White Rock Medical Center

All Charges

Charge

Type

Setting

Price

HIS BUNDLE RECORDING

Facility

$6,825.00

Service Code	CPT 93600
Hospital Charge Code	4613600
Hospital Revenue Code	480
Rate for Payer: Cash Price	$6,006.00

Histoplasma Gal'mannan Ag Ur SO

Facility

$463.00

Service Code	CPT 87385
Hospital Charge Code	1707900
Hospital Revenue Code	306
Min. Negotiated Rate	$5.17
Max. Negotiated Rate	$300.95
Rate for Payer: Aetna Commercial	$13.91
Rate for Payer: Aetna Medicare	$19.88
Rate for Payer: Amerigroup CHIP/Medicaid	$5.17
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$13.25
Rate for Payer: Amerigroup Medicare	$13.25
Rate for Payer: BCBS of TX Blue Advantage	$21.86
Rate for Payer: BCBS of TX Blue Essentials	$26.24
Rate for Payer: BCBS of TX Medicare	$13.25
Rate for Payer: BCBS of TX PPO	$29.28
Rate for Payer: Cash Price	$407.44
Rate for Payer: Cash Price	$407.44
Rate for Payer: Cigna Medicaid	$13.25
Rate for Payer: Cigna Medicare	$13.25
Rate for Payer: Employer Direct Commercial	$13.25
Rate for Payer: Humana Medicare/TRICARE	$13.25
Rate for Payer: Molina CHIP/Medicaid	$13.25
Rate for Payer: Molina Dual Medicare/Medicaid	$13.25
Rate for Payer: Molina Medicare	$13.25
Rate for Payer: Multiplan Auto	$300.95
Rate for Payer: Multiplan Commercial	$300.95
Rate for Payer: Multiplan Workers Comp	$300.95
Rate for Payer: Parkland Medicaid	$13.25
Rate for Payer: Scott and White EPO/PPO	$16.56
Rate for Payer: Scott and White Medicare	$13.25
Rate for Payer: Superior Health Plan CHIP/Medicaid	$13.25
Rate for Payer: Superior Health Plan EPO	$13.25
Rate for Payer: Superior Health Plan Medicare	$13.25
Rate for Payer: Universal American Dual Medicare/Medicaid	$13.25
Rate for Payer: Universal American Medicare	$13.25
Rate for Payer: Wellcare Medicare	$13.25
Rate for Payer: Wellmed Medicare	$13.25

Histoplasma Gal'mannan Ag Ur SO

Facility

$463.00

Service Code	CPT 87385
Hospital Charge Code	1707900
Hospital Revenue Code	306
Rate for Payer: Cash Price	$407.44

HIV 1 and 2 Antibodies

Facility

$234.00

Service Code	CPT 86703
Hospital Charge Code	1602879
Hospital Revenue Code	302
Min. Negotiated Rate	$5.35
Max. Negotiated Rate	$152.10
Rate for Payer: Aetna Commercial	$14.40
Rate for Payer: Aetna Medicare	$20.56
Rate for Payer: Amerigroup CHIP/Medicaid	$5.35
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$13.71
Rate for Payer: Amerigroup Medicare	$13.71
Rate for Payer: BCBS of TX Blue Advantage	$22.62
Rate for Payer: BCBS of TX Blue Essentials	$27.15
Rate for Payer: BCBS of TX Medicare	$13.71
Rate for Payer: BCBS of TX PPO	$30.30
Rate for Payer: Cash Price	$205.92
Rate for Payer: Cash Price	$205.92
Rate for Payer: Cigna Medicaid	$13.71
Rate for Payer: Cigna Medicare	$13.71
Rate for Payer: Employer Direct Commercial	$13.71
Rate for Payer: Humana Medicare/TRICARE	$13.71
Rate for Payer: Molina CHIP/Medicaid	$13.71
Rate for Payer: Molina Dual Medicare/Medicaid	$13.71
Rate for Payer: Molina Medicare	$13.71
Rate for Payer: Multiplan Auto	$152.10
Rate for Payer: Multiplan Commercial	$152.10
Rate for Payer: Multiplan Workers Comp	$152.10
Rate for Payer: Parkland Medicaid	$13.71
Rate for Payer: Scott and White EPO/PPO	$17.14
Rate for Payer: Scott and White Medicare	$13.71
Rate for Payer: Superior Health Plan CHIP/Medicaid	$13.71
Rate for Payer: Superior Health Plan EPO	$13.71
Rate for Payer: Superior Health Plan Medicare	$13.71
Rate for Payer: Universal American Dual Medicare/Medicaid	$13.71
Rate for Payer: Universal American Medicare	$13.71
Rate for Payer: Wellcare Medicare	$13.71
Rate for Payer: Wellmed Medicare	$13.71

