White Rock Medical Center

All Charges

Charge

Type

Setting

Price

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
Rate for Payer: Cash Price	$4,270.52

CHED GI/GU/Rectal Procedures Gastric Intubation w/ Lavage BC

Facility

$576.32

Service Code	CPT 43753
Hospital Charge Code	8912608
Hospital Revenue Code	450
Rate for Payer: Cash Price	$507.16

CHED GI/GU/Rectal Procedures Gastric Intubation w/ Lavage BC

Facility

$576.32

Service Code	CPT 43753
Hospital Charge Code	8912608
Hospital Revenue Code	450
Min. Negotiated Rate	$5.13
Max. Negotiated Rate	$650.28
Rate for Payer: Aetna Commercial	$316.98
Rate for Payer: Aetna Medicare	$430.59
Rate for Payer: Amerigroup CHIP/Medicaid	$51.87
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$287.06
Rate for Payer: Amerigroup Medicare	$287.06
Rate for Payer: BCBS of TX Blue Advantage	$422.68
Rate for Payer: BCBS of TX Blue Essentials	$506.20
Rate for Payer: BCBS of TX Medicare	$287.06
Rate for Payer: BCBS of TX PPO	$637.81
Rate for Payer: Cash Price	$507.16
Rate for Payer: Cash Price	$507.16
Rate for Payer: Cash Price	$507.16
Rate for Payer: Cigna Commercial	$650.28
Rate for Payer: Cigna Medicare	$287.06
Rate for Payer: Employer Direct Commercial	$287.06
Rate for Payer: Humana Medicare/TRICARE	$287.06
Rate for Payer: Molina Dual Medicare/Medicaid	$287.06
Rate for Payer: Molina Medicare	$287.06
Rate for Payer: Multiplan Auto	$374.61
Rate for Payer: Multiplan Commercial	$374.61
Rate for Payer: Multiplan Workers Comp	$374.61
Rate for Payer: Scott and White EPO/PPO	$5.13
Rate for Payer: Scott and White Medicare	$287.06
Rate for Payer: Superior Health Plan EPO	$287.06
Rate for Payer: Superior Health Plan Medicare	$287.06
Rate for Payer: Universal American Dual Medicare/Medicaid	$287.06
Rate for Payer: Universal American Medicare	$287.06
Rate for Payer: Wellcare Medicare	$287.06
Rate for Payer: Wellmed Medicare	$287.06

CHED GI/GU/Rectal Procedures Paraphimosis treatment BCE

Facility

$2,269.06

Service Code	CPT 54450
Hospital Charge Code	8912609
Hospital Revenue Code	450
Rate for Payer: Cash Price	$1,996.77

CHED GI/GU/Rectal Procedures Paraphimosis treatment BCE

Facility

$2,269.06

Service Code	CPT 54450
Hospital Charge Code	8912609
Hospital Revenue Code	450
Min. Negotiated Rate	$4.04
Max. Negotiated Rate	$1,474.89
Rate for Payer: Aetna Commercial	$1,247.98
Rate for Payer: Aetna Medicare	$339.04
Rate for Payer: Amerigroup CHIP/Medicaid	$204.22
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$226.03
Rate for Payer: Amerigroup Medicare	$226.03
Rate for Payer: BCBS of TX Blue Advantage	$392.28
Rate for Payer: BCBS of TX Blue Essentials	$469.80
Rate for Payer: BCBS of TX Medicare	$226.03
Rate for Payer: BCBS of TX PPO	$591.95
Rate for Payer: Cash Price	$1,996.77
Rate for Payer: Cash Price	$1,996.77
Rate for Payer: Cash Price	$1,996.77
Rate for Payer: Cigna Commercial	$512.01
Rate for Payer: Cigna Medicaid	$110.15
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	$110.15
Rate for Payer: Molina Dual Medicare/Medicaid	$226.03
Rate for Payer: Molina Medicare	$226.03
Rate for Payer: Multiplan Auto	$1,474.89
Rate for Payer: Multiplan Commercial	$1,474.89
Rate for Payer: Multiplan Workers Comp	$1,474.89
Rate for Payer: Parkland Medicaid	$110.15
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	$110.15
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

CHED GI/GU/Rectal Procedures Removal of hemorrhoid clot BCE

Facility

$6,289.13

Service Code	CPT 46320
Hospital Charge Code	8912610
Hospital Revenue Code	450
Rate for Payer: Cash Price	$5,534.43

