White Rock Medical Center

All Charges

Charge

Type

Setting

Price

Osteochondral allograft, knee, open

Facility

$78,288.48

Service Code	HCPCS 27415
Hospital Charge Code	9900403
Hospital Revenue Code	360
Min. Negotiated Rate	$8,311.46
Max. Negotiated Rate	$56,367.71
Rate for Payer: Amerigroup CHIP/Medicaid	$8,311.46
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$12,897.19
Rate for Payer: Amerigroup Medicare	$12,897.19
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	$12,897.19
Rate for Payer: BCBS of TX PPO	$29,989.79
Rate for Payer: Cash Price	$53,236.17
Rate for Payer: Cash Price	$53,236.17
Rate for Payer: Cash Price	$53,236.17
Rate for Payer: Cigna Commercial	$27,262.32
Rate for Payer: Cigna Medicaid	$56,367.71
Rate for Payer: Cigna Medicare	$12,897.19
Rate for Payer: Employer Direct Commercial	$12,897.19
Rate for Payer: Humana Medicare/TRICARE	$12,897.19
Rate for Payer: Molina CHIP/Medicaid	$56,367.71
Rate for Payer: Molina Dual Medicare/Medicaid	$12,897.19
Rate for Payer: Molina Medicare	$12,897.19
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	$56,367.71
Rate for Payer: Scott and White EPO/PPO	$22,267.47
Rate for Payer: Scott and White Medicare	$12,897.19
Rate for Payer: Superior Health Plan CHIP/Medicaid	$56,367.71
Rate for Payer: Superior Health Plan EPO	$12,897.19
Rate for Payer: Superior Health Plan Medicare	$12,897.19
Rate for Payer: Universal American Dual Medicare/Medicaid	$12,897.19
Rate for Payer: Universal American Medicare	$12,897.19
Rate for Payer: Wellcare Medicare	$12,897.19
Rate for Payer: Wellmed Medicare	$12,897.19

Osteochondral allograft, knee, open

Facility

$29,989.79

Service Code	CPT 27415
Hospital Charge Code	36027415
Hospital Revenue Code	360
Min. Negotiated Rate	$8,311.46
Max. Negotiated Rate	$29,989.79
Rate for Payer: Amerigroup CHIP/Medicaid	$8,311.46
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$12,897.19
Rate for Payer: Amerigroup Medicare	$12,897.19
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	$12,897.19
Rate for Payer: BCBS of TX PPO	$29,989.79
Rate for Payer: Cigna Commercial	$27,262.32
Rate for Payer: Cigna Medicare	$12,897.19
Rate for Payer: Employer Direct Commercial	$12,897.19
Rate for Payer: Humana Medicare/TRICARE	$12,897.19
Rate for Payer: Molina Dual Medicare/Medicaid	$12,897.19
Rate for Payer: Molina Medicare	$12,897.19
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	$22,267.47
Rate for Payer: Scott and White Medicare	$12,897.19
Rate for Payer: Superior Health Plan EPO	$12,897.19
Rate for Payer: Superior Health Plan Medicare	$12,897.19
Rate for Payer: Universal American Dual Medicare/Medicaid	$12,897.19
Rate for Payer: Universal American Medicare	$12,897.19
Rate for Payer: Wellcare Medicare	$12,897.19
Rate for Payer: Wellmed Medicare	$12,897.19

Osteochondral allograft, knee, open

Facility

$78,288.48

Service Code	HCPCS 27415
Hospital Charge Code	9900403
Hospital Revenue Code	360
Rate for Payer: Cash Price	$53,236.17

OSTEOMYELITIS, SEPTIC ARTHRITIS AND OTHER MUSCULOSKELETAL INFECTIONS

Facility

$3,534.26

Service Code	APR-DRG 3441
Min. Negotiated Rate	$3,332.22
Max. Negotiated Rate	$3,534.26
Rate for Payer: Amerigroup CHIP/Medicaid	$3,332.22
Rate for Payer: Cigna Medicaid	$3,332.22
Rate for Payer: Molina CHIP/Medicaid	$3,332.22
Rate for Payer: Parkland Medicaid	$3,332.22
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3,534.26

