White Rock Medical Center

All Charges

Charge

Type

Setting

Price

WC Npwt Dme >50 Sq cm BCE

Facility

$400.00

Service Code	CPT 97606
Hospital Charge Code	7150626
Hospital Revenue Code	761
Min. Negotiated Rate	$6.52
Max. Negotiated Rate	$826.08
Rate for Payer: Aetna Commercial	$220.00
Rate for Payer: Aetna Medicare	$547.00
Rate for Payer: Amerigroup CHIP/Medicaid	$36.00
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$364.67
Rate for Payer: Amerigroup Medicare	$364.67
Rate for Payer: BCBS of TX Blue Advantage	$38.00
Rate for Payer: BCBS of TX Blue Essentials	$45.00
Rate for Payer: BCBS of TX Medicare	$364.67
Rate for Payer: BCBS of TX PPO	$50.00
Rate for Payer: Cash Price	$352.00
Rate for Payer: Cash Price	$352.00
Rate for Payer: Cash Price	$352.00
Rate for Payer: Cigna Commercial	$826.08
Rate for Payer: Cigna Medicare	$364.67
Rate for Payer: Employer Direct Commercial	$364.67
Rate for Payer: Humana Medicare/TRICARE	$364.67
Rate for Payer: Molina Dual Medicare/Medicaid	$364.67
Rate for Payer: Molina Medicare	$364.67
Rate for Payer: Multiplan Auto	$260.00
Rate for Payer: Multiplan Commercial	$260.00
Rate for Payer: Multiplan Workers Comp	$260.00
Rate for Payer: Scott and White EPO/PPO	$6.52
Rate for Payer: Scott and White Medicare	$364.67
Rate for Payer: Superior Health Plan EPO	$364.67
Rate for Payer: Superior Health Plan Medicare	$364.67
Rate for Payer: Universal American Dual Medicare/Medicaid	$364.67
Rate for Payer: Universal American Medicare	$364.67
Rate for Payer: Wellcare Medicare	$364.67
Rate for Payer: Wellmed Medicare	$364.67

WC Npwt Dme >50 Sq cm BCE

Facility

$400.00

Service Code	CPT 97606
Hospital Charge Code	7150626
Hospital Revenue Code	761
Rate for Payer: Cash Price	$352.00

WC Npwt Nondme <= 50 Sq cm BCE

Facility

$688.00

Service Code	CPT 97607
Hospital Charge Code	7150921
Hospital Revenue Code	761
Rate for Payer: Cash Price	$605.44

WC Npwt Nondme <= 50 Sq cm BCE

Facility

$688.00

Service Code	CPT 97607
Hospital Charge Code	7150921
Hospital Revenue Code	761
Min. Negotiated Rate	$6.52
Max. Negotiated Rate	$826.08
Rate for Payer: Aetna Commercial	$378.40
Rate for Payer: Aetna Medicare	$547.00
Rate for Payer: Amerigroup CHIP/Medicaid	$61.92
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$364.67
Rate for Payer: Amerigroup Medicare	$364.67
Rate for Payer: BCBS of TX Blue Advantage	$38.00
Rate for Payer: BCBS of TX Blue Essentials	$45.00
Rate for Payer: BCBS of TX Medicare	$364.67
Rate for Payer: BCBS of TX PPO	$50.00
Rate for Payer: Cash Price	$605.44
Rate for Payer: Cash Price	$605.44
Rate for Payer: Cash Price	$605.44
Rate for Payer: Cigna Commercial	$826.08
Rate for Payer: Cigna Medicare	$364.67
Rate for Payer: Employer Direct Commercial	$364.67
Rate for Payer: Humana Medicare/TRICARE	$364.67
Rate for Payer: Molina Dual Medicare/Medicaid	$364.67
Rate for Payer: Molina Medicare	$364.67
Rate for Payer: Multiplan Auto	$447.20
Rate for Payer: Multiplan Commercial	$447.20
Rate for Payer: Multiplan Workers Comp	$447.20
Rate for Payer: Scott and White EPO/PPO	$6.52
Rate for Payer: Scott and White Medicare	$364.67
Rate for Payer: Superior Health Plan EPO	$364.67
Rate for Payer: Superior Health Plan Medicare	$364.67
Rate for Payer: Universal American Dual Medicare/Medicaid	$364.67
Rate for Payer: Universal American Medicare	$364.67
Rate for Payer: Wellcare Medicare	$364.67
Rate for Payer: Wellmed Medicare	$364.67