CHED GI/GU/Rectal Procedures Removal of hemorrhoid clot BCE

Facility

$6,289.13

Service Code	CPT 46320
Hospital Charge Code	8912610
Hospital Revenue Code	450
Min. Negotiated Rate	$19.30
Max. Negotiated Rate	$4,087.93
Rate for Payer: Aetna Commercial	$2,200.00
Rate for Payer: Aetna Medicare	$1,618.84
Rate for Payer: Amerigroup CHIP/Medicaid	$566.02
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$1,079.23
Rate for Payer: Amerigroup Medicare	$1,079.23
Rate for Payer: BCBS of TX Blue Advantage	$224.80
Rate for Payer: BCBS of TX Blue Essentials	$269.22
Rate for Payer: BCBS of TX Medicare	$1,079.23
Rate for Payer: BCBS of TX PPO	$339.22
Rate for Payer: Cash Price	$5,534.43
Rate for Payer: Cash Price	$5,534.43
Rate for Payer: Cash Price	$5,534.43
Rate for Payer: Cigna Commercial	$2,444.77
Rate for Payer: Cigna Medicaid	$125.69
Rate for Payer: Cigna Medicare	$1,079.23
Rate for Payer: Employer Direct Commercial	$1,079.23
Rate for Payer: Humana Medicare/TRICARE	$1,079.23
Rate for Payer: Molina CHIP/Medicaid	$125.69
Rate for Payer: Molina Dual Medicare/Medicaid	$1,079.23
Rate for Payer: Molina Medicare	$1,079.23
Rate for Payer: Multiplan Auto	$4,087.93
Rate for Payer: Multiplan Commercial	$4,087.93
Rate for Payer: Multiplan Workers Comp	$4,087.93
Rate for Payer: Parkland Medicaid	$125.69
Rate for Payer: Scott and White EPO/PPO	$19.30
Rate for Payer: Scott and White Medicare	$1,079.23
Rate for Payer: Superior Health Plan CHIP/Medicaid	$125.69
Rate for Payer: Superior Health Plan EPO	$1,079.23
Rate for Payer: Superior Health Plan Medicare	$1,079.23
Rate for Payer: Universal American Dual Medicare/Medicaid	$1,079.23
Rate for Payer: Universal American Medicare	$1,079.23
Rate for Payer: Wellcare Medicare	$1,079.23
Rate for Payer: Wellmed Medicare	$1,079.23

CHED GI/GU/Rectal Procedures Removal of rectal obstruction B

Facility

$8,019.00

Service Code	CPT 45915
Hospital Charge Code	8912611
Hospital Revenue Code	450
Min. Negotiated Rate	$19.30
Max. Negotiated Rate	$5,212.35
Rate for Payer: Aetna Commercial	$2,200.00
Rate for Payer: Aetna Medicare	$1,618.84
Rate for Payer: Amerigroup CHIP/Medicaid	$721.71
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$1,079.23
Rate for Payer: Amerigroup Medicare	$1,079.23
Rate for Payer: BCBS of TX Blue Advantage	$1,677.05
Rate for Payer: BCBS of TX Blue Essentials	$2,008.44
Rate for Payer: BCBS of TX Medicare	$1,079.23
Rate for Payer: BCBS of TX PPO	$2,530.63
Rate for Payer: Cash Price	$7,056.72
Rate for Payer: Cash Price	$7,056.72
Rate for Payer: Cash Price	$7,056.72
Rate for Payer: Cigna Commercial	$2,444.77
Rate for Payer: Cigna Medicaid	$429.26
Rate for Payer: Cigna Medicare	$1,079.23
Rate for Payer: Employer Direct Commercial	$1,079.23
Rate for Payer: Humana Medicare/TRICARE	$1,079.23
Rate for Payer: Molina CHIP/Medicaid	$429.26
Rate for Payer: Molina Dual Medicare/Medicaid	$1,079.23
Rate for Payer: Molina Medicare	$1,079.23
Rate for Payer: Multiplan Auto	$5,212.35
Rate for Payer: Multiplan Commercial	$5,212.35
Rate for Payer: Multiplan Workers Comp	$5,212.35
Rate for Payer: Parkland Medicaid	$429.26
Rate for Payer: Scott and White EPO/PPO	$19.30
Rate for Payer: Scott and White Medicare	$1,079.23
Rate for Payer: Superior Health Plan CHIP/Medicaid	$429.26
Rate for Payer: Superior Health Plan EPO	$1,079.23
Rate for Payer: Superior Health Plan Medicare	$1,079.23
Rate for Payer: Universal American Dual Medicare/Medicaid	$1,079.23
Rate for Payer: Universal American Medicare	$1,079.23
Rate for Payer: Wellcare Medicare	$1,079.23
Rate for Payer: Wellmed Medicare	$1,079.23