OSTEOMYELITIS, SEPTIC ARTHRITIS AND OTHER MUSCULOSKELETAL INFECTIONS

Facility

$4,464.79

Service Code	APR-DRG 3442
Min. Negotiated Rate	$4,209.56
Max. Negotiated Rate	$4,464.79
Rate for Payer: Amerigroup CHIP/Medicaid	$4,209.56
Rate for Payer: Cigna Medicaid	$4,209.56
Rate for Payer: Molina CHIP/Medicaid	$4,209.56
Rate for Payer: Parkland Medicaid	$4,209.56
Rate for Payer: Superior Health Plan CHIP/Medicaid	$4,464.79

OSTEOMYELITIS, SEPTIC ARTHRITIS AND OTHER MUSCULOSKELETAL INFECTIONS

Facility

$6,224.37

Service Code	APR-DRG 3443
Min. Negotiated Rate	$5,868.56
Max. Negotiated Rate	$6,224.37
Rate for Payer: Amerigroup CHIP/Medicaid	$5,868.56
Rate for Payer: Cigna Medicaid	$5,868.56
Rate for Payer: Molina CHIP/Medicaid	$5,868.56
Rate for Payer: Parkland Medicaid	$5,868.56
Rate for Payer: Superior Health Plan CHIP/Medicaid	$6,224.37

OSTEOMYELITIS, SEPTIC ARTHRITIS AND OTHER MUSCULOSKELETAL INFECTIONS

Facility

$11,916.91

Service Code	APR-DRG 3444
Min. Negotiated Rate	$11,235.68
Max. Negotiated Rate	$11,916.91
Rate for Payer: Amerigroup CHIP/Medicaid	$11,235.68
Rate for Payer: Cigna Medicaid	$11,235.68
Rate for Payer: Molina CHIP/Medicaid	$11,235.68
Rate for Payer: Parkland Medicaid	$11,235.68
Rate for Payer: Superior Health Plan CHIP/Medicaid	$11,916.91

OSTEOMYELITIS W CC

Facility

$25,585.40

Service Code	MSDRG 540
Min. Negotiated Rate	$11,153.34
Max. Negotiated Rate	$25,585.40
Rate for Payer: BCBS of TX Blue Advantage	$11,153.34
Rate for Payer: BCBS of TX Blue Essentials	$13,382.71
Rate for Payer: BCBS of TX PPO	$14,870.26

OSTEOMYELITIS WITH CC

Facility

$25,585.40

Service Code	MSDRG 540
Min. Negotiated Rate	$11,153.34
Max. Negotiated Rate	$25,585.40
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$14,260.69
Rate for Payer: Amerigroup Medicare	$14,260.69
Rate for Payer: BCBS of TX Medicare	$14,260.69
Rate for Payer: Cigna Commercial	$16,696.34
Rate for Payer: Cigna Medicare	$14,260.69
Rate for Payer: Employer Direct Commercial	$14,260.69
Rate for Payer: Humana Medicare/TRICARE	$14,260.69
Rate for Payer: Molina Dual Medicare/Medicaid	$14,260.69
Rate for Payer: Molina Medicare	$14,260.69
Rate for Payer: Multiplan Auto	$25,585.40
Rate for Payer: Multiplan Commercial	$25,585.40
Rate for Payer: Multiplan Workers Comp	$25,585.40
Rate for Payer: Scott and White EPO/PPO	$11,782.75
Rate for Payer: Scott and White Medicare	$14,260.69
Rate for Payer: Superior Health Plan EPO	$14,260.69
Rate for Payer: Superior Health Plan Medicare	$14,260.69
Rate for Payer: Universal American Dual Medicare/Medicaid	$14,260.69
Rate for Payer: Universal American Medicare	$14,260.69
Rate for Payer: Wellcare Medicare	$14,260.69
Rate for Payer: Wellmed Medicare	$14,260.69

