White Rock Medical Center

All Charges

Charge

Type

Setting

Price

drs therahoney 4x5

Facility

$32.00

Hospital Charge Code	131624
Hospital Revenue Code	270
Rate for Payer: Cash Price	$28.16

drs therahoney 4x5

Facility

$32.00

Hospital Charge Code	131624
Hospital Revenue Code	270
Min. Negotiated Rate	$2.88
Max. Negotiated Rate	$20.80
Rate for Payer: Aetna Commercial	$17.60
Rate for Payer: Amerigroup CHIP/Medicaid	$2.88
Rate for Payer: BCBS of TX Blue Advantage	$9.60
Rate for Payer: BCBS of TX Blue Essentials	$11.52
Rate for Payer: BCBS of TX PPO	$12.80
Rate for Payer: Cash Price	$28.16
Rate for Payer: Multiplan Auto	$20.80
Rate for Payer: Multiplan Commercial	$20.80
Rate for Payer: Multiplan Workers Comp	$20.80
Rate for Payer: Scott and White EPO/PPO	$16.00
Rate for Payer: Superior Health Plan EPO	$4.35

DRS VAC VERAFLO CLEANS CHOICE MED

Facility

$595.19

Hospital Charge Code	8570486
Hospital Revenue Code	272
Min. Negotiated Rate	$53.57
Max. Negotiated Rate	$386.87
Rate for Payer: Aetna Commercial	$327.35
Rate for Payer: Amerigroup CHIP/Medicaid	$53.57
Rate for Payer: BCBS of TX Blue Advantage	$178.56
Rate for Payer: BCBS of TX Blue Essentials	$214.27
Rate for Payer: BCBS of TX PPO	$238.08
Rate for Payer: Cash Price	$523.77
Rate for Payer: Multiplan Auto	$386.87
Rate for Payer: Multiplan Commercial	$386.87
Rate for Payer: Multiplan Workers Comp	$386.87
Rate for Payer: Scott and White EPO/PPO	$297.60
Rate for Payer: Superior Health Plan EPO	$80.95

DRS VAC VERAFLO CLEANS CHOICE MED

Facility

$595.19

Hospital Charge Code	8570486
Hospital Revenue Code	272
Rate for Payer: Cash Price	$523.77

drs versatel 1-silicone

Facility

$15.25

Hospital Charge Code	130118
Hospital Revenue Code	270
Rate for Payer: Cash Price	$13.42

drs versatel 1-silicone

Facility

$15.25

Hospital Charge Code	130118
Hospital Revenue Code	270
Min. Negotiated Rate	$1.37
Max. Negotiated Rate	$9.91
Rate for Payer: Aetna Commercial	$8.39
Rate for Payer: Amerigroup CHIP/Medicaid	$1.37
Rate for Payer: BCBS of TX Blue Advantage	$4.58
Rate for Payer: BCBS of TX Blue Essentials	$5.49
Rate for Payer: BCBS of TX PPO	$6.10
Rate for Payer: Cash Price	$13.42
Rate for Payer: Multiplan Auto	$9.91
Rate for Payer: Multiplan Commercial	$9.91
Rate for Payer: Multiplan Workers Comp	$9.91
Rate for Payer: Scott and White EPO/PPO	$7.62
Rate for Payer: Superior Health Plan EPO	$2.07

DRS WND 5 1/2 X 5 7/8 -- DHF

Facility

$85.04

Hospital Charge Code	80249667
Hospital Revenue Code	270
Rate for Payer: Cash Price	$74.84

DRS WND 5 1/2 X 5 7/8 -- DHF

Facility

$85.04

Hospital Charge Code	80249667
Hospital Revenue Code	270
Min. Negotiated Rate	$7.65
Max. Negotiated Rate	$55.28
Rate for Payer: Aetna Commercial	$46.77
Rate for Payer: Amerigroup CHIP/Medicaid	$7.65
Rate for Payer: BCBS of TX Blue Advantage	$25.51
Rate for Payer: BCBS of TX Blue Essentials	$30.61
Rate for Payer: BCBS of TX PPO	$34.02
Rate for Payer: Cash Price	$74.84
Rate for Payer: Multiplan Auto	$55.28
Rate for Payer: Multiplan Commercial	$55.28
Rate for Payer: Multiplan Workers Comp	$55.28
Rate for Payer: Scott and White EPO/PPO	$42.52
Rate for Payer: Superior Health Plan EPO	$11.57