CHED GI/GU/Rectal Procedures Removal of rectal obstruction B

Facility

$8,019.00

Service Code	CPT 45915
Hospital Charge Code	8912611
Hospital Revenue Code	450
Rate for Payer: Cash Price	$7,056.72

CHED GI/GU/Rectal Procedures Replace G-tube BCE

Facility

$1,324.10

Service Code	CPT 49452
Hospital Charge Code	8912613
Hospital Revenue Code	450
Min. Negotiated Rate	$14.83
Max. Negotiated Rate	$2,200.00
Rate for Payer: Aetna Commercial	$2,200.00
Rate for Payer: Aetna Medicare	$1,243.53
Rate for Payer: Amerigroup CHIP/Medicaid	$119.17
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$829.02
Rate for Payer: Amerigroup Medicare	$829.02
Rate for Payer: BCBS of TX Blue Advantage	$1,312.49
Rate for Payer: BCBS of TX Blue Essentials	$1,571.84
Rate for Payer: BCBS of TX Medicare	$829.02
Rate for Payer: BCBS of TX PPO	$1,980.52
Rate for Payer: Cash Price	$1,165.21
Rate for Payer: Cash Price	$1,165.21
Rate for Payer: Cash Price	$1,165.21
Rate for Payer: Cigna Commercial	$1,877.98
Rate for Payer: Cigna Medicaid	$334.95
Rate for Payer: Cigna Medicare	$829.02
Rate for Payer: Employer Direct Commercial	$829.02
Rate for Payer: Humana Medicare/TRICARE	$829.02
Rate for Payer: Molina CHIP/Medicaid	$334.95
Rate for Payer: Molina Dual Medicare/Medicaid	$829.02
Rate for Payer: Molina Medicare	$829.02
Rate for Payer: Multiplan Auto	$860.66
Rate for Payer: Multiplan Commercial	$860.66
Rate for Payer: Multiplan Workers Comp	$860.66
Rate for Payer: Parkland Medicaid	$334.95
Rate for Payer: Scott and White EPO/PPO	$14.83
Rate for Payer: Scott and White Medicare	$829.02
Rate for Payer: Superior Health Plan CHIP/Medicaid	$334.95
Rate for Payer: Superior Health Plan EPO	$829.02
Rate for Payer: Superior Health Plan Medicare	$829.02
Rate for Payer: Universal American Dual Medicare/Medicaid	$829.02
Rate for Payer: Universal American Medicare	$829.02
Rate for Payer: Wellcare Medicare	$829.02
Rate for Payer: Wellmed Medicare	$829.02

CHED GI/GU/Rectal Procedures Replace G-tube BCE

Facility

$1,324.10

Service Code	CPT 49452
Hospital Charge Code	8912613
Hospital Revenue Code	450
Rate for Payer: Cash Price	$1,165.21

CHED I AND D OF BARTHOLINS GLND ABS BCE

Facility

$994.45

Service Code	CPT 56420
Hospital Charge Code	8912614
Hospital Revenue Code	450
Min. Negotiated Rate	$3.26
Max. Negotiated Rate	$646.39
Rate for Payer: Aetna Commercial	$546.95
Rate for Payer: Aetna Medicare	$273.36
Rate for Payer: Amerigroup CHIP/Medicaid	$89.50
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$182.24
Rate for Payer: Amerigroup Medicare	$182.24
Rate for Payer: BCBS of TX Blue Advantage	$140.11
Rate for Payer: BCBS of TX Blue Essentials	$167.80
Rate for Payer: BCBS of TX Medicare	$182.24
Rate for Payer: BCBS of TX PPO	$211.43
Rate for Payer: Cash Price	$875.12
Rate for Payer: Cash Price	$875.12
Rate for Payer: Cash Price	$875.12
Rate for Payer: Cigna Commercial	$412.83
Rate for Payer: Cigna Medicaid	$70.52
Rate for Payer: Cigna Medicare	$182.24
Rate for Payer: Employer Direct Commercial	$182.24
Rate for Payer: Humana Medicare/TRICARE	$182.24
Rate for Payer: Molina CHIP/Medicaid	$70.52
Rate for Payer: Molina Dual Medicare/Medicaid	$182.24
Rate for Payer: Molina Medicare	$182.24
Rate for Payer: Multiplan Auto	$646.39
Rate for Payer: Multiplan Commercial	$646.39
Rate for Payer: Multiplan Workers Comp	$646.39
Rate for Payer: Parkland Medicaid	$70.52
Rate for Payer: Scott and White EPO/PPO	$3.26
Rate for Payer: Scott and White Medicare	$182.24
Rate for Payer: Superior Health Plan CHIP/Medicaid	$70.52
Rate for Payer: Superior Health Plan EPO	$182.24
Rate for Payer: Superior Health Plan Medicare	$182.24
Rate for Payer: Universal American Dual Medicare/Medicaid	$182.24
Rate for Payer: Universal American Medicare	$182.24
Rate for Payer: Wellcare Medicare	$182.24
Rate for Payer: Wellmed Medicare	$182.24