OSTEOMYELITIS WITH MCC

Facility

$37,922.10

Service Code	MSDRG 539
Min. Negotiated Rate	$17,365.12
Max. Negotiated Rate	$37,922.10
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$19,196.06
Rate for Payer: Amerigroup Medicare	$19,196.06
Rate for Payer: BCBS of TX Medicare	$19,196.06
Rate for Payer: Cigna Commercial	$25,369.74
Rate for Payer: Cigna Medicare	$19,196.06
Rate for Payer: Employer Direct Commercial	$19,196.06
Rate for Payer: Humana Medicare/TRICARE	$19,196.06
Rate for Payer: Molina Dual Medicare/Medicaid	$19,196.06
Rate for Payer: Molina Medicare	$19,196.06
Rate for Payer: Multiplan Auto	$37,922.10
Rate for Payer: Multiplan Commercial	$37,922.10
Rate for Payer: Multiplan Workers Comp	$37,922.10
Rate for Payer: Scott and White EPO/PPO	$17,464.12
Rate for Payer: Scott and White Medicare	$19,196.06
Rate for Payer: Superior Health Plan EPO	$19,196.06
Rate for Payer: Superior Health Plan Medicare	$19,196.06
Rate for Payer: Universal American Dual Medicare/Medicaid	$19,196.06
Rate for Payer: Universal American Medicare	$19,196.06
Rate for Payer: Wellcare Medicare	$19,196.06
Rate for Payer: Wellmed Medicare	$19,196.06

OSTEOMYELITIS WITHOUT CC/MCC

Facility

$15,542.00

Service Code	MSDRG 541
Min. Negotiated Rate	$7,157.50
Max. Negotiated Rate	$15,542.00
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$10,530.95
Rate for Payer: Amerigroup Medicare	$10,530.95
Rate for Payer: BCBS of TX Medicare	$10,530.95
Rate for Payer: Cigna Commercial	$9,936.92
Rate for Payer: Cigna Medicare	$10,530.95
Rate for Payer: Employer Direct Commercial	$10,530.95
Rate for Payer: Humana Medicare/TRICARE	$10,530.95
Rate for Payer: Molina Dual Medicare/Medicaid	$10,530.95
Rate for Payer: Molina Medicare	$10,530.95
Rate for Payer: Multiplan Auto	$15,542.00
Rate for Payer: Multiplan Commercial	$15,542.00
Rate for Payer: Multiplan Workers Comp	$15,542.00
Rate for Payer: Scott and White EPO/PPO	$7,157.50
Rate for Payer: Scott and White Medicare	$10,530.95
Rate for Payer: Superior Health Plan EPO	$10,530.95
Rate for Payer: Superior Health Plan Medicare	$10,530.95
Rate for Payer: Universal American Dual Medicare/Medicaid	$10,530.95
Rate for Payer: Universal American Medicare	$10,530.95
Rate for Payer: Wellcare Medicare	$10,530.95
Rate for Payer: Wellmed Medicare	$10,530.95

OSTEOMYELITIS W MCC

Facility

$37,922.10

Service Code	MSDRG 539
Min. Negotiated Rate	$17,365.12
Max. Negotiated Rate	$37,922.10
Rate for Payer: BCBS of TX Blue Advantage	$17,365.12
Rate for Payer: BCBS of TX Blue Essentials	$20,836.12
Rate for Payer: BCBS of TX PPO	$23,152.15

OSTEOMYELITIS W/O CC/MCC

Facility

$15,542.00

Service Code	MSDRG 541
Min. Negotiated Rate	$7,157.50
Max. Negotiated Rate	$15,542.00
Rate for Payer: BCBS of TX Blue Advantage	$7,591.22
Rate for Payer: BCBS of TX Blue Essentials	$9,108.58
Rate for Payer: BCBS of TX PPO	$10,121.04

OSTEOSPARX 10CC BONE PUTTY

Facility

$6,159.00

Service Code	HCPCS C9359
Hospital Charge Code	8394480
Hospital Revenue Code	278
Min. Negotiated Rate	$554.31
Max. Negotiated Rate	$4,434.48
Rate for Payer: Amerigroup CHIP/Medicaid	$554.31
Rate for Payer: BCBS of TX Blue Advantage	$1,847.70
Rate for Payer: BCBS of TX Blue Essentials	$2,217.24
Rate for Payer: BCBS of TX PPO	$2,463.60
Rate for Payer: Cash Price	$4,188.12
Rate for Payer: Cigna Medicaid	$4,434.48
Rate for Payer: Molina CHIP/Medicaid	$4,434.48
Rate for Payer: Multiplan Auto	$3,079.50
Rate for Payer: Multiplan Commercial	$3,079.50
Rate for Payer: Multiplan Workers Comp	$3,079.50
Rate for Payer: Parkland Medicaid	$4,434.48
Rate for Payer: Scott and White EPO/PPO	$3,079.50
Rate for Payer: Superior Health Plan CHIP/Medicaid	$4,434.48
Rate for Payer: Superior Health Plan EPO	$837.62

