White Rock Medical Center

All Charges

Charge

Type

Setting

Price

Laparoscopy, surgical, gastric restrictive procedure; with gastric bypass and small intestine reconstruction to limit absorption

Facility

$64,200.00

Service Code	HCPCS 43645
Hospital Charge Code	991058
Hospital Revenue Code	360
Rate for Payer: Cash Price	$43,656.00

Laparoscopy, surgical, gastric restrictive procedure; with gastric bypass and small intestine reconstruction to limit absorption

Facility

$64,200.00

Service Code	HCPCS 43645
Hospital Charge Code	991058
Hospital Revenue Code	360
Min. Negotiated Rate	$3,236.16
Max. Negotiated Rate	$46,224.00
Rate for Payer: Amerigroup CHIP/Medicaid	$5,778.00
Rate for Payer: BCBS of TX Blue Advantage	$3,236.16
Rate for Payer: BCBS of TX Blue Essentials	$3,875.64
Rate for Payer: BCBS of TX PPO	$4,883.31
Rate for Payer: Cash Price	$43,656.00
Rate for Payer: Cash Price	$43,656.00
Rate for Payer: Cash Price	$43,656.00
Rate for Payer: Cigna Medicaid	$46,224.00
Rate for Payer: Molina CHIP/Medicaid	$46,224.00
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
Rate for Payer: Parkland Medicaid	$46,224.00
Rate for Payer: Scott and White EPO/PPO	$32,100.00
Rate for Payer: Superior Health Plan CHIP/Medicaid	$46,224.00
Rate for Payer: Superior Health Plan EPO	$8,731.20

Laparoscopy, surgical, repair, incisional hernia (includes mesh insertion, when performed); reducibl

Facility

$40,084.47

Service Code	HCPCS 49654
Hospital Charge Code	9900728
Hospital Revenue Code	360
Min. Negotiated Rate	$3,607.60
Max. Negotiated Rate	$28,860.82
Rate for Payer: Amerigroup CHIP/Medicaid	$3,607.60
Rate for Payer: BCBS of TX Blue Advantage	$14,049.89
Rate for Payer: BCBS of TX Blue Essentials	$16,826.22
Rate for Payer: BCBS of TX PPO	$21,201.04
Rate for Payer: Cash Price	$27,257.44
Rate for Payer: Cash Price	$27,257.44
Rate for Payer: Cash Price	$27,257.44
Rate for Payer: Cigna Medicaid	$28,860.82
Rate for Payer: Molina CHIP/Medicaid	$28,860.82
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	$28,860.82
Rate for Payer: Scott and White EPO/PPO	$20,042.24
Rate for Payer: Superior Health Plan CHIP/Medicaid	$28,860.82
Rate for Payer: Superior Health Plan EPO	$5,451.49

Laparoscopy, surgical, repair, incisional hernia (includes mesh insertion, when performed); reducibl

Facility

$21,201.04

Service Code	CPT 49654
Hospital Charge Code	36049654
Hospital Revenue Code	360
Min. Negotiated Rate	$10,000.00
Max. Negotiated Rate	$21,201.04
Rate for Payer: BCBS of TX Blue Advantage	$14,049.89
Rate for Payer: BCBS of TX Blue Essentials	$16,826.22
Rate for Payer: BCBS of TX PPO	$21,201.04
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

Laparoscopy, surgical, repair, incisional hernia (includes mesh insertion, when performed); reducibl

Facility

$40,084.47

Service Code	HCPCS 49654
Hospital Charge Code	9900728
Hospital Revenue Code	360
Rate for Payer: Cash Price	$27,257.44

