White Rock Medical Center

All Charges

Charge

Type

Setting

Price

OPEN CRANIOTOMY FOR TRAUMA

Facility

$33,617.72

Service Code	APR-DRG 0204
Min. Negotiated Rate	$31,695.97
Max. Negotiated Rate	$33,617.72
Rate for Payer: Amerigroup CHIP/Medicaid	$31,695.97
Rate for Payer: Cigna Medicaid	$31,695.97
Rate for Payer: Molina CHIP/Medicaid	$31,695.97
Rate for Payer: Parkland Medicaid	$31,695.97
Rate for Payer: Superior Health Plan CHIP/Medicaid	$33,617.72

OPEN EXTRACRANIAL VASCULAR PROCEDURES

Facility

$22,704.89

Service Code	APR-DRG 0244
Min. Negotiated Rate	$21,406.97
Max. Negotiated Rate	$22,704.89
Rate for Payer: Amerigroup CHIP/Medicaid	$21,406.97
Rate for Payer: Cigna Medicaid	$21,406.97
Rate for Payer: Molina CHIP/Medicaid	$21,406.97
Rate for Payer: Parkland Medicaid	$21,406.97
Rate for Payer: Superior Health Plan CHIP/Medicaid	$22,704.89

OPEN EXTRACRANIAL VASCULAR PROCEDURES

Facility

$11,800.36

Service Code	APR-DRG 0243
Min. Negotiated Rate	$11,125.79
Max. Negotiated Rate	$11,800.36
Rate for Payer: Amerigroup CHIP/Medicaid	$11,125.79
Rate for Payer: Cigna Medicaid	$11,125.79
Rate for Payer: Molina CHIP/Medicaid	$11,125.79
Rate for Payer: Parkland Medicaid	$11,125.79
Rate for Payer: Superior Health Plan CHIP/Medicaid	$11,800.36

OPEN EXTRACRANIAL VASCULAR PROCEDURES

Facility

$6,592.13

Service Code	APR-DRG 0242
Min. Negotiated Rate	$6,215.29
Max. Negotiated Rate	$6,592.13
Rate for Payer: Amerigroup CHIP/Medicaid	$6,215.29
Rate for Payer: Cigna Medicaid	$6,215.29
Rate for Payer: Molina CHIP/Medicaid	$6,215.29
Rate for Payer: Parkland Medicaid	$6,215.29
Rate for Payer: Superior Health Plan CHIP/Medicaid	$6,592.13

OPEN EXTRACRANIAL VASCULAR PROCEDURES

Facility

$4,328.62

Service Code	APR-DRG 0241
Min. Negotiated Rate	$4,081.18
Max. Negotiated Rate	$4,328.62
Rate for Payer: Amerigroup CHIP/Medicaid	$4,081.18
Rate for Payer: Cigna Medicaid	$4,081.18
Rate for Payer: Molina CHIP/Medicaid	$4,081.18
Rate for Payer: Parkland Medicaid	$4,081.18
Rate for Payer: Superior Health Plan CHIP/Medicaid	$4,328.62

Open implantation of hypoglossal nerve neurostimulator array, pulse generator, and distal respirator

Facility

$180,380.88

Service Code	HCPCS 64582
Hospital Charge Code	9900815
Hospital Revenue Code	360
Rate for Payer: Cash Price	$122,659.00

Open implantation of hypoglossal nerve neurostimulator array, pulse generator, and distal respirator

