White Rock Medical Center

All Charges

Charge

Type

Setting

Price

EEG Charges -> EEG 24 hr Unmonitored w/ video 95714

Facility

$4,301.75

Service Code	HCPCS 95714
Hospital Charge Code	8794576
Hospital Revenue Code	740
Rate for Payer: Cash Price	$2,925.19

EEG Charges -> EEG Awake/Asleep 95819

Facility

$2,059.00

Service Code	HCPCS 95819
Hospital Charge Code	3000023
Hospital Revenue Code	740
Rate for Payer: Cash Price	$1,400.12

EEG Charges -> EEG Awake/Asleep 95819

Facility

$2,059.00

Service Code	HCPCS 95819
Hospital Charge Code	3000023
Hospital Revenue Code	740
Min. Negotiated Rate	$185.31
Max. Negotiated Rate	$1,482.48
Rate for Payer: Amerigroup CHIP/Medicaid	$185.31
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$216.91
Rate for Payer: Amerigroup Medicare	$216.91
Rate for Payer: BCBS of TX Blue Advantage	$617.70
Rate for Payer: BCBS of TX Blue Essentials	$741.24
Rate for Payer: BCBS of TX Medicare	$216.91
Rate for Payer: BCBS of TX PPO	$823.60
Rate for Payer: Cash Price	$1,400.12
Rate for Payer: Cash Price	$1,400.12
Rate for Payer: Cash Price	$1,400.12
Rate for Payer: Cigna Commercial	$458.51
Rate for Payer: Cigna Medicaid	$1,482.48
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	$1,482.48
Rate for Payer: Molina Dual Medicare/Medicaid	$216.91
Rate for Payer: Molina Medicare	$216.91
Rate for Payer: Multiplan Auto	$1,338.35
Rate for Payer: Multiplan Commercial	$1,338.35
Rate for Payer: Multiplan Workers Comp	$1,338.35
Rate for Payer: Parkland Medicaid	$1,482.48
Rate for Payer: Scott and White EPO/PPO	$562.20
Rate for Payer: Scott and White Medicare	$216.91
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,482.48
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

EEG Charges -> EEG Awake/Drowsy 95816

Facility

$1,908.00

Service Code	HCPCS 95816
Hospital Charge Code	3000015
Hospital Revenue Code	740
Min. Negotiated Rate	$171.72
Max. Negotiated Rate	$1,373.76
Rate for Payer: Amerigroup CHIP/Medicaid	$171.72
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$216.91
Rate for Payer: Amerigroup Medicare	$216.91
Rate for Payer: BCBS of TX Blue Advantage	$572.40
Rate for Payer: BCBS of TX Blue Essentials	$686.88
Rate for Payer: BCBS of TX Medicare	$216.91
Rate for Payer: BCBS of TX PPO	$763.20
Rate for Payer: Cash Price	$1,297.44
Rate for Payer: Cash Price	$1,297.44
Rate for Payer: Cash Price	$1,297.44
Rate for Payer: Cigna Commercial	$458.51
Rate for Payer: Cigna Medicaid	$1,373.76
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	$1,373.76
Rate for Payer: Molina Dual Medicare/Medicaid	$216.91
Rate for Payer: Molina Medicare	$216.91
Rate for Payer: Multiplan Auto	$1,240.20
Rate for Payer: Multiplan Commercial	$1,240.20
Rate for Payer: Multiplan Workers Comp	$1,240.20
Rate for Payer: Parkland Medicaid	$1,373.76
Rate for Payer: Scott and White EPO/PPO	$488.06
Rate for Payer: Scott and White Medicare	$216.91
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,373.76
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

EEG Charges -> EEG Awake/Drowsy 95816

Facility

$1,908.00

Service Code	HCPCS 95816
Hospital Charge Code	3000015
Hospital Revenue Code	740
Rate for Payer: Cash Price	$1,297.44

EEG Charges -> EEG Intraop 95955

Facility

$2,056.60

Service Code	HCPCS 95955
Hospital Charge Code	3000064
Hospital Revenue Code	740
Min. Negotiated Rate	$185.09
Max. Negotiated Rate	$1,480.75
Rate for Payer: Amerigroup CHIP/Medicaid	$185.09
Rate for Payer: BCBS of TX Blue Advantage	$616.98
Rate for Payer: BCBS of TX Blue Essentials	$740.38
Rate for Payer: BCBS of TX PPO	$822.64
Rate for Payer: Cash Price	$1,398.49
Rate for Payer: Cash Price	$1,398.49
Rate for Payer: Cigna Medicaid	$1,480.75
Rate for Payer: Molina CHIP/Medicaid	$1,480.75
Rate for Payer: Multiplan Auto	$1,336.79
Rate for Payer: Multiplan Commercial	$1,336.79
Rate for Payer: Multiplan Workers Comp	$1,336.79
Rate for Payer: Parkland Medicaid	$1,480.75
Rate for Payer: Scott and White EPO/PPO	$235.25
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,480.75
Rate for Payer: Superior Health Plan EPO	$279.70