Laparoscopy, surgical; repair initial inguinal hernia

Facility

$12,837.39

Service Code	CPT 49650
Hospital Charge Code	36049650
Hospital Revenue Code	360
Min. Negotiated Rate	$1,888.85
Max. Negotiated Rate	$12,837.39
Rate for Payer: Amerigroup CHIP/Medicaid	$1,888.85
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$6,073.08
Rate for Payer: Amerigroup Medicare	$6,073.08
Rate for Payer: BCBS of TX Blue Advantage	$8,072.30
Rate for Payer: BCBS of TX Blue Essentials	$9,667.42
Rate for Payer: BCBS of TX Medicare	$6,073.08
Rate for Payer: BCBS of TX PPO	$12,180.95
Rate for Payer: Cigna Commercial	$12,837.39
Rate for Payer: Cigna Medicare	$6,073.08
Rate for Payer: Employer Direct Commercial	$6,073.08
Rate for Payer: Humana Medicare/TRICARE	$6,073.08
Rate for Payer: Molina Dual Medicare/Medicaid	$6,073.08
Rate for Payer: Molina Medicare	$6,073.08
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	$11,235.20
Rate for Payer: Scott and White Medicare	$6,073.08
Rate for Payer: Superior Health Plan EPO	$6,073.08
Rate for Payer: Superior Health Plan Medicare	$6,073.08
Rate for Payer: Universal American Dual Medicare/Medicaid	$6,073.08
Rate for Payer: Universal American Medicare	$6,073.08
Rate for Payer: Wellcare Medicare	$6,073.08
Rate for Payer: Wellmed Medicare	$6,073.08

Laparoscopy, surgical; repair initial inguinal hernia

Facility

$30,362.64

Service Code	HCPCS 49650
Hospital Charge Code	9900726
Hospital Revenue Code	360
Rate for Payer: Cash Price	$20,646.60

Laparoscopy, surgical; repair initial inguinal hernia

Facility

$30,362.64

Service Code	HCPCS 49650
Hospital Charge Code	9900726
Hospital Revenue Code	360
Min. Negotiated Rate	$1,888.85
Max. Negotiated Rate	$21,861.10
Rate for Payer: Amerigroup CHIP/Medicaid	$1,888.85
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$6,073.08
Rate for Payer: Amerigroup Medicare	$6,073.08
Rate for Payer: BCBS of TX Blue Advantage	$8,072.30
Rate for Payer: BCBS of TX Blue Essentials	$9,667.42
Rate for Payer: BCBS of TX Medicare	$6,073.08
Rate for Payer: BCBS of TX PPO	$12,180.95
Rate for Payer: Cash Price	$20,646.60
Rate for Payer: Cash Price	$20,646.60
Rate for Payer: Cash Price	$20,646.60
Rate for Payer: Cigna Commercial	$12,837.39
Rate for Payer: Cigna Medicaid	$21,861.10
Rate for Payer: Cigna Medicare	$6,073.08
Rate for Payer: Employer Direct Commercial	$6,073.08
Rate for Payer: Humana Medicare/TRICARE	$6,073.08
Rate for Payer: Molina CHIP/Medicaid	$21,861.10
Rate for Payer: Molina Dual Medicare/Medicaid	$6,073.08
Rate for Payer: Molina Medicare	$6,073.08
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	$21,861.10
Rate for Payer: Scott and White EPO/PPO	$11,235.20
Rate for Payer: Scott and White Medicare	$6,073.08
Rate for Payer: Superior Health Plan CHIP/Medicaid	$21,861.10
Rate for Payer: Superior Health Plan EPO	$6,073.08
Rate for Payer: Superior Health Plan Medicare	$6,073.08
Rate for Payer: Universal American Dual Medicare/Medicaid	$6,073.08
Rate for Payer: Universal American Medicare	$6,073.08
Rate for Payer: Wellcare Medicare	$6,073.08
Rate for Payer: Wellmed Medicare	$6,073.08

Laparoscopy, surgical, repair of paraesophageal hernia, includes fundoplasty, when performed with i

Facility

$22,269.15

Service Code	HCPCS 43282
Hospital Charge Code	9900681
Hospital Revenue Code	360
Min. Negotiated Rate	$2,004.22
Max. Negotiated Rate	$22,571.94
Rate for Payer: Amerigroup CHIP/Medicaid	$2,004.22
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$10,678.27
Rate for Payer: Amerigroup Medicare	$10,678.27
Rate for Payer: BCBS of TX Blue Advantage	$14,049.89
Rate for Payer: BCBS of TX Blue Essentials	$16,826.22
Rate for Payer: BCBS of TX Medicare	$10,678.27
Rate for Payer: BCBS of TX PPO	$21,201.04
Rate for Payer: Cash Price	$15,143.02
Rate for Payer: Cash Price	$15,143.02
Rate for Payer: Cash Price	$15,143.02
Rate for Payer: Cigna Commercial	$22,571.94
Rate for Payer: Cigna Medicaid	$16,033.79
Rate for Payer: Cigna Medicare	$10,678.27
Rate for Payer: Employer Direct Commercial	$10,678.27
Rate for Payer: Humana Medicare/TRICARE	$10,678.27
Rate for Payer: Molina CHIP/Medicaid	$16,033.79
Rate for Payer: Molina Dual Medicare/Medicaid	$10,678.27
Rate for Payer: Molina Medicare	$10,678.27
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	$16,033.79
Rate for Payer: Scott and White EPO/PPO	$19,754.80
Rate for Payer: Scott and White Medicare	$10,678.27
Rate for Payer: Superior Health Plan CHIP/Medicaid	$16,033.79
Rate for Payer: Superior Health Plan EPO	$10,678.27
Rate for Payer: Superior Health Plan Medicare	$10,678.27
Rate for Payer: Universal American Dual Medicare/Medicaid	$10,678.27
Rate for Payer: Universal American Medicare	$10,678.27
Rate for Payer: Wellcare Medicare	$10,678.27
Rate for Payer: Wellmed Medicare	$10,678.27

