White Rock Medical Center

All Charges

Charge

Type

Setting

Price

CHED ID Body Site Finger, complex BCE

Facility

$1,381.73

Service Code	CPT 26011
Hospital Charge Code	8912618
Hospital Revenue Code	450
Min. Negotiated Rate	$26.52
Max. Negotiated Rate	$3,458.95
Rate for Payer: Aetna Commercial	$2,200.00
Rate for Payer: Aetna Medicare	$2,224.11
Rate for Payer: Amerigroup CHIP/Medicaid	$124.36
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$1,482.74
Rate for Payer: Amerigroup Medicare	$1,482.74
Rate for Payer: BCBS of TX Blue Advantage	$2,292.24
Rate for Payer: BCBS of TX Blue Essentials	$2,745.20
Rate for Payer: BCBS of TX Medicare	$1,482.74
Rate for Payer: BCBS of TX PPO	$3,458.95
Rate for Payer: Cash Price	$1,215.92
Rate for Payer: Cash Price	$1,215.92
Rate for Payer: Cash Price	$1,215.92
Rate for Payer: Cigna Commercial	$3,358.84
Rate for Payer: Cigna Medicaid	$486.45
Rate for Payer: Cigna Medicare	$1,482.74
Rate for Payer: Employer Direct Commercial	$1,482.74
Rate for Payer: Humana Medicare/TRICARE	$1,482.74
Rate for Payer: Molina CHIP/Medicaid	$486.45
Rate for Payer: Molina Dual Medicare/Medicaid	$1,482.74
Rate for Payer: Molina Medicare	$1,482.74
Rate for Payer: Multiplan Auto	$898.12
Rate for Payer: Multiplan Commercial	$898.12
Rate for Payer: Multiplan Workers Comp	$898.12
Rate for Payer: Parkland Medicaid	$486.45
Rate for Payer: Scott and White EPO/PPO	$26.52
Rate for Payer: Scott and White Medicare	$1,482.74
Rate for Payer: Superior Health Plan CHIP/Medicaid	$486.45
Rate for Payer: Superior Health Plan EPO	$1,482.74
Rate for Payer: Superior Health Plan Medicare	$1,482.74
Rate for Payer: Universal American Dual Medicare/Medicaid	$1,482.74
Rate for Payer: Universal American Medicare	$1,482.74
Rate for Payer: Wellcare Medicare	$1,482.74
Rate for Payer: Wellmed Medicare	$1,482.74

CHED ID Body Site Finger, complex BCE

Facility

$1,381.73

Service Code	CPT 26011
Hospital Charge Code	8912618
Hospital Revenue Code	450
Rate for Payer: Cash Price	$1,215.92

CHED ID Body Site Hematoma, Seroma, Fluid collection BCE

Facility

$6,773.30

Service Code	CPT 10140
Hospital Charge Code	8912619
Hospital Revenue Code	450
Min. Negotiated Rate	$26.52
Max. Negotiated Rate	$4,402.64
Rate for Payer: Aetna Commercial	$2,200.00
Rate for Payer: Aetna Medicare	$2,224.11
Rate for Payer: Amerigroup CHIP/Medicaid	$609.60
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$1,482.74
Rate for Payer: Amerigroup Medicare	$1,482.74
Rate for Payer: BCBS of TX Blue Advantage	$183.82
Rate for Payer: BCBS of TX Blue Essentials	$220.14
Rate for Payer: BCBS of TX Medicare	$1,482.74
Rate for Payer: BCBS of TX PPO	$277.38
Rate for Payer: Cash Price	$5,960.50
Rate for Payer: Cash Price	$5,960.50
Rate for Payer: Cash Price	$5,960.50
Rate for Payer: Cigna Commercial	$3,358.84
Rate for Payer: Cigna Medicaid	$90.81
Rate for Payer: Cigna Medicare	$1,482.74
Rate for Payer: Employer Direct Commercial	$1,482.74
Rate for Payer: Humana Medicare/TRICARE	$1,482.74
Rate for Payer: Molina CHIP/Medicaid	$90.81
Rate for Payer: Molina Dual Medicare/Medicaid	$1,482.74
Rate for Payer: Molina Medicare	$1,482.74
Rate for Payer: Multiplan Auto	$4,402.64
Rate for Payer: Multiplan Commercial	$4,402.64
Rate for Payer: Multiplan Workers Comp	$4,402.64
Rate for Payer: Parkland Medicaid	$90.81
Rate for Payer: Scott and White EPO/PPO	$26.52
Rate for Payer: Scott and White Medicare	$1,482.74
Rate for Payer: Superior Health Plan CHIP/Medicaid	$90.81
Rate for Payer: Superior Health Plan EPO	$1,482.74
Rate for Payer: Superior Health Plan Medicare	$1,482.74
Rate for Payer: Universal American Dual Medicare/Medicaid	$1,482.74
Rate for Payer: Universal American Medicare	$1,482.74
Rate for Payer: Wellcare Medicare	$1,482.74
Rate for Payer: Wellmed Medicare	$1,482.74