OSTEOSPARX 10CC BONE PUTTY

Facility

$6,159.00

Service Code	HCPCS C9359
Hospital Charge Code	8394480
Hospital Revenue Code	278
Min. Negotiated Rate	$1,539.75
Max. Negotiated Rate	$3,079.50
Rate for Payer: Cash Price	$4,188.12
Rate for Payer: Cigna Commercial	$1,539.75
Rate for Payer: Multiplan Auto	$3,079.50
Rate for Payer: Multiplan Commercial	$3,079.50
Rate for Payer: Multiplan Workers Comp	$3,079.50
Rate for Payer: Scott and White EPO/PPO	$3,079.50

Osteotomy; calcaneus (eg, Dwyer or Chambers type procedure), with or without internal fixation

Facility

$15,408.22

Service Code	CPT 28300
Hospital Charge Code	36028300
Hospital Revenue Code	360
Min. Negotiated Rate	$3,382.73
Max. Negotiated Rate	$15,408.22
Rate for Payer: Amerigroup CHIP/Medicaid	$3,382.73
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

Osteotomy; calcaneus (eg, Dwyer or Chambers type procedure), with or without internal fixation

Facility

$14,352.00

Service Code	HCPCS 28300
Hospital Charge Code	9900507
Hospital Revenue Code	360
Rate for Payer: Cash Price	$9,759.36

Osteotomy; calcaneus (eg, Dwyer or Chambers type procedure), with or without internal fixation

Facility

$14,352.00

Service Code	HCPCS 28300
Hospital Charge Code	9900507
Hospital Revenue Code	360
Min. Negotiated Rate	$3,382.73
Max. Negotiated Rate	$15,408.22
Rate for Payer: Amerigroup CHIP/Medicaid	$3,382.73
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	$9,759.36
Rate for Payer: Cash Price	$9,759.36
Rate for Payer: Cash Price	$9,759.36
Rate for Payer: Cigna Commercial	$15,408.22
Rate for Payer: Cigna Medicaid	$10,333.44
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	$10,333.44
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	$10,333.44
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	$10,333.44
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

Osteotomy, clavicle, with or without internal fixation; with bone graft for nonunion or malunion (in

Facility

$73,888.56

Service Code	HCPCS 23485
Hospital Charge Code	9900227
Hospital Revenue Code	360
Rate for Payer: Cash Price	$50,244.22

Osteotomy, clavicle, with or without internal fixation; with bone graft for nonunion or malunion (in

Facility

$29,989.79

Service Code	CPT 23485
Hospital Charge Code	36023485
Hospital Revenue Code	360
Min. Negotiated Rate	$6,757.06
Max. Negotiated Rate	$29,989.79
Rate for Payer: Amerigroup CHIP/Medicaid	$6,757.06
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$12,897.19
Rate for Payer: Amerigroup Medicare	$12,897.19
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	$12,897.19
Rate for Payer: BCBS of TX PPO	$29,989.79
Rate for Payer: Cigna Commercial	$27,262.32
Rate for Payer: Cigna Medicare	$12,897.19
Rate for Payer: Employer Direct Commercial	$12,897.19
Rate for Payer: Humana Medicare/TRICARE	$12,897.19
Rate for Payer: Molina Dual Medicare/Medicaid	$12,897.19
Rate for Payer: Molina Medicare	$12,897.19
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	$22,267.47
Rate for Payer: Scott and White Medicare	$12,897.19
Rate for Payer: Superior Health Plan EPO	$12,897.19
Rate for Payer: Superior Health Plan Medicare	$12,897.19
Rate for Payer: Universal American Dual Medicare/Medicaid	$12,897.19
Rate for Payer: Universal American Medicare	$12,897.19
Rate for Payer: Wellcare Medicare	$12,897.19
Rate for Payer: Wellmed Medicare	$12,897.19

