White Rock Medical Center

All Charges

Charge

Type

Setting

Price

ARTELON FLEXBAND PLUS 0.7X8CM 41055

Facility

$15,060.00

Service Code	HCPCS C1734
Hospital Charge Code	145246
Hospital Revenue Code	278
Min. Negotiated Rate	$3,765.00
Max. Negotiated Rate	$7,530.00
Rate for Payer: Cash Price	$10,240.80
Rate for Payer: Cigna Commercial	$3,765.00
Rate for Payer: Multiplan Auto	$7,530.00
Rate for Payer: Multiplan Commercial	$7,530.00
Rate for Payer: Multiplan Workers Comp	$7,530.00
Rate for Payer: Scott and White EPO/PPO	$7,530.00

ARTELON FLEXBAND PLUS 0.7X8CM 41055

Facility

$15,060.00

Service Code	HCPCS C1734
Hospital Charge Code	145246
Hospital Revenue Code	278
Min. Negotiated Rate	$1,355.40
Max. Negotiated Rate	$10,843.20
Rate for Payer: Amerigroup CHIP/Medicaid	$1,355.40
Rate for Payer: BCBS of TX Blue Advantage	$4,518.00
Rate for Payer: BCBS of TX Blue Essentials	$5,421.60
Rate for Payer: BCBS of TX PPO	$6,024.00
Rate for Payer: Cash Price	$10,240.80
Rate for Payer: Cigna Medicaid	$10,843.20
Rate for Payer: Molina CHIP/Medicaid	$10,843.20
Rate for Payer: Multiplan Auto	$7,530.00
Rate for Payer: Multiplan Commercial	$7,530.00
Rate for Payer: Multiplan Workers Comp	$7,530.00
Rate for Payer: Parkland Medicaid	$10,843.20
Rate for Payer: Scott and White EPO/PPO	$7,530.00
Rate for Payer: Superior Health Plan CHIP/Medicaid	$10,843.20
Rate for Payer: Superior Health Plan EPO	$2,048.16

ARTERIAL CLOSURE DEVICE INDIVIDUAL UNITS

Facility

$567.50

Service Code	HCPCS C1760
Hospital Charge Code	991307
Hospital Revenue Code	272
Rate for Payer: Cash Price	$385.90

ARTERIAL CLOSURE DEVICE INDIVIDUAL UNITS

Facility

$567.50

Service Code	HCPCS C1760
Hospital Charge Code	991307
Hospital Revenue Code	272
Min. Negotiated Rate	$51.08
Max. Negotiated Rate	$408.60
Rate for Payer: Amerigroup CHIP/Medicaid	$51.08
Rate for Payer: BCBS of TX Blue Advantage	$170.25
Rate for Payer: BCBS of TX Blue Essentials	$204.30
Rate for Payer: BCBS of TX PPO	$227.00
Rate for Payer: Cash Price	$385.90
Rate for Payer: Cigna Medicaid	$408.60
Rate for Payer: Molina CHIP/Medicaid	$408.60
Rate for Payer: Multiplan Auto	$368.88
Rate for Payer: Multiplan Commercial	$368.88
Rate for Payer: Multiplan Workers Comp	$368.88
Rate for Payer: Parkland Medicaid	$408.60
Rate for Payer: Scott and White EPO/PPO	$283.75
Rate for Payer: Superior Health Plan CHIP/Medicaid	$408.60
Rate for Payer: Superior Health Plan EPO	$77.18

Arterial Line Activity: -> Blood Drawn

Facility

$153.00

Service Code	HCPCS 36600
Hospital Charge Code	4000345
Hospital Revenue Code	410
Rate for Payer: Cash Price	$104.04