CHED ID Body Site Hematoma, Seroma, Fluid collection BCE

Facility

$6,773.30

Service Code	CPT 10140
Hospital Charge Code	8912619
Hospital Revenue Code	450
Rate for Payer: Cash Price	$5,960.50

CHED ID Body Site I&D Abscess/Cyst Complex BCE

Facility

$1,635.97

Service Code	CPT 10061
Hospital Charge Code	8912620
Hospital Revenue Code	450
Rate for Payer: Cash Price	$1,439.65

CHED ID Body Site I&D Abscess/Cyst Complex BCE

Facility

$1,635.97

Service Code	CPT 10061
Hospital Charge Code	8912620
Hospital Revenue Code	450
Min. Negotiated Rate	$6.52
Max. Negotiated Rate	$1,063.38
Rate for Payer: Aetna Commercial	$899.78
Rate for Payer: Aetna Medicare	$547.00
Rate for Payer: Amerigroup CHIP/Medicaid	$147.24
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$364.67
Rate for Payer: Amerigroup Medicare	$364.67
Rate for Payer: BCBS of TX Blue Advantage	$192.87
Rate for Payer: BCBS of TX Blue Essentials	$230.98
Rate for Payer: BCBS of TX Medicare	$364.67
Rate for Payer: BCBS of TX PPO	$291.03
Rate for Payer: Cash Price	$1,439.65
Rate for Payer: Cash Price	$1,439.65
Rate for Payer: Cash Price	$1,439.65
Rate for Payer: Cigna Commercial	$826.08
Rate for Payer: Cigna Medicaid	$98.28
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	$98.28
Rate for Payer: Molina Dual Medicare/Medicaid	$364.67
Rate for Payer: Molina Medicare	$364.67
Rate for Payer: Multiplan Auto	$1,063.38
Rate for Payer: Multiplan Commercial	$1,063.38
Rate for Payer: Multiplan Workers Comp	$1,063.38
Rate for Payer: Parkland Medicaid	$98.28
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	$98.28
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 Body Site I&D Abscess/Cyst Simple BCE