Facility

$180,380.88

Service Code	HCPCS 64582
Hospital Charge Code	9900815
Hospital Revenue Code	360
Min. Negotiated Rate	$10,000.00
Max. Negotiated Rate	$129,874.23
Rate for Payer: Amerigroup CHIP/Medicaid	$19,861.72
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$30,998.31
Rate for Payer: Amerigroup Medicare	$30,998.31
Rate for Payer: BCBS of TX Blue Advantage	$50,206.01
Rate for Payer: BCBS of TX Blue Essentials	$60,126.96
Rate for Payer: BCBS of TX Medicare	$30,998.31
Rate for Payer: BCBS of TX PPO	$75,759.97
Rate for Payer: Cash Price	$122,659.00
Rate for Payer: Cash Price	$122,659.00
Rate for Payer: Cash Price	$122,659.00
Rate for Payer: Cigna Commercial	$65,524.82
Rate for Payer: Cigna Medicaid	$129,874.23
Rate for Payer: Cigna Medicare	$30,998.31
Rate for Payer: Employer Direct Commercial	$30,998.31
Rate for Payer: Humana Medicare/TRICARE	$30,998.31
Rate for Payer: Molina CHIP/Medicaid	$129,874.23
Rate for Payer: Molina Dual Medicare/Medicaid	$30,998.31
Rate for Payer: Molina Medicare	$30,998.31
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	$129,874.23
Rate for Payer: Scott and White EPO/PPO	$52,537.60
Rate for Payer: Scott and White Medicare	$30,998.31
Rate for Payer: Superior Health Plan CHIP/Medicaid	$129,874.23
Rate for Payer: Superior Health Plan EPO	$30,998.31
Rate for Payer: Superior Health Plan Medicare	$30,998.31
Rate for Payer: Universal American Dual Medicare/Medicaid	$30,998.31
Rate for Payer: Universal American Medicare	$30,998.31
Rate for Payer: Wellcare Medicare	$30,998.31
Rate for Payer: Wellmed Medicare	$30,998.31

Open implantation of hypoglossal nerve neurostimulator array, pulse generator, and distal respirator

Facility

$75,759.97

Service Code	CPT 64582
Hospital Charge Code	36064582
Hospital Revenue Code	360
Min. Negotiated Rate	$10,000.00
Max. Negotiated Rate	$75,759.97
Rate for Payer: Amerigroup CHIP/Medicaid	$19,861.72
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$30,998.31
Rate for Payer: Amerigroup Medicare	$30,998.31
Rate for Payer: BCBS of TX Blue Advantage	$50,206.01
Rate for Payer: BCBS of TX Blue Essentials	$60,126.96
Rate for Payer: BCBS of TX Medicare	$30,998.31
Rate for Payer: BCBS of TX PPO	$75,759.97
Rate for Payer: Cigna Commercial	$65,524.82
Rate for Payer: Cigna Medicare	$30,998.31
Rate for Payer: Employer Direct Commercial	$30,998.31
Rate for Payer: Humana Medicare/TRICARE	$30,998.31
Rate for Payer: Molina Dual Medicare/Medicaid	$30,998.31
Rate for Payer: Molina Medicare	$30,998.31
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: Scott and White EPO/PPO	$52,537.60
Rate for Payer: Scott and White Medicare	$30,998.31
Rate for Payer: Superior Health Plan EPO	$30,998.31
Rate for Payer: Superior Health Plan Medicare	$30,998.31
Rate for Payer: Universal American Dual Medicare/Medicaid	$30,998.31
Rate for Payer: Universal American Medicare	$30,998.31
Rate for Payer: Wellcare Medicare	$30,998.31
Rate for Payer: Wellmed Medicare	$30,998.31

Opening Drill DIA 5.5mm

Facility

$2,556.02

Hospital Charge Code	993381
Hospital Revenue Code	272
Rate for Payer: Cash Price	$1,738.09

Opening Drill DIA 5.5mm

Facility

$2,556.02

Hospital Charge Code	993381
Hospital Revenue Code	272
Min. Negotiated Rate	$230.04
Max. Negotiated Rate	$1,840.33
Rate for Payer: Amerigroup CHIP/Medicaid	$230.04
Rate for Payer: BCBS of TX Blue Advantage	$766.81
Rate for Payer: BCBS of TX Blue Essentials	$920.17
Rate for Payer: BCBS of TX PPO	$1,022.41
Rate for Payer: Cash Price	$1,738.09
Rate for Payer: Cigna Medicaid	$1,840.33
Rate for Payer: Molina CHIP/Medicaid	$1,840.33
Rate for Payer: Multiplan Auto	$1,661.41
Rate for Payer: Multiplan Commercial	$1,661.41
Rate for Payer: Multiplan Workers Comp	$1,661.41
Rate for Payer: Parkland Medicaid	$1,840.33
Rate for Payer: Scott and White EPO/PPO	$1,278.01
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,840.33
Rate for Payer: Superior Health Plan EPO	$347.62

OPEN/PERQ PLACE STENT SAME BCE

Facility

$34,432.50

Service Code	HCPCS 37238
Hospital Charge Code	9010984
Hospital Revenue Code	481
Rate for Payer: Cash Price	$23,414.10

