White Rock Medical Center

All Charges

Charge

Type

Setting

Price

EAR TUBE -- DHF

Facility

$155.00

Hospital Charge Code	81210650
Hospital Revenue Code	278
Min. Negotiated Rate	$13.95
Max. Negotiated Rate	$77.50
Rate for Payer: Aetna Commercial	$46.50
Rate for Payer: Amerigroup CHIP/Medicaid	$13.95
Rate for Payer: BCBS of TX Blue Advantage	$46.50
Rate for Payer: BCBS of TX Blue Essentials	$55.80
Rate for Payer: BCBS of TX PPO	$62.00
Rate for Payer: Cash Price	$136.40
Rate for Payer: Multiplan Auto	$77.50
Rate for Payer: Multiplan Commercial	$77.50
Rate for Payer: Multiplan Workers Comp	$77.50
Rate for Payer: Scott and White EPO/PPO	$77.50
Rate for Payer: Superior Health Plan EPO	$21.08

EBV Ab VCA, IgG SO

Facility

$164.00

Service Code	CPT 86665
Hospital Charge Code	1702232
Hospital Revenue Code	302
Min. Negotiated Rate	$7.07
Max. Negotiated Rate	$106.60
Rate for Payer: Aetna Commercial	$19.04
Rate for Payer: Aetna Medicare	$27.21
Rate for Payer: Amerigroup CHIP/Medicaid	$7.07
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$18.14
Rate for Payer: Amerigroup Medicare	$18.14
Rate for Payer: BCBS of TX Blue Advantage	$29.93
Rate for Payer: BCBS of TX Blue Essentials	$35.92
Rate for Payer: BCBS of TX Medicare	$18.14
Rate for Payer: BCBS of TX PPO	$40.09
Rate for Payer: Cash Price	$144.32
Rate for Payer: Cash Price	$144.32
Rate for Payer: Cigna Medicaid	$18.14
Rate for Payer: Cigna Medicare	$18.14
Rate for Payer: Employer Direct Commercial	$18.14
Rate for Payer: Humana Medicare/TRICARE	$18.14
Rate for Payer: Molina CHIP/Medicaid	$18.14
Rate for Payer: Molina Dual Medicare/Medicaid	$18.14
Rate for Payer: Molina Medicare	$18.14
Rate for Payer: Multiplan Auto	$106.60
Rate for Payer: Multiplan Commercial	$106.60
Rate for Payer: Multiplan Workers Comp	$106.60
Rate for Payer: Parkland Medicaid	$18.14
Rate for Payer: Scott and White EPO/PPO	$22.68
Rate for Payer: Scott and White Medicare	$18.14
Rate for Payer: Superior Health Plan CHIP/Medicaid	$18.14
Rate for Payer: Superior Health Plan EPO	$18.14
Rate for Payer: Superior Health Plan Medicare	$18.14
Rate for Payer: Universal American Dual Medicare/Medicaid	$18.14
Rate for Payer: Universal American Medicare	$18.14
Rate for Payer: Wellcare Medicare	$18.14
Rate for Payer: Wellmed Medicare	$18.14