Laparoscopy, surgical, repair of paraesophageal hernia, includes fundoplasty, when performed with i

Facility

$22,269.15

Service Code	HCPCS 43282
Hospital Charge Code	9900681
Hospital Revenue Code	360
Rate for Payer: Cash Price	$15,143.02

Laparoscopy, surgical, repair of paraesophageal hernia, includes fundoplasty, when performed with i

Facility

$22,571.94

Service Code	CPT 43282
Hospital Charge Code	36043282
Hospital Revenue Code	360
Min. Negotiated Rate	$10,000.00
Max. Negotiated Rate	$22,571.94
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$10,678.27
Rate for Payer: Amerigroup Medicare	$10,678.27
Rate for Payer: BCBS of TX Blue Advantage	$14,049.89
Rate for Payer: BCBS of TX Blue Essentials	$16,826.22
Rate for Payer: BCBS of TX Medicare	$10,678.27
Rate for Payer: BCBS of TX PPO	$21,201.04
Rate for Payer: Cigna Commercial	$22,571.94
Rate for Payer: Cigna Medicare	$10,678.27
Rate for Payer: Employer Direct Commercial	$10,678.27
Rate for Payer: Humana Medicare/TRICARE	$10,678.27
Rate for Payer: Molina Dual Medicare/Medicaid	$10,678.27
Rate for Payer: Molina Medicare	$10,678.27
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	$19,754.80
Rate for Payer: Scott and White Medicare	$10,678.27
Rate for Payer: Superior Health Plan EPO	$10,678.27
Rate for Payer: Superior Health Plan Medicare	$10,678.27
Rate for Payer: Universal American Dual Medicare/Medicaid	$10,678.27
Rate for Payer: Universal American Medicare	$10,678.27
Rate for Payer: Wellcare Medicare	$10,678.27
Rate for Payer: Wellmed Medicare	$10,678.27

Laparoscopy, surgical, repair of paraesophageal hernia, includes fundoplasty, when performed; withou

Facility

$22,571.94

Service Code	CPT 43281
Hospital Charge Code	36043281
Hospital Revenue Code	360
Min. Negotiated Rate	$10,000.00
Max. Negotiated Rate	$22,571.94
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$10,678.27
Rate for Payer: Amerigroup Medicare	$10,678.27
Rate for Payer: BCBS of TX Blue Advantage	$14,049.89
Rate for Payer: BCBS of TX Blue Essentials	$16,826.22
Rate for Payer: BCBS of TX Medicare	$10,678.27
Rate for Payer: BCBS of TX PPO	$21,201.04
Rate for Payer: Cigna Commercial	$22,571.94
Rate for Payer: Cigna Medicare	$10,678.27
Rate for Payer: Employer Direct Commercial	$10,678.27
Rate for Payer: Humana Medicare/TRICARE	$10,678.27
Rate for Payer: Molina Dual Medicare/Medicaid	$10,678.27
Rate for Payer: Molina Medicare	$10,678.27
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	$19,754.80
Rate for Payer: Scott and White Medicare	$10,678.27
Rate for Payer: Superior Health Plan EPO	$10,678.27
Rate for Payer: Superior Health Plan Medicare	$10,678.27
Rate for Payer: Universal American Dual Medicare/Medicaid	$10,678.27
Rate for Payer: Universal American Medicare	$10,678.27
Rate for Payer: Wellcare Medicare	$10,678.27
Rate for Payer: Wellmed Medicare	$10,678.27

Laparoscopy, surgical, repair of paraesophageal hernia, includes fundoplasty, when performed; withou

