White Rock Medical Center

All Charges

Charge

Type

Setting

Price

CHED Fracture Site Phalangeal, finger or thumb w/ manipulati

Facility

$1,126.00

Service Code	CPT 26725
Hospital Charge Code	8910618
Hospital Revenue Code	450
Rate for Payer: Cash Price	$990.88

CHED Fracture Site Phalangeal, finger or thumb w/ manipulati

Facility

$1,126.00

Service Code	CPT 26725
Hospital Charge Code	8910618
Hospital Revenue Code	450
Min. Negotiated Rate	$3.86
Max. Negotiated Rate	$731.90
Rate for Payer: Aetna Commercial	$619.30
Rate for Payer: Aetna Medicare	$323.50
Rate for Payer: Amerigroup CHIP/Medicaid	$101.34
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$215.67
Rate for Payer: Amerigroup Medicare	$215.67
Rate for Payer: BCBS of TX Blue Advantage	$181.96
Rate for Payer: BCBS of TX Blue Essentials	$217.92
Rate for Payer: BCBS of TX Medicare	$215.67
Rate for Payer: BCBS of TX PPO	$274.58
Rate for Payer: Cash Price	$990.88
Rate for Payer: Cash Price	$990.88
Rate for Payer: Cash Price	$990.88
Rate for Payer: Cigna Commercial	$488.55
Rate for Payer: Cigna Medicaid	$85.32
Rate for Payer: Cigna Medicare	$215.67
Rate for Payer: Employer Direct Commercial	$215.67
Rate for Payer: Humana Medicare/TRICARE	$215.67
Rate for Payer: Molina CHIP/Medicaid	$85.32
Rate for Payer: Molina Dual Medicare/Medicaid	$215.67
Rate for Payer: Molina Medicare	$215.67
Rate for Payer: Multiplan Auto	$731.90
Rate for Payer: Multiplan Commercial	$731.90
Rate for Payer: Multiplan Workers Comp	$731.90
Rate for Payer: Parkland Medicaid	$85.32
Rate for Payer: Scott and White EPO/PPO	$3.86
Rate for Payer: Scott and White Medicare	$215.67
Rate for Payer: Superior Health Plan CHIP/Medicaid	$85.32
Rate for Payer: Superior Health Plan EPO	$215.67
Rate for Payer: Superior Health Plan Medicare	$215.67
Rate for Payer: Universal American Dual Medicare/Medicaid	$215.67
Rate for Payer: Universal American Medicare	$215.67
Rate for Payer: Wellcare Medicare	$215.67
Rate for Payer: Wellmed Medicare	$215.67

CHED Fracture Site Phalangeal, finger or thumb w/o manipulat

Facility

$714.85

Service Code	CPT 26720
Hospital Charge Code	8912604
Hospital Revenue Code	450
Rate for Payer: Cash Price	$629.07

