White Rock Medical Center

All Charges

Charge

Type

Setting

Price

fentaNYL 50 mcg/mL Inj Soln 2 mL

Facility

$128.17

Service Code	HCPCS J3010
Hospital Charge Code	77567548
Hospital Revenue Code	636
Min. Negotiated Rate	$0.57
Max. Negotiated Rate	$83.31
Rate for Payer: Amerigroup CHIP/Medicaid	$11.54
Rate for Payer: BCBS of TX Blue Advantage	$0.57
Rate for Payer: BCBS of TX Blue Essentials	$0.68
Rate for Payer: BCBS of TX PPO	$0.75
Rate for Payer: Cash Price	$87.16
Rate for Payer: Cash Price	$87.16
Rate for Payer: Multiplan Auto	$83.31
Rate for Payer: Multiplan Commercial	$83.31
Rate for Payer: Multiplan Workers Comp	$83.31
Rate for Payer: Scott and White EPO/PPO	$64.08
Rate for Payer: Superior Health Plan EPO	$17.43

fentaNYL 50 mcg/mL Inj Soln 50 mL

Facility

$128.19

Service Code	HCPCS J3010
Hospital Charge Code	77567841
Hospital Revenue Code	636
Min. Negotiated Rate	$32.05
Max. Negotiated Rate	$64.10
Rate for Payer: Cash Price	$87.17
Rate for Payer: Cigna Commercial	$32.05
Rate for Payer: Scott and White EPO/PPO	$64.10

fentaNYL 50 mcg/mL Inj Soln 50 mL

Facility

$128.19

Service Code	HCPCS J3010
Hospital Charge Code	77567841
Hospital Revenue Code	636
Min. Negotiated Rate	$0.57
Max. Negotiated Rate	$83.32
Rate for Payer: Amerigroup CHIP/Medicaid	$11.54
Rate for Payer: BCBS of TX Blue Advantage	$0.57
Rate for Payer: BCBS of TX Blue Essentials	$0.68
Rate for Payer: BCBS of TX PPO	$0.75
Rate for Payer: Cash Price	$87.17
Rate for Payer: Cash Price	$87.17
Rate for Payer: Multiplan Auto	$83.32
Rate for Payer: Multiplan Commercial	$83.32
Rate for Payer: Multiplan Workers Comp	$83.32
Rate for Payer: Scott and White EPO/PPO	$64.10
Rate for Payer: Superior Health Plan EPO	$17.43

Ferritin

Facility

$271.00

Service Code	CPT 82728
Hospital Charge Code	1602028
Hospital Revenue Code	301
Min. Negotiated Rate	$5.32
Max. Negotiated Rate	$176.15
Rate for Payer: Aetna Commercial	$14.32
Rate for Payer: Aetna Medicare	$20.44
Rate for Payer: Amerigroup CHIP/Medicaid	$5.32
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$13.63
Rate for Payer: Amerigroup Medicare	$13.63
Rate for Payer: BCBS of TX Blue Advantage	$22.49
Rate for Payer: BCBS of TX Blue Essentials	$26.99
Rate for Payer: BCBS of TX Medicare	$13.63
Rate for Payer: BCBS of TX PPO	$30.12
Rate for Payer: Cash Price	$238.48
Rate for Payer: Cash Price	$238.48
Rate for Payer: Cigna Medicaid	$13.63
Rate for Payer: Cigna Medicare	$13.63
Rate for Payer: Employer Direct Commercial	$13.63
Rate for Payer: Humana Medicare/TRICARE	$13.63
Rate for Payer: Molina CHIP/Medicaid	$13.63
Rate for Payer: Molina Dual Medicare/Medicaid	$13.63
Rate for Payer: Molina Medicare	$13.63
Rate for Payer: Multiplan Auto	$176.15
Rate for Payer: Multiplan Commercial	$176.15
Rate for Payer: Multiplan Workers Comp	$176.15
Rate for Payer: Parkland Medicaid	$13.63
Rate for Payer: Scott and White EPO/PPO	$17.04
Rate for Payer: Scott and White Medicare	$13.63
Rate for Payer: Superior Health Plan CHIP/Medicaid	$13.63
Rate for Payer: Superior Health Plan EPO	$13.63
Rate for Payer: Superior Health Plan Medicare	$13.63
Rate for Payer: Universal American Dual Medicare/Medicaid	$13.63
Rate for Payer: Universal American Medicare	$13.63
Rate for Payer: Wellcare Medicare	$13.63
Rate for Payer: Wellmed Medicare	$13.63