DRS WND 7X12 -- DHF

Facility

$261.97

Hospital Charge Code	80249659
Hospital Revenue Code	270
Min. Negotiated Rate	$23.58
Max. Negotiated Rate	$170.28
Rate for Payer: Aetna Commercial	$144.08
Rate for Payer: Amerigroup CHIP/Medicaid	$23.58
Rate for Payer: BCBS of TX Blue Advantage	$78.59
Rate for Payer: BCBS of TX Blue Essentials	$94.31
Rate for Payer: BCBS of TX PPO	$104.79
Rate for Payer: Cash Price	$230.53
Rate for Payer: Multiplan Auto	$170.28
Rate for Payer: Multiplan Commercial	$170.28
Rate for Payer: Multiplan Workers Comp	$170.28
Rate for Payer: Scott and White EPO/PPO	$130.98
Rate for Payer: Superior Health Plan EPO	$35.63

DRS WND 7X12 -- DHF

Facility

$261.97

Hospital Charge Code	80249659
Hospital Revenue Code	270
Rate for Payer: Cash Price	$230.53

DRS WND ANY -- DHF

Facility

$40.74

Hospital Charge Code	80249592
Hospital Revenue Code	272
Min. Negotiated Rate	$3.67
Max. Negotiated Rate	$26.48
Rate for Payer: Aetna Commercial	$22.41
Rate for Payer: Amerigroup CHIP/Medicaid	$3.67
Rate for Payer: BCBS of TX Blue Advantage	$12.22
Rate for Payer: BCBS of TX Blue Essentials	$14.67
Rate for Payer: BCBS of TX PPO	$16.30
Rate for Payer: Cash Price	$35.85
Rate for Payer: Multiplan Auto	$26.48
Rate for Payer: Multiplan Commercial	$26.48
Rate for Payer: Multiplan Workers Comp	$26.48
Rate for Payer: Scott and White EPO/PPO	$20.37
Rate for Payer: Superior Health Plan EPO	$5.54

DRS WND ANY -- DHF

Facility

$40.74

Hospital Charge Code	80249592
Hospital Revenue Code	272
Rate for Payer: Cash Price	$35.85

Drug-induced sleep endoscopy, with dynamic evaluation of velum, pharynx, tongue base, and larynx for

Facility

$10,000.00

Service Code	CPT 42975
Hospital Charge Code	36042975
Hospital Revenue Code	360
Min. Negotiated Rate	$34.24
Max. Negotiated Rate	$10,000.00
Rate for Payer: Aetna Medicare	$2,328.34
Rate for Payer: Amerigroup CHIP/Medicaid	$68.14
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$1,552.23
Rate for Payer: Amerigroup Medicare	$1,552.23
Rate for Payer: BCBS of TX Blue Advantage	$142.38
Rate for Payer: BCBS of TX Blue Essentials	$170.52
Rate for Payer: BCBS of TX Medicare	$1,552.23
Rate for Payer: BCBS of TX PPO	$214.86
Rate for Payer: Cigna Commercial	$3,516.25
Rate for Payer: Cigna Medicaid	$68.14
Rate for Payer: Cigna Medicare	$1,552.23
Rate for Payer: Employer Direct Commercial	$1,552.23
Rate for Payer: Humana Medicare/TRICARE	$1,552.23
Rate for Payer: Molina CHIP/Medicaid	$68.14
Rate for Payer: Molina Dual Medicare/Medicaid	$1,552.23
Rate for Payer: Molina Medicare	$1,552.23
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	$68.14
Rate for Payer: Scott and White EPO/PPO	$34.24
Rate for Payer: Scott and White Medicare	$1,552.23
Rate for Payer: Superior Health Plan CHIP/Medicaid	$68.14
Rate for Payer: Superior Health Plan EPO	$1,552.23
Rate for Payer: Superior Health Plan Medicare	$1,552.23
Rate for Payer: Universal American Dual Medicare/Medicaid	$1,552.23
Rate for Payer: Universal American Medicare	$1,552.23
Rate for Payer: Wellcare Medicare	$1,552.23
Rate for Payer: Wellmed Medicare	$1,552.23

