White Rock Medical Center

All Charges

Charge

Type

Setting

Price

insulin lispro 100 units/mL Subcut Soln 3 mL

Facility

$128.17

Service Code	HCPCS J1815
Hospital Charge Code	77634397
Hospital Revenue Code	636
Min. Negotiated Rate	$32.04
Max. Negotiated Rate	$64.08
Rate for Payer: Cash Price	$87.16
Rate for Payer: Cigna Commercial	$32.04
Rate for Payer: Scott and White EPO/PPO	$64.08

insulin lispro-insulin lispro protamine 25 units-75 units/mL Subcut Susp 10 mL

Facility

$128.17

Service Code	HCPCS J1815
Hospital Charge Code	77634513
Hospital Revenue Code	636
Min. Negotiated Rate	$32.04
Max. Negotiated Rate	$64.08
Rate for Payer: Cash Price	$87.16
Rate for Payer: Cigna Commercial	$32.04
Rate for Payer: Scott and White EPO/PPO	$64.08

insulin lispro-insulin lispro protamine 25 units-75 units/mL Subcut Susp 10 mL

Facility

$128.17

Service Code	HCPCS J1815
Hospital Charge Code	77634513
Hospital Revenue Code	636
Min. Negotiated Rate	$0.20
Max. Negotiated Rate	$83.31
Rate for Payer: Amerigroup CHIP/Medicaid	$11.54
Rate for Payer: BCBS of TX Blue Advantage	$0.20
Rate for Payer: BCBS of TX Blue Essentials	$0.24
Rate for Payer: BCBS of TX PPO	$0.27
Rate for Payer: Cash Price	$87.16
Rate for Payer: Cash Price	$87.16
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: Scott and White EPO/PPO	$64.08
Rate for Payer: Superior Health Plan EPO	$17.43

insulin regular 100 units/mL human recombinant Inj Soln 10 mL

Facility

$175.00

Service Code	HCPCS J1815
Hospital Charge Code	77634802
Hospital Revenue Code	636
Min. Negotiated Rate	$43.75
Max. Negotiated Rate	$87.50
Rate for Payer: Cash Price	$119.00
Rate for Payer: Cigna Commercial	$43.75
Rate for Payer: Scott and White EPO/PPO	$87.50

insulin regular 100 units/mL human recombinant Inj Soln 10 mL

Facility

$175.00

Service Code	HCPCS J1815
Hospital Charge Code	77634802
Hospital Revenue Code	636
Min. Negotiated Rate	$0.20
Max. Negotiated Rate	$113.75
Rate for Payer: Amerigroup CHIP/Medicaid	$15.75
Rate for Payer: BCBS of TX Blue Advantage	$0.20
Rate for Payer: BCBS of TX Blue Essentials	$0.24
Rate for Payer: BCBS of TX PPO	$0.27
Rate for Payer: Cash Price	$119.00
Rate for Payer: Cash Price	$119.00
Rate for Payer: Multiplan Auto	$113.75
Rate for Payer: Multiplan Commercial	$113.75
Rate for Payer: Multiplan Workers Comp	$113.75
Rate for Payer: Scott and White EPO/PPO	$87.50
Rate for Payer: Superior Health Plan EPO	$23.80

