White Rock Medical Center

All Charges

Charge

Type

Setting

Price

REAMER GRAFTMAX FLEX SENTINEL

Facility

$1,514.14

Hospital Charge Code	141510
Hospital Revenue Code	272
Min. Negotiated Rate	$136.27
Max. Negotiated Rate	$984.19
Rate for Payer: Aetna Commercial	$832.78
Rate for Payer: Amerigroup CHIP/Medicaid	$136.27
Rate for Payer: BCBS of TX Blue Advantage	$454.24
Rate for Payer: BCBS of TX Blue Essentials	$545.09
Rate for Payer: BCBS of TX PPO	$605.66
Rate for Payer: Cash Price	$1,332.44
Rate for Payer: Multiplan Auto	$984.19
Rate for Payer: Multiplan Commercial	$984.19
Rate for Payer: Multiplan Workers Comp	$984.19
Rate for Payer: Scott and White EPO/PPO	$757.07
Rate for Payer: Superior Health Plan EPO	$205.92

REAMER HEADED 8MM

Facility

$976.10

Hospital Charge Code	117535
Hospital Revenue Code	272
Rate for Payer: Cash Price	$858.97

REAMER HEADED 8MM

Facility

$976.10

Hospital Charge Code	117535
Hospital Revenue Code	272
Min. Negotiated Rate	$87.85
Max. Negotiated Rate	$634.46
Rate for Payer: Aetna Commercial	$536.86
Rate for Payer: Amerigroup CHIP/Medicaid	$87.85
Rate for Payer: BCBS of TX Blue Advantage	$292.83
Rate for Payer: BCBS of TX Blue Essentials	$351.40
Rate for Payer: BCBS of TX PPO	$390.44
Rate for Payer: Cash Price	$858.97
Rate for Payer: Multiplan Auto	$634.46
Rate for Payer: Multiplan Commercial	$634.46
Rate for Payer: Multiplan Workers Comp	$634.46
Rate for Payer: Scott and White EPO/PPO	$488.05
Rate for Payer: Superior Health Plan EPO	$132.75

REAMER INFINITY RETRO 7MM

Facility

$1,407.40

Hospital Charge Code	8428503
Hospital Revenue Code	272
Rate for Payer: Cash Price	$1,238.51

REAMER INFINITY RETRO 7MM

Facility

$1,407.40

Hospital Charge Code	8428503
Hospital Revenue Code	272
Min. Negotiated Rate	$126.67
Max. Negotiated Rate	$914.81
Rate for Payer: Aetna Commercial	$774.07
Rate for Payer: Amerigroup CHIP/Medicaid	$126.67
Rate for Payer: BCBS of TX Blue Advantage	$422.22
Rate for Payer: BCBS of TX Blue Essentials	$506.66
Rate for Payer: BCBS of TX PPO	$562.96
Rate for Payer: Cash Price	$1,238.51
Rate for Payer: Multiplan Auto	$914.81
Rate for Payer: Multiplan Commercial	$914.81
Rate for Payer: Multiplan Workers Comp	$914.81
Rate for Payer: Scott and White EPO/PPO	$703.70
Rate for Payer: Superior Health Plan EPO	$191.41

REAMER LOW PROFILE

Facility

$2,179.20

Hospital Charge Code	145093
Hospital Revenue Code	272
Rate for Payer: Cash Price	$1,917.70

REAMER LOW PROFILE

Facility

$2,179.20

Hospital Charge Code	145093
Hospital Revenue Code	272
Min. Negotiated Rate	$196.13
Max. Negotiated Rate	$1,416.48
Rate for Payer: Aetna Commercial	$1,198.56
Rate for Payer: Amerigroup CHIP/Medicaid	$196.13
Rate for Payer: BCBS of TX Blue Advantage	$653.76
Rate for Payer: BCBS of TX Blue Essentials	$784.51
Rate for Payer: BCBS of TX PPO	$871.68
Rate for Payer: Cash Price	$1,917.70
Rate for Payer: Multiplan Auto	$1,416.48
Rate for Payer: Multiplan Commercial	$1,416.48
Rate for Payer: Multiplan Workers Comp	$1,416.48
Rate for Payer: Scott and White EPO/PPO	$1,089.60
Rate for Payer: Superior Health Plan EPO	$296.37

REAMER LOW PROFILE 9MM

Facility

$1,292.58

Hospital Charge Code	144816
Hospital Revenue Code	272
Rate for Payer: Cash Price	$1,137.47

