Same network, same procedure, two prices
Medicare pays a hospital about twice what it pays a surgery center for the same procedure. The two hospital systems in the Cost Plus Wellness network with printed outpatient prices list surgery centers in their contracts and price them from the same facility rate table as their hospitals. Baylor Scott & White's contract lists 31 surgery and endoscopy centers. Its table pays a median 5.0 times Medicare's surgery-center rate. The same network already has a surgery-center price: North Texas Surgery Center's contract pays 180% of it.
What this page compares. Only the facility's fee: what the hospital or the surgery center is paid for the room, the staff and the supplies. The surgeon bills separately in both places, so the surgeon's fee is left out. Medicare figures are the 2026 rates (October update), adjusted to Dallas. Contract figures are the dollar rates printed in contracts Cost Plus Wellness publishes. The Baylor and North Texas Surgery Center contracts pay the lesser of the provider's billed charges or the rate, so their figures are the most the plan pays. Children's Health pays its flat schedule rate.
Medicare already pays two prices
Medicare pays a hospital outpatient department from one fee schedule (the OPPS) and a surgery center from another (the ASC schedule). For the same procedure code, the hospital rate is higher. Across the 3,497 procedures on Medicare's surgery-center list that the Baylor table also prices, the Dallas hospital rate is a median 2.0 times the Dallas surgery-center rate. Weighted by how often Texas physicians bill Medicare for each procedure in a facility, it is 1.7 times. (402 office-based procedures are left out. For those, Medicare pays a surgery center from the physician fee schedule, not a facility rate.)
A commercial plan pays more than Medicare at both sites. The question for a network is whether the gap between the sites goes with it.
One table for the hospitals and the surgery centers
Baylor Scott & White's contract (C010) covers 195 sites, listed in Attachment A. By their names, 31 of them are surgery or endoscopy centers: 17 Baylor Scott & White Surgicare centers, the Sports Surgery Center at The Star, the Ambulatory Endoscopy Center, and 12 others such as Park Cities Surgery Center and Texas Endoscopy.
Attachment B sets one price basis for every site:
"Plan Sponsor shall pay Providers for Covered Services at the lesser of Provider's billed charges on a per claim basis or the attached MCC UB-04 Rates Table."
Contract C010, Baylor Scott & White Health, Attachment B, page 16
The table has one outpatient rate per procedure code and no surgery-center column. Its rates follow Medicare's hospital payment groups: in 124 of the 161 groups with more than one code, every code gets the same rate. The rates are a median 2.4 times Medicare's Dallas hospital rate (5,775 codes). For a hospital, that is not high. The Congressional Budget Office found that commercial insurers paid hospitals 240% of Medicare for outpatient services, on average across the studies it reviewed. The point here is the site. Against Medicare's surgery-center rate, the same table is a median 5.0 times, or 4.1 times weighted by Texas Medicare volume.
| Procedure, facility fee | Medicare, surgery center | Medicare, hospital | Baylor table | Baylor over Medicare surgery center |
|---|---|---|---|---|
| Colonoscopy, diagnostic (45378) | $492 | $934 | $2,264 | 4.6x |
| Colonoscopy, polyp removal (45385) | $634 | $1,202 | $2,923 | 4.6x |
| Upper endoscopy with biopsy (43239) | $480 | $911 | $2,246 | 4.7x |
| Cataract removal with lens (66984) | $1,211 | $2,318 | $5,773 | 4.8x |
| Knee arthroscopy, meniscus (29881) | $1,587 | $3,287 | $8,019 | 5.1x |
| Carpal tunnel release (64721) | $915 | $1,962 | $4,783 | 5.2x |
| Rotator cuff repair, arthroscopic (29827) | $3,565 | $7,289 | $17,723 | 5.0x |
| Inguinal hernia repair (49505) | $1,682 | $3,597 | $8,571 | 5.1x |
Medicare: CY2026 OPPS Addendum B and ASC Addendum AA, October 2026, national rates adjusted with the FY2026 wage index for CBSA 19124 Dallas-Plano-Irving (hospital 0.9721, labor share 60%; surgery center 0.9292, the pre-floor index, labor share 50%). Baylor: the MCC UB-04 Rates Table in contract C010, effective December 1, 2025 (pages 18 to 218; outpatient lines on pages 31 to 146). Whole dollars.
What we do not know. We have the contract, not the claims. The contract does not say whether its surgery centers bill on the hospital claim form (the UB-04) the table is named for, or how their claims are paid in practice. A center's billed charges can also be lower than the table, and the plan pays the lower of the two. What the published contract shows is that it gives these 31 centers no price of their own.
The network already has a surgery-center price
North Texas Surgery Center (legal name Desoto Surgicare Partners, Ltd.), a pain management surgery center in Dallas, has its own Wellness contract (C028). It sets the price as a percent of Medicare's surgery-center schedule:
"Plan Sponsor shall pay Provider for Covered Services at the lesser of billed charges or 180% of the then-current Medicare Ambulatory Surgery Center fee schedule applicable to the Covered Service."
Contract C028, North Texas Surgery Center, page 10
For common pain procedures, here is the same procedure at the two contracts' rates:
| Procedure, facility fee | Medicare, surgery center | North Texas Surgery Center, 180% | Baylor table | Baylor over Medicare surgery center |
|---|---|---|---|---|
| Epidural steroid injection, lumbar, one level (64483) | $468 | $843 | $2,258 | 4.8x |
| Epidural injection, lumbar, interlaminar (62323) | $374 | $673 | $1,713 | 4.6x |
| Facet joint injection, lumbar, one level (64493) | $468 | $843 | $2,258 | 4.8x |
| Facet nerve ablation, lumbar (64635) | $915 | $1,647 | $4,783 | 5.2x |
The contract names no locality. The center's address (Dallas, 75237) is in the Dallas wage area, so the Dallas surgery-center rate is used. Medicare's rules for multiple procedures apply under the contract; the table shows one procedure. Medicare's hospital rates for these four codes are $889, $709, $889 and $1,962.
