White Rock Medical Center

All Charges

Charge

Type

Setting

Price

forcep bronch bx 1.8mmx100cm

Facility

$131.66

Hospital Charge Code	8626514
Hospital Revenue Code	272
Rate for Payer: Cash Price	$115.86

FRACTURES OF FEMUR WITH MCC

Facility

$30,996.60

Service Code	MSDRG 533
Min. Negotiated Rate	$11,698.58
Max. Negotiated Rate	$30,996.60
Rate for Payer: Aetna Commercial	$18,353.25
Rate for Payer: Aetna Medicare	$21,744.82
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$14,496.55
Rate for Payer: Amerigroup Medicare	$14,496.55
Rate for Payer: BCBS of TX Blue Advantage	$11,698.58
Rate for Payer: BCBS of TX Blue Essentials	$15,793.23
Rate for Payer: BCBS of TX Medicare	$14,496.55
Rate for Payer: BCBS of TX PPO	$17,548.71
Rate for Payer: Cigna Commercial	$21,012.43
Rate for Payer: Cigna Medicare	$14,496.55
Rate for Payer: Employer Direct Commercial	$14,496.55
Rate for Payer: Humana Medicare/TRICARE	$14,496.55
Rate for Payer: Molina Dual Medicare/Medicaid	$14,496.55
Rate for Payer: Molina Medicare	$14,496.55
Rate for Payer: Multiplan Auto	$30,996.60
Rate for Payer: Multiplan Commercial	$30,996.60
Rate for Payer: Multiplan Workers Comp	$30,996.60
Rate for Payer: Scott and White EPO/PPO	$14,274.75
Rate for Payer: Scott and White Medicare	$14,496.55
Rate for Payer: Superior Health Plan EPO	$14,496.55
Rate for Payer: Superior Health Plan Medicare	$14,496.55
Rate for Payer: Universal American Dual Medicare/Medicaid	$14,496.55
Rate for Payer: Universal American Medicare	$14,496.55
Rate for Payer: Wellcare Medicare	$14,496.55
Rate for Payer: Wellmed Medicare	$14,496.55

FRACTURES OF FEMUR WITHOUT MCC

Facility

$15,390.00

Service Code	MSDRG 534
Min. Negotiated Rate	$6,540.30
Max. Negotiated Rate	$15,390.00
Rate for Payer: Aetna Commercial	$9,112.50
Rate for Payer: Aetna Medicare	$12,952.48
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$8,634.99
Rate for Payer: Amerigroup Medicare	$8,634.99
Rate for Payer: BCBS of TX Blue Advantage	$6,540.30
Rate for Payer: BCBS of TX Blue Essentials	$8,002.38
Rate for Payer: BCBS of TX Medicare	$8,634.99
Rate for Payer: BCBS of TX PPO	$8,891.88
Rate for Payer: Cigna Commercial	$10,432.80
Rate for Payer: Cigna Medicare	$8,634.99
Rate for Payer: Employer Direct Commercial	$8,634.99
Rate for Payer: Humana Medicare/TRICARE	$8,634.99
Rate for Payer: Molina Dual Medicare/Medicaid	$8,634.99
Rate for Payer: Molina Medicare	$8,634.99
Rate for Payer: Multiplan Auto	$15,390.00
Rate for Payer: Multiplan Commercial	$15,390.00
Rate for Payer: Multiplan Workers Comp	$15,390.00
Rate for Payer: Scott and White EPO/PPO	$7,087.50
Rate for Payer: Scott and White Medicare	$8,634.99
Rate for Payer: Superior Health Plan EPO	$8,634.99
Rate for Payer: Superior Health Plan Medicare	$8,634.99
Rate for Payer: Universal American Dual Medicare/Medicaid	$8,634.99
Rate for Payer: Universal American Medicare	$8,634.99
Rate for Payer: Wellcare Medicare	$8,634.99
Rate for Payer: Wellmed Medicare	$8,634.99

