White Rock Medical Center

All Charges

Charge

Type

Setting

Price

DEGENERATIVE NERVOUS SYSTEM DISORDERS W/O MCC

Facility

$24,616.40

Service Code	MSDRG 057
Min. Negotiated Rate	$10,396.54
Max. Negotiated Rate	$24,616.40
Rate for Payer: BCBS of TX Blue Advantage	$10,396.54
Rate for Payer: BCBS of TX Blue Essentials	$12,474.64
Rate for Payer: BCBS of TX PPO	$13,861.25

Delay of flap or sectioning of flap (division and inset) at eyelids, nose, ears, or lips

Facility

$10,000.00

Service Code	CPT 15630
Hospital Charge Code	36015630
Hospital Revenue Code	360
Min. Negotiated Rate	$709.01
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$709.01
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$2,072.68
Rate for Payer: Amerigroup Medicare	$2,072.68
Rate for Payer: BCBS of TX Blue Advantage	$2,709.98
Rate for Payer: BCBS of TX Blue Essentials	$3,245.48
Rate for Payer: BCBS of TX Medicare	$2,072.68
Rate for Payer: BCBS of TX PPO	$4,089.30
Rate for Payer: Cigna Commercial	$4,381.27
Rate for Payer: Cigna Medicare	$2,072.68
Rate for Payer: Employer Direct Commercial	$2,072.68
Rate for Payer: Humana Medicare/TRICARE	$2,072.68
Rate for Payer: Molina Dual Medicare/Medicaid	$2,072.68
Rate for Payer: Molina Medicare	$2,072.68
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: Scott and White EPO/PPO	$3,834.46
Rate for Payer: Scott and White Medicare	$2,072.68
Rate for Payer: Superior Health Plan EPO	$2,072.68
Rate for Payer: Superior Health Plan Medicare	$2,072.68
Rate for Payer: Universal American Dual Medicare/Medicaid	$2,072.68
Rate for Payer: Universal American Medicare	$2,072.68
Rate for Payer: Wellcare Medicare	$2,072.68
Rate for Payer: Wellmed Medicare	$2,072.68

Delay of flap or sectioning of flap (division and inset) at eyelids, nose, ears, or lips

Facility

$14,656.04

Service Code	HCPCS 15630
Hospital Charge Code	9900131
Hospital Revenue Code	360
Min. Negotiated Rate	$709.01
Max. Negotiated Rate	$10,552.35
Rate for Payer: Amerigroup CHIP/Medicaid	$709.01
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$2,072.68
Rate for Payer: Amerigroup Medicare	$2,072.68
Rate for Payer: BCBS of TX Blue Advantage	$2,709.98
Rate for Payer: BCBS of TX Blue Essentials	$3,245.48
Rate for Payer: BCBS of TX Medicare	$2,072.68
Rate for Payer: BCBS of TX PPO	$4,089.30
Rate for Payer: Cash Price	$9,966.11
Rate for Payer: Cash Price	$9,966.11
Rate for Payer: Cash Price	$9,966.11
Rate for Payer: Cigna Commercial	$4,381.27
Rate for Payer: Cigna Medicaid	$10,552.35
Rate for Payer: Cigna Medicare	$2,072.68
Rate for Payer: Employer Direct Commercial	$2,072.68
Rate for Payer: Humana Medicare/TRICARE	$2,072.68
Rate for Payer: Molina CHIP/Medicaid	$10,552.35
Rate for Payer: Molina Dual Medicare/Medicaid	$2,072.68
Rate for Payer: Molina Medicare	$2,072.68
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	$10,552.35
Rate for Payer: Scott and White EPO/PPO	$3,834.46
Rate for Payer: Scott and White Medicare	$2,072.68
Rate for Payer: Superior Health Plan CHIP/Medicaid	$10,552.35
Rate for Payer: Superior Health Plan EPO	$2,072.68
Rate for Payer: Superior Health Plan Medicare	$2,072.68
Rate for Payer: Universal American Dual Medicare/Medicaid	$2,072.68
Rate for Payer: Universal American Medicare	$2,072.68
Rate for Payer: Wellcare Medicare	$2,072.68
Rate for Payer: Wellmed Medicare	$2,072.68