REAMER LOW PROFILE 9MM

Facility

$1,292.58

Hospital Charge Code	144816
Hospital Revenue Code	272
Min. Negotiated Rate	$116.33
Max. Negotiated Rate	$840.18
Rate for Payer: Aetna Commercial	$710.92
Rate for Payer: Amerigroup CHIP/Medicaid	$116.33
Rate for Payer: BCBS of TX Blue Advantage	$387.77
Rate for Payer: BCBS of TX Blue Essentials	$465.33
Rate for Payer: BCBS of TX PPO	$517.03
Rate for Payer: Cash Price	$1,137.47
Rate for Payer: Multiplan Auto	$840.18
Rate for Payer: Multiplan Commercial	$840.18
Rate for Payer: Multiplan Workers Comp	$840.18
Rate for Payer: Scott and White EPO/PPO	$646.29
Rate for Payer: Superior Health Plan EPO	$175.79

REAMER TRINKLE

Facility

$1,803.83

Hospital Charge Code	117569
Hospital Revenue Code	272
Rate for Payer: Cash Price	$1,587.37

REAMER TRINKLE

Facility

$1,803.83

Hospital Charge Code	117569
Hospital Revenue Code	272
Min. Negotiated Rate	$162.34
Max. Negotiated Rate	$1,172.49
Rate for Payer: Aetna Commercial	$992.11
Rate for Payer: Amerigroup CHIP/Medicaid	$162.34
Rate for Payer: BCBS of TX Blue Advantage	$541.15
Rate for Payer: BCBS of TX Blue Essentials	$649.38
Rate for Payer: BCBS of TX PPO	$721.53
Rate for Payer: Cash Price	$1,587.37
Rate for Payer: Multiplan Auto	$1,172.49
Rate for Payer: Multiplan Commercial	$1,172.49
Rate for Payer: Multiplan Workers Comp	$1,172.49
Rate for Payer: Scott and White EPO/PPO	$901.92
Rate for Payer: Superior Health Plan EPO	$245.32

Reconstruction, angular deformity of toe, soft tissue procedures only (eg, overlapping second toe, f

Facility

$10,000.00

Service Code	CPT 28313
Hospital Charge Code	36028313
Hospital Revenue Code	360
Min. Negotiated Rate	$65.29
Max. Negotiated Rate	$10,000.00
Rate for Payer: Aetna Commercial	$3,090.00
Rate for Payer: Aetna Medicare	$4,440.36
Rate for Payer: Amerigroup CHIP/Medicaid	$1,088.27
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$2,960.24
Rate for Payer: Amerigroup Medicare	$2,960.24
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	$2,960.24
Rate for Payer: BCBS of TX PPO	$6,898.37
Rate for Payer: Cigna Commercial	$6,705.80
Rate for Payer: Cigna Medicaid	$1,088.27
Rate for Payer: Cigna Medicare	$2,960.24
Rate for Payer: Employer Direct Commercial	$2,960.24
Rate for Payer: Humana Medicare/TRICARE	$2,960.24
Rate for Payer: Molina CHIP/Medicaid	$1,088.27
Rate for Payer: Molina Dual Medicare/Medicaid	$2,960.24
Rate for Payer: Molina Medicare	$2,960.24
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	$1,088.27
Rate for Payer: Scott and White EPO/PPO	$65.29
Rate for Payer: Scott and White Medicare	$2,960.24
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,088.27
Rate for Payer: Superior Health Plan EPO	$2,960.24
Rate for Payer: Superior Health Plan Medicare	$2,960.24
Rate for Payer: Universal American Dual Medicare/Medicaid	$2,960.24
Rate for Payer: Universal American Medicare	$2,960.24
Rate for Payer: Wellcare Medicare	$2,960.24
Rate for Payer: Wellmed Medicare	$2,960.24