EBV Ab VCA, IgM SO

Facility

$164.00

Service Code	CPT 86665
Hospital Charge Code	1702232
Hospital Revenue Code	302
Min. Negotiated Rate	$7.07
Max. Negotiated Rate	$106.60
Rate for Payer: Aetna Commercial	$19.04
Rate for Payer: Aetna Medicare	$27.21
Rate for Payer: Amerigroup CHIP/Medicaid	$7.07
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$18.14
Rate for Payer: Amerigroup Medicare	$18.14
Rate for Payer: BCBS of TX Blue Advantage	$29.93
Rate for Payer: BCBS of TX Blue Essentials	$35.92
Rate for Payer: BCBS of TX Medicare	$18.14
Rate for Payer: BCBS of TX PPO	$40.09
Rate for Payer: Cash Price	$144.32
Rate for Payer: Cash Price	$144.32
Rate for Payer: Cigna Medicaid	$18.14
Rate for Payer: Cigna Medicare	$18.14
Rate for Payer: Employer Direct Commercial	$18.14
Rate for Payer: Humana Medicare/TRICARE	$18.14
Rate for Payer: Molina CHIP/Medicaid	$18.14
Rate for Payer: Molina Dual Medicare/Medicaid	$18.14
Rate for Payer: Molina Medicare	$18.14
Rate for Payer: Multiplan Auto	$106.60
Rate for Payer: Multiplan Commercial	$106.60
Rate for Payer: Multiplan Workers Comp	$106.60
Rate for Payer: Parkland Medicaid	$18.14
Rate for Payer: Scott and White EPO/PPO	$22.68
Rate for Payer: Scott and White Medicare	$18.14
Rate for Payer: Superior Health Plan CHIP/Medicaid	$18.14
Rate for Payer: Superior Health Plan EPO	$18.14
Rate for Payer: Superior Health Plan Medicare	$18.14
Rate for Payer: Universal American Dual Medicare/Medicaid	$18.14
Rate for Payer: Universal American Medicare	$18.14
Rate for Payer: Wellcare Medicare	$18.14
Rate for Payer: Wellmed Medicare	$18.14

EBV Ab VCA, IgM SO

Facility

$164.00

Service Code	CPT 86665
Hospital Charge Code	1702232
Hospital Revenue Code	302
Rate for Payer: Cash Price	$144.32

EBVCA(IgG+IgM)+EBVNIg SO

Facility

$39.00

Service Code	CPT 86664
Hospital Charge Code	1703040
Hospital Revenue Code	302
Min. Negotiated Rate	$5.96
Max. Negotiated Rate	$33.79
Rate for Payer: Aetna Commercial	$16.05
Rate for Payer: Aetna Medicare	$22.94
Rate for Payer: Amerigroup CHIP/Medicaid	$5.96
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$15.29
Rate for Payer: Amerigroup Medicare	$15.29
Rate for Payer: BCBS of TX Blue Advantage	$25.23
Rate for Payer: BCBS of TX Blue Essentials	$30.27
Rate for Payer: BCBS of TX Medicare	$15.29
Rate for Payer: BCBS of TX PPO	$33.79
Rate for Payer: Cash Price	$34.32
Rate for Payer: Cash Price	$34.32
Rate for Payer: Cigna Medicaid	$15.29
Rate for Payer: Cigna Medicare	$15.29
Rate for Payer: Employer Direct Commercial	$15.29
Rate for Payer: Humana Medicare/TRICARE	$15.29
Rate for Payer: Molina CHIP/Medicaid	$15.29
Rate for Payer: Molina Dual Medicare/Medicaid	$15.29
Rate for Payer: Molina Medicare	$15.29
Rate for Payer: Multiplan Auto	$25.35
Rate for Payer: Multiplan Commercial	$25.35
Rate for Payer: Multiplan Workers Comp	$25.35
Rate for Payer: Parkland Medicaid	$15.29
Rate for Payer: Scott and White EPO/PPO	$19.11
Rate for Payer: Scott and White Medicare	$15.29
Rate for Payer: Superior Health Plan CHIP/Medicaid	$15.29
Rate for Payer: Superior Health Plan EPO	$15.29
Rate for Payer: Superior Health Plan Medicare	$15.29
Rate for Payer: Universal American Dual Medicare/Medicaid	$15.29
Rate for Payer: Universal American Medicare	$15.29
Rate for Payer: Wellcare Medicare	$15.29
Rate for Payer: Wellmed Medicare	$15.29