Facility

$940.35

Service Code	CPT 10060
Hospital Charge Code	8910623
Hospital Revenue Code	450
Min. Negotiated Rate	$3.27
Max. Negotiated Rate	$611.23
Rate for Payer: Aetna Commercial	$517.19
Rate for Payer: Aetna Medicare	$274.64
Rate for Payer: Amerigroup CHIP/Medicaid	$84.63
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$183.09
Rate for Payer: Amerigroup Medicare	$183.09
Rate for Payer: BCBS of TX Blue Advantage	$125.97
Rate for Payer: BCBS of TX Blue Essentials	$150.86
Rate for Payer: BCBS of TX Medicare	$183.09
Rate for Payer: BCBS of TX PPO	$190.08
Rate for Payer: Cash Price	$827.51
Rate for Payer: Cash Price	$827.51
Rate for Payer: Cash Price	$827.51
Rate for Payer: Cigna Commercial	$414.75
Rate for Payer: Cigna Medicaid	$65.06
Rate for Payer: Cigna Medicare	$183.09
Rate for Payer: Employer Direct Commercial	$183.09
Rate for Payer: Humana Medicare/TRICARE	$183.09
Rate for Payer: Molina CHIP/Medicaid	$65.06
Rate for Payer: Molina Dual Medicare/Medicaid	$183.09
Rate for Payer: Molina Medicare	$183.09
Rate for Payer: Multiplan Auto	$611.23
Rate for Payer: Multiplan Commercial	$611.23
Rate for Payer: Multiplan Workers Comp	$611.23
Rate for Payer: Parkland Medicaid	$65.06
Rate for Payer: Scott and White EPO/PPO	$3.27
Rate for Payer: Scott and White Medicare	$183.09
Rate for Payer: Superior Health Plan CHIP/Medicaid	$65.06
Rate for Payer: Superior Health Plan EPO	$183.09
Rate for Payer: Superior Health Plan Medicare	$183.09
Rate for Payer: Universal American Dual Medicare/Medicaid	$183.09
Rate for Payer: Universal American Medicare	$183.09
Rate for Payer: Wellcare Medicare	$183.09
Rate for Payer: Wellmed Medicare	$183.09

CHED ID Body Site I&D Abscess/Cyst Simple BCE

Facility

$940.35

Service Code	CPT 10060
Hospital Charge Code	8910623
Hospital Revenue Code	450
Rate for Payer: Cash Price	$827.51

CHED ID Body Site Perianal, superficial BCE

Facility

$3,738.75

Service Code	CPT 46050
Hospital Charge Code	8912621
Hospital Revenue Code	450
Rate for Payer: Cash Price	$3,290.10

CHED ID Body Site Perianal, superficial BCE

Facility

$3,738.75

Service Code	CPT 46050
Hospital Charge Code	8912621
Hospital Revenue Code	450
Min. Negotiated Rate	$14.95
Max. Negotiated Rate	$2,430.19
Rate for Payer: Aetna Commercial	$1,400.00
Rate for Payer: Aetna Medicare	$1,253.79
Rate for Payer: Amerigroup CHIP/Medicaid	$336.49
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$835.86
Rate for Payer: Amerigroup Medicare	$835.86
Rate for Payer: BCBS of TX Blue Advantage	$1,275.68
Rate for Payer: BCBS of TX Blue Essentials	$1,527.76
Rate for Payer: BCBS of TX Medicare	$835.86
Rate for Payer: BCBS of TX PPO	$1,924.98
Rate for Payer: Cash Price	$3,290.10
Rate for Payer: Cash Price	$3,290.10
Rate for Payer: Cash Price	$3,290.10
Rate for Payer: Cigna Commercial	$1,893.46
Rate for Payer: Cigna Medicaid	$328.50
Rate for Payer: Cigna Medicare	$835.86
Rate for Payer: Employer Direct Commercial	$835.86
Rate for Payer: Humana Medicare/TRICARE	$835.86
Rate for Payer: Molina CHIP/Medicaid	$328.50
Rate for Payer: Molina Dual Medicare/Medicaid	$835.86
Rate for Payer: Molina Medicare	$835.86
Rate for Payer: Multiplan Auto	$2,430.19
Rate for Payer: Multiplan Commercial	$2,430.19
Rate for Payer: Multiplan Workers Comp	$2,430.19
Rate for Payer: Parkland Medicaid	$328.50
Rate for Payer: Scott and White EPO/PPO	$14.95
Rate for Payer: Scott and White Medicare	$835.86
Rate for Payer: Superior Health Plan CHIP/Medicaid	$328.50
Rate for Payer: Superior Health Plan EPO	$835.86
Rate for Payer: Superior Health Plan Medicare	$835.86
Rate for Payer: Universal American Dual Medicare/Medicaid	$835.86
Rate for Payer: Universal American Medicare	$835.86
Rate for Payer: Wellcare Medicare	$835.86
Rate for Payer: Wellmed Medicare	$835.86

