White Rock Medical Center

All Charges

Charge

Type

Setting

Price

AFP, Serum, Tumor Marker SO

Facility

$243.00

Service Code	CPT 82105
Hospital Charge Code	1603075
Hospital Revenue Code	301
Rate for Payer: Cash Price	$213.84

After 9.1.2020 / Injection, anesthetic agent sphenopalatine ganglion

Facility

$10,000.00

Service Code	CPT 64505
Hospital Charge Code	36064505
Hospital Revenue Code	360
Min. Negotiated Rate	$70.60
Max. Negotiated Rate	$10,000.00
Rate for Payer: Aetna Medicare	$406.31
Rate for Payer: Amerigroup CHIP/Medicaid	$70.60
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$270.87
Rate for Payer: Amerigroup Medicare	$270.87
Rate for Payer: BCBS of TX Blue Advantage	$119.34
Rate for Payer: BCBS of TX Blue Essentials	$142.92
Rate for Payer: BCBS of TX Medicare	$270.87
Rate for Payer: BCBS of TX PPO	$180.08
Rate for Payer: Cigna Commercial	$613.61
Rate for Payer: Cigna Medicaid	$70.60
Rate for Payer: Cigna Medicare	$270.87
Rate for Payer: Employer Direct Commercial	$270.87
Rate for Payer: Humana Medicare/TRICARE	$270.87
Rate for Payer: Molina CHIP/Medicaid	$70.60
Rate for Payer: Molina Dual Medicare/Medicaid	$270.87
Rate for Payer: Molina Medicare	$270.87
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	$70.60
Rate for Payer: Scott and White EPO/PPO	$501.11
Rate for Payer: Scott and White Medicare	$270.87
Rate for Payer: Superior Health Plan CHIP/Medicaid	$70.60
Rate for Payer: Superior Health Plan EPO	$270.87
Rate for Payer: Superior Health Plan Medicare	$270.87
Rate for Payer: Universal American Dual Medicare/Medicaid	$270.87
Rate for Payer: Universal American Medicare	$270.87
Rate for Payer: Wellcare Medicare	$270.87
Rate for Payer: Wellmed Medicare	$270.87

AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC

Facility

$16,400.26

Service Code	MSDRG 560
Min. Negotiated Rate	$9,222.64
Max. Negotiated Rate	$16,400.26
Rate for Payer: Aetna Commercial	$12,736.12
Rate for Payer: Aetna Medicare	$16,400.26
Rate for Payer: BCBS of TX Blue Advantage	$9,222.64
Rate for Payer: BCBS of TX Blue Essentials	$10,542.92
Rate for Payer: BCBS of TX PPO	$11,714.81
Rate for Payer: Cigna Commercial	$14,581.45

AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC

Facility

$24,090.10

Service Code	MSDRG 559
Min. Negotiated Rate	$16,033.84
Max. Negotiated Rate	$24,090.10
Rate for Payer: Aetna Commercial	$20,818.12
Rate for Payer: Aetna Medicare	$24,090.10
Rate for Payer: BCBS of TX Blue Advantage	$16,033.84
Rate for Payer: BCBS of TX Blue Essentials	$18,560.79
Rate for Payer: BCBS of TX PPO	$20,623.89
Rate for Payer: Cigna Commercial	$23,834.44

AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC

Facility

$12,633.50

Service Code	MSDRG 561
Min. Negotiated Rate	$6,368.30
Max. Negotiated Rate	$12,633.50
Rate for Payer: Aetna Commercial	$8,777.25
Rate for Payer: Aetna Medicare	$12,633.50
Rate for Payer: BCBS of TX Blue Advantage	$6,368.30
Rate for Payer: BCBS of TX Blue Essentials	$7,802.20
Rate for Payer: BCBS of TX PPO	$8,669.44
Rate for Payer: Cigna Commercial	$10,048.98