Reconstruction-collateral ligament, interphalangeal joint

Facility

$10,000.00

Service Code	CPT 26545
Hospital Charge Code	36026545
Hospital Revenue Code	360
Min. Negotiated Rate	$65.29
Max. Negotiated Rate	$10,000.00
Rate for Payer: Aetna Commercial	$4,635.00
Rate for Payer: Aetna Medicare	$4,440.36
Rate for Payer: Amerigroup CHIP/Medicaid	$1,088.27
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$2,960.24
Rate for Payer: Amerigroup Medicare	$2,960.24
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	$2,960.24
Rate for Payer: BCBS of TX PPO	$6,898.37
Rate for Payer: Cigna Commercial	$6,705.80
Rate for Payer: Cigna Medicaid	$1,088.27
Rate for Payer: Cigna Medicare	$2,960.24
Rate for Payer: Employer Direct Commercial	$2,960.24
Rate for Payer: Humana Medicare/TRICARE	$2,960.24
Rate for Payer: Molina CHIP/Medicaid	$1,088.27
Rate for Payer: Molina Dual Medicare/Medicaid	$2,960.24
Rate for Payer: Molina Medicare	$2,960.24
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	$1,088.27
Rate for Payer: Scott and White EPO/PPO	$65.29
Rate for Payer: Scott and White Medicare	$2,960.24
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,088.27
Rate for Payer: Superior Health Plan EPO	$2,960.24
Rate for Payer: Superior Health Plan Medicare	$2,960.24
Rate for Payer: Universal American Dual Medicare/Medicaid	$2,960.24
Rate for Payer: Universal American Medicare	$2,960.24
Rate for Payer: Wellcare Medicare	$2,960.24
Rate for Payer: Wellmed Medicare	$2,960.24

Reconstruction, collateral ligament, metacarpophalangeal joint, single; with tendon or fascial graft

Facility

$10,000.00

Service Code	CPT 26541
Hospital Charge Code	36026541
Hospital Revenue Code	360
Min. Negotiated Rate	$65.29
Max. Negotiated Rate	$10,000.00
Rate for Payer: Aetna Commercial	$4,635.00
Rate for Payer: Aetna Medicare	$4,440.36
Rate for Payer: Amerigroup CHIP/Medicaid	$1,088.27
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$2,960.24
Rate for Payer: Amerigroup Medicare	$2,960.24
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	$2,960.24
Rate for Payer: BCBS of TX PPO	$6,898.37
Rate for Payer: Cigna Commercial	$6,705.80
Rate for Payer: Cigna Medicaid	$1,088.27
Rate for Payer: Cigna Medicare	$2,960.24
Rate for Payer: Employer Direct Commercial	$2,960.24
Rate for Payer: Humana Medicare/TRICARE	$2,960.24
Rate for Payer: Molina CHIP/Medicaid	$1,088.27
Rate for Payer: Molina Dual Medicare/Medicaid	$2,960.24
Rate for Payer: Molina Medicare	$2,960.24
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	$1,088.27
Rate for Payer: Scott and White EPO/PPO	$65.29
Rate for Payer: Scott and White Medicare	$2,960.24
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,088.27
Rate for Payer: Superior Health Plan EPO	$2,960.24
Rate for Payer: Superior Health Plan Medicare	$2,960.24
Rate for Payer: Universal American Dual Medicare/Medicaid	$2,960.24
Rate for Payer: Universal American Medicare	$2,960.24
Rate for Payer: Wellcare Medicare	$2,960.24
Rate for Payer: Wellmed Medicare	$2,960.24

Reconstruction for stabilization of unstable distal ulna or distal radioulnar joint, secondary by so

Facility

$15,074.51

Service Code	CPT 25337
Hospital Charge Code	36025337
Hospital Revenue Code	360
Min. Negotiated Rate	$144.31
Max. Negotiated Rate	$15,074.51
Rate for Payer: Aetna Commercial	$6,077.00
Rate for Payer: Aetna Medicare	$9,814.08
Rate for Payer: Amerigroup CHIP/Medicaid	$3,136.09
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$6,542.72
Rate for Payer: Amerigroup Medicare	$6,542.72
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	$6,542.72
Rate for Payer: BCBS of TX PPO	$15,074.51
Rate for Payer: Cigna Commercial	$14,821.16
Rate for Payer: Cigna Medicaid	$3,136.09
Rate for Payer: Cigna Medicare	$6,542.72
Rate for Payer: Employer Direct Commercial	$6,542.72
Rate for Payer: Humana Medicare/TRICARE	$6,542.72
Rate for Payer: Molina CHIP/Medicaid	$3,136.09
Rate for Payer: Molina Dual Medicare/Medicaid	$6,542.72
Rate for Payer: Molina Medicare	$6,542.72
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	$3,136.09
Rate for Payer: Scott and White EPO/PPO	$144.31
Rate for Payer: Scott and White Medicare	$6,542.72
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3,136.09
Rate for Payer: Superior Health Plan EPO	$6,542.72
Rate for Payer: Superior Health Plan Medicare	$6,542.72
Rate for Payer: Universal American Dual Medicare/Medicaid	$6,542.72
Rate for Payer: Universal American Medicare	$6,542.72
Rate for Payer: Wellcare Medicare	$6,542.72
Rate for Payer: Wellmed Medicare	$6,542.72