CHED Fracture Site Phalangeal, finger or thumb w/o manipulat

Facility

$714.85

Service Code	CPT 26720
Hospital Charge Code	8912604
Hospital Revenue Code	450
Min. Negotiated Rate	$3.86
Max. Negotiated Rate	$488.55
Rate for Payer: Aetna Commercial	$393.17
Rate for Payer: Aetna Medicare	$323.50
Rate for Payer: Amerigroup CHIP/Medicaid	$64.34
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$215.67
Rate for Payer: Amerigroup Medicare	$215.67
Rate for Payer: BCBS of TX Blue Advantage	$181.96
Rate for Payer: BCBS of TX Blue Essentials	$217.92
Rate for Payer: BCBS of TX Medicare	$215.67
Rate for Payer: BCBS of TX PPO	$274.58
Rate for Payer: Cash Price	$629.07
Rate for Payer: Cash Price	$629.07
Rate for Payer: Cash Price	$629.07
Rate for Payer: Cigna Commercial	$488.55
Rate for Payer: Cigna Medicaid	$85.32
Rate for Payer: Cigna Medicare	$215.67
Rate for Payer: Employer Direct Commercial	$215.67
Rate for Payer: Humana Medicare/TRICARE	$215.67
Rate for Payer: Molina CHIP/Medicaid	$85.32
Rate for Payer: Molina Dual Medicare/Medicaid	$215.67
Rate for Payer: Molina Medicare	$215.67
Rate for Payer: Multiplan Auto	$464.65
Rate for Payer: Multiplan Commercial	$464.65
Rate for Payer: Multiplan Workers Comp	$464.65
Rate for Payer: Parkland Medicaid	$85.32
Rate for Payer: Scott and White EPO/PPO	$3.86
Rate for Payer: Scott and White Medicare	$215.67
Rate for Payer: Superior Health Plan CHIP/Medicaid	$85.32
Rate for Payer: Superior Health Plan EPO	$215.67
Rate for Payer: Superior Health Plan Medicare	$215.67
Rate for Payer: Universal American Dual Medicare/Medicaid	$215.67
Rate for Payer: Universal American Medicare	$215.67
Rate for Payer: Wellcare Medicare	$215.67
Rate for Payer: Wellmed Medicare	$215.67

CHED Fracture Site Radius/Ulna fx, distal, w/ manipulation B

Facility

$2,496.25

Service Code	CPT 25605
Hospital Charge Code	8914595
Hospital Revenue Code	450
Min. Negotiated Rate	$26.29
Max. Negotiated Rate	$3,415.58
Rate for Payer: Aetna Commercial	$1,400.00
Rate for Payer: Aetna Medicare	$2,204.79
Rate for Payer: Amerigroup CHIP/Medicaid	$224.66
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$1,469.86
Rate for Payer: Amerigroup Medicare	$1,469.86
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	$1,469.86
Rate for Payer: BCBS of TX PPO	$3,415.58
Rate for Payer: Cash Price	$2,196.70
Rate for Payer: Cash Price	$2,196.70
Rate for Payer: Cash Price	$2,196.70
Rate for Payer: Cigna Commercial	$3,329.66
Rate for Payer: Cigna Medicaid	$593.04
Rate for Payer: Cigna Medicare	$1,469.86
Rate for Payer: Employer Direct Commercial	$1,469.86
Rate for Payer: Humana Medicare/TRICARE	$1,469.86
Rate for Payer: Molina CHIP/Medicaid	$593.04
Rate for Payer: Molina Dual Medicare/Medicaid	$1,469.86
Rate for Payer: Molina Medicare	$1,469.86
Rate for Payer: Multiplan Auto	$1,622.56
Rate for Payer: Multiplan Commercial	$1,622.56
Rate for Payer: Multiplan Workers Comp	$1,622.56
Rate for Payer: Parkland Medicaid	$593.04
Rate for Payer: Scott and White EPO/PPO	$26.29
Rate for Payer: Scott and White Medicare	$1,469.86
Rate for Payer: Superior Health Plan CHIP/Medicaid	$593.04
Rate for Payer: Superior Health Plan EPO	$1,469.86
Rate for Payer: Superior Health Plan Medicare	$1,469.86
Rate for Payer: Universal American Dual Medicare/Medicaid	$1,469.86
Rate for Payer: Universal American Medicare	$1,469.86
Rate for Payer: Wellcare Medicare	$1,469.86
Rate for Payer: Wellmed Medicare	$1,469.86

CHED Fracture Site Radius/Ulna fx, distal, w/ manipulation B

Facility

$2,496.25

Service Code	CPT 25605
Hospital Charge Code	8914595
Hospital Revenue Code	450
Rate for Payer: Cash Price	$2,196.70

CHED Fracture Site Radius/Ulna fx, distal, w/o manipulation

Facility

$837.00

Service Code	CPT 25600
Hospital Charge Code	8912605
Hospital Revenue Code	450
Rate for Payer: Cash Price	$736.56

