White Rock Medical Center

All Charges

Charge

Type

Setting

Price

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

Facility

$20,302.00

Service Code	HCPCS 27422
Hospital Charge Code	9900405
Hospital Revenue Code	360
Rate for Payer: Cash Price	$13,805.36

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

Facility

$20,302.00

Service Code	HCPCS 27422
Hospital Charge Code	9900405
Hospital Revenue Code	360
Min. Negotiated Rate	$2,398.52
Max. Negotiated Rate	$15,408.22
Rate for Payer: Amerigroup CHIP/Medicaid	$2,398.52
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	$13,805.36
Rate for Payer: Cash Price	$13,805.36
Rate for Payer: Cash Price	$13,805.36
Rate for Payer: Cigna Commercial	$15,408.22
Rate for Payer: Cigna Medicaid	$14,617.44
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	$14,617.44
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	$14,617.44
Rate for Payer: Scott and White EPO/PPO	$13,485.17
Rate for Payer: Scott and White Medicare	$7,289.28
Rate for Payer: Superior Health Plan CHIP/Medicaid	$14,617.44
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

Reconstruction of mandibular rami, horizontal, vertical, C, or L osteotomy; without bone graft

Facility

$22,318.84

Service Code	HCPCS 21193
Hospital Charge Code	990964
Hospital Revenue Code	360
Rate for Payer: Cash Price	$15,176.81

Reconstruction of mandibular rami, horizontal, vertical, C, or L osteotomy; without bone graft

Facility

$22,318.84

Service Code	HCPCS 21193
Hospital Charge Code	990964
Hospital Revenue Code	360
Min. Negotiated Rate	$2,008.70
Max. Negotiated Rate	$16,069.56
Rate for Payer: Amerigroup CHIP/Medicaid	$2,008.70
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$5,946.81
Rate for Payer: Amerigroup Medicare	$5,946.81
Rate for Payer: BCBS of TX Blue Advantage	$8,100.39
Rate for Payer: BCBS of TX Blue Essentials	$9,701.06
Rate for Payer: BCBS of TX Medicare	$5,946.81
Rate for Payer: BCBS of TX PPO	$12,223.34
Rate for Payer: Cash Price	$15,176.81
Rate for Payer: Cash Price	$15,176.81
Rate for Payer: Cash Price	$15,176.81
Rate for Payer: Cigna Commercial	$12,570.48
Rate for Payer: Cigna Medicaid	$16,069.56
Rate for Payer: Cigna Medicare	$5,946.81
Rate for Payer: Employer Direct Commercial	$5,946.81
Rate for Payer: Humana Medicare/TRICARE	$5,946.81
Rate for Payer: Molina CHIP/Medicaid	$16,069.56
Rate for Payer: Molina Dual Medicare/Medicaid	$5,946.81
Rate for Payer: Molina Medicare	$5,946.81
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	$16,069.56
Rate for Payer: Scott and White EPO/PPO	$11,001.60
Rate for Payer: Scott and White Medicare	$5,946.81
Rate for Payer: Superior Health Plan CHIP/Medicaid	$16,069.56
Rate for Payer: Superior Health Plan EPO	$5,946.81
Rate for Payer: Superior Health Plan Medicare	$5,946.81
Rate for Payer: Universal American Dual Medicare/Medicaid	$5,946.81
Rate for Payer: Universal American Medicare	$5,946.81
Rate for Payer: Wellcare Medicare	$5,946.81
Rate for Payer: Wellmed Medicare	$5,946.81

