White Rock Medical Center

All Charges

Charge

Type

Setting

Price

COLLECTOR WOUND DRAINAGE /9778-LARGE

Facility

$24.20

Hospital Charge Code	131582
Hospital Revenue Code	270
Min. Negotiated Rate	$2.18
Max. Negotiated Rate	$15.73
Rate for Payer: Aetna Commercial	$13.31
Rate for Payer: Amerigroup CHIP/Medicaid	$2.18
Rate for Payer: BCBS of TX Blue Advantage	$7.26
Rate for Payer: BCBS of TX Blue Essentials	$8.71
Rate for Payer: BCBS of TX PPO	$9.68
Rate for Payer: Cash Price	$21.30
Rate for Payer: Multiplan Auto	$15.73
Rate for Payer: Multiplan Commercial	$15.73
Rate for Payer: Multiplan Workers Comp	$15.73
Rate for Payer: Scott and White EPO/PPO	$12.10
Rate for Payer: Superior Health Plan EPO	$3.29

COLLECTOR WOUND DRAINAGE W/BARRIER CAP 3 3/4

Facility

$15.89

Hospital Charge Code	2510865
Hospital Revenue Code	272
Rate for Payer: Cash Price	$13.98

COLLECTOR WOUND DRAINAGE W/BARRIER CAP 3 3/4

Facility

$15.89

Hospital Charge Code	2510865
Hospital Revenue Code	272
Min. Negotiated Rate	$1.43
Max. Negotiated Rate	$10.33
Rate for Payer: Aetna Commercial	$8.74
Rate for Payer: Amerigroup CHIP/Medicaid	$1.43
Rate for Payer: BCBS of TX Blue Advantage	$4.77
Rate for Payer: BCBS of TX Blue Essentials	$5.72
Rate for Payer: BCBS of TX PPO	$6.36
Rate for Payer: Cash Price	$13.98
Rate for Payer: Multiplan Auto	$10.33
Rate for Payer: Multiplan Commercial	$10.33
Rate for Payer: Multiplan Workers Comp	$10.33
Rate for Payer: Scott and White EPO/PPO	$7.95
Rate for Payer: Superior Health Plan EPO	$2.16

COLL FLEXISEAL FECAL -- DHF

Facility

$472.47

Hospital Charge Code	80317639
Hospital Revenue Code	270
Min. Negotiated Rate	$42.52
Max. Negotiated Rate	$307.11
Rate for Payer: Aetna Commercial	$259.86
Rate for Payer: Amerigroup CHIP/Medicaid	$42.52
Rate for Payer: BCBS of TX Blue Advantage	$141.74
Rate for Payer: BCBS of TX Blue Essentials	$170.09
Rate for Payer: BCBS of TX PPO	$188.99
Rate for Payer: Cash Price	$415.77
Rate for Payer: Multiplan Auto	$307.11
Rate for Payer: Multiplan Commercial	$307.11
Rate for Payer: Multiplan Workers Comp	$307.11
Rate for Payer: Scott and White EPO/PPO	$236.24
Rate for Payer: Superior Health Plan EPO	$64.26

COLL FLEXISEAL FECAL -- DHF

Facility

$472.47

Hospital Charge Code	80317639
Hospital Revenue Code	270
Rate for Payer: Cash Price	$415.77

COLL & INTERP DATA EA 30 DAYS

Facility

$613.00

Service Code	CPT 99091
Hospital Charge Code	6019904
Hospital Revenue Code	510
Min. Negotiated Rate	$55.17
Max. Negotiated Rate	$398.45
Rate for Payer: Aetna Commercial	$337.15
Rate for Payer: Amerigroup CHIP/Medicaid	$55.17
Rate for Payer: BCBS of TX Blue Advantage	$101.58
Rate for Payer: BCBS of TX Blue Essentials	$121.43
Rate for Payer: BCBS of TX PPO	$135.44
Rate for Payer: Cash Price	$539.44
Rate for Payer: Cash Price	$539.44
Rate for Payer: Multiplan Auto	$398.45
Rate for Payer: Multiplan Commercial	$398.45
Rate for Payer: Multiplan Workers Comp	$398.45
Rate for Payer: Scott and White EPO/PPO	$66.11

