White Rock Medical Center

All Charges

Charge

Type

Setting

Price

Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips

Facility

$250.00

Service Code	HCPCS E0114
Hospital Charge Code	990952
Hospital Revenue Code	270
Rate for Payer: Cash Price	$170.00

Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips

Facility

$250.00

Service Code	HCPCS E0114
Hospital Charge Code	990952
Hospital Revenue Code	270
Min. Negotiated Rate	$22.50
Max. Negotiated Rate	$180.00
Rate for Payer: Amerigroup CHIP/Medicaid	$22.50
Rate for Payer: BCBS of TX Blue Advantage	$69.37
Rate for Payer: BCBS of TX Blue Essentials	$83.24
Rate for Payer: BCBS of TX PPO	$92.33
Rate for Payer: Cash Price	$170.00
Rate for Payer: Cash Price	$170.00
Rate for Payer: Cigna Medicaid	$180.00
Rate for Payer: Molina CHIP/Medicaid	$180.00
Rate for Payer: Multiplan Auto	$162.50
Rate for Payer: Multiplan Commercial	$162.50
Rate for Payer: Multiplan Workers Comp	$162.50
Rate for Payer: Parkland Medicaid	$180.00
Rate for Payer: Scott and White EPO/PPO	$125.00
Rate for Payer: Superior Health Plan CHIP/Medicaid	$180.00
Rate for Payer: Superior Health Plan EPO	$34.00

Cryoglobulin Ql Serum Rflx SO

Facility

$104.61

Service Code	HCPCS 82595
Hospital Charge Code	1705482
Hospital Revenue Code	301
Rate for Payer: Cash Price	$71.13

Cryoglobulin Ql Serum Rflx SO

Facility

$104.61

Service Code	HCPCS 82595
Hospital Charge Code	1705482
Hospital Revenue Code	301
Min. Negotiated Rate	$2.52
Max. Negotiated Rate	$75.32
Rate for Payer: Amerigroup CHIP/Medicaid	$2.52
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$6.47
Rate for Payer: Amerigroup Medicare	$6.47
Rate for Payer: BCBS of TX Blue Advantage	$31.38
Rate for Payer: BCBS of TX Blue Essentials	$37.66
Rate for Payer: BCBS of TX Medicare	$6.47
Rate for Payer: BCBS of TX PPO	$41.84
Rate for Payer: Cash Price	$71.13
Rate for Payer: Cash Price	$71.13
Rate for Payer: Cigna Medicaid	$75.32
Rate for Payer: Cigna Medicare	$6.47
Rate for Payer: Employer Direct Commercial	$6.47
Rate for Payer: Humana Medicare/TRICARE	$6.47
Rate for Payer: Molina CHIP/Medicaid	$75.32
Rate for Payer: Molina Dual Medicare/Medicaid	$6.47
Rate for Payer: Molina Medicare	$6.47
Rate for Payer: Multiplan Auto	$68.00
Rate for Payer: Multiplan Commercial	$68.00
Rate for Payer: Multiplan Workers Comp	$68.00
Rate for Payer: Parkland Medicaid	$75.32
Rate for Payer: Scott and White EPO/PPO	$8.09
Rate for Payer: Scott and White Medicare	$6.47
Rate for Payer: Superior Health Plan CHIP/Medicaid	$75.32
Rate for Payer: Superior Health Plan EPO	$6.47
Rate for Payer: Superior Health Plan Medicare	$6.47
Rate for Payer: Universal American Dual Medicare/Medicaid	$6.47
Rate for Payer: Universal American Medicare	$6.47
Rate for Payer: Wellcare Medicare	$6.47
Rate for Payer: Wellmed Medicare	$6.47

.Cryptococcus Ag Titer CSF 183018 SO

Facility

$117.00

Service Code	HCPCS 87899
Hospital Charge Code	1605872
Hospital Revenue Code	306
Rate for Payer: Cash Price	$79.56