Reconstruction medial collateral ligament, elbow, with tendon graft (includes harvesting of graft)

Facility

$29,989.79

Service Code	CPT 24346
Hospital Charge Code	36024346
Hospital Revenue Code	360
Min. Negotiated Rate	$265.49
Max. Negotiated Rate	$29,989.79
Rate for Payer: Aetna Commercial	$6,077.00
Rate for Payer: Aetna Medicare	$18,054.70
Rate for Payer: Amerigroup CHIP/Medicaid	$4,811.02
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$12,036.47
Rate for Payer: Amerigroup Medicare	$12,036.47
Rate for Payer: BCBS of TX Blue Advantage	$19,874.19
Rate for Payer: BCBS of TX Blue Essentials	$23,801.42
Rate for Payer: BCBS of TX Medicare	$12,036.47
Rate for Payer: BCBS of TX PPO	$29,989.79
Rate for Payer: Cigna Commercial	$27,266.10
Rate for Payer: Cigna Medicaid	$4,811.02
Rate for Payer: Cigna Medicare	$12,036.47
Rate for Payer: Employer Direct Commercial	$12,036.47
Rate for Payer: Humana Medicare/TRICARE	$12,036.47
Rate for Payer: Molina CHIP/Medicaid	$4,811.02
Rate for Payer: Molina Dual Medicare/Medicaid	$12,036.47
Rate for Payer: Molina Medicare	$12,036.47
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	$4,811.02
Rate for Payer: Scott and White EPO/PPO	$265.49
Rate for Payer: Scott and White Medicare	$12,036.47
Rate for Payer: Superior Health Plan CHIP/Medicaid	$4,811.02
Rate for Payer: Superior Health Plan EPO	$12,036.47
Rate for Payer: Superior Health Plan Medicare	$12,036.47
Rate for Payer: Universal American Dual Medicare/Medicaid	$12,036.47
Rate for Payer: Universal American Medicare	$12,036.47
Rate for Payer: Wellcare Medicare	$12,036.47
Rate for Payer: Wellmed Medicare	$12,036.47

Reconstruction of dislocating patella; (eg, Hauser type procedure)

Facility

$15,074.51

Service Code	CPT 27420
Hospital Charge Code	36027420
Hospital Revenue Code	360
Min. Negotiated Rate	$144.31
Max. Negotiated Rate	$15,074.51
Rate for Payer: Aetna Commercial	$6,077.00
Rate for Payer: Aetna Medicare	$9,814.08
Rate for Payer: Amerigroup CHIP/Medicaid	$2,398.52
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$6,542.72
Rate for Payer: Amerigroup Medicare	$6,542.72
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	$6,542.72
Rate for Payer: BCBS of TX PPO	$15,074.51
Rate for Payer: Cigna Commercial	$14,821.16
Rate for Payer: Cigna Medicaid	$2,398.52
Rate for Payer: Cigna Medicare	$6,542.72
Rate for Payer: Employer Direct Commercial	$6,542.72
Rate for Payer: Humana Medicare/TRICARE	$6,542.72
Rate for Payer: Molina CHIP/Medicaid	$2,398.52
Rate for Payer: Molina Dual Medicare/Medicaid	$6,542.72
Rate for Payer: Molina Medicare	$6,542.72
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	$2,398.52
Rate for Payer: Scott and White EPO/PPO	$144.31
Rate for Payer: Scott and White Medicare	$6,542.72
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2,398.52
Rate for Payer: Superior Health Plan EPO	$6,542.72
Rate for Payer: Superior Health Plan Medicare	$6,542.72
Rate for Payer: Universal American Dual Medicare/Medicaid	$6,542.72
Rate for Payer: Universal American Medicare	$6,542.72
Rate for Payer: Wellcare Medicare	$6,542.72
Rate for Payer: Wellmed Medicare	$6,542.72

Reconstruction of dislocating patella with extensor realignment and/or muscle advancement or releas