Coll & Interp Data Ea 30 Days BCE

Facility

$613.00

Service Code	CPT 99091
Hospital Charge Code	6019904
Hospital Revenue Code	510
Min. Negotiated Rate	$55.17
Max. Negotiated Rate	$398.45
Rate for Payer: Aetna Commercial	$337.15
Rate for Payer: Amerigroup CHIP/Medicaid	$55.17
Rate for Payer: BCBS of TX Blue Advantage	$101.58
Rate for Payer: BCBS of TX Blue Essentials	$121.43
Rate for Payer: BCBS of TX PPO	$135.44
Rate for Payer: Cash Price	$539.44
Rate for Payer: Cash Price	$539.44
Rate for Payer: Multiplan Auto	$398.45
Rate for Payer: Multiplan Commercial	$398.45
Rate for Payer: Multiplan Workers Comp	$398.45
Rate for Payer: Scott and White EPO/PPO	$66.11

Coll & Interp Data Ea 30 Days BCE

Facility

$613.00

Service Code	CPT 99091
Hospital Charge Code	6019904
Hospital Revenue Code	510
Rate for Payer: Cash Price	$539.44

Colonoscopy, flexible diagnostic, including collection of specimen(s) by brushing or washing, when

Facility

$10,000.00

Service Code	CPT 45378
Hospital Charge Code	36045378
Hospital Revenue Code	360
Min. Negotiated Rate	$328.50
Max. Negotiated Rate	$10,000.00
Rate for Payer: Aetna Commercial	$2,200.00
Rate for Payer: Aetna Medicare	$1,253.79
Rate for Payer: Amerigroup CHIP/Medicaid	$328.50
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$835.86
Rate for Payer: Amerigroup Medicare	$835.86
Rate for Payer: BCBS of TX Blue Advantage	$1,275.68
Rate for Payer: BCBS of TX Blue Essentials	$1,527.76
Rate for Payer: BCBS of TX Medicare	$835.86
Rate for Payer: BCBS of TX PPO	$1,924.98
Rate for Payer: Cigna Commercial	$1,893.46
Rate for Payer: Cigna Medicaid	$328.50
Rate for Payer: Cigna Medicare	$835.86
Rate for Payer: Employer Direct Commercial	$835.86
Rate for Payer: Humana Medicare/TRICARE	$835.86
Rate for Payer: Molina CHIP/Medicaid	$328.50
Rate for Payer: Molina Dual Medicare/Medicaid	$835.86
Rate for Payer: Molina Medicare	$835.86
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	$328.50
Rate for Payer: Scott and White EPO/PPO	$1,546.34
Rate for Payer: Scott and White Medicare	$835.86
Rate for Payer: Superior Health Plan CHIP/Medicaid	$328.50
Rate for Payer: Superior Health Plan EPO	$835.86
Rate for Payer: Superior Health Plan Medicare	$835.86
Rate for Payer: Universal American Dual Medicare/Medicaid	$835.86
Rate for Payer: Universal American Medicare	$835.86
Rate for Payer: Wellcare Medicare	$835.86
Rate for Payer: Wellmed Medicare	$835.86

Colonoscopy, flexible; with biopsy, single or multiple

Facility

$10,000.00

Service Code	CPT 45380
Hospital Charge Code	36045380
Hospital Revenue Code	360
Min. Negotiated Rate	$429.26
Max. Negotiated Rate	$10,000.00
Rate for Payer: Aetna Commercial	$2,200.00
Rate for Payer: Aetna Medicare	$1,618.85
Rate for Payer: Amerigroup CHIP/Medicaid	$429.26
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$1,079.23
Rate for Payer: Amerigroup Medicare	$1,079.23
Rate for Payer: BCBS of TX Blue Advantage	$1,677.05
Rate for Payer: BCBS of TX Blue Essentials	$2,008.44
Rate for Payer: BCBS of TX Medicare	$1,079.23
Rate for Payer: BCBS of TX PPO	$2,530.63
Rate for Payer: Cigna Commercial	$2,444.77
Rate for Payer: Cigna Medicaid	$429.26
Rate for Payer: Cigna Medicare	$1,079.23
Rate for Payer: Employer Direct Commercial	$1,079.23
Rate for Payer: Humana Medicare/TRICARE	$1,079.23
Rate for Payer: Molina CHIP/Medicaid	$429.26
Rate for Payer: Molina Dual Medicare/Medicaid	$1,079.23
Rate for Payer: Molina Medicare	$1,079.23
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	$429.26
Rate for Payer: Scott and White EPO/PPO	$1,996.58
Rate for Payer: Scott and White Medicare	$1,079.23
Rate for Payer: Superior Health Plan CHIP/Medicaid	$429.26
Rate for Payer: Superior Health Plan EPO	$1,079.23
Rate for Payer: Superior Health Plan Medicare	$1,079.23
Rate for Payer: Universal American Dual Medicare/Medicaid	$1,079.23
Rate for Payer: Universal American Medicare	$1,079.23
Rate for Payer: Wellcare Medicare	$1,079.23
Rate for Payer: Wellmed Medicare	$1,079.23