CHED ID Body Site Peritonsillar BCE

Facility

$1,336.00

Service Code	CPT 42700
Hospital Charge Code	8914602
Hospital Revenue Code	450
Rate for Payer: Cash Price	$1,175.68

CHED ID Body Site Peritonsillar BCE

Facility

$1,336.00

Service Code	CPT 42700
Hospital Charge Code	8914602
Hospital Revenue Code	450
Min. Negotiated Rate	$4.00
Max. Negotiated Rate	$868.40
Rate for Payer: Aetna Commercial	$734.80
Rate for Payer: Aetna Medicare	$335.08
Rate for Payer: Amerigroup CHIP/Medicaid	$120.24
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$223.39
Rate for Payer: Amerigroup Medicare	$223.39
Rate for Payer: BCBS of TX Blue Advantage	$340.08
Rate for Payer: BCBS of TX Blue Essentials	$407.28
Rate for Payer: BCBS of TX Medicare	$223.39
Rate for Payer: BCBS of TX PPO	$513.17
Rate for Payer: Cash Price	$1,175.68
Rate for Payer: Cash Price	$1,175.68
Rate for Payer: Cash Price	$1,175.68
Rate for Payer: Cigna Commercial	$506.05
Rate for Payer: Cigna Medicaid	$87.58
Rate for Payer: Cigna Medicare	$223.39
Rate for Payer: Employer Direct Commercial	$223.39
Rate for Payer: Humana Medicare/TRICARE	$223.39
Rate for Payer: Molina CHIP/Medicaid	$87.58
Rate for Payer: Molina Dual Medicare/Medicaid	$223.39
Rate for Payer: Molina Medicare	$223.39
Rate for Payer: Multiplan Auto	$868.40
Rate for Payer: Multiplan Commercial	$868.40
Rate for Payer: Multiplan Workers Comp	$868.40
Rate for Payer: Parkland Medicaid	$87.58
Rate for Payer: Scott and White EPO/PPO	$4.00
Rate for Payer: Scott and White Medicare	$223.39
Rate for Payer: Superior Health Plan CHIP/Medicaid	$87.58
Rate for Payer: Superior Health Plan EPO	$223.39
Rate for Payer: Superior Health Plan Medicare	$223.39
Rate for Payer: Universal American Dual Medicare/Medicaid	$223.39
Rate for Payer: Universal American Medicare	$223.39
Rate for Payer: Wellcare Medicare	$223.39
Rate for Payer: Wellmed Medicare	$223.39

CHED ID Body Site Pilonidal cyst, multiple BCE

Facility

$3,559.73

Service Code	CPT 10081
Hospital Charge Code	8910624
Hospital Revenue Code	450
Rate for Payer: Cash Price	$3,132.56

CHED ID Body Site Pilonidal cyst, multiple BCE

Facility

$3,559.73

Service Code	CPT 10081
Hospital Charge Code	8910624
Hospital Revenue Code	450
Min. Negotiated Rate	$11.51
Max. Negotiated Rate	$2,313.82
Rate for Payer: Aetna Commercial	$1,400.00
Rate for Payer: Aetna Medicare	$965.18
Rate for Payer: Amerigroup CHIP/Medicaid	$320.38
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$643.45
Rate for Payer: Amerigroup Medicare	$643.45
Rate for Payer: BCBS of TX Blue Advantage	$348.36
Rate for Payer: BCBS of TX Blue Essentials	$417.20
Rate for Payer: BCBS of TX Medicare	$643.45
Rate for Payer: BCBS of TX PPO	$525.67
Rate for Payer: Cash Price	$3,132.56
Rate for Payer: Cash Price	$3,132.56
Rate for Payer: Cash Price	$3,132.56
Rate for Payer: Cigna Commercial	$1,457.60
Rate for Payer: Cigna Medicaid	$209.30
Rate for Payer: Cigna Medicare	$643.45
Rate for Payer: Employer Direct Commercial	$643.45
Rate for Payer: Humana Medicare/TRICARE	$643.45
Rate for Payer: Molina CHIP/Medicaid	$209.30
Rate for Payer: Molina Dual Medicare/Medicaid	$643.45
Rate for Payer: Molina Medicare	$643.45
Rate for Payer: Multiplan Auto	$2,313.82
Rate for Payer: Multiplan Commercial	$2,313.82
Rate for Payer: Multiplan Workers Comp	$2,313.82
Rate for Payer: Parkland Medicaid	$209.30
Rate for Payer: Scott and White EPO/PPO	$11.51
Rate for Payer: Scott and White Medicare	$643.45
Rate for Payer: Superior Health Plan CHIP/Medicaid	$209.30
Rate for Payer: Superior Health Plan EPO	$643.45
Rate for Payer: Superior Health Plan Medicare	$643.45
Rate for Payer: Universal American Dual Medicare/Medicaid	$643.45
Rate for Payer: Universal American Medicare	$643.45
Rate for Payer: Wellcare Medicare	$643.45
Rate for Payer: Wellmed Medicare	$643.45