HIV 1 and 2 Antibodies

Facility

$234.00

Service Code	CPT 86703
Hospital Charge Code	1602879
Hospital Revenue Code	302
Rate for Payer: Cash Price	$205.92

HIV-1/HIV-2 Qualitative RNA SO

Facility

$414.00

Service Code	CPT 87535
Hospital Charge Code	8738617
Hospital Revenue Code	306
Min. Negotiated Rate	$13.69
Max. Negotiated Rate	$269.10
Rate for Payer: Aetna Commercial	$36.84
Rate for Payer: Aetna Medicare	$52.64
Rate for Payer: Amerigroup CHIP/Medicaid	$13.69
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$35.09
Rate for Payer: Amerigroup Medicare	$35.09
Rate for Payer: BCBS of TX Blue Advantage	$57.90
Rate for Payer: BCBS of TX Blue Essentials	$69.48
Rate for Payer: BCBS of TX Medicare	$35.09
Rate for Payer: BCBS of TX PPO	$77.55
Rate for Payer: Cash Price	$364.32
Rate for Payer: Cash Price	$364.32
Rate for Payer: Cigna Medicaid	$35.09
Rate for Payer: Cigna Medicare	$35.09
Rate for Payer: Employer Direct Commercial	$35.09
Rate for Payer: Humana Medicare/TRICARE	$35.09
Rate for Payer: Molina CHIP/Medicaid	$35.09
Rate for Payer: Molina Dual Medicare/Medicaid	$35.09
Rate for Payer: Molina Medicare	$35.09
Rate for Payer: Multiplan Auto	$269.10
Rate for Payer: Multiplan Commercial	$269.10
Rate for Payer: Multiplan Workers Comp	$269.10
Rate for Payer: Parkland Medicaid	$35.09
Rate for Payer: Scott and White EPO/PPO	$43.86
Rate for Payer: Scott and White Medicare	$35.09
Rate for Payer: Superior Health Plan CHIP/Medicaid	$35.09
Rate for Payer: Superior Health Plan EPO	$35.09
Rate for Payer: Superior Health Plan Medicare	$35.09
Rate for Payer: Universal American Dual Medicare/Medicaid	$35.09
Rate for Payer: Universal American Medicare	$35.09
Rate for Payer: Wellcare Medicare	$35.09
Rate for Payer: Wellmed Medicare	$35.09

HIV-1/HIV-2 Qualitative RNA SO

Facility

$414.00

Service Code	CPT 87535
Hospital Charge Code	8738617
Hospital Revenue Code	306
Rate for Payer: Cash Price	$364.32

