White Rock Medical Center

All Charges

Charge

Type

Setting

Price

DERMACARRIER -- DHF

Facility

$546.91

Hospital Charge Code	81740102
Hospital Revenue Code	272
Rate for Payer: Cash Price	$371.90

DERMACARRIER -- DHF

Facility

$546.91

Hospital Charge Code	81740102
Hospital Revenue Code	272
Min. Negotiated Rate	$49.22
Max. Negotiated Rate	$393.78
Rate for Payer: Amerigroup CHIP/Medicaid	$49.22
Rate for Payer: BCBS of TX Blue Advantage	$164.07
Rate for Payer: BCBS of TX Blue Essentials	$196.89
Rate for Payer: BCBS of TX PPO	$218.76
Rate for Payer: Cash Price	$371.90
Rate for Payer: Cigna Medicaid	$393.78
Rate for Payer: Molina CHIP/Medicaid	$393.78
Rate for Payer: Multiplan Auto	$355.49
Rate for Payer: Multiplan Commercial	$355.49
Rate for Payer: Multiplan Workers Comp	$355.49
Rate for Payer: Parkland Medicaid	$393.78
Rate for Payer: Scott and White EPO/PPO	$273.45
Rate for Payer: Superior Health Plan CHIP/Medicaid	$393.78
Rate for Payer: Superior Health Plan EPO	$74.38

DERMAGRAFT PER SQ CM

Facility

$280.00

Service Code	HCPCS Q4106
Hospital Charge Code	82461260
Hospital Revenue Code	278
Min. Negotiated Rate	$70.00
Max. Negotiated Rate	$140.00
Rate for Payer: Cash Price	$190.40
Rate for Payer: Cigna Commercial	$70.00
Rate for Payer: Multiplan Auto	$140.00
Rate for Payer: Multiplan Commercial	$140.00
Rate for Payer: Multiplan Workers Comp	$140.00
Rate for Payer: Scott and White EPO/PPO	$140.00

DERMAGRAFT PER SQ CM

Facility

$280.00

Service Code	HCPCS Q4106
Hospital Charge Code	82461260
Hospital Revenue Code	278
Min. Negotiated Rate	$25.20
Max. Negotiated Rate	$201.60
Rate for Payer: Amerigroup CHIP/Medicaid	$25.20
Rate for Payer: BCBS of TX Blue Advantage	$84.00
Rate for Payer: BCBS of TX Blue Essentials	$100.80
Rate for Payer: BCBS of TX PPO	$112.00
Rate for Payer: Cash Price	$190.40
Rate for Payer: Cigna Medicaid	$201.60
Rate for Payer: Molina CHIP/Medicaid	$201.60
Rate for Payer: Multiplan Auto	$140.00
Rate for Payer: Multiplan Commercial	$140.00
Rate for Payer: Multiplan Workers Comp	$140.00
Rate for Payer: Parkland Medicaid	$201.60
Rate for Payer: Scott and White EPO/PPO	$140.00
Rate for Payer: Superior Health Plan CHIP/Medicaid	$201.60
Rate for Payer: Superior Health Plan EPO	$38.08

Dermal substitute, native, non-denatured collagen, fetal bovine origin (SurgiMend Collagen Matrix), per 0.5 square centimeters

Facility

$2,500.00

Service Code	HCPCS C9360
Hospital Charge Code	990940
Hospital Revenue Code	278
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$1,800.00
Rate for Payer: Amerigroup CHIP/Medicaid	$225.00
Rate for Payer: BCBS of TX Blue Advantage	$750.00
Rate for Payer: BCBS of TX Blue Essentials	$900.00
Rate for Payer: BCBS of TX PPO	$1,000.00
Rate for Payer: Cash Price	$1,700.00
Rate for Payer: Cigna Medicaid	$1,800.00
Rate for Payer: Molina CHIP/Medicaid	$1,800.00
Rate for Payer: Multiplan Auto	$1,250.00
Rate for Payer: Multiplan Commercial	$1,250.00
Rate for Payer: Multiplan Workers Comp	$1,250.00
Rate for Payer: Parkland Medicaid	$1,800.00
Rate for Payer: Scott and White EPO/PPO	$1,250.00
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,800.00
Rate for Payer: Superior Health Plan EPO	$340.00