Ferritin

Facility

$271.00

Service Code	CPT 82728
Hospital Charge Code	1602028
Hospital Revenue Code	301
Rate for Payer: Cash Price	$238.48

ferrous sulfate 325 mg (65 mg elemental iron) Tab

Facility

$7.65

Service Code	HCPCS J3490
Hospital Charge Code	77570678
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

ferrous sulfate 325 mg (65 mg elemental iron) Tab

Facility

$7.65

Service Code	HCPCS J3490
Hospital Charge Code	77570678
Hospital Revenue Code	250
Rate for Payer: Cash Price	$5.20

ferrous sulfate (as elemental iron) 15 mg/mL Oral Liquid 5 mL REPACK

Facility

$10.00

Service Code	HCPCS J3490
Hospital Charge Code	79165028
Hospital Revenue Code	250
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$6.50
Rate for Payer: Amerigroup CHIP/Medicaid	$0.90
Rate for Payer: BCBS of TX Blue Advantage	$3.00
Rate for Payer: BCBS of TX Blue Essentials	$3.60
Rate for Payer: BCBS of TX PPO	$4.00
Rate for Payer: Cash Price	$6.80
Rate for Payer: Multiplan Auto	$6.50
Rate for Payer: Multiplan Commercial	$6.50
Rate for Payer: Multiplan Workers Comp	$6.50
Rate for Payer: Scott and White EPO/PPO	$5.00
Rate for Payer: Superior Health Plan EPO	$1.36

ferrous sulfate (as elemental iron) 15 mg/mL Oral Liquid 5 mL REPACK

Facility

$10.00

Service Code	HCPCS J3490
Hospital Charge Code	79165028
Hospital Revenue Code	250
Rate for Payer: Cash Price	$6.80

Fetal Fibronectin

Facility

$809.00

Service Code	CPT 82731
Hospital Charge Code	1709203
Hospital Revenue Code	301
Min. Negotiated Rate	$25.12
Max. Negotiated Rate	$525.85
Rate for Payer: Aetna Commercial	$67.64
Rate for Payer: Aetna Medicare	$96.62
Rate for Payer: Amerigroup CHIP/Medicaid	$25.12
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$64.41
Rate for Payer: Amerigroup Medicare	$64.41
Rate for Payer: BCBS of TX Blue Advantage	$106.28
Rate for Payer: BCBS of TX Blue Essentials	$127.53
Rate for Payer: BCBS of TX Medicare	$64.41
Rate for Payer: BCBS of TX PPO	$142.35
Rate for Payer: Cash Price	$711.92
Rate for Payer: Cash Price	$711.92
Rate for Payer: Cigna Medicaid	$64.41
Rate for Payer: Cigna Medicare	$64.41
Rate for Payer: Employer Direct Commercial	$64.41
Rate for Payer: Humana Medicare/TRICARE	$64.41
Rate for Payer: Molina CHIP/Medicaid	$64.41
Rate for Payer: Molina Dual Medicare/Medicaid	$64.41
Rate for Payer: Molina Medicare	$64.41
Rate for Payer: Multiplan Auto	$525.85
Rate for Payer: Multiplan Commercial	$525.85
Rate for Payer: Multiplan Workers Comp	$525.85
Rate for Payer: Parkland Medicaid	$64.41
Rate for Payer: Scott and White EPO/PPO	$80.51
Rate for Payer: Scott and White Medicare	$64.41
Rate for Payer: Superior Health Plan CHIP/Medicaid	$64.41
Rate for Payer: Superior Health Plan EPO	$64.41
Rate for Payer: Superior Health Plan Medicare	$64.41
Rate for Payer: Universal American Dual Medicare/Medicaid	$64.41
Rate for Payer: Universal American Medicare	$64.41
Rate for Payer: Wellcare Medicare	$64.41
Rate for Payer: Wellmed Medicare	$64.41