AFTERCARE WITH CC/MCC

Facility

$15,765.51

Service Code	MSDRG 949
Min. Negotiated Rate	$8,120.12
Max. Negotiated Rate	$15,765.51
Rate for Payer: Aetna Commercial	$11,656.12
Rate for Payer: Aetna Medicare	$15,765.51
Rate for Payer: BCBS of TX Blue Advantage	$8,120.12
Rate for Payer: BCBS of TX Blue Essentials	$11,827.64
Rate for Payer: BCBS of TX PPO	$13,142.33
Rate for Payer: Cigna Commercial	$13,344.97

AFTERCARE WITHOUT CC/MCC

Facility

$11,117.79

Service Code	MSDRG 950
Min. Negotiated Rate	$4,867.60
Max. Negotiated Rate	$11,117.79
Rate for Payer: Aetna Commercial	$7,067.25
Rate for Payer: Aetna Medicare	$11,117.79
Rate for Payer: BCBS of TX Blue Advantage	$4,867.60
Rate for Payer: BCBS of TX Blue Essentials	$7,686.62
Rate for Payer: BCBS of TX PPO	$8,541.02
Rate for Payer: Cigna Commercial	$8,091.22

AICD GENERATOR PROCEDURES

Facility

$58,364.43

Service Code	MSDRG 245
Min. Negotiated Rate	$41,061.56
Max. Negotiated Rate	$58,364.43
Rate for Payer: Aetna Commercial	$50,978.25
Rate for Payer: Aetna Medicare	$52,786.69
Rate for Payer: BCBS of TX Blue Advantage	$41,061.56
Rate for Payer: BCBS of TX Blue Essentials	$51,719.86
Rate for Payer: BCBS of TX PPO	$57,468.74
Rate for Payer: Cigna Commercial	$58,364.43

AICD LEAD PROCEDURES

Facility

$45,519.21

Service Code	MSDRG 265
Min. Negotiated Rate	$27,615.46
Max. Negotiated Rate	$45,519.21
Rate for Payer: Aetna Commercial	$39,758.62
Rate for Payer: Aetna Medicare	$42,111.51
Rate for Payer: BCBS of TX Blue Advantage	$27,615.46
Rate for Payer: BCBS of TX Blue Essentials	$32,161.23
Rate for Payer: BCBS of TX PPO	$35,736.08
Rate for Payer: Cigna Commercial	$45,519.21

Alanine Aminotransferase

Facility

$225.00

Service Code	CPT 84460
Hospital Charge Code	1602341
Hospital Revenue Code	301
Rate for Payer: Cash Price	$198.00

Alanine Aminotransferase

Facility

$225.00

Service Code	CPT 84460
Hospital Charge Code	1602341
Hospital Revenue Code	301
Min. Negotiated Rate	$2.07
Max. Negotiated Rate	$146.25
Rate for Payer: Aetna Commercial	$5.57
Rate for Payer: Aetna Medicare	$7.95
Rate for Payer: Amerigroup CHIP/Medicaid	$2.07
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$5.30
Rate for Payer: Amerigroup Medicare	$5.30
Rate for Payer: BCBS of TX Blue Advantage	$8.74
Rate for Payer: BCBS of TX Blue Essentials	$10.49
Rate for Payer: BCBS of TX Medicare	$5.30
Rate for Payer: BCBS of TX PPO	$11.71
Rate for Payer: Cash Price	$198.00
Rate for Payer: Cash Price	$198.00
Rate for Payer: Cigna Medicaid	$5.30
Rate for Payer: Cigna Medicare	$5.30
Rate for Payer: Employer Direct Commercial	$5.30
Rate for Payer: Humana Medicare/TRICARE	$5.30
Rate for Payer: Molina CHIP/Medicaid	$5.30
Rate for Payer: Molina Dual Medicare/Medicaid	$5.30
Rate for Payer: Molina Medicare	$5.30
Rate for Payer: Multiplan Auto	$146.25
Rate for Payer: Multiplan Commercial	$146.25
Rate for Payer: Multiplan Workers Comp	$146.25
Rate for Payer: Parkland Medicaid	$5.30
Rate for Payer: Scott and White EPO/PPO	$6.62
Rate for Payer: Scott and White Medicare	$5.30
Rate for Payer: Superior Health Plan CHIP/Medicaid	$5.30
Rate for Payer: Superior Health Plan EPO	$5.30
Rate for Payer: Superior Health Plan Medicare	$5.30
Rate for Payer: Universal American Dual Medicare/Medicaid	$5.30
Rate for Payer: Universal American Medicare	$5.30
Rate for Payer: Wellcare Medicare	$5.30
Rate for Payer: Wellmed Medicare	$5.30