Dermal substitute, native, non-denatured collagen, fetal bovine origin (SurgiMend Collagen Matrix), per 0.5 square centimeters

Facility

$2,500.00

Service Code	HCPCS C9360
Hospital Charge Code	990940
Hospital Revenue Code	278
Min. Negotiated Rate	$625.00
Max. Negotiated Rate	$1,250.00
Rate for Payer: Cash Price	$1,700.00
Rate for Payer: Cigna Commercial	$625.00
Rate for Payer: Multiplan Auto	$1,250.00
Rate for Payer: Multiplan Commercial	$1,250.00
Rate for Payer: Multiplan Workers Comp	$1,250.00
Rate for Payer: Scott and White EPO/PPO	$1,250.00

DERMAPURE ALLOGRAFT 4X6

Facility

$17,778.00

Service Code	HCPCS C1762
Hospital Charge Code	146366
Hospital Revenue Code	278
Min. Negotiated Rate	$4,444.50
Max. Negotiated Rate	$8,889.00
Rate for Payer: Cash Price	$12,089.04
Rate for Payer: Cigna Commercial	$4,444.50
Rate for Payer: Multiplan Auto	$8,889.00
Rate for Payer: Multiplan Commercial	$8,889.00
Rate for Payer: Multiplan Workers Comp	$8,889.00
Rate for Payer: Scott and White EPO/PPO	$8,889.00

DERMAPURE ALLOGRAFT 4X6

Facility

$17,778.00

Service Code	HCPCS C1762
Hospital Charge Code	146366
Hospital Revenue Code	278
Min. Negotiated Rate	$1,600.02
Max. Negotiated Rate	$12,800.16
Rate for Payer: Amerigroup CHIP/Medicaid	$1,600.02
Rate for Payer: BCBS of TX Blue Advantage	$5,333.40
Rate for Payer: BCBS of TX Blue Essentials	$6,400.08
Rate for Payer: BCBS of TX PPO	$7,111.20
Rate for Payer: Cash Price	$12,089.04
Rate for Payer: Cigna Medicaid	$12,800.16
Rate for Payer: Molina CHIP/Medicaid	$12,800.16
Rate for Payer: Multiplan Auto	$8,889.00
Rate for Payer: Multiplan Commercial	$8,889.00
Rate for Payer: Multiplan Workers Comp	$8,889.00
Rate for Payer: Parkland Medicaid	$12,800.16
Rate for Payer: Scott and White EPO/PPO	$8,889.00
Rate for Payer: Superior Health Plan CHIP/Medicaid	$12,800.16
Rate for Payer: Superior Health Plan EPO	$2,417.81

desflurane Inh Liquid 240 mL

Facility

$128.17

Service Code	HCPCS j3490
Hospital Charge Code	77495057
Hospital Revenue Code	250
Rate for Payer: Cash Price	$87.16

desflurane Inh Liquid 240 mL

Facility

$128.17

Service Code	HCPCS j3490
Hospital Charge Code	77495057
Hospital Revenue Code	250
Min. Negotiated Rate	$11.54
Max. Negotiated Rate	$92.28
Rate for Payer: Amerigroup CHIP/Medicaid	$11.54
Rate for Payer: BCBS of TX Blue Advantage	$38.45
Rate for Payer: BCBS of TX Blue Essentials	$46.14
Rate for Payer: BCBS of TX PPO	$51.27
Rate for Payer: Cash Price	$87.16
Rate for Payer: Cigna Medicaid	$92.28
Rate for Payer: Molina CHIP/Medicaid	$92.28
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: Parkland Medicaid	$92.28
Rate for Payer: Scott and White EPO/PPO	$64.08
Rate for Payer: Superior Health Plan CHIP/Medicaid	$92.28
Rate for Payer: Superior Health Plan EPO	$17.43