OPEN/PERQ PLACE STENT SAME BCE

Facility

$34,432.50

Service Code	HCPCS 37238
Hospital Charge Code	9010984
Hospital Revenue Code	481
Min. Negotiated Rate	$363.09
Max. Negotiated Rate	$24,969.37
Rate for Payer: Amerigroup CHIP/Medicaid	$3,098.93
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$11,596.79
Rate for Payer: Amerigroup Medicare	$11,596.79
Rate for Payer: BCBS of TX Blue Advantage	$16,547.16
Rate for Payer: BCBS of TX Blue Essentials	$19,816.96
Rate for Payer: BCBS of TX Medicare	$11,596.79
Rate for Payer: BCBS of TX PPO	$24,969.37
Rate for Payer: Cash Price	$23,414.10
Rate for Payer: Cash Price	$23,414.10
Rate for Payer: Cash Price	$23,414.10
Rate for Payer: Cigna Commercial	$24,513.51
Rate for Payer: Cigna Medicaid	$24,791.40
Rate for Payer: Cigna Medicare	$11,596.79
Rate for Payer: Employer Direct Commercial	$11,596.79
Rate for Payer: Humana Medicare/TRICARE	$11,596.79
Rate for Payer: Molina CHIP/Medicaid	$24,791.40
Rate for Payer: Molina Dual Medicare/Medicaid	$11,596.79
Rate for Payer: Molina Medicare	$11,596.79
Rate for Payer: Multiplan Auto	$22,381.12
Rate for Payer: Multiplan Commercial	$22,381.12
Rate for Payer: Multiplan Workers Comp	$22,381.12
Rate for Payer: Parkland Medicaid	$24,791.40
Rate for Payer: Scott and White EPO/PPO	$363.09
Rate for Payer: Scott and White Medicare	$11,596.79
Rate for Payer: Superior Health Plan CHIP/Medicaid	$24,791.40
Rate for Payer: Superior Health Plan EPO	$11,596.79
Rate for Payer: Superior Health Plan Medicare	$11,596.79
Rate for Payer: Universal American Dual Medicare/Medicaid	$11,596.79
Rate for Payer: Universal American Medicare	$11,596.79
Rate for Payer: Wellcare Medicare	$11,596.79
Rate for Payer: Wellmed Medicare	$11,596.79

OPEN RING DIA 155 mm - ALUMINIUM

Facility

$8,530.66

Service Code	HCPCS C1713
Hospital Charge Code	993428
Hospital Revenue Code	278
Min. Negotiated Rate	$767.76
Max. Negotiated Rate	$6,142.08
Rate for Payer: Amerigroup CHIP/Medicaid	$767.76
Rate for Payer: BCBS of TX Blue Advantage	$2,559.20
Rate for Payer: BCBS of TX Blue Essentials	$3,071.04
Rate for Payer: BCBS of TX PPO	$3,412.26
Rate for Payer: Cash Price	$5,800.85
Rate for Payer: Cigna Medicaid	$6,142.08
Rate for Payer: Molina CHIP/Medicaid	$6,142.08
Rate for Payer: Multiplan Auto	$4,265.33
Rate for Payer: Multiplan Commercial	$4,265.33
Rate for Payer: Multiplan Workers Comp	$4,265.33
Rate for Payer: Parkland Medicaid	$6,142.08
Rate for Payer: Scott and White EPO/PPO	$4,265.33
Rate for Payer: Superior Health Plan CHIP/Medicaid	$6,142.08
Rate for Payer: Superior Health Plan EPO	$1,160.17

OPEN RING DIA 155 mm - ALUMINIUM

Facility

$8,530.66

Service Code	HCPCS C1713
Hospital Charge Code	993428
Hospital Revenue Code	278
Min. Negotiated Rate	$2,132.66
Max. Negotiated Rate	$4,265.33
Rate for Payer: Cash Price	$5,800.85
Rate for Payer: Cigna Commercial	$2,132.66
Rate for Payer: Multiplan Auto	$4,265.33
Rate for Payer: Multiplan Commercial	$4,265.33
Rate for Payer: Multiplan Workers Comp	$4,265.33
Rate for Payer: Scott and White EPO/PPO	$4,265.33

Open thrombect av fistula

Facility

$20,943.68

Service Code	HCPCS 36831
Hospital Charge Code	991310
Hospital Revenue Code	360
Rate for Payer: Cash Price	$14,241.70