Albumin, 24-Hr Urine SO

Facility

$226.00

Service Code	CPT 82043
Hospital Charge Code	1603281
Hospital Revenue Code	301
Min. Negotiated Rate	$2.25
Max. Negotiated Rate	$146.90
Rate for Payer: Aetna Commercial	$6.07
Rate for Payer: Aetna Medicare	$8.67
Rate for Payer: Amerigroup CHIP/Medicaid	$2.25
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$5.78
Rate for Payer: Amerigroup Medicare	$5.78
Rate for Payer: BCBS of TX Blue Advantage	$9.54
Rate for Payer: BCBS of TX Blue Essentials	$11.44
Rate for Payer: BCBS of TX Medicare	$5.78
Rate for Payer: BCBS of TX PPO	$12.77
Rate for Payer: Cash Price	$198.88
Rate for Payer: Cash Price	$198.88
Rate for Payer: Cigna Medicaid	$5.78
Rate for Payer: Cigna Medicare	$5.78
Rate for Payer: Employer Direct Commercial	$5.78
Rate for Payer: Humana Medicare/TRICARE	$5.78
Rate for Payer: Molina CHIP/Medicaid	$5.78
Rate for Payer: Molina Dual Medicare/Medicaid	$5.78
Rate for Payer: Molina Medicare	$5.78
Rate for Payer: Multiplan Auto	$146.90
Rate for Payer: Multiplan Commercial	$146.90
Rate for Payer: Multiplan Workers Comp	$146.90
Rate for Payer: Parkland Medicaid	$5.78
Rate for Payer: Scott and White EPO/PPO	$7.22
Rate for Payer: Scott and White Medicare	$5.78
Rate for Payer: Superior Health Plan CHIP/Medicaid	$5.78
Rate for Payer: Superior Health Plan EPO	$5.78
Rate for Payer: Superior Health Plan Medicare	$5.78
Rate for Payer: Universal American Dual Medicare/Medicaid	$5.78
Rate for Payer: Universal American Medicare	$5.78
Rate for Payer: Wellcare Medicare	$5.78
Rate for Payer: Wellmed Medicare	$5.78

Albumin, Body Fluid SO

Facility

$140.00

Service Code	CPT 82042
Hospital Charge Code	1600816
Hospital Revenue Code	301
Min. Negotiated Rate	$3.03
Max. Negotiated Rate	$91.00
Rate for Payer: Aetna Commercial	$8.17
Rate for Payer: Aetna Medicare	$11.67
Rate for Payer: Amerigroup CHIP/Medicaid	$3.03
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$7.78
Rate for Payer: Amerigroup Medicare	$7.78
Rate for Payer: BCBS of TX Blue Advantage	$12.84
Rate for Payer: BCBS of TX Blue Essentials	$15.40
Rate for Payer: BCBS of TX Medicare	$7.78
Rate for Payer: BCBS of TX PPO	$17.19
Rate for Payer: Cash Price	$123.20
Rate for Payer: Cash Price	$123.20
Rate for Payer: Cigna Medicaid	$7.78
Rate for Payer: Cigna Medicare	$7.78
Rate for Payer: Employer Direct Commercial	$7.78
Rate for Payer: Humana Medicare/TRICARE	$7.78
Rate for Payer: Molina CHIP/Medicaid	$7.78
Rate for Payer: Molina Dual Medicare/Medicaid	$7.78
Rate for Payer: Molina Medicare	$7.78
Rate for Payer: Multiplan Auto	$91.00
Rate for Payer: Multiplan Commercial	$91.00
Rate for Payer: Multiplan Workers Comp	$91.00
Rate for Payer: Parkland Medicaid	$7.78
Rate for Payer: Scott and White EPO/PPO	$9.72
Rate for Payer: Scott and White Medicare	$7.78
Rate for Payer: Superior Health Plan CHIP/Medicaid	$7.78
Rate for Payer: Superior Health Plan EPO	$7.78
Rate for Payer: Superior Health Plan Medicare	$7.78
Rate for Payer: Universal American Dual Medicare/Medicaid	$7.78
Rate for Payer: Universal American Medicare	$7.78
Rate for Payer: Wellcare Medicare	$7.78
Rate for Payer: Wellmed Medicare	$7.78