Drug Screen 10 w/Conf, Serum SO

Facility

$317.00

Service Code	CPT 80307
Hospital Charge Code	1640102
Hospital Revenue Code	300
Min. Negotiated Rate	$24.23
Max. Negotiated Rate	$206.05
Rate for Payer: Aetna Commercial	$65.24
Rate for Payer: Aetna Medicare	$93.21
Rate for Payer: Amerigroup CHIP/Medicaid	$24.23
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$62.14
Rate for Payer: Amerigroup Medicare	$62.14
Rate for Payer: BCBS of TX Blue Advantage	$102.53
Rate for Payer: BCBS of TX Blue Essentials	$123.04
Rate for Payer: BCBS of TX Medicare	$62.14
Rate for Payer: BCBS of TX PPO	$137.33
Rate for Payer: Cash Price	$278.96
Rate for Payer: Cash Price	$278.96
Rate for Payer: Cigna Medicaid	$62.14
Rate for Payer: Cigna Medicare	$62.14
Rate for Payer: Employer Direct Commercial	$62.14
Rate for Payer: Humana Medicare/TRICARE	$62.14
Rate for Payer: Molina CHIP/Medicaid	$62.14
Rate for Payer: Molina Dual Medicare/Medicaid	$62.14
Rate for Payer: Molina Medicare	$62.14
Rate for Payer: Multiplan Auto	$206.05
Rate for Payer: Multiplan Commercial	$206.05
Rate for Payer: Multiplan Workers Comp	$206.05
Rate for Payer: Parkland Medicaid	$62.14
Rate for Payer: Scott and White EPO/PPO	$77.68
Rate for Payer: Scott and White Medicare	$62.14
Rate for Payer: Superior Health Plan CHIP/Medicaid	$62.14
Rate for Payer: Superior Health Plan EPO	$62.14
Rate for Payer: Superior Health Plan Medicare	$62.14
Rate for Payer: Universal American Dual Medicare/Medicaid	$62.14
Rate for Payer: Universal American Medicare	$62.14
Rate for Payer: Wellcare Medicare	$62.14
Rate for Payer: Wellmed Medicare	$62.14

Drug Screen Urine

Facility

$317.00

Service Code	CPT 80307
Hospital Charge Code	1640102
Hospital Revenue Code	300
Min. Negotiated Rate	$24.23
Max. Negotiated Rate	$206.05
Rate for Payer: Aetna Commercial	$65.24
Rate for Payer: Aetna Medicare	$93.21
Rate for Payer: Amerigroup CHIP/Medicaid	$24.23
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$62.14
Rate for Payer: Amerigroup Medicare	$62.14
Rate for Payer: BCBS of TX Blue Advantage	$102.53
Rate for Payer: BCBS of TX Blue Essentials	$123.04
Rate for Payer: BCBS of TX Medicare	$62.14
Rate for Payer: BCBS of TX PPO	$137.33
Rate for Payer: Cash Price	$278.96
Rate for Payer: Cash Price	$278.96
Rate for Payer: Cigna Medicaid	$62.14
Rate for Payer: Cigna Medicare	$62.14
Rate for Payer: Employer Direct Commercial	$62.14
Rate for Payer: Humana Medicare/TRICARE	$62.14
Rate for Payer: Molina CHIP/Medicaid	$62.14
Rate for Payer: Molina Dual Medicare/Medicaid	$62.14
Rate for Payer: Molina Medicare	$62.14
Rate for Payer: Multiplan Auto	$206.05
Rate for Payer: Multiplan Commercial	$206.05
Rate for Payer: Multiplan Workers Comp	$206.05
Rate for Payer: Parkland Medicaid	$62.14
Rate for Payer: Scott and White EPO/PPO	$77.68
Rate for Payer: Scott and White Medicare	$62.14
Rate for Payer: Superior Health Plan CHIP/Medicaid	$62.14
Rate for Payer: Superior Health Plan EPO	$62.14
Rate for Payer: Superior Health Plan Medicare	$62.14
Rate for Payer: Universal American Dual Medicare/Medicaid	$62.14
Rate for Payer: Universal American Medicare	$62.14
Rate for Payer: Wellcare Medicare	$62.14
Rate for Payer: Wellmed Medicare	$62.14