.Cryptococcus Ag Titer CSF 183018 SO

Facility

$117.00

Service Code	HCPCS 87899
Hospital Charge Code	1605872
Hospital Revenue Code	306
Min. Negotiated Rate	$6.27
Max. Negotiated Rate	$84.24
Rate for Payer: Amerigroup CHIP/Medicaid	$6.27
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$16.07
Rate for Payer: Amerigroup Medicare	$16.07
Rate for Payer: BCBS of TX Blue Advantage	$35.10
Rate for Payer: BCBS of TX Blue Essentials	$42.12
Rate for Payer: BCBS of TX Medicare	$16.07
Rate for Payer: BCBS of TX PPO	$46.80
Rate for Payer: Cash Price	$79.56
Rate for Payer: Cash Price	$79.56
Rate for Payer: Cigna Medicaid	$84.24
Rate for Payer: Cigna Medicare	$16.07
Rate for Payer: Employer Direct Commercial	$16.07
Rate for Payer: Humana Medicare/TRICARE	$16.07
Rate for Payer: Molina CHIP/Medicaid	$84.24
Rate for Payer: Molina Dual Medicare/Medicaid	$16.07
Rate for Payer: Molina Medicare	$16.07
Rate for Payer: Multiplan Auto	$76.05
Rate for Payer: Multiplan Commercial	$76.05
Rate for Payer: Multiplan Workers Comp	$76.05
Rate for Payer: Parkland Medicaid	$84.24
Rate for Payer: Scott and White EPO/PPO	$20.09
Rate for Payer: Scott and White Medicare	$16.07
Rate for Payer: Superior Health Plan CHIP/Medicaid	$84.24
Rate for Payer: Superior Health Plan EPO	$16.07
Rate for Payer: Superior Health Plan Medicare	$16.07
Rate for Payer: Universal American Dual Medicare/Medicaid	$16.07
Rate for Payer: Universal American Medicare	$16.07
Rate for Payer: Wellcare Medicare	$16.07
Rate for Payer: Wellmed Medicare	$16.07

Cryptosporidium Ag, EIA

Facility

$137.11

Service Code	HCPCS 87328
Hospital Charge Code	9146993
Hospital Revenue Code	306
Rate for Payer: Cash Price	$93.23

Cryptosporidium Ag, EIA

Facility

$137.11

Service Code	HCPCS 87328
Hospital Charge Code	9146993
Hospital Revenue Code	306
Min. Negotiated Rate	$5.39
Max. Negotiated Rate	$98.72
Rate for Payer: Amerigroup CHIP/Medicaid	$5.39
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$13.82
Rate for Payer: Amerigroup Medicare	$13.82
Rate for Payer: BCBS of TX Blue Advantage	$41.13
Rate for Payer: BCBS of TX Blue Essentials	$49.36
Rate for Payer: BCBS of TX Medicare	$13.82
Rate for Payer: BCBS of TX PPO	$54.84
Rate for Payer: Cash Price	$93.23
Rate for Payer: Cash Price	$93.23
Rate for Payer: Cigna Medicaid	$98.72
Rate for Payer: Cigna Medicare	$13.82
Rate for Payer: Employer Direct Commercial	$13.82
Rate for Payer: Humana Medicare/TRICARE	$13.82
Rate for Payer: Molina CHIP/Medicaid	$98.72
Rate for Payer: Molina Dual Medicare/Medicaid	$13.82
Rate for Payer: Molina Medicare	$13.82
Rate for Payer: Multiplan Auto	$89.12
Rate for Payer: Multiplan Commercial	$89.12
Rate for Payer: Multiplan Workers Comp	$89.12
Rate for Payer: Parkland Medicaid	$98.72
Rate for Payer: Scott and White EPO/PPO	$17.27
Rate for Payer: Scott and White Medicare	$13.82
Rate for Payer: Superior Health Plan CHIP/Medicaid	$98.72
Rate for Payer: Superior Health Plan EPO	$13.82
Rate for Payer: Superior Health Plan Medicare	$13.82
Rate for Payer: Universal American Dual Medicare/Medicaid	$13.82
Rate for Payer: Universal American Medicare	$13.82
Rate for Payer: Wellcare Medicare	$13.82
Rate for Payer: Wellmed Medicare	$13.82

CRYSTAL VIOLET-C

Facility

$179.60

Hospital Charge Code	992631
Hospital Revenue Code	270
Min. Negotiated Rate	$16.16
Max. Negotiated Rate	$129.31
Rate for Payer: Amerigroup CHIP/Medicaid	$16.16
Rate for Payer: BCBS of TX Blue Advantage	$53.88
Rate for Payer: BCBS of TX Blue Essentials	$64.66
Rate for Payer: BCBS of TX PPO	$71.84
Rate for Payer: Cash Price	$122.13
Rate for Payer: Cigna Medicaid	$129.31
Rate for Payer: Molina CHIP/Medicaid	$129.31
Rate for Payer: Multiplan Auto	$116.74
Rate for Payer: Multiplan Commercial	$116.74
Rate for Payer: Multiplan Workers Comp	$116.74
Rate for Payer: Parkland Medicaid	$129.31
Rate for Payer: Scott and White EPO/PPO	$89.80
Rate for Payer: Superior Health Plan CHIP/Medicaid	$129.31
Rate for Payer: Superior Health Plan EPO	$24.43

