White Rock Medical Center

All Charges

Charge

Type

Setting

Price

Suture of 1 nerve; ulnar motor

Facility

$23,295.80

Service Code	HCPCS 64836
Hospital Charge Code	9900853
Hospital Revenue Code	360
Rate for Payer: Cash Price	$15,841.14

Suture of digital nerve, hand or foot

Facility

$14,035.12

Service Code	HCPCS 64831
Hospital Charge Code	9900850
Hospital Revenue Code	360
Rate for Payer: Cash Price	$9,543.88

Suture of digital nerve, hand or foot

Facility

$10,000.00

Service Code	CPT 64831
Hospital Charge Code	36064831
Hospital Revenue Code	360
Min. Negotiated Rate	$659.94
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$659.94
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$1,961.62
Rate for Payer: Amerigroup Medicare	$1,961.62
Rate for Payer: BCBS of TX Blue Advantage	$2,871.31
Rate for Payer: BCBS of TX Blue Essentials	$3,438.70
Rate for Payer: BCBS of TX Medicare	$1,961.62
Rate for Payer: BCBS of TX PPO	$4,332.76
Rate for Payer: Cigna Commercial	$4,146.52
Rate for Payer: Cigna Medicare	$1,961.62
Rate for Payer: Employer Direct Commercial	$1,961.62
Rate for Payer: Humana Medicare/TRICARE	$1,961.62
Rate for Payer: Molina Dual Medicare/Medicaid	$1,961.62
Rate for Payer: Molina Medicare	$1,961.62
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	$3,629.00
Rate for Payer: Scott and White Medicare	$1,961.62
Rate for Payer: Superior Health Plan EPO	$1,961.62
Rate for Payer: Superior Health Plan Medicare	$1,961.62
Rate for Payer: Universal American Dual Medicare/Medicaid	$1,961.62
Rate for Payer: Universal American Medicare	$1,961.62
Rate for Payer: Wellcare Medicare	$1,961.62
Rate for Payer: Wellmed Medicare	$1,961.62

Suture of digital nerve, hand or foot

Facility

$14,035.12

Service Code	HCPCS 64831
Hospital Charge Code	9900850
Hospital Revenue Code	360
Min. Negotiated Rate	$659.94
Max. Negotiated Rate	$10,105.29
Rate for Payer: Amerigroup CHIP/Medicaid	$659.94
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$1,961.62
Rate for Payer: Amerigroup Medicare	$1,961.62
Rate for Payer: BCBS of TX Blue Advantage	$2,871.31
Rate for Payer: BCBS of TX Blue Essentials	$3,438.70
Rate for Payer: BCBS of TX Medicare	$1,961.62
Rate for Payer: BCBS of TX PPO	$4,332.76
Rate for Payer: Cash Price	$9,543.88
Rate for Payer: Cash Price	$9,543.88
Rate for Payer: Cash Price	$9,543.88
Rate for Payer: Cigna Commercial	$4,146.52
Rate for Payer: Cigna Medicaid	$10,105.29
Rate for Payer: Cigna Medicare	$1,961.62
Rate for Payer: Employer Direct Commercial	$1,961.62
Rate for Payer: Humana Medicare/TRICARE	$1,961.62
Rate for Payer: Molina CHIP/Medicaid	$10,105.29
Rate for Payer: Molina Dual Medicare/Medicaid	$1,961.62
Rate for Payer: Molina Medicare	$1,961.62
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	$10,105.29
Rate for Payer: Scott and White EPO/PPO	$3,629.00
Rate for Payer: Scott and White Medicare	$1,961.62
Rate for Payer: Superior Health Plan CHIP/Medicaid	$10,105.29
Rate for Payer: Superior Health Plan EPO	$1,961.62
Rate for Payer: Superior Health Plan Medicare	$1,961.62
Rate for Payer: Universal American Dual Medicare/Medicaid	$1,961.62
Rate for Payer: Universal American Medicare	$1,961.62
Rate for Payer: Wellcare Medicare	$1,961.62
Rate for Payer: Wellmed Medicare	$1,961.62

Suture of infrapatellar tendon; primary

Facility

$15,408.22

Service Code	CPT 27380
Hospital Charge Code	36027380
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

