White Rock Medical Center

All Charges

Charge

Type

Setting

Price

CHOLECYSTECTOMY WITH C.D.E. WITH MCC

Facility

$54,729.50

Service Code	MSDRG 411
Min. Negotiated Rate	$24,551.26
Max. Negotiated Rate	$54,729.50
Rate for Payer: Aetna Commercial	$32,405.62
Rate for Payer: Aetna Medicare	$36,826.89
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$24,551.26
Rate for Payer: Amerigroup Medicare	$24,551.26
Rate for Payer: BCBS of TX Blue Advantage	$30,638.36
Rate for Payer: BCBS of TX Blue Essentials	$41,256.39
Rate for Payer: BCBS of TX Medicare	$24,551.26
Rate for Payer: BCBS of TX PPO	$45,842.21
Rate for Payer: Cigna Commercial	$37,100.84
Rate for Payer: Cigna Medicare	$24,551.26
Rate for Payer: Employer Direct Commercial	$24,551.26
Rate for Payer: Humana Medicare/TRICARE	$24,551.26
Rate for Payer: Molina Dual Medicare/Medicaid	$24,551.26
Rate for Payer: Molina Medicare	$24,551.26
Rate for Payer: Multiplan Auto	$54,729.50
Rate for Payer: Multiplan Commercial	$54,729.50
Rate for Payer: Multiplan Workers Comp	$54,729.50
Rate for Payer: Scott and White EPO/PPO	$25,204.38
Rate for Payer: Scott and White Medicare	$24,551.26
Rate for Payer: Superior Health Plan EPO	$24,551.26
Rate for Payer: Superior Health Plan Medicare	$24,551.26
Rate for Payer: Universal American Dual Medicare/Medicaid	$24,551.26
Rate for Payer: Universal American Medicare	$24,551.26
Rate for Payer: Wellcare Medicare	$24,551.26
Rate for Payer: Wellmed Medicare	$24,551.26

CHOLECYSTECTOMY WITH C.D.E. WITHOUT CC/MCC

Facility

$28,682.40

Service Code	MSDRG 413
Min. Negotiated Rate	$13,209.00
Max. Negotiated Rate	$28,682.40
Rate for Payer: Aetna Commercial	$16,983.00
Rate for Payer: Aetna Medicare	$20,441.06
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$13,627.37
Rate for Payer: Amerigroup Medicare	$13,627.37
Rate for Payer: BCBS of TX Blue Advantage	$15,385.40
Rate for Payer: BCBS of TX Blue Essentials	$17,399.90
Rate for Payer: BCBS of TX Medicare	$13,627.37
Rate for Payer: BCBS of TX PPO	$19,333.97
Rate for Payer: Cigna Commercial	$19,443.65
Rate for Payer: Cigna Medicare	$13,627.37
Rate for Payer: Employer Direct Commercial	$13,627.37
Rate for Payer: Humana Medicare/TRICARE	$13,627.37
Rate for Payer: Molina Dual Medicare/Medicaid	$13,627.37
Rate for Payer: Molina Medicare	$13,627.37
Rate for Payer: Multiplan Auto	$28,682.40
Rate for Payer: Multiplan Commercial	$28,682.40
Rate for Payer: Multiplan Workers Comp	$28,682.40
Rate for Payer: Scott and White EPO/PPO	$13,209.00
Rate for Payer: Scott and White Medicare	$13,627.37
Rate for Payer: Superior Health Plan EPO	$13,627.37
Rate for Payer: Superior Health Plan Medicare	$13,627.37
Rate for Payer: Universal American Dual Medicare/Medicaid	$13,627.37
Rate for Payer: Universal American Medicare	$13,627.37
Rate for Payer: Wellcare Medicare	$13,627.37
Rate for Payer: Wellmed Medicare	$13,627.37

Cholesterol Body Fluid

Facility

$334.00

Service Code	CPT 84311
Hospital Charge Code	4104311
Hospital Revenue Code	301
Rate for Payer: Cash Price	$293.92

