White Rock Medical Center

All Charges

Charge

Type

Setting

Price

TENDON, MUSCLE AND OTHER SOFT TISSUE PROCEDURES

Facility

$15,599.03

Service Code	APR-DRG 3174
Min. Negotiated Rate	$14,707.31
Max. Negotiated Rate	$15,599.03
Rate for Payer: Amerigroup CHIP/Medicaid	$14,707.31
Rate for Payer: Cigna Medicaid	$14,707.31
Rate for Payer: Molina CHIP/Medicaid	$14,707.31
Rate for Payer: Parkland Medicaid	$14,707.31
Rate for Payer: Superior Health Plan CHIP/Medicaid	$15,599.03

Tendon sheath incision (eg, for trigger finger)

Facility

$10,000.00

Service Code	CPT 26055
Hospital Charge Code	36026055
Hospital Revenue Code	360
Min. Negotiated Rate	$593.04
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$593.04
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$1,615.32
Rate for Payer: Amerigroup Medicare	$1,615.32
Rate for Payer: BCBS of TX Blue Advantage	$2,263.50
Rate for Payer: BCBS of TX Blue Essentials	$2,710.78
Rate for Payer: BCBS of TX Medicare	$1,615.32
Rate for Payer: BCBS of TX PPO	$3,415.58
Rate for Payer: Cigna Commercial	$3,414.49
Rate for Payer: Cigna Medicare	$1,615.32
Rate for Payer: Employer Direct Commercial	$1,615.32
Rate for Payer: Humana Medicare/TRICARE	$1,615.32
Rate for Payer: Molina Dual Medicare/Medicaid	$1,615.32
Rate for Payer: Molina Medicare	$1,615.32
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	$2,719.24
Rate for Payer: Scott and White Medicare	$1,615.32
Rate for Payer: Superior Health Plan EPO	$1,615.32
Rate for Payer: Superior Health Plan Medicare	$1,615.32
Rate for Payer: Universal American Dual Medicare/Medicaid	$1,615.32
Rate for Payer: Universal American Medicare	$1,615.32
Rate for Payer: Wellcare Medicare	$1,615.32
Rate for Payer: Wellmed Medicare	$1,615.32

Tendon sheath incision (eg, for trigger finger)

Facility

$8,354.10

Service Code	HCPCS 26055
Hospital Charge Code	9900314
Hospital Revenue Code	360
Rate for Payer: Cash Price	$5,680.79

Tendon sheath incision (eg, for trigger finger)

Facility

$8,354.10

Service Code	HCPCS 26055
Hospital Charge Code	9900314
Hospital Revenue Code	360
Min. Negotiated Rate	$593.04
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$593.04
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$1,615.32
Rate for Payer: Amerigroup Medicare	$1,615.32
Rate for Payer: BCBS of TX Blue Advantage	$2,263.50
Rate for Payer: BCBS of TX Blue Essentials	$2,710.78
Rate for Payer: BCBS of TX Medicare	$1,615.32
Rate for Payer: BCBS of TX PPO	$3,415.58
Rate for Payer: Cash Price	$5,680.79
Rate for Payer: Cash Price	$5,680.79
Rate for Payer: Cash Price	$5,680.79
Rate for Payer: Cigna Commercial	$3,414.49
Rate for Payer: Cigna Medicaid	$6,014.95
Rate for Payer: Cigna Medicare	$1,615.32
Rate for Payer: Employer Direct Commercial	$1,615.32
Rate for Payer: Humana Medicare/TRICARE	$1,615.32
Rate for Payer: Molina CHIP/Medicaid	$6,014.95
Rate for Payer: Molina Dual Medicare/Medicaid	$1,615.32
Rate for Payer: Molina Medicare	$1,615.32
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	$6,014.95
Rate for Payer: Scott and White EPO/PPO	$2,719.24
Rate for Payer: Scott and White Medicare	$1,615.32
Rate for Payer: Superior Health Plan CHIP/Medicaid	$6,014.95
Rate for Payer: Superior Health Plan EPO	$1,615.32
Rate for Payer: Superior Health Plan Medicare	$1,615.32
Rate for Payer: Universal American Dual Medicare/Medicaid	$1,615.32
Rate for Payer: Universal American Medicare	$1,615.32
Rate for Payer: Wellcare Medicare	$1,615.32
Rate for Payer: Wellmed Medicare	$1,615.32