CHED I AND D OF BARTHOLINS GLND ABS BCE

Facility

$994.45

Service Code	CPT 56420
Hospital Charge Code	8912614
Hospital Revenue Code	450
Rate for Payer: Cash Price	$875.12

CHED ID Aspirate Abscess/Cyst/Hematoma BCE

Facility

$1,638.67

Service Code	CPT 10160
Hospital Charge Code	8912615
Hospital Revenue Code	450
Rate for Payer: Cash Price	$1,442.03

CHED ID Aspirate Abscess/Cyst/Hematoma BCE

Facility

$1,638.67

Service Code	CPT 10160
Hospital Charge Code	8912615
Hospital Revenue Code	450
Min. Negotiated Rate	$6.52
Max. Negotiated Rate	$1,065.14
Rate for Payer: Aetna Commercial	$901.27
Rate for Payer: Aetna Medicare	$547.00
Rate for Payer: Amerigroup CHIP/Medicaid	$147.48
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	$1,442.03
Rate for Payer: Cash Price	$1,442.03
Rate for Payer: Cash Price	$1,442.03
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	$1,065.14
Rate for Payer: Multiplan Commercial	$1,065.14
Rate for Payer: Multiplan Workers Comp	$1,065.14
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

CHED ID Aspirate Arthrocentesis - fingers or toes BCE

Facility

$1,343.27

Service Code	CPT 20600
Hospital Charge Code	8912616
Hospital Revenue Code	450
Rate for Payer: Cash Price	$1,182.08

CHED ID Aspirate Arthrocentesis - fingers or toes BCE

Facility

$1,343.27

Service Code	CPT 20600
Hospital Charge Code	8912616
Hospital Revenue Code	450
Min. Negotiated Rate	$4.84
Max. Negotiated Rate	$873.13
Rate for Payer: Aetna Commercial	$738.80
Rate for Payer: Aetna Medicare	$406.30
Rate for Payer: Amerigroup CHIP/Medicaid	$120.89
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$270.87
Rate for Payer: Amerigroup Medicare	$270.87
Rate for Payer: BCBS of TX Blue Advantage	$41.58
Rate for Payer: BCBS of TX Blue Essentials	$49.80
Rate for Payer: BCBS of TX Medicare	$270.87
Rate for Payer: BCBS of TX PPO	$62.75
Rate for Payer: Cash Price	$1,182.08
Rate for Payer: Cash Price	$1,182.08
Rate for Payer: Cash Price	$1,182.08
Rate for Payer: Cigna Commercial	$613.60
Rate for Payer: Cigna Medicaid	$22.70
Rate for Payer: Cigna Medicare	$270.87
Rate for Payer: Employer Direct Commercial	$270.87
Rate for Payer: Humana Medicare/TRICARE	$270.87
Rate for Payer: Molina CHIP/Medicaid	$22.70
Rate for Payer: Molina Dual Medicare/Medicaid	$270.87
Rate for Payer: Molina Medicare	$270.87
Rate for Payer: Multiplan Auto	$873.13
Rate for Payer: Multiplan Commercial	$873.13
Rate for Payer: Multiplan Workers Comp	$873.13
Rate for Payer: Parkland Medicaid	$22.70
Rate for Payer: Scott and White EPO/PPO	$4.84
Rate for Payer: Scott and White Medicare	$270.87
Rate for Payer: Superior Health Plan CHIP/Medicaid	$22.70
Rate for Payer: Superior Health Plan EPO	$270.87
Rate for Payer: Superior Health Plan Medicare	$270.87
Rate for Payer: Universal American Dual Medicare/Medicaid	$270.87
Rate for Payer: Universal American Medicare	$270.87
Rate for Payer: Wellcare Medicare	$270.87
Rate for Payer: Wellmed Medicare	$270.87