Fetal Fibronectin

Facility

$809.00

Service Code	CPT 82731
Hospital Charge Code	1709203
Hospital Revenue Code	301
Rate for Payer: Cash Price	$711.92

Fetal Hgb Flow Cyto (Ref Lab)

Facility

$438.00

Service Code	CPT 88184
Hospital Charge Code	7108818
Hospital Revenue Code	311
Rate for Payer: Cash Price	$385.44

Fetal Hgb Flow Cyto (Ref Lab)

Facility

$438.00

Service Code	CPT 88184
Hospital Charge Code	7108818
Hospital Revenue Code	311
Min. Negotiated Rate	$5.88
Max. Negotiated Rate	$744.67
Rate for Payer: Aetna Commercial	$74.22
Rate for Payer: Aetna Medicare	$493.10
Rate for Payer: Amerigroup CHIP/Medicaid	$26.60
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$328.73
Rate for Payer: Amerigroup Medicare	$328.73
Rate for Payer: BCBS of TX Blue Advantage	$467.63
Rate for Payer: BCBS of TX Blue Essentials	$561.15
Rate for Payer: BCBS of TX Medicare	$328.73
Rate for Payer: BCBS of TX PPO	$626.34
Rate for Payer: Cash Price	$385.44
Rate for Payer: Cash Price	$385.44
Rate for Payer: Cash Price	$385.44
Rate for Payer: Cigna Commercial	$744.67
Rate for Payer: Cigna Medicare	$328.73
Rate for Payer: Employer Direct Commercial	$328.73
Rate for Payer: Humana Medicare/TRICARE	$328.73
Rate for Payer: Molina Dual Medicare/Medicaid	$328.73
Rate for Payer: Molina Medicare	$328.73
Rate for Payer: Multiplan Auto	$284.70
Rate for Payer: Multiplan Commercial	$284.70
Rate for Payer: Multiplan Workers Comp	$284.70
Rate for Payer: Scott and White EPO/PPO	$5.88
Rate for Payer: Scott and White Medicare	$328.73
Rate for Payer: Superior Health Plan EPO	$328.73
Rate for Payer: Superior Health Plan Medicare	$328.73
Rate for Payer: Universal American Dual Medicare/Medicaid	$328.73
Rate for Payer: Universal American Medicare	$328.73
Rate for Payer: Wellcare Medicare	$328.73
Rate for Payer: Wellmed Medicare	$328.73

Fetal Non-Stress Test (NST)

Facility

$1,004.00

Service Code	CPT 59025
Hospital Charge Code	300467
Hospital Revenue Code	920
Min. Negotiated Rate	$3.26
Max. Negotiated Rate	$652.60
Rate for Payer: Aetna Commercial	$552.20
Rate for Payer: Aetna Medicare	$273.36
Rate for Payer: Amerigroup CHIP/Medicaid	$90.36
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$182.24
Rate for Payer: Amerigroup Medicare	$182.24
Rate for Payer: BCBS of TX Blue Advantage	$30.92
Rate for Payer: BCBS of TX Blue Essentials	$37.11
Rate for Payer: BCBS of TX Medicare	$182.24
Rate for Payer: BCBS of TX PPO	$41.42
Rate for Payer: Cash Price	$883.52
Rate for Payer: Cash Price	$883.52
Rate for Payer: Cash Price	$883.52
Rate for Payer: Cigna Commercial	$412.83
Rate for Payer: Cigna Medicaid	$15.78
Rate for Payer: Cigna Medicare	$182.24
Rate for Payer: Employer Direct Commercial	$182.24
Rate for Payer: Humana Medicare/TRICARE	$182.24
Rate for Payer: Molina CHIP/Medicaid	$15.78
Rate for Payer: Molina Dual Medicare/Medicaid	$182.24
Rate for Payer: Molina Medicare	$182.24
Rate for Payer: Multiplan Auto	$652.60
Rate for Payer: Multiplan Commercial	$652.60
Rate for Payer: Multiplan Workers Comp	$652.60
Rate for Payer: Parkland Medicaid	$15.78
Rate for Payer: Scott and White EPO/PPO	$3.26
Rate for Payer: Scott and White Medicare	$182.24
Rate for Payer: Superior Health Plan CHIP/Medicaid	$15.78
Rate for Payer: Superior Health Plan EPO	$182.24
Rate for Payer: Superior Health Plan Medicare	$182.24
Rate for Payer: Universal American Dual Medicare/Medicaid	$182.24
Rate for Payer: Universal American Medicare	$182.24
Rate for Payer: Wellcare Medicare	$182.24
Rate for Payer: Wellmed Medicare	$182.24