Insulin SO

Facility

$327.00

Service Code	CPT 83525
Hospital Charge Code	1709047
Hospital Revenue Code	301
Min. Negotiated Rate	$4.46
Max. Negotiated Rate	$212.55
Rate for Payer: Aetna Commercial	$12.00
Rate for Payer: Aetna Medicare	$17.14
Rate for Payer: Amerigroup CHIP/Medicaid	$4.46
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$11.43
Rate for Payer: Amerigroup Medicare	$11.43
Rate for Payer: BCBS of TX Blue Advantage	$18.86
Rate for Payer: BCBS of TX Blue Essentials	$22.63
Rate for Payer: BCBS of TX Medicare	$11.43
Rate for Payer: BCBS of TX PPO	$25.26
Rate for Payer: Cash Price	$287.76
Rate for Payer: Cash Price	$287.76
Rate for Payer: Cigna Medicaid	$11.43
Rate for Payer: Cigna Medicare	$11.43
Rate for Payer: Employer Direct Commercial	$11.43
Rate for Payer: Humana Medicare/TRICARE	$11.43
Rate for Payer: Molina CHIP/Medicaid	$11.43
Rate for Payer: Molina Dual Medicare/Medicaid	$11.43
Rate for Payer: Molina Medicare	$11.43
Rate for Payer: Multiplan Auto	$212.55
Rate for Payer: Multiplan Commercial	$212.55
Rate for Payer: Multiplan Workers Comp	$212.55
Rate for Payer: Parkland Medicaid	$11.43
Rate for Payer: Scott and White EPO/PPO	$14.29
Rate for Payer: Scott and White Medicare	$11.43
Rate for Payer: Superior Health Plan CHIP/Medicaid	$11.43
Rate for Payer: Superior Health Plan EPO	$11.43
Rate for Payer: Superior Health Plan Medicare	$11.43
Rate for Payer: Universal American Dual Medicare/Medicaid	$11.43
Rate for Payer: Universal American Medicare	$11.43
Rate for Payer: Wellcare Medicare	$11.43
Rate for Payer: Wellmed Medicare	$11.43

Insulin SO

Facility

$327.00

Service Code	CPT 83525
Hospital Charge Code	1709047
Hospital Revenue Code	301
Rate for Payer: Cash Price	$287.76

integuseal skin prep

Facility

$204.53

Hospital Charge Code	144771
Hospital Revenue Code	272
Rate for Payer: Cash Price	$179.99

integuseal skin prep

Facility

$204.53

Hospital Charge Code	144771
Hospital Revenue Code	272
Min. Negotiated Rate	$18.41
Max. Negotiated Rate	$132.94
Rate for Payer: Aetna Commercial	$112.49
Rate for Payer: Amerigroup CHIP/Medicaid	$18.41
Rate for Payer: BCBS of TX Blue Advantage	$61.36
Rate for Payer: BCBS of TX Blue Essentials	$73.63
Rate for Payer: BCBS of TX PPO	$81.81
Rate for Payer: Cash Price	$179.99
Rate for Payer: Multiplan Auto	$132.94
Rate for Payer: Multiplan Commercial	$132.94
Rate for Payer: Multiplan Workers Comp	$132.94
Rate for Payer: Scott and White EPO/PPO	$102.26
Rate for Payer: Superior Health Plan EPO	$27.82

INTENSIVE C/R W/EXERCISE Units

Facility

$581.00

Service Code	HCPCS G0422
Hospital Charge Code	6019909
Hospital Revenue Code	943
Min. Negotiated Rate	$2.16
Max. Negotiated Rate	$377.65
Rate for Payer: Aetna Commercial	$319.55
Rate for Payer: Aetna Medicare	$181.28
Rate for Payer: Amerigroup CHIP/Medicaid	$52.29
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$120.85
Rate for Payer: Amerigroup Medicare	$120.85
Rate for Payer: BCBS of TX Blue Advantage	$205.69
Rate for Payer: BCBS of TX Blue Essentials	$245.88
Rate for Payer: BCBS of TX Medicare	$120.85
Rate for Payer: BCBS of TX PPO	$274.25
Rate for Payer: Cash Price	$511.28
Rate for Payer: Cash Price	$511.28
Rate for Payer: Cash Price	$511.28
Rate for Payer: Cigna Commercial	$273.75
Rate for Payer: Cigna Medicare	$120.85
Rate for Payer: Employer Direct Commercial	$120.85
Rate for Payer: Humana Medicare/TRICARE	$120.85
Rate for Payer: Molina Dual Medicare/Medicaid	$120.85
Rate for Payer: Molina Medicare	$120.85
Rate for Payer: Multiplan Auto	$377.65
Rate for Payer: Multiplan Commercial	$377.65
Rate for Payer: Multiplan Workers Comp	$377.65
Rate for Payer: Scott and White EPO/PPO	$2.16
Rate for Payer: Scott and White Medicare	$120.85
Rate for Payer: Superior Health Plan EPO	$120.85
Rate for Payer: Superior Health Plan Medicare	$120.85
Rate for Payer: Universal American Dual Medicare/Medicaid	$120.85
Rate for Payer: Universal American Medicare	$120.85
Rate for Payer: Wellcare Medicare	$120.85
Rate for Payer: Wellmed Medicare	$120.85