Delay of flap or sectioning of flap (division and inset) at eyelids, nose, ears, or lips

Facility

$14,656.04

Service Code	HCPCS 15630
Hospital Charge Code	9900131
Hospital Revenue Code	360
Rate for Payer: Cash Price	$9,966.11

Delay of flap or sectioning of flap (division and inset); at forehead, cheeks, chin, neck, axillae,

Facility

$10,000.00

Service Code	CPT 15620
Hospital Charge Code	36015620
Hospital Revenue Code	360
Min. Negotiated Rate	$709.01
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$709.01
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$2,072.68
Rate for Payer: Amerigroup Medicare	$2,072.68
Rate for Payer: BCBS of TX Blue Advantage	$2,709.98
Rate for Payer: BCBS of TX Blue Essentials	$3,245.48
Rate for Payer: BCBS of TX Medicare	$2,072.68
Rate for Payer: BCBS of TX PPO	$4,089.30
Rate for Payer: Cigna Commercial	$4,381.27
Rate for Payer: Cigna Medicare	$2,072.68
Rate for Payer: Employer Direct Commercial	$2,072.68
Rate for Payer: Humana Medicare/TRICARE	$2,072.68
Rate for Payer: Molina Dual Medicare/Medicaid	$2,072.68
Rate for Payer: Molina Medicare	$2,072.68
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: Scott and White EPO/PPO	$3,834.46
Rate for Payer: Scott and White Medicare	$2,072.68
Rate for Payer: Superior Health Plan EPO	$2,072.68
Rate for Payer: Superior Health Plan Medicare	$2,072.68
Rate for Payer: Universal American Dual Medicare/Medicaid	$2,072.68
Rate for Payer: Universal American Medicare	$2,072.68
Rate for Payer: Wellcare Medicare	$2,072.68
Rate for Payer: Wellmed Medicare	$2,072.68

Delay of flap or sectioning of flap (division and inset); at forehead, cheeks, chin, neck, axillae,

Facility

$7,719.12

Service Code	HCPCS 15620
Hospital Charge Code	9900130
Hospital Revenue Code	360
Rate for Payer: Cash Price	$5,249.00

Delay of flap or sectioning of flap (division and inset); at forehead, cheeks, chin, neck, axillae,

Facility

$7,719.12

Service Code	HCPCS 15620
Hospital Charge Code	9900130
Hospital Revenue Code	360
Min. Negotiated Rate	$709.01
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$709.01
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$2,072.68
Rate for Payer: Amerigroup Medicare	$2,072.68
Rate for Payer: BCBS of TX Blue Advantage	$2,709.98
Rate for Payer: BCBS of TX Blue Essentials	$3,245.48
Rate for Payer: BCBS of TX Medicare	$2,072.68
Rate for Payer: BCBS of TX PPO	$4,089.30
Rate for Payer: Cash Price	$5,249.00
Rate for Payer: Cash Price	$5,249.00
Rate for Payer: Cash Price	$5,249.00
Rate for Payer: Cigna Commercial	$4,381.27
Rate for Payer: Cigna Medicaid	$5,557.77
Rate for Payer: Cigna Medicare	$2,072.68
Rate for Payer: Employer Direct Commercial	$2,072.68
Rate for Payer: Humana Medicare/TRICARE	$2,072.68
Rate for Payer: Molina CHIP/Medicaid	$5,557.77
Rate for Payer: Molina Dual Medicare/Medicaid	$2,072.68
Rate for Payer: Molina Medicare	$2,072.68
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	$5,557.77
Rate for Payer: Scott and White EPO/PPO	$3,834.46
Rate for Payer: Scott and White Medicare	$2,072.68
Rate for Payer: Superior Health Plan CHIP/Medicaid	$5,557.77
Rate for Payer: Superior Health Plan EPO	$2,072.68
Rate for Payer: Superior Health Plan Medicare	$2,072.68
Rate for Payer: Universal American Dual Medicare/Medicaid	$2,072.68
Rate for Payer: Universal American Medicare	$2,072.68
Rate for Payer: Wellcare Medicare	$2,072.68
Rate for Payer: Wellmed Medicare	$2,072.68