FRACTURES OF HIP AND PELVIS WITH MCC

Facility

$24,637.30

Service Code	MSDRG 535
Min. Negotiated Rate	$10,257.22
Max. Negotiated Rate	$24,637.30
Rate for Payer: Aetna Commercial	$14,587.88
Rate for Payer: Aetna Medicare	$18,162.16
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$12,108.11
Rate for Payer: Amerigroup Medicare	$12,108.11
Rate for Payer: BCBS of TX Blue Advantage	$10,257.22
Rate for Payer: BCBS of TX Blue Essentials	$12,948.28
Rate for Payer: BCBS of TX Medicare	$12,108.11
Rate for Payer: BCBS of TX PPO	$14,387.54
Rate for Payer: Cigna Commercial	$16,701.50
Rate for Payer: Cigna Medicare	$12,108.11
Rate for Payer: Employer Direct Commercial	$12,108.11
Rate for Payer: Humana Medicare/TRICARE	$12,108.11
Rate for Payer: Molina Dual Medicare/Medicaid	$12,108.11
Rate for Payer: Molina Medicare	$12,108.11
Rate for Payer: Multiplan Auto	$24,637.30
Rate for Payer: Multiplan Commercial	$24,637.30
Rate for Payer: Multiplan Workers Comp	$24,637.30
Rate for Payer: Scott and White EPO/PPO	$11,346.12
Rate for Payer: Scott and White Medicare	$12,108.11
Rate for Payer: Superior Health Plan EPO	$12,108.11
Rate for Payer: Superior Health Plan Medicare	$12,108.11
Rate for Payer: Universal American Dual Medicare/Medicaid	$12,108.11
Rate for Payer: Universal American Medicare	$12,108.11
Rate for Payer: Wellcare Medicare	$12,108.11
Rate for Payer: Wellmed Medicare	$12,108.11

FRACTURES OF HIP AND PELVIS WITHOUT MCC

Facility

$14,954.90

Service Code	MSDRG 536
Min. Negotiated Rate	$6,218.66
Max. Negotiated Rate	$14,954.90
Rate for Payer: Aetna Commercial	$8,854.88
Rate for Payer: Aetna Medicare	$12,707.37
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$8,471.58
Rate for Payer: Amerigroup Medicare	$8,471.58
Rate for Payer: BCBS of TX Blue Advantage	$6,218.66
Rate for Payer: BCBS of TX Blue Essentials	$7,811.48
Rate for Payer: BCBS of TX Medicare	$8,471.58
Rate for Payer: BCBS of TX PPO	$8,679.76
Rate for Payer: Cigna Commercial	$10,137.85
Rate for Payer: Cigna Medicare	$8,471.58
Rate for Payer: Employer Direct Commercial	$8,471.58
Rate for Payer: Humana Medicare/TRICARE	$8,471.58
Rate for Payer: Molina Dual Medicare/Medicaid	$8,471.58
Rate for Payer: Molina Medicare	$8,471.58
Rate for Payer: Multiplan Auto	$14,954.90
Rate for Payer: Multiplan Commercial	$14,954.90
Rate for Payer: Multiplan Workers Comp	$14,954.90
Rate for Payer: Scott and White EPO/PPO	$6,887.12
Rate for Payer: Scott and White Medicare	$8,471.58
Rate for Payer: Superior Health Plan EPO	$8,471.58
Rate for Payer: Superior Health Plan Medicare	$8,471.58
Rate for Payer: Universal American Dual Medicare/Medicaid	$8,471.58
Rate for Payer: Universal American Medicare	$8,471.58
Rate for Payer: Wellcare Medicare	$8,471.58
Rate for Payer: Wellmed Medicare	$8,471.58

FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITH MCC

Facility

$28,893.30

Service Code	MSDRG 562
Min. Negotiated Rate	$11,362.32
Max. Negotiated Rate	$28,893.30
Rate for Payer: Aetna Commercial	$17,107.88
Rate for Payer: Aetna Medicare	$20,559.88
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$13,706.59
Rate for Payer: Amerigroup Medicare	$13,706.59
Rate for Payer: BCBS of TX Blue Advantage	$11,362.32
Rate for Payer: BCBS of TX Blue Essentials	$14,530.18
Rate for Payer: BCBS of TX Medicare	$13,706.59
Rate for Payer: BCBS of TX PPO	$16,145.27
Rate for Payer: Cigna Commercial	$19,586.62
Rate for Payer: Cigna Medicare	$13,706.59
Rate for Payer: Employer Direct Commercial	$13,706.59
Rate for Payer: Humana Medicare/TRICARE	$13,706.59
Rate for Payer: Molina Dual Medicare/Medicaid	$13,706.59
Rate for Payer: Molina Medicare	$13,706.59
Rate for Payer: Multiplan Auto	$28,893.30
Rate for Payer: Multiplan Commercial	$28,893.30
Rate for Payer: Multiplan Workers Comp	$28,893.30
Rate for Payer: Scott and White EPO/PPO	$13,306.12
Rate for Payer: Scott and White Medicare	$13,706.59
Rate for Payer: Superior Health Plan EPO	$13,706.59
Rate for Payer: Superior Health Plan Medicare	$13,706.59
Rate for Payer: Universal American Dual Medicare/Medicaid	$13,706.59
Rate for Payer: Universal American Medicare	$13,706.59
Rate for Payer: Wellcare Medicare	$13,706.59
Rate for Payer: Wellmed Medicare	$13,706.59

FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITHOUT MCC

Facility

$17,016.40

Service Code	MSDRG 563
Min. Negotiated Rate	$6,806.90
Max. Negotiated Rate	$17,016.40
Rate for Payer: Aetna Commercial	$10,075.50
Rate for Payer: Aetna Medicare	$13,868.78
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$9,245.85
Rate for Payer: Amerigroup Medicare	$9,245.85
Rate for Payer: BCBS of TX Blue Advantage	$6,806.90
Rate for Payer: BCBS of TX Blue Essentials	$8,648.35
Rate for Payer: BCBS of TX Medicare	$9,245.85
Rate for Payer: BCBS of TX PPO	$9,609.65
Rate for Payer: Cigna Commercial	$11,535.33
Rate for Payer: Cigna Medicare	$9,245.85
Rate for Payer: Employer Direct Commercial	$9,245.85
Rate for Payer: Humana Medicare/TRICARE	$9,245.85
Rate for Payer: Molina Dual Medicare/Medicaid	$9,245.85
Rate for Payer: Molina Medicare	$9,245.85
Rate for Payer: Multiplan Auto	$17,016.40
Rate for Payer: Multiplan Commercial	$17,016.40
Rate for Payer: Multiplan Workers Comp	$17,016.40
Rate for Payer: Scott and White EPO/PPO	$7,836.50
Rate for Payer: Scott and White Medicare	$9,245.85
Rate for Payer: Superior Health Plan EPO	$9,245.85
Rate for Payer: Superior Health Plan Medicare	$9,245.85
Rate for Payer: Universal American Dual Medicare/Medicaid	$9,245.85
Rate for Payer: Universal American Medicare	$9,245.85
Rate for Payer: Wellcare Medicare	$9,245.85
Rate for Payer: Wellmed Medicare	$9,245.85