CHED ID Aspirate Arthrocentesis - shoulder/hip/knee/subacrom

Facility

$1,594.93

Service Code	CPT 20610
Hospital Charge Code	8914600
Hospital Revenue Code	450
Rate for Payer: Cash Price	$1,403.54

CHED ID Aspirate Arthrocentesis - shoulder/hip/knee/subacrom

Facility

$1,594.93

Service Code	CPT 20610
Hospital Charge Code	8914600
Hospital Revenue Code	450
Min. Negotiated Rate	$4.84
Max. Negotiated Rate	$1,036.70
Rate for Payer: Aetna Commercial	$877.21
Rate for Payer: Aetna Medicare	$406.30
Rate for Payer: Amerigroup CHIP/Medicaid	$143.54
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$270.87
Rate for Payer: Amerigroup Medicare	$270.87
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	$270.87
Rate for Payer: BCBS of TX PPO	$78.22
Rate for Payer: Cash Price	$1,403.54
Rate for Payer: Cash Price	$1,403.54
Rate for Payer: Cash Price	$1,403.54
Rate for Payer: Cigna Commercial	$613.60
Rate for Payer: Cigna Medicaid	$27.96
Rate for Payer: Cigna Medicare	$270.87
Rate for Payer: Employer Direct Commercial	$270.87
Rate for Payer: Humana Medicare/TRICARE	$270.87
Rate for Payer: Molina CHIP/Medicaid	$27.96
Rate for Payer: Molina Dual Medicare/Medicaid	$270.87
Rate for Payer: Molina Medicare	$270.87
Rate for Payer: Multiplan Auto	$1,036.70
Rate for Payer: Multiplan Commercial	$1,036.70
Rate for Payer: Multiplan Workers Comp	$1,036.70
Rate for Payer: Parkland Medicaid	$27.96
Rate for Payer: Scott and White EPO/PPO	$4.84
Rate for Payer: Scott and White Medicare	$270.87
Rate for Payer: Superior Health Plan CHIP/Medicaid	$27.96
Rate for Payer: Superior Health Plan EPO	$270.87
Rate for Payer: Superior Health Plan Medicare	$270.87
Rate for Payer: Universal American Dual Medicare/Medicaid	$270.87
Rate for Payer: Universal American Medicare	$270.87
Rate for Payer: Wellcare Medicare	$270.87
Rate for Payer: Wellmed Medicare	$270.87

CHED ID Aspirate Arthro - temporomandibul/AC/wrist/elbow/ank

Facility

$479.42

Service Code	CPT 20605
Hospital Charge Code	8914601
Hospital Revenue Code	450
Min. Negotiated Rate	$4.84
Max. Negotiated Rate	$613.60
Rate for Payer: Aetna Commercial	$263.68
Rate for Payer: Aetna Medicare	$406.30
Rate for Payer: Amerigroup CHIP/Medicaid	$43.15
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$270.87
Rate for Payer: Amerigroup Medicare	$270.87
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	$270.87
Rate for Payer: BCBS of TX PPO	$65.47
Rate for Payer: Cash Price	$421.89
Rate for Payer: Cash Price	$421.89
Rate for Payer: Cash Price	$421.89
Rate for Payer: Cigna Commercial	$613.60
Rate for Payer: Cigna Medicaid	$23.54
Rate for Payer: Cigna Medicare	$270.87
Rate for Payer: Employer Direct Commercial	$270.87
Rate for Payer: Humana Medicare/TRICARE	$270.87
Rate for Payer: Molina CHIP/Medicaid	$23.54
Rate for Payer: Molina Dual Medicare/Medicaid	$270.87
Rate for Payer: Molina Medicare	$270.87
Rate for Payer: Multiplan Auto	$311.62
Rate for Payer: Multiplan Commercial	$311.62
Rate for Payer: Multiplan Workers Comp	$311.62
Rate for Payer: Parkland Medicaid	$23.54
Rate for Payer: Scott and White EPO/PPO	$4.84
Rate for Payer: Scott and White Medicare	$270.87
Rate for Payer: Superior Health Plan CHIP/Medicaid	$23.54
Rate for Payer: Superior Health Plan EPO	$270.87
Rate for Payer: Superior Health Plan Medicare	$270.87
Rate for Payer: Universal American Dual Medicare/Medicaid	$270.87
Rate for Payer: Universal American Medicare	$270.87
Rate for Payer: Wellcare Medicare	$270.87
Rate for Payer: Wellmed Medicare	$270.87