Tendon transplantation or transfer, flexor or extensor, forearm and/or wrist, single each tendon

Facility

$13,479.00

Service Code	HCPCS 25310
Hospital Charge Code	9900287
Hospital Revenue Code	360
Min. Negotiated Rate	$1,088.27
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$1,088.27
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$3,286.91
Rate for Payer: Amerigroup Medicare	$3,286.91
Rate for Payer: BCBS of TX Blue Advantage	$4,571.54
Rate for Payer: BCBS of TX Blue Essentials	$5,474.90
Rate for Payer: BCBS of TX Medicare	$3,286.91
Rate for Payer: BCBS of TX PPO	$6,898.37
Rate for Payer: Cash Price	$9,165.72
Rate for Payer: Cash Price	$9,165.72
Rate for Payer: Cash Price	$9,165.72
Rate for Payer: Cigna Commercial	$6,947.94
Rate for Payer: Cigna Medicaid	$9,704.88
Rate for Payer: Cigna Medicare	$3,286.91
Rate for Payer: Employer Direct Commercial	$3,286.91
Rate for Payer: Humana Medicare/TRICARE	$3,286.91
Rate for Payer: Molina CHIP/Medicaid	$9,704.88
Rate for Payer: Molina Dual Medicare/Medicaid	$3,286.91
Rate for Payer: Molina Medicare	$3,286.91
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	$9,704.88
Rate for Payer: Scott and White EPO/PPO	$5,476.44
Rate for Payer: Scott and White Medicare	$3,286.91
Rate for Payer: Superior Health Plan CHIP/Medicaid	$9,704.88
Rate for Payer: Superior Health Plan EPO	$3,286.91
Rate for Payer: Superior Health Plan Medicare	$3,286.91
Rate for Payer: Universal American Dual Medicare/Medicaid	$3,286.91
Rate for Payer: Universal American Medicare	$3,286.91
Rate for Payer: Wellcare Medicare	$3,286.91
Rate for Payer: Wellmed Medicare	$3,286.91

Tendon transplantation or transfer, flexor or extensor, forearm and/or wrist, single each tendon

Facility

$13,479.00

Service Code	HCPCS 25310
Hospital Charge Code	9900287
Hospital Revenue Code	360
Rate for Payer: Cash Price	$9,165.72

Tendon transplantation or transfer, flexor or extensor, forearm and/or wrist, single each tendon

Facility

$10,000.00

Service Code	CPT 25310
Hospital Charge Code	36025310
Hospital Revenue Code	360
Min. Negotiated Rate	$1,088.27
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$1,088.27
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$3,286.91
Rate for Payer: Amerigroup Medicare	$3,286.91
Rate for Payer: BCBS of TX Blue Advantage	$4,571.54
Rate for Payer: BCBS of TX Blue Essentials	$5,474.90
Rate for Payer: BCBS of TX Medicare	$3,286.91
Rate for Payer: BCBS of TX PPO	$6,898.37
Rate for Payer: Cigna Commercial	$6,947.94
Rate for Payer: Cigna Medicare	$3,286.91
Rate for Payer: Employer Direct Commercial	$3,286.91
Rate for Payer: Humana Medicare/TRICARE	$3,286.91
Rate for Payer: Molina Dual Medicare/Medicaid	$3,286.91
Rate for Payer: Molina Medicare	$3,286.91
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	$5,476.44
Rate for Payer: Scott and White Medicare	$3,286.91
Rate for Payer: Superior Health Plan EPO	$3,286.91
Rate for Payer: Superior Health Plan Medicare	$3,286.91
Rate for Payer: Universal American Dual Medicare/Medicaid	$3,286.91
Rate for Payer: Universal American Medicare	$3,286.91
Rate for Payer: Wellcare Medicare	$3,286.91
Rate for Payer: Wellmed Medicare	$3,286.91

Tendril Leads_U_PR

Facility

$2,472.29

Service Code	HCPCS C1898
Hospital Charge Code	82418658
Hospital Revenue Code	278
Min. Negotiated Rate	$618.07
Max. Negotiated Rate	$1,236.14
Rate for Payer: Cash Price	$1,681.16
Rate for Payer: Cigna Commercial	$618.07
Rate for Payer: Multiplan Auto	$1,236.14
Rate for Payer: Multiplan Commercial	$1,236.14
Rate for Payer: Multiplan Workers Comp	$1,236.14
Rate for Payer: Scott and White EPO/PPO	$1,236.14