CHED ID Body Site Pilonidal cyst, single BCE

Facility

$177.00

Service Code	CPT 10080
Hospital Charge Code	8910625
Hospital Revenue Code	450
Min. Negotiated Rate	$11.51
Max. Negotiated Rate	$1,457.60
Rate for Payer: Aetna Commercial	$1,400.00
Rate for Payer: Aetna Medicare	$965.18
Rate for Payer: Amerigroup CHIP/Medicaid	$15.93
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$643.45
Rate for Payer: Amerigroup Medicare	$643.45
Rate for Payer: BCBS of TX Blue Advantage	$276.03
Rate for Payer: BCBS of TX Blue Essentials	$330.58
Rate for Payer: BCBS of TX Medicare	$643.45
Rate for Payer: BCBS of TX PPO	$416.53
Rate for Payer: Cash Price	$155.76
Rate for Payer: Cash Price	$155.76
Rate for Payer: Cash Price	$155.76
Rate for Payer: Cigna Commercial	$1,457.60
Rate for Payer: Cigna Medicaid	$174.14
Rate for Payer: Cigna Medicare	$643.45
Rate for Payer: Employer Direct Commercial	$643.45
Rate for Payer: Humana Medicare/TRICARE	$643.45
Rate for Payer: Molina CHIP/Medicaid	$174.14
Rate for Payer: Molina Dual Medicare/Medicaid	$643.45
Rate for Payer: Molina Medicare	$643.45
Rate for Payer: Multiplan Auto	$115.05
Rate for Payer: Multiplan Commercial	$115.05
Rate for Payer: Multiplan Workers Comp	$115.05
Rate for Payer: Parkland Medicaid	$174.14
Rate for Payer: Scott and White EPO/PPO	$11.51
Rate for Payer: Scott and White Medicare	$643.45
Rate for Payer: Superior Health Plan CHIP/Medicaid	$174.14
Rate for Payer: Superior Health Plan EPO	$643.45
Rate for Payer: Superior Health Plan Medicare	$643.45
Rate for Payer: Universal American Dual Medicare/Medicaid	$643.45
Rate for Payer: Universal American Medicare	$643.45
Rate for Payer: Wellcare Medicare	$643.45
Rate for Payer: Wellmed Medicare	$643.45

CHED ID Body Site Pilonidal cyst, single BCE

Facility

$177.00

Service Code	CPT 10080
Hospital Charge Code	8910625
Hospital Revenue Code	450
Rate for Payer: Cash Price	$155.76