Intensive C/R W/Exercise Units BCE

Facility

$581.00

Service Code	HCPCS G0422
Hospital Charge Code	6019909
Hospital Revenue Code	943
Min. Negotiated Rate	$2.16
Max. Negotiated Rate	$377.65
Rate for Payer: Aetna Commercial	$319.55
Rate for Payer: Aetna Medicare	$181.28
Rate for Payer: Amerigroup CHIP/Medicaid	$52.29
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$120.85
Rate for Payer: Amerigroup Medicare	$120.85
Rate for Payer: BCBS of TX Blue Advantage	$205.69
Rate for Payer: BCBS of TX Blue Essentials	$245.88
Rate for Payer: BCBS of TX Medicare	$120.85
Rate for Payer: BCBS of TX PPO	$274.25
Rate for Payer: Cash Price	$511.28
Rate for Payer: Cash Price	$511.28
Rate for Payer: Cash Price	$511.28
Rate for Payer: Cigna Commercial	$273.75
Rate for Payer: Cigna Medicare	$120.85
Rate for Payer: Employer Direct Commercial	$120.85
Rate for Payer: Humana Medicare/TRICARE	$120.85
Rate for Payer: Molina Dual Medicare/Medicaid	$120.85
Rate for Payer: Molina Medicare	$120.85
Rate for Payer: Multiplan Auto	$377.65
Rate for Payer: Multiplan Commercial	$377.65
Rate for Payer: Multiplan Workers Comp	$377.65
Rate for Payer: Scott and White EPO/PPO	$2.16
Rate for Payer: Scott and White Medicare	$120.85
Rate for Payer: Superior Health Plan EPO	$120.85
Rate for Payer: Superior Health Plan Medicare	$120.85
Rate for Payer: Universal American Dual Medicare/Medicaid	$120.85
Rate for Payer: Universal American Medicare	$120.85
Rate for Payer: Wellcare Medicare	$120.85
Rate for Payer: Wellmed Medicare	$120.85

Intensive C/R W/Exercise Units BCE

Facility

$581.00

Service Code	HCPCS G0422
Hospital Charge Code	6019909
Hospital Revenue Code	943
Rate for Payer: Cash Price	$511.28