.dRVVT Confirm 117923 SO

Facility

$150.00

Service Code	CPT 85613
Hospital Charge Code	1708353
Hospital Revenue Code	305
Min. Negotiated Rate	$3.74
Max. Negotiated Rate	$97.50
Rate for Payer: Aetna Commercial	$10.06
Rate for Payer: Aetna Medicare	$14.37
Rate for Payer: Amerigroup CHIP/Medicaid	$3.74
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$9.58
Rate for Payer: Amerigroup Medicare	$9.58
Rate for Payer: BCBS of TX Blue Advantage	$15.81
Rate for Payer: BCBS of TX Blue Essentials	$18.97
Rate for Payer: BCBS of TX Medicare	$9.58
Rate for Payer: BCBS of TX PPO	$21.17
Rate for Payer: Cash Price	$132.00
Rate for Payer: Cash Price	$132.00
Rate for Payer: Cigna Medicaid	$9.58
Rate for Payer: Cigna Medicare	$9.58
Rate for Payer: Employer Direct Commercial	$9.58
Rate for Payer: Humana Medicare/TRICARE	$9.58
Rate for Payer: Molina CHIP/Medicaid	$9.58
Rate for Payer: Molina Dual Medicare/Medicaid	$9.58
Rate for Payer: Molina Medicare	$9.58
Rate for Payer: Multiplan Auto	$97.50
Rate for Payer: Multiplan Commercial	$97.50
Rate for Payer: Multiplan Workers Comp	$97.50
Rate for Payer: Parkland Medicaid	$9.58
Rate for Payer: Scott and White EPO/PPO	$11.98
Rate for Payer: Scott and White Medicare	$9.58
Rate for Payer: Superior Health Plan CHIP/Medicaid	$9.58
Rate for Payer: Superior Health Plan EPO	$9.58
Rate for Payer: Superior Health Plan Medicare	$9.58
Rate for Payer: Universal American Dual Medicare/Medicaid	$9.58
Rate for Payer: Universal American Medicare	$9.58
Rate for Payer: Wellcare Medicare	$9.58
Rate for Payer: Wellmed Medicare	$9.58

.dRVVT Mix 117912 SO

Facility

$150.00

Service Code	CPT 85613
Hospital Charge Code	1708353
Hospital Revenue Code	305
Min. Negotiated Rate	$3.74
Max. Negotiated Rate	$97.50
Rate for Payer: Aetna Commercial	$10.06
Rate for Payer: Aetna Medicare	$14.37
Rate for Payer: Amerigroup CHIP/Medicaid	$3.74
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$9.58
Rate for Payer: Amerigroup Medicare	$9.58
Rate for Payer: BCBS of TX Blue Advantage	$15.81
Rate for Payer: BCBS of TX Blue Essentials	$18.97
Rate for Payer: BCBS of TX Medicare	$9.58
Rate for Payer: BCBS of TX PPO	$21.17
Rate for Payer: Cash Price	$132.00
Rate for Payer: Cash Price	$132.00
Rate for Payer: Cigna Medicaid	$9.58
Rate for Payer: Cigna Medicare	$9.58
Rate for Payer: Employer Direct Commercial	$9.58
Rate for Payer: Humana Medicare/TRICARE	$9.58
Rate for Payer: Molina CHIP/Medicaid	$9.58
Rate for Payer: Molina Dual Medicare/Medicaid	$9.58
Rate for Payer: Molina Medicare	$9.58
Rate for Payer: Multiplan Auto	$97.50
Rate for Payer: Multiplan Commercial	$97.50
Rate for Payer: Multiplan Workers Comp	$97.50
Rate for Payer: Parkland Medicaid	$9.58
Rate for Payer: Scott and White EPO/PPO	$11.98
Rate for Payer: Scott and White Medicare	$9.58
Rate for Payer: Superior Health Plan CHIP/Medicaid	$9.58
Rate for Payer: Superior Health Plan EPO	$9.58
Rate for Payer: Superior Health Plan Medicare	$9.58
Rate for Payer: Universal American Dual Medicare/Medicaid	$9.58
Rate for Payer: Universal American Medicare	$9.58
Rate for Payer: Wellcare Medicare	$9.58
Rate for Payer: Wellmed Medicare	$9.58

