White Rock Medical Center

All Charges

Charge

Type

Setting

Price

AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC

Facility

$36,936.00

Service Code	MSDRG 617
Min. Negotiated Rate	$17,010.00
Max. Negotiated Rate	$36,936.00
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$18,467.56
Rate for Payer: Amerigroup Medicare	$18,467.56
Rate for Payer: BCBS of TX Medicare	$18,467.56
Rate for Payer: Cigna Commercial	$24,089.46
Rate for Payer: Cigna Medicare	$18,467.56
Rate for Payer: Employer Direct Commercial	$18,467.56
Rate for Payer: Humana Medicare/TRICARE	$18,467.56
Rate for Payer: Molina Dual Medicare/Medicaid	$18,467.56
Rate for Payer: Molina Medicare	$18,467.56
Rate for Payer: Multiplan Auto	$36,936.00
Rate for Payer: Multiplan Commercial	$36,936.00
Rate for Payer: Multiplan Workers Comp	$36,936.00
Rate for Payer: Scott and White EPO/PPO	$17,010.00
Rate for Payer: Scott and White Medicare	$18,467.56
Rate for Payer: Superior Health Plan EPO	$18,467.56
Rate for Payer: Superior Health Plan Medicare	$18,467.56
Rate for Payer: Universal American Dual Medicare/Medicaid	$18,467.56
Rate for Payer: Universal American Medicare	$18,467.56
Rate for Payer: Wellcare Medicare	$18,467.56
Rate for Payer: Wellmed Medicare	$18,467.56

AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH MCC

Facility

$71,525.50

Service Code	MSDRG 616
Min. Negotiated Rate	$30,319.33
Max. Negotiated Rate	$71,525.50
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$30,319.33
Rate for Payer: Amerigroup Medicare	$30,319.33
Rate for Payer: BCBS of TX Medicare	$30,319.33
Rate for Payer: Cigna Commercial	$44,917.71
Rate for Payer: Cigna Medicare	$30,319.33
Rate for Payer: Employer Direct Commercial	$30,319.33
Rate for Payer: Humana Medicare/TRICARE	$30,319.33
Rate for Payer: Molina Dual Medicare/Medicaid	$30,319.33
Rate for Payer: Molina Medicare	$30,319.33
Rate for Payer: Multiplan Auto	$71,525.50
Rate for Payer: Multiplan Commercial	$71,525.50
Rate for Payer: Multiplan Workers Comp	$71,525.50
Rate for Payer: Scott and White EPO/PPO	$32,939.38
Rate for Payer: Scott and White Medicare	$30,319.33
Rate for Payer: Superior Health Plan EPO	$30,319.33
Rate for Payer: Superior Health Plan Medicare	$30,319.33
Rate for Payer: Universal American Dual Medicare/Medicaid	$30,319.33
Rate for Payer: Universal American Medicare	$30,319.33
Rate for Payer: Wellcare Medicare	$30,319.33
Rate for Payer: Wellmed Medicare	$30,319.33

AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CC/MCC

Facility

$22,285.10

Service Code	MSDRG 618
Min. Negotiated Rate	$9,969.98
Max. Negotiated Rate	$22,285.10
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$15,154.84
Rate for Payer: Amerigroup Medicare	$15,154.84
Rate for Payer: BCBS of TX Medicare	$15,154.84
Rate for Payer: Cigna Commercial	$18,267.70
Rate for Payer: Cigna Medicare	$15,154.84
Rate for Payer: Employer Direct Commercial	$15,154.84
Rate for Payer: Humana Medicare/TRICARE	$15,154.84
Rate for Payer: Molina Dual Medicare/Medicaid	$15,154.84
Rate for Payer: Molina Medicare	$15,154.84
Rate for Payer: Multiplan Auto	$22,285.10
Rate for Payer: Multiplan Commercial	$22,285.10
Rate for Payer: Multiplan Workers Comp	$22,285.10
Rate for Payer: Scott and White EPO/PPO	$10,262.88
Rate for Payer: Scott and White Medicare	$15,154.84
Rate for Payer: Superior Health Plan EPO	$15,154.84
Rate for Payer: Superior Health Plan Medicare	$15,154.84
Rate for Payer: Universal American Dual Medicare/Medicaid	$15,154.84
Rate for Payer: Universal American Medicare	$15,154.84
Rate for Payer: Wellcare Medicare	$15,154.84
Rate for Payer: Wellmed Medicare	$15,154.84