CHED Fracture Site Radius/Ulna fx, distal, w/o manipulation

Facility

$837.00

Service Code	CPT 25600
Hospital Charge Code	8912605
Hospital Revenue Code	450
Min. Negotiated Rate	$3.86
Max. Negotiated Rate	$544.05
Rate for Payer: Aetna Commercial	$460.35
Rate for Payer: Aetna Medicare	$323.50
Rate for Payer: Amerigroup CHIP/Medicaid	$75.33
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$215.67
Rate for Payer: Amerigroup Medicare	$215.67
Rate for Payer: BCBS of TX Blue Advantage	$181.96
Rate for Payer: BCBS of TX Blue Essentials	$217.92
Rate for Payer: BCBS of TX Medicare	$215.67
Rate for Payer: BCBS of TX PPO	$274.58
Rate for Payer: Cash Price	$736.56
Rate for Payer: Cash Price	$736.56
Rate for Payer: Cash Price	$736.56
Rate for Payer: Cigna Commercial	$488.55
Rate for Payer: Cigna Medicaid	$85.32
Rate for Payer: Cigna Medicare	$215.67
Rate for Payer: Employer Direct Commercial	$215.67
Rate for Payer: Humana Medicare/TRICARE	$215.67
Rate for Payer: Molina CHIP/Medicaid	$85.32
Rate for Payer: Molina Dual Medicare/Medicaid	$215.67
Rate for Payer: Molina Medicare	$215.67
Rate for Payer: Multiplan Auto	$544.05
Rate for Payer: Multiplan Commercial	$544.05
Rate for Payer: Multiplan Workers Comp	$544.05
Rate for Payer: Parkland Medicaid	$85.32
Rate for Payer: Scott and White EPO/PPO	$3.86
Rate for Payer: Scott and White Medicare	$215.67
Rate for Payer: Superior Health Plan CHIP/Medicaid	$85.32
Rate for Payer: Superior Health Plan EPO	$215.67
Rate for Payer: Superior Health Plan Medicare	$215.67
Rate for Payer: Universal American Dual Medicare/Medicaid	$215.67
Rate for Payer: Universal American Medicare	$215.67
Rate for Payer: Wellcare Medicare	$215.67
Rate for Payer: Wellmed Medicare	$215.67

CHED Fracture Site Radius/Ulna fx, shaft, w/ manipulation BC

Facility

$658.75

Service Code	CPT 25565
Hospital Charge Code	8912606
Hospital Revenue Code	450
Min. Negotiated Rate	$26.29
Max. Negotiated Rate	$3,415.58
Rate for Payer: Aetna Commercial	$362.31
Rate for Payer: Aetna Medicare	$2,204.79
Rate for Payer: Amerigroup CHIP/Medicaid	$59.29
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$1,469.86
Rate for Payer: Amerigroup Medicare	$1,469.86
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	$1,469.86
Rate for Payer: BCBS of TX PPO	$3,415.58
Rate for Payer: Cash Price	$579.70
Rate for Payer: Cash Price	$579.70
Rate for Payer: Cash Price	$579.70
Rate for Payer: Cigna Commercial	$3,329.66
Rate for Payer: Cigna Medicaid	$593.04
Rate for Payer: Cigna Medicare	$1,469.86
Rate for Payer: Employer Direct Commercial	$1,469.86
Rate for Payer: Humana Medicare/TRICARE	$1,469.86
Rate for Payer: Molina CHIP/Medicaid	$593.04
Rate for Payer: Molina Dual Medicare/Medicaid	$1,469.86
Rate for Payer: Molina Medicare	$1,469.86
Rate for Payer: Multiplan Auto	$428.19
Rate for Payer: Multiplan Commercial	$428.19
Rate for Payer: Multiplan Workers Comp	$428.19
Rate for Payer: Parkland Medicaid	$593.04
Rate for Payer: Scott and White EPO/PPO	$26.29
Rate for Payer: Scott and White Medicare	$1,469.86
Rate for Payer: Superior Health Plan CHIP/Medicaid	$593.04
Rate for Payer: Superior Health Plan EPO	$1,469.86
Rate for Payer: Superior Health Plan Medicare	$1,469.86
Rate for Payer: Universal American Dual Medicare/Medicaid	$1,469.86
Rate for Payer: Universal American Medicare	$1,469.86
Rate for Payer: Wellcare Medicare	$1,469.86
Rate for Payer: Wellmed Medicare	$1,469.86