WC Paring/Cutting Benign Lesion 2-4 BCE

Facility

$403.00

Service Code	CPT 11056
Hospital Charge Code	7150779
Hospital Revenue Code	761
Min. Negotiated Rate	$3.27
Max. Negotiated Rate	$440.32
Rate for Payer: Aetna Commercial	$221.65
Rate for Payer: Aetna Medicare	$274.64
Rate for Payer: Amerigroup CHIP/Medicaid	$36.27
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$183.09
Rate for Payer: Amerigroup Medicare	$183.09
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	$183.09
Rate for Payer: BCBS of TX PPO	$440.32
Rate for Payer: Cash Price	$354.64
Rate for Payer: Cash Price	$354.64
Rate for Payer: Cash Price	$354.64
Rate for Payer: Cigna Commercial	$414.75
Rate for Payer: Cigna Medicare	$183.09
Rate for Payer: Employer Direct Commercial	$183.09
Rate for Payer: Humana Medicare/TRICARE	$183.09
Rate for Payer: Molina Dual Medicare/Medicaid	$183.09
Rate for Payer: Molina Medicare	$183.09
Rate for Payer: Multiplan Auto	$261.95
Rate for Payer: Multiplan Commercial	$261.95
Rate for Payer: Multiplan Workers Comp	$261.95
Rate for Payer: Scott and White EPO/PPO	$3.27
Rate for Payer: Scott and White Medicare	$183.09
Rate for Payer: Superior Health Plan EPO	$183.09
Rate for Payer: Superior Health Plan Medicare	$183.09
Rate for Payer: Universal American Dual Medicare/Medicaid	$183.09
Rate for Payer: Universal American Medicare	$183.09
Rate for Payer: Wellcare Medicare	$183.09
Rate for Payer: Wellmed Medicare	$183.09

WC Paring/Cutting Benign Lesion 2-4 BCE

Facility

$403.00

Service Code	CPT 11056
Hospital Charge Code	7150779
Hospital Revenue Code	761
Rate for Payer: Cash Price	$354.64

WC Paring/Cutting Benign Lesion Over 4 BCE

Facility

$521.00

Service Code	CPT 11057
Hospital Charge Code	7150780
Hospital Revenue Code	761
Rate for Payer: Cash Price	$458.48

WC Paring/Cutting Benign Lesion Over 4 BCE

Facility

$521.00

Service Code	CPT 11057
Hospital Charge Code	7150780
Hospital Revenue Code	761
Min. Negotiated Rate	$3.27
Max. Negotiated Rate	$414.75
Rate for Payer: Aetna Commercial	$286.55
Rate for Payer: Aetna Medicare	$274.64
Rate for Payer: Amerigroup CHIP/Medicaid	$46.89
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$183.09
Rate for Payer: Amerigroup Medicare	$183.09
Rate for Payer: BCBS of TX Blue Advantage	$97.03
Rate for Payer: BCBS of TX Blue Essentials	$116.20
Rate for Payer: BCBS of TX Medicare	$183.09
Rate for Payer: BCBS of TX PPO	$146.41
Rate for Payer: Cash Price	$458.48
Rate for Payer: Cash Price	$458.48
Rate for Payer: Cash Price	$458.48
Rate for Payer: Cigna Commercial	$414.75
Rate for Payer: Cigna Medicaid	$55.65
Rate for Payer: Cigna Medicare	$183.09
Rate for Payer: Employer Direct Commercial	$183.09
Rate for Payer: Humana Medicare/TRICARE	$183.09
Rate for Payer: Molina CHIP/Medicaid	$55.65
Rate for Payer: Molina Dual Medicare/Medicaid	$183.09
Rate for Payer: Molina Medicare	$183.09
Rate for Payer: Multiplan Auto	$338.65
Rate for Payer: Multiplan Commercial	$338.65
Rate for Payer: Multiplan Workers Comp	$338.65
Rate for Payer: Parkland Medicaid	$55.65
Rate for Payer: Scott and White EPO/PPO	$3.27
Rate for Payer: Scott and White Medicare	$183.09
Rate for Payer: Superior Health Plan CHIP/Medicaid	$55.65
Rate for Payer: Superior Health Plan EPO	$183.09
Rate for Payer: Superior Health Plan Medicare	$183.09
Rate for Payer: Universal American Dual Medicare/Medicaid	$183.09
Rate for Payer: Universal American Medicare	$183.09
Rate for Payer: Wellcare Medicare	$183.09
Rate for Payer: Wellmed Medicare	$183.09