Reconstruction of nail bed with graft

Facility

$7,719.12

Service Code	HCPCS 11762
Hospital Charge Code	9900102
Hospital Revenue Code	360
Min. Negotiated Rate	$148.94
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$148.94
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$2,072.68
Rate for Payer: Amerigroup Medicare	$2,072.68
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	$2,072.68
Rate for Payer: BCBS of TX PPO	$471.09
Rate for Payer: Cash Price	$5,249.00
Rate for Payer: Cash Price	$5,249.00
Rate for Payer: Cash Price	$5,249.00
Rate for Payer: Cigna Commercial	$4,381.27
Rate for Payer: Cigna Medicaid	$5,557.77
Rate for Payer: Cigna Medicare	$2,072.68
Rate for Payer: Employer Direct Commercial	$2,072.68
Rate for Payer: Humana Medicare/TRICARE	$2,072.68
Rate for Payer: Molina CHIP/Medicaid	$5,557.77
Rate for Payer: Molina Dual Medicare/Medicaid	$2,072.68
Rate for Payer: Molina Medicare	$2,072.68
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	$5,557.77
Rate for Payer: Scott and White EPO/PPO	$3,834.46
Rate for Payer: Scott and White Medicare	$2,072.68
Rate for Payer: Superior Health Plan CHIP/Medicaid	$5,557.77
Rate for Payer: Superior Health Plan EPO	$2,072.68
Rate for Payer: Superior Health Plan Medicare	$2,072.68
Rate for Payer: Universal American Dual Medicare/Medicaid	$2,072.68
Rate for Payer: Universal American Medicare	$2,072.68
Rate for Payer: Wellcare Medicare	$2,072.68
Rate for Payer: Wellmed Medicare	$2,072.68

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	$148.94
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$148.94
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$2,072.68
Rate for Payer: Amerigroup Medicare	$2,072.68
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	$2,072.68
Rate for Payer: BCBS of TX PPO	$471.09
Rate for Payer: Cigna Commercial	$4,381.27
Rate for Payer: Cigna Medicare	$2,072.68
Rate for Payer: Employer Direct Commercial	$2,072.68
Rate for Payer: Humana Medicare/TRICARE	$2,072.68
Rate for Payer: Molina Dual Medicare/Medicaid	$2,072.68
Rate for Payer: Molina Medicare	$2,072.68
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	$3,834.46
Rate for Payer: Scott and White Medicare	$2,072.68
Rate for Payer: Superior Health Plan EPO	$2,072.68
Rate for Payer: Superior Health Plan Medicare	$2,072.68
Rate for Payer: Universal American Dual Medicare/Medicaid	$2,072.68
Rate for Payer: Universal American Medicare	$2,072.68
Rate for Payer: Wellcare Medicare	$2,072.68
Rate for Payer: Wellmed Medicare	$2,072.68

Reconstruction of nail bed with graft

Facility

$7,719.12

Service Code	HCPCS 11762
Hospital Charge Code	9900102
Hospital Revenue Code	360
Rate for Payer: Cash Price	$5,249.00

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

Facility

$8,986.00

Service Code	HCPCS 26500
Hospital Charge Code	9900347
Hospital Revenue Code	360
Min. Negotiated Rate	$2,398.52
Max. Negotiated Rate	$15,408.22
Rate for Payer: Amerigroup CHIP/Medicaid	$2,398.52
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	$6,110.48
Rate for Payer: Cash Price	$6,110.48
Rate for Payer: Cash Price	$6,110.48
Rate for Payer: Cigna Commercial	$15,408.22
Rate for Payer: Cigna Medicaid	$6,469.92
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	$6,469.92
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	$6,469.92
Rate for Payer: Scott and White EPO/PPO	$13,485.17
Rate for Payer: Scott and White Medicare	$7,289.28
Rate for Payer: Superior Health Plan CHIP/Medicaid	$6,469.92
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

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

Facility

$15,408.22

Service Code	CPT 26500
Hospital Charge Code	36026500
Hospital Revenue Code	360
Min. Negotiated Rate	$2,398.52
Max. Negotiated Rate	$15,408.22
Rate for Payer: Amerigroup CHIP/Medicaid	$2,398.52
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	$13,485.17
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

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

Facility

$8,986.00

Service Code	HCPCS 26500
Hospital Charge Code	9900347
Hospital Revenue Code	360
Rate for Payer: Cash Price	$6,110.48

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	$593.04
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$593.04
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$1,615.32
Rate for Payer: Amerigroup Medicare	$1,615.32
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	$1,615.32
Rate for Payer: BCBS of TX PPO	$3,415.58
Rate for Payer: Cigna Commercial	$3,414.49
Rate for Payer: Cigna Medicare	$1,615.32
Rate for Payer: Employer Direct Commercial	$1,615.32
Rate for Payer: Humana Medicare/TRICARE	$1,615.32
Rate for Payer: Molina Dual Medicare/Medicaid	$1,615.32
Rate for Payer: Molina Medicare	$1,615.32
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	$2,988.34
Rate for Payer: Scott and White Medicare	$1,615.32
Rate for Payer: Superior Health Plan EPO	$1,615.32
Rate for Payer: Superior Health Plan Medicare	$1,615.32
Rate for Payer: Universal American Dual Medicare/Medicaid	$1,615.32
Rate for Payer: Universal American Medicare	$1,615.32
Rate for Payer: Wellcare Medicare	$1,615.32
Rate for Payer: Wellmed Medicare	$1,615.32