EEG Charges -> EEG Intraop 95955

Facility

$2,056.60

Service Code	HCPCS 95955
Hospital Charge Code	3000064
Hospital Revenue Code	740
Rate for Payer: Cash Price	$1,398.49

EEG Charges -> EEG Setup/Disconnect for LT-VEEG 95700

Facility

$1,431.50

Service Code	HCPCS 95700
Hospital Charge Code	12102306
Hospital Revenue Code	740
Min. Negotiated Rate	$128.84
Max. Negotiated Rate	$1,030.68
Rate for Payer: Amerigroup CHIP/Medicaid	$128.84
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$216.91
Rate for Payer: Amerigroup Medicare	$216.91
Rate for Payer: BCBS of TX Blue Advantage	$429.45
Rate for Payer: BCBS of TX Blue Essentials	$515.34
Rate for Payer: BCBS of TX Medicare	$216.91
Rate for Payer: BCBS of TX PPO	$572.60
Rate for Payer: Cash Price	$973.42
Rate for Payer: Cash Price	$973.42
Rate for Payer: Cash Price	$973.42
Rate for Payer: Cigna Commercial	$458.51
Rate for Payer: Cigna Medicaid	$1,030.68
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	$1,030.68
Rate for Payer: Molina Dual Medicare/Medicaid	$216.91
Rate for Payer: Molina Medicare	$216.91
Rate for Payer: Multiplan Auto	$930.48
Rate for Payer: Multiplan Commercial	$930.48
Rate for Payer: Multiplan Workers Comp	$930.48
Rate for Payer: Parkland Medicaid	$1,030.68
Rate for Payer: Scott and White EPO/PPO	$715.75
Rate for Payer: Scott and White Medicare	$216.91
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,030.68
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

EEG Charges -> EEG Setup/Disconnect for LT-VEEG 95700

Facility

$1,431.50

Service Code	HCPCS 95700
Hospital Charge Code	12102306
Hospital Revenue Code	740
Rate for Payer: Cash Price	$973.42

Egd balloon dil esoph30 mm/>

Facility

$7,251.96

Service Code	HCPCS 43233
Hospital Charge Code	9900669
Hospital Revenue Code	360
Min. Negotiated Rate	$564.97
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$564.97
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$1,927.65
Rate for Payer: Amerigroup Medicare	$1,927.65
Rate for Payer: BCBS of TX Blue Advantage	$2,600.86
Rate for Payer: BCBS of TX Blue Essentials	$3,114.80
Rate for Payer: BCBS of TX Medicare	$1,927.65
Rate for Payer: BCBS of TX PPO	$3,924.65
Rate for Payer: Cash Price	$4,931.33
Rate for Payer: Cash Price	$4,931.33
Rate for Payer: Cash Price	$4,931.33
Rate for Payer: Cigna Commercial	$4,074.70
Rate for Payer: Cigna Medicaid	$5,221.41
Rate for Payer: Cigna Medicare	$1,927.65
Rate for Payer: Employer Direct Commercial	$1,927.65
Rate for Payer: Humana Medicare/TRICARE	$1,927.65
Rate for Payer: Molina CHIP/Medicaid	$5,221.41
Rate for Payer: Molina Dual Medicare/Medicaid	$1,927.65
Rate for Payer: Molina Medicare	$1,927.65
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	$5,221.41
Rate for Payer: Scott and White EPO/PPO	$3,219.41
Rate for Payer: Scott and White Medicare	$1,927.65
Rate for Payer: Superior Health Plan CHIP/Medicaid	$5,221.41
Rate for Payer: Superior Health Plan EPO	$1,927.65
Rate for Payer: Superior Health Plan Medicare	$1,927.65
Rate for Payer: Universal American Dual Medicare/Medicaid	$1,927.65
Rate for Payer: Universal American Medicare	$1,927.65
Rate for Payer: Wellcare Medicare	$1,927.65
Rate for Payer: Wellmed Medicare	$1,927.65

Egd balloon dil esoph30 mm/>

Facility

$7,251.96

Service Code	HCPCS 43233
Hospital Charge Code	9900669
Hospital Revenue Code	360
Rate for Payer: Cash Price	$4,931.33

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 - 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	$7.78
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	$7.78
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 - 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	$10.25
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	$10.25
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 -> 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 -> Cardiovascular stress test trace 93017

Facility

$2,571.00

Service Code	HCPCS 93017
Hospital Charge Code	2800142
Hospital Revenue Code	482
Min. Negotiated Rate	$46.46
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	$46.46
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
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	$130.60
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 -> 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 -> 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 -> Color Flow Mapping 93325

Facility

$980.00

Service Code	HCPCS 93325
Hospital Charge Code	2800266
Hospital Revenue Code	480
Min. Negotiated Rate	$28.86
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: 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	$28.86
Rate for Payer: Superior Health Plan CHIP/Medicaid	$705.60
Rate for Payer: Superior Health Plan EPO	$133.28

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	$242.57
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	$242.57
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	$121.88
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	$121.88
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

Know your out-of-pocket cost for care.

All Charges