CHED ID Aspirate Arthro - temporomandibul/AC/wrist/elbow/ank

Facility

$479.42

Service Code	CPT 20605
Hospital Charge Code	8914601
Hospital Revenue Code	450
Rate for Payer: Cash Price	$421.89

CHED ID Aspirate For biopsy BCE

Facility

$5,334.28

Service Code	CPT 10021
Hospital Charge Code	8912617
Hospital Revenue Code	450
Min. Negotiated Rate	$6.52
Max. Negotiated Rate	$3,467.28
Rate for Payer: Aetna Commercial	$2,933.85
Rate for Payer: Aetna Medicare	$547.00
Rate for Payer: Amerigroup CHIP/Medicaid	$480.09
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$364.67
Rate for Payer: Amerigroup Medicare	$364.67
Rate for Payer: BCBS of TX Blue Advantage	$98.85
Rate for Payer: BCBS of TX Blue Essentials	$118.38
Rate for Payer: BCBS of TX Medicare	$364.67
Rate for Payer: BCBS of TX PPO	$149.16
Rate for Payer: Cash Price	$4,694.17
Rate for Payer: Cash Price	$4,694.17
Rate for Payer: Cash Price	$4,694.17
Rate for Payer: Cigna Commercial	$826.08
Rate for Payer: Cigna Medicaid	$51.77
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	$51.77
Rate for Payer: Molina Dual Medicare/Medicaid	$364.67
Rate for Payer: Molina Medicare	$364.67
Rate for Payer: Multiplan Auto	$3,467.28
Rate for Payer: Multiplan Commercial	$3,467.28
Rate for Payer: Multiplan Workers Comp	$3,467.28
Rate for Payer: Parkland Medicaid	$51.77
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	$51.77
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

CHED ID Aspirate For biopsy BCE

Facility

$5,334.28

Service Code	CPT 10021
Hospital Charge Code	8912617
Hospital Revenue Code	450
Rate for Payer: Cash Price	$4,694.17

CHED ID Aspirate Ganglion Cyst BCE

Facility

$627.50

Service Code	CPT 20612
Hospital Charge Code	8910622
Hospital Revenue Code	450
Min. Negotiated Rate	$4.84
Max. Negotiated Rate	$613.60
Rate for Payer: Aetna Commercial	$345.12
Rate for Payer: Aetna Medicare	$406.30
Rate for Payer: Amerigroup CHIP/Medicaid	$56.48
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$270.87
Rate for Payer: Amerigroup Medicare	$270.87
Rate for Payer: BCBS of TX Blue Advantage	$58.47
Rate for Payer: BCBS of TX Blue Essentials	$70.02
Rate for Payer: BCBS of TX Medicare	$270.87
Rate for Payer: BCBS of TX PPO	$88.23
Rate for Payer: Cash Price	$552.20
Rate for Payer: Cash Price	$552.20
Rate for Payer: Cash Price	$552.20
Rate for Payer: Cigna Commercial	$613.60
Rate for Payer: Cigna Medicaid	$30.46
Rate for Payer: Cigna Medicare	$270.87
Rate for Payer: Employer Direct Commercial	$270.87
Rate for Payer: Humana Medicare/TRICARE	$270.87
Rate for Payer: Molina CHIP/Medicaid	$30.46
Rate for Payer: Molina Dual Medicare/Medicaid	$270.87
Rate for Payer: Molina Medicare	$270.87
Rate for Payer: Multiplan Auto	$407.88
Rate for Payer: Multiplan Commercial	$407.88
Rate for Payer: Multiplan Workers Comp	$407.88
Rate for Payer: Parkland Medicaid	$30.46
Rate for Payer: Scott and White EPO/PPO	$4.84
Rate for Payer: Scott and White Medicare	$270.87
Rate for Payer: Superior Health Plan CHIP/Medicaid	$30.46
Rate for Payer: Superior Health Plan EPO	$270.87
Rate for Payer: Superior Health Plan Medicare	$270.87
Rate for Payer: Universal American Dual Medicare/Medicaid	$270.87
Rate for Payer: Universal American Medicare	$270.87
Rate for Payer: Wellcare Medicare	$270.87
Rate for Payer: Wellmed Medicare	$270.87

CHED ID Aspirate Ganglion Cyst BCE

Facility

$627.50

Service Code	CPT 20612
Hospital Charge Code	8910622
Hospital Revenue Code	450
Rate for Payer: Cash Price	$552.20

Know your out-of-pocket cost for care.

All Charges