frcp bx needle 160cm

Facility

$133.48

Hospital Charge Code	8638506
Hospital Revenue Code	272
Min. Negotiated Rate	$12.01
Max. Negotiated Rate	$86.76
Rate for Payer: Aetna Commercial	$73.41
Rate for Payer: Amerigroup CHIP/Medicaid	$12.01
Rate for Payer: BCBS of TX Blue Advantage	$40.04
Rate for Payer: BCBS of TX Blue Essentials	$48.05
Rate for Payer: BCBS of TX PPO	$53.39
Rate for Payer: Cash Price	$117.46
Rate for Payer: Multiplan Auto	$86.76
Rate for Payer: Multiplan Commercial	$86.76
Rate for Payer: Multiplan Workers Comp	$86.76
Rate for Payer: Scott and White EPO/PPO	$66.74
Rate for Payer: Superior Health Plan EPO	$18.15

frcp bx needle 160cm

Facility

$133.48

Hospital Charge Code	8638506
Hospital Revenue Code	272
Rate for Payer: Cash Price	$117.46

FRCP DISP 1 -- DHF

Facility

$152.07

Hospital Charge Code	80811516
Hospital Revenue Code	272
Rate for Payer: Cash Price	$133.82

FRCP DISP 1 -- DHF

Facility

$152.07

Hospital Charge Code	80811516
Hospital Revenue Code	272
Min. Negotiated Rate	$13.69
Max. Negotiated Rate	$98.85
Rate for Payer: Aetna Commercial	$83.64
Rate for Payer: Amerigroup CHIP/Medicaid	$13.69
Rate for Payer: BCBS of TX Blue Advantage	$45.62
Rate for Payer: BCBS of TX Blue Essentials	$54.75
Rate for Payer: BCBS of TX PPO	$60.83
Rate for Payer: Cash Price	$133.82
Rate for Payer: Multiplan Auto	$98.85
Rate for Payer: Multiplan Commercial	$98.85
Rate for Payer: Multiplan Workers Comp	$98.85
Rate for Payer: Scott and White EPO/PPO	$76.04
Rate for Payer: Superior Health Plan EPO	$20.68

FRCP DISP 3 -- DHF

Facility

$61.29

Hospital Charge Code	80811532
Hospital Revenue Code	272
Min. Negotiated Rate	$5.52
Max. Negotiated Rate	$39.84
Rate for Payer: Aetna Commercial	$33.71
Rate for Payer: Amerigroup CHIP/Medicaid	$5.52
Rate for Payer: BCBS of TX Blue Advantage	$18.39
Rate for Payer: BCBS of TX Blue Essentials	$22.06
Rate for Payer: BCBS of TX PPO	$24.52
Rate for Payer: Cash Price	$53.94
Rate for Payer: Multiplan Auto	$39.84
Rate for Payer: Multiplan Commercial	$39.84
Rate for Payer: Multiplan Workers Comp	$39.84
Rate for Payer: Scott and White EPO/PPO	$30.64
Rate for Payer: Superior Health Plan EPO	$8.34

FRCP DISP 3 -- DHF

Facility

$61.29

Hospital Charge Code	80811532
Hospital Revenue Code	272
Rate for Payer: Cash Price	$53.94

FRCP GRSPNG -- DHF

Facility

$2,203.45

Hospital Charge Code	80811607
Hospital Revenue Code	272
Rate for Payer: Cash Price	$1,939.04

FRCP GRSPNG -- DHF

Facility

$2,203.45

Hospital Charge Code	80811607
Hospital Revenue Code	272
Min. Negotiated Rate	$198.31
Max. Negotiated Rate	$1,432.24
Rate for Payer: Aetna Commercial	$1,211.90
Rate for Payer: Amerigroup CHIP/Medicaid	$198.31
Rate for Payer: BCBS of TX Blue Advantage	$661.04
Rate for Payer: BCBS of TX Blue Essentials	$793.24
Rate for Payer: BCBS of TX PPO	$881.38
Rate for Payer: Cash Price	$1,939.04
Rate for Payer: Multiplan Auto	$1,432.24
Rate for Payer: Multiplan Commercial	$1,432.24
Rate for Payer: Multiplan Workers Comp	$1,432.24
Rate for Payer: Scott and White EPO/PPO	$1,101.72
Rate for Payer: Superior Health Plan EPO	$299.67