Albumin, Cerebrospinal Fluid SO

Facility

$140.00

Service Code	CPT 82042
Hospital Charge Code	1600816
Hospital Revenue Code	301
Min. Negotiated Rate	$3.03
Max. Negotiated Rate	$91.00
Rate for Payer: Aetna Commercial	$8.17
Rate for Payer: Aetna Medicare	$11.67
Rate for Payer: Amerigroup CHIP/Medicaid	$3.03
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$7.78
Rate for Payer: Amerigroup Medicare	$7.78
Rate for Payer: BCBS of TX Blue Advantage	$12.84
Rate for Payer: BCBS of TX Blue Essentials	$15.40
Rate for Payer: BCBS of TX Medicare	$7.78
Rate for Payer: BCBS of TX PPO	$17.19
Rate for Payer: Cash Price	$123.20
Rate for Payer: Cash Price	$123.20
Rate for Payer: Cigna Medicaid	$7.78
Rate for Payer: Cigna Medicare	$7.78
Rate for Payer: Employer Direct Commercial	$7.78
Rate for Payer: Humana Medicare/TRICARE	$7.78
Rate for Payer: Molina CHIP/Medicaid	$7.78
Rate for Payer: Molina Dual Medicare/Medicaid	$7.78
Rate for Payer: Molina Medicare	$7.78
Rate for Payer: Multiplan Auto	$91.00
Rate for Payer: Multiplan Commercial	$91.00
Rate for Payer: Multiplan Workers Comp	$91.00
Rate for Payer: Parkland Medicaid	$7.78
Rate for Payer: Scott and White EPO/PPO	$9.72
Rate for Payer: Scott and White Medicare	$7.78
Rate for Payer: Superior Health Plan CHIP/Medicaid	$7.78
Rate for Payer: Superior Health Plan EPO	$7.78
Rate for Payer: Superior Health Plan Medicare	$7.78
Rate for Payer: Universal American Dual Medicare/Medicaid	$7.78
Rate for Payer: Universal American Medicare	$7.78
Rate for Payer: Wellcare Medicare	$7.78
Rate for Payer: Wellmed Medicare	$7.78

Albumin, Cerebrospinal Fluid SO

Facility

$140.00

Service Code	CPT 82042
Hospital Charge Code	1600816
Hospital Revenue Code	301
Rate for Payer: Cash Price	$123.20

Albumin/Creatinine Ratio,Ur SO

Facility

$226.00

Service Code	CPT 82043
Hospital Charge Code	1603281
Hospital Revenue Code	301
Min. Negotiated Rate	$2.25
Max. Negotiated Rate	$146.90
Rate for Payer: Aetna Commercial	$6.07
Rate for Payer: Aetna Medicare	$8.67
Rate for Payer: Amerigroup CHIP/Medicaid	$2.25
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$5.78
Rate for Payer: Amerigroup Medicare	$5.78
Rate for Payer: BCBS of TX Blue Advantage	$9.54
Rate for Payer: BCBS of TX Blue Essentials	$11.44
Rate for Payer: BCBS of TX Medicare	$5.78
Rate for Payer: BCBS of TX PPO	$12.77
Rate for Payer: Cash Price	$198.88
Rate for Payer: Cash Price	$198.88
Rate for Payer: Cigna Medicaid	$5.78
Rate for Payer: Cigna Medicare	$5.78
Rate for Payer: Employer Direct Commercial	$5.78
Rate for Payer: Humana Medicare/TRICARE	$5.78
Rate for Payer: Molina CHIP/Medicaid	$5.78
Rate for Payer: Molina Dual Medicare/Medicaid	$5.78
Rate for Payer: Molina Medicare	$5.78
Rate for Payer: Multiplan Auto	$146.90
Rate for Payer: Multiplan Commercial	$146.90
Rate for Payer: Multiplan Workers Comp	$146.90
Rate for Payer: Parkland Medicaid	$5.78
Rate for Payer: Scott and White EPO/PPO	$7.22
Rate for Payer: Scott and White Medicare	$5.78
Rate for Payer: Superior Health Plan CHIP/Medicaid	$5.78
Rate for Payer: Superior Health Plan EPO	$5.78
Rate for Payer: Superior Health Plan Medicare	$5.78
Rate for Payer: Universal American Dual Medicare/Medicaid	$5.78
Rate for Payer: Universal American Medicare	$5.78
Rate for Payer: Wellcare Medicare	$5.78
Rate for Payer: Wellmed Medicare	$5.78