Colonoscopy, flexible with directed submucosal injection(s), any substance

Facility

$10,000.00

Service Code	CPT 45381
Hospital Charge Code	36045381
Hospital Revenue Code	360
Min. Negotiated Rate	$429.26
Max. Negotiated Rate	$10,000.00
Rate for Payer: Aetna Commercial	$2,200.00
Rate for Payer: Aetna Medicare	$1,618.85
Rate for Payer: Amerigroup CHIP/Medicaid	$429.26
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$1,079.23
Rate for Payer: Amerigroup Medicare	$1,079.23
Rate for Payer: BCBS of TX Blue Advantage	$1,677.05
Rate for Payer: BCBS of TX Blue Essentials	$2,008.44
Rate for Payer: BCBS of TX Medicare	$1,079.23
Rate for Payer: BCBS of TX PPO	$2,530.63
Rate for Payer: Cigna Commercial	$2,444.77
Rate for Payer: Cigna Medicaid	$429.26
Rate for Payer: Cigna Medicare	$1,079.23
Rate for Payer: Employer Direct Commercial	$1,079.23
Rate for Payer: Humana Medicare/TRICARE	$1,079.23
Rate for Payer: Molina CHIP/Medicaid	$429.26
Rate for Payer: Molina Dual Medicare/Medicaid	$1,079.23
Rate for Payer: Molina Medicare	$1,079.23
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	$429.26
Rate for Payer: Scott and White EPO/PPO	$1,996.58
Rate for Payer: Scott and White Medicare	$1,079.23
Rate for Payer: Superior Health Plan CHIP/Medicaid	$429.26
Rate for Payer: Superior Health Plan EPO	$1,079.23
Rate for Payer: Superior Health Plan Medicare	$1,079.23
Rate for Payer: Universal American Dual Medicare/Medicaid	$1,079.23
Rate for Payer: Universal American Medicare	$1,079.23
Rate for Payer: Wellcare Medicare	$1,079.23
Rate for Payer: Wellmed Medicare	$1,079.23

Colonoscopy, flexible with removal of tumor(s), polyp(s), or other lesion(s) by snare technique

Facility

$10,000.00

Service Code	CPT 45385
Hospital Charge Code	36045385
Hospital Revenue Code	360
Min. Negotiated Rate	$429.26
Max. Negotiated Rate	$10,000.00
Rate for Payer: Aetna Commercial	$2,200.00
Rate for Payer: Aetna Medicare	$1,618.85
Rate for Payer: Amerigroup CHIP/Medicaid	$429.26
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$1,079.23
Rate for Payer: Amerigroup Medicare	$1,079.23
Rate for Payer: BCBS of TX Blue Advantage	$1,677.05
Rate for Payer: BCBS of TX Blue Essentials	$2,008.44
Rate for Payer: BCBS of TX Medicare	$1,079.23
Rate for Payer: BCBS of TX PPO	$2,530.63
Rate for Payer: Cigna Commercial	$2,444.77
Rate for Payer: Cigna Medicaid	$429.26
Rate for Payer: Cigna Medicare	$1,079.23
Rate for Payer: Employer Direct Commercial	$1,079.23
Rate for Payer: Humana Medicare/TRICARE	$1,079.23
Rate for Payer: Molina CHIP/Medicaid	$429.26
Rate for Payer: Molina Dual Medicare/Medicaid	$1,079.23
Rate for Payer: Molina Medicare	$1,079.23
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	$429.26
Rate for Payer: Scott and White EPO/PPO	$1,996.58
Rate for Payer: Scott and White Medicare	$1,079.23
Rate for Payer: Superior Health Plan CHIP/Medicaid	$429.26
Rate for Payer: Superior Health Plan EPO	$1,079.23
Rate for Payer: Superior Health Plan Medicare	$1,079.23
Rate for Payer: Universal American Dual Medicare/Medicaid	$1,079.23
Rate for Payer: Universal American Medicare	$1,079.23
Rate for Payer: Wellcare Medicare	$1,079.23
Rate for Payer: Wellmed Medicare	$1,079.23