Delay of flap or sectioning of flap (division and inset); at scalp, arms, or legs

Facility

$10,000.00

Service Code	CPT 15610
Hospital Charge Code	36015610
Hospital Revenue Code	360
Min. Negotiated Rate	$709.01
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$709.01
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$2,072.68
Rate for Payer: Amerigroup Medicare	$2,072.68
Rate for Payer: BCBS of TX Blue Advantage	$2,709.98
Rate for Payer: BCBS of TX Blue Essentials	$3,245.48
Rate for Payer: BCBS of TX Medicare	$2,072.68
Rate for Payer: BCBS of TX PPO	$4,089.30
Rate for Payer: Cigna Commercial	$4,381.27
Rate for Payer: Cigna Medicare	$2,072.68
Rate for Payer: Employer Direct Commercial	$2,072.68
Rate for Payer: Humana Medicare/TRICARE	$2,072.68
Rate for Payer: Molina Dual Medicare/Medicaid	$2,072.68
Rate for Payer: Molina Medicare	$2,072.68
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: Scott and White EPO/PPO	$3,834.46
Rate for Payer: Scott and White Medicare	$2,072.68
Rate for Payer: Superior Health Plan EPO	$2,072.68
Rate for Payer: Superior Health Plan Medicare	$2,072.68
Rate for Payer: Universal American Dual Medicare/Medicaid	$2,072.68
Rate for Payer: Universal American Medicare	$2,072.68
Rate for Payer: Wellcare Medicare	$2,072.68
Rate for Payer: Wellmed Medicare	$2,072.68

Delay of flap or sectioning of flap (division and inset); at scalp, arms, or legs

Facility

$5,247.78

Service Code	HCPCS 15610
Hospital Charge Code	9900129
Hospital Revenue Code	360
Min. Negotiated Rate	$709.01
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$709.01
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$2,072.68
Rate for Payer: Amerigroup Medicare	$2,072.68
Rate for Payer: BCBS of TX Blue Advantage	$2,709.98
Rate for Payer: BCBS of TX Blue Essentials	$3,245.48
Rate for Payer: BCBS of TX Medicare	$2,072.68
Rate for Payer: BCBS of TX PPO	$4,089.30
Rate for Payer: Cash Price	$3,568.49
Rate for Payer: Cash Price	$3,568.49
Rate for Payer: Cash Price	$3,568.49
Rate for Payer: Cigna Commercial	$4,381.27
Rate for Payer: Cigna Medicaid	$3,778.40
Rate for Payer: Cigna Medicare	$2,072.68
Rate for Payer: Employer Direct Commercial	$2,072.68
Rate for Payer: Humana Medicare/TRICARE	$2,072.68
Rate for Payer: Molina CHIP/Medicaid	$3,778.40
Rate for Payer: Molina Dual Medicare/Medicaid	$2,072.68
Rate for Payer: Molina Medicare	$2,072.68
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	$3,778.40
Rate for Payer: Scott and White EPO/PPO	$3,834.46
Rate for Payer: Scott and White Medicare	$2,072.68
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3,778.40
Rate for Payer: Superior Health Plan EPO	$2,072.68
Rate for Payer: Superior Health Plan Medicare	$2,072.68
Rate for Payer: Universal American Dual Medicare/Medicaid	$2,072.68
Rate for Payer: Universal American Medicare	$2,072.68
Rate for Payer: Wellcare Medicare	$2,072.68
Rate for Payer: Wellmed Medicare	$2,072.68

Delay of flap or sectioning of flap (division and inset); at scalp, arms, or legs