WC Paring Of Single Callus BCE

Facility

$358.00

Service Code	CPT 11055
Hospital Charge Code	7150778
Hospital Revenue Code	761
Min. Negotiated Rate	$3.27
Max. Negotiated Rate	$440.32
Rate for Payer: Aetna Commercial	$196.90
Rate for Payer: Aetna Medicare	$274.64
Rate for Payer: Amerigroup CHIP/Medicaid	$32.22
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$183.09
Rate for Payer: Amerigroup Medicare	$183.09
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	$183.09
Rate for Payer: BCBS of TX PPO	$440.32
Rate for Payer: Cash Price	$315.04
Rate for Payer: Cash Price	$315.04
Rate for Payer: Cash Price	$315.04
Rate for Payer: Cigna Commercial	$414.75
Rate for Payer: Cigna Medicare	$183.09
Rate for Payer: Employer Direct Commercial	$183.09
Rate for Payer: Humana Medicare/TRICARE	$183.09
Rate for Payer: Molina Dual Medicare/Medicaid	$183.09
Rate for Payer: Molina Medicare	$183.09
Rate for Payer: Multiplan Auto	$232.70
Rate for Payer: Multiplan Commercial	$232.70
Rate for Payer: Multiplan Workers Comp	$232.70
Rate for Payer: Scott and White EPO/PPO	$3.27
Rate for Payer: Scott and White Medicare	$183.09
Rate for Payer: Superior Health Plan EPO	$183.09
Rate for Payer: Superior Health Plan Medicare	$183.09
Rate for Payer: Universal American Dual Medicare/Medicaid	$183.09
Rate for Payer: Universal American Medicare	$183.09
Rate for Payer: Wellcare Medicare	$183.09
Rate for Payer: Wellmed Medicare	$183.09

WC Paring Of Single Callus BCE

Facility

$358.00

Service Code	CPT 11055
Hospital Charge Code	7150778
Hospital Revenue Code	761
Rate for Payer: Cash Price	$315.04

WC Punch Biopsy Skin, Ea Add BCE

Facility

$346.00

Service Code	CPT 11105
Hospital Charge Code	7150054
Hospital Revenue Code	761
Min. Negotiated Rate	$31.14
Max. Negotiated Rate	$224.90
Rate for Payer: Aetna Commercial	$190.30
Rate for Payer: Amerigroup CHIP/Medicaid	$31.14
Rate for Payer: BCBS of TX Blue Advantage	$38.00
Rate for Payer: BCBS of TX Blue Essentials	$45.00
Rate for Payer: BCBS of TX PPO	$50.00
Rate for Payer: Cash Price	$304.48
Rate for Payer: Cash Price	$304.48
Rate for Payer: Multiplan Auto	$224.90
Rate for Payer: Multiplan Commercial	$224.90
Rate for Payer: Multiplan Workers Comp	$224.90
Rate for Payer: Scott and White EPO/PPO	$173.00
Rate for Payer: Superior Health Plan EPO	$47.06

WC Punch Biopsy Skin, Ea Add BCE

Facility

$346.00

Service Code	CPT 11105
Hospital Charge Code	7150054
Hospital Revenue Code	761
Rate for Payer: Cash Price	$304.48

WC Punch Biopsy Skn, One Lsn BCE

Facility

$688.00

Service Code	CPT 11104
Hospital Charge Code	7150051
Hospital Revenue Code	761
Rate for Payer: Cash Price	$605.44