HIV-1/O/2, 4th Generation SO

Facility

$190.00

Service Code	CPT 87389
Hospital Charge Code	1640071
Hospital Revenue Code	302
Min. Negotiated Rate	$9.39
Max. Negotiated Rate	$123.50
Rate for Payer: Aetna Commercial	$25.29
Rate for Payer: Aetna Medicare	$36.12
Rate for Payer: Amerigroup CHIP/Medicaid	$9.39
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$24.08
Rate for Payer: Amerigroup Medicare	$24.08
Rate for Payer: BCBS of TX Blue Advantage	$39.73
Rate for Payer: BCBS of TX Blue Essentials	$47.68
Rate for Payer: BCBS of TX Medicare	$24.08
Rate for Payer: BCBS of TX PPO	$53.22
Rate for Payer: Cash Price	$167.20
Rate for Payer: Cash Price	$167.20
Rate for Payer: Cigna Medicaid	$24.08
Rate for Payer: Cigna Medicare	$24.08
Rate for Payer: Employer Direct Commercial	$24.08
Rate for Payer: Humana Medicare/TRICARE	$24.08
Rate for Payer: Molina CHIP/Medicaid	$24.08
Rate for Payer: Molina Dual Medicare/Medicaid	$24.08
Rate for Payer: Molina Medicare	$24.08
Rate for Payer: Multiplan Auto	$123.50
Rate for Payer: Multiplan Commercial	$123.50
Rate for Payer: Multiplan Workers Comp	$123.50
Rate for Payer: Parkland Medicaid	$24.08
Rate for Payer: Scott and White EPO/PPO	$30.10
Rate for Payer: Scott and White Medicare	$24.08
Rate for Payer: Superior Health Plan CHIP/Medicaid	$24.08
Rate for Payer: Superior Health Plan EPO	$24.08
Rate for Payer: Superior Health Plan Medicare	$24.08
Rate for Payer: Universal American Dual Medicare/Medicaid	$24.08
Rate for Payer: Universal American Medicare	$24.08
Rate for Payer: Wellcare Medicare	$24.08
Rate for Payer: Wellmed Medicare	$24.08

HIV-1/O/2, 4th Generation SO

Facility

$190.00

Service Code	CPT 87389
Hospital Charge Code	1640071
Hospital Revenue Code	302
Rate for Payer: Cash Price	$167.20

HIV WITH EXTENSIVE O.R. PROCEDURES WITH MCC

Facility

$130,579.40

Service Code	MSDRG 969
Min. Negotiated Rate	$50,536.18
Max. Negotiated Rate	$130,579.40
Rate for Payer: Aetna Commercial	$77,316.75
Rate for Payer: Aetna Medicare	$77,847.10
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$51,898.07
Rate for Payer: Amerigroup Medicare	$51,898.07
Rate for Payer: BCBS of TX Blue Advantage	$50,536.18
Rate for Payer: BCBS of TX Blue Essentials	$57,772.99
Rate for Payer: BCBS of TX Medicare	$51,898.07
Rate for Payer: BCBS of TX PPO	$64,194.69
Rate for Payer: Cigna Commercial	$88,519.09
Rate for Payer: Cigna Medicare	$51,898.07
Rate for Payer: Employer Direct Commercial	$51,898.07
Rate for Payer: Humana Medicare/TRICARE	$51,898.07
Rate for Payer: Molina Dual Medicare/Medicaid	$51,898.07
Rate for Payer: Molina Medicare	$51,898.07
Rate for Payer: Multiplan Auto	$130,579.40
Rate for Payer: Multiplan Commercial	$130,579.40
Rate for Payer: Multiplan Workers Comp	$130,579.40
Rate for Payer: Scott and White EPO/PPO	$60,135.25
Rate for Payer: Scott and White Medicare	$51,898.07
Rate for Payer: Superior Health Plan EPO	$51,898.07
Rate for Payer: Superior Health Plan Medicare	$51,898.07
Rate for Payer: Universal American Dual Medicare/Medicaid	$51,898.07
Rate for Payer: Universal American Medicare	$51,898.07
Rate for Payer: Wellcare Medicare	$51,898.07
Rate for Payer: Wellmed Medicare	$51,898.07