Suture of infrapatellar tendon; primary

Facility

$18,794.85

Service Code	HCPCS 27380
Hospital Charge Code	9900400
Hospital Revenue Code	360
Rate for Payer: Cash Price	$12,780.50

Suture of infrapatellar tendon; primary

Facility

$18,794.85

Service Code	HCPCS 27380
Hospital Charge Code	9900400
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	$12,780.50
Rate for Payer: Cash Price	$12,780.50
Rate for Payer: Cash Price	$12,780.50
Rate for Payer: Cigna Commercial	$15,408.22
Rate for Payer: Cigna Medicaid	$13,532.29
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	$13,532.29
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	$13,532.29
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	$13,532.29
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

Suture of iris, ciliary body (separate procedure) with retrieval of suture through small incision (e

Facility

$5,717.69

Service Code	HCPCS 66682
Hospital Charge Code	9900866
Hospital Revenue Code	360
Rate for Payer: Cash Price	$3,888.03

Suture of iris, ciliary body (separate procedure) with retrieval of suture through small incision (e

Facility

$5,717.69

Service Code	HCPCS 66682
Hospital Charge Code	9900866
Hospital Revenue Code	360
Min. Negotiated Rate	$849.94
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$849.94
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$2,318.34
Rate for Payer: Amerigroup Medicare	$2,318.34
Rate for Payer: BCBS of TX Blue Advantage	$3,376.51
Rate for Payer: BCBS of TX Blue Essentials	$4,043.72
Rate for Payer: BCBS of TX Medicare	$2,318.34
Rate for Payer: BCBS of TX PPO	$5,095.09
Rate for Payer: Cash Price	$3,888.03
Rate for Payer: Cash Price	$3,888.03
Rate for Payer: Cash Price	$3,888.03
Rate for Payer: Cigna Commercial	$4,900.56
Rate for Payer: Cigna Medicaid	$4,116.74
Rate for Payer: Cigna Medicare	$2,318.34
Rate for Payer: Employer Direct Commercial	$2,318.34
Rate for Payer: Humana Medicare/TRICARE	$2,318.34
Rate for Payer: Molina CHIP/Medicaid	$4,116.74
Rate for Payer: Molina Dual Medicare/Medicaid	$2,318.34
Rate for Payer: Molina Medicare	$2,318.34
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	$4,116.74
Rate for Payer: Scott and White EPO/PPO	$4,288.93
Rate for Payer: Scott and White Medicare	$2,318.34
Rate for Payer: Superior Health Plan CHIP/Medicaid	$4,116.74
Rate for Payer: Superior Health Plan EPO	$2,318.34
Rate for Payer: Superior Health Plan Medicare	$2,318.34
Rate for Payer: Universal American Dual Medicare/Medicaid	$2,318.34
Rate for Payer: Universal American Medicare	$2,318.34
Rate for Payer: Wellcare Medicare	$2,318.34
Rate for Payer: Wellmed Medicare	$2,318.34

Suture of iris, ciliary body (separate procedure) with retrieval of suture through small incision (e

Facility

$10,000.00

Service Code	CPT 66682
Hospital Charge Code	36066682
Hospital Revenue Code	360
Min. Negotiated Rate	$849.94
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$849.94
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$2,318.34
Rate for Payer: Amerigroup Medicare	$2,318.34
Rate for Payer: BCBS of TX Blue Advantage	$3,376.51
Rate for Payer: BCBS of TX Blue Essentials	$4,043.72
Rate for Payer: BCBS of TX Medicare	$2,318.34
Rate for Payer: BCBS of TX PPO	$5,095.09
Rate for Payer: Cigna Commercial	$4,900.56
Rate for Payer: Cigna Medicare	$2,318.34
Rate for Payer: Employer Direct Commercial	$2,318.34
Rate for Payer: Humana Medicare/TRICARE	$2,318.34
Rate for Payer: Molina Dual Medicare/Medicaid	$2,318.34
Rate for Payer: Molina Medicare	$2,318.34
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	$4,288.93
Rate for Payer: Scott and White Medicare	$2,318.34
Rate for Payer: Superior Health Plan EPO	$2,318.34
Rate for Payer: Superior Health Plan Medicare	$2,318.34
Rate for Payer: Universal American Dual Medicare/Medicaid	$2,318.34
Rate for Payer: Universal American Medicare	$2,318.34
Rate for Payer: Wellcare Medicare	$2,318.34
Rate for Payer: Wellmed Medicare	$2,318.34