CHED ID Body Site Scrotal Space BCE

Facility

$7,660.00

Service Code	CPT 54700
Hospital Charge Code	8910626
Hospital Revenue Code	450
Min. Negotiated Rate	$33.31
Max. Negotiated Rate	$4,979.00
Rate for Payer: Aetna Commercial	$3,090.00
Rate for Payer: Aetna Medicare	$2,794.14
Rate for Payer: Amerigroup CHIP/Medicaid	$689.40
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$1,862.76
Rate for Payer: Amerigroup Medicare	$1,862.76
Rate for Payer: BCBS of TX Blue Advantage	$2,958.49
Rate for Payer: BCBS of TX Blue Essentials	$3,543.10
Rate for Payer: BCBS of TX Medicare	$1,862.76
Rate for Payer: BCBS of TX PPO	$4,464.31
Rate for Payer: Cash Price	$6,740.80
Rate for Payer: Cash Price	$6,740.80
Rate for Payer: Cash Price	$6,740.80
Rate for Payer: Cigna Commercial	$4,219.69
Rate for Payer: Cigna Medicaid	$652.80
Rate for Payer: Cigna Medicare	$1,862.76
Rate for Payer: Employer Direct Commercial	$1,862.76
Rate for Payer: Humana Medicare/TRICARE	$1,862.76
Rate for Payer: Molina CHIP/Medicaid	$652.80
Rate for Payer: Molina Dual Medicare/Medicaid	$1,862.76
Rate for Payer: Molina Medicare	$1,862.76
Rate for Payer: Multiplan Auto	$4,979.00
Rate for Payer: Multiplan Commercial	$4,979.00
Rate for Payer: Multiplan Workers Comp	$4,979.00
Rate for Payer: Parkland Medicaid	$652.80
Rate for Payer: Scott and White EPO/PPO	$33.31
Rate for Payer: Scott and White Medicare	$1,862.76
Rate for Payer: Superior Health Plan CHIP/Medicaid	$652.80
Rate for Payer: Superior Health Plan EPO	$1,862.76
Rate for Payer: Superior Health Plan Medicare	$1,862.76
Rate for Payer: Universal American Dual Medicare/Medicaid	$1,862.76
Rate for Payer: Universal American Medicare	$1,862.76
Rate for Payer: Wellcare Medicare	$1,862.76
Rate for Payer: Wellmed Medicare	$1,862.76

CHED ID Body Site Scrotal Space BCE

Facility

$7,660.00

Service Code	CPT 54700
Hospital Charge Code	8910626
Hospital Revenue Code	450
Rate for Payer: Cash Price	$6,740.80

CHED ID Body Site Vestibule of Mouth, Complex BCE

Facility

$4,220.72

Service Code	CPT 40801
Hospital Charge Code	8914603
Hospital Revenue Code	450
Min. Negotiated Rate	$9.00
Max. Negotiated Rate	$2,743.47
Rate for Payer: Aetna Commercial	$2,321.40
Rate for Payer: Aetna Medicare	$754.78
Rate for Payer: Amerigroup CHIP/Medicaid	$379.86
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$503.19
Rate for Payer: Amerigroup Medicare	$503.19
Rate for Payer: BCBS of TX Blue Advantage	$737.67
Rate for Payer: BCBS of TX Blue Essentials	$883.44
Rate for Payer: BCBS of TX Medicare	$503.19
Rate for Payer: BCBS of TX PPO	$1,113.13
Rate for Payer: Cash Price	$3,714.23
Rate for Payer: Cash Price	$3,714.23
Rate for Payer: Cash Price	$3,714.23
Rate for Payer: Cigna Commercial	$1,139.87
Rate for Payer: Cigna Medicaid	$187.22
Rate for Payer: Cigna Medicare	$503.19
Rate for Payer: Employer Direct Commercial	$503.19
Rate for Payer: Humana Medicare/TRICARE	$503.19
Rate for Payer: Molina CHIP/Medicaid	$187.22
Rate for Payer: Molina Dual Medicare/Medicaid	$503.19
Rate for Payer: Molina Medicare	$503.19
Rate for Payer: Multiplan Auto	$2,743.47
Rate for Payer: Multiplan Commercial	$2,743.47
Rate for Payer: Multiplan Workers Comp	$2,743.47
Rate for Payer: Parkland Medicaid	$187.22
Rate for Payer: Scott and White EPO/PPO	$9.00
Rate for Payer: Scott and White Medicare	$503.19
Rate for Payer: Superior Health Plan CHIP/Medicaid	$187.22
Rate for Payer: Superior Health Plan EPO	$503.19
Rate for Payer: Superior Health Plan Medicare	$503.19
Rate for Payer: Universal American Dual Medicare/Medicaid	$503.19
Rate for Payer: Universal American Medicare	$503.19
Rate for Payer: Wellcare Medicare	$503.19
Rate for Payer: Wellmed Medicare	$503.19

