.19
Rate for Payer: Cigna Medicare	$19,488.52
Rate for Payer: Employer Direct Commercial	$19,488.52
Rate for Payer: Humana Medicare/TRICARE	$19,488.52
Rate for Payer: Molina Dual Medicare/Medicaid	$19,488.52
Rate for Payer: Molina Medicare	$19,488.52
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	$36,053.76
Rate for Payer: Scott and White Medicare	$19,488.52
Rate for Payer: Superior Health Plan EPO	$19,488.52
Rate for Payer: Superior Health Plan Medicare	$19,488.52
Rate for Payer: Universal American Dual Medicare/Medicaid	$19,488.52
Rate for Payer: Universal American Medicare	$19,488.52
Rate for Payer: Wellcare Medicare	$19,488.52
Rate for Payer: Wellmed Medicare	$19,488.52

Laminectomy for implantation of neurostimulator electrodes, plate/paddle, epidural

Facility

$61,439.34

Service Code	HCPCS 63655
Hospital Charge Code	9900772
Hospital Revenue Code	360
Rate for Payer: Cash Price	$41,778.75

Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, fo

Facility

$31,324.75

Service Code	HCPCS 63030
Hospital Charge Code	9900761
Hospital Revenue Code	360
Rate for Payer: Cash Price	$21,300.83

Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, fo

Facility

$15,408.22

Service Code	CPT 63042
Hospital Charge Code	36063042
Hospital Revenue Code	360
Min. Negotiated Rate	$2,398.52
Max. Negotiated Rate	$15,408.22
Rate for Payer: Amerigroup CHIP/Medicaid	$2,398.52
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$7,289.28
Rate for Payer: Amerigroup Medicare	$7,289.28
Rate for Payer: BCBS of TX Blue Advantage	$9,989.86
Rate for Payer: BCBS of TX Blue Essentials	$11,963.90
Rate for Payer: BCBS of TX Medicare	$7,289.28
Rate for Payer: BCBS of TX PPO	$15,074.51
Rate for Payer: Cigna Commercial	$15,408.22
Rate for Payer: Cigna Medicare	$7,289.28
Rate for Payer: Employer Direct Commercial	$7,289.28
Rate for Payer: Humana Medicare/TRICARE	$7,289.28
Rate for Payer: Molina Dual Medicare/Medicaid	$7,289.28
Rate for Payer: Molina Medicare	$7,289.28
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	$13,485.17
Rate for Payer: Scott and White Medicare	$7,289.28
Rate for Payer: Superior Health Plan EPO	$7,289.28
Rate for Payer: Superior Health Plan Medicare	$7,289.28
Rate for Payer: Universal American Dual Medicare/Medicaid	$7,289.28
Rate for Payer: Universal American Medicare	$7,289.28
Rate for Payer: Wellcare Medicare	$7,289.28
Rate for Payer: Wellmed Medicare	$7,289.28

Know your out-of-pocket cost for care.

All Charges