Suture of major peripheral nerve, arm or leg, except sciatic including transposition

Facility

$18,635.09

Service Code	CPT 64856
Hospital Charge Code	36064856
Hospital Revenue Code	360
Min. Negotiated Rate	$1,996.58
Max. Negotiated Rate	$18,635.09
Rate for Payer: Amerigroup CHIP/Medicaid	$1,996.58
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$8,815.84
Rate for Payer: Amerigroup Medicare	$8,815.84
Rate for Payer: BCBS of TX Blue Advantage	$9,200.05
Rate for Payer: BCBS of TX Blue Essentials	$11,018.02
Rate for Payer: BCBS of TX Medicare	$8,815.84
Rate for Payer: BCBS of TX PPO	$13,882.71
Rate for Payer: Cigna Commercial	$18,635.09
Rate for Payer: Cigna Medicare	$8,815.84
Rate for Payer: Employer Direct Commercial	$8,815.84
Rate for Payer: Humana Medicare/TRICARE	$8,815.84
Rate for Payer: Molina Dual Medicare/Medicaid	$8,815.84
Rate for Payer: Molina Medicare	$8,815.84
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: Scott and White EPO/PPO	$16,309.30
Rate for Payer: Scott and White Medicare	$8,815.84
Rate for Payer: Superior Health Plan EPO	$8,815.84
Rate for Payer: Superior Health Plan Medicare	$8,815.84
Rate for Payer: Universal American Dual Medicare/Medicaid	$8,815.84
Rate for Payer: Universal American Medicare	$8,815.84
Rate for Payer: Wellcare Medicare	$8,815.84
Rate for Payer: Wellmed Medicare	$8,815.84

Suture of major peripheral nerve, arm or leg, except sciatic including transposition

Facility

$46,642.30

Service Code	HCPCS 64856
Hospital Charge Code	9900854
Hospital Revenue Code	360
Min. Negotiated Rate	$1,996.58
Max. Negotiated Rate	$33,582.46
Rate for Payer: Amerigroup CHIP/Medicaid	$1,996.58
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$8,815.84
Rate for Payer: Amerigroup Medicare	$8,815.84
Rate for Payer: BCBS of TX Blue Advantage	$9,200.05
Rate for Payer: BCBS of TX Blue Essentials	$11,018.02
Rate for Payer: BCBS of TX Medicare	$8,815.84
Rate for Payer: BCBS of TX PPO	$13,882.71
Rate for Payer: Cash Price	$31,716.76
Rate for Payer: Cash Price	$31,716.76
Rate for Payer: Cash Price	$31,716.76
Rate for Payer: Cigna Commercial	$18,635.09
Rate for Payer: Cigna Medicaid	$33,582.46
Rate for Payer: Cigna Medicare	$8,815.84
Rate for Payer: Employer Direct Commercial	$8,815.84
Rate for Payer: Humana Medicare/TRICARE	$8,815.84
Rate for Payer: Molina CHIP/Medicaid	$33,582.46
Rate for Payer: Molina Dual Medicare/Medicaid	$8,815.84
Rate for Payer: Molina Medicare	$8,815.84
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	$33,582.46
Rate for Payer: Scott and White EPO/PPO	$16,309.30
Rate for Payer: Scott and White Medicare	$8,815.84
Rate for Payer: Superior Health Plan CHIP/Medicaid	$33,582.46
Rate for Payer: Superior Health Plan EPO	$8,815.84
Rate for Payer: Superior Health Plan Medicare	$8,815.84
Rate for Payer: Universal American Dual Medicare/Medicaid	$8,815.84
Rate for Payer: Universal American Medicare	$8,815.84
Rate for Payer: Wellcare Medicare	$8,815.84
Rate for Payer: Wellmed Medicare	$8,815.84

Suture of major peripheral nerve, arm or leg, except sciatic including transposition

Facility

$46,642.30

Service Code	HCPCS 64856
Hospital Charge Code	9900854
Hospital Revenue Code	360
Rate for Payer: Cash Price	$31,716.76

Suture of major peripheral nerve, arm or leg, except sciatic without transposition