Cholesterol Body Fluid

Facility

$334.00

Service Code	CPT 84311
Hospital Charge Code	4104311
Hospital Revenue Code	301
Min. Negotiated Rate	$3.16
Max. Negotiated Rate	$217.10
Rate for Payer: Aetna Commercial	$8.50
Rate for Payer: Aetna Medicare	$12.15
Rate for Payer: Amerigroup CHIP/Medicaid	$3.16
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$8.10
Rate for Payer: Amerigroup Medicare	$8.10
Rate for Payer: BCBS of TX Blue Advantage	$13.36
Rate for Payer: BCBS of TX Blue Essentials	$16.04
Rate for Payer: BCBS of TX Medicare	$8.10
Rate for Payer: BCBS of TX PPO	$17.90
Rate for Payer: Cash Price	$293.92
Rate for Payer: Cash Price	$293.92
Rate for Payer: Cigna Medicaid	$8.10
Rate for Payer: Cigna Medicare	$8.10
Rate for Payer: Employer Direct Commercial	$8.10
Rate for Payer: Humana Medicare/TRICARE	$8.10
Rate for Payer: Molina CHIP/Medicaid	$8.10
Rate for Payer: Molina Dual Medicare/Medicaid	$8.10
Rate for Payer: Molina Medicare	$8.10
Rate for Payer: Multiplan Auto	$217.10
Rate for Payer: Multiplan Commercial	$217.10
Rate for Payer: Multiplan Workers Comp	$217.10
Rate for Payer: Parkland Medicaid	$8.10
Rate for Payer: Scott and White EPO/PPO	$10.12
Rate for Payer: Scott and White Medicare	$8.10
Rate for Payer: Superior Health Plan CHIP/Medicaid	$8.10
Rate for Payer: Superior Health Plan EPO	$8.10
Rate for Payer: Superior Health Plan Medicare	$8.10
Rate for Payer: Universal American Dual Medicare/Medicaid	$8.10
Rate for Payer: Universal American Medicare	$8.10
Rate for Payer: Wellcare Medicare	$8.10
Rate for Payer: Wellmed Medicare	$8.10

Cholesterol, Fluid SO

Facility

$334.00

Service Code	CPT 84311
Hospital Charge Code	1708650
Hospital Revenue Code	301
Min. Negotiated Rate	$3.16
Max. Negotiated Rate	$217.10
Rate for Payer: Aetna Commercial	$8.50
Rate for Payer: Aetna Medicare	$12.15
Rate for Payer: Amerigroup CHIP/Medicaid	$3.16
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$8.10
Rate for Payer: Amerigroup Medicare	$8.10
Rate for Payer: BCBS of TX Blue Advantage	$13.36
Rate for Payer: BCBS of TX Blue Essentials	$16.04
Rate for Payer: BCBS of TX Medicare	$8.10
Rate for Payer: BCBS of TX PPO	$17.90
Rate for Payer: Cash Price	$293.92
Rate for Payer: Cash Price	$293.92
Rate for Payer: Cigna Medicaid	$8.10
Rate for Payer: Cigna Medicare	$8.10
Rate for Payer: Employer Direct Commercial	$8.10
Rate for Payer: Humana Medicare/TRICARE	$8.10
Rate for Payer: Molina CHIP/Medicaid	$8.10
Rate for Payer: Molina Dual Medicare/Medicaid	$8.10
Rate for Payer: Molina Medicare	$8.10
Rate for Payer: Multiplan Auto	$217.10
Rate for Payer: Multiplan Commercial	$217.10
Rate for Payer: Multiplan Workers Comp	$217.10
Rate for Payer: Parkland Medicaid	$8.10
Rate for Payer: Scott and White EPO/PPO	$10.12
Rate for Payer: Scott and White Medicare	$8.10
Rate for Payer: Superior Health Plan CHIP/Medicaid	$8.10
Rate for Payer: Superior Health Plan EPO	$8.10
Rate for Payer: Superior Health Plan Medicare	$8.10
Rate for Payer: Universal American Dual Medicare/Medicaid	$8.10
Rate for Payer: Universal American Medicare	$8.10
Rate for Payer: Wellcare Medicare	$8.10
Rate for Payer: Wellmed Medicare	$8.10

Cholesterol HDL

Facility

$136.00

Service Code	CPT 83718
Hospital Charge Code	1602150
Hospital Revenue Code	301
Rate for Payer: Cash Price	$119.68

