White Rock Medical Center

All Charges

Charge

Type

Setting

Price

EKG Charges - ED -> Rhythm ECG 1-3 leads tracing only

Facility

$242.00

Service Code	HCPCS 93041
Hospital Charge Code	5367567
Hospital Revenue Code	730
Min. Negotiated Rate	$21.78
Max. Negotiated Rate	$174.24
Rate for Payer: Amerigroup CHIP/Medicaid	$21.78
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$59.26
Rate for Payer: Amerigroup Medicare	$59.26
Rate for Payer: BCBS of TX Blue Advantage	$72.60
Rate for Payer: BCBS of TX Blue Essentials	$87.12
Rate for Payer: BCBS of TX Medicare	$59.26
Rate for Payer: BCBS of TX PPO	$96.80
Rate for Payer: Cash Price	$164.56
Rate for Payer: Cash Price	$164.56
Rate for Payer: Cash Price	$164.56
Rate for Payer: Cigna Commercial	$125.27
Rate for Payer: Cigna Medicaid	$174.24
Rate for Payer: Cigna Medicare	$59.26
Rate for Payer: Employer Direct Commercial	$59.26
Rate for Payer: Humana Medicare/TRICARE	$59.26
Rate for Payer: Molina CHIP/Medicaid	$174.24
Rate for Payer: Molina Dual Medicare/Medicaid	$59.26
Rate for Payer: Molina Medicare	$59.26
Rate for Payer: Multiplan Auto	$157.30
Rate for Payer: Multiplan Commercial	$157.30
Rate for Payer: Multiplan Workers Comp	$157.30
Rate for Payer: Parkland Medicaid	$174.24
Rate for Payer: Scott and White EPO/PPO	$121.00
Rate for Payer: Scott and White Medicare	$59.26
Rate for Payer: Superior Health Plan CHIP/Medicaid	$174.24
Rate for Payer: Superior Health Plan EPO	$59.26
Rate for Payer: Superior Health Plan Medicare	$59.26
Rate for Payer: Universal American Dual Medicare/Medicaid	$59.26
Rate for Payer: Universal American Medicare	$59.26
Rate for Payer: Wellcare Medicare	$59.26
Rate for Payer: Wellmed Medicare	$59.26

EKG Charges - ED -> Rhythm ECG 1-3 leads tracing only

Facility

$242.00

Service Code	HCPCS 93041
Hospital Charge Code	5367567
Hospital Revenue Code	730
Rate for Payer: Cash Price	$164.56

EKG Charges - EKG -> 30 Day Event Monitor Recording 93270

Facility

$522.71

Service Code	HCPCS 93270
Hospital Charge Code	2800076
Hospital Revenue Code	480
Rate for Payer: Cash Price	$355.44

EKG Charges - EKG -> 30 Day Event Monitor Recording 93270

Facility

$522.71

Service Code	HCPCS 93270
Hospital Charge Code	2800076
Hospital Revenue Code	480
Min. Negotiated Rate	$37.49
Max. Negotiated Rate	$376.35
Rate for Payer: Amerigroup CHIP/Medicaid	$47.04
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$37.49
Rate for Payer: Amerigroup Medicare	$37.49
Rate for Payer: BCBS of TX Blue Advantage	$156.81
Rate for Payer: BCBS of TX Blue Essentials	$188.18
Rate for Payer: BCBS of TX Medicare	$37.49
Rate for Payer: BCBS of TX PPO	$209.08
Rate for Payer: Cash Price	$355.44
Rate for Payer: Cash Price	$355.44
Rate for Payer: Cash Price	$355.44
Rate for Payer: Cigna Commercial	$79.25
Rate for Payer: Cigna Medicaid	$376.35
Rate for Payer: Cigna Medicare	$37.49
Rate for Payer: Employer Direct Commercial	$37.49
Rate for Payer: Humana Medicare/TRICARE	$37.49
Rate for Payer: Molina CHIP/Medicaid	$376.35
Rate for Payer: Molina Dual Medicare/Medicaid	$37.49
Rate for Payer: Molina Medicare	$37.49
Rate for Payer: Multiplan Auto	$339.76
Rate for Payer: Multiplan Commercial	$339.76
Rate for Payer: Multiplan Workers Comp	$339.76
Rate for Payer: Parkland Medicaid	$376.35
Rate for Payer: Scott and White EPO/PPO	$261.36
Rate for Payer: Scott and White Medicare	$37.49
Rate for Payer: Superior Health Plan CHIP/Medicaid	$376.35
Rate for Payer: Superior Health Plan EPO	$37.49
Rate for Payer: Superior Health Plan Medicare	$37.49
Rate for Payer: Universal American Dual Medicare/Medicaid	$37.49
Rate for Payer: Universal American Medicare	$37.49
Rate for Payer: Wellcare Medicare	$37.49
Rate for Payer: Wellmed Medicare	$37.49