CRYSTAL VIOLET-C

Facility

$179.60

Hospital Charge Code	992631
Hospital Revenue Code	270
Rate for Payer: Cash Price	$122.13

CT Abdomen w/ IV & Oral Contrast

Facility

$5,161.00

Service Code	HCPCS 74160
Hospital Charge Code	3800257
Hospital Revenue Code	352
Rate for Payer: Cash Price	$3,509.48

CT Abdomen w/ IV & Oral Contrast

Facility

$5,161.00

Service Code	HCPCS 74160
Hospital Charge Code	3800257
Hospital Revenue Code	352
Min. Negotiated Rate	$175.06
Max. Negotiated Rate	$3,715.92
Rate for Payer: Amerigroup CHIP/Medicaid	$175.06
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$176.20
Rate for Payer: Amerigroup Medicare	$176.20
Rate for Payer: BCBS of TX Blue Advantage	$300.66
Rate for Payer: BCBS of TX Blue Essentials	$360.80
Rate for Payer: BCBS of TX Medicare	$176.20
Rate for Payer: BCBS of TX PPO	$402.71
Rate for Payer: Cash Price	$3,509.48
Rate for Payer: Cash Price	$3,509.48
Rate for Payer: Cash Price	$3,509.48
Rate for Payer: Cigna Commercial	$372.46
Rate for Payer: Cigna Medicaid	$3,715.92
Rate for Payer: Cigna Medicare	$176.20
Rate for Payer: Employer Direct Commercial	$176.20
Rate for Payer: Humana Medicare/TRICARE	$176.20
Rate for Payer: Molina CHIP/Medicaid	$3,715.92
Rate for Payer: Molina Dual Medicare/Medicaid	$176.20
Rate for Payer: Molina Medicare	$176.20
Rate for Payer: Multiplan Auto	$3,354.65
Rate for Payer: Multiplan Commercial	$3,354.65
Rate for Payer: Multiplan Workers Comp	$3,354.65
Rate for Payer: Parkland Medicaid	$3,715.92
Rate for Payer: Scott and White EPO/PPO	$295.66
Rate for Payer: Scott and White Medicare	$176.20
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3,715.92
Rate for Payer: Superior Health Plan EPO	$176.20
Rate for Payer: Superior Health Plan Medicare	$176.20
Rate for Payer: Universal American Dual Medicare/Medicaid	$176.20
Rate for Payer: Universal American Medicare	$176.20
Rate for Payer: Wellcare Medicare	$176.20
Rate for Payer: Wellmed Medicare	$176.20

CT Abdomen w/o IV and Oral Contrast

Facility

$4,150.00

Service Code	HCPCS 74150
Hospital Charge Code	3800117
Hospital Revenue Code	352
Rate for Payer: Cash Price	$2,822.00

CT Abdomen w/o IV and Oral Contrast

Facility

$4,150.00

Service Code	HCPCS 74150
Hospital Charge Code	3800117
Hospital Revenue Code	352
Min. Negotiated Rate	$104.75
Max. Negotiated Rate	$2,988.00
Rate for Payer: Amerigroup CHIP/Medicaid	$104.75
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$105.02
Rate for Payer: Amerigroup Medicare	$105.02
Rate for Payer: BCBS of TX Blue Advantage	$184.93
Rate for Payer: BCBS of TX Blue Essentials	$221.92
Rate for Payer: BCBS of TX Medicare	$105.02
Rate for Payer: BCBS of TX PPO	$247.70
Rate for Payer: Cash Price	$2,822.00
Rate for Payer: Cash Price	$2,822.00
Rate for Payer: Cash Price	$2,822.00
Rate for Payer: Cigna Commercial	$222.00
Rate for Payer: Cigna Medicaid	$2,988.00
Rate for Payer: Cigna Medicare	$105.02
Rate for Payer: Employer Direct Commercial	$105.02
Rate for Payer: Humana Medicare/TRICARE	$105.02
Rate for Payer: Molina CHIP/Medicaid	$2,988.00
Rate for Payer: Molina Dual Medicare/Medicaid	$105.02
Rate for Payer: Molina Medicare	$105.02
Rate for Payer: Multiplan Auto	$2,697.50
Rate for Payer: Multiplan Commercial	$2,697.50
Rate for Payer: Multiplan Workers Comp	$2,697.50
Rate for Payer: Parkland Medicaid	$2,988.00
Rate for Payer: Scott and White EPO/PPO	$172.94
Rate for Payer: Scott and White Medicare	$105.02
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2,988.00
Rate for Payer: Superior Health Plan EPO	$105.02
Rate for Payer: Superior Health Plan Medicare	$105.02
Rate for Payer: Universal American Dual Medicare/Medicaid	$105.02
Rate for Payer: Universal American Medicare	$105.02
Rate for Payer: Wellcare Medicare	$105.02
Rate for Payer: Wellmed Medicare	$105.02