EBV Early Antigen Ab, IgG SO

Facility

$93.00

Service Code	CPT 86663
Hospital Charge Code	1702224
Hospital Revenue Code	302
Min. Negotiated Rate	$5.12
Max. Negotiated Rate	$60.45
Rate for Payer: Aetna Commercial	$13.77
Rate for Payer: Aetna Medicare	$19.68
Rate for Payer: Amerigroup CHIP/Medicaid	$5.12
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$13.12
Rate for Payer: Amerigroup Medicare	$13.12
Rate for Payer: BCBS of TX Blue Advantage	$21.65
Rate for Payer: BCBS of TX Blue Essentials	$25.98
Rate for Payer: BCBS of TX Medicare	$13.12
Rate for Payer: BCBS of TX PPO	$29.00
Rate for Payer: Cash Price	$81.84
Rate for Payer: Cash Price	$81.84
Rate for Payer: Cigna Medicaid	$13.12
Rate for Payer: Cigna Medicare	$13.12
Rate for Payer: Employer Direct Commercial	$13.12
Rate for Payer: Humana Medicare/TRICARE	$13.12
Rate for Payer: Molina CHIP/Medicaid	$13.12
Rate for Payer: Molina Dual Medicare/Medicaid	$13.12
Rate for Payer: Molina Medicare	$13.12
Rate for Payer: Multiplan Auto	$60.45
Rate for Payer: Multiplan Commercial	$60.45
Rate for Payer: Multiplan Workers Comp	$60.45
Rate for Payer: Parkland Medicaid	$13.12
Rate for Payer: Scott and White EPO/PPO	$16.40
Rate for Payer: Scott and White Medicare	$13.12
Rate for Payer: Superior Health Plan CHIP/Medicaid	$13.12
Rate for Payer: Superior Health Plan EPO	$13.12
Rate for Payer: Superior Health Plan Medicare	$13.12
Rate for Payer: Universal American Dual Medicare/Medicaid	$13.12
Rate for Payer: Universal American Medicare	$13.12
Rate for Payer: Wellcare Medicare	$13.12
Rate for Payer: Wellmed Medicare	$13.12

EBV Early Antigen Ab, IgG SO

Facility

$93.00

Service Code	CPT 86663
Hospital Charge Code	1702224
Hospital Revenue Code	302
Rate for Payer: Cash Price	$81.84

EBV Nuclear Antigen Ab, IgG SO

Facility

$39.00

Service Code	CPT 86664
Hospital Charge Code	1703040
Hospital Revenue Code	302
Rate for Payer: Cash Price	$34.32

EBV Nuclear Antigen Ab, IgG SO

Facility

$39.00

Service Code	CPT 86664
Hospital Charge Code	1703040
Hospital Revenue Code	302
Min. Negotiated Rate	$5.96
Max. Negotiated Rate	$33.79
Rate for Payer: Aetna Commercial	$16.05
Rate for Payer: Aetna Medicare	$22.94
Rate for Payer: Amerigroup CHIP/Medicaid	$5.96
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$15.29
Rate for Payer: Amerigroup Medicare	$15.29
Rate for Payer: BCBS of TX Blue Advantage	$25.23
Rate for Payer: BCBS of TX Blue Essentials	$30.27
Rate for Payer: BCBS of TX Medicare	$15.29
Rate for Payer: BCBS of TX PPO	$33.79
Rate for Payer: Cash Price	$34.32
Rate for Payer: Cash Price	$34.32
Rate for Payer: Cigna Medicaid	$15.29
Rate for Payer: Cigna Medicare	$15.29
Rate for Payer: Employer Direct Commercial	$15.29
Rate for Payer: Humana Medicare/TRICARE	$15.29
Rate for Payer: Molina CHIP/Medicaid	$15.29
Rate for Payer: Molina Dual Medicare/Medicaid	$15.29
Rate for Payer: Molina Medicare	$15.29
Rate for Payer: Multiplan Auto	$25.35
Rate for Payer: Multiplan Commercial	$25.35
Rate for Payer: Multiplan Workers Comp	$25.35
Rate for Payer: Parkland Medicaid	$15.29
Rate for Payer: Scott and White EPO/PPO	$19.11
Rate for Payer: Scott and White Medicare	$15.29
Rate for Payer: Superior Health Plan CHIP/Medicaid	$15.29
Rate for Payer: Superior Health Plan EPO	$15.29
Rate for Payer: Superior Health Plan Medicare	$15.29
Rate for Payer: Universal American Dual Medicare/Medicaid	$15.29
Rate for Payer: Universal American Medicare	$15.29
Rate for Payer: Wellcare Medicare	$15.29
Rate for Payer: Wellmed Medicare	$15.29