EKG Charges - EKG -> Cardiovascular stress test trace 93017

Facility

$2,571.00

Service Code	HCPCS 93017
Hospital Charge Code	2800142
Hospital Revenue Code	482
Min. Negotiated Rate	$216.91
Max. Negotiated Rate	$1,851.12
Rate for Payer: Amerigroup CHIP/Medicaid	$231.39
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$216.91
Rate for Payer: Amerigroup Medicare	$216.91
Rate for Payer: BCBS of TX Blue Advantage	$771.30
Rate for Payer: BCBS of TX Blue Essentials	$925.56
Rate for Payer: BCBS of TX Medicare	$216.91
Rate for Payer: BCBS of TX PPO	$1,028.40
Rate for Payer: Cash Price	$1,748.28
Rate for Payer: Cash Price	$1,748.28
Rate for Payer: Cash Price	$1,748.28
Rate for Payer: Cigna Commercial	$458.51
Rate for Payer: Cigna Medicaid	$1,851.12
Rate for Payer: Cigna Medicare	$216.91
Rate for Payer: Employer Direct Commercial	$216.91
Rate for Payer: Humana Medicare/TRICARE	$216.91
Rate for Payer: Molina CHIP/Medicaid	$1,851.12
Rate for Payer: Molina Dual Medicare/Medicaid	$216.91
Rate for Payer: Molina Medicare	$216.91
Rate for Payer: Multiplan Auto	$1,671.15
Rate for Payer: Multiplan Commercial	$1,671.15
Rate for Payer: Multiplan Workers Comp	$1,671.15
Rate for Payer: Parkland Medicaid	$1,851.12
Rate for Payer: Scott and White EPO/PPO	$1,285.50
Rate for Payer: Scott and White Medicare	$216.91
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,851.12
Rate for Payer: Superior Health Plan EPO	$216.91
Rate for Payer: Superior Health Plan Medicare	$216.91
Rate for Payer: Universal American Dual Medicare/Medicaid	$216.91
Rate for Payer: Universal American Medicare	$216.91
Rate for Payer: Wellcare Medicare	$216.91
Rate for Payer: Wellmed Medicare	$216.91

EKG Charges - EKG -> Cardiovascular stress test trace 93017

Facility

$2,571.00

Service Code	HCPCS 93017
Hospital Charge Code	2800142
Hospital Revenue Code	482
Rate for Payer: Cash Price	$1,748.28

EKG Charges - EKG -> Cardioversion 92960

Facility

$1,363.00

Service Code	HCPCS 92960
Hospital Charge Code	2800381
Hospital Revenue Code	480
Rate for Payer: Cash Price	$926.84