Colorectal cancer screening; colonoscopy on individual at high risk

Facility

$10,000.00

Service Code	CPT G0105
Hospital Charge Code	360G0105
Hospital Revenue Code	360
Min. Negotiated Rate	$222.93
Max. Negotiated Rate	$10,000.00
Rate for Payer: Aetna Commercial	$1,400.00
Rate for Payer: Aetna Medicare	$1,253.79
Rate for Payer: Amerigroup CHIP/Medicaid	$328.50
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$835.86
Rate for Payer: Amerigroup Medicare	$835.86
Rate for Payer: BCBS of TX Blue Advantage	$1,275.68
Rate for Payer: BCBS of TX Blue Essentials	$1,527.76
Rate for Payer: BCBS of TX Medicare	$835.86
Rate for Payer: BCBS of TX PPO	$1,924.98
Rate for Payer: Cigna Commercial	$1,893.46
Rate for Payer: Cigna Medicaid	$328.50
Rate for Payer: Cigna Medicare	$835.86
Rate for Payer: Employer Direct Commercial	$835.86
Rate for Payer: Humana Medicare/TRICARE	$835.86
Rate for Payer: Molina CHIP/Medicaid	$328.50
Rate for Payer: Molina Dual Medicare/Medicaid	$835.86
Rate for Payer: Molina Medicare	$835.86
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	$328.50
Rate for Payer: Scott and White EPO/PPO	$222.93
Rate for Payer: Scott and White Medicare	$835.86
Rate for Payer: Superior Health Plan CHIP/Medicaid	$328.50
Rate for Payer: Superior Health Plan EPO	$835.86
Rate for Payer: Superior Health Plan Medicare	$835.86
Rate for Payer: Universal American Dual Medicare/Medicaid	$835.86
Rate for Payer: Universal American Medicare	$835.86
Rate for Payer: Wellcare Medicare	$835.86
Rate for Payer: Wellmed Medicare	$835.86

Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk

Facility

$10,000.00

Service Code	CPT G0121
Hospital Charge Code	360G0121
Hospital Revenue Code	360
Min. Negotiated Rate	$223.29
Max. Negotiated Rate	$10,000.00
Rate for Payer: Aetna Commercial	$1,400.00
Rate for Payer: Aetna Medicare	$1,253.79
Rate for Payer: Amerigroup CHIP/Medicaid	$328.50
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$835.86
Rate for Payer: Amerigroup Medicare	$835.86
Rate for Payer: BCBS of TX Blue Advantage	$1,275.68
Rate for Payer: BCBS of TX Blue Essentials	$1,527.76
Rate for Payer: BCBS of TX Medicare	$835.86
Rate for Payer: BCBS of TX PPO	$1,924.98
Rate for Payer: Cigna Commercial	$1,893.46
Rate for Payer: Cigna Medicaid	$328.50
Rate for Payer: Cigna Medicare	$835.86
Rate for Payer: Employer Direct Commercial	$835.86
Rate for Payer: Humana Medicare/TRICARE	$835.86
Rate for Payer: Molina CHIP/Medicaid	$328.50
Rate for Payer: Molina Dual Medicare/Medicaid	$835.86
Rate for Payer: Molina Medicare	$835.86
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	$328.50
Rate for Payer: Scott and White EPO/PPO	$223.29
Rate for Payer: Scott and White Medicare	$835.86
Rate for Payer: Superior Health Plan CHIP/Medicaid	$328.50
Rate for Payer: Superior Health Plan EPO	$835.86
Rate for Payer: Superior Health Plan Medicare	$835.86
Rate for Payer: Universal American Dual Medicare/Medicaid	$835.86
Rate for Payer: Universal American Medicare	$835.86
Rate for Payer: Wellcare Medicare	$835.86
Rate for Payer: Wellmed Medicare	$835.86

Color Flow Mapping 93325

Facility

$980.00

Service Code	CPT 93325
Hospital Charge Code	2800266
Hospital Revenue Code	480
Min. Negotiated Rate	$28.86
Max. Negotiated Rate	$637.00
Rate for Payer: Aetna Commercial	$35.78
Rate for Payer: Amerigroup CHIP/Medicaid	$88.20
Rate for Payer: BCBS of TX Blue Advantage	$38.87
Rate for Payer: BCBS of TX Blue Essentials	$46.47
Rate for Payer: BCBS of TX PPO	$51.83
Rate for Payer: Cash Price	$862.40
Rate for Payer: Cash Price	$862.40
Rate for Payer: Multiplan Auto	$637.00
Rate for Payer: Multiplan Commercial	$637.00
Rate for Payer: Multiplan Workers Comp	$637.00
Rate for Payer: Scott and White EPO/PPO	$28.86
Rate for Payer: Superior Health Plan EPO	$133.28