CHED ID Body Site Vestibule of Mouth, Complex BCE

Facility

$4,220.72

Service Code	CPT 40801
Hospital Charge Code	8914603
Hospital Revenue Code	450
Rate for Payer: Cash Price	$3,714.23

CHED ID Body Site Vestibule of Mouth, Simple BCE

Facility

$1,289.70

Service Code	CPT 40800
Hospital Charge Code	8914604
Hospital Revenue Code	450
Min. Negotiated Rate	$11.51
Max. Negotiated Rate	$1,457.60
Rate for Payer: Aetna Commercial	$1,400.00
Rate for Payer: Aetna Medicare	$965.18
Rate for Payer: Amerigroup CHIP/Medicaid	$116.07
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$643.45
Rate for Payer: Amerigroup Medicare	$643.45
Rate for Payer: BCBS of TX Blue Advantage	$277.84
Rate for Payer: BCBS of TX Blue Essentials	$332.74
Rate for Payer: BCBS of TX Medicare	$643.45
Rate for Payer: BCBS of TX PPO	$419.25
Rate for Payer: Cash Price	$1,134.94
Rate for Payer: Cash Price	$1,134.94
Rate for Payer: Cash Price	$1,134.94
Rate for Payer: Cigna Commercial	$1,457.60
Rate for Payer: Cigna Medicaid	$131.78
Rate for Payer: Cigna Medicare	$643.45
Rate for Payer: Employer Direct Commercial	$643.45
Rate for Payer: Humana Medicare/TRICARE	$643.45
Rate for Payer: Molina CHIP/Medicaid	$131.78
Rate for Payer: Molina Dual Medicare/Medicaid	$643.45
Rate for Payer: Molina Medicare	$643.45
Rate for Payer: Multiplan Auto	$838.30
Rate for Payer: Multiplan Commercial	$838.30
Rate for Payer: Multiplan Workers Comp	$838.30
Rate for Payer: Parkland Medicaid	$131.78
Rate for Payer: Scott and White EPO/PPO	$11.51
Rate for Payer: Scott and White Medicare	$643.45
Rate for Payer: Superior Health Plan CHIP/Medicaid	$131.78
Rate for Payer: Superior Health Plan EPO	$643.45
Rate for Payer: Superior Health Plan Medicare	$643.45
Rate for Payer: Universal American Dual Medicare/Medicaid	$643.45
Rate for Payer: Universal American Medicare	$643.45
Rate for Payer: Wellcare Medicare	$643.45
Rate for Payer: Wellmed Medicare	$643.45

CHED ID Body Site Vestibule of Mouth, Simple BCE

Facility

$1,289.70

Service Code	CPT 40800
Hospital Charge Code	8914604
Hospital Revenue Code	450
Rate for Payer: Cash Price	$1,134.94

CHED ID Drainage Eyelid BCE

Facility

$4,865.88

Service Code	CPT 67700
Hospital Charge Code	8914605
Hospital Revenue Code	450
Rate for Payer: Cash Price	$4,281.97