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

Facility

$5,738.08

Service Code	HCPCS 28345
Hospital Charge Code	9900515
Hospital Revenue Code	360
Rate for Payer: Cash Price	$3,901.89

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

Facility

$5,738.08

Service Code	HCPCS 28345
Hospital Charge Code	9900515
Hospital Revenue Code	360
Min. Negotiated Rate	$593.04
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$593.04
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$1,615.32
Rate for Payer: Amerigroup Medicare	$1,615.32
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	$1,615.32
Rate for Payer: BCBS of TX PPO	$3,415.58
Rate for Payer: Cash Price	$3,901.89
Rate for Payer: Cash Price	$3,901.89
Rate for Payer: Cash Price	$3,901.89
Rate for Payer: Cigna Commercial	$3,414.49
Rate for Payer: Cigna Medicaid	$4,131.42
Rate for Payer: Cigna Medicare	$1,615.32
Rate for Payer: Employer Direct Commercial	$1,615.32
Rate for Payer: Humana Medicare/TRICARE	$1,615.32
Rate for Payer: Molina CHIP/Medicaid	$4,131.42
Rate for Payer: Molina Dual Medicare/Medicaid	$1,615.32
Rate for Payer: Molina Medicare	$1,615.32
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	$4,131.42
Rate for Payer: Scott and White EPO/PPO	$2,988.34
Rate for Payer: Scott and White Medicare	$1,615.32
Rate for Payer: Superior Health Plan CHIP/Medicaid	$4,131.42
Rate for Payer: Superior Health Plan EPO	$1,615.32
Rate for Payer: Superior Health Plan Medicare	$1,615.32
Rate for Payer: Universal American Dual Medicare/Medicaid	$1,615.32
Rate for Payer: Universal American Medicare	$1,615.32
Rate for Payer: Wellcare Medicare	$1,615.32
Rate for Payer: Wellmed Medicare	$1,615.32

Recovery Room

Facility

$1,219.16

Hospital Charge Code	3223571
Hospital Revenue Code	710
Min. Negotiated Rate	$109.72
Max. Negotiated Rate	$877.80
Rate for Payer: Amerigroup CHIP/Medicaid	$109.72
Rate for Payer: BCBS of TX Blue Advantage	$365.75
Rate for Payer: BCBS of TX Blue Essentials	$438.90
Rate for Payer: BCBS of TX PPO	$487.66
Rate for Payer: Cash Price	$829.03
Rate for Payer: Cigna Medicaid	$877.80
Rate for Payer: Molina CHIP/Medicaid	$877.80
Rate for Payer: Multiplan Auto	$792.45
Rate for Payer: Multiplan Commercial	$792.45
Rate for Payer: Multiplan Workers Comp	$792.45
Rate for Payer: Parkland Medicaid	$877.80
Rate for Payer: Scott and White EPO/PPO	$609.58
Rate for Payer: Superior Health Plan CHIP/Medicaid	$877.80
Rate for Payer: Superior Health Plan EPO	$165.81

Recovery Room

Facility

$1,219.16

Hospital Charge Code	3223571
Hospital Revenue Code	710
Rate for Payer: Cash Price	$829.03

RECTAL RESECTION W CC

Facility

$44,501.80

Service Code	MSDRG 333
Min. Negotiated Rate	$16,579.08
Max. Negotiated Rate	$44,501.80
Rate for Payer: BCBS of TX Blue Advantage	$16,579.08
Rate for Payer: BCBS of TX Blue Essentials	$19,892.97
Rate for Payer: BCBS of TX PPO	$22,104.15