INTENSIVE C/R W/O EXERCISE

Facility

$581.00

Service Code	HCPCS G0423
Hospital Charge Code	6019910
Hospital Revenue Code	943
Min. Negotiated Rate	$2.16
Max. Negotiated Rate	$377.65
Rate for Payer: Aetna Commercial	$319.55
Rate for Payer: Aetna Medicare	$181.28
Rate for Payer: Amerigroup CHIP/Medicaid	$52.29
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$120.85
Rate for Payer: Amerigroup Medicare	$120.85
Rate for Payer: BCBS of TX Blue Advantage	$205.69
Rate for Payer: BCBS of TX Blue Essentials	$245.88
Rate for Payer: BCBS of TX Medicare	$120.85
Rate for Payer: BCBS of TX PPO	$274.25
Rate for Payer: Cash Price	$511.28
Rate for Payer: Cash Price	$511.28
Rate for Payer: Cash Price	$511.28
Rate for Payer: Cigna Commercial	$273.75
Rate for Payer: Cigna Medicare	$120.85
Rate for Payer: Employer Direct Commercial	$120.85
Rate for Payer: Humana Medicare/TRICARE	$120.85
Rate for Payer: Molina Dual Medicare/Medicaid	$120.85
Rate for Payer: Molina Medicare	$120.85
Rate for Payer: Multiplan Auto	$377.65
Rate for Payer: Multiplan Commercial	$377.65
Rate for Payer: Multiplan Workers Comp	$377.65
Rate for Payer: Scott and White EPO/PPO	$2.16
Rate for Payer: Scott and White Medicare	$120.85
Rate for Payer: Superior Health Plan EPO	$120.85
Rate for Payer: Superior Health Plan Medicare	$120.85
Rate for Payer: Universal American Dual Medicare/Medicaid	$120.85
Rate for Payer: Universal American Medicare	$120.85
Rate for Payer: Wellcare Medicare	$120.85
Rate for Payer: Wellmed Medicare	$120.85

Intensive C/R W/O Exercise BCE

Facility

$581.00

Service Code	HCPCS G0423
Hospital Charge Code	6019910
Hospital Revenue Code	943
Min. Negotiated Rate	$2.16
Max. Negotiated Rate	$377.65
Rate for Payer: Aetna Commercial	$319.55
Rate for Payer: Aetna Medicare	$181.28
Rate for Payer: Amerigroup CHIP/Medicaid	$52.29
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$120.85
Rate for Payer: Amerigroup Medicare	$120.85
Rate for Payer: BCBS of TX Blue Advantage	$205.69
Rate for Payer: BCBS of TX Blue Essentials	$245.88
Rate for Payer: BCBS of TX Medicare	$120.85
Rate for Payer: BCBS of TX PPO	$274.25
Rate for Payer: Cash Price	$511.28
Rate for Payer: Cash Price	$511.28
Rate for Payer: Cash Price	$511.28
Rate for Payer: Cigna Commercial	$273.75
Rate for Payer: Cigna Medicare	$120.85
Rate for Payer: Employer Direct Commercial	$120.85
Rate for Payer: Humana Medicare/TRICARE	$120.85
Rate for Payer: Molina Dual Medicare/Medicaid	$120.85
Rate for Payer: Molina Medicare	$120.85
Rate for Payer: Multiplan Auto	$377.65
Rate for Payer: Multiplan Commercial	$377.65
Rate for Payer: Multiplan Workers Comp	$377.65
Rate for Payer: Scott and White EPO/PPO	$2.16
Rate for Payer: Scott and White Medicare	$120.85
Rate for Payer: Superior Health Plan EPO	$120.85
Rate for Payer: Superior Health Plan Medicare	$120.85
Rate for Payer: Universal American Dual Medicare/Medicaid	$120.85
Rate for Payer: Universal American Medicare	$120.85
Rate for Payer: Wellcare Medicare	$120.85
Rate for Payer: Wellmed Medicare	$120.85

Intensive C/R W/O Exercise BCE

Facility

$581.00

Service Code	HCPCS G0423
Hospital Charge Code	6019910
Hospital Revenue Code	943
Rate for Payer: Cash Price	$511.28

Interleukin-6, Serum SO

Facility

$431.00

Service Code	CPT 83529
Hospital Charge Code	1706332
Hospital Revenue Code	301
Rate for Payer: Cash Price	$379.28