Open thrombect av fistula

Facility

$20,943.68

Service Code	HCPCS 36831
Hospital Charge Code	991310
Hospital Revenue Code	360
Min. Negotiated Rate	$1,939.15
Max. Negotiated Rate	$15,079.45
Rate for Payer: Amerigroup CHIP/Medicaid	$1,939.15
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$5,589.84
Rate for Payer: Amerigroup Medicare	$5,589.84
Rate for Payer: BCBS of TX Blue Advantage	$7,675.64
Rate for Payer: BCBS of TX Blue Essentials	$9,192.38
Rate for Payer: BCBS of TX Medicare	$5,589.84
Rate for Payer: BCBS of TX PPO	$11,582.40
Rate for Payer: Cash Price	$14,241.70
Rate for Payer: Cash Price	$14,241.70
Rate for Payer: Cash Price	$14,241.70
Rate for Payer: Cigna Commercial	$11,815.91
Rate for Payer: Cigna Medicaid	$15,079.45
Rate for Payer: Cigna Medicare	$5,589.84
Rate for Payer: Employer Direct Commercial	$5,589.84
Rate for Payer: Humana Medicare/TRICARE	$5,589.84
Rate for Payer: Molina CHIP/Medicaid	$15,079.45
Rate for Payer: Molina Dual Medicare/Medicaid	$5,589.84
Rate for Payer: Molina Medicare	$5,589.84
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	$15,079.45
Rate for Payer: Scott and White EPO/PPO	$9,297.64
Rate for Payer: Scott and White Medicare	$5,589.84
Rate for Payer: Superior Health Plan CHIP/Medicaid	$15,079.45
Rate for Payer: Superior Health Plan EPO	$5,589.84
Rate for Payer: Superior Health Plan Medicare	$5,589.84
Rate for Payer: Universal American Dual Medicare/Medicaid	$5,589.84
Rate for Payer: Universal American Medicare	$5,589.84
Rate for Payer: Wellcare Medicare	$5,589.84
Rate for Payer: Wellmed Medicare	$5,589.84

Open treatment of acromioclavicular dislocation, acute or chronic with fascial graft (includes obta

Facility

$23,096.00

Service Code	HCPCS 23552
Hospital Charge Code	9900230
Hospital Revenue Code	360
Min. Negotiated Rate	$3,196.82
Max. Negotiated Rate	$16,629.12
Rate for Payer: Amerigroup CHIP/Medicaid	$3,196.82
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$7,289.28
Rate for Payer: Amerigroup Medicare	$7,289.28
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	$7,289.28
Rate for Payer: BCBS of TX PPO	$15,074.51
Rate for Payer: Cash Price	$15,705.28
Rate for Payer: Cash Price	$15,705.28
Rate for Payer: Cash Price	$15,705.28
Rate for Payer: Cigna Commercial	$15,408.22
Rate for Payer: Cigna Medicaid	$16,629.12
Rate for Payer: Cigna Medicare	$7,289.28
Rate for Payer: Employer Direct Commercial	$7,289.28
Rate for Payer: Humana Medicare/TRICARE	$7,289.28
Rate for Payer: Molina CHIP/Medicaid	$16,629.12
Rate for Payer: Molina Dual Medicare/Medicaid	$7,289.28
Rate for Payer: Molina Medicare	$7,289.28
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	$16,629.12
Rate for Payer: Scott and White EPO/PPO	$12,104.03
Rate for Payer: Scott and White Medicare	$7,289.28
Rate for Payer: Superior Health Plan CHIP/Medicaid	$16,629.12
Rate for Payer: Superior Health Plan EPO	$7,289.28
Rate for Payer: Superior Health Plan Medicare	$7,289.28
Rate for Payer: Universal American Dual Medicare/Medicaid	$7,289.28
Rate for Payer: Universal American Medicare	$7,289.28
Rate for Payer: Wellcare Medicare	$7,289.28
Rate for Payer: Wellmed Medicare	$7,289.28

Open treatment of acromioclavicular dislocation, acute or chronic with fascial graft (includes obta