Osteotomy, clavicle, with or without internal fixation; with bone graft for nonunion or malunion (in

Facility

$73,888.56

Service Code	HCPCS 23485
Hospital Charge Code	9900227
Hospital Revenue Code	360
Min. Negotiated Rate	$6,757.06
Max. Negotiated Rate	$53,199.76
Rate for Payer: Amerigroup CHIP/Medicaid	$6,757.06
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$12,897.19
Rate for Payer: Amerigroup Medicare	$12,897.19
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	$12,897.19
Rate for Payer: BCBS of TX PPO	$29,989.79
Rate for Payer: Cash Price	$50,244.22
Rate for Payer: Cash Price	$50,244.22
Rate for Payer: Cash Price	$50,244.22
Rate for Payer: Cigna Commercial	$27,262.32
Rate for Payer: Cigna Medicaid	$53,199.76
Rate for Payer: Cigna Medicare	$12,897.19
Rate for Payer: Employer Direct Commercial	$12,897.19
Rate for Payer: Humana Medicare/TRICARE	$12,897.19
Rate for Payer: Molina CHIP/Medicaid	$53,199.76
Rate for Payer: Molina Dual Medicare/Medicaid	$12,897.19
Rate for Payer: Molina Medicare	$12,897.19
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	$53,199.76
Rate for Payer: Scott and White EPO/PPO	$22,267.47
Rate for Payer: Scott and White Medicare	$12,897.19
Rate for Payer: Superior Health Plan CHIP/Medicaid	$53,199.76
Rate for Payer: Superior Health Plan EPO	$12,897.19
Rate for Payer: Superior Health Plan Medicare	$12,897.19
Rate for Payer: Universal American Dual Medicare/Medicaid	$12,897.19
Rate for Payer: Universal American Medicare	$12,897.19
Rate for Payer: Wellcare Medicare	$12,897.19
Rate for Payer: Wellmed Medicare	$12,897.19

Osteotomy, femur, shaft or supracondylar; with fixation

Facility

$23,400.00

Service Code	HCPCS 27450
Hospital Charge Code	9900410
Hospital Revenue Code	360
Rate for Payer: Cash Price	$15,912.00

Osteotomy, femur, shaft or supracondylar; with fixation

Facility

$23,400.00

Service Code	HCPCS 27450
Hospital Charge Code	9900410
Hospital Revenue Code	360
Min. Negotiated Rate	$1,763.44
Max. Negotiated Rate	$16,848.00
Rate for Payer: Amerigroup CHIP/Medicaid	$2,106.00
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	$1,763.44
Rate for Payer: BCBS of TX Blue Essentials	$2,111.90
Rate for Payer: BCBS of TX Medicare	$7,289.28
Rate for Payer: BCBS of TX PPO	$2,660.99
Rate for Payer: Cash Price	$15,912.00
Rate for Payer: Cash Price	$15,912.00
Rate for Payer: Cash Price	$15,912.00
Rate for Payer: Cigna Commercial	$15,408.22
Rate for Payer: Cigna Medicaid	$16,848.00
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	$16,848.00
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	$16,848.00
Rate for Payer: Scott and White EPO/PPO	$11,700.00
Rate for Payer: Scott and White Medicare	$7,289.28
Rate for Payer: Superior Health Plan CHIP/Medicaid	$16,848.00
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

Osteotomy, femur, shaft or supracondylar; with fixation

Facility

$15,408.22

Service Code	CPT 27450
Hospital Charge Code	36027450
Hospital Revenue Code	360
Min. Negotiated Rate	$1,244.44
Max. Negotiated Rate	$15,408.22
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	$1,763.44
Rate for Payer: BCBS of TX Blue Essentials	$2,111.90
Rate for Payer: BCBS of TX Medicare	$7,289.28
Rate for Payer: BCBS of TX PPO	$2,660.99
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	$1,244.44
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

Osteotomy; fibula

Facility

$12,336.12

Service Code	HCPCS 27707
Hospital Charge Code	991031
Hospital Revenue Code	360
Rate for Payer: Cash Price	$8,388.56

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All Charges