CHED ID Drainage Eyelid BCE

Facility

$4,865.88

Service Code	CPT 67700
Hospital Charge Code	8914605
Hospital Revenue Code	450
Min. Negotiated Rate	$4.76
Max. Negotiated Rate	$3,162.82
Rate for Payer: Aetna Commercial	$2,676.23
Rate for Payer: Aetna Medicare	$399.63
Rate for Payer: Amerigroup CHIP/Medicaid	$437.93
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$266.42
Rate for Payer: Amerigroup Medicare	$266.42
Rate for Payer: BCBS of TX Blue Advantage	$228.26
Rate for Payer: BCBS of TX Blue Essentials	$273.36
Rate for Payer: BCBS of TX Medicare	$266.42
Rate for Payer: BCBS of TX PPO	$344.43
Rate for Payer: Cash Price	$4,281.97
Rate for Payer: Cash Price	$4,281.97
Rate for Payer: Cash Price	$4,281.97
Rate for Payer: Cigna Commercial	$603.52
Rate for Payer: Cigna Medicaid	$108.29
Rate for Payer: Cigna Medicare	$266.42
Rate for Payer: Employer Direct Commercial	$266.42
Rate for Payer: Humana Medicare/TRICARE	$266.42
Rate for Payer: Molina CHIP/Medicaid	$108.29
Rate for Payer: Molina Dual Medicare/Medicaid	$266.42
Rate for Payer: Molina Medicare	$266.42
Rate for Payer: Multiplan Auto	$3,162.82
Rate for Payer: Multiplan Commercial	$3,162.82
Rate for Payer: Multiplan Workers Comp	$3,162.82
Rate for Payer: Parkland Medicaid	$108.29
Rate for Payer: Scott and White EPO/PPO	$4.76
Rate for Payer: Scott and White Medicare	$266.42
Rate for Payer: Superior Health Plan CHIP/Medicaid	$108.29
Rate for Payer: Superior Health Plan EPO	$266.42
Rate for Payer: Superior Health Plan Medicare	$266.42
Rate for Payer: Universal American Dual Medicare/Medicaid	$266.42
Rate for Payer: Universal American Medicare	$266.42
Rate for Payer: Wellcare Medicare	$266.42
Rate for Payer: Wellmed Medicare	$266.42

CHED ID Drainage Nose, Internal BCE

Facility

$1,990.00

Service Code	CPT 30000
Hospital Charge Code	8912622
Hospital Revenue Code	450
Min. Negotiated Rate	$4.00
Max. Negotiated Rate	$1,293.50
Rate for Payer: Aetna Commercial	$1,094.50
Rate for Payer: Aetna Medicare	$335.08
Rate for Payer: Amerigroup CHIP/Medicaid	$179.10
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$223.39
Rate for Payer: Amerigroup Medicare	$223.39
Rate for Payer: BCBS of TX Blue Advantage	$171.83
Rate for Payer: BCBS of TX Blue Essentials	$205.78
Rate for Payer: BCBS of TX Medicare	$223.39
Rate for Payer: BCBS of TX PPO	$259.28
Rate for Payer: Cash Price	$1,751.20
Rate for Payer: Cash Price	$1,751.20
Rate for Payer: Cash Price	$1,751.20
Rate for Payer: Cigna Commercial	$506.05
Rate for Payer: Cigna Medicaid	$87.58
Rate for Payer: Cigna Medicare	$223.39
Rate for Payer: Employer Direct Commercial	$223.39
Rate for Payer: Humana Medicare/TRICARE	$223.39
Rate for Payer: Molina CHIP/Medicaid	$87.58
Rate for Payer: Molina Dual Medicare/Medicaid	$223.39
Rate for Payer: Molina Medicare	$223.39
Rate for Payer: Multiplan Auto	$1,293.50
Rate for Payer: Multiplan Commercial	$1,293.50
Rate for Payer: Multiplan Workers Comp	$1,293.50
Rate for Payer: Parkland Medicaid	$87.58
Rate for Payer: Scott and White EPO/PPO	$4.00
Rate for Payer: Scott and White Medicare	$223.39
Rate for Payer: Superior Health Plan CHIP/Medicaid	$87.58
Rate for Payer: Superior Health Plan EPO	$223.39
Rate for Payer: Superior Health Plan Medicare	$223.39
Rate for Payer: Universal American Dual Medicare/Medicaid	$223.39
Rate for Payer: Universal American Medicare	$223.39
Rate for Payer: Wellcare Medicare	$223.39
Rate for Payer: Wellmed Medicare	$223.39

Know your out-of-pocket cost for care.

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