Facility

$45,602.32

Service Code	HCPCS 64857
Hospital Charge Code	9900855
Hospital Revenue Code	360
Rate for Payer: Cash Price	$31,009.58

Suture of major peripheral nerve, arm or leg, except sciatic without transposition

Facility

$45,602.32

Service Code	HCPCS 64857
Hospital Charge Code	9900855
Hospital Revenue Code	360
Min. Negotiated Rate	$1,996.58
Max. Negotiated Rate	$32,833.67
Rate for Payer: Amerigroup CHIP/Medicaid	$1,996.58
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$3,431.72
Rate for Payer: Amerigroup Medicare	$3,431.72
Rate for Payer: BCBS of TX Blue Advantage	$9,200.05
Rate for Payer: BCBS of TX Blue Essentials	$11,018.02
Rate for Payer: BCBS of TX Medicare	$3,431.72
Rate for Payer: BCBS of TX PPO	$13,882.71
Rate for Payer: Cash Price	$31,009.58
Rate for Payer: Cash Price	$31,009.58
Rate for Payer: Cash Price	$31,009.58
Rate for Payer: Cigna Commercial	$7,254.03
Rate for Payer: Cigna Medicaid	$32,833.67
Rate for Payer: Cigna Medicare	$3,431.72
Rate for Payer: Employer Direct Commercial	$3,431.72
Rate for Payer: Humana Medicare/TRICARE	$3,431.72
Rate for Payer: Molina CHIP/Medicaid	$32,833.67
Rate for Payer: Molina Dual Medicare/Medicaid	$3,431.72
Rate for Payer: Molina Medicare	$3,431.72
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	$32,833.67
Rate for Payer: Scott and White EPO/PPO	$6,348.68
Rate for Payer: Scott and White Medicare	$3,431.72
Rate for Payer: Superior Health Plan CHIP/Medicaid	$32,833.67
Rate for Payer: Superior Health Plan EPO	$3,431.72
Rate for Payer: Superior Health Plan Medicare	$3,431.72
Rate for Payer: Universal American Dual Medicare/Medicaid	$3,431.72
Rate for Payer: Universal American Medicare	$3,431.72
Rate for Payer: Wellcare Medicare	$3,431.72
Rate for Payer: Wellmed Medicare	$3,431.72

Suture of major peripheral nerve, arm or leg, except sciatic without transposition

Facility

$13,882.71

Service Code	CPT 64857
Hospital Charge Code	36064857
Hospital Revenue Code	360
Min. Negotiated Rate	$1,996.58
Max. Negotiated Rate	$13,882.71
Rate for Payer: Amerigroup CHIP/Medicaid	$1,996.58
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$3,431.72
Rate for Payer: Amerigroup Medicare	$3,431.72
Rate for Payer: BCBS of TX Blue Advantage	$9,200.05
Rate for Payer: BCBS of TX Blue Essentials	$11,018.02
Rate for Payer: BCBS of TX Medicare	$3,431.72
Rate for Payer: BCBS of TX PPO	$13,882.71
Rate for Payer: Cigna Commercial	$7,254.03
Rate for Payer: Cigna Medicare	$3,431.72
Rate for Payer: Employer Direct Commercial	$3,431.72
Rate for Payer: Humana Medicare/TRICARE	$3,431.72
Rate for Payer: Molina Dual Medicare/Medicaid	$3,431.72
Rate for Payer: Molina Medicare	$3,431.72
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: Scott and White EPO/PPO	$6,348.68
Rate for Payer: Scott and White Medicare	$3,431.72
Rate for Payer: Superior Health Plan EPO	$3,431.72
Rate for Payer: Superior Health Plan Medicare	$3,431.72
Rate for Payer: Universal American Dual Medicare/Medicaid	$3,431.72
Rate for Payer: Universal American Medicare	$3,431.72
Rate for Payer: Wellcare Medicare	$3,431.72
Rate for Payer: Wellmed Medicare	$3,431.72

Suture of mesentery (separate procedure)

Facility

$10,016.90

Service Code	HCPCS 44850
Hospital Charge Code	9900698
Hospital Revenue Code	360
Rate for Payer: Cash Price	$6,811.49

Suture of mesentery (separate procedure)