Arterial Line Activity: -> Blood Drawn

Facility

$153.00

Service Code	HCPCS 36600
Hospital Charge Code	4000345
Hospital Revenue Code	410
Min. Negotiated Rate	$13.77
Max. Negotiated Rate	$282.53
Rate for Payer: Amerigroup CHIP/Medicaid	$13.77
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$133.65
Rate for Payer: Amerigroup Medicare	$133.65
Rate for Payer: BCBS of TX Blue Advantage	$182.08
Rate for Payer: BCBS of TX Blue Essentials	$218.06
Rate for Payer: BCBS of TX Medicare	$133.65
Rate for Payer: BCBS of TX PPO	$274.76
Rate for Payer: Cash Price	$104.04
Rate for Payer: Cash Price	$104.04
Rate for Payer: Cash Price	$104.04
Rate for Payer: Cigna Commercial	$282.53
Rate for Payer: Cigna Medicaid	$110.16
Rate for Payer: Cigna Medicare	$133.65
Rate for Payer: Employer Direct Commercial	$133.65
Rate for Payer: Humana Medicare/TRICARE	$133.65
Rate for Payer: Molina CHIP/Medicaid	$110.16
Rate for Payer: Molina Dual Medicare/Medicaid	$133.65
Rate for Payer: Molina Medicare	$133.65
Rate for Payer: Multiplan Auto	$99.45
Rate for Payer: Multiplan Commercial	$99.45
Rate for Payer: Multiplan Workers Comp	$99.45
Rate for Payer: Parkland Medicaid	$110.16
Rate for Payer: Scott and White EPO/PPO	$18.09
Rate for Payer: Scott and White Medicare	$133.65
Rate for Payer: Superior Health Plan CHIP/Medicaid	$110.16
Rate for Payer: Superior Health Plan EPO	$133.65
Rate for Payer: Superior Health Plan Medicare	$133.65
Rate for Payer: Universal American Dual Medicare/Medicaid	$133.65
Rate for Payer: Universal American Medicare	$133.65
Rate for Payer: Wellcare Medicare	$133.65
Rate for Payer: Wellmed Medicare	$133.65

ARTERIOG CAR NKHD SEL

Facility

$16,514.00

Service Code	HCPCS 36224
Hospital Charge Code	4616226
Hospital Revenue Code	481
Rate for Payer: Cash Price	$11,229.52

ARTERIOG CAR NKHD SEL

Facility

$16,514.00

Service Code	HCPCS 36224
Hospital Charge Code	4616226
Hospital Revenue Code	481
Min. Negotiated Rate	$441.36
Max. Negotiated Rate	$11,890.08
Rate for Payer: Amerigroup CHIP/Medicaid	$1,486.26
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$5,589.84
Rate for Payer: Amerigroup Medicare	$5,589.84
Rate for Payer: BCBS of TX Blue Advantage	$7,675.64
Rate for Payer: BCBS of TX Blue Essentials	$9,192.38
Rate for Payer: BCBS of TX Medicare	$5,589.84
Rate for Payer: BCBS of TX PPO	$11,582.40
Rate for Payer: Cash Price	$11,229.52
Rate for Payer: Cash Price	$11,229.52
Rate for Payer: Cash Price	$11,229.52
Rate for Payer: Cigna Commercial	$11,815.91
Rate for Payer: Cigna Medicaid	$11,890.08
Rate for Payer: Cigna Medicare	$5,589.84
Rate for Payer: Employer Direct Commercial	$5,589.84
Rate for Payer: Humana Medicare/TRICARE	$5,589.84
Rate for Payer: Molina CHIP/Medicaid	$11,890.08
Rate for Payer: Molina Dual Medicare/Medicaid	$5,589.84
Rate for Payer: Molina Medicare	$5,589.84
Rate for Payer: Multiplan Auto	$10,734.10
Rate for Payer: Multiplan Commercial	$10,734.10
Rate for Payer: Multiplan Workers Comp	$10,734.10
Rate for Payer: Parkland Medicaid	$11,890.08
Rate for Payer: Scott and White EPO/PPO	$441.36
Rate for Payer: Scott and White Medicare	$5,589.84
Rate for Payer: Superior Health Plan CHIP/Medicaid	$11,890.08
Rate for Payer: Superior Health Plan EPO	$5,589.84
Rate for Payer: Superior Health Plan Medicare	$5,589.84
Rate for Payer: Universal American Dual Medicare/Medicaid	$5,589.84
Rate for Payer: Universal American Medicare	$5,589.84
Rate for Payer: Wellcare Medicare	$5,589.84
Rate for Payer: Wellmed Medicare	$5,589.84