Albumin/Creatinine Ratio,Ur SO

Facility

$226.00

Service Code	CPT 82043
Hospital Charge Code	1603281
Hospital Revenue Code	301
Rate for Payer: Cash Price	$198.88

albumin human 25% IV Soln 50 mL

Facility

$128.00

Service Code	HCPCS P9046
Hospital Charge Code	77358389
Hospital Revenue Code	250
Rate for Payer: Cash Price	$87.04

albumin human 25% IV Soln 50 mL

Facility

$128.00

Service Code	HCPCS P9046
Hospital Charge Code	77358389
Hospital Revenue Code	250
Min. Negotiated Rate	$11.52
Max. Negotiated Rate	$83.20
Rate for Payer: Aetna Medicare	$31.85
Rate for Payer: Amerigroup CHIP/Medicaid	$11.52
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$21.23
Rate for Payer: Amerigroup Medicare	$21.23
Rate for Payer: BCBS of TX Blue Advantage	$36.08
Rate for Payer: BCBS of TX Blue Essentials	$43.29
Rate for Payer: BCBS of TX Medicare	$21.23
Rate for Payer: BCBS of TX PPO	$48.02
Rate for Payer: Cash Price	$87.04
Rate for Payer: Cash Price	$87.04
Rate for Payer: Cigna Medicaid	$21.23
Rate for Payer: Cigna Medicare	$21.23
Rate for Payer: Employer Direct Commercial	$21.23
Rate for Payer: Humana Medicare/TRICARE	$21.23
Rate for Payer: Molina CHIP/Medicaid	$21.23
Rate for Payer: Molina Dual Medicare/Medicaid	$21.23
Rate for Payer: Molina Medicare	$21.23
Rate for Payer: Multiplan Auto	$83.20
Rate for Payer: Multiplan Commercial	$83.20
Rate for Payer: Multiplan Workers Comp	$83.20
Rate for Payer: Parkland Medicaid	$21.23
Rate for Payer: Scott and White EPO/PPO	$26.54
Rate for Payer: Scott and White Medicare	$21.23
Rate for Payer: Superior Health Plan CHIP/Medicaid	$21.23
Rate for Payer: Superior Health Plan EPO	$21.23
Rate for Payer: Superior Health Plan Medicare	$21.23
Rate for Payer: Universal American Dual Medicare/Medicaid	$21.23
Rate for Payer: Universal American Medicare	$21.23
Rate for Payer: Wellcare Medicare	$21.23
Rate for Payer: Wellmed Medicare	$21.23

albumin human 5% IV Soln 250 mL

Facility

$128.00

Service Code	HCPCS P9045
Hospital Charge Code	77358503
Hospital Revenue Code	250
Rate for Payer: Cash Price	$87.04