Cholesterol HDL

Facility

$136.00

Service Code	CPT 83718
Hospital Charge Code	1602150
Hospital Revenue Code	301
Min. Negotiated Rate	$3.19
Max. Negotiated Rate	$88.40
Rate for Payer: Aetna Commercial	$8.59
Rate for Payer: Aetna Medicare	$12.28
Rate for Payer: Amerigroup CHIP/Medicaid	$3.19
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$8.19
Rate for Payer: Amerigroup Medicare	$8.19
Rate for Payer: BCBS of TX Blue Advantage	$13.51
Rate for Payer: BCBS of TX Blue Essentials	$16.22
Rate for Payer: BCBS of TX Medicare	$8.19
Rate for Payer: BCBS of TX PPO	$18.10
Rate for Payer: Cash Price	$119.68
Rate for Payer: Cash Price	$119.68
Rate for Payer: Cigna Medicaid	$8.19
Rate for Payer: Cigna Medicare	$8.19
Rate for Payer: Employer Direct Commercial	$8.19
Rate for Payer: Humana Medicare/TRICARE	$8.19
Rate for Payer: Molina CHIP/Medicaid	$8.19
Rate for Payer: Molina Dual Medicare/Medicaid	$8.19
Rate for Payer: Molina Medicare	$8.19
Rate for Payer: Multiplan Auto	$88.40
Rate for Payer: Multiplan Commercial	$88.40
Rate for Payer: Multiplan Workers Comp	$88.40
Rate for Payer: Parkland Medicaid	$8.19
Rate for Payer: Scott and White EPO/PPO	$10.24
Rate for Payer: Scott and White Medicare	$8.19
Rate for Payer: Superior Health Plan CHIP/Medicaid	$8.19
Rate for Payer: Superior Health Plan EPO	$8.19
Rate for Payer: Superior Health Plan Medicare	$8.19
Rate for Payer: Universal American Dual Medicare/Medicaid	$8.19
Rate for Payer: Universal American Medicare	$8.19
Rate for Payer: Wellcare Medicare	$8.19
Rate for Payer: Wellmed Medicare	$8.19

Cholesterol Total

Facility

$154.00

Service Code	CPT 82465
Hospital Charge Code	1601723
Hospital Revenue Code	301
Rate for Payer: Cash Price	$135.52

Cholesterol Total

Facility

$154.00

Service Code	CPT 82465
Hospital Charge Code	1601723
Hospital Revenue Code	301
Min. Negotiated Rate	$1.70
Max. Negotiated Rate	$100.10
Rate for Payer: Aetna Commercial	$4.57
Rate for Payer: Aetna Medicare	$6.52
Rate for Payer: Amerigroup CHIP/Medicaid	$1.70
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$4.35
Rate for Payer: Amerigroup Medicare	$4.35
Rate for Payer: BCBS of TX Blue Advantage	$7.18
Rate for Payer: BCBS of TX Blue Essentials	$8.61
Rate for Payer: BCBS of TX Medicare	$4.35
Rate for Payer: BCBS of TX PPO	$9.61
Rate for Payer: Cash Price	$135.52
Rate for Payer: Cash Price	$135.52
Rate for Payer: Cigna Medicaid	$4.35
Rate for Payer: Cigna Medicare	$4.35
Rate for Payer: Employer Direct Commercial	$4.35
Rate for Payer: Humana Medicare/TRICARE	$4.35
Rate for Payer: Molina CHIP/Medicaid	$4.35
Rate for Payer: Molina Dual Medicare/Medicaid	$4.35
Rate for Payer: Molina Medicare	$4.35
Rate for Payer: Multiplan Auto	$100.10
Rate for Payer: Multiplan Commercial	$100.10
Rate for Payer: Multiplan Workers Comp	$100.10
Rate for Payer: Parkland Medicaid	$4.35
Rate for Payer: Scott and White EPO/PPO	$5.44
Rate for Payer: Scott and White Medicare	$4.35
Rate for Payer: Superior Health Plan CHIP/Medicaid	$4.35
Rate for Payer: Superior Health Plan EPO	$4.35
Rate for Payer: Superior Health Plan Medicare	$4.35
Rate for Payer: Universal American Dual Medicare/Medicaid	$4.35
Rate for Payer: Universal American Medicare	$4.35
Rate for Payer: Wellcare Medicare	$4.35
Rate for Payer: Wellmed Medicare	$4.35

cholestyramine 4 gram 5.5 gm packet

Facility

$7.65

Service Code	HCPCS J3490
Hospital Charge Code	77465494
Hospital Revenue Code	250
Rate for Payer: Cash Price	$5.20