Free K+L Lt Chains,Qn,S SO

Facility

$168.00

Service Code	CPT 83521
Hospital Charge Code	1706530
Hospital Revenue Code	301
Rate for Payer: Cash Price	$147.84

Free K+L Lt Chains,Qn,S SO

Facility

$168.00

Service Code	CPT 83521
Hospital Charge Code	1706530
Hospital Revenue Code	301
Min. Negotiated Rate	$6.74
Max. Negotiated Rate	$109.20
Rate for Payer: Aetna Commercial	$18.13
Rate for Payer: Aetna Medicare	$25.90
Rate for Payer: Amerigroup CHIP/Medicaid	$6.74
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$17.27
Rate for Payer: Amerigroup Medicare	$17.27
Rate for Payer: BCBS of TX Blue Advantage	$28.50
Rate for Payer: BCBS of TX Blue Essentials	$34.19
Rate for Payer: BCBS of TX Medicare	$17.27
Rate for Payer: BCBS of TX PPO	$38.17
Rate for Payer: Cash Price	$147.84
Rate for Payer: Cash Price	$147.84
Rate for Payer: Cigna Medicaid	$17.27
Rate for Payer: Cigna Medicare	$17.27
Rate for Payer: Employer Direct Commercial	$17.27
Rate for Payer: Humana Medicare/TRICARE	$17.27
Rate for Payer: Molina CHIP/Medicaid	$17.27
Rate for Payer: Molina Dual Medicare/Medicaid	$17.27
Rate for Payer: Molina Medicare	$17.27
Rate for Payer: Multiplan Auto	$109.20
Rate for Payer: Multiplan Commercial	$109.20
Rate for Payer: Multiplan Workers Comp	$109.20
Rate for Payer: Parkland Medicaid	$17.27
Rate for Payer: Scott and White EPO/PPO	$21.59
Rate for Payer: Scott and White Medicare	$17.27
Rate for Payer: Superior Health Plan CHIP/Medicaid	$17.27
Rate for Payer: Superior Health Plan EPO	$17.27
Rate for Payer: Superior Health Plan Medicare	$17.27
Rate for Payer: Universal American Dual Medicare/Medicaid	$17.27
Rate for Payer: Universal American Medicare	$17.27
Rate for Payer: Wellcare Medicare	$17.27
Rate for Payer: Wellmed Medicare	$17.27

Free K+L Lt Chains,Qn,U SO

Facility

$168.00

Service Code	CPT 83521
Hospital Charge Code	8604525
Hospital Revenue Code	301
Min. Negotiated Rate	$6.74
Max. Negotiated Rate	$109.20
Rate for Payer: Aetna Commercial	$18.13
Rate for Payer: Aetna Medicare	$25.90
Rate for Payer: Amerigroup CHIP/Medicaid	$6.74
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$17.27
Rate for Payer: Amerigroup Medicare	$17.27
Rate for Payer: BCBS of TX Blue Advantage	$28.50
Rate for Payer: BCBS of TX Blue Essentials	$34.19
Rate for Payer: BCBS of TX Medicare	$17.27
Rate for Payer: BCBS of TX PPO	$38.17
Rate for Payer: Cash Price	$147.84
Rate for Payer: Cash Price	$147.84
Rate for Payer: Cigna Medicaid	$17.27
Rate for Payer: Cigna Medicare	$17.27
Rate for Payer: Employer Direct Commercial	$17.27
Rate for Payer: Humana Medicare/TRICARE	$17.27
Rate for Payer: Molina CHIP/Medicaid	$17.27
Rate for Payer: Molina Dual Medicare/Medicaid	$17.27
Rate for Payer: Molina Medicare	$17.27
Rate for Payer: Multiplan Auto	$109.20
Rate for Payer: Multiplan Commercial	$109.20
Rate for Payer: Multiplan Workers Comp	$109.20
Rate for Payer: Parkland Medicaid	$17.27
Rate for Payer: Scott and White EPO/PPO	$21.59
Rate for Payer: Scott and White Medicare	$17.27
Rate for Payer: Superior Health Plan CHIP/Medicaid	$17.27
Rate for Payer: Superior Health Plan EPO	$17.27
Rate for Payer: Superior Health Plan Medicare	$17.27
Rate for Payer: Universal American Dual Medicare/Medicaid	$17.27
Rate for Payer: Universal American Medicare	$17.27
Rate for Payer: Wellcare Medicare	$17.27
Rate for Payer: Wellmed Medicare	$17.27