Facility

$5,247.78

Service Code	HCPCS 15610
Hospital Charge Code	9900129
Hospital Revenue Code	360
Rate for Payer: Cash Price	$3,568.49

DENTAL AND ORAL DISEASES WITH CC

Facility

$17,286.20

Service Code	MSDRG 158
Min. Negotiated Rate	$7,656.58
Max. Negotiated Rate	$17,286.20
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$11,428.03
Rate for Payer: Amerigroup Medicare	$11,428.03
Rate for Payer: BCBS of TX Medicare	$11,428.03
Rate for Payer: Cigna Commercial	$11,718.22
Rate for Payer: Cigna Medicare	$11,428.03
Rate for Payer: Employer Direct Commercial	$11,428.03
Rate for Payer: Humana Medicare/TRICARE	$11,428.03
Rate for Payer: Molina Dual Medicare/Medicaid	$11,428.03
Rate for Payer: Molina Medicare	$11,428.03
Rate for Payer: Multiplan Auto	$17,286.20
Rate for Payer: Multiplan Commercial	$17,286.20
Rate for Payer: Multiplan Workers Comp	$17,286.20
Rate for Payer: Scott and White EPO/PPO	$7,960.75
Rate for Payer: Scott and White Medicare	$11,428.03
Rate for Payer: Superior Health Plan EPO	$11,428.03
Rate for Payer: Superior Health Plan Medicare	$11,428.03
Rate for Payer: Universal American Dual Medicare/Medicaid	$11,428.03
Rate for Payer: Universal American Medicare	$11,428.03
Rate for Payer: Wellcare Medicare	$11,428.03
Rate for Payer: Wellmed Medicare	$11,428.03

DENTAL AND ORAL DISEASES WITH MCC

Facility

$32,619.20

Service Code	MSDRG 157
Min. Negotiated Rate	$14,387.80
Max. Negotiated Rate	$32,619.20
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$17,342.56
Rate for Payer: Amerigroup Medicare	$17,342.56
Rate for Payer: BCBS of TX Medicare	$17,342.56
Rate for Payer: Cigna Commercial	$22,112.38
Rate for Payer: Cigna Medicare	$17,342.56
Rate for Payer: Employer Direct Commercial	$17,342.56
Rate for Payer: Humana Medicare/TRICARE	$17,342.56
Rate for Payer: Molina Dual Medicare/Medicaid	$17,342.56
Rate for Payer: Molina Medicare	$17,342.56
Rate for Payer: Multiplan Auto	$32,619.20
Rate for Payer: Multiplan Commercial	$32,619.20
Rate for Payer: Multiplan Workers Comp	$32,619.20
Rate for Payer: Scott and White EPO/PPO	$15,022.00
Rate for Payer: Scott and White Medicare	$17,342.56
Rate for Payer: Superior Health Plan EPO	$17,342.56
Rate for Payer: Superior Health Plan Medicare	$17,342.56
Rate for Payer: Universal American Dual Medicare/Medicaid	$17,342.56
Rate for Payer: Universal American Medicare	$17,342.56
Rate for Payer: Wellcare Medicare	$17,342.56
Rate for Payer: Wellmed Medicare	$17,342.56

DENTAL AND ORAL DISEASES WITHOUT CC/MCC

Facility

$13,461.50

Service Code	MSDRG 159
Min. Negotiated Rate	$5,834.24
Max. Negotiated Rate	$13,461.50
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$9,952.70
Rate for Payer: Amerigroup Medicare	$9,952.70
Rate for Payer: BCBS of TX Medicare	$9,952.70
Rate for Payer: Cigna Commercial	$9,125.48
Rate for Payer: Cigna Medicare	$9,952.70
Rate for Payer: Employer Direct Commercial	$9,952.70
Rate for Payer: Humana Medicare/TRICARE	$9,952.70
Rate for Payer: Molina Dual Medicare/Medicaid	$9,952.70
Rate for Payer: Molina Medicare	$9,952.70
Rate for Payer: Multiplan Auto	$13,461.50
Rate for Payer: Multiplan Commercial	$13,461.50
Rate for Payer: Multiplan Workers Comp	$13,461.50
Rate for Payer: Scott and White EPO/PPO	$6,199.38
Rate for Payer: Scott and White Medicare	$9,952.70
Rate for Payer: Superior Health Plan EPO	$9,952.70
Rate for Payer: Superior Health Plan Medicare	$9,952.70
Rate for Payer: Universal American Dual Medicare/Medicaid	$9,952.70
Rate for Payer: Universal American Medicare	$9,952.70
Rate for Payer: Wellcare Medicare	$9,952.70
Rate for Payer: Wellmed Medicare	$9,952.70

