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Charge Type Setting Price  
Service Code HCPCS 86757
Hospital Charge Code 9152986
Hospital Revenue Code 302
Rate for Payer: Cash Price $98.60
Service Code HCPCS 86757
Hospital Charge Code 9152986
Hospital Revenue Code 302
Min. Negotiated Rate $7.55
Max. Negotiated Rate $104.40
Rate for Payer: Amerigroup CHIP/Medicaid $7.55
Rate for Payer: Amerigroup Dual Medicare/Medicaid $19.35
Rate for Payer: Amerigroup Medicare $19.35
Rate for Payer: BCBS of TX Blue Advantage $43.50
Rate for Payer: BCBS of TX Blue Essentials $52.20
Rate for Payer: BCBS of TX Medicare $19.35
Rate for Payer: BCBS of TX PPO $58.00
Rate for Payer: Cash Price $98.60
Rate for Payer: Cash Price $98.60
Rate for Payer: Cigna Medicaid $104.40
Rate for Payer: Cigna Medicare $19.35
Rate for Payer: Employer Direct Commercial $19.35
Rate for Payer: Humana Medicare/TRICARE $19.35
Rate for Payer: Molina CHIP/Medicaid $104.40
Rate for Payer: Molina Dual Medicare/Medicaid $19.35
Rate for Payer: Molina Medicare $19.35
Rate for Payer: Multiplan Auto $94.25
Rate for Payer: Multiplan Commercial $94.25
Rate for Payer: Multiplan Workers Comp $94.25
Rate for Payer: Parkland Medicaid $104.40
Rate for Payer: Scott and White EPO/PPO $24.19
Rate for Payer: Scott and White Medicare $19.35
Rate for Payer: Superior Health Plan CHIP/Medicaid $104.40
Rate for Payer: Superior Health Plan EPO $19.35
Rate for Payer: Superior Health Plan Medicare $19.35
Rate for Payer: Universal American Dual Medicare/Medicaid $19.35
Rate for Payer: Universal American Medicare $19.35
Rate for Payer: Wellcare Medicare $19.35
Rate for Payer: Wellmed Medicare $19.35
Hospital Charge Code 131924
Hospital Revenue Code 270
Min. Negotiated Rate $1.46
Max. Negotiated Rate $11.67
Rate for Payer: Amerigroup CHIP/Medicaid $1.46
Rate for Payer: BCBS of TX Blue Advantage $4.86
Rate for Payer: BCBS of TX Blue Essentials $5.84
Rate for Payer: BCBS of TX PPO $6.48
Rate for Payer: Cash Price $11.02
Rate for Payer: Cigna Medicaid $11.67
Rate for Payer: Molina CHIP/Medicaid $11.67
Rate for Payer: Multiplan Auto $10.54
Rate for Payer: Multiplan Commercial $10.54
Rate for Payer: Multiplan Workers Comp $10.54
Rate for Payer: Parkland Medicaid $11.67
Rate for Payer: Scott and White EPO/PPO $8.11
Rate for Payer: Superior Health Plan CHIP/Medicaid $11.67
Rate for Payer: Superior Health Plan EPO $2.20
Hospital Charge Code 131924
Hospital Revenue Code 270
Rate for Payer: Cash Price $11.02
Service Code HCPCS 82705
Hospital Charge Code 1630029
Hospital Revenue Code 301
Min. Negotiated Rate $1.99
Max. Negotiated Rate $71.28
Rate for Payer: Amerigroup CHIP/Medicaid $1.99
Rate for Payer: Amerigroup Dual Medicare/Medicaid $5.10
Rate for Payer: Amerigroup Medicare $5.10
Rate for Payer: BCBS of TX Blue Advantage $29.70
Rate for Payer: BCBS of TX Blue Essentials $35.64
Rate for Payer: BCBS of TX Medicare $5.10
Rate for Payer: BCBS of TX PPO $39.60
Rate for Payer: Cash Price $67.32
Rate for Payer: Cash Price $67.32
Rate for Payer: Cigna Medicaid $71.28
Rate for Payer: Cigna Medicare $5.10
Rate for Payer: Employer Direct Commercial $5.10
Rate for Payer: Humana Medicare/TRICARE $5.10
Rate for Payer: Molina CHIP/Medicaid $71.28