Tendril Leads_U_PR

Facility

$2,472.29

Service Code	HCPCS C1898
Hospital Charge Code	991309
Hospital Revenue Code	278
Min. Negotiated Rate	$222.51
Max. Negotiated Rate	$1,780.05
Rate for Payer: Amerigroup CHIP/Medicaid	$222.51
Rate for Payer: BCBS of TX Blue Advantage	$741.69
Rate for Payer: BCBS of TX Blue Essentials	$890.02
Rate for Payer: BCBS of TX PPO	$988.92
Rate for Payer: Cash Price	$1,681.16
Rate for Payer: Cigna Medicaid	$1,780.05
Rate for Payer: Molina CHIP/Medicaid	$1,780.05
Rate for Payer: Multiplan Auto	$1,236.14
Rate for Payer: Multiplan Commercial	$1,236.14
Rate for Payer: Multiplan Workers Comp	$1,236.14
Rate for Payer: Parkland Medicaid	$1,780.05
Rate for Payer: Scott and White EPO/PPO	$1,236.14
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,780.05
Rate for Payer: Superior Health Plan EPO	$336.23

Tendril Leads_U_PR

Facility

$2,472.29

Service Code	HCPCS C1898
Hospital Charge Code	82418658
Hospital Revenue Code	278
Min. Negotiated Rate	$222.51
Max. Negotiated Rate	$1,780.05
Rate for Payer: Amerigroup CHIP/Medicaid	$222.51
Rate for Payer: BCBS of TX Blue Advantage	$741.69
Rate for Payer: BCBS of TX Blue Essentials	$890.02
Rate for Payer: BCBS of TX PPO	$988.92
Rate for Payer: Cash Price	$1,681.16
Rate for Payer: Cigna Medicaid	$1,780.05
Rate for Payer: Molina CHIP/Medicaid	$1,780.05
Rate for Payer: Multiplan Auto	$1,236.14
Rate for Payer: Multiplan Commercial	$1,236.14
Rate for Payer: Multiplan Workers Comp	$1,236.14
Rate for Payer: Parkland Medicaid	$1,780.05
Rate for Payer: Scott and White EPO/PPO	$1,236.14
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,780.05
Rate for Payer: Superior Health Plan EPO	$336.23

Tendril Leads_U_PR

Facility

$2,472.29

Service Code	HCPCS C1898
Hospital Charge Code	991309
Hospital Revenue Code	278
Min. Negotiated Rate	$618.07
Max. Negotiated Rate	$1,236.14
Rate for Payer: Cash Price	$1,681.16
Rate for Payer: Cigna Commercial	$618.07
Rate for Payer: Multiplan Auto	$1,236.14
Rate for Payer: Multiplan Commercial	$1,236.14
Rate for Payer: Multiplan Workers Comp	$1,236.14
Rate for Payer: Scott and White EPO/PPO	$1,236.14

Tendril STS Leads_U_MY

Facility

$1,863.22

Hospital Charge Code	993849
Hospital Revenue Code	272
Rate for Payer: Cash Price	$1,266.99

Tendril STS Leads_U_MY

Facility

$1,863.22

Hospital Charge Code	993849
Hospital Revenue Code	272
Min. Negotiated Rate	$167.69
Max. Negotiated Rate	$1,341.52
Rate for Payer: Amerigroup CHIP/Medicaid	$167.69
Rate for Payer: BCBS of TX Blue Advantage	$558.97
Rate for Payer: BCBS of TX Blue Essentials	$670.76
Rate for Payer: BCBS of TX PPO	$745.29
Rate for Payer: Cash Price	$1,266.99
Rate for Payer: Cigna Medicaid	$1,341.52
Rate for Payer: Molina CHIP/Medicaid	$1,341.52
Rate for Payer: Multiplan Auto	$1,211.09
Rate for Payer: Multiplan Commercial	$1,211.09
Rate for Payer: Multiplan Workers Comp	$1,211.09
Rate for Payer: Parkland Medicaid	$1,341.52
Rate for Payer: Scott and White EPO/PPO	$931.61
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,341.52
Rate for Payer: Superior Health Plan EPO	$253.40