desmopressin 4 mcg/mL Inj Soln 1 mL

Facility

$128.00

Service Code	HCPCS J2597
Hospital Charge Code	78431185
Hospital Revenue Code	636
Min. Negotiated Rate	$32.00
Max. Negotiated Rate	$64.00
Rate for Payer: Cash Price	$87.04
Rate for Payer: Cigna Commercial	$32.00
Rate for Payer: Scott and White EPO/PPO	$64.00

desmopressin 4 mcg/mL Inj Soln 1 mL

Facility

$128.00

Service Code	HCPCS J2597
Hospital Charge Code	78431185
Hospital Revenue Code	636
Min. Negotiated Rate	$3.13
Max. Negotiated Rate	$92.16
Rate for Payer: Amerigroup CHIP/Medicaid	$11.52
Rate for Payer: BCBS of TX Blue Advantage	$3.13
Rate for Payer: BCBS of TX Blue Essentials	$3.76
Rate for Payer: BCBS of TX PPO	$4.17
Rate for Payer: Cash Price	$87.04
Rate for Payer: Cash Price	$87.04
Rate for Payer: Cigna Medicaid	$92.16
Rate for Payer: Molina CHIP/Medicaid	$92.16
Rate for Payer: Multiplan Auto	$83.20
Rate for Payer: Multiplan Commercial	$83.20
Rate for Payer: Multiplan Workers Comp	$83.20
Rate for Payer: Parkland Medicaid	$92.16
Rate for Payer: Scott and White EPO/PPO	$64.00
Rate for Payer: Superior Health Plan CHIP/Medicaid	$92.16
Rate for Payer: Superior Health Plan EPO	$17.41

DESTINATION 6FR 65CN STRAIGHT CCV 35CM

Facility

$547.71

Hospital Charge Code	993906
Hospital Revenue Code	272
Min. Negotiated Rate	$49.29
Max. Negotiated Rate	$394.35
Rate for Payer: Amerigroup CHIP/Medicaid	$49.29
Rate for Payer: BCBS of TX Blue Advantage	$164.31
Rate for Payer: BCBS of TX Blue Essentials	$197.18
Rate for Payer: BCBS of TX PPO	$219.08
Rate for Payer: Cash Price	$372.44
Rate for Payer: Cigna Medicaid	$394.35
Rate for Payer: Molina CHIP/Medicaid	$394.35
Rate for Payer: Multiplan Auto	$356.01
Rate for Payer: Multiplan Commercial	$356.01
Rate for Payer: Multiplan Workers Comp	$356.01
Rate for Payer: Parkland Medicaid	$394.35
Rate for Payer: Scott and White EPO/PPO	$273.86
Rate for Payer: Superior Health Plan CHIP/Medicaid	$394.35
Rate for Payer: Superior Health Plan EPO	$74.49

DESTINATION 6FR 65CN STRAIGHT CCV 35CM

Facility

$547.71

Hospital Charge Code	993906
Hospital Revenue Code	272
Rate for Payer: Cash Price	$372.44

