White Rock Medical Center

All Charges

Charge

Type

Setting

Price

DEEP VEIN THROMBOPHLEBITIS WITHOUT CC/MCC

Facility

$16,828.30

Service Code	MSDRG 295
Min. Negotiated Rate	$4,741.18
Max. Negotiated Rate	$16,828.30
Rate for Payer: Multiplan Auto	$16,828.30
Rate for Payer: Multiplan Commercial	$16,828.30
Rate for Payer: Multiplan Workers Comp	$16,828.30
Rate for Payer: Scott and White EPO/PPO	$7,749.88

DEEP VEIN THROMBOPHLEBITIS W/O CC/MCC

Facility

$16,828.30

Service Code	MSDRG 295
Min. Negotiated Rate	$4,741.18
Max. Negotiated Rate	$16,828.30
Rate for Payer: BCBS of TX Blue Advantage	$4,741.18
Rate for Payer: BCBS of TX Blue Essentials	$5,688.86
Rate for Payer: BCBS of TX PPO	$6,321.21

DEFIBRILLATOR IMPLANTS

Facility

$17,656.97

Service Code	APR-DRG 1792
Min. Negotiated Rate	$16,647.61
Max. Negotiated Rate	$17,656.97
Rate for Payer: Amerigroup CHIP/Medicaid	$16,647.61
Rate for Payer: Cigna Medicaid	$16,647.61
Rate for Payer: Molina CHIP/Medicaid	$16,647.61
Rate for Payer: Parkland Medicaid	$16,647.61
Rate for Payer: Superior Health Plan CHIP/Medicaid	$17,656.97

DEFIBRILLATOR IMPLANTS

Facility

$13,190.68

Service Code	APR-DRG 1791
Min. Negotiated Rate	$12,436.63
Max. Negotiated Rate	$13,190.68
Rate for Payer: Amerigroup CHIP/Medicaid	$12,436.63
Rate for Payer: Cigna Medicaid	$12,436.63
Rate for Payer: Molina CHIP/Medicaid	$12,436.63
Rate for Payer: Parkland Medicaid	$12,436.63
Rate for Payer: Superior Health Plan CHIP/Medicaid	$13,190.68

DEFIBRILLATOR IMPLANTS

Facility

$27,184.39

Service Code	APR-DRG 1794
Min. Negotiated Rate	$25,630.39
Max. Negotiated Rate	$27,184.39
Rate for Payer: Amerigroup CHIP/Medicaid	$25,630.39
Rate for Payer: Cigna Medicaid	$25,630.39
Rate for Payer: Molina CHIP/Medicaid	$25,630.39
Rate for Payer: Parkland Medicaid	$25,630.39
Rate for Payer: Superior Health Plan CHIP/Medicaid	$27,184.39

DEFIBRILLATOR IMPLANTS

Facility

$20,844.60

Service Code	APR-DRG 1793
Min. Negotiated Rate	$19,653.01
Max. Negotiated Rate	$20,844.60
Rate for Payer: Amerigroup CHIP/Medicaid	$19,653.01
Rate for Payer: Cigna Medicaid	$19,653.01
Rate for Payer: Molina CHIP/Medicaid	$19,653.01
Rate for Payer: Parkland Medicaid	$19,653.01
Rate for Payer: Superior Health Plan CHIP/Medicaid	$20,844.60

DEGENERATIVE NERVOUS SYSTEM DISORDERS EXCEPT MULTIPLE SCLEROSIS

Facility

$7,679.95

Service Code	APR-DRG 0423
Min. Negotiated Rate	$7,240.92
Max. Negotiated Rate	$7,679.95
Rate for Payer: Amerigroup CHIP/Medicaid	$7,240.92
Rate for Payer: Cigna Medicaid	$7,240.92
Rate for Payer: Molina CHIP/Medicaid	$7,240.92
Rate for Payer: Parkland Medicaid	$7,240.92
Rate for Payer: Superior Health Plan CHIP/Medicaid	$7,679.95

DEGENERATIVE NERVOUS SYSTEM DISORDERS EXCEPT MULTIPLE SCLEROSIS

Facility

$3,531.24

Service Code	APR-DRG 0421
Min. Negotiated Rate	$3,329.38
Max. Negotiated Rate	$3,531.24
Rate for Payer: Amerigroup CHIP/Medicaid	$3,329.38
Rate for Payer: Cigna Medicaid	$3,329.38
Rate for Payer: Molina CHIP/Medicaid	$3,329.38
Rate for Payer: Parkland Medicaid	$3,329.38
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3,531.24

DEGENERATIVE NERVOUS SYSTEM DISORDERS EXCEPT MULTIPLE SCLEROSIS

Facility

$4,886.86

Service Code	APR-DRG 0422
Min. Negotiated Rate	$4,607.50
Max. Negotiated Rate	$4,886.86
Rate for Payer: Amerigroup CHIP/Medicaid	$4,607.50
Rate for Payer: Cigna Medicaid	$4,607.50
Rate for Payer: Molina CHIP/Medicaid	$4,607.50
Rate for Payer: Parkland Medicaid	$4,607.50
Rate for Payer: Superior Health Plan CHIP/Medicaid	$4,886.86