CHED Fracture Site Radius/Ulna fx, shaft, w/ manipulation BC

Facility

$658.75

Service Code	CPT 25565
Hospital Charge Code	8912606
Hospital Revenue Code	450
Rate for Payer: Cash Price	$579.70

CHED Fracture Site Radius/Ulna fx, shaft, w/o manipulation B

Facility

$791.40

Service Code	CPT 25560
Hospital Charge Code	8914596
Hospital Revenue Code	450
Min. Negotiated Rate	$3.86
Max. Negotiated Rate	$514.41
Rate for Payer: Aetna Commercial	$435.27
Rate for Payer: Aetna Medicare	$323.50
Rate for Payer: Amerigroup CHIP/Medicaid	$71.23
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$215.67
Rate for Payer: Amerigroup Medicare	$215.67
Rate for Payer: BCBS of TX Blue Advantage	$181.96
Rate for Payer: BCBS of TX Blue Essentials	$217.92
Rate for Payer: BCBS of TX Medicare	$215.67
Rate for Payer: BCBS of TX PPO	$274.58
Rate for Payer: Cash Price	$696.43
Rate for Payer: Cash Price	$696.43
Rate for Payer: Cash Price	$696.43
Rate for Payer: Cigna Commercial	$488.55
Rate for Payer: Cigna Medicaid	$85.32
Rate for Payer: Cigna Medicare	$215.67
Rate for Payer: Employer Direct Commercial	$215.67
Rate for Payer: Humana Medicare/TRICARE	$215.67
Rate for Payer: Molina CHIP/Medicaid	$85.32
Rate for Payer: Molina Dual Medicare/Medicaid	$215.67
Rate for Payer: Molina Medicare	$215.67
Rate for Payer: Multiplan Auto	$514.41
Rate for Payer: Multiplan Commercial	$514.41
Rate for Payer: Multiplan Workers Comp	$514.41
Rate for Payer: Parkland Medicaid	$85.32
Rate for Payer: Scott and White EPO/PPO	$3.86
Rate for Payer: Scott and White Medicare	$215.67
Rate for Payer: Superior Health Plan CHIP/Medicaid	$85.32
Rate for Payer: Superior Health Plan EPO	$215.67
Rate for Payer: Superior Health Plan Medicare	$215.67
Rate for Payer: Universal American Dual Medicare/Medicaid	$215.67
Rate for Payer: Universal American Medicare	$215.67
Rate for Payer: Wellcare Medicare	$215.67
Rate for Payer: Wellmed Medicare	$215.67

CHED Fracture Site Radius/Ulna fx, shaft, w/o manipulation B

Facility

$791.40

Service Code	CPT 25560
Hospital Charge Code	8914596
Hospital Revenue Code	450
Rate for Payer: Cash Price	$696.43

CHED Fracture Site Radius w/o manipulation BCE

Facility

$699.48

Service Code	CPT 25500
Hospital Charge Code	8910619
Hospital Revenue Code	450
Rate for Payer: Cash Price	$615.54