Destroy lumb/sac facet jnt

Facility

$10,000.00

Service Code	CPT 64635
Hospital Charge Code	36064635
Hospital Revenue Code	360
Min. Negotiated Rate	$659.94
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$659.94
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$1,961.62
Rate for Payer: Amerigroup Medicare	$1,961.62
Rate for Payer: BCBS of TX Blue Advantage	$2,871.31
Rate for Payer: BCBS of TX Blue Essentials	$3,438.70
Rate for Payer: BCBS of TX Medicare	$1,961.62
Rate for Payer: BCBS of TX PPO	$4,332.76
Rate for Payer: Cigna Commercial	$4,146.52
Rate for Payer: Cigna Medicare	$1,961.62
Rate for Payer: Employer Direct Commercial	$1,961.62
Rate for Payer: Humana Medicare/TRICARE	$1,961.62
Rate for Payer: Molina Dual Medicare/Medicaid	$1,961.62
Rate for Payer: Molina Medicare	$1,961.62
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	$3,629.00
Rate for Payer: Scott and White Medicare	$1,961.62
Rate for Payer: Superior Health Plan EPO	$1,961.62
Rate for Payer: Superior Health Plan Medicare	$1,961.62
Rate for Payer: Universal American Dual Medicare/Medicaid	$1,961.62
Rate for Payer: Universal American Medicare	$1,961.62
Rate for Payer: Wellcare Medicare	$1,961.62
Rate for Payer: Wellmed Medicare	$1,961.62

Destroy lumb/sac facet jnt

Facility

$17,576.65

Service Code	HCPCS 64635
Hospital Charge Code	9900830
Hospital Revenue Code	360
Rate for Payer: Cash Price	$11,952.12

Destroy lumb/sac facet jnt

Facility

$17,576.65

Service Code	HCPCS 64635
Hospital Charge Code	9900830
Hospital Revenue Code	360
Min. Negotiated Rate	$659.94
Max. Negotiated Rate	$12,655.19
Rate for Payer: Amerigroup CHIP/Medicaid	$659.94
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$1,961.62
Rate for Payer: Amerigroup Medicare	$1,961.62
Rate for Payer: BCBS of TX Blue Advantage	$2,871.31
Rate for Payer: BCBS of TX Blue Essentials	$3,438.70
Rate for Payer: BCBS of TX Medicare	$1,961.62
Rate for Payer: BCBS of TX PPO	$4,332.76
Rate for Payer: Cash Price	$11,952.12
Rate for Payer: Cash Price	$11,952.12
Rate for Payer: Cash Price	$11,952.12
Rate for Payer: Cigna Commercial	$4,146.52
Rate for Payer: Cigna Medicaid	$12,655.19
Rate for Payer: Cigna Medicare	$1,961.62
Rate for Payer: Employer Direct Commercial	$1,961.62
Rate for Payer: Humana Medicare/TRICARE	$1,961.62
Rate for Payer: Molina CHIP/Medicaid	$12,655.19
Rate for Payer: Molina Dual Medicare/Medicaid	$1,961.62
Rate for Payer: Molina Medicare	$1,961.62
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	$12,655.19
Rate for Payer: Scott and White EPO/PPO	$3,629.00
Rate for Payer: Scott and White Medicare	$1,961.62
Rate for Payer: Superior Health Plan CHIP/Medicaid	$12,655.19
Rate for Payer: Superior Health Plan EPO	$1,961.62
Rate for Payer: Superior Health Plan Medicare	$1,961.62
Rate for Payer: Universal American Dual Medicare/Medicaid	$1,961.62
Rate for Payer: Universal American Medicare	$1,961.62
Rate for Payer: Wellcare Medicare	$1,961.62
Rate for Payer: Wellmed Medicare	$1,961.62

Destroy lumb/sac facet jnt addl lvl

Facility

$17,576.65

Service Code	HCPCS 64636
Hospital Charge Code	9900831
Hospital Revenue Code	360
Rate for Payer: Cash Price	$11,952.12

Destroy lumb/sac facet jnt addl lvl

Facility

$17,576.65

Service Code	HCPCS 64636
Hospital Charge Code	9900831
Hospital Revenue Code	360
Min. Negotiated Rate	$1,581.90
Max. Negotiated Rate	$12,655.19
Rate for Payer: Amerigroup CHIP/Medicaid	$1,581.90
Rate for Payer: BCBS of TX Blue Advantage	$5,272.99
Rate for Payer: BCBS of TX Blue Essentials	$6,327.59
Rate for Payer: BCBS of TX PPO	$7,030.66
Rate for Payer: Cash Price	$11,952.12
Rate for Payer: Cash Price	$11,952.12
Rate for Payer: Cigna Medicaid	$12,655.19
Rate for Payer: Molina CHIP/Medicaid	$12,655.19
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	$12,655.19
Rate for Payer: Scott and White EPO/PPO	$8,788.33
Rate for Payer: Superior Health Plan CHIP/Medicaid	$12,655.19
Rate for Payer: Superior Health Plan EPO	$2,390.42