Facility

$10,000.00

Service Code	CPT 44850
Hospital Charge Code	36044850
Hospital Revenue Code	360
Min. Negotiated Rate	$1,306.02
Max. Negotiated Rate	$10,000.00
Rate for Payer: BCBS of TX Blue Advantage	$1,306.02
Rate for Payer: BCBS of TX Blue Essentials	$1,564.10
Rate for Payer: BCBS of TX PPO	$1,970.77
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

Suture of mesentery (separate procedure)

Facility

$10,016.90

Service Code	HCPCS 44850
Hospital Charge Code	9900698
Hospital Revenue Code	360
Min. Negotiated Rate	$901.52
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$901.52
Rate for Payer: BCBS of TX Blue Advantage	$1,306.02
Rate for Payer: BCBS of TX Blue Essentials	$1,564.10
Rate for Payer: BCBS of TX PPO	$1,970.77
Rate for Payer: Cash Price	$6,811.49
Rate for Payer: Cash Price	$6,811.49
Rate for Payer: Cash Price	$6,811.49
Rate for Payer: Cigna Medicaid	$7,212.17
Rate for Payer: Molina CHIP/Medicaid	$7,212.17
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	$7,212.17
Rate for Payer: Scott and White EPO/PPO	$5,008.45
Rate for Payer: Superior Health Plan CHIP/Medicaid	$7,212.17
Rate for Payer: Superior Health Plan EPO	$1,362.30

Suture of quadriceps or hamstring muscle rupture; primary

Facility

$18,794.85

Service Code	HCPCS 27385
Hospital Charge Code	9900401
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	$12,780.50
Rate for Payer: Cash Price	$12,780.50
Rate for Payer: Cash Price	$12,780.50
Rate for Payer: Cigna Commercial	$15,408.22
Rate for Payer: Cigna Medicaid	$13,532.29
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	$13,532.29
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	$13,532.29
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	$13,532.29
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

Suture of quadriceps or hamstring muscle rupture; primary

Facility

$18,794.85

Service Code	HCPCS 27385
Hospital Charge Code	9900401
Hospital Revenue Code	360
Rate for Payer: Cash Price	$12,780.50

Suture of quadriceps or hamstring muscle rupture; primary

Facility

$15,408.22

Service Code	CPT 27385
Hospital Charge Code	36027385
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

Suture of quadriceps or hamstring muscle rupture; secondary reconstruction, including fascial or tendon graft

Facility

$27,265.32

Service Code	HCPCS 27386
Hospital Charge Code	991329
Hospital Revenue Code	360
Min. Negotiated Rate	$2,398.52
Max. Negotiated Rate	$19,631.03
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	$18,540.42
Rate for Payer: Cash Price	$18,540.42
Rate for Payer: Cash Price	$18,540.42
Rate for Payer: Cigna Commercial	$15,408.22
Rate for Payer: Cigna Medicaid	$19,631.03
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	$19,631.03
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	$19,631.03
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	$19,631.03
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

Suture of quadriceps or hamstring muscle rupture; secondary reconstruction, including fascial or tendon graft

Facility

$27,265.32

Service Code	HCPCS 27386
Hospital Charge Code	991329
Hospital Revenue Code	360
Rate for Payer: Cash Price	$18,540.42

SUTURE ORTHOCORD #2 MO-7

Facility

$295.87

Hospital Charge Code	121483
Hospital Revenue Code	272
Min. Negotiated Rate	$26.63
Max. Negotiated Rate	$213.03
Rate for Payer: Amerigroup CHIP/Medicaid	$26.63
Rate for Payer: BCBS of TX Blue Advantage	$88.76
Rate for Payer: BCBS of TX Blue Essentials	$106.51
Rate for Payer: BCBS of TX PPO	$118.35
Rate for Payer: Cash Price	$201.19
Rate for Payer: Cigna Medicaid	$213.03
Rate for Payer: Molina CHIP/Medicaid	$213.03
Rate for Payer: Multiplan Auto	$192.32
Rate for Payer: Multiplan Commercial	$192.32
Rate for Payer: Multiplan Workers Comp	$192.32
Rate for Payer: Parkland Medicaid	$213.03
Rate for Payer: Scott and White EPO/PPO	$147.94
Rate for Payer: Superior Health Plan CHIP/Medicaid	$213.03
Rate for Payer: Superior Health Plan EPO	$40.24

Know your out-of-pocket cost for care.

All Charges