Interleukin-6, Serum SO

Facility

$431.00

Service Code	CPT 83529
Hospital Charge Code	1706332
Hospital Revenue Code	301
Min. Negotiated Rate	$6.74
Max. Negotiated Rate	$280.15
Rate for Payer: Aetna Commercial	$18.13
Rate for Payer: Aetna Medicare	$25.90
Rate for Payer: Amerigroup CHIP/Medicaid	$6.74
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$17.27
Rate for Payer: Amerigroup Medicare	$17.27
Rate for Payer: BCBS of TX Blue Advantage	$28.50
Rate for Payer: BCBS of TX Blue Essentials	$34.19
Rate for Payer: BCBS of TX Medicare	$17.27
Rate for Payer: BCBS of TX PPO	$38.17
Rate for Payer: Cash Price	$379.28
Rate for Payer: Cash Price	$379.28
Rate for Payer: Cigna Medicaid	$17.27
Rate for Payer: Cigna Medicare	$17.27
Rate for Payer: Employer Direct Commercial	$17.27
Rate for Payer: Humana Medicare/TRICARE	$17.27
Rate for Payer: Molina CHIP/Medicaid	$17.27
Rate for Payer: Molina Dual Medicare/Medicaid	$17.27
Rate for Payer: Molina Medicare	$17.27
Rate for Payer: Multiplan Auto	$280.15
Rate for Payer: Multiplan Commercial	$280.15
Rate for Payer: Multiplan Workers Comp	$280.15
Rate for Payer: Parkland Medicaid	$17.27
Rate for Payer: Scott and White EPO/PPO	$21.59
Rate for Payer: Scott and White Medicare	$17.27
Rate for Payer: Superior Health Plan CHIP/Medicaid	$17.27
Rate for Payer: Superior Health Plan EPO	$17.27
Rate for Payer: Superior Health Plan Medicare	$17.27
Rate for Payer: Universal American Dual Medicare/Medicaid	$17.27
Rate for Payer: Universal American Medicare	$17.27
Rate for Payer: Wellcare Medicare	$17.27
Rate for Payer: Wellmed Medicare	$17.27

INTERSTITIAL LUNG DISEASE WITH CC

Facility

$18,952.50

Service Code	MSDRG 197
Min. Negotiated Rate	$8,728.12
Max. Negotiated Rate	$18,952.50
Rate for Payer: Aetna Commercial	$11,221.88
Rate for Payer: Aetna Medicare	$14,959.50
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$9,973.00
Rate for Payer: Amerigroup Medicare	$9,973.00
Rate for Payer: BCBS of TX Blue Advantage	$9,103.10
Rate for Payer: BCBS of TX Blue Essentials	$10,336.54
Rate for Payer: BCBS of TX Medicare	$9,973.00
Rate for Payer: BCBS of TX PPO	$11,485.49
Rate for Payer: Cigna Commercial	$12,847.80
Rate for Payer: Cigna Medicare	$9,973.00
Rate for Payer: Employer Direct Commercial	$9,973.00
Rate for Payer: Humana Medicare/TRICARE	$9,973.00
Rate for Payer: Molina Dual Medicare/Medicaid	$9,973.00
Rate for Payer: Molina Medicare	$9,973.00
Rate for Payer: Multiplan Auto	$18,952.50
Rate for Payer: Multiplan Commercial	$18,952.50
Rate for Payer: Multiplan Workers Comp	$18,952.50
Rate for Payer: Scott and White EPO/PPO	$8,728.12
Rate for Payer: Scott and White Medicare	$9,973.00
Rate for Payer: Superior Health Plan EPO	$9,973.00
Rate for Payer: Superior Health Plan Medicare	$9,973.00
Rate for Payer: Universal American Dual Medicare/Medicaid	$9,973.00
Rate for Payer: Universal American Medicare	$9,973.00
Rate for Payer: Wellcare Medicare	$9,973.00
Rate for Payer: Wellmed Medicare	$9,973.00