Destroy lumb/sac facet jnt addl lvl

Facility

$10,000.00

Service Code	CPT 64636
Hospital Charge Code	36064636
Hospital Revenue Code	360
Min. Negotiated Rate	$10,000.00
Max. Negotiated Rate	$10,000.00
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

Destruction by neurolytic agent, genicular nerve branches including imaging guidance, when performed

Facility

$9,210.80

Service Code	HCPCS 64624
Hospital Charge Code	9900823
Hospital Revenue Code	360
Min. Negotiated Rate	$532.18
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$659.94
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$1,961.62
Rate for Payer: Amerigroup Medicare	$1,961.62
Rate for Payer: BCBS of TX Blue Advantage	$532.18
Rate for Payer: BCBS of TX Blue Essentials	$637.34
Rate for Payer: BCBS of TX Medicare	$1,961.62
Rate for Payer: BCBS of TX PPO	$803.05
Rate for Payer: Cash Price	$6,263.34
Rate for Payer: Cash Price	$6,263.34
Rate for Payer: Cash Price	$6,263.34
Rate for Payer: Cigna Commercial	$4,146.52
Rate for Payer: Cigna Medicaid	$6,631.78
Rate for Payer: Cigna Medicare	$1,961.62
Rate for Payer: Employer Direct Commercial	$1,961.62
Rate for Payer: Humana Medicare/TRICARE	$1,961.62
Rate for Payer: Molina CHIP/Medicaid	$6,631.78
Rate for Payer: Molina Dual Medicare/Medicaid	$1,961.62
Rate for Payer: Molina Medicare	$1,961.62
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	$6,631.78
Rate for Payer: Scott and White EPO/PPO	$3,629.00
Rate for Payer: Scott and White Medicare	$1,961.62
Rate for Payer: Superior Health Plan CHIP/Medicaid	$6,631.78
Rate for Payer: Superior Health Plan EPO	$1,961.62
Rate for Payer: Superior Health Plan Medicare	$1,961.62
Rate for Payer: Universal American Dual Medicare/Medicaid	$1,961.62
Rate for Payer: Universal American Medicare	$1,961.62
Rate for Payer: Wellcare Medicare	$1,961.62
Rate for Payer: Wellmed Medicare	$1,961.62

Destruction by neurolytic agent, genicular nerve branches including imaging guidance, when performed

Facility

$10,000.00

Service Code	CPT 64624
Hospital Charge Code	36064624
Hospital Revenue Code	360
Min. Negotiated Rate	$532.18
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$659.94
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$1,961.62
Rate for Payer: Amerigroup Medicare	$1,961.62
Rate for Payer: BCBS of TX Blue Advantage	$532.18
Rate for Payer: BCBS of TX Blue Essentials	$637.34
Rate for Payer: BCBS of TX Medicare	$1,961.62
Rate for Payer: BCBS of TX PPO	$803.05
Rate for Payer: Cigna Commercial	$4,146.52
Rate for Payer: Cigna Medicare	$1,961.62
Rate for Payer: Employer Direct Commercial	$1,961.62
Rate for Payer: Humana Medicare/TRICARE	$1,961.62
Rate for Payer: Molina Dual Medicare/Medicaid	$1,961.62
Rate for Payer: Molina Medicare	$1,961.62
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	$3,629.00
Rate for Payer: Scott and White Medicare	$1,961.62
Rate for Payer: Superior Health Plan EPO	$1,961.62
Rate for Payer: Superior Health Plan Medicare	$1,961.62
Rate for Payer: Universal American Dual Medicare/Medicaid	$1,961.62
Rate for Payer: Universal American Medicare	$1,961.62
Rate for Payer: Wellcare Medicare	$1,961.62
Rate for Payer: Wellmed Medicare	$1,961.62