ECHELON 60MM REINFORCEMENT ECH60R

Facility

$930.70

Hospital Charge Code	8708547
Hospital Revenue Code	272
Min. Negotiated Rate	$83.76
Max. Negotiated Rate	$604.96
Rate for Payer: Aetna Commercial	$511.88
Rate for Payer: Amerigroup CHIP/Medicaid	$83.76
Rate for Payer: BCBS of TX Blue Advantage	$279.21
Rate for Payer: BCBS of TX Blue Essentials	$335.05
Rate for Payer: BCBS of TX PPO	$372.28
Rate for Payer: Cash Price	$819.02
Rate for Payer: Multiplan Auto	$604.96
Rate for Payer: Multiplan Commercial	$604.96
Rate for Payer: Multiplan Workers Comp	$604.96
Rate for Payer: Scott and White EPO/PPO	$465.35
Rate for Payer: Superior Health Plan EPO	$126.58

ECHELON 60MM REINFORCEMENT ECH60R

Facility

$930.70

Hospital Charge Code	8708547
Hospital Revenue Code	272
Rate for Payer: Cash Price	$819.02

Echo2D Spectr/Color FLO 93306

Facility

$4,727.00

Service Code	CPT 93306
Hospital Charge Code	2800852
Hospital Revenue Code	480
Min. Negotiated Rate	$9.02
Max. Negotiated Rate	$3,072.55
Rate for Payer: Aetna Commercial	$223.97
Rate for Payer: Aetna Medicare	$756.80
Rate for Payer: Amerigroup CHIP/Medicaid	$425.43
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$504.53
Rate for Payer: Amerigroup Medicare	$504.53
Rate for Payer: BCBS of TX Blue Advantage	$235.79
Rate for Payer: BCBS of TX Blue Essentials	$281.86
Rate for Payer: BCBS of TX Medicare	$504.53
Rate for Payer: BCBS of TX PPO	$314.38
Rate for Payer: Cash Price	$4,159.76
Rate for Payer: Cash Price	$4,159.76
Rate for Payer: Cash Price	$4,159.76
Rate for Payer: Cigna Commercial	$1,142.91
Rate for Payer: Cigna Medicare	$504.53
Rate for Payer: Employer Direct Commercial	$504.53
Rate for Payer: Humana Medicare/TRICARE	$504.53
Rate for Payer: Molina Dual Medicare/Medicaid	$504.53
Rate for Payer: Molina Medicare	$504.53
Rate for Payer: Multiplan Auto	$3,072.55
Rate for Payer: Multiplan Commercial	$3,072.55
Rate for Payer: Multiplan Workers Comp	$3,072.55
Rate for Payer: Scott and White EPO/PPO	$9.02
Rate for Payer: Scott and White Medicare	$504.53
Rate for Payer: Superior Health Plan EPO	$504.53
Rate for Payer: Superior Health Plan Medicare	$504.53
Rate for Payer: Universal American Dual Medicare/Medicaid	$504.53
Rate for Payer: Universal American Medicare	$504.53
Rate for Payer: Wellcare Medicare	$504.53
Rate for Payer: Wellmed Medicare	$504.53

Echo2D Spectr/Color FLO 93306 BCE

Facility

$4,727.00

Service Code	CPT 93306
Hospital Charge Code	2800852
Hospital Revenue Code	480
Rate for Payer: Cash Price	$4,159.76