tenecteplase 50mg VL

Facility

$17,025.97

Service Code	HCPCS J3101
Hospital Charge Code	7894597
Hospital Revenue Code	636
Min. Negotiated Rate	$175.09
Max. Negotiated Rate	$12,258.70
Rate for Payer: Amerigroup CHIP/Medicaid	$1,532.34
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$186.97
Rate for Payer: Amerigroup Medicare	$186.97
Rate for Payer: BCBS of TX Blue Advantage	$175.09
Rate for Payer: BCBS of TX Blue Essentials	$210.10
Rate for Payer: BCBS of TX Medicare	$186.97
Rate for Payer: BCBS of TX PPO	$233.05
Rate for Payer: Cash Price	$11,577.66
Rate for Payer: Cash Price	$11,577.66
Rate for Payer: Cigna Medicaid	$12,258.70
Rate for Payer: Cigna Medicare	$186.97
Rate for Payer: Employer Direct Commercial	$186.97
Rate for Payer: Humana Medicare/TRICARE	$186.97
Rate for Payer: Molina CHIP/Medicaid	$12,258.70
Rate for Payer: Molina Dual Medicare/Medicaid	$186.97
Rate for Payer: Molina Medicare	$186.97
Rate for Payer: Multiplan Auto	$11,066.88
Rate for Payer: Multiplan Commercial	$11,066.88
Rate for Payer: Multiplan Workers Comp	$11,066.88
Rate for Payer: Parkland Medicaid	$12,258.70
Rate for Payer: Scott and White EPO/PPO	$8,512.99
Rate for Payer: Scott and White Medicare	$186.97
Rate for Payer: Superior Health Plan CHIP/Medicaid	$12,258.70
Rate for Payer: Superior Health Plan EPO	$186.97
Rate for Payer: Superior Health Plan Medicare	$186.97
Rate for Payer: Universal American Dual Medicare/Medicaid	$186.97
Rate for Payer: Universal American Medicare	$186.97
Rate for Payer: Wellcare Medicare	$186.97
Rate for Payer: Wellmed Medicare	$186.97

tenecteplase 50mg VL

Facility

$17,025.97

Service Code	HCPCS J3101
Hospital Charge Code	7894597
Hospital Revenue Code	636
Min. Negotiated Rate	$4,256.49
Max. Negotiated Rate	$8,512.99
Rate for Payer: Cash Price	$11,577.66
Rate for Payer: Cigna Commercial	$4,256.49
Rate for Payer: Scott and White EPO/PPO	$8,512.99

Tenodesis at wrist extensors of fingers

Facility

$10,000.00

Service Code	CPT 25301
Hospital Charge Code	36025301
Hospital Revenue Code	360
Min. Negotiated Rate	$1,088.27
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$1,088.27
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$3,286.91
Rate for Payer: Amerigroup Medicare	$3,286.91
Rate for Payer: BCBS of TX Blue Advantage	$4,571.54
Rate for Payer: BCBS of TX Blue Essentials	$5,474.90
Rate for Payer: BCBS of TX Medicare	$3,286.91
Rate for Payer: BCBS of TX PPO	$6,898.37
Rate for Payer: Cigna Commercial	$6,947.94
Rate for Payer: Cigna Medicare	$3,286.91
Rate for Payer: Employer Direct Commercial	$3,286.91
Rate for Payer: Humana Medicare/TRICARE	$3,286.91
Rate for Payer: Molina Dual Medicare/Medicaid	$3,286.91
Rate for Payer: Molina Medicare	$3,286.91
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	$5,476.44
Rate for Payer: Scott and White Medicare	$3,286.91
Rate for Payer: Superior Health Plan EPO	$3,286.91
Rate for Payer: Superior Health Plan Medicare	$3,286.91
Rate for Payer: Universal American Dual Medicare/Medicaid	$3,286.91
Rate for Payer: Universal American Medicare	$3,286.91
Rate for Payer: Wellcare Medicare	$3,286.91
Rate for Payer: Wellmed Medicare	$3,286.91