Amputation, thigh, through femur, any level

Facility

$46,200.00

Service Code	HCPCS 27590
Hospital Charge Code	991145
Hospital Revenue Code	360
Min. Negotiated Rate	$1,381.26
Max. Negotiated Rate	$33,264.00
Rate for Payer: Amerigroup CHIP/Medicaid	$4,158.00
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	$1,381.26
Rate for Payer: BCBS of TX Blue Essentials	$1,654.20
Rate for Payer: BCBS of TX Medicare	$3,286.91
Rate for Payer: BCBS of TX PPO	$2,084.29
Rate for Payer: Cash Price	$31,416.00
Rate for Payer: Cash Price	$31,416.00
Rate for Payer: Cash Price	$31,416.00
Rate for Payer: Cigna Commercial	$6,947.94
Rate for Payer: Cigna Medicaid	$33,264.00
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	$33,264.00
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	$33,264.00
Rate for Payer: Scott and White EPO/PPO	$23,100.00
Rate for Payer: Scott and White Medicare	$3,286.91
Rate for Payer: Superior Health Plan CHIP/Medicaid	$33,264.00
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

Amputation, thigh, through femur, any level

Facility

$46,200.00

Service Code	HCPCS 27590
Hospital Charge Code	991145
Hospital Revenue Code	360
Rate for Payer: Cash Price	$31,416.00

Amputation, toe; interphalangeal joint

Facility

$7,783.60

Service Code	HCPCS 28825
Hospital Charge Code	9900536
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

Amputation, toe; interphalangeal joint

Facility

$10,000.00

Service Code	CPT 28825
Hospital Charge Code	36028825
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

Amputation, toe; interphalangeal joint

Facility

$7,783.60

Service Code	HCPCS 28825
Hospital Charge Code	9900536
Hospital Revenue Code	360
Rate for Payer: Cash Price	$5,292.85

Amputation, toe metatarsophalangeal joint

Facility

$7,076.00

Service Code	HCPCS 28820
Hospital Charge Code	9900535
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	$4,811.68
Rate for Payer: Cash Price	$4,811.68
Rate for Payer: Cash Price	$4,811.68
Rate for Payer: Cigna Commercial	$6,947.94
Rate for Payer: Cigna Medicaid	$5,094.72
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	$5,094.72
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	$5,094.72
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	$5,094.72
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

Amputation, toe metatarsophalangeal joint

Facility

$10,000.00

Service Code	CPT 28820
Hospital Charge Code	36028820
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

Amputation, toe metatarsophalangeal joint

Facility

$7,076.00

Service Code	HCPCS 28820
Hospital Charge Code	9900535
Hospital Revenue Code	360
Rate for Payer: Cash Price	$4,811.68

AMPUTAT OF LOWER LIMB FOR ENDOCRINE,NUTRIT,& METABOL DIS W CC

Facility

$36,936.00

Service Code	MSDRG 617
Min. Negotiated Rate	$17,010.00
Max. Negotiated Rate	$36,936.00
Rate for Payer: BCBS of TX Blue Advantage	$17,832.96
Rate for Payer: BCBS of TX Blue Essentials	$21,397.48
Rate for Payer: BCBS of TX PPO	$23,775.90

AMPUTAT OF LOWER LIMB FOR ENDOCRINE,NUTRIT,& METABOL DIS W MCC

Facility

$71,525.50

Service Code	MSDRG 616
Min. Negotiated Rate	$30,319.33
Max. Negotiated Rate	$71,525.50
Rate for Payer: BCBS of TX Blue Advantage	$35,562.72
Rate for Payer: BCBS of TX Blue Essentials	$42,671.13
Rate for Payer: BCBS of TX PPO	$47,414.20

AMPUTAT OF LOWER LIMB FOR ENDOCRINE,NUTRIT,& METABOL DIS W/O CC/MCC

Facility

$22,285.10

Service Code	MSDRG 618
Min. Negotiated Rate	$9,969.98
Max. Negotiated Rate	$22,285.10
Rate for Payer: BCBS of TX Blue Advantage	$9,969.98
Rate for Payer: BCBS of TX Blue Essentials	$11,962.82
Rate for Payer: BCBS of TX PPO	$13,292.53

Amylase Level 24 Hour Urine

Facility

$305.00

Service Code	HCPCS 82150
Hospital Charge Code	1601624
Hospital Revenue Code	301
Rate for Payer: Cash Price	$207.40