HIV WITH EXTENSIVE O.R. PROCEDURES WITHOUT MCC

Facility

$45,683.60

Service Code	MSDRG 970
Min. Negotiated Rate	$20,787.06
Max. Negotiated Rate	$45,683.60
Rate for Payer: Aetna Commercial	$27,049.50
Rate for Payer: Aetna Medicare	$34,035.27
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$22,690.18
Rate for Payer: Amerigroup Medicare	$22,690.18
Rate for Payer: BCBS of TX Blue Advantage	$20,787.06
Rate for Payer: BCBS of TX Blue Essentials	$28,766.28
Rate for Payer: BCBS of TX Medicare	$22,690.18
Rate for Payer: BCBS of TX PPO	$31,963.77
Rate for Payer: Cigna Commercial	$30,968.67
Rate for Payer: Cigna Medicare	$22,690.18
Rate for Payer: Employer Direct Commercial	$22,690.18
Rate for Payer: Humana Medicare/TRICARE	$22,690.18
Rate for Payer: Molina Dual Medicare/Medicaid	$22,690.18
Rate for Payer: Molina Medicare	$22,690.18
Rate for Payer: Multiplan Auto	$45,683.60
Rate for Payer: Multiplan Commercial	$45,683.60
Rate for Payer: Multiplan Workers Comp	$45,683.60
Rate for Payer: Scott and White EPO/PPO	$21,038.50
Rate for Payer: Scott and White Medicare	$22,690.18
Rate for Payer: Superior Health Plan EPO	$22,690.18
Rate for Payer: Superior Health Plan Medicare	$22,690.18
Rate for Payer: Universal American Dual Medicare/Medicaid	$22,690.18
Rate for Payer: Universal American Medicare	$22,690.18
Rate for Payer: Wellcare Medicare	$22,690.18
Rate for Payer: Wellmed Medicare	$22,690.18

HIV WITH MAJOR RELATED CONDITION WITH CC

Facility

$25,902.70

Service Code	MSDRG 975
Min. Negotiated Rate	$10,947.80
Max. Negotiated Rate	$25,902.70
Rate for Payer: Aetna Commercial	$15,337.12
Rate for Payer: Aetna Medicare	$18,875.06
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$12,583.37
Rate for Payer: Amerigroup Medicare	$12,583.37
Rate for Payer: BCBS of TX Blue Advantage	$10,947.80
Rate for Payer: BCBS of TX Blue Essentials	$13,310.48
Rate for Payer: BCBS of TX Medicare	$12,583.37
Rate for Payer: BCBS of TX PPO	$14,789.99
Rate for Payer: Cigna Commercial	$17,559.30
Rate for Payer: Cigna Medicare	$12,583.37
Rate for Payer: Employer Direct Commercial	$12,583.37
Rate for Payer: Humana Medicare/TRICARE	$12,583.37
Rate for Payer: Molina Dual Medicare/Medicaid	$12,583.37
Rate for Payer: Molina Medicare	$12,583.37
Rate for Payer: Multiplan Auto	$25,902.70
Rate for Payer: Multiplan Commercial	$25,902.70
Rate for Payer: Multiplan Workers Comp	$25,902.70
Rate for Payer: Scott and White EPO/PPO	$11,928.88
Rate for Payer: Scott and White Medicare	$12,583.37
Rate for Payer: Superior Health Plan EPO	$12,583.37
Rate for Payer: Superior Health Plan Medicare	$12,583.37
Rate for Payer: Universal American Dual Medicare/Medicaid	$12,583.37
Rate for Payer: Universal American Medicare	$12,583.37
Rate for Payer: Wellcare Medicare	$12,583.37
Rate for Payer: Wellmed Medicare	$12,583.37

HIV WITH MAJOR RELATED CONDITION WITH MCC

Facility

$55,413.50

Service Code	MSDRG 974
Min. Negotiated Rate	$22,937.92
Max. Negotiated Rate	$55,413.50
Rate for Payer: Aetna Commercial	$32,810.62
Rate for Payer: Aetna Medicare	$35,500.65
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$23,667.10
Rate for Payer: Amerigroup Medicare	$23,667.10
Rate for Payer: BCBS of TX Blue Advantage	$22,937.92
Rate for Payer: BCBS of TX Blue Essentials	$28,098.64
Rate for Payer: BCBS of TX Medicare	$23,667.10
Rate for Payer: BCBS of TX PPO	$31,221.92
Rate for Payer: Cigna Commercial	$37,564.52
Rate for Payer: Cigna Medicare	$23,667.10
Rate for Payer: Employer Direct Commercial	$23,667.10
Rate for Payer: Humana Medicare/TRICARE	$23,667.10
Rate for Payer: Molina Dual Medicare/Medicaid	$23,667.10
Rate for Payer: Molina Medicare	$23,667.10
Rate for Payer: Multiplan Auto	$55,413.50
Rate for Payer: Multiplan Commercial	$55,413.50
Rate for Payer: Multiplan Workers Comp	$55,413.50
Rate for Payer: Scott and White EPO/PPO	$25,519.38
Rate for Payer: Scott and White Medicare	$23,667.10
Rate for Payer: Superior Health Plan EPO	$23,667.10
Rate for Payer: Superior Health Plan Medicare	$23,667.10
Rate for Payer: Universal American Dual Medicare/Medicaid	$23,667.10
Rate for Payer: Universal American Medicare	$23,667.10
Rate for Payer: Wellcare Medicare	$23,667.10
Rate for Payer: Wellmed Medicare	$23,667.10