RECTAL RESECTION WITH CC

Facility

$44,501.80

Service Code	MSDRG 333
Min. Negotiated Rate	$16,579.08
Max. Negotiated Rate	$44,501.80
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$21,926.13
Rate for Payer: Amerigroup Medicare	$21,926.13
Rate for Payer: BCBS of TX Medicare	$21,926.13
Rate for Payer: Cigna Commercial	$30,167.54
Rate for Payer: Cigna Medicare	$21,926.13
Rate for Payer: Employer Direct Commercial	$21,926.13
Rate for Payer: Humana Medicare/TRICARE	$21,926.13
Rate for Payer: Molina Dual Medicare/Medicaid	$21,926.13
Rate for Payer: Molina Medicare	$21,926.13
Rate for Payer: Multiplan Auto	$44,501.80
Rate for Payer: Multiplan Commercial	$44,501.80
Rate for Payer: Multiplan Workers Comp	$44,501.80
Rate for Payer: Scott and White EPO/PPO	$20,494.25
Rate for Payer: Scott and White Medicare	$21,926.13
Rate for Payer: Superior Health Plan EPO	$21,926.13
Rate for Payer: Superior Health Plan Medicare	$21,926.13
Rate for Payer: Universal American Dual Medicare/Medicaid	$21,926.13
Rate for Payer: Universal American Medicare	$21,926.13
Rate for Payer: Wellcare Medicare	$21,926.13
Rate for Payer: Wellmed Medicare	$21,926.13

RECTAL RESECTION WITH MCC

Facility

$68,793.30

Service Code	MSDRG 332
Min. Negotiated Rate	$29,224.52
Max. Negotiated Rate	$68,793.30
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$31,296.29
Rate for Payer: Amerigroup Medicare	$31,296.29
Rate for Payer: BCBS of TX Medicare	$31,296.29
Rate for Payer: Cigna Commercial	$46,634.62
Rate for Payer: Cigna Medicare	$31,296.29
Rate for Payer: Employer Direct Commercial	$31,296.29
Rate for Payer: Humana Medicare/TRICARE	$31,296.29
Rate for Payer: Molina Dual Medicare/Medicaid	$31,296.29
Rate for Payer: Molina Medicare	$31,296.29
Rate for Payer: Multiplan Auto	$68,793.30
Rate for Payer: Multiplan Commercial	$68,793.30
Rate for Payer: Multiplan Workers Comp	$68,793.30
Rate for Payer: Scott and White EPO/PPO	$31,681.12
Rate for Payer: Scott and White Medicare	$31,296.29
Rate for Payer: Superior Health Plan EPO	$31,296.29
Rate for Payer: Superior Health Plan Medicare	$31,296.29
Rate for Payer: Universal American Dual Medicare/Medicaid	$31,296.29
Rate for Payer: Universal American Medicare	$31,296.29
Rate for Payer: Wellcare Medicare	$31,296.29
Rate for Payer: Wellmed Medicare	$31,296.29

RECTAL RESECTION WITHOUT CC/MCC

Facility

$31,120.10

Service Code	MSDRG 334
Min. Negotiated Rate	$11,233.32
Max. Negotiated Rate	$31,120.10
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$16,764.29
Rate for Payer: Amerigroup Medicare	$16,764.29
Rate for Payer: BCBS of TX Medicare	$16,764.29
Rate for Payer: Cigna Commercial	$21,096.15
Rate for Payer: Cigna Medicare	$16,764.29
Rate for Payer: Employer Direct Commercial	$16,764.29
Rate for Payer: Humana Medicare/TRICARE	$16,764.29
Rate for Payer: Molina Dual Medicare/Medicaid	$16,764.29
Rate for Payer: Molina Medicare	$16,764.29
Rate for Payer: Multiplan Auto	$31,120.10
Rate for Payer: Multiplan Commercial	$31,120.10
Rate for Payer: Multiplan Workers Comp	$31,120.10
Rate for Payer: Scott and White EPO/PPO	$14,331.62
Rate for Payer: Scott and White Medicare	$16,764.29
Rate for Payer: Superior Health Plan EPO	$16,764.29
Rate for Payer: Superior Health Plan Medicare	$16,764.29
Rate for Payer: Universal American Dual Medicare/Medicaid	$16,764.29
Rate for Payer: Universal American Medicare	$16,764.29
Rate for Payer: Wellcare Medicare	$16,764.29
Rate for Payer: Wellmed Medicare	$16,764.29

RECTAL RESECTION W MCC

Facility

$68,793.30

Service Code	MSDRG 332
Min. Negotiated Rate	$29,224.52
Max. Negotiated Rate	$68,793.30
Rate for Payer: BCBS of TX Blue Advantage	$29,224.52
Rate for Payer: BCBS of TX Blue Essentials	$35,066.03
Rate for Payer: BCBS of TX PPO	$38,963.76