Rate for Payer: Molina Dual Medicare/Medicaid $5.10
Rate for Payer: Molina Medicare $5.10
Rate for Payer: Multiplan Auto $64.35
Rate for Payer: Multiplan Commercial $64.35
Rate for Payer: Multiplan Workers Comp $64.35
Rate for Payer: Parkland Medicaid $71.28
Rate for Payer: Scott and White EPO/PPO $6.38
Rate for Payer: Scott and White Medicare $5.10
Rate for Payer: Superior Health Plan CHIP/Medicaid $71.28
Rate for Payer: Superior Health Plan EPO $5.10
Rate for Payer: Superior Health Plan Medicare $5.10
Rate for Payer: Universal American Dual Medicare/Medicaid $5.10
Rate for Payer: Universal American Medicare $5.10
Rate for Payer: Wellcare Medicare $5.10
Rate for Payer: Wellmed Medicare $5.10
Service Code HCPCS 82705
Hospital Charge Code 1630029
Hospital Revenue Code 301
Rate for Payer: Cash Price $67.32
Service Code HCPCS 89055
Hospital Charge Code 1611888
Hospital Revenue Code 300
Rate for Payer: Cash Price $116.28
Service Code HCPCS 89055
Hospital Charge Code 1611888
Hospital Revenue Code 300
Min. Negotiated Rate $1.67
Max. Negotiated Rate $123.12
Rate for Payer: Amerigroup CHIP/Medicaid $1.67
Rate for Payer: Amerigroup Dual Medicare/Medicaid $4.27
Rate for Payer: Amerigroup Medicare $4.27
Rate for Payer: BCBS of TX Blue Advantage $51.30
Rate for Payer: BCBS of TX Blue Essentials $61.56
Rate for Payer: BCBS of TX Medicare $4.27
Rate for Payer: BCBS of TX PPO $68.40
Rate for Payer: Cash Price $116.28
Rate for Payer: Cash Price $116.28
Rate for Payer: Cigna Medicaid $123.12
Rate for Payer: Cigna Medicare $4.27
Rate for Payer: Employer Direct Commercial $4.27
Rate for Payer: Humana Medicare/TRICARE $4.27
Rate for Payer: Molina CHIP/Medicaid $123.12
Rate for Payer: Molina Dual Medicare/Medicaid $4.27
Rate for Payer: Molina Medicare $4.27
Rate for Payer: Multiplan Auto $111.15
Rate for Payer: Multiplan Commercial $111.15
Rate for Payer: Multiplan Workers Comp $111.15
Rate for Payer: Parkland Medicaid $123.12
Rate for Payer: Scott and White EPO/PPO $5.34
Rate for Payer: Scott and White Medicare $4.27
Rate for Payer: Superior Health Plan CHIP/Medicaid $123.12
Rate for Payer: Superior Health Plan EPO $4.27
Rate for Payer: Superior Health Plan Medicare $4.27
Rate for Payer: Universal American Dual Medicare/Medicaid $4.27
Rate for Payer: Universal American Medicare $4.27
Rate for Payer: Wellcare Medicare $4.27
Rate for Payer: Wellmed Medicare $4.27
Service Code APR-DRG 5314
Min. Negotiated Rate $9,042.88
Max. Negotiated Rate $9,591.16
Rate for Payer: Amerigroup CHIP/Medicaid $9,042.88
Rate for Payer: Cigna Medicaid $9,042.88
Rate for Payer: Molina CHIP/Medicaid $9,042.88
Rate for Payer: Parkland Medicaid $9,042.88
Rate for Payer: Superior Health Plan CHIP/Medicaid $9,591.16
Service Code APR-DRG 5313
Min. Negotiated Rate $4,749.40
Max. Negotiated Rate $5,037.36
Rate for Payer: Amerigroup CHIP/Medicaid $4,749.40
Rate for Payer: Cigna Medicaid $4,749.40
Rate for Payer: Molina CHIP/Medicaid $4,749.40
Rate for Payer: Parkland Medicaid $4,749.40
Rate for Payer: Superior Health Plan CHIP/Medicaid $5,037.36
Service Code APR-DRG 5312
Min. Negotiated Rate $3,125.25
Max. Negotiated Rate $3,314.74
Rate for Payer: Amerigroup CHIP/Medicaid $3,125.25
Rate for Payer: Cigna Medicaid $3,125.25