CHED Fracture Site Radius w/o manipulation BCE

Facility

$699.48

Service Code	CPT 25500
Hospital Charge Code	8910619
Hospital Revenue Code	450
Min. Negotiated Rate	$3.86
Max. Negotiated Rate	$488.55
Rate for Payer: Aetna Commercial	$384.71
Rate for Payer: Aetna Medicare	$323.50
Rate for Payer: Amerigroup CHIP/Medicaid	$62.95
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$215.67
Rate for Payer: Amerigroup Medicare	$215.67
Rate for Payer: BCBS of TX Blue Advantage	$181.96
Rate for Payer: BCBS of TX Blue Essentials	$217.92
Rate for Payer: BCBS of TX Medicare	$215.67
Rate for Payer: BCBS of TX PPO	$274.58
Rate for Payer: Cash Price	$615.54
Rate for Payer: Cash Price	$615.54
Rate for Payer: Cash Price	$615.54
Rate for Payer: Cigna Commercial	$488.55
Rate for Payer: Cigna Medicaid	$85.32
Rate for Payer: Cigna Medicare	$215.67
Rate for Payer: Employer Direct Commercial	$215.67
Rate for Payer: Humana Medicare/TRICARE	$215.67
Rate for Payer: Molina CHIP/Medicaid	$85.32
Rate for Payer: Molina Dual Medicare/Medicaid	$215.67
Rate for Payer: Molina Medicare	$215.67
Rate for Payer: Multiplan Auto	$454.66
Rate for Payer: Multiplan Commercial	$454.66
Rate for Payer: Multiplan Workers Comp	$454.66
Rate for Payer: Parkland Medicaid	$85.32
Rate for Payer: Scott and White EPO/PPO	$3.86
Rate for Payer: Scott and White Medicare	$215.67
Rate for Payer: Superior Health Plan CHIP/Medicaid	$85.32
Rate for Payer: Superior Health Plan EPO	$215.67
Rate for Payer: Superior Health Plan Medicare	$215.67
Rate for Payer: Universal American Dual Medicare/Medicaid	$215.67
Rate for Payer: Universal American Medicare	$215.67
Rate for Payer: Wellcare Medicare	$215.67
Rate for Payer: Wellmed Medicare	$215.67

CHED Fracture Site Tibia fx, Distal, w/ manipulation BCE

Facility

$4,765.00

Service Code	CPT 27825
Hospital Charge Code	8910620
Hospital Revenue Code	450
Min. Negotiated Rate	$26.29
Max. Negotiated Rate	$3,415.58
Rate for Payer: Aetna Commercial	$2,200.00
Rate for Payer: Aetna Medicare	$2,204.79
Rate for Payer: Amerigroup CHIP/Medicaid	$428.85
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$1,469.86
Rate for Payer: Amerigroup Medicare	$1,469.86
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	$1,469.86
Rate for Payer: BCBS of TX PPO	$3,415.58
Rate for Payer: Cash Price	$4,193.20
Rate for Payer: Cash Price	$4,193.20
Rate for Payer: Cash Price	$4,193.20
Rate for Payer: Cigna Commercial	$3,329.66
Rate for Payer: Cigna Medicaid	$593.04
Rate for Payer: Cigna Medicare	$1,469.86
Rate for Payer: Employer Direct Commercial	$1,469.86
Rate for Payer: Humana Medicare/TRICARE	$1,469.86
Rate for Payer: Molina CHIP/Medicaid	$593.04
Rate for Payer: Molina Dual Medicare/Medicaid	$1,469.86
Rate for Payer: Molina Medicare	$1,469.86
Rate for Payer: Multiplan Auto	$3,097.25
Rate for Payer: Multiplan Commercial	$3,097.25
Rate for Payer: Multiplan Workers Comp	$3,097.25
Rate for Payer: Parkland Medicaid	$593.04
Rate for Payer: Scott and White EPO/PPO	$26.29
Rate for Payer: Scott and White Medicare	$1,469.86
Rate for Payer: Superior Health Plan CHIP/Medicaid	$593.04
Rate for Payer: Superior Health Plan EPO	$1,469.86
Rate for Payer: Superior Health Plan Medicare	$1,469.86
Rate for Payer: Universal American Dual Medicare/Medicaid	$1,469.86
Rate for Payer: Universal American Medicare	$1,469.86
Rate for Payer: Wellcare Medicare	$1,469.86
Rate for Payer: Wellmed Medicare	$1,469.86

CHED Fracture Site Tibia fx, Distal, w/ manipulation BCE

Facility

$4,765.00

Service Code	CPT 27825
Hospital Charge Code	8910620
Hospital Revenue Code	450
Rate for Payer: Cash Price	$4,193.20