DEGENERATIVE NERVOUS SYSTEM DISORDERS EXCEPT MULTIPLE SCLEROSIS

Facility

$19,026.92

Service Code	APR-DRG 0424
Min. Negotiated Rate	$17,939.25
Max. Negotiated Rate	$19,026.92
Rate for Payer: Amerigroup CHIP/Medicaid	$17,939.25
Rate for Payer: Cigna Medicaid	$17,939.25
Rate for Payer: Molina CHIP/Medicaid	$17,939.25
Rate for Payer: Parkland Medicaid	$17,939.25
Rate for Payer: Superior Health Plan CHIP/Medicaid	$19,026.92

DEGENERATIVE NERVOUS SYSTEM DISORDERS WITH MCC

Facility

$42,385.20

Service Code	MSDRG 056
Min. Negotiated Rate	$18,270.70
Max. Negotiated Rate	$42,385.20
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$21,786.14
Rate for Payer: Amerigroup Medicare	$21,786.14
Rate for Payer: BCBS of TX Medicare	$21,786.14
Rate for Payer: Cigna Commercial	$29,921.53
Rate for Payer: Cigna Medicare	$21,786.14
Rate for Payer: Employer Direct Commercial	$21,786.14
Rate for Payer: Humana Medicare/TRICARE	$21,786.14
Rate for Payer: Molina Dual Medicare/Medicaid	$21,786.14
Rate for Payer: Molina Medicare	$21,786.14
Rate for Payer: Multiplan Auto	$42,385.20
Rate for Payer: Multiplan Commercial	$42,385.20
Rate for Payer: Multiplan Workers Comp	$42,385.20
Rate for Payer: Scott and White EPO/PPO	$19,519.50
Rate for Payer: Scott and White Medicare	$21,786.14
Rate for Payer: Superior Health Plan EPO	$21,786.14
Rate for Payer: Superior Health Plan Medicare	$21,786.14
Rate for Payer: Universal American Dual Medicare/Medicaid	$21,786.14
Rate for Payer: Universal American Medicare	$21,786.14
Rate for Payer: Wellcare Medicare	$21,786.14
Rate for Payer: Wellmed Medicare	$21,786.14

DEGENERATIVE NERVOUS SYSTEM DISORDERS WITHOUT MCC

Facility

$24,728.50

Service Code	MSDRG 057
Min. Negotiated Rate	$10,396.54
Max. Negotiated Rate	$24,728.50
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$14,255.58
Rate for Payer: Amerigroup Medicare	$14,255.58
Rate for Payer: BCBS of TX Medicare	$14,255.58
Rate for Payer: Cigna Commercial	$16,687.33
Rate for Payer: Cigna Medicare	$14,255.58
Rate for Payer: Employer Direct Commercial	$14,255.58
Rate for Payer: Humana Medicare/TRICARE	$14,255.58
Rate for Payer: Molina Dual Medicare/Medicaid	$14,255.58
Rate for Payer: Molina Medicare	$14,255.58
Rate for Payer: Multiplan Auto	$24,728.50
Rate for Payer: Multiplan Commercial	$24,728.50
Rate for Payer: Multiplan Workers Comp	$24,728.50
Rate for Payer: Scott and White EPO/PPO	$11,388.12
Rate for Payer: Scott and White Medicare	$14,255.58
Rate for Payer: Superior Health Plan EPO	$14,255.58
Rate for Payer: Superior Health Plan Medicare	$14,255.58
Rate for Payer: Universal American Dual Medicare/Medicaid	$14,255.58
Rate for Payer: Universal American Medicare	$14,255.58
Rate for Payer: Wellcare Medicare	$14,255.58
Rate for Payer: Wellmed Medicare	$14,255.58

DEGENERATIVE NERVOUS SYSTEM DISORDERS W MCC

Facility

$42,385.20

Service Code	MSDRG 056
Min. Negotiated Rate	$18,270.70
Max. Negotiated Rate	$42,385.20
Rate for Payer: BCBS of TX Blue Advantage	$18,270.70
Rate for Payer: BCBS of TX Blue Essentials	$21,922.72
Rate for Payer: BCBS of TX PPO	$24,359.52

DEGENERATIVE NERVOUS SYSTEM DISORDERS W/O MCC

Facility

$24,728.50

Service Code	MSDRG 057
Min. Negotiated Rate	$10,396.54
Max. Negotiated Rate	$24,728.50
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

$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	$3,085.41
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

$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	$3,085.41
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
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

$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	$3,085.41
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 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	$3,085.41
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 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

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	$3,085.41
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	$3,085.41
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

DENTAL AND ORAL DISEASES WITH CC

Facility

$17,652.90

Service Code	MSDRG 158
Min. Negotiated Rate	$7,656.58
Max. Negotiated Rate	$17,652.90
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	$17,652.90
Rate for Payer: Multiplan Commercial	$17,652.90
Rate for Payer: Multiplan Workers Comp	$17,652.90
Rate for Payer: Scott and White EPO/PPO	$8,129.62
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

$31,764.20

Service Code	MSDRG 157
Min. Negotiated Rate	$14,387.80
Max. Negotiated Rate	$31,764.20
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	$31,764.20
Rate for Payer: Multiplan Commercial	$31,764.20
Rate for Payer: Multiplan Workers Comp	$31,764.20
Rate for Payer: Scott and White EPO/PPO	$14,628.25
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

Know your out-of-pocket cost for care.

All Charges