Rate for Payer: Molina CHIP/Medicaid $3,125.25
Rate for Payer: Parkland Medicaid $3,125.25
Rate for Payer: Superior Health Plan CHIP/Medicaid $3,314.74
Service Code APR-DRG 5311
Min. Negotiated Rate $2,137.67
Max. Negotiated Rate $2,267.28
Rate for Payer: Amerigroup CHIP/Medicaid $2,137.67
Rate for Payer: Cigna Medicaid $2,137.67
Rate for Payer: Molina CHIP/Medicaid $2,137.67
Rate for Payer: Parkland Medicaid $2,137.67
Rate for Payer: Superior Health Plan CHIP/Medicaid $2,267.28
Service Code APR-DRG 5303
Min. Negotiated Rate $6,164.08
Max. Negotiated Rate $6,537.82
Rate for Payer: Amerigroup CHIP/Medicaid $6,164.08
Rate for Payer: Cigna Medicaid $6,164.08
Rate for Payer: Molina CHIP/Medicaid $6,164.08
Rate for Payer: Parkland Medicaid $6,164.08
Rate for Payer: Superior Health Plan CHIP/Medicaid $6,537.82
Service Code APR-DRG 5301
Min. Negotiated Rate $2,991.89
Max. Negotiated Rate $3,173.29
Rate for Payer: Amerigroup CHIP/Medicaid $2,991.89
Rate for Payer: Cigna Medicaid $2,991.89
Rate for Payer: Molina CHIP/Medicaid $2,991.89
Rate for Payer: Parkland Medicaid $2,991.89
Rate for Payer: Superior Health Plan CHIP/Medicaid $3,173.29
Service Code APR-DRG 5304
Min. Negotiated Rate $9,193.67
Max. Negotiated Rate $9,751.09
Rate for Payer: Amerigroup CHIP/Medicaid $9,193.67
Rate for Payer: Cigna Medicaid $9,193.67
Rate for Payer: Molina CHIP/Medicaid $9,193.67
Rate for Payer: Parkland Medicaid $9,193.67
Rate for Payer: Superior Health Plan CHIP/Medicaid $9,751.09
Service Code APR-DRG 5302
Min. Negotiated Rate $3,804.50
Max. Negotiated Rate $4,035.17
Rate for Payer: Amerigroup CHIP/Medicaid $3,804.50
Rate for Payer: Cigna Medicaid $3,804.50
Rate for Payer: Molina CHIP/Medicaid $3,804.50
Rate for Payer: Parkland Medicaid $3,804.50
Rate for Payer: Superior Health Plan CHIP/Medicaid $4,035.17
Service Code APR-DRG 5143
Min. Negotiated Rate $11,797.93
Max. Negotiated Rate $12,513.25
Rate for Payer: Amerigroup CHIP/Medicaid $11,797.93
Rate for Payer: Cigna Medicaid $11,797.93
Rate for Payer: Molina CHIP/Medicaid $11,797.93
Rate for Payer: Parkland Medicaid $11,797.93
Rate for Payer: Superior Health Plan CHIP/Medicaid $12,513.25
Service Code APR-DRG 5141
Min. Negotiated Rate $5,076.93
Max. Negotiated Rate $5,384.75
Rate for Payer: Amerigroup CHIP/Medicaid $5,076.93
Rate for Payer: Cigna Medicaid $5,076.93
Rate for Payer: Molina CHIP/Medicaid $5,076.93
Rate for Payer: Parkland Medicaid $5,076.93
Rate for Payer: Superior Health Plan CHIP/Medicaid $5,384.75
Service Code APR-DRG 5144
Min. Negotiated Rate $21,156.61
Max. Negotiated Rate $22,439.35
Rate for Payer: Amerigroup CHIP/Medicaid $21,156.61
Rate for Payer: Cigna Medicaid $21,156.61
Rate for Payer: Molina CHIP/Medicaid $21,156.61
Rate for Payer: Parkland Medicaid $21,156.61
Rate for Payer: Superior Health Plan CHIP/Medicaid $22,439.35
Service Code APR-DRG 5142
Min. Negotiated Rate $6,898.81
Max. Negotiated Rate $7,317.09
Rate for Payer: Amerigroup CHIP/Medicaid $6,898.81
Rate for Payer: Cigna Medicaid $6,898.81
Rate for Payer: Molina CHIP/Medicaid $6,898.81
Rate for Payer: Parkland Medicaid $6,898.81
Rate for Payer: Superior Health Plan CHIP/Medicaid $7,317.09
Service Code MSDRG 748
Min. Negotiated Rate $11,128.40
Max. Negotiated Rate $26,358.70