CHED Fracture Site Toe w/ manipulation BCE

Facility

$1,000.75

Service Code	CPT 28515
Hospital Charge Code	8912607
Hospital Revenue Code	450
Rate for Payer: Cash Price	$880.66

CHED Fracture Site Toe w/ manipulation BCE

Facility

$1,000.75

Service Code	CPT 28515
Hospital Charge Code	8912607
Hospital Revenue Code	450
Min. Negotiated Rate	$3.86
Max. Negotiated Rate	$650.49
Rate for Payer: Aetna Commercial	$550.41
Rate for Payer: Aetna Medicare	$323.50
Rate for Payer: Amerigroup CHIP/Medicaid	$90.07
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$215.67
Rate for Payer: Amerigroup Medicare	$215.67
Rate for Payer: BCBS of TX Blue Advantage	$176.59
Rate for Payer: BCBS of TX Blue Essentials	$211.48
Rate for Payer: BCBS of TX Medicare	$215.67
Rate for Payer: BCBS of TX PPO	$266.46
Rate for Payer: Cash Price	$880.66
Rate for Payer: Cash Price	$880.66
Rate for Payer: Cash Price	$880.66
Rate for Payer: Cigna Commercial	$488.55
Rate for Payer: Cigna Medicaid	$85.32
Rate for Payer: Cigna Medicare	$215.67
Rate for Payer: Employer Direct Commercial	$215.67
Rate for Payer: Humana Medicare/TRICARE	$215.67
Rate for Payer: Molina CHIP/Medicaid	$85.32
Rate for Payer: Molina Dual Medicare/Medicaid	$215.67
Rate for Payer: Molina Medicare	$215.67
Rate for Payer: Multiplan Auto	$650.49
Rate for Payer: Multiplan Commercial	$650.49
Rate for Payer: Multiplan Workers Comp	$650.49
Rate for Payer: Parkland Medicaid	$85.32
Rate for Payer: Scott and White EPO/PPO	$3.86
Rate for Payer: Scott and White Medicare	$215.67
Rate for Payer: Superior Health Plan CHIP/Medicaid	$85.32
Rate for Payer: Superior Health Plan EPO	$215.67
Rate for Payer: Superior Health Plan Medicare	$215.67
Rate for Payer: Universal American Dual Medicare/Medicaid	$215.67
Rate for Payer: Universal American Medicare	$215.67
Rate for Payer: Wellcare Medicare	$215.67
Rate for Payer: Wellmed Medicare	$215.67

CHED Fracture Site Trimalleolar fx, w/ manipulation BCE

Facility

$2,376.64

Service Code	CPT 27818
Hospital Charge Code	8914597
Hospital Revenue Code	450
Min. Negotiated Rate	$26.29
Max. Negotiated Rate	$3,415.58
Rate for Payer: Aetna Commercial	$1,400.00
Rate for Payer: Aetna Medicare	$2,204.79
Rate for Payer: Amerigroup CHIP/Medicaid	$213.90
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$1,469.86
Rate for Payer: Amerigroup Medicare	$1,469.86
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	$1,469.86
Rate for Payer: BCBS of TX PPO	$3,415.58
Rate for Payer: Cash Price	$2,091.44
Rate for Payer: Cash Price	$2,091.44
Rate for Payer: Cash Price	$2,091.44
Rate for Payer: Cigna Commercial	$3,329.66
Rate for Payer: Cigna Medicaid	$593.04
Rate for Payer: Cigna Medicare	$1,469.86
Rate for Payer: Employer Direct Commercial	$1,469.86
Rate for Payer: Humana Medicare/TRICARE	$1,469.86
Rate for Payer: Molina CHIP/Medicaid	$593.04
Rate for Payer: Molina Dual Medicare/Medicaid	$1,469.86
Rate for Payer: Molina Medicare	$1,469.86
Rate for Payer: Multiplan Auto	$1,544.82
Rate for Payer: Multiplan Commercial	$1,544.82
Rate for Payer: Multiplan Workers Comp	$1,544.82
Rate for Payer: Parkland Medicaid	$593.04
Rate for Payer: Scott and White EPO/PPO	$26.29
Rate for Payer: Scott and White Medicare	$1,469.86
Rate for Payer: Superior Health Plan CHIP/Medicaid	$593.04
Rate for Payer: Superior Health Plan EPO	$1,469.86
Rate for Payer: Superior Health Plan Medicare	$1,469.86
Rate for Payer: Universal American Dual Medicare/Medicaid	$1,469.86
Rate for Payer: Universal American Medicare	$1,469.86
Rate for Payer: Wellcare Medicare	$1,469.86
Rate for Payer: Wellmed Medicare	$1,469.86