Amylase Level 24 Hour Urine

Facility

$305.00

Service Code	HCPCS 82150
Hospital Charge Code	1601624
Hospital Revenue Code	301
Min. Negotiated Rate	$2.53
Max. Negotiated Rate	$219.60
Rate for Payer: Amerigroup CHIP/Medicaid	$2.53
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$6.48
Rate for Payer: Amerigroup Medicare	$6.48
Rate for Payer: BCBS of TX Blue Advantage	$91.50
Rate for Payer: BCBS of TX Blue Essentials	$109.80
Rate for Payer: BCBS of TX Medicare	$6.48
Rate for Payer: BCBS of TX PPO	$122.00
Rate for Payer: Cash Price	$207.40
Rate for Payer: Cash Price	$207.40
Rate for Payer: Cigna Medicaid	$219.60
Rate for Payer: Cigna Medicare	$6.48
Rate for Payer: Employer Direct Commercial	$6.48
Rate for Payer: Humana Medicare/TRICARE	$6.48
Rate for Payer: Molina CHIP/Medicaid	$219.60
Rate for Payer: Molina Dual Medicare/Medicaid	$6.48
Rate for Payer: Molina Medicare	$6.48
Rate for Payer: Multiplan Auto	$198.25
Rate for Payer: Multiplan Commercial	$198.25
Rate for Payer: Multiplan Workers Comp	$198.25
Rate for Payer: Parkland Medicaid	$219.60
Rate for Payer: Scott and White EPO/PPO	$8.10
Rate for Payer: Scott and White Medicare	$6.48
Rate for Payer: Superior Health Plan CHIP/Medicaid	$219.60
Rate for Payer: Superior Health Plan EPO	$6.48
Rate for Payer: Superior Health Plan Medicare	$6.48
Rate for Payer: Universal American Dual Medicare/Medicaid	$6.48
Rate for Payer: Universal American Medicare	$6.48
Rate for Payer: Wellcare Medicare	$6.48
Rate for Payer: Wellmed Medicare	$6.48

Anaerobe Identification (Vitek)

Facility

$182.00

Service Code	HCPCS 87076
Hospital Charge Code	4107076
Hospital Revenue Code	306
Min. Negotiated Rate	$3.15
Max. Negotiated Rate	$131.04
Rate for Payer: Amerigroup CHIP/Medicaid	$3.15
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$8.08
Rate for Payer: Amerigroup Medicare	$8.08
Rate for Payer: BCBS of TX Blue Advantage	$54.60
Rate for Payer: BCBS of TX Blue Essentials	$65.52
Rate for Payer: BCBS of TX Medicare	$8.08
Rate for Payer: BCBS of TX PPO	$72.80
Rate for Payer: Cash Price	$123.76
Rate for Payer: Cash Price	$123.76
Rate for Payer: Cigna Medicaid	$131.04
Rate for Payer: Cigna Medicare	$8.08
Rate for Payer: Employer Direct Commercial	$8.08
Rate for Payer: Humana Medicare/TRICARE	$8.08
Rate for Payer: Molina CHIP/Medicaid	$131.04
Rate for Payer: Molina Dual Medicare/Medicaid	$8.08
Rate for Payer: Molina Medicare	$8.08
Rate for Payer: Multiplan Auto	$118.30
Rate for Payer: Multiplan Commercial	$118.30
Rate for Payer: Multiplan Workers Comp	$118.30
Rate for Payer: Parkland Medicaid	$131.04
Rate for Payer: Scott and White EPO/PPO	$10.10
Rate for Payer: Scott and White Medicare	$8.08
Rate for Payer: Superior Health Plan CHIP/Medicaid	$131.04
Rate for Payer: Superior Health Plan EPO	$8.08
Rate for Payer: Superior Health Plan Medicare	$8.08
Rate for Payer: Universal American Dual Medicare/Medicaid	$8.08
Rate for Payer: Universal American Medicare	$8.08
Rate for Payer: Wellcare Medicare	$8.08
Rate for Payer: Wellmed Medicare	$8.08

Anaerobe Identification (Vitek)

Facility

$182.00

Service Code	HCPCS 87076
Hospital Charge Code	4107076
Hospital Revenue Code	306
Rate for Payer: Cash Price	$123.76

ANAEROGRO CHOPPED MEAT GLUCOSE BROTH, 16 X 125 MM

Facility

$68.61

Hospital Charge Code	993103
Hospital Revenue Code	270
Rate for Payer: Cash Price	$46.65