Facility

$22,269.15

Service Code	HCPCS 43281
Hospital Charge Code	9900680
Hospital Revenue Code	360
Rate for Payer: Cash Price	$15,143.02

Laparoscopy, surgical, repair of paraesophageal hernia, includes fundoplasty, when performed; withou

Facility

$22,269.15

Service Code	HCPCS 43281
Hospital Charge Code	9900680
Hospital Revenue Code	360
Min. Negotiated Rate	$2,004.22
Max. Negotiated Rate	$22,571.94
Rate for Payer: Amerigroup CHIP/Medicaid	$2,004.22
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$10,678.27
Rate for Payer: Amerigroup Medicare	$10,678.27
Rate for Payer: BCBS of TX Blue Advantage	$14,049.89
Rate for Payer: BCBS of TX Blue Essentials	$16,826.22
Rate for Payer: BCBS of TX Medicare	$10,678.27
Rate for Payer: BCBS of TX PPO	$21,201.04
Rate for Payer: Cash Price	$15,143.02
Rate for Payer: Cash Price	$15,143.02
Rate for Payer: Cash Price	$15,143.02
Rate for Payer: Cigna Commercial	$22,571.94
Rate for Payer: Cigna Medicaid	$16,033.79
Rate for Payer: Cigna Medicare	$10,678.27
Rate for Payer: Employer Direct Commercial	$10,678.27
Rate for Payer: Humana Medicare/TRICARE	$10,678.27
Rate for Payer: Molina CHIP/Medicaid	$16,033.79
Rate for Payer: Molina Dual Medicare/Medicaid	$10,678.27
Rate for Payer: Molina Medicare	$10,678.27
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	$16,033.79
Rate for Payer: Scott and White EPO/PPO	$19,754.80
Rate for Payer: Scott and White Medicare	$10,678.27
Rate for Payer: Superior Health Plan CHIP/Medicaid	$16,033.79
Rate for Payer: Superior Health Plan EPO	$10,678.27
Rate for Payer: Superior Health Plan Medicare	$10,678.27
Rate for Payer: Universal American Dual Medicare/Medicaid	$10,678.27
Rate for Payer: Universal American Medicare	$10,678.27
Rate for Payer: Wellcare Medicare	$10,678.27
Rate for Payer: Wellmed Medicare	$10,678.27

Laparoscopy, surgical, repair, ventral, umbilical, spigelian or epigastric hernia (includes mesh ins

Facility

$17,173.32

Service Code	HCPCS 49653
Hospital Charge Code	9900727
Hospital Revenue Code	360
Rate for Payer: Cash Price	$11,677.86

Laparoscopy, surgical, repair, ventral, umbilical, spigelian or epigastric hernia (includes mesh ins

Facility

$17,173.32

Service Code	HCPCS 49653
Hospital Charge Code	9900727
Hospital Revenue Code	360
Min. Negotiated Rate	$1,545.60
Max. Negotiated Rate	$12,364.79
Rate for Payer: Amerigroup CHIP/Medicaid	$1,545.60
Rate for Payer: BCBS of TX Blue Advantage	$8,072.30
Rate for Payer: BCBS of TX Blue Essentials	$9,667.42
Rate for Payer: BCBS of TX PPO	$12,180.95
Rate for Payer: Cash Price	$11,677.86
Rate for Payer: Cash Price	$11,677.86
Rate for Payer: Cash Price	$11,677.86
Rate for Payer: Cigna Medicaid	$12,364.79
Rate for Payer: Molina CHIP/Medicaid	$12,364.79
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	$12,364.79
Rate for Payer: Scott and White EPO/PPO	$8,586.66
Rate for Payer: Superior Health Plan CHIP/Medicaid	$12,364.79
Rate for Payer: Superior Health Plan EPO	$2,335.57

Laparoscopy, surgical, repair, ventral, umbilical, spigelian or epigastric hernia (includes mesh ins

Facility

$12,180.95

Service Code	CPT 49653
Hospital Charge Code	36049653
Hospital Revenue Code	360
Min. Negotiated Rate	$8,072.30
Max. Negotiated Rate	$12,180.95
Rate for Payer: BCBS of TX Blue Advantage	$8,072.30
Rate for Payer: BCBS of TX Blue Essentials	$9,667.42
Rate for Payer: BCBS of TX PPO	$12,180.95
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

Laparoscopy, surgical; with aspiration of cavity or cyst (eg, ovarian cyst) (single or multiple)