ARTERIOGR CAR NK SEL

Facility

$9,038.00

Service Code	HCPCS 36222
Hospital Charge Code	4616222
Hospital Revenue Code	481
Min. Negotiated Rate	$340.99
Max. Negotiated Rate	$6,983.63
Rate for Payer: Amerigroup CHIP/Medicaid	$813.42
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$3,171.87
Rate for Payer: Amerigroup Medicare	$3,171.87
Rate for Payer: BCBS of TX Blue Advantage	$4,628.04
Rate for Payer: BCBS of TX Blue Essentials	$5,542.56
Rate for Payer: BCBS of TX Medicare	$3,171.87
Rate for Payer: BCBS of TX PPO	$6,983.63
Rate for Payer: Cash Price	$6,145.84
Rate for Payer: Cash Price	$6,145.84
Rate for Payer: Cash Price	$6,145.84
Rate for Payer: Cigna Commercial	$6,704.76
Rate for Payer: Cigna Medicaid	$6,507.36
Rate for Payer: Cigna Medicare	$3,171.87
Rate for Payer: Employer Direct Commercial	$3,171.87
Rate for Payer: Humana Medicare/TRICARE	$3,171.87
Rate for Payer: Molina CHIP/Medicaid	$6,507.36
Rate for Payer: Molina Dual Medicare/Medicaid	$3,171.87
Rate for Payer: Molina Medicare	$3,171.87
Rate for Payer: Multiplan Auto	$5,874.70
Rate for Payer: Multiplan Commercial	$5,874.70
Rate for Payer: Multiplan Workers Comp	$5,874.70
Rate for Payer: Parkland Medicaid	$6,507.36
Rate for Payer: Scott and White EPO/PPO	$340.99
Rate for Payer: Scott and White Medicare	$3,171.87
Rate for Payer: Superior Health Plan CHIP/Medicaid	$6,507.36
Rate for Payer: Superior Health Plan EPO	$3,171.87
Rate for Payer: Superior Health Plan Medicare	$3,171.87
Rate for Payer: Universal American Dual Medicare/Medicaid	$3,171.87
Rate for Payer: Universal American Medicare	$3,171.87
Rate for Payer: Wellcare Medicare	$3,171.87
Rate for Payer: Wellmed Medicare	$3,171.87

ARTERIOGR CAR NK SEL

Facility

$9,038.00

Service Code	HCPCS 36222
Hospital Charge Code	4616222
Hospital Revenue Code	481
Rate for Payer: Cash Price	$6,145.84

ARTERIOG SUBC/INOM

Facility

$7,212.00

Service Code	HCPCS 36225
Hospital Charge Code	4616228
Hospital Revenue Code	481
Min. Negotiated Rate	$390.01
Max. Negotiated Rate	$6,983.63
Rate for Payer: Amerigroup CHIP/Medicaid	$649.08
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$3,171.87
Rate for Payer: Amerigroup Medicare	$3,171.87
Rate for Payer: BCBS of TX Blue Advantage	$4,628.04
Rate for Payer: BCBS of TX Blue Essentials	$5,542.56
Rate for Payer: BCBS of TX Medicare	$3,171.87
Rate for Payer: BCBS of TX PPO	$6,983.63
Rate for Payer: Cash Price	$4,904.16
Rate for Payer: Cash Price	$4,904.16
Rate for Payer: Cash Price	$4,904.16
Rate for Payer: Cigna Commercial	$6,704.76
Rate for Payer: Cigna Medicaid	$5,192.64
Rate for Payer: Cigna Medicare	$3,171.87
Rate for Payer: Employer Direct Commercial	$3,171.87
Rate for Payer: Humana Medicare/TRICARE	$3,171.87
Rate for Payer: Molina CHIP/Medicaid	$5,192.64
Rate for Payer: Molina Dual Medicare/Medicaid	$3,171.87
Rate for Payer: Molina Medicare	$3,171.87
Rate for Payer: Multiplan Auto	$4,687.80
Rate for Payer: Multiplan Commercial	$4,687.80
Rate for Payer: Multiplan Workers Comp	$4,687.80
Rate for Payer: Parkland Medicaid	$5,192.64
Rate for Payer: Scott and White EPO/PPO	$390.01
Rate for Payer: Scott and White Medicare	$3,171.87
Rate for Payer: Superior Health Plan CHIP/Medicaid	$5,192.64
Rate for Payer: Superior Health Plan EPO	$3,171.87
Rate for Payer: Superior Health Plan Medicare	$3,171.87
Rate for Payer: Universal American Dual Medicare/Medicaid	$3,171.87
Rate for Payer: Universal American Medicare	$3,171.87
Rate for Payer: Wellcare Medicare	$3,171.87
Rate for Payer: Wellmed Medicare	$3,171.87

ARTERIOG SUBC/INOM

Facility

$7,212.00

Service Code	HCPCS 36225
Hospital Charge Code	4616228
Hospital Revenue Code	481
Rate for Payer: Cash Price	$4,904.16