Fetal Non-Stress Test (NST)

Facility

$1,004.00

Service Code	CPT 59025
Hospital Charge Code	300467
Hospital Revenue Code	920
Rate for Payer: Cash Price	$883.52

Fetal Screen

Facility

$31.00

Service Code	CPT 83033
Hospital Charge Code	1708932
Hospital Revenue Code	301
Min. Negotiated Rate	$3.12
Max. Negotiated Rate	$20.15
Rate for Payer: Aetna Commercial	$8.40
Rate for Payer: Aetna Medicare	$12.00
Rate for Payer: Amerigroup CHIP/Medicaid	$3.12
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$8.00
Rate for Payer: Amerigroup Medicare	$8.00
Rate for Payer: BCBS of TX Blue Advantage	$13.20
Rate for Payer: BCBS of TX Blue Essentials	$15.84
Rate for Payer: BCBS of TX Medicare	$8.00
Rate for Payer: BCBS of TX PPO	$17.68
Rate for Payer: Cash Price	$27.28
Rate for Payer: Cash Price	$27.28
Rate for Payer: Cigna Medicaid	$8.00
Rate for Payer: Cigna Medicare	$8.00
Rate for Payer: Employer Direct Commercial	$8.00
Rate for Payer: Humana Medicare/TRICARE	$8.00
Rate for Payer: Molina CHIP/Medicaid	$8.00
Rate for Payer: Molina Dual Medicare/Medicaid	$8.00
Rate for Payer: Molina Medicare	$8.00
Rate for Payer: Multiplan Auto	$20.15
Rate for Payer: Multiplan Commercial	$20.15
Rate for Payer: Multiplan Workers Comp	$20.15
Rate for Payer: Parkland Medicaid	$8.00
Rate for Payer: Scott and White EPO/PPO	$10.00
Rate for Payer: Scott and White Medicare	$8.00
Rate for Payer: Superior Health Plan CHIP/Medicaid	$8.00
Rate for Payer: Superior Health Plan EPO	$8.00
Rate for Payer: Superior Health Plan Medicare	$8.00
Rate for Payer: Universal American Dual Medicare/Medicaid	$8.00
Rate for Payer: Universal American Medicare	$8.00
Rate for Payer: Wellcare Medicare	$8.00
Rate for Payer: Wellmed Medicare	$8.00

Fetal Screen

Facility

$31.00

Service Code	CPT 83033
Hospital Charge Code	1708932
Hospital Revenue Code	301
Rate for Payer: Cash Price	$27.28