Rate for Payer: Amerigroup Dual Medicare/Medicaid $14,927.65
Rate for Payer: Amerigroup Medicare $14,927.65
Rate for Payer: BCBS of TX Blue Advantage $11,128.40
Rate for Payer: BCBS of TX Blue Essentials $13,352.79
Rate for Payer: BCBS of TX Medicare $14,927.65
Rate for Payer: BCBS of TX PPO $14,837.00
Rate for Payer: Cigna Commercial $17,868.42
Rate for Payer: Cigna Medicare $14,927.65
Rate for Payer: Employer Direct Commercial $14,927.65
Rate for Payer: Humana Medicare/TRICARE $14,927.65
Rate for Payer: Molina Dual Medicare/Medicaid $14,927.65
Rate for Payer: Molina Medicare $14,927.65
Rate for Payer: Multiplan Auto $26,358.70
Rate for Payer: Multiplan Commercial $26,358.70
Rate for Payer: Multiplan Workers Comp $26,358.70
Rate for Payer: Scott and White EPO/PPO $12,138.88
Rate for Payer: Scott and White Medicare $14,927.65
Rate for Payer: Superior Health Plan EPO $14,927.65
Rate for Payer: Superior Health Plan Medicare $14,927.65
Rate for Payer: Universal American Dual Medicare/Medicaid $14,927.65
Rate for Payer: Universal American Medicare $14,927.65
Rate for Payer: Wellcare Medicare $14,927.65
Rate for Payer: Wellmed Medicare $14,927.65
Hospital Charge Code 80846017
Hospital Revenue Code 272
Rate for Payer: Cash Price $360.79
Hospital Charge Code 80846017
Hospital Revenue Code 272
Min. Negotiated Rate $47.75
Max. Negotiated Rate $382.01
Rate for Payer: Amerigroup CHIP/Medicaid $47.75
Rate for Payer: BCBS of TX Blue Advantage $159.17
Rate for Payer: BCBS of TX Blue Essentials $191.01
Rate for Payer: BCBS of TX PPO $212.23
Rate for Payer: Cash Price $360.79
Rate for Payer: Cigna Medicaid $382.01
Rate for Payer: Molina CHIP/Medicaid $382.01
Rate for Payer: Multiplan Auto $344.87
Rate for Payer: Multiplan Commercial $344.87
Rate for Payer: Multiplan Workers Comp $344.87
Rate for Payer: Parkland Medicaid $382.01
Rate for Payer: Scott and White EPO/PPO $265.29
Rate for Payer: Superior Health Plan CHIP/Medicaid $382.01
Rate for Payer: Superior Health Plan EPO $72.16
Service Code HCPCS C1734
Hospital Charge Code 992267
Hospital Revenue Code 278
Min. Negotiated Rate $795.13
Max. Negotiated Rate $6,361.07
Rate for Payer: Amerigroup CHIP/Medicaid $795.13
Rate for Payer: BCBS of TX Blue Advantage $2,650.45
Rate for Payer: BCBS of TX Blue Essentials $3,180.54
Rate for Payer: BCBS of TX PPO $3,533.93
Rate for Payer: Cash Price $6,007.68
Rate for Payer: Cigna Medicaid $6,361.07
Rate for Payer: Molina CHIP/Medicaid $6,361.07
Rate for Payer: Multiplan Auto $4,417.41
Rate for Payer: Multiplan Commercial $4,417.41
Rate for Payer: Multiplan Workers Comp $4,417.41
Rate for Payer: Parkland Medicaid $6,361.07
Rate for Payer: Scott and White EPO/PPO $4,417.41
Rate for Payer: Superior Health Plan CHIP/Medicaid $6,361.07
Rate for Payer: Superior Health Plan EPO $1,201.54
Service Code HCPCS C1734
Hospital Charge Code 992267
Hospital Revenue Code 278
Min. Negotiated Rate $2,208.70
Max. Negotiated Rate $4,417.41
Rate for Payer: Cash Price $6,007.68
Rate for Payer: Cigna Commercial $2,208.70
Rate for Payer: Multiplan Auto $4,417.41
Rate for Payer: Multiplan Commercial $4,417.41
Rate for Payer: Multiplan Workers Comp $4,417.41
Rate for Payer: Scott and White EPO/PPO $4,417.41