Facility

$23,337.44

Service Code	HCPCS 49323
Hospital Charge Code	994097
Hospital Revenue Code	360
Min. Negotiated Rate	$2,100.37
Max. Negotiated Rate	$16,802.96
Rate for Payer: Amerigroup CHIP/Medicaid	$2,100.37
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$6,073.08
Rate for Payer: Amerigroup Medicare	$6,073.08
Rate for Payer: BCBS of TX Blue Advantage	$8,072.30
Rate for Payer: BCBS of TX Blue Essentials	$9,667.42
Rate for Payer: BCBS of TX Medicare	$6,073.08
Rate for Payer: BCBS of TX PPO	$12,180.95
Rate for Payer: Cash Price	$15,869.46
Rate for Payer: Cash Price	$15,869.46
Rate for Payer: Cash Price	$15,869.46
Rate for Payer: Cigna Commercial	$12,837.39
Rate for Payer: Cigna Medicaid	$16,802.96
Rate for Payer: Cigna Medicare	$6,073.08
Rate for Payer: Employer Direct Commercial	$6,073.08
Rate for Payer: Humana Medicare/TRICARE	$6,073.08
Rate for Payer: Molina CHIP/Medicaid	$16,802.96
Rate for Payer: Molina Dual Medicare/Medicaid	$6,073.08
Rate for Payer: Molina Medicare	$6,073.08
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	$16,802.96
Rate for Payer: Scott and White EPO/PPO	$11,235.20
Rate for Payer: Scott and White Medicare	$6,073.08
Rate for Payer: Superior Health Plan CHIP/Medicaid	$16,802.96
Rate for Payer: Superior Health Plan EPO	$6,073.08
Rate for Payer: Superior Health Plan Medicare	$6,073.08
Rate for Payer: Universal American Dual Medicare/Medicaid	$6,073.08
Rate for Payer: Universal American Medicare	$6,073.08
Rate for Payer: Wellcare Medicare	$6,073.08
Rate for Payer: Wellmed Medicare	$6,073.08

Laparoscopy, surgical; with aspiration of cavity or cyst (eg, ovarian cyst) (single or multiple)

Facility

$23,337.44

Service Code	HCPCS 49323
Hospital Charge Code	994097
Hospital Revenue Code	360
Rate for Payer: Cash Price	$15,869.46

Laparoscopy, surgical with biopsy (single or multiple)

Facility

$20,695.00

Service Code	HCPCS 49321
Hospital Charge Code	9900710
Hospital Revenue Code	360
Min. Negotiated Rate	$1,888.85
Max. Negotiated Rate	$14,900.40
Rate for Payer: Amerigroup CHIP/Medicaid	$1,888.85
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$6,073.08
Rate for Payer: Amerigroup Medicare	$6,073.08
Rate for Payer: BCBS of TX Blue Advantage	$8,072.30
Rate for Payer: BCBS of TX Blue Essentials	$9,667.42
Rate for Payer: BCBS of TX Medicare	$6,073.08
Rate for Payer: BCBS of TX PPO	$12,180.95
Rate for Payer: Cash Price	$14,072.60
Rate for Payer: Cash Price	$14,072.60
Rate for Payer: Cash Price	$14,072.60
Rate for Payer: Cigna Commercial	$12,837.39
Rate for Payer: Cigna Medicaid	$14,900.40
Rate for Payer: Cigna Medicare	$6,073.08
Rate for Payer: Employer Direct Commercial	$6,073.08
Rate for Payer: Humana Medicare/TRICARE	$6,073.08
Rate for Payer: Molina CHIP/Medicaid	$14,900.40
Rate for Payer: Molina Dual Medicare/Medicaid	$6,073.08
Rate for Payer: Molina Medicare	$6,073.08
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	$14,900.40
Rate for Payer: Scott and White EPO/PPO	$11,235.20
Rate for Payer: Scott and White Medicare	$6,073.08
Rate for Payer: Superior Health Plan CHIP/Medicaid	$14,900.40
Rate for Payer: Superior Health Plan EPO	$6,073.08
Rate for Payer: Superior Health Plan Medicare	$6,073.08
Rate for Payer: Universal American Dual Medicare/Medicaid	$6,073.08
Rate for Payer: Universal American Medicare	$6,073.08
Rate for Payer: Wellcare Medicare	$6,073.08
Rate for Payer: Wellmed Medicare	$6,073.08

Laparoscopy, surgical with biopsy (single or multiple)