RECTAL RESECTION W/O CC/MCC

Facility

$31,120.10

Service Code	MSDRG 334
Min. Negotiated Rate	$11,233.32
Max. Negotiated Rate	$31,120.10
Rate for Payer: BCBS of TX Blue Advantage	$11,233.32
Rate for Payer: BCBS of TX Blue Essentials	$13,478.68
Rate for Payer: BCBS of TX PPO	$14,976.89

RED BLOOD CELL DISORDERS WITH MCC

Facility

$26,681.70

Service Code	MSDRG 811
Min. Negotiated Rate	$11,661.60
Max. Negotiated Rate	$26,681.70
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$15,052.24
Rate for Payer: Amerigroup Medicare	$15,052.24
Rate for Payer: BCBS of TX Medicare	$15,052.24
Rate for Payer: Cigna Commercial	$18,087.38
Rate for Payer: Cigna Medicare	$15,052.24
Rate for Payer: Employer Direct Commercial	$15,052.24
Rate for Payer: Humana Medicare/TRICARE	$15,052.24
Rate for Payer: Molina Dual Medicare/Medicaid	$15,052.24
Rate for Payer: Molina Medicare	$15,052.24
Rate for Payer: Multiplan Auto	$26,681.70
Rate for Payer: Multiplan Commercial	$26,681.70
Rate for Payer: Multiplan Workers Comp	$26,681.70
Rate for Payer: Scott and White EPO/PPO	$12,287.62
Rate for Payer: Scott and White Medicare	$15,052.24
Rate for Payer: Superior Health Plan EPO	$15,052.24
Rate for Payer: Superior Health Plan Medicare	$15,052.24
Rate for Payer: Universal American Dual Medicare/Medicaid	$15,052.24
Rate for Payer: Universal American Medicare	$15,052.24
Rate for Payer: Wellcare Medicare	$15,052.24
Rate for Payer: Wellmed Medicare	$15,052.24

RED BLOOD CELL DISORDERS WITHOUT MCC

Facility

$17,445.80

Service Code	MSDRG 812
Min. Negotiated Rate	$7,595.52
Max. Negotiated Rate	$17,445.80
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$11,489.59
Rate for Payer: Amerigroup Medicare	$11,489.59
Rate for Payer: BCBS of TX Medicare	$11,489.59
Rate for Payer: Cigna Commercial	$11,826.42
Rate for Payer: Cigna Medicare	$11,489.59
Rate for Payer: Employer Direct Commercial	$11,489.59
Rate for Payer: Humana Medicare/TRICARE	$11,489.59
Rate for Payer: Molina Dual Medicare/Medicaid	$11,489.59
Rate for Payer: Molina Medicare	$11,489.59
Rate for Payer: Multiplan Auto	$17,445.80
Rate for Payer: Multiplan Commercial	$17,445.80
Rate for Payer: Multiplan Workers Comp	$17,445.80
Rate for Payer: Scott and White EPO/PPO	$8,034.25
Rate for Payer: Scott and White Medicare	$11,489.59
Rate for Payer: Superior Health Plan EPO	$11,489.59
Rate for Payer: Superior Health Plan Medicare	$11,489.59
Rate for Payer: Universal American Dual Medicare/Medicaid	$11,489.59
Rate for Payer: Universal American Medicare	$11,489.59
Rate for Payer: Wellcare Medicare	$11,489.59
Rate for Payer: Wellmed Medicare	$11,489.59

RED BLOOD CELL DISORDERS W MCC

Facility

$26,681.70

Service Code	MSDRG 811
Min. Negotiated Rate	$11,661.60
Max. Negotiated Rate	$26,681.70
Rate for Payer: BCBS of TX Blue Advantage	$11,661.60
Rate for Payer: BCBS of TX Blue Essentials	$13,992.56
Rate for Payer: BCBS of TX PPO	$15,547.90

RED BLOOD CELL DISORDERS W/O MCC

Facility

$17,445.80

Service Code	MSDRG 812
Min. Negotiated Rate	$7,595.52
Max. Negotiated Rate	$17,445.80
Rate for Payer: BCBS of TX Blue Advantage	$7,595.52
Rate for Payer: BCBS of TX Blue Essentials	$9,113.74
Rate for Payer: BCBS of TX PPO	$10,126.77

Know your out-of-pocket cost for care.

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