Facility

$15,408.22

Service Code	CPT 23552
Hospital Charge Code	36023552
Hospital Revenue Code	360
Min. Negotiated Rate	$3,196.82
Max. Negotiated Rate	$15,408.22
Rate for Payer: Amerigroup CHIP/Medicaid	$3,196.82
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$7,289.28
Rate for Payer: Amerigroup Medicare	$7,289.28
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	$7,289.28
Rate for Payer: BCBS of TX PPO	$15,074.51
Rate for Payer: Cigna Commercial	$15,408.22
Rate for Payer: Cigna Medicare	$7,289.28
Rate for Payer: Employer Direct Commercial	$7,289.28
Rate for Payer: Humana Medicare/TRICARE	$7,289.28
Rate for Payer: Molina Dual Medicare/Medicaid	$7,289.28
Rate for Payer: Molina Medicare	$7,289.28
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: Scott and White EPO/PPO	$12,104.03
Rate for Payer: Scott and White Medicare	$7,289.28
Rate for Payer: Superior Health Plan EPO	$7,289.28
Rate for Payer: Superior Health Plan Medicare	$7,289.28
Rate for Payer: Universal American Dual Medicare/Medicaid	$7,289.28
Rate for Payer: Universal American Medicare	$7,289.28
Rate for Payer: Wellcare Medicare	$7,289.28
Rate for Payer: Wellmed Medicare	$7,289.28

Open treatment of acromioclavicular dislocation, acute or chronic with fascial graft (includes obta

Facility

$23,096.00

Service Code	HCPCS 23552
Hospital Charge Code	9900230
Hospital Revenue Code	360
Rate for Payer: Cash Price	$15,705.28

Open treatment of articular fracture, involving metacarpophalangeal or interphalangeal joint, includ

Facility

$7,783.60

Service Code	HCPCS 26746
Hospital Charge Code	9900367
Hospital Revenue Code	360
Rate for Payer: Cash Price	$5,292.85

Open treatment of articular fracture, involving metacarpophalangeal or interphalangeal joint, includ

Facility

$10,000.00

Service Code	CPT 26746
Hospital Charge Code	36026746
Hospital Revenue Code	360
Min. Negotiated Rate	$1,088.27
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$1,088.27
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$3,286.91
Rate for Payer: Amerigroup Medicare	$3,286.91
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	$3,286.91
Rate for Payer: BCBS of TX PPO	$6,898.37
Rate for Payer: Cigna Commercial	$6,947.94
Rate for Payer: Cigna Medicare	$3,286.91
Rate for Payer: Employer Direct Commercial	$3,286.91
Rate for Payer: Humana Medicare/TRICARE	$3,286.91
Rate for Payer: Molina Dual Medicare/Medicaid	$3,286.91
Rate for Payer: Molina Medicare	$3,286.91
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: Scott and White EPO/PPO	$5,476.44
Rate for Payer: Scott and White Medicare	$3,286.91
Rate for Payer: Superior Health Plan EPO	$3,286.91
Rate for Payer: Superior Health Plan Medicare	$3,286.91
Rate for Payer: Universal American Dual Medicare/Medicaid	$3,286.91
Rate for Payer: Universal American Medicare	$3,286.91
Rate for Payer: Wellcare Medicare	$3,286.91
Rate for Payer: Wellmed Medicare	$3,286.91

Open treatment of articular fracture, involving metacarpophalangeal or interphalangeal joint, includ

Facility

$7,783.60

Service Code	HCPCS 26746
Hospital Charge Code	9900367
Hospital Revenue Code	360
Min. Negotiated Rate	$1,088.27
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$1,088.27
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$3,286.91
Rate for Payer: Amerigroup Medicare	$3,286.91
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	$3,286.91
Rate for Payer: BCBS of TX PPO	$6,898.37
Rate for Payer: Cash Price	$5,292.85
Rate for Payer: Cash Price	$5,292.85
Rate for Payer: Cash Price	$5,292.85
Rate for Payer: Cigna Commercial	$6,947.94
Rate for Payer: Cigna Medicaid	$5,604.19
Rate for Payer: Cigna Medicare	$3,286.91
Rate for Payer: Employer Direct Commercial	$3,286.91
Rate for Payer: Humana Medicare/TRICARE	$3,286.91
Rate for Payer: Molina CHIP/Medicaid	$5,604.19
Rate for Payer: Molina Dual Medicare/Medicaid	$3,286.91
Rate for Payer: Molina Medicare	$3,286.91
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	$5,604.19
Rate for Payer: Scott and White EPO/PPO	$5,476.44
Rate for Payer: Scott and White Medicare	$3,286.91
Rate for Payer: Superior Health Plan CHIP/Medicaid	$5,604.19
Rate for Payer: Superior Health Plan EPO	$3,286.91
Rate for Payer: Superior Health Plan Medicare	$3,286.91
Rate for Payer: Universal American Dual Medicare/Medicaid	$3,286.91
Rate for Payer: Universal American Medicare	$3,286.91
Rate for Payer: Wellcare Medicare	$3,286.91
Rate for Payer: Wellmed Medicare	$3,286.91