DUAL CHAMBER IMPL DEFIBRILLATOR ELLIPS

Facility

$108,102.41

Service Code	HCPCS C1721
Hospital Charge Code	8394467
Hospital Revenue Code	275
Min. Negotiated Rate	$27,025.60
Max. Negotiated Rate	$54,051.20
Rate for Payer: Aetna Commercial	$32,430.72
Rate for Payer: Cash Price	$95,130.12
Rate for Payer: Cigna Commercial	$27,025.60
Rate for Payer: Multiplan Auto	$54,051.20
Rate for Payer: Multiplan Commercial	$54,051.20
Rate for Payer: Multiplan Workers Comp	$54,051.20
Rate for Payer: Scott and White EPO/PPO	$54,051.20

DUAL CHAMBER IMPL DEFIBRILLATOR ELLIPS

Facility

$108,102.41

Service Code	HCPCS C1721
Hospital Charge Code	8394467
Hospital Revenue Code	275
Min. Negotiated Rate	$9,729.22
Max. Negotiated Rate	$54,051.20
Rate for Payer: Aetna Commercial	$32,430.72
Rate for Payer: Amerigroup CHIP/Medicaid	$9,729.22
Rate for Payer: BCBS of TX Blue Advantage	$32,430.72
Rate for Payer: BCBS of TX Blue Essentials	$38,916.87
Rate for Payer: BCBS of TX PPO	$43,240.96
Rate for Payer: Cash Price	$95,130.12
Rate for Payer: Multiplan Auto	$54,051.20
Rate for Payer: Multiplan Commercial	$54,051.20
Rate for Payer: Multiplan Workers Comp	$54,051.20
Rate for Payer: Scott and White EPO/PPO	$54,051.20
Rate for Payer: Superior Health Plan EPO	$14,701.93

DULoxetine 20 mg DR Cap

Facility

$25.50

Service Code	HCPCS J3490
Hospital Charge Code	78419952
Hospital Revenue Code	250
Rate for Payer: Cash Price	$17.34

DULoxetine 20 mg DR Cap

Facility

$25.50

Service Code	HCPCS J3490
Hospital Charge Code	78419952
Hospital Revenue Code	250
Min. Negotiated Rate	$2.30
Max. Negotiated Rate	$16.58
Rate for Payer: Amerigroup CHIP/Medicaid	$2.30
Rate for Payer: BCBS of TX Blue Advantage	$7.65
Rate for Payer: BCBS of TX Blue Essentials	$9.18
Rate for Payer: BCBS of TX PPO	$10.20
Rate for Payer: Cash Price	$17.34
Rate for Payer: Multiplan Auto	$16.58
Rate for Payer: Multiplan Commercial	$16.58
Rate for Payer: Multiplan Workers Comp	$16.58
Rate for Payer: Scott and White EPO/PPO	$12.75
Rate for Payer: Superior Health Plan EPO	$3.47

DULoxetine 30 mg DR Cap

Facility

$30.10

Service Code	HCPCS J3490
Hospital Charge Code	77528696
Hospital Revenue Code	250
Rate for Payer: Cash Price	$20.47

DULoxetine 30 mg DR Cap

Facility

$30.10

Service Code	HCPCS J3490
Hospital Charge Code	77528696
Hospital Revenue Code	250
Min. Negotiated Rate	$2.71
Max. Negotiated Rate	$19.56
Rate for Payer: Amerigroup CHIP/Medicaid	$2.71
Rate for Payer: BCBS of TX Blue Advantage	$9.03
Rate for Payer: BCBS of TX Blue Essentials	$10.84
Rate for Payer: BCBS of TX PPO	$12.04
Rate for Payer: Cash Price	$20.47
Rate for Payer: Multiplan Auto	$19.56
Rate for Payer: Multiplan Commercial	$19.56
Rate for Payer: Multiplan Workers Comp	$19.56
Rate for Payer: Scott and White EPO/PPO	$15.05
Rate for Payer: Superior Health Plan EPO	$4.09