WC Punch Biopsy Skn, One Lsn BCE

Facility

$688.00

Service Code	CPT 11104
Hospital Charge Code	7150051
Hospital Revenue Code	761
Min. Negotiated Rate	$6.52
Max. Negotiated Rate	$826.08
Rate for Payer: Aetna Commercial	$378.40
Rate for Payer: Aetna Medicare	$547.00
Rate for Payer: Amerigroup CHIP/Medicaid	$61.92
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$364.67
Rate for Payer: Amerigroup Medicare	$364.67
Rate for Payer: BCBS of TX Blue Advantage	$147.44
Rate for Payer: BCBS of TX Blue Essentials	$176.58
Rate for Payer: BCBS of TX Medicare	$364.67
Rate for Payer: BCBS of TX PPO	$222.49
Rate for Payer: Cash Price	$605.44
Rate for Payer: Cash Price	$605.44
Rate for Payer: Cash Price	$605.44
Rate for Payer: Cigna Commercial	$826.08
Rate for Payer: Cigna Medicaid	$79.46
Rate for Payer: Cigna Medicare	$364.67
Rate for Payer: Employer Direct Commercial	$364.67
Rate for Payer: Humana Medicare/TRICARE	$364.67
Rate for Payer: Molina CHIP/Medicaid	$79.46
Rate for Payer: Molina Dual Medicare/Medicaid	$364.67
Rate for Payer: Molina Medicare	$364.67
Rate for Payer: Multiplan Auto	$447.20
Rate for Payer: Multiplan Commercial	$447.20
Rate for Payer: Multiplan Workers Comp	$447.20
Rate for Payer: Parkland Medicaid	$79.46
Rate for Payer: Scott and White EPO/PPO	$6.52
Rate for Payer: Scott and White Medicare	$364.67
Rate for Payer: Superior Health Plan CHIP/Medicaid	$79.46
Rate for Payer: Superior Health Plan EPO	$364.67
Rate for Payer: Superior Health Plan Medicare	$364.67
Rate for Payer: Universal American Dual Medicare/Medicaid	$364.67
Rate for Payer: Universal American Medicare	$364.67
Rate for Payer: Wellcare Medicare	$364.67
Rate for Payer: Wellmed Medicare	$364.67

WC Puncture Drainage Of Lesion BCE

Facility

$895.00

Service Code	CPT 10160
Hospital Charge Code	7150113
Hospital Revenue Code	761
Rate for Payer: Cash Price	$787.60

WC Puncture Drainage Of Lesion BCE

Facility

$895.00

Service Code	CPT 10160
Hospital Charge Code	7150113
Hospital Revenue Code	761
Min. Negotiated Rate	$6.52
Max. Negotiated Rate	$826.08
Rate for Payer: Aetna Commercial	$492.25
Rate for Payer: Aetna Medicare	$547.00
Rate for Payer: Amerigroup CHIP/Medicaid	$80.55
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$364.67
Rate for Payer: Amerigroup Medicare	$364.67
Rate for Payer: BCBS of TX Blue Advantage	$139.23
Rate for Payer: BCBS of TX Blue Essentials	$166.74
Rate for Payer: BCBS of TX Medicare	$364.67
Rate for Payer: BCBS of TX PPO	$210.09
Rate for Payer: Cash Price	$787.60
Rate for Payer: Cash Price	$787.60
Rate for Payer: Cash Price	$787.60
Rate for Payer: Cigna Commercial	$826.08
Rate for Payer: Cigna Medicaid	$67.83
Rate for Payer: Cigna Medicare	$364.67
Rate for Payer: Employer Direct Commercial	$364.67
Rate for Payer: Humana Medicare/TRICARE	$364.67
Rate for Payer: Molina CHIP/Medicaid	$67.83
Rate for Payer: Molina Dual Medicare/Medicaid	$364.67
Rate for Payer: Molina Medicare	$364.67
Rate for Payer: Multiplan Auto	$581.75
Rate for Payer: Multiplan Commercial	$581.75
Rate for Payer: Multiplan Workers Comp	$581.75
Rate for Payer: Parkland Medicaid	$67.83
Rate for Payer: Scott and White EPO/PPO	$6.52
Rate for Payer: Scott and White Medicare	$364.67
Rate for Payer: Superior Health Plan CHIP/Medicaid	$67.83
Rate for Payer: Superior Health Plan EPO	$364.67
Rate for Payer: Superior Health Plan Medicare	$364.67
Rate for Payer: Universal American Dual Medicare/Medicaid	$364.67
Rate for Payer: Universal American Medicare	$364.67
Rate for Payer: Wellcare Medicare	$364.67
Rate for Payer: Wellmed Medicare	$364.67