Open treatment of bimalleolar ankle fracture (eg, lateral and medial malleoli, or lateral and poster

Facility

$15,408.22

Service Code	CPT 27814
Hospital Charge Code	36027814
Hospital Revenue Code	360
Min. Negotiated Rate	$3,221.80
Max. Negotiated Rate	$15,408.22
Rate for Payer: Amerigroup CHIP/Medicaid	$3,221.80
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$7,289.28
Rate for Payer: Amerigroup Medicare	$7,289.28
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	$7,289.28
Rate for Payer: BCBS of TX PPO	$15,074.51
Rate for Payer: Cigna Commercial	$15,408.22
Rate for Payer: Cigna Medicare	$7,289.28
Rate for Payer: Employer Direct Commercial	$7,289.28
Rate for Payer: Humana Medicare/TRICARE	$7,289.28
Rate for Payer: Molina Dual Medicare/Medicaid	$7,289.28
Rate for Payer: Molina Medicare	$7,289.28
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: Scott and White EPO/PPO	$12,104.03
Rate for Payer: Scott and White Medicare	$7,289.28
Rate for Payer: Superior Health Plan EPO	$7,289.28
Rate for Payer: Superior Health Plan Medicare	$7,289.28
Rate for Payer: Universal American Dual Medicare/Medicaid	$7,289.28
Rate for Payer: Universal American Medicare	$7,289.28
Rate for Payer: Wellcare Medicare	$7,289.28
Rate for Payer: Wellmed Medicare	$7,289.28

Open treatment of bimalleolar ankle fracture (eg, lateral and medial malleoli, or lateral and poster

Facility

$18,453.00

Service Code	HCPCS 27814
Hospital Charge Code	9900446
Hospital Revenue Code	360
Min. Negotiated Rate	$3,221.80
Max. Negotiated Rate	$15,408.22
Rate for Payer: Amerigroup CHIP/Medicaid	$3,221.80
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$7,289.28
Rate for Payer: Amerigroup Medicare	$7,289.28
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	$7,289.28
Rate for Payer: BCBS of TX PPO	$15,074.51
Rate for Payer: Cash Price	$12,548.04
Rate for Payer: Cash Price	$12,548.04
Rate for Payer: Cash Price	$12,548.04
Rate for Payer: Cigna Commercial	$15,408.22
Rate for Payer: Cigna Medicaid	$13,286.16
Rate for Payer: Cigna Medicare	$7,289.28
Rate for Payer: Employer Direct Commercial	$7,289.28
Rate for Payer: Humana Medicare/TRICARE	$7,289.28
Rate for Payer: Molina CHIP/Medicaid	$13,286.16
Rate for Payer: Molina Dual Medicare/Medicaid	$7,289.28
Rate for Payer: Molina Medicare	$7,289.28
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	$13,286.16
Rate for Payer: Scott and White EPO/PPO	$12,104.03
Rate for Payer: Scott and White Medicare	$7,289.28
Rate for Payer: Superior Health Plan CHIP/Medicaid	$13,286.16
Rate for Payer: Superior Health Plan EPO	$7,289.28
Rate for Payer: Superior Health Plan Medicare	$7,289.28
Rate for Payer: Universal American Dual Medicare/Medicaid	$7,289.28
Rate for Payer: Universal American Medicare	$7,289.28
Rate for Payer: Wellcare Medicare	$7,289.28
Rate for Payer: Wellmed Medicare	$7,289.28

Open treatment of bimalleolar ankle fracture (eg, lateral and medial malleoli, or lateral and poster

Facility

$18,453.00

Service Code	HCPCS 27814
Hospital Charge Code	9900446
Hospital Revenue Code	360
Rate for Payer: Cash Price	$12,548.04

Know your out-of-pocket cost for care.

All Charges