Color Flow Mapping 93325

Facility

$980.00

Service Code	CPT 93325
Hospital Charge Code	2800266
Hospital Revenue Code	480
Rate for Payer: Cash Price	$862.40

Color Flow Mapping 93325 BCE

Facility

$980.00

Service Code	CPT 93325
Hospital Charge Code	2800266
Hospital Revenue Code	480
Min. Negotiated Rate	$28.86
Max. Negotiated Rate	$637.00
Rate for Payer: Aetna Commercial	$35.78
Rate for Payer: Amerigroup CHIP/Medicaid	$88.20
Rate for Payer: BCBS of TX Blue Advantage	$38.87
Rate for Payer: BCBS of TX Blue Essentials	$46.47
Rate for Payer: BCBS of TX PPO	$51.83
Rate for Payer: Cash Price	$862.40
Rate for Payer: Cash Price	$862.40
Rate for Payer: Multiplan Auto	$637.00
Rate for Payer: Multiplan Commercial	$637.00
Rate for Payer: Multiplan Workers Comp	$637.00
Rate for Payer: Scott and White EPO/PPO	$28.86
Rate for Payer: Superior Health Plan EPO	$133.28

COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION WITH CC

Facility

$78,777.94

Service Code	MSDRG 454
Min. Negotiated Rate	$65,389.44
Max. Negotiated Rate	$78,777.94
Rate for Payer: Aetna Commercial	$68,808.38
Rate for Payer: Aetna Medicare	$69,751.59
Rate for Payer: BCBS of TX Blue Advantage	$69,840.60
Rate for Payer: BCBS of TX Blue Essentials	$65,389.44
Rate for Payer: BCBS of TX PPO	$72,657.75
Rate for Payer: Cigna Commercial	$78,777.94

COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION WITH MCC

Facility

$114,134.83

Service Code	MSDRG 453
Min. Negotiated Rate	$93,274.74
Max. Negotiated Rate	$114,134.83
Rate for Payer: Aetna Commercial	$99,690.75
Rate for Payer: Aetna Medicare	$99,135.39
Rate for Payer: BCBS of TX Blue Advantage	$93,274.74
Rate for Payer: BCBS of TX Blue Essentials	$97,998.51
Rate for Payer: BCBS of TX PPO	$108,891.46
Rate for Payer: Cigna Commercial	$114,134.83

COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION WITHOUT CC/MCC

Facility

$59,320.13

Service Code	MSDRG 455
Min. Negotiated Rate	$51,595.00
Max. Negotiated Rate	$59,320.13
Rate for Payer: Aetna Commercial	$51,813.00
Rate for Payer: Aetna Medicare	$53,580.92
Rate for Payer: BCBS of TX Blue Advantage	$54,581.62
Rate for Payer: BCBS of TX Blue Essentials	$51,595.00
Rate for Payer: BCBS of TX PPO	$57,330.00
Rate for Payer: Cigna Commercial	$59,320.13

COMP EP ABL AFIB

Facility

$34,838.00

Service Code	CPT 93656
Hospital Charge Code	4613663
Hospital Revenue Code	480
Min. Negotiated Rate	$1,123.49
Max. Negotiated Rate	$51,496.88
Rate for Payer: Aetna Commercial	$10,300.00
Rate for Payer: Aetna Medicare	$32,581.28
Rate for Payer: Amerigroup CHIP/Medicaid	$3,135.42
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$21,720.85
Rate for Payer: Amerigroup Medicare	$21,720.85
Rate for Payer: BCBS of TX Blue Advantage	$34,126.90
Rate for Payer: BCBS of TX Blue Essentials	$40,870.54
Rate for Payer: BCBS of TX Medicare	$21,720.85
Rate for Payer: BCBS of TX PPO	$51,496.88
Rate for Payer: Cash Price	$30,657.44
Rate for Payer: Cash Price	$30,657.44
Rate for Payer: Cash Price	$30,657.44
Rate for Payer: Cigna Commercial	$49,204.03
Rate for Payer: Cigna Medicare	$21,720.85
Rate for Payer: Employer Direct Commercial	$21,720.85
Rate for Payer: Humana Medicare/TRICARE	$21,720.85
Rate for Payer: Molina Dual Medicare/Medicaid	$21,720.85
Rate for Payer: Molina Medicare	$21,720.85
Rate for Payer: Multiplan Auto	$22,644.70
Rate for Payer: Multiplan Commercial	$22,644.70
Rate for Payer: Multiplan Workers Comp	$22,644.70
Rate for Payer: Scott and White EPO/PPO	$1,123.49
Rate for Payer: Scott and White Medicare	$21,720.85
Rate for Payer: Superior Health Plan EPO	$21,720.85
Rate for Payer: Superior Health Plan Medicare	$21,720.85
Rate for Payer: Universal American Dual Medicare/Medicaid	$21,720.85
Rate for Payer: Universal American Medicare	$21,720.85
Rate for Payer: Wellcare Medicare	$21,720.85
Rate for Payer: Wellmed Medicare	$21,720.85