WC Removal Of Ear Wax By Instru Unilat BCE

Facility

$1,639.00

Service Code	CPT 69210
Hospital Charge Code	7150378
Hospital Revenue Code	761
Rate for Payer: Cash Price	$1,442.32

WC Removal Of Ear Wax By Instru Unilat BCE

Facility

$1,639.00

Service Code	CPT 69210
Hospital Charge Code	7150378
Hospital Revenue Code	761
Min. Negotiated Rate	$1.00
Max. Negotiated Rate	$1,065.35
Rate for Payer: Aetna Commercial	$901.45
Rate for Payer: Aetna Medicare	$83.91
Rate for Payer: Amerigroup CHIP/Medicaid	$147.51
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	$1,442.32
Rate for Payer: Cash Price	$1,442.32
Rate for Payer: Cash Price	$1,442.32
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	$1,065.35
Rate for Payer: Multiplan Commercial	$1,065.35
Rate for Payer: Multiplan Workers Comp	$1,065.35
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

WC Removal Of Nail Bed BCE

Facility

$4,009.00

Service Code	CPT 11750
Hospital Charge Code	7150818
Hospital Revenue Code	761
Rate for Payer: Cash Price	$3,527.92

WC Removal Of Nail Bed BCE

Facility

$4,009.00

Service Code	CPT 11750
Hospital Charge Code	7150818
Hospital Revenue Code	761
Min. Negotiated Rate	$6.52
Max. Negotiated Rate	$2,605.85
Rate for Payer: Aetna Commercial	$2,204.95
Rate for Payer: Aetna Medicare	$547.00
Rate for Payer: Amerigroup CHIP/Medicaid	$360.81
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$364.67
Rate for Payer: Amerigroup Medicare	$364.67
Rate for Payer: BCBS of TX Blue Advantage	$165.75
Rate for Payer: BCBS of TX Blue Essentials	$198.50
Rate for Payer: BCBS of TX Medicare	$364.67
Rate for Payer: BCBS of TX PPO	$250.11
Rate for Payer: Cash Price	$3,527.92
Rate for Payer: Cash Price	$3,527.92
Rate for Payer: Cash Price	$3,527.92
Rate for Payer: Cigna Commercial	$826.08
Rate for Payer: Cigna Medicaid	$84.71
Rate for Payer: Cigna Medicare	$364.67
Rate for Payer: Employer Direct Commercial	$364.67
Rate for Payer: Humana Medicare/TRICARE	$364.67
Rate for Payer: Molina CHIP/Medicaid	$84.71
Rate for Payer: Molina Dual Medicare/Medicaid	$364.67
Rate for Payer: Molina Medicare	$364.67
Rate for Payer: Multiplan Auto	$2,605.85
Rate for Payer: Multiplan Commercial	$2,605.85
Rate for Payer: Multiplan Workers Comp	$2,605.85
Rate for Payer: Parkland Medicaid	$84.71
Rate for Payer: Scott and White EPO/PPO	$6.52
Rate for Payer: Scott and White Medicare	$364.67
Rate for Payer: Superior Health Plan CHIP/Medicaid	$84.71
Rate for Payer: Superior Health Plan EPO	$364.67
Rate for Payer: Superior Health Plan Medicare	$364.67
Rate for Payer: Universal American Dual Medicare/Medicaid	$364.67
Rate for Payer: Universal American Medicare	$364.67
Rate for Payer: Wellcare Medicare	$364.67
Rate for Payer: Wellmed Medicare	$364.67

WC Removal Of Skin Lesion BCE

Facility

$2,477.00

Service Code	CPT 11200
Hospital Charge Code	7150212
Hospital Revenue Code	761
Rate for Payer: Cash Price	$2,179.76