Echo2D Spectr/Color FLO 93306 BCE

Facility

$4,727.00

Service Code	CPT 93306
Hospital Charge Code	2800852
Hospital Revenue Code	480
Min. Negotiated Rate	$9.02
Max. Negotiated Rate	$3,072.55
Rate for Payer: Aetna Commercial	$223.97
Rate for Payer: Aetna Medicare	$756.80
Rate for Payer: Amerigroup CHIP/Medicaid	$425.43
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$504.53
Rate for Payer: Amerigroup Medicare	$504.53
Rate for Payer: BCBS of TX Blue Advantage	$235.79
Rate for Payer: BCBS of TX Blue Essentials	$281.86
Rate for Payer: BCBS of TX Medicare	$504.53
Rate for Payer: BCBS of TX PPO	$314.38
Rate for Payer: Cash Price	$4,159.76
Rate for Payer: Cash Price	$4,159.76
Rate for Payer: Cash Price	$4,159.76
Rate for Payer: Cigna Commercial	$1,142.91
Rate for Payer: Cigna Medicare	$504.53
Rate for Payer: Employer Direct Commercial	$504.53
Rate for Payer: Humana Medicare/TRICARE	$504.53
Rate for Payer: Molina Dual Medicare/Medicaid	$504.53
Rate for Payer: Molina Medicare	$504.53
Rate for Payer: Multiplan Auto	$3,072.55
Rate for Payer: Multiplan Commercial	$3,072.55
Rate for Payer: Multiplan Workers Comp	$3,072.55
Rate for Payer: Scott and White EPO/PPO	$9.02
Rate for Payer: Scott and White Medicare	$504.53
Rate for Payer: Superior Health Plan EPO	$504.53
Rate for Payer: Superior Health Plan Medicare	$504.53
Rate for Payer: Universal American Dual Medicare/Medicaid	$504.53
Rate for Payer: Universal American Medicare	$504.53
Rate for Payer: Wellcare Medicare	$504.53
Rate for Payer: Wellmed Medicare	$504.53

Echocardio 2D LTD 93308

Facility

$1,518.00

Service Code	CPT 93308
Hospital Charge Code	2800688
Hospital Revenue Code	480
Min. Negotiated Rate	$4.01
Max. Negotiated Rate	$986.70
Rate for Payer: Aetna Commercial	$127.27
Rate for Payer: Aetna Medicare	$336.15
Rate for Payer: Amerigroup CHIP/Medicaid	$136.62
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$224.10
Rate for Payer: Amerigroup Medicare	$224.10
Rate for Payer: BCBS of TX Blue Advantage	$128.55
Rate for Payer: BCBS of TX Blue Essentials	$153.67
Rate for Payer: BCBS of TX Medicare	$224.10
Rate for Payer: BCBS of TX PPO	$171.40
Rate for Payer: Cash Price	$1,335.84
Rate for Payer: Cash Price	$1,335.84
Rate for Payer: Cash Price	$1,335.84
Rate for Payer: Cigna Commercial	$507.64
Rate for Payer: Cigna Medicaid	$98.24
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	$98.24
Rate for Payer: Molina Dual Medicare/Medicaid	$224.10
Rate for Payer: Molina Medicare	$224.10
Rate for Payer: Multiplan Auto	$986.70
Rate for Payer: Multiplan Commercial	$986.70
Rate for Payer: Multiplan Workers Comp	$986.70
Rate for Payer: Parkland Medicaid	$98.24
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	$98.24
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

Echocardio 2D LTD 93308 BCE

Facility

$1,518.00

Service Code	CPT 93308
Hospital Charge Code	2800688
Hospital Revenue Code	480
Min. Negotiated Rate	$4.01
Max. Negotiated Rate	$986.70
Rate for Payer: Aetna Commercial	$127.27
Rate for Payer: Aetna Medicare	$336.15
Rate for Payer: Amerigroup CHIP/Medicaid	$136.62
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$224.10
Rate for Payer: Amerigroup Medicare	$224.10
Rate for Payer: BCBS of TX Blue Advantage	$128.55
Rate for Payer: BCBS of TX Blue Essentials	$153.67
Rate for Payer: BCBS of TX Medicare	$224.10
Rate for Payer: BCBS of TX PPO	$171.40
Rate for Payer: Cash Price	$1,335.84
Rate for Payer: Cash Price	$1,335.84
Rate for Payer: Cash Price	$1,335.84
Rate for Payer: Cigna Commercial	$507.64
Rate for Payer: Cigna Medicaid	$98.24
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	$98.24
Rate for Payer: Molina Dual Medicare/Medicaid	$224.10
Rate for Payer: Molina Medicare	$224.10
Rate for Payer: Multiplan Auto	$986.70
Rate for Payer: Multiplan Commercial	$986.70
Rate for Payer: Multiplan Workers Comp	$986.70
Rate for Payer: Parkland Medicaid	$98.24
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	$98.24
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

Echocardio 2D LTD 93308 BCE

Facility

$1,518.00

Service Code	CPT 93308
Hospital Charge Code	2800688
Hospital Revenue Code	480
Rate for Payer: Cash Price	$1,335.84