Facility

$15,074.51

Service Code	CPT 27422
Hospital Charge Code	36027422
Hospital Revenue Code	360
Min. Negotiated Rate	$144.31
Max. Negotiated Rate	$15,074.51
Rate for Payer: Aetna Commercial	$6,077.00
Rate for Payer: Aetna Medicare	$9,814.08
Rate for Payer: Amerigroup CHIP/Medicaid	$2,398.52
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$6,542.72
Rate for Payer: Amerigroup Medicare	$6,542.72
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	$6,542.72
Rate for Payer: BCBS of TX PPO	$15,074.51
Rate for Payer: Cigna Commercial	$14,821.16
Rate for Payer: Cigna Medicaid	$2,398.52
Rate for Payer: Cigna Medicare	$6,542.72
Rate for Payer: Employer Direct Commercial	$6,542.72
Rate for Payer: Humana Medicare/TRICARE	$6,542.72
Rate for Payer: Molina CHIP/Medicaid	$2,398.52
Rate for Payer: Molina Dual Medicare/Medicaid	$6,542.72
Rate for Payer: Molina Medicare	$6,542.72
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	$2,398.52
Rate for Payer: Scott and White EPO/PPO	$144.31
Rate for Payer: Scott and White Medicare	$6,542.72
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2,398.52
Rate for Payer: Superior Health Plan EPO	$6,542.72
Rate for Payer: Superior Health Plan Medicare	$6,542.72
Rate for Payer: Universal American Dual Medicare/Medicaid	$6,542.72
Rate for Payer: Universal American Medicare	$6,542.72
Rate for Payer: Wellcare Medicare	$6,542.72
Rate for Payer: Wellmed Medicare	$6,542.72

Reconstruction of nail bed with graft

Facility

$10,000.00

Service Code	CPT 11762
Hospital Charge Code	36011762
Hospital Revenue Code	360
Min. Negotiated Rate	$36.79
Max. Negotiated Rate	$10,000.00
Rate for Payer: Aetna Commercial	$2,200.00
Rate for Payer: Aetna Medicare	$2,501.68
Rate for Payer: Amerigroup CHIP/Medicaid	$148.94
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$1,667.79
Rate for Payer: Amerigroup Medicare	$1,667.79
Rate for Payer: BCBS of TX Blue Advantage	$312.19
Rate for Payer: BCBS of TX Blue Essentials	$373.88
Rate for Payer: BCBS of TX Medicare	$1,667.79
Rate for Payer: BCBS of TX PPO	$471.09
Rate for Payer: Cigna Commercial	$3,778.02
Rate for Payer: Cigna Medicaid	$148.94
Rate for Payer: Cigna Medicare	$1,667.79
Rate for Payer: Employer Direct Commercial	$1,667.79
Rate for Payer: Humana Medicare/TRICARE	$1,667.79
Rate for Payer: Molina CHIP/Medicaid	$148.94
Rate for Payer: Molina Dual Medicare/Medicaid	$1,667.79
Rate for Payer: Molina Medicare	$1,667.79
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	$148.94
Rate for Payer: Scott and White EPO/PPO	$36.79
Rate for Payer: Scott and White Medicare	$1,667.79
Rate for Payer: Superior Health Plan CHIP/Medicaid	$148.94
Rate for Payer: Superior Health Plan EPO	$1,667.79
Rate for Payer: Superior Health Plan Medicare	$1,667.79
Rate for Payer: Universal American Dual Medicare/Medicaid	$1,667.79
Rate for Payer: Universal American Medicare	$1,667.79
Rate for Payer: Wellcare Medicare	$1,667.79
Rate for Payer: Wellmed Medicare	$1,667.79

Reconstruction of tendon pulley, each tendon; with local tissues (separate procedure)