EKG Charges - EKG -> Cardioversion 92960

Facility

$1,363.00

Service Code	HCPCS 92960
Hospital Charge Code	2800381
Hospital Revenue Code	480
Min. Negotiated Rate	$122.67
Max. Negotiated Rate	$1,403.47
Rate for Payer: Amerigroup CHIP/Medicaid	$122.67
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$663.96
Rate for Payer: Amerigroup Medicare	$663.96
Rate for Payer: BCBS of TX Blue Advantage	$895.89
Rate for Payer: BCBS of TX Blue Essentials	$1,072.92
Rate for Payer: BCBS of TX Medicare	$663.96
Rate for Payer: BCBS of TX PPO	$1,351.88
Rate for Payer: Cash Price	$926.84
Rate for Payer: Cash Price	$926.84
Rate for Payer: Cash Price	$926.84
Rate for Payer: Cigna Commercial	$1,403.47
Rate for Payer: Cigna Medicaid	$981.36
Rate for Payer: Cigna Medicare	$663.96
Rate for Payer: Employer Direct Commercial	$663.96
Rate for Payer: Humana Medicare/TRICARE	$663.96
Rate for Payer: Molina CHIP/Medicaid	$981.36
Rate for Payer: Molina Dual Medicare/Medicaid	$663.96
Rate for Payer: Molina Medicare	$663.96
Rate for Payer: Multiplan Auto	$885.95
Rate for Payer: Multiplan Commercial	$885.95
Rate for Payer: Multiplan Workers Comp	$885.95
Rate for Payer: Parkland Medicaid	$981.36
Rate for Payer: Scott and White EPO/PPO	$681.50
Rate for Payer: Scott and White Medicare	$663.96
Rate for Payer: Superior Health Plan CHIP/Medicaid	$981.36
Rate for Payer: Superior Health Plan EPO	$663.96
Rate for Payer: Superior Health Plan Medicare	$663.96
Rate for Payer: Universal American Dual Medicare/Medicaid	$663.96
Rate for Payer: Universal American Medicare	$663.96
Rate for Payer: Wellcare Medicare	$663.96
Rate for Payer: Wellmed Medicare	$663.96

EKG Charges - EKG -> Color Flow Mapping 93325

Facility

$980.00

Service Code	HCPCS 93325
Hospital Charge Code	2800266
Hospital Revenue Code	480
Min. Negotiated Rate	$88.20
Max. Negotiated Rate	$705.60
Rate for Payer: Amerigroup CHIP/Medicaid	$88.20
Rate for Payer: BCBS of TX Blue Advantage	$294.00
Rate for Payer: BCBS of TX Blue Essentials	$352.80
Rate for Payer: BCBS of TX PPO	$392.00
Rate for Payer: Cash Price	$666.40
Rate for Payer: Cigna Medicaid	$705.60
Rate for Payer: Molina CHIP/Medicaid	$705.60
Rate for Payer: Multiplan Auto	$637.00
Rate for Payer: Multiplan Commercial	$637.00
Rate for Payer: Multiplan Workers Comp	$637.00
Rate for Payer: Parkland Medicaid	$705.60
Rate for Payer: Scott and White EPO/PPO	$490.00
Rate for Payer: Superior Health Plan CHIP/Medicaid	$705.60
Rate for Payer: Superior Health Plan EPO	$133.28

EKG Charges - EKG -> Color Flow Mapping 93325

Facility

$980.00

Service Code	HCPCS 93325
Hospital Charge Code	2800266
Hospital Revenue Code	480
Rate for Payer: Cash Price	$666.40

EKG Charges - EKG -> Echo2D Spectr/Color FLO 93306

Facility

$4,727.00

Service Code	HCPCS 93306
Hospital Charge Code	2800852
Hospital Revenue Code	480
Min. Negotiated Rate	$425.43
Max. Negotiated Rate	$3,403.44
Rate for Payer: Amerigroup CHIP/Medicaid	$425.43
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$548.90
Rate for Payer: Amerigroup Medicare	$548.90
Rate for Payer: BCBS of TX Blue Advantage	$1,418.10
Rate for Payer: BCBS of TX Blue Essentials	$1,701.72
Rate for Payer: BCBS of TX Medicare	$548.90
Rate for Payer: BCBS of TX PPO	$1,890.80
Rate for Payer: Cash Price	$3,214.36
Rate for Payer: Cash Price	$3,214.36
Rate for Payer: Cash Price	$3,214.36
Rate for Payer: Cigna Commercial	$1,160.29
Rate for Payer: Cigna Medicaid	$3,403.44
Rate for Payer: Cigna Medicare	$548.90
Rate for Payer: Employer Direct Commercial	$548.90
Rate for Payer: Humana Medicare/TRICARE	$548.90
Rate for Payer: Molina CHIP/Medicaid	$3,403.44
Rate for Payer: Molina Dual Medicare/Medicaid	$548.90
Rate for Payer: Molina Medicare	$548.90
Rate for Payer: Multiplan Auto	$3,072.55
Rate for Payer: Multiplan Commercial	$3,072.55
Rate for Payer: Multiplan Workers Comp	$3,072.55
Rate for Payer: Parkland Medicaid	$3,403.44
Rate for Payer: Scott and White EPO/PPO	$2,363.50
Rate for Payer: Scott and White Medicare	$548.90
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3,403.44
Rate for Payer: Superior Health Plan EPO	$548.90
Rate for Payer: Superior Health Plan Medicare	$548.90
Rate for Payer: Universal American Dual Medicare/Medicaid	$548.90
Rate for Payer: Universal American Medicare	$548.90
Rate for Payer: Wellcare Medicare	$548.90
Rate for Payer: Wellmed Medicare	$548.90