INTERSTITIAL LUNG DISEASE WITH MCC

Facility

$36,012.60

Service Code	MSDRG 196
Min. Negotiated Rate	$13,990.48
Max. Negotiated Rate	$36,012.60
Rate for Payer: Aetna Commercial	$21,323.25
Rate for Payer: Aetna Medicare	$24,570.70
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$16,380.47
Rate for Payer: Amerigroup Medicare	$16,380.47
Rate for Payer: BCBS of TX Blue Advantage	$13,990.48
Rate for Payer: BCBS of TX Blue Essentials	$16,903.55
Rate for Payer: BCBS of TX Medicare	$16,380.47
Rate for Payer: BCBS of TX PPO	$18,782.45
Rate for Payer: Cigna Commercial	$24,412.75
Rate for Payer: Cigna Medicare	$16,380.47
Rate for Payer: Employer Direct Commercial	$16,380.47
Rate for Payer: Humana Medicare/TRICARE	$16,380.47
Rate for Payer: Molina Dual Medicare/Medicaid	$16,380.47
Rate for Payer: Molina Medicare	$16,380.47
Rate for Payer: Multiplan Auto	$36,012.60
Rate for Payer: Multiplan Commercial	$36,012.60
Rate for Payer: Multiplan Workers Comp	$36,012.60
Rate for Payer: Scott and White EPO/PPO	$16,584.75
Rate for Payer: Scott and White Medicare	$16,380.47
Rate for Payer: Superior Health Plan EPO	$16,380.47
Rate for Payer: Superior Health Plan Medicare	$16,380.47
Rate for Payer: Universal American Dual Medicare/Medicaid	$16,380.47
Rate for Payer: Universal American Medicare	$16,380.47
Rate for Payer: Wellcare Medicare	$16,380.47
Rate for Payer: Wellmed Medicare	$16,380.47

INTERSTITIAL LUNG DISEASE WITHOUT CC/MCC

Facility

$14,785.80

Service Code	MSDRG 198
Min. Negotiated Rate	$6,809.25
Max. Negotiated Rate	$14,785.80
Rate for Payer: Aetna Commercial	$8,754.75
Rate for Payer: Aetna Medicare	$12,612.12
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$8,408.08
Rate for Payer: Amerigroup Medicare	$8,408.08
Rate for Payer: BCBS of TX Blue Advantage	$6,963.42
Rate for Payer: BCBS of TX Blue Essentials	$7,826.96
Rate for Payer: BCBS of TX Medicare	$8,408.08
Rate for Payer: BCBS of TX PPO	$8,696.96
Rate for Payer: Cigna Commercial	$10,023.22
Rate for Payer: Cigna Medicare	$8,408.08
Rate for Payer: Employer Direct Commercial	$8,408.08
Rate for Payer: Humana Medicare/TRICARE	$8,408.08
Rate for Payer: Molina Dual Medicare/Medicaid	$8,408.08
Rate for Payer: Molina Medicare	$8,408.08
Rate for Payer: Multiplan Auto	$14,785.80
Rate for Payer: Multiplan Commercial	$14,785.80
Rate for Payer: Multiplan Workers Comp	$14,785.80
Rate for Payer: Scott and White EPO/PPO	$6,809.25
Rate for Payer: Scott and White Medicare	$8,408.08
Rate for Payer: Superior Health Plan EPO	$8,408.08
Rate for Payer: Superior Health Plan Medicare	$8,408.08
Rate for Payer: Universal American Dual Medicare/Medicaid	$8,408.08
Rate for Payer: Universal American Medicare	$8,408.08
Rate for Payer: Wellcare Medicare	$8,408.08
Rate for Payer: Wellmed Medicare	$8,408.08

INTRACARD ECHO

Facility

$5,734.00

Service Code	CPT 93662
Hospital Charge Code	4613662
Hospital Revenue Code	480
Rate for Payer: Cash Price	$5,045.92