ANAEROGRO CHOPPED MEAT GLUCOSE BROTH, 16 X 125 MM

Facility

$68.61

Hospital Charge Code	993103
Hospital Revenue Code	270
Min. Negotiated Rate	$6.17
Max. Negotiated Rate	$49.40
Rate for Payer: Amerigroup CHIP/Medicaid	$6.17
Rate for Payer: BCBS of TX Blue Advantage	$20.58
Rate for Payer: BCBS of TX Blue Essentials	$24.70
Rate for Payer: BCBS of TX PPO	$27.44
Rate for Payer: Cash Price	$46.65
Rate for Payer: Cigna Medicaid	$49.40
Rate for Payer: Molina CHIP/Medicaid	$49.40
Rate for Payer: Multiplan Auto	$44.60
Rate for Payer: Multiplan Commercial	$44.60
Rate for Payer: Multiplan Workers Comp	$44.60
Rate for Payer: Parkland Medicaid	$49.40
Rate for Payer: Scott and White EPO/PPO	$34.30
Rate for Payer: Superior Health Plan CHIP/Medicaid	$49.40
Rate for Payer: Superior Health Plan EPO	$9.33

ANAL AND PERINEAL PROCEDURES

Facility

$20,773.31

Service Code	APR-DRG 2264
Min. Negotiated Rate	$19,585.80
Max. Negotiated Rate	$20,773.31
Rate for Payer: Amerigroup CHIP/Medicaid	$19,585.80
Rate for Payer: Cigna Medicaid	$19,585.80
Rate for Payer: Molina CHIP/Medicaid	$19,585.80
Rate for Payer: Parkland Medicaid	$19,585.80
Rate for Payer: Superior Health Plan CHIP/Medicaid	$20,773.31

ANAL AND PERINEAL PROCEDURES

Facility

$4,307.50

Service Code	APR-DRG 2261
Min. Negotiated Rate	$4,061.26
Max. Negotiated Rate	$4,307.50
Rate for Payer: Amerigroup CHIP/Medicaid	$4,061.26
Rate for Payer: Cigna Medicaid	$4,061.26
Rate for Payer: Molina CHIP/Medicaid	$4,061.26
Rate for Payer: Parkland Medicaid	$4,061.26
Rate for Payer: Superior Health Plan CHIP/Medicaid	$4,307.50

ANAL AND PERINEAL PROCEDURES

Facility

$7,113.41

Service Code	APR-DRG 2263
Min. Negotiated Rate	$6,706.77
Max. Negotiated Rate	$7,113.41
Rate for Payer: Amerigroup CHIP/Medicaid	$6,706.77
Rate for Payer: Cigna Medicaid	$6,706.77
Rate for Payer: Molina CHIP/Medicaid	$6,706.77
Rate for Payer: Parkland Medicaid	$6,706.77
Rate for Payer: Superior Health Plan CHIP/Medicaid	$7,113.41

ANAL AND PERINEAL PROCEDURES

Facility

$6,138.37

Service Code	APR-DRG 2262
Min. Negotiated Rate	$5,787.47
Max. Negotiated Rate	$6,138.37
Rate for Payer: Amerigroup CHIP/Medicaid	$5,787.47
Rate for Payer: Cigna Medicaid	$5,787.47
Rate for Payer: Molina CHIP/Medicaid	$5,787.47
Rate for Payer: Parkland Medicaid	$5,787.47
Rate for Payer: Superior Health Plan CHIP/Medicaid	$6,138.37

ANAL AND STOMAL PROCEDURES WITH CC

Facility

$26,239.00

Service Code	MSDRG 348
Min. Negotiated Rate	$12,040.00
Max. Negotiated Rate	$26,239.00
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$14,352.31
Rate for Payer: Amerigroup Medicare	$14,352.31
Rate for Payer: BCBS of TX Medicare	$14,352.31
Rate for Payer: Cigna Commercial	$16,857.34
Rate for Payer: Cigna Medicare	$14,352.31
Rate for Payer: Employer Direct Commercial	$14,352.31
Rate for Payer: Humana Medicare/TRICARE	$14,352.31
Rate for Payer: Molina Dual Medicare/Medicaid	$14,352.31
Rate for Payer: Molina Medicare	$14,352.31
Rate for Payer: Multiplan Auto	$26,239.00
Rate for Payer: Multiplan Commercial	$26,239.00
Rate for Payer: Multiplan Workers Comp	$26,239.00
Rate for Payer: Scott and White EPO/PPO	$12,083.75
Rate for Payer: Scott and White Medicare	$14,352.31
Rate for Payer: Superior Health Plan EPO	$14,352.31
Rate for Payer: Superior Health Plan Medicare	$14,352.31
Rate for Payer: Universal American Dual Medicare/Medicaid	$14,352.31
Rate for Payer: Universal American Medicare	$14,352.31
Rate for Payer: Wellcare Medicare	$14,352.31
Rate for Payer: Wellmed Medicare	$14,352.31

Know your out-of-pocket cost for care.

All Charges