CHED Fracture Site Trimalleolar fx, w/ manipulation BCE

Facility

$2,376.64

Service Code	CPT 27818
Hospital Charge Code	8914597
Hospital Revenue Code	450
Rate for Payer: Cash Price	$2,091.44

CHED Fracture Site Ulnar Shaft, w/ manipulation BCE

Facility

$5,129.15

Service Code	CPT 25535
Hospital Charge Code	8910621
Hospital Revenue Code	450
Min. Negotiated Rate	$3.86
Max. Negotiated Rate	$3,333.95
Rate for Payer: Aetna Commercial	$2,821.03
Rate for Payer: Aetna Medicare	$323.50
Rate for Payer: Amerigroup CHIP/Medicaid	$461.62
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$215.67
Rate for Payer: Amerigroup Medicare	$215.67
Rate for Payer: BCBS of TX Blue Advantage	$360.12
Rate for Payer: BCBS of TX Blue Essentials	$431.28
Rate for Payer: BCBS of TX Medicare	$215.67
Rate for Payer: BCBS of TX PPO	$543.41
Rate for Payer: Cash Price	$4,513.65
Rate for Payer: Cash Price	$4,513.65
Rate for Payer: Cash Price	$4,513.65
Rate for Payer: Cigna Commercial	$488.55
Rate for Payer: Cigna Medicaid	$85.32
Rate for Payer: Cigna Medicare	$215.67
Rate for Payer: Employer Direct Commercial	$215.67
Rate for Payer: Humana Medicare/TRICARE	$215.67
Rate for Payer: Molina CHIP/Medicaid	$85.32
Rate for Payer: Molina Dual Medicare/Medicaid	$215.67
Rate for Payer: Molina Medicare	$215.67
Rate for Payer: Multiplan Auto	$3,333.95
Rate for Payer: Multiplan Commercial	$3,333.95
Rate for Payer: Multiplan Workers Comp	$3,333.95
Rate for Payer: Parkland Medicaid	$85.32
Rate for Payer: Scott and White EPO/PPO	$3.86
Rate for Payer: Scott and White Medicare	$215.67
Rate for Payer: Superior Health Plan CHIP/Medicaid	$85.32
Rate for Payer: Superior Health Plan EPO	$215.67
Rate for Payer: Superior Health Plan Medicare	$215.67
Rate for Payer: Universal American Dual Medicare/Medicaid	$215.67
Rate for Payer: Universal American Medicare	$215.67
Rate for Payer: Wellcare Medicare	$215.67
Rate for Payer: Wellmed Medicare	$215.67

CHED Fracture Site Ulnar Shaft, w/ manipulation BCE

Facility

$5,129.15

Service Code	CPT 25535
Hospital Charge Code	8910621
Hospital Revenue Code	450
Rate for Payer: Cash Price	$4,513.65

CHED GI/GU/Rectal Procedures Anoscopy BCE

Facility

$712.00

Service Code	CPT 46600
Hospital Charge Code	8912612
Hospital Revenue Code	450
Rate for Payer: Cash Price	$626.56