Arteriovenous anastomosis, open; by upper arm cephalic vein transposition

Facility

$21,622.80

Service Code	HCPCS 36818
Hospital Charge Code	994115
Hospital Revenue Code	360
Rate for Payer: Cash Price	$14,703.50

Arteriovenous anastomosis, open; by upper arm cephalic vein transposition

Facility

$21,622.80

Service Code	HCPCS 36818
Hospital Charge Code	994115
Hospital Revenue Code	360
Min. Negotiated Rate	$1,939.15
Max. Negotiated Rate	$15,568.42
Rate for Payer: Amerigroup CHIP/Medicaid	$1,939.15
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$5,589.84
Rate for Payer: Amerigroup Medicare	$5,589.84
Rate for Payer: BCBS of TX Blue Advantage	$7,675.64
Rate for Payer: BCBS of TX Blue Essentials	$9,192.38
Rate for Payer: BCBS of TX Medicare	$5,589.84
Rate for Payer: BCBS of TX PPO	$11,582.40
Rate for Payer: Cash Price	$14,703.50
Rate for Payer: Cash Price	$14,703.50
Rate for Payer: Cash Price	$14,703.50
Rate for Payer: Cigna Commercial	$11,815.91
Rate for Payer: Cigna Medicaid	$15,568.42
Rate for Payer: Cigna Medicare	$5,589.84
Rate for Payer: Employer Direct Commercial	$5,589.84
Rate for Payer: Humana Medicare/TRICARE	$5,589.84
Rate for Payer: Molina CHIP/Medicaid	$15,568.42
Rate for Payer: Molina Dual Medicare/Medicaid	$5,589.84
Rate for Payer: Molina Medicare	$5,589.84
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	$15,568.42
Rate for Payer: Scott and White EPO/PPO	$9,297.64
Rate for Payer: Scott and White Medicare	$5,589.84
Rate for Payer: Superior Health Plan CHIP/Medicaid	$15,568.42
Rate for Payer: Superior Health Plan EPO	$5,589.84
Rate for Payer: Superior Health Plan Medicare	$5,589.84
Rate for Payer: Universal American Dual Medicare/Medicaid	$5,589.84
Rate for Payer: Universal American Medicare	$5,589.84
Rate for Payer: Wellcare Medicare	$5,589.84
Rate for Payer: Wellmed Medicare	$5,589.84

Arteriovenous anastomosis, open; direct, any site (eg, Cimino type) (separate procedure)

Facility

$12,148.04

Service Code	HCPCS 36821
Hospital Charge Code	991128
Hospital Revenue Code	480
Rate for Payer: Cash Price	$8,260.67

Arteriovenous anastomosis, open; direct, any site (eg, Cimino type) (separate procedure)

Facility

$12,148.04

Service Code	HCPCS 36821
Hospital Charge Code	991128
Hospital Revenue Code	480
Min. Negotiated Rate	$785.55
Max. Negotiated Rate	$8,746.59
Rate for Payer: Amerigroup CHIP/Medicaid	$1,093.32
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$3,171.87
Rate for Payer: Amerigroup Medicare	$3,171.87
Rate for Payer: BCBS of TX Blue Advantage	$4,628.04
Rate for Payer: BCBS of TX Blue Essentials	$5,542.56
Rate for Payer: BCBS of TX Medicare	$3,171.87
Rate for Payer: BCBS of TX PPO	$6,983.63
Rate for Payer: Cash Price	$8,260.67
Rate for Payer: Cash Price	$8,260.67
Rate for Payer: Cash Price	$8,260.67
Rate for Payer: Cigna Commercial	$6,704.76
Rate for Payer: Cigna Medicaid	$8,746.59
Rate for Payer: Cigna Medicare	$3,171.87
Rate for Payer: Employer Direct Commercial	$3,171.87
Rate for Payer: Humana Medicare/TRICARE	$3,171.87
Rate for Payer: Molina CHIP/Medicaid	$8,746.59
Rate for Payer: Molina Dual Medicare/Medicaid	$3,171.87
Rate for Payer: Molina Medicare	$3,171.87
Rate for Payer: Multiplan Auto	$7,896.23
Rate for Payer: Multiplan Commercial	$7,896.23
Rate for Payer: Multiplan Workers Comp	$7,896.23
Rate for Payer: Parkland Medicaid	$8,746.59
Rate for Payer: Scott and White EPO/PPO	$785.55
Rate for Payer: Scott and White Medicare	$3,171.87
Rate for Payer: Superior Health Plan CHIP/Medicaid	$8,746.59
Rate for Payer: Superior Health Plan EPO	$3,171.87
Rate for Payer: Superior Health Plan Medicare	$3,171.87
Rate for Payer: Universal American Dual Medicare/Medicaid	$3,171.87
Rate for Payer: Universal American Medicare	$3,171.87
Rate for Payer: Wellcare Medicare	$3,171.87
Rate for Payer: Wellmed Medicare	$3,171.87