Facility

$15,074.51

Service Code	CPT 26500
Hospital Charge Code	36026500
Hospital Revenue Code	360
Min. Negotiated Rate	$144.31
Max. Negotiated Rate	$15,074.51
Rate for Payer: Aetna Commercial	$2,200.00
Rate for Payer: Aetna Medicare	$9,814.08
Rate for Payer: Amerigroup CHIP/Medicaid	$2,398.52
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$6,542.72
Rate for Payer: Amerigroup Medicare	$6,542.72
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	$6,542.72
Rate for Payer: BCBS of TX PPO	$15,074.51
Rate for Payer: Cigna Commercial	$14,821.16
Rate for Payer: Cigna Medicaid	$2,398.52
Rate for Payer: Cigna Medicare	$6,542.72
Rate for Payer: Employer Direct Commercial	$6,542.72
Rate for Payer: Humana Medicare/TRICARE	$6,542.72
Rate for Payer: Molina CHIP/Medicaid	$2,398.52
Rate for Payer: Molina Dual Medicare/Medicaid	$6,542.72
Rate for Payer: Molina Medicare	$6,542.72
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	$2,398.52
Rate for Payer: Scott and White EPO/PPO	$144.31
Rate for Payer: Scott and White Medicare	$6,542.72
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2,398.52
Rate for Payer: Superior Health Plan EPO	$6,542.72
Rate for Payer: Superior Health Plan Medicare	$6,542.72
Rate for Payer: Universal American Dual Medicare/Medicaid	$6,542.72
Rate for Payer: Universal American Medicare	$6,542.72
Rate for Payer: Wellcare Medicare	$6,542.72
Rate for Payer: Wellmed Medicare	$6,542.72

Reconstruction, toe(s); syndactyly, with or without skin graft(s), each web

Facility

$10,000.00

Service Code	CPT 28345
Hospital Charge Code	36028345
Hospital Revenue Code	360
Min. Negotiated Rate	$32.42
Max. Negotiated Rate	$10,000.00
Rate for Payer: Aetna Commercial	$3,090.00
Rate for Payer: Aetna Medicare	$2,204.79
Rate for Payer: Amerigroup CHIP/Medicaid	$593.04
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: 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	$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	$593.04
Rate for Payer: Scott and White EPO/PPO	$32.42
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

RECTAL RESECTION WITH CC

Facility

$39,510.50

Service Code	MSDRG 333
Min. Negotiated Rate	$17,694.22
Max. Negotiated Rate	$39,510.50
Rate for Payer: Aetna Commercial	$23,394.38
Rate for Payer: Aetna Medicare	$26,541.33
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$17,694.22
Rate for Payer: Amerigroup Medicare	$17,694.22
Rate for Payer: BCBS of TX Blue Advantage	$21,419.16
Rate for Payer: BCBS of TX Blue Essentials	$19,892.97
Rate for Payer: BCBS of TX Medicare	$17,694.22
Rate for Payer: BCBS of TX PPO	$22,104.15
Rate for Payer: Cigna Commercial	$26,783.96
Rate for Payer: Cigna Medicare	$17,694.22
Rate for Payer: Employer Direct Commercial	$17,694.22
Rate for Payer: Humana Medicare/TRICARE	$17,694.22
Rate for Payer: Molina Dual Medicare/Medicaid	$17,694.22
Rate for Payer: Molina Medicare	$17,694.22
Rate for Payer: Multiplan Auto	$39,510.50
Rate for Payer: Multiplan Commercial	$39,510.50
Rate for Payer: Multiplan Workers Comp	$39,510.50
Rate for Payer: Scott and White EPO/PPO	$18,195.62
Rate for Payer: Scott and White Medicare	$17,694.22
Rate for Payer: Superior Health Plan EPO	$17,694.22
Rate for Payer: Superior Health Plan Medicare	$17,694.22
Rate for Payer: Universal American Dual Medicare/Medicaid	$17,694.22
Rate for Payer: Universal American Medicare	$17,694.22
Rate for Payer: Wellcare Medicare	$17,694.22
Rate for Payer: Wellmed Medicare	$17,694.22

RECTAL RESECTION WITH MCC

Facility

$68,924.40

Service Code	MSDRG 332
Min. Negotiated Rate	$28,932.08
Max. Negotiated Rate	$68,924.40
Rate for Payer: Aetna Commercial	$40,810.50
Rate for Payer: Aetna Medicare	$43,398.12
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$28,932.08
Rate for Payer: Amerigroup Medicare	$28,932.08
Rate for Payer: BCBS of TX Blue Advantage	$41,079.62
Rate for Payer: BCBS of TX Blue Essentials	$35,066.03
Rate for Payer: BCBS of TX Medicare	$28,932.08
Rate for Payer: BCBS of TX PPO	$38,963.76
Rate for Payer: Cigna Commercial	$46,723.49
Rate for Payer: Cigna Medicare	$28,932.08
Rate for Payer: Employer Direct Commercial	$28,932.08
Rate for Payer: Humana Medicare/TRICARE	$28,932.08
Rate for Payer: Molina Dual Medicare/Medicaid	$28,932.08
Rate for Payer: Molina Medicare	$28,932.08
Rate for Payer: Multiplan Auto	$68,924.40
Rate for Payer: Multiplan Commercial	$68,924.40
Rate for Payer: Multiplan Workers Comp	$68,924.40
Rate for Payer: Scott and White EPO/PPO	$31,741.50
Rate for Payer: Scott and White Medicare	$28,932.08
Rate for Payer: Superior Health Plan EPO	$28,932.08
Rate for Payer: Superior Health Plan Medicare	$28,932.08
Rate for Payer: Universal American Dual Medicare/Medicaid	$28,932.08
Rate for Payer: Universal American Medicare	$28,932.08
Rate for Payer: Wellcare Medicare	$28,932.08
Rate for Payer: Wellmed Medicare	$28,932.08