HIV WITH MAJOR RELATED CONDITION WITHOUT CC/MCC

Facility

$16,060.70

Service Code	MSDRG 976
Min. Negotiated Rate	$7,396.38
Max. Negotiated Rate	$16,060.70
Rate for Payer: Aetna Commercial	$9,509.62
Rate for Payer: Aetna Medicare	$13,330.34
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$8,886.89
Rate for Payer: Amerigroup Medicare	$8,886.89
Rate for Payer: BCBS of TX Blue Advantage	$7,554.24
Rate for Payer: BCBS of TX Blue Essentials	$9,685.41
Rate for Payer: BCBS of TX Medicare	$8,886.89
Rate for Payer: BCBS of TX PPO	$10,761.99
Rate for Payer: Cigna Commercial	$10,887.46
Rate for Payer: Cigna Medicare	$8,886.89
Rate for Payer: Employer Direct Commercial	$8,886.89
Rate for Payer: Humana Medicare/TRICARE	$8,886.89
Rate for Payer: Molina Dual Medicare/Medicaid	$8,886.89
Rate for Payer: Molina Medicare	$8,886.89
Rate for Payer: Multiplan Auto	$16,060.70
Rate for Payer: Multiplan Commercial	$16,060.70
Rate for Payer: Multiplan Workers Comp	$16,060.70
Rate for Payer: Scott and White EPO/PPO	$7,396.38
Rate for Payer: Scott and White Medicare	$8,886.89
Rate for Payer: Superior Health Plan EPO	$8,886.89
Rate for Payer: Superior Health Plan Medicare	$8,886.89
Rate for Payer: Universal American Dual Medicare/Medicaid	$8,886.89
Rate for Payer: Universal American Medicare	$8,886.89
Rate for Payer: Wellcare Medicare	$8,886.89
Rate for Payer: Wellmed Medicare	$8,886.89

HIV WITH OR WITHOUT OTHER RELATED CONDITION

Facility

$26,905.90

Service Code	MSDRG 977
Min. Negotiated Rate	$10,668.30
Max. Negotiated Rate	$26,905.90
Rate for Payer: Aetna Commercial	$15,931.12
Rate for Payer: Aetna Medicare	$19,440.22
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$12,960.15
Rate for Payer: Amerigroup Medicare	$12,960.15
Rate for Payer: BCBS of TX Blue Advantage	$10,668.30
Rate for Payer: BCBS of TX Blue Essentials	$12,072.20
Rate for Payer: BCBS of TX Medicare	$12,960.15
Rate for Payer: BCBS of TX PPO	$13,414.07
Rate for Payer: Cigna Commercial	$18,239.37
Rate for Payer: Cigna Medicare	$12,960.15
Rate for Payer: Employer Direct Commercial	$12,960.15
Rate for Payer: Humana Medicare/TRICARE	$12,960.15
Rate for Payer: Molina Dual Medicare/Medicaid	$12,960.15
Rate for Payer: Molina Medicare	$12,960.15
Rate for Payer: Multiplan Auto	$26,905.90
Rate for Payer: Multiplan Commercial	$26,905.90
Rate for Payer: Multiplan Workers Comp	$26,905.90
Rate for Payer: Scott and White EPO/PPO	$12,390.88
Rate for Payer: Scott and White Medicare	$12,960.15
Rate for Payer: Superior Health Plan EPO	$12,960.15
Rate for Payer: Superior Health Plan Medicare	$12,960.15
Rate for Payer: Universal American Dual Medicare/Medicaid	$12,960.15
Rate for Payer: Universal American Medicare	$12,960.15
Rate for Payer: Wellcare Medicare	$12,960.15
Rate for Payer: Wellmed Medicare	$12,960.15