CT Abdomen w/ + w/o IV Contrast Only

Facility

$6,367.00

Service Code	HCPCS 74170
Hospital Charge Code	3800182
Hospital Revenue Code	352
Rate for Payer: Cash Price	$4,329.56

CT Abdomen w/ + w/o IV Contrast Only

Facility

$6,367.00

Service Code	HCPCS 74170
Hospital Charge Code	3800182
Hospital Revenue Code	352
Min. Negotiated Rate	$175.06
Max. Negotiated Rate	$4,584.24
Rate for Payer: Amerigroup CHIP/Medicaid	$175.06
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$176.20
Rate for Payer: Amerigroup Medicare	$176.20
Rate for Payer: BCBS of TX Blue Advantage	$300.66
Rate for Payer: BCBS of TX Blue Essentials	$360.80
Rate for Payer: BCBS of TX Medicare	$176.20
Rate for Payer: BCBS of TX PPO	$402.71
Rate for Payer: Cash Price	$4,329.56
Rate for Payer: Cash Price	$4,329.56
Rate for Payer: Cash Price	$4,329.56
Rate for Payer: Cigna Commercial	$372.46
Rate for Payer: Cigna Medicaid	$4,584.24
Rate for Payer: Cigna Medicare	$176.20
Rate for Payer: Employer Direct Commercial	$176.20
Rate for Payer: Humana Medicare/TRICARE	$176.20
Rate for Payer: Molina CHIP/Medicaid	$4,584.24
Rate for Payer: Molina Dual Medicare/Medicaid	$176.20
Rate for Payer: Molina Medicare	$176.20
Rate for Payer: Multiplan Auto	$4,138.55
Rate for Payer: Multiplan Commercial	$4,138.55
Rate for Payer: Multiplan Workers Comp	$4,138.55
Rate for Payer: Parkland Medicaid	$4,584.24
Rate for Payer: Scott and White EPO/PPO	$332.38
Rate for Payer: Scott and White Medicare	$176.20
Rate for Payer: Superior Health Plan CHIP/Medicaid	$4,584.24
Rate for Payer: Superior Health Plan EPO	$176.20
Rate for Payer: Superior Health Plan Medicare	$176.20
Rate for Payer: Universal American Dual Medicare/Medicaid	$176.20
Rate for Payer: Universal American Medicare	$176.20
Rate for Payer: Wellcare Medicare	$176.20
Rate for Payer: Wellmed Medicare	$176.20