Echocardiogram Doppler 93320

Facility

$920.00

Service Code	CPT 93320
Hospital Charge Code	2800241
Hospital Revenue Code	480
Min. Negotiated Rate	$58.02
Max. Negotiated Rate	$598.00
Rate for Payer: Aetna Commercial	$58.02
Rate for Payer: Amerigroup CHIP/Medicaid	$82.80
Rate for Payer: BCBS of TX Blue Advantage	$62.08
Rate for Payer: BCBS of TX Blue Essentials	$74.21
Rate for Payer: BCBS of TX PPO	$82.78
Rate for Payer: Cash Price	$809.60
Rate for Payer: Cash Price	$809.60
Rate for Payer: Multiplan Auto	$598.00
Rate for Payer: Multiplan Commercial	$598.00
Rate for Payer: Multiplan Workers Comp	$598.00
Rate for Payer: Scott and White EPO/PPO	$460.00
Rate for Payer: Superior Health Plan EPO	$125.12

Echocardiogram Doppler 93320 BCE

Facility

$920.00

Service Code	CPT 93320
Hospital Charge Code	2800241
Hospital Revenue Code	480
Min. Negotiated Rate	$58.02
Max. Negotiated Rate	$598.00
Rate for Payer: Aetna Commercial	$58.02
Rate for Payer: Amerigroup CHIP/Medicaid	$82.80
Rate for Payer: BCBS of TX Blue Advantage	$62.08
Rate for Payer: BCBS of TX Blue Essentials	$74.21
Rate for Payer: BCBS of TX PPO	$82.78
Rate for Payer: Cash Price	$809.60
Rate for Payer: Cash Price	$809.60
Rate for Payer: Multiplan Auto	$598.00
Rate for Payer: Multiplan Commercial	$598.00
Rate for Payer: Multiplan Workers Comp	$598.00
Rate for Payer: Scott and White EPO/PPO	$460.00
Rate for Payer: Superior Health Plan EPO	$125.12

Echocardiogram Doppler 93320 BCE

Facility

$920.00

Service Code	CPT 93320
Hospital Charge Code	2800241
Hospital Revenue Code	480
Rate for Payer: Cash Price	$809.60

Echocardiogram Ex Stress 93350

Facility

$2,782.00

Service Code	CPT 93350
Hospital Charge Code	2800704
Hospital Revenue Code	480
Min. Negotiated Rate	$9.02
Max. Negotiated Rate	$1,808.30
Rate for Payer: Aetna Commercial	$206.63
Rate for Payer: Aetna Medicare	$756.80
Rate for Payer: Amerigroup CHIP/Medicaid	$250.38
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$504.53
Rate for Payer: Amerigroup Medicare	$504.53
Rate for Payer: BCBS of TX Blue Advantage	$206.31
Rate for Payer: BCBS of TX Blue Essentials	$246.63
Rate for Payer: BCBS of TX Medicare	$504.53
Rate for Payer: BCBS of TX PPO	$275.08
Rate for Payer: Cash Price	$2,448.16
Rate for Payer: Cash Price	$2,448.16
Rate for Payer: Cash Price	$2,448.16
Rate for Payer: Cigna Commercial	$1,142.91
Rate for Payer: Cigna Medicaid	$185.11
Rate for Payer: Cigna Medicare	$504.53
Rate for Payer: Employer Direct Commercial	$504.53
Rate for Payer: Humana Medicare/TRICARE	$504.53
Rate for Payer: Molina CHIP/Medicaid	$185.11
Rate for Payer: Molina Dual Medicare/Medicaid	$504.53
Rate for Payer: Molina Medicare	$504.53
Rate for Payer: Multiplan Auto	$1,808.30
Rate for Payer: Multiplan Commercial	$1,808.30
Rate for Payer: Multiplan Workers Comp	$1,808.30
Rate for Payer: Parkland Medicaid	$185.11
Rate for Payer: Scott and White EPO/PPO	$9.02
Rate for Payer: Scott and White Medicare	$504.53
Rate for Payer: Superior Health Plan CHIP/Medicaid	$185.11
Rate for Payer: Superior Health Plan EPO	$504.53
Rate for Payer: Superior Health Plan Medicare	$504.53
Rate for Payer: Universal American Dual Medicare/Medicaid	$504.53
Rate for Payer: Universal American Medicare	$504.53
Rate for Payer: Wellcare Medicare	$504.53
Rate for Payer: Wellmed Medicare	$504.53