RECTAL RESECTION WITHOUT CC/MCC

Facility

$30,496.90

Service Code	MSDRG 334
Min. Negotiated Rate	$13,478.68
Max. Negotiated Rate	$30,496.90
Rate for Payer: Aetna Commercial	$18,057.38
Rate for Payer: Aetna Medicare	$21,463.30
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$14,308.87
Rate for Payer: Amerigroup Medicare	$14,308.87
Rate for Payer: BCBS of TX Blue Advantage	$13,720.44
Rate for Payer: BCBS of TX Blue Essentials	$13,478.68
Rate for Payer: BCBS of TX Medicare	$14,308.87
Rate for Payer: BCBS of TX PPO	$14,976.89
Rate for Payer: Cigna Commercial	$20,673.69
Rate for Payer: Cigna Medicare	$14,308.87
Rate for Payer: Employer Direct Commercial	$14,308.87
Rate for Payer: Humana Medicare/TRICARE	$14,308.87
Rate for Payer: Molina Dual Medicare/Medicaid	$14,308.87
Rate for Payer: Molina Medicare	$14,308.87
Rate for Payer: Multiplan Auto	$30,496.90
Rate for Payer: Multiplan Commercial	$30,496.90
Rate for Payer: Multiplan Workers Comp	$30,496.90
Rate for Payer: Scott and White EPO/PPO	$14,044.62
Rate for Payer: Scott and White Medicare	$14,308.87
Rate for Payer: Superior Health Plan EPO	$14,308.87
Rate for Payer: Superior Health Plan Medicare	$14,308.87
Rate for Payer: Universal American Dual Medicare/Medicaid	$14,308.87
Rate for Payer: Universal American Medicare	$14,308.87
Rate for Payer: Wellcare Medicare	$14,308.87
Rate for Payer: Wellmed Medicare	$14,308.87

RED BLOOD CELL DISORDERS WITH MCC

Facility

$26,668.40

Service Code	MSDRG 811
Min. Negotiated Rate	$11,482.72
Max. Negotiated Rate	$26,668.40
Rate for Payer: Aetna Commercial	$15,790.50
Rate for Payer: Aetna Medicare	$19,306.44
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$12,870.96
Rate for Payer: Amerigroup Medicare	$12,870.96
Rate for Payer: BCBS of TX Blue Advantage	$11,482.72
Rate for Payer: BCBS of TX Blue Essentials	$13,992.56
Rate for Payer: BCBS of TX Medicare	$12,870.96
Rate for Payer: BCBS of TX PPO	$15,547.90
Rate for Payer: Cigna Commercial	$18,078.37
Rate for Payer: Cigna Medicare	$12,870.96
Rate for Payer: Employer Direct Commercial	$12,870.96
Rate for Payer: Humana Medicare/TRICARE	$12,870.96
Rate for Payer: Molina Dual Medicare/Medicaid	$12,870.96
Rate for Payer: Molina Medicare	$12,870.96
Rate for Payer: Multiplan Auto	$26,668.40
Rate for Payer: Multiplan Commercial	$26,668.40
Rate for Payer: Multiplan Workers Comp	$26,668.40
Rate for Payer: Scott and White EPO/PPO	$12,281.50
Rate for Payer: Scott and White Medicare	$12,870.96
Rate for Payer: Superior Health Plan EPO	$12,870.96
Rate for Payer: Superior Health Plan Medicare	$12,870.96
Rate for Payer: Universal American Dual Medicare/Medicaid	$12,870.96
Rate for Payer: Universal American Medicare	$12,870.96
Rate for Payer: Wellcare Medicare	$12,870.96
Rate for Payer: Wellmed Medicare	$12,870.96

Know your out-of-pocket cost for care.

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