ARTEROGRAM ARCH NON SEL

Facility

$6,863.00

Service Code	HCPCS 36221
Hospital Charge Code	4616221
Hospital Revenue Code	361
Rate for Payer: Cash Price	$4,666.84

ARTEROGRAM ARCH NON SEL

Facility

$6,863.00

Service Code	HCPCS 36221
Hospital Charge Code	4616221
Hospital Revenue Code	361
Min. Negotiated Rate	$617.67
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$617.67
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$3,171.87
Rate for Payer: Amerigroup Medicare	$3,171.87
Rate for Payer: BCBS of TX Blue Advantage	$4,628.04
Rate for Payer: BCBS of TX Blue Essentials	$5,542.56
Rate for Payer: BCBS of TX Medicare	$3,171.87
Rate for Payer: BCBS of TX PPO	$6,983.63
Rate for Payer: Cash Price	$4,666.84
Rate for Payer: Cash Price	$4,666.84
Rate for Payer: Cash Price	$4,666.84
Rate for Payer: Cigna Commercial	$6,704.76
Rate for Payer: Cigna Medicaid	$4,941.36
Rate for Payer: Cigna Medicare	$3,171.87
Rate for Payer: Employer Direct Commercial	$3,171.87
Rate for Payer: Humana Medicare/TRICARE	$3,171.87
Rate for Payer: Molina CHIP/Medicaid	$4,941.36
Rate for Payer: Molina Dual Medicare/Medicaid	$3,171.87
Rate for Payer: Molina Medicare	$3,171.87
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	$4,941.36
Rate for Payer: Scott and White EPO/PPO	$5,392.94
Rate for Payer: Scott and White Medicare	$3,171.87
Rate for Payer: Superior Health Plan CHIP/Medicaid	$4,941.36
Rate for Payer: Superior Health Plan EPO	$3,171.87
Rate for Payer: Superior Health Plan Medicare	$3,171.87
Rate for Payer: Universal American Dual Medicare/Medicaid	$3,171.87
Rate for Payer: Universal American Medicare	$3,171.87
Rate for Payer: Wellcare Medicare	$3,171.87
Rate for Payer: Wellmed Medicare	$3,171.87

Arthrocentesis, aspiration an..

Facility

$10,000.00

Service Code	CPT 20610
Hospital Charge Code	36020610
Hospital Revenue Code	360
Min. Negotiated Rate	$27.96
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$27.96
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$308.35
Rate for Payer: Amerigroup Medicare	$308.35
Rate for Payer: BCBS of TX Blue Advantage	$51.84
Rate for Payer: BCBS of TX Blue Essentials	$62.08
Rate for Payer: BCBS of TX Medicare	$308.35
Rate for Payer: BCBS of TX PPO	$78.22
Rate for Payer: Cigna Commercial	$651.79
Rate for Payer: Cigna Medicare	$308.35
Rate for Payer: Employer Direct Commercial	$308.35
Rate for Payer: Humana Medicare/TRICARE	$308.35
Rate for Payer: Molina Dual Medicare/Medicaid	$308.35
Rate for Payer: Molina Medicare	$308.35
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	$501.11
Rate for Payer: Scott and White Medicare	$308.35
Rate for Payer: Superior Health Plan EPO	$308.35
Rate for Payer: Superior Health Plan Medicare	$308.35
Rate for Payer: Universal American Dual Medicare/Medicaid	$308.35
Rate for Payer: Universal American Medicare	$308.35
Rate for Payer: Wellcare Medicare	$308.35
Rate for Payer: Wellmed Medicare	$308.35

Arthrocentesis, aspiration an..