EKG Charges - EKG -> Echo2D Spectr/Color FLO 93306

Facility

$4,727.00

Service Code	HCPCS 93306
Hospital Charge Code	2800852
Hospital Revenue Code	480
Rate for Payer: Cash Price	$3,214.36

EKG Charges - EKG -> Echocardio 2D LTD 93308

Facility

$1,518.00

Service Code	HCPCS 93308
Hospital Charge Code	2800688
Hospital Revenue Code	480
Min. Negotiated Rate	$136.62
Max. Negotiated Rate	$1,092.96
Rate for Payer: Amerigroup CHIP/Medicaid	$136.62
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$239.69
Rate for Payer: Amerigroup Medicare	$239.69
Rate for Payer: BCBS of TX Blue Advantage	$455.40
Rate for Payer: BCBS of TX Blue Essentials	$546.48
Rate for Payer: BCBS of TX Medicare	$239.69
Rate for Payer: BCBS of TX PPO	$607.20
Rate for Payer: Cash Price	$1,032.24
Rate for Payer: Cash Price	$1,032.24
Rate for Payer: Cash Price	$1,032.24
Rate for Payer: Cigna Commercial	$506.65
Rate for Payer: Cigna Medicaid	$1,092.96
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	$1,092.96
Rate for Payer: Molina Dual Medicare/Medicaid	$239.69
Rate for Payer: Molina Medicare	$239.69
Rate for Payer: Multiplan Auto	$986.70
Rate for Payer: Multiplan Commercial	$986.70
Rate for Payer: Multiplan Workers Comp	$986.70
Rate for Payer: Parkland Medicaid	$1,092.96
Rate for Payer: Scott and White EPO/PPO	$759.00
Rate for Payer: Scott and White Medicare	$239.69
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,092.96
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

EKG Charges - EKG -> Echocardio 2D LTD 93308

Facility

$1,518.00

Service Code	HCPCS 93308
Hospital Charge Code	2800688
Hospital Revenue Code	480
Rate for Payer: Cash Price	$1,032.24

EKG Charges - EKG -> Echocardiogram Doppler 93320

Facility

$920.00

Service Code	HCPCS 93320
Hospital Charge Code	2800241
Hospital Revenue Code	480
Min. Negotiated Rate	$82.80
Max. Negotiated Rate	$662.40
Rate for Payer: Amerigroup CHIP/Medicaid	$82.80
Rate for Payer: BCBS of TX Blue Advantage	$276.00
Rate for Payer: BCBS of TX Blue Essentials	$331.20
Rate for Payer: BCBS of TX PPO	$368.00
Rate for Payer: Cash Price	$625.60
Rate for Payer: Cigna Medicaid	$662.40
Rate for Payer: Molina CHIP/Medicaid	$662.40
Rate for Payer: Multiplan Auto	$598.00
Rate for Payer: Multiplan Commercial	$598.00
Rate for Payer: Multiplan Workers Comp	$598.00
Rate for Payer: Parkland Medicaid	$662.40
Rate for Payer: Scott and White EPO/PPO	$460.00
Rate for Payer: Superior Health Plan CHIP/Medicaid	$662.40
Rate for Payer: Superior Health Plan EPO	$125.12