INTRACARD ECHO

Facility

$5,734.00

Service Code	CPT 93662
Hospital Charge Code	4613662
Hospital Revenue Code	480
Min. Negotiated Rate	$255.22
Max. Negotiated Rate	$3,727.10
Rate for Payer: Aetna Commercial	$3,153.70
Rate for Payer: Amerigroup CHIP/Medicaid	$516.06
Rate for Payer: BCBS of TX Blue Advantage	$255.22
Rate for Payer: BCBS of TX Blue Essentials	$305.09
Rate for Payer: BCBS of TX PPO	$340.30
Rate for Payer: Cash Price	$5,045.92
Rate for Payer: Cash Price	$5,045.92
Rate for Payer: Multiplan Auto	$3,727.10
Rate for Payer: Multiplan Commercial	$3,727.10
Rate for Payer: Multiplan Workers Comp	$3,727.10
Rate for Payer: Scott and White EPO/PPO	$2,867.00
Rate for Payer: Superior Health Plan EPO	$779.82

INTRA CORONARY ULTRASOUND

Facility

$7,415.00

Service Code	CPT 92978
Hospital Charge Code	2302214
Hospital Revenue Code	480
Rate for Payer: Cash Price	$6,525.20

INTRA CORONARY ULTRASOUND

Facility

$7,415.00

Service Code	CPT 92978
Hospital Charge Code	2302214
Hospital Revenue Code	480
Min. Negotiated Rate	$174.96
Max. Negotiated Rate	$4,819.75
Rate for Payer: Aetna Commercial	$4,078.25
Rate for Payer: Amerigroup CHIP/Medicaid	$667.35
Rate for Payer: BCBS of TX Blue Advantage	$174.96
Rate for Payer: BCBS of TX Blue Essentials	$209.14
Rate for Payer: BCBS of TX PPO	$233.28
Rate for Payer: Cash Price	$6,525.20
Rate for Payer: Cash Price	$6,525.20
Rate for Payer: Multiplan Auto	$4,819.75
Rate for Payer: Multiplan Commercial	$4,819.75
Rate for Payer: Multiplan Workers Comp	$4,819.75
Rate for Payer: Scott and White EPO/PPO	$3,707.50
Rate for Payer: Superior Health Plan EPO	$1,008.44

INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH CC OR TPA IN 24 HOURS

Facility

$19,311.60

Service Code	MSDRG 065
Min. Negotiated Rate	$8,893.50
Max. Negotiated Rate	$19,311.60
Rate for Payer: Aetna Commercial	$11,434.50
Rate for Payer: Aetna Medicare	$15,161.80
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$10,107.87
Rate for Payer: Amerigroup Medicare	$10,107.87
Rate for Payer: BCBS of TX Blue Advantage	$8,970.66
Rate for Payer: BCBS of TX Blue Essentials	$10,644.05
Rate for Payer: BCBS of TX Medicare	$10,107.87
Rate for Payer: BCBS of TX PPO	$11,827.18
Rate for Payer: Cigna Commercial	$13,091.23
Rate for Payer: Cigna Medicare	$10,107.87
Rate for Payer: Employer Direct Commercial	$10,107.87
Rate for Payer: Humana Medicare/TRICARE	$10,107.87
Rate for Payer: Molina Dual Medicare/Medicaid	$10,107.87
Rate for Payer: Molina Medicare	$10,107.87
Rate for Payer: Multiplan Auto	$19,311.60
Rate for Payer: Multiplan Commercial	$19,311.60
Rate for Payer: Multiplan Workers Comp	$19,311.60
Rate for Payer: Scott and White EPO/PPO	$8,893.50
Rate for Payer: Scott and White Medicare	$10,107.87
Rate for Payer: Superior Health Plan EPO	$10,107.87
Rate for Payer: Superior Health Plan Medicare	$10,107.87
Rate for Payer: Universal American Dual Medicare/Medicaid	$10,107.87
Rate for Payer: Universal American Medicare	$10,107.87
Rate for Payer: Wellcare Medicare	$10,107.87
Rate for Payer: Wellmed Medicare	$10,107.87

Know your out-of-pocket cost for care.

All Charges