Tenodesis at wrist extensors of fingers

Facility

$22,566.55

Service Code	HCPCS 25301
Hospital Charge Code	9900286
Hospital Revenue Code	360
Min. Negotiated Rate	$1,088.27
Max. Negotiated Rate	$16,247.92
Rate for Payer: Amerigroup CHIP/Medicaid	$1,088.27
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$3,286.91
Rate for Payer: Amerigroup Medicare	$3,286.91
Rate for Payer: BCBS of TX Blue Advantage	$4,571.54
Rate for Payer: BCBS of TX Blue Essentials	$5,474.90
Rate for Payer: BCBS of TX Medicare	$3,286.91
Rate for Payer: BCBS of TX PPO	$6,898.37
Rate for Payer: Cash Price	$15,345.25
Rate for Payer: Cash Price	$15,345.25
Rate for Payer: Cash Price	$15,345.25
Rate for Payer: Cigna Commercial	$6,947.94
Rate for Payer: Cigna Medicaid	$16,247.92
Rate for Payer: Cigna Medicare	$3,286.91
Rate for Payer: Employer Direct Commercial	$3,286.91
Rate for Payer: Humana Medicare/TRICARE	$3,286.91
Rate for Payer: Molina CHIP/Medicaid	$16,247.92
Rate for Payer: Molina Dual Medicare/Medicaid	$3,286.91
Rate for Payer: Molina Medicare	$3,286.91
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	$16,247.92
Rate for Payer: Scott and White EPO/PPO	$5,476.44
Rate for Payer: Scott and White Medicare	$3,286.91
Rate for Payer: Superior Health Plan CHIP/Medicaid	$16,247.92
Rate for Payer: Superior Health Plan EPO	$3,286.91
Rate for Payer: Superior Health Plan Medicare	$3,286.91
Rate for Payer: Universal American Dual Medicare/Medicaid	$3,286.91
Rate for Payer: Universal American Medicare	$3,286.91
Rate for Payer: Wellcare Medicare	$3,286.91
Rate for Payer: Wellmed Medicare	$3,286.91

Tenodesis at wrist extensors of fingers

Facility

$22,566.55

Service Code	HCPCS 25301
Hospital Charge Code	9900286
Hospital Revenue Code	360
Rate for Payer: Cash Price	$15,345.25

Tenodesis of long tendon of biceps

Facility

$50,119.60

Service Code	HCPCS 23430
Hospital Charge Code	9900224
Hospital Revenue Code	360
Rate for Payer: Cash Price	$34,081.33

Tenodesis of long tendon of biceps

Facility

$15,408.22

Service Code	CPT 23430
Hospital Charge Code	36023430
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	$12,104.03
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

Tenodesis of long tendon of biceps

Facility

$50,119.60

Service Code	HCPCS 23430
Hospital Charge Code	9900224
Hospital Revenue Code	360
Min. Negotiated Rate	$2,398.52
Max. Negotiated Rate	$36,086.11
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	$34,081.33
Rate for Payer: Cash Price	$34,081.33
Rate for Payer: Cash Price	$34,081.33
Rate for Payer: Cigna Commercial	$15,408.22
Rate for Payer: Cigna Medicaid	$36,086.11
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	$36,086.11
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	$36,086.11
Rate for Payer: Scott and White EPO/PPO	$12,104.03
Rate for Payer: Scott and White Medicare	$7,289.28
Rate for Payer: Superior Health Plan CHIP/Medicaid	$36,086.11
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

Tenolysis, complex, extensor tendon, finger, including forearm, each tendon

Facility

$10,000.00

Service Code	CPT 26449
Hospital Charge Code	36026449
Hospital Revenue Code	360
Min. Negotiated Rate	$1,088.27
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$1,088.27
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$3,286.91
Rate for Payer: Amerigroup Medicare	$3,286.91
Rate for Payer: BCBS of TX Blue Advantage	$4,571.54
Rate for Payer: BCBS of TX Blue Essentials	$5,474.90
Rate for Payer: BCBS of TX Medicare	$3,286.91
Rate for Payer: BCBS of TX PPO	$6,898.37
Rate for Payer: Cigna Commercial	$6,947.94
Rate for Payer: Cigna Medicare	$3,286.91
Rate for Payer: Employer Direct Commercial	$3,286.91
Rate for Payer: Humana Medicare/TRICARE	$3,286.91
Rate for Payer: Molina Dual Medicare/Medicaid	$3,286.91
Rate for Payer: Molina Medicare	$3,286.91
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	$5,476.44
Rate for Payer: Scott and White Medicare	$3,286.91
Rate for Payer: Superior Health Plan EPO	$3,286.91
Rate for Payer: Superior Health Plan Medicare	$3,286.91
Rate for Payer: Universal American Dual Medicare/Medicaid	$3,286.91
Rate for Payer: Universal American Medicare	$3,286.91
Rate for Payer: Wellcare Medicare	$3,286.91
Rate for Payer: Wellmed Medicare	$3,286.91