EKG Charges - EKG -> Echocardiogram Doppler 93320

Facility

$920.00

Service Code	HCPCS 93320
Hospital Charge Code	2800241
Hospital Revenue Code	480
Rate for Payer: Cash Price	$625.60

EKG Charges - EKG -> Echocardiogram Ex Stress 93350

Facility

$2,782.00

Service Code	HCPCS 93350
Hospital Charge Code	2800704
Hospital Revenue Code	480
Min. Negotiated Rate	$250.38
Max. Negotiated Rate	$2,003.04
Rate for Payer: Amerigroup CHIP/Medicaid	$250.38
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$548.90
Rate for Payer: Amerigroup Medicare	$548.90
Rate for Payer: BCBS of TX Blue Advantage	$834.60
Rate for Payer: BCBS of TX Blue Essentials	$1,001.52
Rate for Payer: BCBS of TX Medicare	$548.90
Rate for Payer: BCBS of TX PPO	$1,112.80
Rate for Payer: Cash Price	$1,891.76
Rate for Payer: Cash Price	$1,891.76
Rate for Payer: Cash Price	$1,891.76
Rate for Payer: Cigna Commercial	$1,160.29
Rate for Payer: Cigna Medicaid	$2,003.04
Rate for Payer: Cigna Medicare	$548.90
Rate for Payer: Employer Direct Commercial	$548.90
Rate for Payer: Humana Medicare/TRICARE	$548.90
Rate for Payer: Molina CHIP/Medicaid	$2,003.04
Rate for Payer: Molina Dual Medicare/Medicaid	$548.90
Rate for Payer: Molina Medicare	$548.90
Rate for Payer: Multiplan Auto	$1,808.30
Rate for Payer: Multiplan Commercial	$1,808.30
Rate for Payer: Multiplan Workers Comp	$1,808.30
Rate for Payer: Parkland Medicaid	$2,003.04
Rate for Payer: Scott and White EPO/PPO	$1,391.00
Rate for Payer: Scott and White Medicare	$548.90
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2,003.04
Rate for Payer: Superior Health Plan EPO	$548.90
Rate for Payer: Superior Health Plan Medicare	$548.90
Rate for Payer: Universal American Dual Medicare/Medicaid	$548.90
Rate for Payer: Universal American Medicare	$548.90
Rate for Payer: Wellcare Medicare	$548.90
Rate for Payer: Wellmed Medicare	$548.90

EKG Charges - EKG -> Echocardiogram Ex Stress 93350

Facility

$2,782.00

Service Code	HCPCS 93350
Hospital Charge Code	2800704
Hospital Revenue Code	480
Rate for Payer: Cash Price	$1,891.76

EKG Charges - EKG -> Echocardiogram w/ Contrast 99307

Facility

$3,991.00

Service Code	HCPCS 93307
Hospital Charge Code	9230980
Hospital Revenue Code	480
Min. Negotiated Rate	$239.69
Max. Negotiated Rate	$2,873.52
Rate for Payer: Amerigroup CHIP/Medicaid	$359.19
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$239.69
Rate for Payer: Amerigroup Medicare	$239.69
Rate for Payer: BCBS of TX Blue Advantage	$1,197.30
Rate for Payer: BCBS of TX Blue Essentials	$1,436.76
Rate for Payer: BCBS of TX Medicare	$239.69
Rate for Payer: BCBS of TX PPO	$1,596.40
Rate for Payer: Cash Price	$2,713.88
Rate for Payer: Cash Price	$2,713.88
Rate for Payer: Cash Price	$2,713.88
Rate for Payer: Cigna Commercial	$506.65
Rate for Payer: Cigna Medicaid	$2,873.52
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	$2,873.52
Rate for Payer: Molina Dual Medicare/Medicaid	$239.69
Rate for Payer: Molina Medicare	$239.69
Rate for Payer: Multiplan Auto	$2,594.15
Rate for Payer: Multiplan Commercial	$2,594.15
Rate for Payer: Multiplan Workers Comp	$2,594.15
Rate for Payer: Parkland Medicaid	$2,873.52
Rate for Payer: Scott and White EPO/PPO	$1,995.50
Rate for Payer: Scott and White Medicare	$239.69
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2,873.52
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