albumin human 5% IV Soln 250 mL

Facility

$128.00

Service Code	HCPCS P9045
Hospital Charge Code	77358503
Hospital Revenue Code	250
Min. Negotiated Rate	$11.52
Max. Negotiated Rate	$120.07
Rate for Payer: Aetna Medicare	$79.62
Rate for Payer: Amerigroup CHIP/Medicaid	$11.52
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$53.08
Rate for Payer: Amerigroup Medicare	$53.08
Rate for Payer: BCBS of TX Blue Advantage	$90.20
Rate for Payer: BCBS of TX Blue Essentials	$108.25
Rate for Payer: BCBS of TX Medicare	$53.08
Rate for Payer: BCBS of TX PPO	$120.07
Rate for Payer: Cash Price	$87.04
Rate for Payer: Cash Price	$87.04
Rate for Payer: Cigna Medicaid	$53.08
Rate for Payer: Cigna Medicare	$53.08
Rate for Payer: Employer Direct Commercial	$53.08
Rate for Payer: Humana Medicare/TRICARE	$53.08
Rate for Payer: Molina CHIP/Medicaid	$53.08
Rate for Payer: Molina Dual Medicare/Medicaid	$53.08
Rate for Payer: Molina Medicare	$53.08
Rate for Payer: Multiplan Auto	$83.20
Rate for Payer: Multiplan Commercial	$83.20
Rate for Payer: Multiplan Workers Comp	$83.20
Rate for Payer: Parkland Medicaid	$53.08
Rate for Payer: Scott and White EPO/PPO	$66.35
Rate for Payer: Scott and White Medicare	$53.08
Rate for Payer: Superior Health Plan CHIP/Medicaid	$53.08
Rate for Payer: Superior Health Plan EPO	$53.08
Rate for Payer: Superior Health Plan Medicare	$53.08
Rate for Payer: Universal American Dual Medicare/Medicaid	$53.08
Rate for Payer: Universal American Medicare	$53.08
Rate for Payer: Wellcare Medicare	$53.08
Rate for Payer: Wellmed Medicare	$53.08

Albumin Level

Facility

$180.00

Service Code	CPT 82040
Hospital Charge Code	1601491
Hospital Revenue Code	301
Min. Negotiated Rate	$1.93
Max. Negotiated Rate	$117.00
Rate for Payer: Aetna Commercial	$5.20
Rate for Payer: Aetna Medicare	$7.42
Rate for Payer: Amerigroup CHIP/Medicaid	$1.93
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$4.95
Rate for Payer: Amerigroup Medicare	$4.95
Rate for Payer: BCBS of TX Blue Advantage	$8.17
Rate for Payer: BCBS of TX Blue Essentials	$9.80
Rate for Payer: BCBS of TX Medicare	$4.95
Rate for Payer: BCBS of TX PPO	$10.94
Rate for Payer: Cash Price	$158.40
Rate for Payer: Cash Price	$158.40
Rate for Payer: Cigna Medicaid	$4.95
Rate for Payer: Cigna Medicare	$4.95
Rate for Payer: Employer Direct Commercial	$4.95
Rate for Payer: Humana Medicare/TRICARE	$4.95
Rate for Payer: Molina CHIP/Medicaid	$4.95
Rate for Payer: Molina Dual Medicare/Medicaid	$4.95
Rate for Payer: Molina Medicare	$4.95
Rate for Payer: Multiplan Auto	$117.00
Rate for Payer: Multiplan Commercial	$117.00
Rate for Payer: Multiplan Workers Comp	$117.00
Rate for Payer: Parkland Medicaid	$4.95
Rate for Payer: Scott and White EPO/PPO	$6.19
Rate for Payer: Scott and White Medicare	$4.95
Rate for Payer: Superior Health Plan CHIP/Medicaid	$4.95
Rate for Payer: Superior Health Plan EPO	$4.95
Rate for Payer: Superior Health Plan Medicare	$4.95
Rate for Payer: Universal American Dual Medicare/Medicaid	$4.95
Rate for Payer: Universal American Medicare	$4.95
Rate for Payer: Wellcare Medicare	$4.95
Rate for Payer: Wellmed Medicare	$4.95