Free K+L Lt Chains,Qn,U SO

Facility

$168.00

Service Code	CPT 83521
Hospital Charge Code	8604525
Hospital Revenue Code	301
Rate for Payer: Cash Price	$147.84

Free T4 Level

Facility

$316.00

Service Code	CPT 84439
Hospital Charge Code	1602317
Hospital Revenue Code	301
Min. Negotiated Rate	$3.52
Max. Negotiated Rate	$205.40
Rate for Payer: Aetna Commercial	$9.47
Rate for Payer: Aetna Medicare	$13.53
Rate for Payer: Amerigroup CHIP/Medicaid	$3.52
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$9.02
Rate for Payer: Amerigroup Medicare	$9.02
Rate for Payer: BCBS of TX Blue Advantage	$14.88
Rate for Payer: BCBS of TX Blue Essentials	$17.86
Rate for Payer: BCBS of TX Medicare	$9.02
Rate for Payer: BCBS of TX PPO	$19.93
Rate for Payer: Cash Price	$278.08
Rate for Payer: Cash Price	$278.08
Rate for Payer: Cigna Medicaid	$9.02
Rate for Payer: Cigna Medicare	$9.02
Rate for Payer: Employer Direct Commercial	$9.02
Rate for Payer: Humana Medicare/TRICARE	$9.02
Rate for Payer: Molina CHIP/Medicaid	$9.02
Rate for Payer: Molina Dual Medicare/Medicaid	$9.02
Rate for Payer: Molina Medicare	$9.02
Rate for Payer: Multiplan Auto	$205.40
Rate for Payer: Multiplan Commercial	$205.40
Rate for Payer: Multiplan Workers Comp	$205.40
Rate for Payer: Parkland Medicaid	$9.02
Rate for Payer: Scott and White EPO/PPO	$11.28
Rate for Payer: Scott and White Medicare	$9.02
Rate for Payer: Superior Health Plan CHIP/Medicaid	$9.02
Rate for Payer: Superior Health Plan EPO	$9.02
Rate for Payer: Superior Health Plan Medicare	$9.02
Rate for Payer: Universal American Dual Medicare/Medicaid	$9.02
Rate for Payer: Universal American Medicare	$9.02
Rate for Payer: Wellcare Medicare	$9.02
Rate for Payer: Wellmed Medicare	$9.02

Free T4 Level

Facility

$316.00

Service Code	CPT 84439
Hospital Charge Code	1602317
Hospital Revenue Code	301
Rate for Payer: Cash Price	$278.08