HLA B 27 Disease Association SO

Facility

$503.00

Service Code	CPT 81374
Hospital Charge Code	1740985
Hospital Revenue Code	310
Rate for Payer: Cash Price	$442.64

HLA B 27 Disease Association SO

Facility

$503.00

Service Code	CPT 81374
Hospital Charge Code	1740985
Hospital Revenue Code	310
Min. Negotiated Rate	$28.99
Max. Negotiated Rate	$326.95
Rate for Payer: Aetna Commercial	$78.05
Rate for Payer: Aetna Medicare	$111.50
Rate for Payer: Amerigroup CHIP/Medicaid	$28.99
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$74.33
Rate for Payer: Amerigroup Medicare	$74.33
Rate for Payer: BCBS of TX Blue Advantage	$122.64
Rate for Payer: BCBS of TX Blue Essentials	$147.17
Rate for Payer: BCBS of TX Medicare	$74.33
Rate for Payer: BCBS of TX PPO	$164.27
Rate for Payer: Cash Price	$442.64
Rate for Payer: Cash Price	$442.64
Rate for Payer: Cigna Medicaid	$74.33
Rate for Payer: Cigna Medicare	$74.33
Rate for Payer: Employer Direct Commercial	$74.33
Rate for Payer: Humana Medicare/TRICARE	$74.33
Rate for Payer: Molina CHIP/Medicaid	$74.33
Rate for Payer: Molina Dual Medicare/Medicaid	$74.33
Rate for Payer: Molina Medicare	$74.33
Rate for Payer: Multiplan Auto	$326.95
Rate for Payer: Multiplan Commercial	$326.95
Rate for Payer: Multiplan Workers Comp	$326.95
Rate for Payer: Parkland Medicaid	$74.33
Rate for Payer: Scott and White EPO/PPO	$92.91
Rate for Payer: Scott and White Medicare	$74.33
Rate for Payer: Superior Health Plan CHIP/Medicaid	$74.33
Rate for Payer: Superior Health Plan EPO	$74.33
Rate for Payer: Superior Health Plan Medicare	$74.33
Rate for Payer: Universal American Dual Medicare/Medicaid	$74.33
Rate for Payer: Universal American Medicare	$74.33
Rate for Payer: Wellcare Medicare	$74.33
Rate for Payer: Wellmed Medicare	$74.33

HLA B5701 Test SO

Facility

$608.00

Service Code	CPT 81381
Hospital Charge Code	1740971
Hospital Revenue Code	310
Rate for Payer: Cash Price	$535.04

HLA B5701 Test SO

Facility

$608.00

Service Code	CPT 81381
Hospital Charge Code	1740971
Hospital Revenue Code	310
Min. Negotiated Rate	$66.26
Max. Negotiated Rate	$395.20
Rate for Payer: Aetna Commercial	$178.40
Rate for Payer: Aetna Medicare	$254.85
Rate for Payer: Amerigroup CHIP/Medicaid	$66.26
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$169.90
Rate for Payer: Amerigroup Medicare	$169.90
Rate for Payer: BCBS of TX Blue Advantage	$280.34
Rate for Payer: BCBS of TX Blue Essentials	$336.40
Rate for Payer: BCBS of TX Medicare	$169.90
Rate for Payer: BCBS of TX PPO	$375.48
Rate for Payer: Cash Price	$535.04
Rate for Payer: Cash Price	$535.04
Rate for Payer: Cigna Medicaid	$169.90
Rate for Payer: Cigna Medicare	$169.90
Rate for Payer: Employer Direct Commercial	$169.90
Rate for Payer: Humana Medicare/TRICARE	$169.90
Rate for Payer: Molina CHIP/Medicaid	$169.90
Rate for Payer: Molina Dual Medicare/Medicaid	$169.90
Rate for Payer: Molina Medicare	$169.90
Rate for Payer: Multiplan Auto	$395.20
Rate for Payer: Multiplan Commercial	$395.20
Rate for Payer: Multiplan Workers Comp	$395.20
Rate for Payer: Parkland Medicaid	$169.90
Rate for Payer: Scott and White EPO/PPO	$212.38
Rate for Payer: Scott and White Medicare	$169.90
Rate for Payer: Superior Health Plan CHIP/Medicaid	$169.90
Rate for Payer: Superior Health Plan EPO	$169.90
Rate for Payer: Superior Health Plan Medicare	$169.90
Rate for Payer: Universal American Dual Medicare/Medicaid	$169.90
Rate for Payer: Universal American Medicare	$169.90
Rate for Payer: Wellcare Medicare	$169.90
Rate for Payer: Wellmed Medicare	$169.90