WC Removal Of Skin Lesion BCE

Facility

$2,477.00

Service Code	CPT 11200
Hospital Charge Code	7150212
Hospital Revenue Code	761
Min. Negotiated Rate	$3.27
Max. Negotiated Rate	$1,610.05
Rate for Payer: Aetna Commercial	$1,362.35
Rate for Payer: Aetna Medicare	$274.64
Rate for Payer: Amerigroup CHIP/Medicaid	$222.93
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$183.09
Rate for Payer: Amerigroup Medicare	$183.09
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	$183.09
Rate for Payer: BCBS of TX PPO	$440.32
Rate for Payer: Cash Price	$2,179.76
Rate for Payer: Cash Price	$2,179.76
Rate for Payer: Cash Price	$2,179.76
Rate for Payer: Cigna Commercial	$414.75
Rate for Payer: Cigna Medicare	$183.09
Rate for Payer: Employer Direct Commercial	$183.09
Rate for Payer: Humana Medicare/TRICARE	$183.09
Rate for Payer: Molina Dual Medicare/Medicaid	$183.09
Rate for Payer: Molina Medicare	$183.09
Rate for Payer: Multiplan Auto	$1,610.05
Rate for Payer: Multiplan Commercial	$1,610.05
Rate for Payer: Multiplan Workers Comp	$1,610.05
Rate for Payer: Scott and White EPO/PPO	$3.27
Rate for Payer: Scott and White Medicare	$183.09
Rate for Payer: Superior Health Plan EPO	$183.09
Rate for Payer: Superior Health Plan Medicare	$183.09
Rate for Payer: Universal American Dual Medicare/Medicaid	$183.09
Rate for Payer: Universal American Medicare	$183.09
Rate for Payer: Wellcare Medicare	$183.09
Rate for Payer: Wellmed Medicare	$183.09

WC Remove Foreign Body, Simple BCE

Facility

$1,029.00

Service Code	CPT 10120
Hospital Charge Code	7150139
Hospital Revenue Code	761
Min. Negotiated Rate	$6.52
Max. Negotiated Rate	$826.08
Rate for Payer: Aetna Commercial	$565.95
Rate for Payer: Aetna Medicare	$547.00
Rate for Payer: Amerigroup CHIP/Medicaid	$92.61
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$364.67
Rate for Payer: Amerigroup Medicare	$364.67
Rate for Payer: BCBS of TX Blue Advantage	$178.41
Rate for Payer: BCBS of TX Blue Essentials	$213.66
Rate for Payer: BCBS of TX Medicare	$364.67
Rate for Payer: BCBS of TX PPO	$269.21
Rate for Payer: Cash Price	$905.52
Rate for Payer: Cash Price	$905.52
Rate for Payer: Cash Price	$905.52
Rate for Payer: Cigna Commercial	$826.08
Rate for Payer: Cigna Medicaid	$86.38
Rate for Payer: Cigna Medicare	$364.67
Rate for Payer: Employer Direct Commercial	$364.67
Rate for Payer: Humana Medicare/TRICARE	$364.67
Rate for Payer: Molina CHIP/Medicaid	$86.38
Rate for Payer: Molina Dual Medicare/Medicaid	$364.67
Rate for Payer: Molina Medicare	$364.67
Rate for Payer: Multiplan Auto	$668.85
Rate for Payer: Multiplan Commercial	$668.85
Rate for Payer: Multiplan Workers Comp	$668.85
Rate for Payer: Parkland Medicaid	$86.38
Rate for Payer: Scott and White EPO/PPO	$6.52
Rate for Payer: Scott and White Medicare	$364.67
Rate for Payer: Superior Health Plan CHIP/Medicaid	$86.38
Rate for Payer: Superior Health Plan EPO	$364.67
Rate for Payer: Superior Health Plan Medicare	$364.67
Rate for Payer: Universal American Dual Medicare/Medicaid	$364.67
Rate for Payer: Universal American Medicare	$364.67
Rate for Payer: Wellcare Medicare	$364.67
Rate for Payer: Wellmed Medicare	$364.67

WC Remove Foreign Body, Simple BCE

Facility

$1,029.00

Service Code	CPT 10120
Hospital Charge Code	7150139
Hospital Revenue Code	761
Rate for Payer: Cash Price	$905.52

WC Sel Sharp Deb <=20 Sq cm BCE

Facility

$399.00

Service Code	CPT 97597
Hospital Charge Code	7150659
Hospital Revenue Code	761
Rate for Payer: Cash Price	$351.12

Know your out-of-pocket cost for care.

All Charges