Destruction by neurolytic agent, genicular nerve branches including imaging guidance, when performed

Facility

$9,210.80

Service Code	HCPCS 64624
Hospital Charge Code	9900823
Hospital Revenue Code	360
Rate for Payer: Cash Price	$6,263.34

Destruction by neurolytic agent, intercostal nerve

Facility

$2,467.38

Service Code	HCPCS 64620
Hospital Charge Code	9900822
Hospital Revenue Code	360
Min. Negotiated Rate	$340.77
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$340.77
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$888.50
Rate for Payer: Amerigroup Medicare	$888.50
Rate for Payer: BCBS of TX Blue Advantage	$1,356.12
Rate for Payer: BCBS of TX Blue Essentials	$1,624.10
Rate for Payer: BCBS of TX Medicare	$888.50
Rate for Payer: BCBS of TX PPO	$2,046.37
Rate for Payer: Cash Price	$1,677.82
Rate for Payer: Cash Price	$1,677.82
Rate for Payer: Cash Price	$1,677.82
Rate for Payer: Cigna Commercial	$1,878.13
Rate for Payer: Cigna Medicaid	$1,776.51
Rate for Payer: Cigna Medicare	$888.50
Rate for Payer: Employer Direct Commercial	$888.50
Rate for Payer: Humana Medicare/TRICARE	$888.50
Rate for Payer: Molina CHIP/Medicaid	$1,776.51
Rate for Payer: Molina Dual Medicare/Medicaid	$888.50
Rate for Payer: Molina Medicare	$888.50
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	$1,776.51
Rate for Payer: Scott and White EPO/PPO	$1,643.72
Rate for Payer: Scott and White Medicare	$888.50
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,776.51
Rate for Payer: Superior Health Plan EPO	$888.50
Rate for Payer: Superior Health Plan Medicare	$888.50
Rate for Payer: Universal American Dual Medicare/Medicaid	$888.50
Rate for Payer: Universal American Medicare	$888.50
Rate for Payer: Wellcare Medicare	$888.50
Rate for Payer: Wellmed Medicare	$888.50

Destruction by neurolytic agent, intercostal nerve

Facility

$10,000.00

Service Code	CPT 64620
Hospital Charge Code	36064620
Hospital Revenue Code	360
Min. Negotiated Rate	$340.77
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$340.77
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$888.50
Rate for Payer: Amerigroup Medicare	$888.50
Rate for Payer: BCBS of TX Blue Advantage	$1,356.12
Rate for Payer: BCBS of TX Blue Essentials	$1,624.10
Rate for Payer: BCBS of TX Medicare	$888.50
Rate for Payer: BCBS of TX PPO	$2,046.37
Rate for Payer: Cigna Commercial	$1,878.13
Rate for Payer: Cigna Medicare	$888.50
Rate for Payer: Employer Direct Commercial	$888.50
Rate for Payer: Humana Medicare/TRICARE	$888.50
Rate for Payer: Molina Dual Medicare/Medicaid	$888.50
Rate for Payer: Molina Medicare	$888.50
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	$1,643.72
Rate for Payer: Scott and White Medicare	$888.50
Rate for Payer: Superior Health Plan EPO	$888.50
Rate for Payer: Superior Health Plan Medicare	$888.50
Rate for Payer: Universal American Dual Medicare/Medicaid	$888.50
Rate for Payer: Universal American Medicare	$888.50
Rate for Payer: Wellcare Medicare	$888.50
Rate for Payer: Wellmed Medicare	$888.50

Know your out-of-pocket cost for care.

All Charges