HL ENDO T -- DHF

Facility

$437.09

Hospital Charge Code	82047507
Hospital Revenue Code	270
Rate for Payer: Cash Price	$384.64

HL ENDO T -- DHF

Facility

$437.09

Hospital Charge Code	82047507
Hospital Revenue Code	270
Min. Negotiated Rate	$39.34
Max. Negotiated Rate	$284.11
Rate for Payer: Aetna Commercial	$240.40
Rate for Payer: Amerigroup CHIP/Medicaid	$39.34
Rate for Payer: BCBS of TX Blue Advantage	$131.13
Rate for Payer: BCBS of TX Blue Essentials	$157.35
Rate for Payer: BCBS of TX PPO	$174.84
Rate for Payer: Cash Price	$384.64
Rate for Payer: Multiplan Auto	$284.11
Rate for Payer: Multiplan Commercial	$284.11
Rate for Payer: Multiplan Workers Comp	$284.11
Rate for Payer: Scott and White EPO/PPO	$218.54
Rate for Payer: Superior Health Plan EPO	$59.44

HL HAND ADLT -- DHF

Facility

$422.97

Hospital Charge Code	81143109
Hospital Revenue Code	270
Rate for Payer: Cash Price	$372.21

HL HAND ADLT -- DHF

Facility

$422.97

Hospital Charge Code	81143109
Hospital Revenue Code	270
Min. Negotiated Rate	$38.07
Max. Negotiated Rate	$274.93
Rate for Payer: Aetna Commercial	$232.63
Rate for Payer: Amerigroup CHIP/Medicaid	$38.07
Rate for Payer: BCBS of TX Blue Advantage	$126.89
Rate for Payer: BCBS of TX Blue Essentials	$152.27
Rate for Payer: BCBS of TX PPO	$169.19
Rate for Payer: Cash Price	$372.21
Rate for Payer: Multiplan Auto	$274.93
Rate for Payer: Multiplan Commercial	$274.93
Rate for Payer: Multiplan Workers Comp	$274.93
Rate for Payer: Scott and White EPO/PPO	$211.48
Rate for Payer: Superior Health Plan EPO	$57.52

HL HAND BABY -- DHF

Facility

$115.36

Hospital Charge Code	81143158
Hospital Revenue Code	270
Rate for Payer: Cash Price	$101.52

HL HAND BABY -- DHF

Facility

$115.36

Hospital Charge Code	81143158
Hospital Revenue Code	270
Min. Negotiated Rate	$10.38
Max. Negotiated Rate	$74.98
Rate for Payer: Aetna Commercial	$63.45
Rate for Payer: Amerigroup CHIP/Medicaid	$10.38
Rate for Payer: BCBS of TX Blue Advantage	$34.61
Rate for Payer: BCBS of TX Blue Essentials	$41.53
Rate for Payer: BCBS of TX PPO	$46.14
Rate for Payer: Cash Price	$101.52
Rate for Payer: Multiplan Auto	$74.98
Rate for Payer: Multiplan Commercial	$74.98
Rate for Payer: Multiplan Workers Comp	$74.98
Rate for Payer: Scott and White EPO/PPO	$57.68
Rate for Payer: Superior Health Plan EPO	$15.69

Know your out-of-pocket cost for care.

All Charges