Across all 3,497 procedures, the Baylor table is a median 2.8 times the North Texas Surgery Center terms. The 180% is not a low price either. It is 180% of what Medicare pays the same center.
What a surgery-center price would change
Take one diagnostic colonoscopy, facility fee only, at a Baylor endoscopy center:
- $2,264 under the published table, the hospital rate.
- $1,201 if the table's multiple of Medicare (a median 2.4 times) applied to Medicare's surgery-center rate instead of its hospital rate. The multiple stays the same; only the base changes.
- $886 at the North Texas Surgery Center terms, 180% of the surgery-center rate. That is $1,378 less than the table, for the same procedure, in the same network.
The member does not see this gap. Most Wellness contracts bar coinsurance, so a member pays the same at either site. The price difference falls on the plan, and the choice of site is made by referral, scheduling and network design. A contract with a surgery-center column makes the lower price the default for the work that is already done in surgery centers.
Children's Health does the same, at different prices
Children's Health (C036) is the other hospital system with printed outpatient prices in the network. Its Attachment A lists Legacy Trail Surgery Center, which does business as Live Oak Surgery Center, beside its hospitals, and pays facility services from one schedule, Attachment B-1. That schedule, headed "Proposed Rate", gives one flat price for each of 15 outpatient surgeries, with no surgery-center rate. Against Medicare's Dallas hospital rate, those prices run from about 0.6 times to 7.5 times. Children's prices are below Baylor's for some procedures and above them for others:
| Procedure, facility fee | Medicare, hospital | Children's Health | Baylor table |
|---|---|---|---|
| Tonsillectomy with adenoidectomy (42820) | $5,947 | $5,750 | $14,507 |
| Colonoscopy, diagnostic (45378) | $934 | $2,900 | $2,264 |
| Upper endoscopy with biopsy (43239) | $911 | $6,800 | $2,246 |
| Ear tubes, general anesthesia (69436) | $1,559 | $3,015 | $3,778 |
Children's Health: contract C036, Attachment A (page 10) and Attachment B-1, Outpatient Compensation Schedule (pages 11 to 13). Its facility services not on the schedule are paid at 68% of billed charges. Children's treats children, so its case mix differs from an adult hospital's.
Every procedure, both Medicare rates, the Baylor table
The 3,497 procedures on Medicare's surgery-center list that the Baylor table prices, the 402 office-based procedures left out. Sorted by how many times Texas physicians billed Medicare for each one in a facility in 2024, including inpatient stays (a ranking only; it is not the Wellness network's volume). Search by code or name.
| Code | Procedure | Texas Medicare services, 2024 | Medicare, surgery center | Medicare, hospital | Baylor table | Baylor over surgery center |
|---|
Download CSV Download JSON All 3,497 procedures, with the page of contract C010 for each Baylor rate.
Method
- Contracts: Baylor Scott & White Health (C010), North Texas Surgery Center (C028) and Children's Health (C036), as published on costpluswellness.com and read for Wellness 003. The Baylor rate table was transcribed in full (6,528 outpatient lines) and each rate carries its page number.
- Medicare: CY2026 OPPS Addendum B and CY2026 ASC Addendum AA, October 2026 updates. Dallas rates use the standard formulas: hospital = national rate x (0.60 x 0.9721 + 0.40); surgery center = national rate x (0.50 x 0.9292 + 0.50). The wage indexes are from the FY2026 IPPS final rule, Table 3. A hospital's own wage index can differ from its area's.
- Procedures compared: every code on Addendum AA with a payment rate that also has an OPPS rate and a line in the Baylor table, less the 402 office-based codes that Medicare pays a surgery center from the physician fee schedule (ASC payment indicator P3): 3,497. The 2.4 times figure uses every Baylor outpatient code that OPPS pays separately (status indicators J1, J2, T, S, Q1, Q2, Q3 and V): 5,775.
- Ranking weight: CMS, Medicare Physician & Other Practitioners, by Geography and Service, 2024, Texas, facility place of service, total services. It counts services billed by physicians in any facility, including hospital inpatient stays. It is Medicare volume, not the Wellness network's.
- Surgery centers on Attachment A: sites whose names say Surgicare, Surgery Center, SurgCenter or Endoscopy. North Central Surgical Center is registered as a hospital (NPI 1548236524) and is not counted. We looked up each name in the NPPES registry. 9 of the 31 names match a registry name. Those entries are registered as ambulatory surgical centers, except one Texas Endoscopy entry registered as a clinic. The other 22, including the 17 Surgicare centers, are counted by name only.
- Benchmark: Congressional Budget Office, "The Prices That Commercial Health Insurers and Medicare Pay for Hospitals' and Physicians' Services", January 2022.
- The build checks the parsed sources against hand-typed values and checks that this page states each figure it produces. Any mismatch stops the build.
What this can and cannot say. These are contract rates, not payments. For Baylor and North Texas Surgery Center, each rate is the most the plan pays, and the plan pays billed charges when they are lower. Children's Health pays its flat schedule rate. Medicare's hospital rate for a comprehensive procedure covers more of the related services on the same claim than its surgery-center rate does, so part of Medicare's own gap is packaging. The page does not say how often Wellness members use any of these sites, and it says nothing about the quality of care at any of them.