Albumin, Random Urine SO

Facility

$226.00

Service Code	CPT 82043
Hospital Charge Code	1603281
Hospital Revenue Code	301
Min. Negotiated Rate	$2.25
Max. Negotiated Rate	$146.90
Rate for Payer: Aetna Commercial	$6.07
Rate for Payer: Aetna Medicare	$8.67
Rate for Payer: Amerigroup CHIP/Medicaid	$2.25
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$5.78
Rate for Payer: Amerigroup Medicare	$5.78
Rate for Payer: BCBS of TX Blue Advantage	$9.54
Rate for Payer: BCBS of TX Blue Essentials	$11.44
Rate for Payer: BCBS of TX Medicare	$5.78
Rate for Payer: BCBS of TX PPO	$12.77
Rate for Payer: Cash Price	$198.88
Rate for Payer: Cash Price	$198.88
Rate for Payer: Cigna Medicaid	$5.78
Rate for Payer: Cigna Medicare	$5.78
Rate for Payer: Employer Direct Commercial	$5.78
Rate for Payer: Humana Medicare/TRICARE	$5.78
Rate for Payer: Molina CHIP/Medicaid	$5.78
Rate for Payer: Molina Dual Medicare/Medicaid	$5.78
Rate for Payer: Molina Medicare	$5.78
Rate for Payer: Multiplan Auto	$146.90
Rate for Payer: Multiplan Commercial	$146.90
Rate for Payer: Multiplan Workers Comp	$146.90
Rate for Payer: Parkland Medicaid	$5.78
Rate for Payer: Scott and White EPO/PPO	$7.22
Rate for Payer: Scott and White Medicare	$5.78
Rate for Payer: Superior Health Plan CHIP/Medicaid	$5.78
Rate for Payer: Superior Health Plan EPO	$5.78
Rate for Payer: Superior Health Plan Medicare	$5.78
Rate for Payer: Universal American Dual Medicare/Medicaid	$5.78
Rate for Payer: Universal American Medicare	$5.78
Rate for Payer: Wellcare Medicare	$5.78
Rate for Payer: Wellmed Medicare	$5.78

ALBUMIN URINE/OTHER SOURCE QUANT

Facility

$140.00

Service Code	CPT 82042
Hospital Charge Code	1600816
Hospital Revenue Code	301
Min. Negotiated Rate	$3.03
Max. Negotiated Rate	$91.00
Rate for Payer: Aetna Commercial	$8.17
Rate for Payer: Aetna Medicare	$11.67
Rate for Payer: Amerigroup CHIP/Medicaid	$3.03
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$7.78
Rate for Payer: Amerigroup Medicare	$7.78
Rate for Payer: BCBS of TX Blue Advantage	$12.84
Rate for Payer: BCBS of TX Blue Essentials	$15.40
Rate for Payer: BCBS of TX Medicare	$7.78
Rate for Payer: BCBS of TX PPO	$17.19
Rate for Payer: Cash Price	$123.20
Rate for Payer: Cash Price	$123.20
Rate for Payer: Cigna Medicaid	$7.78
Rate for Payer: Cigna Medicare	$7.78
Rate for Payer: Employer Direct Commercial	$7.78
Rate for Payer: Humana Medicare/TRICARE	$7.78
Rate for Payer: Molina CHIP/Medicaid	$7.78
Rate for Payer: Molina Dual Medicare/Medicaid	$7.78
Rate for Payer: Molina Medicare	$7.78
Rate for Payer: Multiplan Auto	$91.00
Rate for Payer: Multiplan Commercial	$91.00
Rate for Payer: Multiplan Workers Comp	$91.00
Rate for Payer: Parkland Medicaid	$7.78
Rate for Payer: Scott and White EPO/PPO	$9.72
Rate for Payer: Scott and White Medicare	$7.78
Rate for Payer: Superior Health Plan CHIP/Medicaid	$7.78
Rate for Payer: Superior Health Plan EPO	$7.78
Rate for Payer: Superior Health Plan Medicare	$7.78
Rate for Payer: Universal American Dual Medicare/Medicaid	$7.78
Rate for Payer: Universal American Medicare	$7.78
Rate for Payer: Wellcare Medicare	$7.78
Rate for Payer: Wellmed Medicare	$7.78

albuterol 2.5 mg/3 mL (0.083%) Inh Soln 3 mL

Facility

$128.17

Service Code	HCPCS J7613
Hospital Charge Code	78403337
Hospital Revenue Code	636
Min. Negotiated Rate	$32.04
Max. Negotiated Rate	$64.08
Rate for Payer: Cash Price	$87.16
Rate for Payer: Cigna Commercial	$32.04
Rate for Payer: Scott and White EPO/PPO	$64.08

Know your out-of-pocket cost for care.

All Charges