Fructosamine SO

Facility

$76.00

Service Code	CPT 82985
Hospital Charge Code	1706522
Hospital Revenue Code	301
Min. Negotiated Rate	$6.54
Max. Negotiated Rate	$49.40
Rate for Payer: Aetna Commercial	$17.60
Rate for Payer: Aetna Medicare	$25.14
Rate for Payer: Amerigroup CHIP/Medicaid	$6.54
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$16.76
Rate for Payer: Amerigroup Medicare	$16.76
Rate for Payer: BCBS of TX Blue Advantage	$27.65
Rate for Payer: BCBS of TX Blue Essentials	$33.18
Rate for Payer: BCBS of TX Medicare	$16.76
Rate for Payer: BCBS of TX PPO	$37.04
Rate for Payer: Cash Price	$66.88
Rate for Payer: Cash Price	$66.88
Rate for Payer: Cigna Medicaid	$16.76
Rate for Payer: Cigna Medicare	$16.76
Rate for Payer: Employer Direct Commercial	$16.76
Rate for Payer: Humana Medicare/TRICARE	$16.76
Rate for Payer: Molina CHIP/Medicaid	$16.76
Rate for Payer: Molina Dual Medicare/Medicaid	$16.76
Rate for Payer: Molina Medicare	$16.76
Rate for Payer: Multiplan Auto	$49.40
Rate for Payer: Multiplan Commercial	$49.40
Rate for Payer: Multiplan Workers Comp	$49.40
Rate for Payer: Parkland Medicaid	$16.76
Rate for Payer: Scott and White EPO/PPO	$20.95
Rate for Payer: Scott and White Medicare	$16.76
Rate for Payer: Superior Health Plan CHIP/Medicaid	$16.76
Rate for Payer: Superior Health Plan EPO	$16.76
Rate for Payer: Superior Health Plan Medicare	$16.76
Rate for Payer: Universal American Dual Medicare/Medicaid	$16.76
Rate for Payer: Universal American Medicare	$16.76
Rate for Payer: Wellcare Medicare	$16.76
Rate for Payer: Wellmed Medicare	$16.76

Fructosamine SO

Facility

$76.00

Service Code	CPT 82985
Hospital Charge Code	1706522
Hospital Revenue Code	301
Rate for Payer: Cash Price	$66.88

FSH, Serum SO

Facility

$421.00

Service Code	CPT 83001
Hospital Charge Code	1601871
Hospital Revenue Code	301
Rate for Payer: Cash Price	$370.48

FSH, Serum SO

Facility

$421.00

Service Code	CPT 83001
Hospital Charge Code	1601871
Hospital Revenue Code	301
Min. Negotiated Rate	$7.25
Max. Negotiated Rate	$273.65
Rate for Payer: Aetna Commercial	$19.51
Rate for Payer: Aetna Medicare	$27.87
Rate for Payer: Amerigroup CHIP/Medicaid	$7.25
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$18.58
Rate for Payer: Amerigroup Medicare	$18.58
Rate for Payer: BCBS of TX Blue Advantage	$30.66
Rate for Payer: BCBS of TX Blue Essentials	$36.79
Rate for Payer: BCBS of TX Medicare	$18.58
Rate for Payer: BCBS of TX PPO	$41.06
Rate for Payer: Cash Price	$370.48
Rate for Payer: Cash Price	$370.48
Rate for Payer: Cigna Medicaid	$18.58
Rate for Payer: Cigna Medicare	$18.58
Rate for Payer: Employer Direct Commercial	$18.58
Rate for Payer: Humana Medicare/TRICARE	$18.58
Rate for Payer: Molina CHIP/Medicaid	$18.58
Rate for Payer: Molina Dual Medicare/Medicaid	$18.58
Rate for Payer: Molina Medicare	$18.58
Rate for Payer: Multiplan Auto	$273.65
Rate for Payer: Multiplan Commercial	$273.65
Rate for Payer: Multiplan Workers Comp	$273.65
Rate for Payer: Parkland Medicaid	$18.58
Rate for Payer: Scott and White EPO/PPO	$23.22
Rate for Payer: Scott and White Medicare	$18.58
Rate for Payer: Superior Health Plan CHIP/Medicaid	$18.58
Rate for Payer: Superior Health Plan EPO	$18.58
Rate for Payer: Superior Health Plan Medicare	$18.58
Rate for Payer: Universal American Dual Medicare/Medicaid	$18.58
Rate for Payer: Universal American Medicare	$18.58
Rate for Payer: Wellcare Medicare	$18.58
Rate for Payer: Wellmed Medicare	$18.58

Know your out-of-pocket cost for care.

All Charges