Echocardiogram Ex Stress 93350 BCE

Facility

$2,782.00

Service Code	CPT 93350
Hospital Charge Code	2800704
Hospital Revenue Code	480
Min. Negotiated Rate	$9.02
Max. Negotiated Rate	$1,808.30
Rate for Payer: Aetna Commercial	$206.63
Rate for Payer: Aetna Medicare	$756.80
Rate for Payer: Amerigroup CHIP/Medicaid	$250.38
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$504.53
Rate for Payer: Amerigroup Medicare	$504.53
Rate for Payer: BCBS of TX Blue Advantage	$206.31
Rate for Payer: BCBS of TX Blue Essentials	$246.63
Rate for Payer: BCBS of TX Medicare	$504.53
Rate for Payer: BCBS of TX PPO	$275.08
Rate for Payer: Cash Price	$2,448.16
Rate for Payer: Cash Price	$2,448.16
Rate for Payer: Cash Price	$2,448.16
Rate for Payer: Cigna Commercial	$1,142.91
Rate for Payer: Cigna Medicaid	$185.11
Rate for Payer: Cigna Medicare	$504.53
Rate for Payer: Employer Direct Commercial	$504.53
Rate for Payer: Humana Medicare/TRICARE	$504.53
Rate for Payer: Molina CHIP/Medicaid	$185.11
Rate for Payer: Molina Dual Medicare/Medicaid	$504.53
Rate for Payer: Molina Medicare	$504.53
Rate for Payer: Multiplan Auto	$1,808.30
Rate for Payer: Multiplan Commercial	$1,808.30
Rate for Payer: Multiplan Workers Comp	$1,808.30
Rate for Payer: Parkland Medicaid	$185.11
Rate for Payer: Scott and White EPO/PPO	$9.02
Rate for Payer: Scott and White Medicare	$504.53
Rate for Payer: Superior Health Plan CHIP/Medicaid	$185.11
Rate for Payer: Superior Health Plan EPO	$504.53
Rate for Payer: Superior Health Plan Medicare	$504.53
Rate for Payer: Universal American Dual Medicare/Medicaid	$504.53
Rate for Payer: Universal American Medicare	$504.53
Rate for Payer: Wellcare Medicare	$504.53
Rate for Payer: Wellmed Medicare	$504.53

Echocardiogram Ex Stress 93350 BCE

Facility

$2,782.00

Service Code	CPT 93350
Hospital Charge Code	2800704
Hospital Revenue Code	480
Rate for Payer: Cash Price	$2,448.16

Echocardiogram Transesophageal (TEE) BCE

Facility

$2,932.00

Service Code	CPT 93314
Hospital Charge Code	8614517
Hospital Revenue Code	483
Min. Negotiated Rate	$243.58
Max. Negotiated Rate	$1,905.80
Rate for Payer: Aetna Commercial	$243.58
Rate for Payer: Amerigroup CHIP/Medicaid	$263.88
Rate for Payer: BCBS of TX Blue Advantage	$258.36
Rate for Payer: BCBS of TX Blue Essentials	$308.84
Rate for Payer: BCBS of TX PPO	$344.47
Rate for Payer: Cash Price	$2,580.16
Rate for Payer: Cash Price	$2,580.16
Rate for Payer: Multiplan Auto	$1,905.80
Rate for Payer: Multiplan Commercial	$1,905.80
Rate for Payer: Multiplan Workers Comp	$1,905.80
Rate for Payer: Scott and White EPO/PPO	$1,466.00
Rate for Payer: Superior Health Plan EPO	$398.75

Echocardiogram Transesophageal (TEE) BCE

Facility

$2,932.00

Service Code	CPT 93314
Hospital Charge Code	8614517
Hospital Revenue Code	483
Rate for Payer: Cash Price	$2,580.16

Know your out-of-pocket cost for care.

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