CT Abd/Pelvis w/o IV and Oral Contrast

Facility

$7,799.00

Service Code	HCPCS 74176
Hospital Charge Code	3890210
Hospital Revenue Code	352
Min. Negotiated Rate	$188.11
Max. Negotiated Rate	$5,615.28
Rate for Payer: Amerigroup CHIP/Medicaid	$188.11
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$239.69
Rate for Payer: Amerigroup Medicare	$239.69
Rate for Payer: BCBS of TX Blue Advantage	$384.52
Rate for Payer: BCBS of TX Blue Essentials	$461.42
Rate for Payer: BCBS of TX Medicare	$239.69
Rate for Payer: BCBS of TX PPO	$515.02
Rate for Payer: Cash Price	$5,303.32
Rate for Payer: Cash Price	$5,303.32
Rate for Payer: Cash Price	$5,303.32
Rate for Payer: Cigna Commercial	$506.65
Rate for Payer: Cigna Medicaid	$5,615.28
Rate for Payer: Cigna Medicare	$239.69
Rate for Payer: Employer Direct Commercial	$239.69
Rate for Payer: Humana Medicare/TRICARE	$239.69
Rate for Payer: Molina CHIP/Medicaid	$5,615.28
Rate for Payer: Molina Dual Medicare/Medicaid	$239.69
Rate for Payer: Molina Medicare	$239.69
Rate for Payer: Multiplan Auto	$5,069.35
Rate for Payer: Multiplan Commercial	$5,069.35
Rate for Payer: Multiplan Workers Comp	$5,069.35
Rate for Payer: Parkland Medicaid	$5,615.28
Rate for Payer: Scott and White EPO/PPO	$231.75
Rate for Payer: Scott and White Medicare	$239.69
Rate for Payer: Superior Health Plan CHIP/Medicaid	$5,615.28
Rate for Payer: Superior Health Plan EPO	$239.69
Rate for Payer: Superior Health Plan Medicare	$239.69
Rate for Payer: Universal American Dual Medicare/Medicaid	$239.69
Rate for Payer: Universal American Medicare	$239.69
Rate for Payer: Wellcare Medicare	$239.69
Rate for Payer: Wellmed Medicare	$239.69

CT Abd/Pelvis w/o IV and Oral Contrast

Facility

$7,799.00

Service Code	HCPCS 74176
Hospital Charge Code	3890210
Hospital Revenue Code	352
Rate for Payer: Cash Price	$5,303.32

CT Abd/Pelvis w/ + w/o IV&Oral Contrast

Facility

$9,419.00

Service Code	HCPCS 74178
Hospital Charge Code	3890212
Hospital Revenue Code	352
Min. Negotiated Rate	$350.18
Max. Negotiated Rate	$6,781.68
Rate for Payer: Amerigroup CHIP/Medicaid	$350.18
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$350.46
Rate for Payer: Amerigroup Medicare	$350.46
Rate for Payer: BCBS of TX Blue Advantage	$630.05
Rate for Payer: BCBS of TX Blue Essentials	$756.06
Rate for Payer: BCBS of TX Medicare	$350.46
Rate for Payer: BCBS of TX PPO	$843.89
Rate for Payer: Cash Price	$6,404.92
Rate for Payer: Cash Price	$6,404.92
Rate for Payer: Cash Price	$6,404.92
Rate for Payer: Cigna Commercial	$740.81
Rate for Payer: Cigna Medicaid	$6,781.68
Rate for Payer: Cigna Medicare	$350.46
Rate for Payer: Employer Direct Commercial	$350.46
Rate for Payer: Humana Medicare/TRICARE	$350.46
Rate for Payer: Molina CHIP/Medicaid	$6,781.68
Rate for Payer: Molina Dual Medicare/Medicaid	$350.46
Rate for Payer: Molina Medicare	$350.46
Rate for Payer: Multiplan Auto	$6,122.35
Rate for Payer: Multiplan Commercial	$6,122.35
Rate for Payer: Multiplan Workers Comp	$6,122.35
Rate for Payer: Parkland Medicaid	$6,781.68
Rate for Payer: Scott and White EPO/PPO	$431.59
Rate for Payer: Scott and White Medicare	$350.46
Rate for Payer: Superior Health Plan CHIP/Medicaid	$6,781.68
Rate for Payer: Superior Health Plan EPO	$350.46
Rate for Payer: Superior Health Plan Medicare	$350.46
Rate for Payer: Universal American Dual Medicare/Medicaid	$350.46
Rate for Payer: Universal American Medicare	$350.46
Rate for Payer: Wellcare Medicare	$350.46
Rate for Payer: Wellmed Medicare	$350.46

CT Abd/Pelvis w/ + w/o IV&Oral Contrast

Facility

$9,419.00

Service Code	HCPCS 74178
Hospital Charge Code	3890212
Hospital Revenue Code	352
Rate for Payer: Cash Price	$6,404.92