Facility

$12,837.39

Service Code	CPT 49321
Hospital Charge Code	36049321
Hospital Revenue Code	360
Min. Negotiated Rate	$1,888.85
Max. Negotiated Rate	$12,837.39
Rate for Payer: Amerigroup CHIP/Medicaid	$1,888.85
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$6,073.08
Rate for Payer: Amerigroup Medicare	$6,073.08
Rate for Payer: BCBS of TX Blue Advantage	$8,072.30
Rate for Payer: BCBS of TX Blue Essentials	$9,667.42
Rate for Payer: BCBS of TX Medicare	$6,073.08
Rate for Payer: BCBS of TX PPO	$12,180.95
Rate for Payer: Cigna Commercial	$12,837.39
Rate for Payer: Cigna Medicare	$6,073.08
Rate for Payer: Employer Direct Commercial	$6,073.08
Rate for Payer: Humana Medicare/TRICARE	$6,073.08
Rate for Payer: Molina Dual Medicare/Medicaid	$6,073.08
Rate for Payer: Molina Medicare	$6,073.08
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	$11,235.20
Rate for Payer: Scott and White Medicare	$6,073.08
Rate for Payer: Superior Health Plan EPO	$6,073.08
Rate for Payer: Superior Health Plan Medicare	$6,073.08
Rate for Payer: Universal American Dual Medicare/Medicaid	$6,073.08
Rate for Payer: Universal American Medicare	$6,073.08
Rate for Payer: Wellcare Medicare	$6,073.08
Rate for Payer: Wellmed Medicare	$6,073.08

Laparoscopy, surgical with biopsy (single or multiple)

Facility

$20,695.00

Service Code	HCPCS 49321
Hospital Charge Code	9900710
Hospital Revenue Code	360
Rate for Payer: Cash Price	$14,072.60

Laparoscopy, surgical; with insertion of tunneled intraperitoneal catheter

Facility

$21,990.36

Service Code	HCPCS 49324
Hospital Charge Code	991111
Hospital Revenue Code	360
Min. Negotiated Rate	$1,888.85
Max. Negotiated Rate	$15,833.06
Rate for Payer: Amerigroup CHIP/Medicaid	$1,888.85
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$6,073.08
Rate for Payer: Amerigroup Medicare	$6,073.08
Rate for Payer: BCBS of TX Blue Advantage	$8,072.30
Rate for Payer: BCBS of TX Blue Essentials	$9,667.42
Rate for Payer: BCBS of TX Medicare	$6,073.08
Rate for Payer: BCBS of TX PPO	$12,180.95
Rate for Payer: Cash Price	$14,953.44
Rate for Payer: Cash Price	$14,953.44
Rate for Payer: Cash Price	$14,953.44
Rate for Payer: Cigna Commercial	$12,837.39
Rate for Payer: Cigna Medicaid	$15,833.06
Rate for Payer: Cigna Medicare	$6,073.08
Rate for Payer: Employer Direct Commercial	$6,073.08
Rate for Payer: Humana Medicare/TRICARE	$6,073.08
Rate for Payer: Molina CHIP/Medicaid	$15,833.06
Rate for Payer: Molina Dual Medicare/Medicaid	$6,073.08
Rate for Payer: Molina Medicare	$6,073.08
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	$15,833.06
Rate for Payer: Scott and White EPO/PPO	$11,235.20
Rate for Payer: Scott and White Medicare	$6,073.08
Rate for Payer: Superior Health Plan CHIP/Medicaid	$15,833.06
Rate for Payer: Superior Health Plan EPO	$6,073.08
Rate for Payer: Superior Health Plan Medicare	$6,073.08
Rate for Payer: Universal American Dual Medicare/Medicaid	$6,073.08
Rate for Payer: Universal American Medicare	$6,073.08
Rate for Payer: Wellcare Medicare	$6,073.08
Rate for Payer: Wellmed Medicare	$6,073.08

Laparoscopy, surgical; with insertion of tunneled intraperitoneal catheter

Facility

$21,990.36

Service Code	HCPCS 49324
Hospital Charge Code	991111
Hospital Revenue Code	360
Rate for Payer: Cash Price	$14,953.44

Laparoscopy w/revision intraperitoneal cannula or catheter, with removal of intraluminal obstructive

Facility

$24,705.88

Service Code	HCPCS 49325
Hospital Charge Code	994225
Hospital Revenue Code	360
Rate for Payer: Cash Price	$16,800.00

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