FEVER AND INFLAMMATORY CONDITIONS

Facility

$16,773.20

Service Code	MSDRG 864
Min. Negotiated Rate	$7,211.10
Max. Negotiated Rate	$16,773.20
Rate for Payer: Aetna Commercial	$9,931.50
Rate for Payer: Aetna Medicare	$13,731.75
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$9,154.50
Rate for Payer: Amerigroup Medicare	$9,154.50
Rate for Payer: BCBS of TX Blue Advantage	$7,211.10
Rate for Payer: BCBS of TX Blue Essentials	$8,918.71
Rate for Payer: BCBS of TX Medicare	$9,154.50
Rate for Payer: BCBS of TX PPO	$9,910.06
Rate for Payer: Cigna Commercial	$11,370.46
Rate for Payer: Cigna Medicare	$9,154.50
Rate for Payer: Employer Direct Commercial	$9,154.50
Rate for Payer: Humana Medicare/TRICARE	$9,154.50
Rate for Payer: Molina Dual Medicare/Medicaid	$9,154.50
Rate for Payer: Molina Medicare	$9,154.50
Rate for Payer: Multiplan Auto	$16,773.20
Rate for Payer: Multiplan Commercial	$16,773.20
Rate for Payer: Multiplan Workers Comp	$16,773.20
Rate for Payer: Scott and White EPO/PPO	$7,724.50
Rate for Payer: Scott and White Medicare	$9,154.50
Rate for Payer: Superior Health Plan EPO	$9,154.50
Rate for Payer: Superior Health Plan Medicare	$9,154.50
Rate for Payer: Universal American Dual Medicare/Medicaid	$9,154.50
Rate for Payer: Universal American Medicare	$9,154.50
Rate for Payer: Wellcare Medicare	$9,154.50
Rate for Payer: Wellmed Medicare	$9,154.50

FIBER LASER GREEN LIGHT

Facility

$4,994.00

Hospital Charge Code	8492482
Hospital Revenue Code	272
Min. Negotiated Rate	$449.46
Max. Negotiated Rate	$3,246.10
Rate for Payer: Aetna Commercial	$2,746.70
Rate for Payer: Amerigroup CHIP/Medicaid	$449.46
Rate for Payer: BCBS of TX Blue Advantage	$1,498.20
Rate for Payer: BCBS of TX Blue Essentials	$1,797.84
Rate for Payer: BCBS of TX PPO	$1,997.60
Rate for Payer: Cash Price	$4,394.72
Rate for Payer: Multiplan Auto	$3,246.10
Rate for Payer: Multiplan Commercial	$3,246.10
Rate for Payer: Multiplan Workers Comp	$3,246.10
Rate for Payer: Scott and White EPO/PPO	$2,497.00
Rate for Payer: Superior Health Plan EPO	$679.18

FIBER LASER GREEN LIGHT

Facility

$4,994.00

Hospital Charge Code	8492482
Hospital Revenue Code	272
Rate for Payer: Cash Price	$4,394.72

Fibrinogen Activity SO

Facility

$240.00

Service Code	CPT 85384
Hospital Charge Code	1600311
Hospital Revenue Code	305
Min. Negotiated Rate	$3.79
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$10.20
Rate for Payer: Aetna Medicare	$14.58
Rate for Payer: Amerigroup CHIP/Medicaid	$3.79
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$9.72
Rate for Payer: Amerigroup Medicare	$9.72
Rate for Payer: BCBS of TX Blue Advantage	$16.04
Rate for Payer: BCBS of TX Blue Essentials	$19.25
Rate for Payer: BCBS of TX Medicare	$9.72
Rate for Payer: BCBS of TX PPO	$21.48
Rate for Payer: Cash Price	$211.20
Rate for Payer: Cash Price	$211.20
Rate for Payer: Cigna Medicaid	$9.72
Rate for Payer: Cigna Medicare	$9.72
Rate for Payer: Employer Direct Commercial	$9.72
Rate for Payer: Humana Medicare/TRICARE	$9.72
Rate for Payer: Molina CHIP/Medicaid	$9.72
Rate for Payer: Molina Dual Medicare/Medicaid	$9.72
Rate for Payer: Molina Medicare	$9.72
Rate for Payer: Multiplan Auto	$156.00
Rate for Payer: Multiplan Commercial	$156.00
Rate for Payer: Multiplan Workers Comp	$156.00
Rate for Payer: Parkland Medicaid	$9.72
Rate for Payer: Scott and White EPO/PPO	$12.15
Rate for Payer: Scott and White Medicare	$9.72
Rate for Payer: Superior Health Plan CHIP/Medicaid	$9.72
Rate for Payer: Superior Health Plan EPO	$9.72
Rate for Payer: Superior Health Plan Medicare	$9.72
Rate for Payer: Universal American Dual Medicare/Medicaid	$9.72
Rate for Payer: Universal American Medicare	$9.72
Rate for Payer: Wellcare Medicare	$9.72
Rate for Payer: Wellmed Medicare	$9.72