DENTAL DISEASES AND DISORDERS

Facility

$2,751.97

Service Code	APR-DRG 1142
Min. Negotiated Rate	$2,594.65
Max. Negotiated Rate	$2,751.97
Rate for Payer: Amerigroup CHIP/Medicaid	$2,594.65
Rate for Payer: Cigna Medicaid	$2,594.65
Rate for Payer: Molina CHIP/Medicaid	$2,594.65
Rate for Payer: Parkland Medicaid	$2,594.65
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2,751.97

DENTAL DISEASES AND DISORDERS

Facility

$4,026.12

Service Code	APR-DRG 1143
Min. Negotiated Rate	$3,795.96
Max. Negotiated Rate	$4,026.12
Rate for Payer: Amerigroup CHIP/Medicaid	$3,795.96
Rate for Payer: Cigna Medicaid	$3,795.96
Rate for Payer: Molina CHIP/Medicaid	$3,795.96
Rate for Payer: Parkland Medicaid	$3,795.96
Rate for Payer: Superior Health Plan CHIP/Medicaid	$4,026.12

DENTAL DISEASES AND DISORDERS

Facility

$13,257.06

Service Code	APR-DRG 1144
Min. Negotiated Rate	$12,499.22
Max. Negotiated Rate	$13,257.06
Rate for Payer: Amerigroup CHIP/Medicaid	$12,499.22
Rate for Payer: Cigna Medicaid	$12,499.22
Rate for Payer: Molina CHIP/Medicaid	$12,499.22
Rate for Payer: Parkland Medicaid	$12,499.22
Rate for Payer: Superior Health Plan CHIP/Medicaid	$13,257.06

DENTAL DISEASES AND DISORDERS

Facility

$2,244.27

Service Code	APR-DRG 1141
Min. Negotiated Rate	$2,115.98
Max. Negotiated Rate	$2,244.27
Rate for Payer: Amerigroup CHIP/Medicaid	$2,115.98
Rate for Payer: Cigna Medicaid	$2,115.98
Rate for Payer: Molina CHIP/Medicaid	$2,115.98
Rate for Payer: Parkland Medicaid	$2,115.98
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2,244.27

DENTAL & ORAL DISEASES W CC

Facility

$17,286.20

Service Code	MSDRG 158
Min. Negotiated Rate	$7,656.58
Max. Negotiated Rate	$17,286.20
Rate for Payer: BCBS of TX Blue Advantage	$7,656.58
Rate for Payer: BCBS of TX Blue Essentials	$9,187.01
Rate for Payer: BCBS of TX PPO	$10,208.18

DENTAL & ORAL DISEASES W MCC

Facility

$32,619.20

Service Code	MSDRG 157
Min. Negotiated Rate	$14,387.80
Max. Negotiated Rate	$32,619.20
Rate for Payer: BCBS of TX Blue Advantage	$14,387.80
Rate for Payer: BCBS of TX Blue Essentials	$17,263.69
Rate for Payer: BCBS of TX PPO	$19,182.62

DENTAL & ORAL DISEASES W/O CC/MCC

Facility

$13,461.50

Service Code	MSDRG 159
Min. Negotiated Rate	$5,834.24
Max. Negotiated Rate	$13,461.50
Rate for Payer: BCBS of TX Blue Advantage	$5,834.24
Rate for Payer: BCBS of TX Blue Essentials	$7,000.41
Rate for Payer: BCBS of TX PPO	$7,778.53