cholestyramine 4 gram 5.5 gm packet

Facility

$7.65

Service Code	HCPCS J3490
Hospital Charge Code	77465494
Hospital Revenue Code	250
Min. Negotiated Rate	$0.69
Max. Negotiated Rate	$4.97
Rate for Payer: Amerigroup CHIP/Medicaid	$0.69
Rate for Payer: BCBS of TX Blue Advantage	$2.30
Rate for Payer: BCBS of TX Blue Essentials	$2.75
Rate for Payer: BCBS of TX PPO	$3.06
Rate for Payer: Cash Price	$5.20
Rate for Payer: Multiplan Auto	$4.97
Rate for Payer: Multiplan Commercial	$4.97
Rate for Payer: Multiplan Workers Comp	$4.97
Rate for Payer: Scott and White EPO/PPO	$3.82
Rate for Payer: Superior Health Plan EPO	$1.04

CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH CC

Facility

$16,131.00

Service Code	MSDRG 191
Min. Negotiated Rate	$7,428.75
Max. Negotiated Rate	$16,131.00
Rate for Payer: Aetna Commercial	$9,551.25
Rate for Payer: Aetna Medicare	$13,369.94
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$8,913.29
Rate for Payer: Amerigroup Medicare	$8,913.29
Rate for Payer: BCBS of TX Blue Advantage	$7,898.24
Rate for Payer: BCBS of TX Blue Essentials	$9,430.53
Rate for Payer: BCBS of TX Medicare	$8,913.29
Rate for Payer: BCBS of TX PPO	$10,478.78
Rate for Payer: Cigna Commercial	$10,935.12
Rate for Payer: Cigna Medicare	$8,913.29
Rate for Payer: Employer Direct Commercial	$8,913.29
Rate for Payer: Humana Medicare/TRICARE	$8,913.29
Rate for Payer: Molina Dual Medicare/Medicaid	$8,913.29
Rate for Payer: Molina Medicare	$8,913.29
Rate for Payer: Multiplan Auto	$16,131.00
Rate for Payer: Multiplan Commercial	$16,131.00
Rate for Payer: Multiplan Workers Comp	$16,131.00
Rate for Payer: Scott and White EPO/PPO	$7,428.75
Rate for Payer: Scott and White Medicare	$8,913.29
Rate for Payer: Superior Health Plan EPO	$8,913.29
Rate for Payer: Superior Health Plan Medicare	$8,913.29
Rate for Payer: Universal American Dual Medicare/Medicaid	$8,913.29
Rate for Payer: Universal American Medicare	$8,913.29
Rate for Payer: Wellcare Medicare	$8,913.29
Rate for Payer: Wellmed Medicare	$8,913.29

CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH MCC

Facility

$20,938.00

Service Code	MSDRG 190
Min. Negotiated Rate	$9,642.50
Max. Negotiated Rate	$20,938.00
Rate for Payer: Aetna Commercial	$12,397.50
Rate for Payer: Aetna Medicare	$16,078.06
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$10,718.71
Rate for Payer: Amerigroup Medicare	$10,718.71
Rate for Payer: BCBS of TX Blue Advantage	$9,873.66
Rate for Payer: BCBS of TX Blue Essentials	$12,286.83
Rate for Payer: BCBS of TX Medicare	$10,718.71
Rate for Payer: BCBS of TX PPO	$13,652.57
Rate for Payer: Cigna Commercial	$14,193.76
Rate for Payer: Cigna Medicare	$10,718.71
Rate for Payer: Employer Direct Commercial	$10,718.71
Rate for Payer: Humana Medicare/TRICARE	$10,718.71
Rate for Payer: Molina Dual Medicare/Medicaid	$10,718.71
Rate for Payer: Molina Medicare	$10,718.71
Rate for Payer: Multiplan Auto	$20,938.00
Rate for Payer: Multiplan Commercial	$20,938.00
Rate for Payer: Multiplan Workers Comp	$20,938.00
Rate for Payer: Scott and White EPO/PPO	$9,642.50
Rate for Payer: Scott and White Medicare	$10,718.71
Rate for Payer: Superior Health Plan EPO	$10,718.71
Rate for Payer: Superior Health Plan Medicare	$10,718.71
Rate for Payer: Universal American Dual Medicare/Medicaid	$10,718.71
Rate for Payer: Universal American Medicare	$10,718.71
Rate for Payer: Wellcare Medicare	$10,718.71
Rate for Payer: Wellmed Medicare	$10,718.71

CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITHOUT CC/MCC

Facility

$12,194.20

Service Code	MSDRG 192
Min. Negotiated Rate	$5,615.75
Max. Negotiated Rate	$12,194.20
Rate for Payer: Aetna Commercial	$7,220.25
Rate for Payer: Aetna Medicare	$11,152.04
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$7,434.69
Rate for Payer: Amerigroup Medicare	$7,434.69
Rate for Payer: BCBS of TX Blue Advantage	$6,221.24
Rate for Payer: BCBS of TX Blue Essentials	$7,471.99
Rate for Payer: BCBS of TX Medicare	$7,434.69
Rate for Payer: BCBS of TX PPO	$8,302.53
Rate for Payer: Cigna Commercial	$8,266.38
Rate for Payer: Cigna Medicare	$7,434.69
Rate for Payer: Employer Direct Commercial	$7,434.69
Rate for Payer: Humana Medicare/TRICARE	$7,434.69
Rate for Payer: Molina Dual Medicare/Medicaid	$7,434.69
Rate for Payer: Molina Medicare	$7,434.69
Rate for Payer: Multiplan Auto	$12,194.20
Rate for Payer: Multiplan Commercial	$12,194.20
Rate for Payer: Multiplan Workers Comp	$12,194.20
Rate for Payer: Scott and White EPO/PPO	$5,615.75
Rate for Payer: Scott and White Medicare	$7,434.69
Rate for Payer: Superior Health Plan EPO	$7,434.69
Rate for Payer: Superior Health Plan Medicare	$7,434.69
Rate for Payer: Universal American Dual Medicare/Medicaid	$7,434.69
Rate for Payer: Universal American Medicare	$7,434.69
Rate for Payer: Wellcare Medicare	$7,434.69
Rate for Payer: Wellmed Medicare	$7,434.69

CHWR 4 X 4's STERILE PACK EACH

Facility

$36.69

Hospital Charge Code	8024515
Hospital Revenue Code	272
Min. Negotiated Rate	$3.30
Max. Negotiated Rate	$23.85
Rate for Payer: Aetna Commercial	$20.18
Rate for Payer: Amerigroup CHIP/Medicaid	$3.30
Rate for Payer: BCBS of TX Blue Advantage	$11.01
Rate for Payer: BCBS of TX Blue Essentials	$13.21
Rate for Payer: BCBS of TX PPO	$14.68
Rate for Payer: Cash Price	$32.29
Rate for Payer: Multiplan Auto	$23.85
Rate for Payer: Multiplan Commercial	$23.85
Rate for Payer: Multiplan Workers Comp	$23.85
Rate for Payer: Scott and White EPO/PPO	$18.34
Rate for Payer: Superior Health Plan EPO	$4.99

CHWR 4 X 4's STERILE PACK EACH BCE

Facility

$36.69

Hospital Charge Code	8024515
Hospital Revenue Code	272
Rate for Payer: Cash Price	$32.29

CHWR 4 X 4's STERILE PACK EACH BCE

Facility

$36.69

Hospital Charge Code	8024515
Hospital Revenue Code	272
Min. Negotiated Rate	$3.30
Max. Negotiated Rate	$23.85
Rate for Payer: Aetna Commercial	$20.18
Rate for Payer: Amerigroup CHIP/Medicaid	$3.30
Rate for Payer: BCBS of TX Blue Advantage	$11.01
Rate for Payer: BCBS of TX Blue Essentials	$13.21
Rate for Payer: BCBS of TX PPO	$14.68
Rate for Payer: Cash Price	$32.29
Rate for Payer: Multiplan Auto	$23.85
Rate for Payer: Multiplan Commercial	$23.85
Rate for Payer: Multiplan Workers Comp	$23.85
Rate for Payer: Scott and White EPO/PPO	$18.34
Rate for Payer: Superior Health Plan EPO	$4.99

CHWR ACHIEVE NEEDLES

Facility

$239.93

Hospital Charge Code	8032770
Hospital Revenue Code	272
Rate for Payer: Cash Price	$211.14

CHWR ACHIEVE NEEDLES

Facility

$239.93

Hospital Charge Code	8032770
Hospital Revenue Code	272
Min. Negotiated Rate	$21.59
Max. Negotiated Rate	$155.95
Rate for Payer: Aetna Commercial	$131.96
Rate for Payer: Amerigroup CHIP/Medicaid	$21.59
Rate for Payer: BCBS of TX Blue Advantage	$71.98
Rate for Payer: BCBS of TX Blue Essentials	$86.37
Rate for Payer: BCBS of TX PPO	$95.97
Rate for Payer: Cash Price	$211.14
Rate for Payer: Multiplan Auto	$155.95
Rate for Payer: Multiplan Commercial	$155.95
Rate for Payer: Multiplan Workers Comp	$155.95
Rate for Payer: Scott and White EPO/PPO	$119.96
Rate for Payer: Superior Health Plan EPO	$32.63