CHED GI/GU/Rectal Procedures Anoscopy BCE

Facility

$712.00

Service Code	CPT 46600
Hospital Charge Code	8912612
Hospital Revenue Code	450
Min. Negotiated Rate	$2.09
Max. Negotiated Rate	$462.80
Rate for Payer: Aetna Commercial	$391.60
Rate for Payer: Aetna Medicare	$175.23
Rate for Payer: Amerigroup CHIP/Medicaid	$64.08
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$116.82
Rate for Payer: Amerigroup Medicare	$116.82
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	$116.82
Rate for Payer: BCBS of TX PPO	$274.76
Rate for Payer: Cash Price	$626.56
Rate for Payer: Cash Price	$626.56
Rate for Payer: Cash Price	$626.56
Rate for Payer: Cigna Commercial	$264.63
Rate for Payer: Cigna Medicare	$116.82
Rate for Payer: Employer Direct Commercial	$116.82
Rate for Payer: Humana Medicare/TRICARE	$116.82
Rate for Payer: Molina Dual Medicare/Medicaid	$116.82
Rate for Payer: Molina Medicare	$116.82
Rate for Payer: Multiplan Auto	$462.80
Rate for Payer: Multiplan Commercial	$462.80
Rate for Payer: Multiplan Workers Comp	$462.80
Rate for Payer: Scott and White EPO/PPO	$2.09
Rate for Payer: Scott and White Medicare	$116.82
Rate for Payer: Superior Health Plan EPO	$116.82
Rate for Payer: Superior Health Plan Medicare	$116.82
Rate for Payer: Universal American Dual Medicare/Medicaid	$116.82
Rate for Payer: Universal American Medicare	$116.82
Rate for Payer: Wellcare Medicare	$116.82
Rate for Payer: Wellmed Medicare	$116.82

CHED GI/GU/Rectal Procedures Cystostomy/Foley change BCE

Facility

$4,852.86

Service Code	CPT 51705
Hospital Charge Code	8914598
Hospital Revenue Code	450
Min. Negotiated Rate	$4.04
Max. Negotiated Rate	$3,154.36
Rate for Payer: Aetna Commercial	$2,669.07
Rate for Payer: Aetna Medicare	$339.04
Rate for Payer: Amerigroup CHIP/Medicaid	$436.76
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$226.03
Rate for Payer: Amerigroup Medicare	$226.03
Rate for Payer: BCBS of TX Blue Advantage	$102.45
Rate for Payer: BCBS of TX Blue Essentials	$122.70
Rate for Payer: BCBS of TX Medicare	$226.03
Rate for Payer: BCBS of TX PPO	$154.60
Rate for Payer: Cash Price	$4,270.52
Rate for Payer: Cash Price	$4,270.52
Rate for Payer: Cash Price	$4,270.52
Rate for Payer: Cigna Commercial	$512.01
Rate for Payer: Cigna Medicaid	$51.77
Rate for Payer: Cigna Medicare	$226.03
Rate for Payer: Employer Direct Commercial	$226.03
Rate for Payer: Humana Medicare/TRICARE	$226.03
Rate for Payer: Molina CHIP/Medicaid	$51.77
Rate for Payer: Molina Dual Medicare/Medicaid	$226.03
Rate for Payer: Molina Medicare	$226.03
Rate for Payer: Multiplan Auto	$3,154.36
Rate for Payer: Multiplan Commercial	$3,154.36
Rate for Payer: Multiplan Workers Comp	$3,154.36
Rate for Payer: Parkland Medicaid	$51.77
Rate for Payer: Scott and White EPO/PPO	$4.04
Rate for Payer: Scott and White Medicare	$226.03
Rate for Payer: Superior Health Plan CHIP/Medicaid	$51.77
Rate for Payer: Superior Health Plan EPO	$226.03
Rate for Payer: Superior Health Plan Medicare	$226.03
Rate for Payer: Universal American Dual Medicare/Medicaid	$226.03
Rate for Payer: Universal American Medicare	$226.03
Rate for Payer: Wellcare Medicare	$226.03
Rate for Payer: Wellmed Medicare	$226.03

Know your out-of-pocket cost for care.

All Charges