Fibrinogen Activity SO

Facility

$240.00

Service Code	CPT 85384
Hospital Charge Code	1600311
Hospital Revenue Code	305
Rate for Payer: Cash Price	$211.20

Fibrinogen Level

Facility

$240.00

Service Code	CPT 85384
Hospital Charge Code	1600311
Hospital Revenue Code	305
Min. Negotiated Rate	$3.79
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$10.20
Rate for Payer: Aetna Medicare	$14.58
Rate for Payer: Amerigroup CHIP/Medicaid	$3.79
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$9.72
Rate for Payer: Amerigroup Medicare	$9.72
Rate for Payer: BCBS of TX Blue Advantage	$16.04
Rate for Payer: BCBS of TX Blue Essentials	$19.25
Rate for Payer: BCBS of TX Medicare	$9.72
Rate for Payer: BCBS of TX PPO	$21.48
Rate for Payer: Cash Price	$211.20
Rate for Payer: Cash Price	$211.20
Rate for Payer: Cigna Medicaid	$9.72
Rate for Payer: Cigna Medicare	$9.72
Rate for Payer: Employer Direct Commercial	$9.72
Rate for Payer: Humana Medicare/TRICARE	$9.72
Rate for Payer: Molina CHIP/Medicaid	$9.72
Rate for Payer: Molina Dual Medicare/Medicaid	$9.72
Rate for Payer: Molina Medicare	$9.72
Rate for Payer: Multiplan Auto	$156.00
Rate for Payer: Multiplan Commercial	$156.00
Rate for Payer: Multiplan Workers Comp	$156.00
Rate for Payer: Parkland Medicaid	$9.72
Rate for Payer: Scott and White EPO/PPO	$12.15
Rate for Payer: Scott and White Medicare	$9.72
Rate for Payer: Superior Health Plan CHIP/Medicaid	$9.72
Rate for Payer: Superior Health Plan EPO	$9.72
Rate for Payer: Superior Health Plan Medicare	$9.72
Rate for Payer: Universal American Dual Medicare/Medicaid	$9.72
Rate for Payer: Universal American Medicare	$9.72
Rate for Payer: Wellcare Medicare	$9.72
Rate for Payer: Wellmed Medicare	$9.72

FIBULOCK IMPLANT SYSTEM

Facility

$6,024.10

Service Code	HCPCS C1713
Hospital Charge Code	145499
Hospital Revenue Code	278
Min. Negotiated Rate	$542.17
Max. Negotiated Rate	$3,012.05
Rate for Payer: Aetna Commercial	$1,807.23
Rate for Payer: Amerigroup CHIP/Medicaid	$542.17
Rate for Payer: BCBS of TX Blue Advantage	$1,807.23
Rate for Payer: BCBS of TX Blue Essentials	$2,168.68
Rate for Payer: BCBS of TX PPO	$2,409.64
Rate for Payer: Cash Price	$5,301.21
Rate for Payer: Multiplan Auto	$3,012.05
Rate for Payer: Multiplan Commercial	$3,012.05
Rate for Payer: Multiplan Workers Comp	$3,012.05
Rate for Payer: Scott and White EPO/PPO	$3,012.05
Rate for Payer: Superior Health Plan EPO	$819.28

FIBULOCK IMPLANT SYSTEM

Facility

$6,024.10

Service Code	HCPCS C1713
Hospital Charge Code	145499
Hospital Revenue Code	278
Min. Negotiated Rate	$1,506.02
Max. Negotiated Rate	$3,012.05
Rate for Payer: Aetna Commercial	$1,807.23
Rate for Payer: Cash Price	$5,301.21
Rate for Payer: Cigna Commercial	$1,506.02
Rate for Payer: Multiplan Auto	$3,012.05
Rate for Payer: Multiplan Commercial	$3,012.05
Rate for Payer: Multiplan Workers Comp	$3,012.05
Rate for Payer: Scott and White EPO/PPO	$3,012.05

Know your out-of-pocket cost for care.

All Charges