DEPRESSION EXCEPT MAJOR DEPRESSIVE DISORDER

Facility

$1,779.95

Service Code	APR-DRG 7542
Min. Negotiated Rate	$1,678.20
Max. Negotiated Rate	$1,779.95
Rate for Payer: Amerigroup CHIP/Medicaid	$1,678.20
Rate for Payer: Cigna Medicaid	$1,678.20
Rate for Payer: Molina CHIP/Medicaid	$1,678.20
Rate for Payer: Parkland Medicaid	$1,678.20
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,779.95

DEPRESSION EXCEPT MAJOR DEPRESSIVE DISORDER

Facility

$3,198.94

Service Code	APR-DRG 7543
Min. Negotiated Rate	$3,016.07
Max. Negotiated Rate	$3,198.94
Rate for Payer: Amerigroup CHIP/Medicaid	$3,016.07
Rate for Payer: Cigna Medicaid	$3,016.07
Rate for Payer: Molina CHIP/Medicaid	$3,016.07
Rate for Payer: Parkland Medicaid	$3,016.07
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3,198.94

DEPRESSION EXCEPT MAJOR DEPRESSIVE DISORDER

Facility

$9,235.10

Service Code	APR-DRG 7544
Min. Negotiated Rate	$8,707.17
Max. Negotiated Rate	$9,235.10
Rate for Payer: Amerigroup CHIP/Medicaid	$8,707.17
Rate for Payer: Cigna Medicaid	$8,707.17
Rate for Payer: Molina CHIP/Medicaid	$8,707.17
Rate for Payer: Parkland Medicaid	$8,707.17
Rate for Payer: Superior Health Plan CHIP/Medicaid	$9,235.10

DEPRESSION EXCEPT MAJOR DEPRESSIVE DISORDER

Facility

$1,265.09

Service Code	APR-DRG 7541
Min. Negotiated Rate	$1,192.77
Max. Negotiated Rate	$1,265.09
Rate for Payer: Amerigroup CHIP/Medicaid	$1,192.77
Rate for Payer: Cigna Medicaid	$1,192.77
Rate for Payer: Molina CHIP/Medicaid	$1,192.77
Rate for Payer: Parkland Medicaid	$1,192.77
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,265.09

DEPRESSIVE NEUROSES

Facility

$17,877.10

Service Code	MSDRG 881
Min. Negotiated Rate	$6,523.10
Max. Negotiated Rate	$17,877.10
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$11,655.97
Rate for Payer: Amerigroup Medicare	$11,655.97
Rate for Payer: BCBS of TX Blue Advantage	$6,523.10
Rate for Payer: BCBS of TX Blue Essentials	$7,826.96
Rate for Payer: BCBS of TX Medicare	$11,655.97
Rate for Payer: BCBS of TX PPO	$8,696.96
Rate for Payer: Cigna Commercial	$12,118.79
Rate for Payer: Cigna Medicare	$11,655.97
Rate for Payer: Employer Direct Commercial	$11,655.97
Rate for Payer: Molina Dual Medicare/Medicaid	$11,655.97
Rate for Payer: Molina Medicare	$11,655.97
Rate for Payer: Multiplan Auto	$17,877.10
Rate for Payer: Multiplan Commercial	$17,877.10
Rate for Payer: Multiplan Workers Comp	$17,877.10
Rate for Payer: Scott and White EPO/PPO	$8,232.88
Rate for Payer: Scott and White Medicare	$11,655.97
Rate for Payer: Superior Health Plan EPO	$11,655.97
Rate for Payer: Superior Health Plan Medicare	$11,655.97
Rate for Payer: Universal American Dual Medicare/Medicaid	$11,655.97
Rate for Payer: Universal American Medicare	$11,655.97
Rate for Payer: Wellcare Medicare	$11,655.97
Rate for Payer: Wellmed Medicare	$11,655.97

Know your out-of-pocket cost for care.

All Charges