Facility

$1,567.02

Service Code	HCPCS 20610
Hospital Charge Code	9900177
Hospital Revenue Code	360
Min. Negotiated Rate	$27.96
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$27.96
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$308.35
Rate for Payer: Amerigroup Medicare	$308.35
Rate for Payer: BCBS of TX Blue Advantage	$51.84
Rate for Payer: BCBS of TX Blue Essentials	$62.08
Rate for Payer: BCBS of TX Medicare	$308.35
Rate for Payer: BCBS of TX PPO	$78.22
Rate for Payer: Cash Price	$1,065.57
Rate for Payer: Cash Price	$1,065.57
Rate for Payer: Cash Price	$1,065.57
Rate for Payer: Cigna Commercial	$651.79
Rate for Payer: Cigna Medicaid	$1,128.25
Rate for Payer: Cigna Medicare	$308.35
Rate for Payer: Employer Direct Commercial	$308.35
Rate for Payer: Humana Medicare/TRICARE	$308.35
Rate for Payer: Molina CHIP/Medicaid	$1,128.25
Rate for Payer: Molina Dual Medicare/Medicaid	$308.35
Rate for Payer: Molina Medicare	$308.35
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	$1,128.25
Rate for Payer: Scott and White EPO/PPO	$501.11
Rate for Payer: Scott and White Medicare	$308.35
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,128.25
Rate for Payer: Superior Health Plan EPO	$308.35
Rate for Payer: Superior Health Plan Medicare	$308.35
Rate for Payer: Universal American Dual Medicare/Medicaid	$308.35
Rate for Payer: Universal American Medicare	$308.35
Rate for Payer: Wellcare Medicare	$308.35
Rate for Payer: Wellmed Medicare	$308.35

Arthrocentesis, aspiration an..

Facility

$1,567.02

Service Code	HCPCS 20610
Hospital Charge Code	9900177
Hospital Revenue Code	360
Rate for Payer: Cash Price	$1,065.57

Arthrocentesis, aspiration and/or injection, intermediate joint or bursa (eg, temporomandibular, acr

Facility

$10,000.00

Service Code	CPT 20606
Hospital Charge Code	36020606
Hospital Revenue Code	360
Min. Negotiated Rate	$42.36
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$42.36
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$709.10
Rate for Payer: Amerigroup Medicare	$709.10
Rate for Payer: BCBS of TX Blue Advantage	$77.76
Rate for Payer: BCBS of TX Blue Essentials	$93.12
Rate for Payer: BCBS of TX Medicare	$709.10
Rate for Payer: BCBS of TX PPO	$117.33
Rate for Payer: Cigna Commercial	$1,498.91
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 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: Scott and White EPO/PPO	$1,170.03
Rate for Payer: Scott and White Medicare	$709.10
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

Arthrocentesis, aspiration and/or injection, intermediate joint or bursa (eg, temporomandibular, acr

Facility

$3,807.54

Service Code	HCPCS 20606
Hospital Charge Code	9900176
Hospital Revenue Code	360
Rate for Payer: Cash Price	$2,589.13

Arthrocentesis, aspiration and/or injection, intermediate joint or bursa (eg, temporomandibular, acr

Facility

$10,000.00

Service Code	CPT 20605
Hospital Charge Code	36020605
Hospital Revenue Code	360
Min. Negotiated Rate	$23.54
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$23.54
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$308.35
Rate for Payer: Amerigroup Medicare	$308.35
Rate for Payer: BCBS of TX Blue Advantage	$43.39
Rate for Payer: BCBS of TX Blue Essentials	$51.96
Rate for Payer: BCBS of TX Medicare	$308.35
Rate for Payer: BCBS of TX PPO	$65.47
Rate for Payer: Cigna Commercial	$651.79
Rate for Payer: Cigna Medicare	$308.35
Rate for Payer: Employer Direct Commercial	$308.35
Rate for Payer: Humana Medicare/TRICARE	$308.35
Rate for Payer: Molina Dual Medicare/Medicaid	$308.35
Rate for Payer: Molina Medicare	$308.35
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	$501.11
Rate for Payer: Scott and White Medicare	$308.35
Rate for Payer: Superior Health Plan EPO	$308.35
Rate for Payer: Superior Health Plan Medicare	$308.35
Rate for Payer: Universal American Dual Medicare/Medicaid	$308.35
Rate for Payer: Universal American Medicare	$308.35
Rate for Payer: Wellcare Medicare	$308.35
Rate for Payer: Wellmed Medicare	$308.35

Arthrocentesis, aspiration and/or injection, intermediate joint or bursa (eg, temporomandibular, acr

Facility

$1,567.02

Service Code	HCPCS 20605
Hospital Charge Code	9900175
Hospital Revenue Code	360
Rate for Payer: Cash Price	$1,065.57

Know your out-of-pocket cost for care.

All Charges