COMP EP ABL AFIB

Facility

$34,838.00

Service Code	CPT 93656
Hospital Charge Code	4613663
Hospital Revenue Code	480
Rate for Payer: Cash Price	$30,657.44

COMP EP/ABLAT V-TACH 3D

Facility

$28,038.00

Service Code	CPT 93654
Hospital Charge Code	4613654
Hospital Revenue Code	480
Min. Negotiated Rate	$1,193.64
Max. Negotiated Rate	$51,496.88
Rate for Payer: Aetna Commercial	$10,300.00
Rate for Payer: Aetna Medicare	$32,581.28
Rate for Payer: Amerigroup CHIP/Medicaid	$2,523.42
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$21,720.85
Rate for Payer: Amerigroup Medicare	$21,720.85
Rate for Payer: BCBS of TX Blue Advantage	$34,126.90
Rate for Payer: BCBS of TX Blue Essentials	$40,870.54
Rate for Payer: BCBS of TX Medicare	$21,720.85
Rate for Payer: BCBS of TX PPO	$51,496.88
Rate for Payer: Cash Price	$24,673.44
Rate for Payer: Cash Price	$24,673.44
Rate for Payer: Cash Price	$24,673.44
Rate for Payer: Cigna Commercial	$49,204.03
Rate for Payer: Cigna Medicare	$21,720.85
Rate for Payer: Employer Direct Commercial	$21,720.85
Rate for Payer: Humana Medicare/TRICARE	$21,720.85
Rate for Payer: Molina Dual Medicare/Medicaid	$21,720.85
Rate for Payer: Molina Medicare	$21,720.85
Rate for Payer: Multiplan Auto	$18,224.70
Rate for Payer: Multiplan Commercial	$18,224.70
Rate for Payer: Multiplan Workers Comp	$18,224.70
Rate for Payer: Scott and White EPO/PPO	$1,193.64
Rate for Payer: Scott and White Medicare	$21,720.85
Rate for Payer: Superior Health Plan EPO	$21,720.85
Rate for Payer: Superior Health Plan Medicare	$21,720.85
Rate for Payer: Universal American Dual Medicare/Medicaid	$21,720.85
Rate for Payer: Universal American Medicare	$21,720.85
Rate for Payer: Wellcare Medicare	$21,720.85
Rate for Payer: Wellmed Medicare	$21,720.85

COMP EP/ABLAT V-TACH 3D

Facility

$28,038.00

Service Code	CPT 93654
Hospital Charge Code	4613654
Hospital Revenue Code	480
Rate for Payer: Cash Price	$24,673.44

COMP EP EVAL/LV RECORD

Facility

$6,966.00

Service Code	CPT 93622
Hospital Charge Code	4610612
Hospital Revenue Code	480
Min. Negotiated Rate	$314.80
Max. Negotiated Rate	$4,527.90
Rate for Payer: Aetna Commercial	$3,831.30
Rate for Payer: Amerigroup CHIP/Medicaid	$626.94
Rate for Payer: BCBS of TX Blue Advantage	$314.80
Rate for Payer: BCBS of TX Blue Essentials	$376.31
Rate for Payer: BCBS of TX PPO	$419.73
Rate for Payer: Cash Price	$6,130.08
Rate for Payer: Cash Price	$6,130.08
Rate for Payer: Multiplan Auto	$4,527.90
Rate for Payer: Multiplan Commercial	$4,527.90
Rate for Payer: Multiplan Workers Comp	$4,527.90
Rate for Payer: Scott and White EPO/PPO	$3,483.00
Rate for Payer: Superior Health Plan EPO	$947.38

Know your out-of-pocket cost for care.

All Charges