EKG Charges - EKG -> Echocardiogram w/ Contrast 99307

Facility

$3,991.00

Service Code	HCPCS 93307
Hospital Charge Code	9230980
Hospital Revenue Code	480
Rate for Payer: Cash Price	$2,713.88

EKG Charges - EKG -> Echocardiogram w/o Contrast 93307

Facility

$3,991.00

Service Code	HCPCS 93307
Hospital Charge Code	2800159
Hospital Revenue Code	480
Min. Negotiated Rate	$239.69
Max. Negotiated Rate	$2,873.52
Rate for Payer: Amerigroup CHIP/Medicaid	$359.19
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$239.69
Rate for Payer: Amerigroup Medicare	$239.69
Rate for Payer: BCBS of TX Blue Advantage	$1,197.30
Rate for Payer: BCBS of TX Blue Essentials	$1,436.76
Rate for Payer: BCBS of TX Medicare	$239.69
Rate for Payer: BCBS of TX PPO	$1,596.40
Rate for Payer: Cash Price	$2,713.88
Rate for Payer: Cash Price	$2,713.88
Rate for Payer: Cash Price	$2,713.88
Rate for Payer: Cigna Commercial	$506.65
Rate for Payer: Cigna Medicaid	$2,873.52
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	$2,873.52
Rate for Payer: Molina Dual Medicare/Medicaid	$239.69
Rate for Payer: Molina Medicare	$239.69
Rate for Payer: Multiplan Auto	$2,594.15
Rate for Payer: Multiplan Commercial	$2,594.15
Rate for Payer: Multiplan Workers Comp	$2,594.15
Rate for Payer: Parkland Medicaid	$2,873.52
Rate for Payer: Scott and White EPO/PPO	$1,995.50
Rate for Payer: Scott and White Medicare	$239.69
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2,873.52
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

EKG Charges - EKG -> Echocardiogram w/o Contrast 93307

Facility

$3,991.00

Service Code	HCPCS 93307
Hospital Charge Code	2800159
Hospital Revenue Code	480
Rate for Payer: Cash Price	$2,713.88

EKG Charges - EKG -> Echo Doppler LTD or Follow Up 93321

Facility

$697.00

Service Code	HCPCS 93321
Hospital Charge Code	2810002
Hospital Revenue Code	483
Rate for Payer: Cash Price	$473.96

EKG Charges - EKG -> Echo Doppler LTD or Follow Up 93321

Facility

$697.00

Service Code	HCPCS 93321
Hospital Charge Code	2810002
Hospital Revenue Code	483
Min. Negotiated Rate	$62.73
Max. Negotiated Rate	$501.84
Rate for Payer: Amerigroup CHIP/Medicaid	$62.73
Rate for Payer: BCBS of TX Blue Advantage	$209.10
Rate for Payer: BCBS of TX Blue Essentials	$250.92
Rate for Payer: BCBS of TX PPO	$278.80
Rate for Payer: Cash Price	$473.96
Rate for Payer: Cigna Medicaid	$501.84
Rate for Payer: Molina CHIP/Medicaid	$501.84
Rate for Payer: Multiplan Auto	$453.05
Rate for Payer: Multiplan Commercial	$453.05
Rate for Payer: Multiplan Workers Comp	$453.05
Rate for Payer: Parkland Medicaid	$501.84
Rate for Payer: Scott and White EPO/PPO	$348.50
Rate for Payer: Superior Health Plan CHIP/Medicaid	$501.84
Rate for Payer: Superior Health Plan EPO	$94.79

EKG Charges - EKG -> Echo Trans ESO w/ Probe w/ Contrast 93312

Facility

$3,210.00

Service Code	HCPCS 93312
Hospital Charge Code	2800696
Hospital Revenue Code	480
Rate for Payer: Cash Price	$2,182.80

Know your out-of-pocket cost for care.

All Charges