Tenolysis, complex, extensor tendon, finger, including forearm, each tendon

Facility

$8,491.20

Service Code	HCPCS 26449
Hospital Charge Code	9900344
Hospital Revenue Code	360
Min. Negotiated Rate	$1,088.27
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$1,088.27
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$3,286.91
Rate for Payer: Amerigroup Medicare	$3,286.91
Rate for Payer: BCBS of TX Blue Advantage	$4,571.54
Rate for Payer: BCBS of TX Blue Essentials	$5,474.90
Rate for Payer: BCBS of TX Medicare	$3,286.91
Rate for Payer: BCBS of TX PPO	$6,898.37
Rate for Payer: Cash Price	$5,774.02
Rate for Payer: Cash Price	$5,774.02
Rate for Payer: Cash Price	$5,774.02
Rate for Payer: Cigna Commercial	$6,947.94
Rate for Payer: Cigna Medicaid	$6,113.66
Rate for Payer: Cigna Medicare	$3,286.91
Rate for Payer: Employer Direct Commercial	$3,286.91
Rate for Payer: Humana Medicare/TRICARE	$3,286.91
Rate for Payer: Molina CHIP/Medicaid	$6,113.66
Rate for Payer: Molina Dual Medicare/Medicaid	$3,286.91
Rate for Payer: Molina Medicare	$3,286.91
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	$6,113.66
Rate for Payer: Scott and White EPO/PPO	$5,476.44
Rate for Payer: Scott and White Medicare	$3,286.91
Rate for Payer: Superior Health Plan CHIP/Medicaid	$6,113.66
Rate for Payer: Superior Health Plan EPO	$3,286.91
Rate for Payer: Superior Health Plan Medicare	$3,286.91
Rate for Payer: Universal American Dual Medicare/Medicaid	$3,286.91
Rate for Payer: Universal American Medicare	$3,286.91
Rate for Payer: Wellcare Medicare	$3,286.91
Rate for Payer: Wellmed Medicare	$3,286.91

Tenolysis, complex, extensor tendon, finger, including forearm, each tendon

Facility

$8,491.20

Service Code	HCPCS 26449
Hospital Charge Code	9900344
Hospital Revenue Code	360
Rate for Payer: Cash Price	$5,774.02

Tenolysis, flexor, foot; single tendon

Facility

$10,000.00

Service Code	CPT 28220
Hospital Charge Code	36028220
Hospital Revenue Code	360
Min. Negotiated Rate	$227.02
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$227.02
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$1,615.32
Rate for Payer: Amerigroup Medicare	$1,615.32
Rate for Payer: BCBS of TX Blue Advantage	$476.13
Rate for Payer: BCBS of TX Blue Essentials	$570.22
Rate for Payer: BCBS of TX Medicare	$1,615.32
Rate for Payer: BCBS of TX PPO	$718.48
Rate for Payer: Cigna Commercial	$3,414.49
Rate for Payer: Cigna Medicare	$1,615.32
Rate for Payer: Employer Direct Commercial	$1,615.32
Rate for Payer: Humana Medicare/TRICARE	$1,615.32
Rate for Payer: Molina Dual Medicare/Medicaid	$1,615.32
Rate for Payer: Molina Medicare	$1,615.32
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	$2,719.24
Rate for Payer: Scott and White Medicare	$1,615.32
Rate for Payer: Superior Health Plan EPO	$1,615.32
Rate for Payer: Superior Health Plan Medicare	$1,615.32
Rate for Payer: Universal American Dual Medicare/Medicaid	$1,615.32
Rate for Payer: Universal American Medicare	$1,615.32
Rate for Payer: Wellcare Medicare	$1,615.32
Rate for Payer: Wellmed Medicare	$1,615.32

Know your out-of-pocket cost for care.

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