CT Ablation Renal RF Left

Facility

$12,650.00

Service Code	HCPCS 50592
Hospital Charge Code	4610592
Hospital Revenue Code	361
Min. Negotiated Rate	$1,888.85
Max. Negotiated Rate	$12,837.39
Rate for Payer: Amerigroup CHIP/Medicaid	$1,888.85
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$6,073.08
Rate for Payer: Amerigroup Medicare	$6,073.08
Rate for Payer: BCBS of TX Blue Advantage	$8,072.30
Rate for Payer: BCBS of TX Blue Essentials	$9,667.42
Rate for Payer: BCBS of TX Medicare	$6,073.08
Rate for Payer: BCBS of TX PPO	$12,180.95
Rate for Payer: Cash Price	$8,602.00
Rate for Payer: Cash Price	$8,602.00
Rate for Payer: Cash Price	$8,602.00
Rate for Payer: Cigna Commercial	$12,837.39
Rate for Payer: Cigna Medicaid	$9,108.00
Rate for Payer: Cigna Medicare	$6,073.08
Rate for Payer: Employer Direct Commercial	$6,073.08
Rate for Payer: Humana Medicare/TRICARE	$6,073.08
Rate for Payer: Molina CHIP/Medicaid	$9,108.00
Rate for Payer: Molina Dual Medicare/Medicaid	$6,073.08
Rate for Payer: Molina Medicare	$6,073.08
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	$9,108.00
Rate for Payer: Scott and White EPO/PPO	$9,762.30
Rate for Payer: Scott and White Medicare	$6,073.08
Rate for Payer: Superior Health Plan CHIP/Medicaid	$9,108.00
Rate for Payer: Superior Health Plan EPO	$6,073.08
Rate for Payer: Superior Health Plan Medicare	$6,073.08
Rate for Payer: Universal American Dual Medicare/Medicaid	$6,073.08
Rate for Payer: Universal American Medicare	$6,073.08
Rate for Payer: Wellcare Medicare	$6,073.08
Rate for Payer: Wellmed Medicare	$6,073.08

CT Ablation Renal RF Left

Facility

$12,650.00

Service Code	HCPCS 50592
Hospital Charge Code	4610592
Hospital Revenue Code	361
Rate for Payer: Cash Price	$8,602.00

CTA Heart w/ Contrast

Facility

$1,385.00

Service Code	HCPCS 75574
Hospital Charge Code	5050215
Hospital Revenue Code	350
Rate for Payer: Cash Price	$941.80

CTA Heart w/ Contrast

Facility

$1,385.00

Service Code	HCPCS 75574
Hospital Charge Code	5050215
Hospital Revenue Code	350
Min. Negotiated Rate	$175.06
Max. Negotiated Rate	$997.20
Rate for Payer: Amerigroup CHIP/Medicaid	$175.06
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$350.46
Rate for Payer: Amerigroup Medicare	$350.46
Rate for Payer: BCBS of TX Blue Advantage	$333.00
Rate for Payer: BCBS of TX Blue Essentials	$399.60
Rate for Payer: BCBS of TX Medicare	$350.46
Rate for Payer: BCBS of TX PPO	$446.02
Rate for Payer: Cash Price	$941.80
Rate for Payer: Cash Price	$941.80
Rate for Payer: Cash Price	$941.80
Rate for Payer: Cigna Commercial	$740.81
Rate for Payer: Cigna Medicaid	$997.20
Rate for Payer: Cigna Medicare	$350.46
Rate for Payer: Employer Direct Commercial	$350.46
Rate for Payer: Humana Medicare/TRICARE	$350.46
Rate for Payer: Molina CHIP/Medicaid	$997.20
Rate for Payer: Molina Dual Medicare/Medicaid	$350.46
Rate for Payer: Molina Medicare	$350.46
Rate for Payer: Multiplan Auto	$900.25
Rate for Payer: Multiplan Commercial	$900.25
Rate for Payer: Multiplan Workers Comp	$900.25
Rate for Payer: Parkland Medicaid	$997.20
Rate for Payer: Scott and White EPO/PPO	$407.64
Rate for Payer: Scott and White Medicare	$350.46
Rate for Payer: Superior Health Plan CHIP/Medicaid	$997.20
Rate for Payer: Superior Health Plan EPO	$350.46
Rate for Payer: Superior Health Plan Medicare	$350.46
Rate for Payer: Universal American Dual Medicare/Medicaid	$350.46
Rate for Payer: Universal American Medicare	$350.46
Rate for Payer: Wellcare Medicare	$350.46
Rate for Payer: Wellmed Medicare	$350.46

CT Angio Abdomen

Facility

$6,558.00

Service Code	HCPCS 74175
Hospital Charge Code	3890209
Hospital Revenue Code	352
Rate for Payer: Cash Price	$4,459.44

Know your out-of-pocket cost for care.

All Charges