Duplex Scan Extremity Veins Complete Bilateral

Facility

$2,850.00

Service Code	CPT 93970
Hospital Charge Code	7100332
Hospital Revenue Code	921
Min. Negotiated Rate	$4.01
Max. Negotiated Rate	$1,852.50
Rate for Payer: Aetna Commercial	$315.95
Rate for Payer: Aetna Medicare	$336.15
Rate for Payer: Amerigroup CHIP/Medicaid	$256.50
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$224.10
Rate for Payer: Amerigroup Medicare	$224.10
Rate for Payer: BCBS of TX Blue Advantage	$284.70
Rate for Payer: BCBS of TX Blue Essentials	$340.33
Rate for Payer: BCBS of TX Medicare	$224.10
Rate for Payer: BCBS of TX PPO	$379.60
Rate for Payer: Cash Price	$2,508.00
Rate for Payer: Cash Price	$2,508.00
Rate for Payer: Cash Price	$2,508.00
Rate for Payer: Cigna Commercial	$507.64
Rate for Payer: Cigna Medicaid	$188.79
Rate for Payer: Cigna Medicare	$224.10
Rate for Payer: Employer Direct Commercial	$224.10
Rate for Payer: Humana Medicare/TRICARE	$224.10
Rate for Payer: Molina CHIP/Medicaid	$188.79
Rate for Payer: Molina Dual Medicare/Medicaid	$224.10
Rate for Payer: Molina Medicare	$224.10
Rate for Payer: Multiplan Auto	$1,852.50
Rate for Payer: Multiplan Commercial	$1,852.50
Rate for Payer: Multiplan Workers Comp	$1,852.50
Rate for Payer: Parkland Medicaid	$188.79
Rate for Payer: Scott and White EPO/PPO	$4.01
Rate for Payer: Scott and White Medicare	$224.10
Rate for Payer: Superior Health Plan CHIP/Medicaid	$188.79
Rate for Payer: Superior Health Plan EPO	$224.10
Rate for Payer: Superior Health Plan Medicare	$224.10
Rate for Payer: Universal American Dual Medicare/Medicaid	$224.10
Rate for Payer: Universal American Medicare	$224.10
Rate for Payer: Wellcare Medicare	$224.10
Rate for Payer: Wellmed Medicare	$224.10

Duplex scan of extremity veins including responses to compression and other maneuvers; complete bila

Facility

$10,000.00

Service Code	CPT 93970
Hospital Charge Code	36093970
Hospital Revenue Code	360
Min. Negotiated Rate	$4.01
Max. Negotiated Rate	$10,000.00
Rate for Payer: Aetna Commercial	$315.95
Rate for Payer: Aetna Medicare	$336.15
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$224.10
Rate for Payer: Amerigroup Medicare	$224.10
Rate for Payer: BCBS of TX Blue Advantage	$284.70
Rate for Payer: BCBS of TX Blue Essentials	$340.33
Rate for Payer: BCBS of TX Medicare	$224.10
Rate for Payer: BCBS of TX PPO	$379.60
Rate for Payer: Cigna Commercial	$507.64
Rate for Payer: Cigna Medicaid	$188.79
Rate for Payer: Cigna Medicare	$224.10
Rate for Payer: Employer Direct Commercial	$224.10
Rate for Payer: Humana Medicare/TRICARE	$224.10
Rate for Payer: Molina CHIP/Medicaid	$188.79
Rate for Payer: Molina Dual Medicare/Medicaid	$224.10
Rate for Payer: Molina Medicare	$224.10
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	$188.79
Rate for Payer: Scott and White EPO/PPO	$4.01
Rate for Payer: Scott and White Medicare	$224.10
Rate for Payer: Superior Health Plan CHIP/Medicaid	$188.79
Rate for Payer: Superior Health Plan EPO	$224.10
Rate for Payer: Superior Health Plan Medicare	$224.10
Rate for Payer: Universal American Dual Medicare/Medicaid	$224.10
Rate for Payer: Universal American Medicare	$224.10
Rate for Payer: Wellcare Medicare	$224.10
Rate for Payer: Wellmed Medicare	$224.10

Know your out-of-pocket cost for care.

All Charges