CHWR ARTHROGRAM TRAY

Facility

$276.94

Hospital Charge Code	8082935
Hospital Revenue Code	272
Min. Negotiated Rate	$24.92
Max. Negotiated Rate	$180.01
Rate for Payer: Aetna Commercial	$152.32
Rate for Payer: Amerigroup CHIP/Medicaid	$24.92
Rate for Payer: BCBS of TX Blue Advantage	$83.08
Rate for Payer: BCBS of TX Blue Essentials	$99.70
Rate for Payer: BCBS of TX PPO	$110.78
Rate for Payer: Cash Price	$243.71
Rate for Payer: Multiplan Auto	$180.01
Rate for Payer: Multiplan Commercial	$180.01
Rate for Payer: Multiplan Workers Comp	$180.01
Rate for Payer: Scott and White EPO/PPO	$138.47
Rate for Payer: Superior Health Plan EPO	$37.66

CHWR ARTHROGRAM TRAY

Facility

$276.94

Hospital Charge Code	8082935
Hospital Revenue Code	272
Rate for Payer: Cash Price	$243.71

CHWR ARTHROGRAM TRAY BCE

Facility

$54.48

Hospital Charge Code	8082935
Hospital Revenue Code	272
Rate for Payer: Cash Price	$47.94

CHWR ARTHROGRAM TRAY BCE

Facility

$54.48

Hospital Charge Code	8082935
Hospital Revenue Code	272
Min. Negotiated Rate	$4.90
Max. Negotiated Rate	$35.41
Rate for Payer: Aetna Commercial	$29.96
Rate for Payer: Amerigroup CHIP/Medicaid	$4.90
Rate for Payer: BCBS of TX Blue Advantage	$16.34
Rate for Payer: BCBS of TX Blue Essentials	$19.61
Rate for Payer: BCBS of TX PPO	$21.79
Rate for Payer: Cash Price	$47.94
Rate for Payer: Multiplan Auto	$35.41
Rate for Payer: Multiplan Commercial	$35.41
Rate for Payer: Multiplan Workers Comp	$35.41
Rate for Payer: Scott and White EPO/PPO	$27.24
Rate for Payer: Superior Health Plan EPO	$7.41

CHWR BARDS BREAST MARKERS

Facility

$422.05

Hospital Charge Code	8182909
Hospital Revenue Code	272
Min. Negotiated Rate	$37.98
Max. Negotiated Rate	$274.33
Rate for Payer: Aetna Commercial	$232.13
Rate for Payer: Amerigroup CHIP/Medicaid	$37.98
Rate for Payer: BCBS of TX Blue Advantage	$126.62
Rate for Payer: BCBS of TX Blue Essentials	$151.94
Rate for Payer: BCBS of TX PPO	$168.82
Rate for Payer: Cash Price	$371.40
Rate for Payer: Multiplan Auto	$274.33
Rate for Payer: Multiplan Commercial	$274.33
Rate for Payer: Multiplan Workers Comp	$274.33
Rate for Payer: Scott and White EPO/PPO	$211.02
Rate for Payer: Superior Health Plan EPO	$57.40

CHWR BARDS BREAST MARKERS BCE

Facility

$422.05

Hospital Charge Code	8182909
Hospital Revenue Code	272
Min. Negotiated Rate	$37.98
Max. Negotiated Rate	$274.33
Rate for Payer: Aetna Commercial	$232.13
Rate for Payer: Amerigroup CHIP/Medicaid	$37.98
Rate for Payer: BCBS of TX Blue Advantage	$126.62
Rate for Payer: BCBS of TX Blue Essentials	$151.94
Rate for Payer: BCBS of TX PPO	$168.82
Rate for Payer: Cash Price	$371.40
Rate for Payer: Multiplan Auto	$274.33
Rate for Payer: Multiplan Commercial	$274.33
Rate for Payer: Multiplan Workers Comp	$274.33
Rate for Payer: Scott and White EPO/PPO	$211.02
Rate for Payer: Superior Health Plan EPO	$57.40

Know your out-of-pocket cost for care.

All Charges